Expert: Pat G - 1/28/2011

Question
QUESTION: Hello pat i am 6 weeks pregnant with my 4 child im worried because i have to have another c-section being my 4th c-section the problem is i only had my 3rd 5 months ago can you please give me some advice on the dangers of this thank you

ANSWER: Hello, jodie,

C-sections should be avoided if possible, because they do greatly increase the risk in childbirth. I don't think the fact that you had one fairly recently will make that much difference, but you should ask your doctor about that. Why have you been having C-sections?

There is such a thing as vaginal birth after C-section. A lot of doctors don't like to do it, but some women will ask for trial labor, and the doctor will allow it. You should see if you can find a doctor who will do this.

In the meantime, you can safeguard yourself from the main risk they are worried about when you have had a C-section. They're afraid your uterus will rupture, and this is why they don't like to take the risk with vaginal birth. But the reason for the rupture is that the scars from a C-section tend to be much stronger than surrounding tissue. So the surrounding tissue may rupture. The scars also have few blood vessels. If you can get your body to grow blood vessels in the scar tissue, it will greatly change the risk for the better. Here's what you do. Think of the length of the outer scar as the diameter of a circle. As you advance in pregnancy, massage your skin and the uterus with a motion somewhat like kneading bread. This means to push your fingers into the area repeatedly. Don't be too rough; just push in the flesh. The uterus has three sets of muscles running in different directions, and doctors prefer to cut between muscle fibers. So do this over the entire circle, because you actually have scars running three different directions in your uterine muscles. Do this daily for a few minutes. It will cause the scars to form blood vessels, and soften them. Ask your doctor to watch and examine you. I am aware of a woman who did this. She had a fused tailbone, which is why she had a C-section to begin with. Because of the problem, she had to have another, but when the doctor operated, he said there is no way her scars would ever have ruptured.

Spend some time on the internet, and use the search term VBAC, and search for an organization in Australia. They can help you and inform you on how best to seek an alternative. If you do end up having another C-section, you really will have the same risks regardless of how soon after another C-section you had it.

Please let me know what happens. Good luck!

---------- FOLLOW-UP ----------

QUESTION: Thank you very much for all your advice,
The reason i have had c-sections is i have had premature babies and a viginal birth was apparently to dangerous on the babies

Answer
Jodie,

Thank you for the additional information. How premature were your children? I can see why some doctors may reach this conclusion. One of the things to do is to see if you can carry your baby longer. If you have ever had a surgical abortion, this weakened your cervix and may result in it being unable to carry the weight of a full term baby. Also, improving your nutritional status may help. If you are a vegetarian, you may not be getting the fatty acids you need to be getting to make hormones that will allow you to carry your babies longer. If your cervix is weak, they can do cerclage, to keep it shut longer. Ask about this, if this is relevant to your situation. Vaginal birth is generally better for the baby, because it stimulates his body, and he bonds better with his mother, and for lots of other reasons. A smaller baby won't have to endure the same force as a larger one. See if you can find a doctor who doesn't view it the same way. You deserve to have a second opinion. You may have to talk to several, but ask your local childbirth organizations, and La Leche League or other breastfeeding organization, which doctors like to intervene the least.

I know of one case where the baby hadn't been growing because something was wrong with the placenta. The baby was fully developed, but just very small. She was born under 5 pounds in weight. She quickly caught up, and is now large for her age. If the placenta is normal, the baby should be all right. Some women routinely have their babies 2 to 3 weeks early. I am one of those.

There are lots of questions you can ask.

I hope this helps.