Paging Dr. Grunebaum: The Truth About C-Sections

Even more than vaginal births, there seems to be a world of questions surrounding c-sections.  And, since many women who end up with one don’t plan to have one originally, they often leave the hospital with even more questions than they came in with.  We’ve put together all the nitty gritty questions we could think of and posed them to Dr. Grunebaum  of BabyMed.com, Director of Obstetrics and Chief of Labor & Delivery at NewYork-Presbyterian Hospital/Weill Cornell Medical Center.

(1) During a c-section, do the doctors really remove your intestines?

Dr. G: The intestines are not routinely touched or removed from the abdomen anymore. This is only done in rare circumstances where there could be a problem and the intestines need to be checked

(2) Should I request a plastic surgeon to sew up my c-section incision to minimize scarring?

Dr. G: There is really no secret anymore to having a nice scar. Most obstetricians are very well trained to close the skin in a way that maximizes healing. You may want to discuss this with your doctor as a “subcuticular suture” (a suture just below the skin) usually heals better that staples.

(3) Can I really get a tummy tuck at the same time as my cesarean?

Dr. G: You not only can’t really get a tummy tuck at the same time – you shouldn’t. An abdominoplasty (the medical term for “tummy tuck”) requires much more invasive surgery than just a cesarean section and involves removing skin and fat. Healing after a Cesarean may not be good enough to do a tummy tuck at that time.

(4) We’ve heard that c-sections are really the safest form of giving birth.  Is this true?  If so, why?

Dr. G: Whether you believe that a cesarean section is the safest form of giving birth depends on how you define “safe” and for whom.

A vaginal delivery is still the safest way to deliver a baby, as long as it’s a normal labor with not too many interventions. Cesarean sections are safe, though they are still associated with increased risks to the mother such as more bleeding and infections. Recovery takes longer and there are additional risks in future pregnancies, such as abnormal growth of the placenta.

There should be an indication for doing a cesarean and you need to understand exactly why it’s being done.

(5) Why do some people recover quickly from c-sections and others not?  Is there anything that can be done while still pregnant to improve c-section recovery afterwards?

Dr. G: There are still some mysteries in medicine and why some people heal faster than others is one of these mysteries.

Exercising, being in your best shape and being at a healthy weight helps you recover more quickly from labor and birth, whether you deliver via cesarean or a vaginal delivery. Getting out of bed the day of delivery and starting to eat solid food will definitely make recovery faster.

(6) We’ve heard mention of something called “referred pain”, with some moms having pain in entirely unimpacted areas like the shoulders or back.  What is this?  Does it just happen with c-sections?

Dr. G: Referred or reflective pain is pain that appears in areas away from where the actual incision was made. For example, you may have surgery on the uterus but there is some pain in your shoulders. This is a normal medical phenomenon but the exact cause is unknown. There are some theories about referred pain and some relate to pain fibers traveling from one body area to another. But in general, doctors are still studying exactly what these are.  If you are experiencing pain in an area that seems odd (such as your collar bone region, or shoulders) let your doctors and nurses know so that they can help you alleviate the pain.

(7) Many doctors say that, with a vaginal birth, you can start exercising right away.  What is the truth about c-sections?

Dr. G: If you feel well, you can start exercising as soon as you feel ready. The skin is closed within a few days after a cesarean and is not going to open with exercise. If you start slowly and gently and listen to your body then exercise is safe.

(8) You often here that women can’t have more than 3 c-sections.  Is there really a limit on the number of c-sections you can have?  If so, why?

Dr. G: Yes and no. There is no absolute limit to the number of cesareans and I have seen women who have had seven or eight cesareans. However, with each additional cesarean surgery there is more scar tissue, making the next surgery more difficult.

(9) What are your thoughts on VBACs?  How often do they succeed?  Would you encourage your patients to have one?  Is it worth it?

Dr. G: VBAC stands for “vaginal birth after cesarean”. Whether you can have a successful VBAC or not depends on several factors. If you previously had a vaginal delivery and a cesarean section than having a vaginal delivery now is more successful. But if you never had a vaginal delivery before then you chance of a vaginal delivery is reduced. In addition, the reason for having had a cesarean section is important. For example, if you previously were in labor and the cervix was dilated but then you had a cesarean section, then you are likely more successful now delivering vaginally.

Trying for a VBAC is associated with a low but significant risk such as rupturing the uterus. So you should be carefully monitored in labor when trying for a VBAC.

(10) Some moms who have had c-sections report that the nurses and doctors frequently ask whether they’ve, ahem, “passed gas” since the procedure.  Why does this matter?

Dr. G: It does not matter really. They are asking to make sure your bowels are starting to work normally, but scientifically there is no proof that passing gas makes a difference.

(11) When and why do women get catheters during birth?

Dr. G: The urinary catheter is inserted into the bladder to drain urine during labor and a cesarean. This is mostly done when you had an epidural or spinal and you cannot feel the bladder filling up. Draining the bladder is important because full bladder can lead to complications.

(12) The news loves to discuss the prevalence of “convenience c-sections”, either for the doctor’s schedule or the mother’s.  Do you actually see that in your practice?  

Dr. G: Cesarean on maternal request (CMR) is a known phenomenon and has been discussed for some time now.

It is a cesarean without medical indications, purely because the mother wants it. If a mother wants a cesarean without there being a medical reasons, she should discuss it with her obstetrician to better understand risks and advantages.

As to doctors doing it for their own schedule, I would hope hospitals (and moms) monitor doctors better to prevent this from happening.

(13) Is there anything else we should know about?

Dr. G: There is so much more to know about getting pregnant, being pregnant, and having a baby, I am glad to have chosen this specialty. It’s a wonderful job and I am here to answer all your questions.