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Special Features

Cut It Out: A Mother's Guide to C-sections

By: Risa Caldoza, MD, FPAMS, FPAPSHPI article_13

Two of my three boys are of Caesarian birth. During my labor, Skyler, the middle child, had his arm alongside his head (called a compound presentation) and warranted an emergency C-section. Knowing that ‘cutting me up’ is what’s best for my child and knowing full well that this means a painful wound, a long recovery, an unsightly scar, and not to mention the cost, I closed my eyes and signed the consent form. My request? Bikini cut, please.

Two years and a hideous angry brown thick worm-like scar later, I was back again at the labor room, this time with the last of my brood, Santi. Vanity has reared its ugly head and I chose to have an elective (yes, my choice) C-section – no judging, please. I needed my scar revised. I wanted, no, demanded a tiny, thin sliver of a scar. And I got just that, no kidding! It’s a secret my ob-gyn and I share.

Hail Ceasar!

A Caesarian or a C-section is a medical procedure where a baby, rather than being born vaginally, is surgically removed from the mother’s uterus or womb. The word came from the Latin caesus, meaning to cut.

It has been part of human culture for a long time. In Greek mythology, Apollo (god of music) removed Asclepius (god of medicine) from his mommy’s stomach. Around 700 BC, a law called Lex Caesaria ordered that if a pregnant woman died, the baby had to be taken from her womb. This law complied with the Roman ritual forbidding the burial of pregnant women. The first written record of a C-section was in Switzerland in the 1500s where a desperate sow gelder (one who castrates pigs) operated on his wife who was in labor for several days, with the permission of authorities of course.

A C-section is usually warranted when there are complications during labor or the baby has developmental conditions. Other reasons include early pregnancy complications, mother’s health problems such as high blood pressure or unstable heart disease, and problems with the placenta such as placental abruption or placenta previa. The World Health Organization (WHO) recommends that C-section be performed only when medically necessary. Around the world, 1% of all caesarian deliveries are carried out without medical need.

According to the Centers for Disease Control and Prevention (CDC), one of four women undergoes C-section, and the number continues to rise. In the Philippines, two of 10 women claim the honor. China has the highest C-section rates in the whole world. Between 2004-2008, almost half of its babies were born via C-section. Also, once a C-section mom, almost always (at 90%) a C-section mom. But most women who have had a C-section can safely deliver their next baby normally, known as vaginal birth after caesarian (VBAC).

In modern times, women are usually given regional anesthesia (safer than general anesthesia), either an epidural or a spinal block, which both numb the lower half of the mom’s body. A bonus is the mother is usually awake to see the miracle of birth.

During surgery, the mom’s stomach wall and the wall of the uterus are divided to get the baby. The first cut, normally 10 cm in the stomach, can be vertical (classic or up-and-down) or horizontal (side-to-side, transverse, Pfannenstiel incision or bikini cut). Muscles are not cut but only shoved aside so your doctor can get to the next layer, the uterus. A cut is made here, usually horizontal. The protective membrane (amniotic sac) that surrounds the baby is ruptured, the baby is taken out, the umbilical cord is cut, and voila! Congratulations on the beautiful healthy baby! The cuts made during surgery are repaired with stitches that will dissolve in time.

The downside after C-section is that skin and nerves take time to heal, pain meds for about two weeks, bleeding for about 4-6 weeks, and no sex nor strenuous activity for a time. And then there’s the scar of course.

A Mark of Purpose

The physical scars we mothers bear is a testament to our strength and love as we bring our child out to the world. Scar tissue is fibrous tissue that replaces the normal tissue after an injury, such as in surgery. It is still made of collagen, like the normal tissue but an inferior kind. Healing is unique for each person so scars don’t look the same. While healing, look out for signs of infection – pain, swelling, warmth or redness, red streaks leading from the incision, pus, swollen lymph nodes or fever. See your doctor immediately.

C-section scars are normally 4-6 inches long after healing and can be dry, rough, dark or red in appearance, itchy or painful. The lucky ones have pale, silvery and thin scars. For better luck, you can pray to the patron saint of C-section (yes, we have that), Caesarius of Africa or Saint Cesareo.

A hypertrophic scar us as a red or dark pink, raised, sometimes itchy scar confined within the border of the original cut and generally has a poor final appearance. Some form keloids, an irregular overproduction of collagen and fibrous tissue at the cut site, giving it a very elevated or thicker look. A keloidal scar goes over the original boundaries of the cut. Those with darker skin are more prone to keloids.

Although you have earned that battle scar, there are some ways to make it look better. Don’t forget to baby your body! It’s important to keeping the incision clean to prevent infection. There are skin products, such as topical self-drying silicone gel, that you can use to flatten, soften, and lighten scars although they work best on raised scars that are less than two years old. Silicone is the only US-FDA approved material to treat scarring.

A study on Asian women who used silicone gel twice daily for 3 months after surgery showed scars were significantly flatter, less red, more pliable, less painful, and less itchy. A 15-gram tube has enough silicone gel to treat 3-4 inches (7.5-10 cm) scar twice a day for over 3 months. Don’t forget to apply it as a thin film then rub it with your fingertips (gently!) for 2-3 minutes. Massaging and moving the scar tissue makes it softer, more similar to the tissue around it, and reduces tightness that breaks up adhesions (when scar tissue attaches to a nearby structure).

Other treatments include steroid injections and laser procedures (multiple sessions) like fractional lasers, usually done 6-8 weeks after surgery for best results. In any case, congratulations on your war wound… that’s a sign of life!


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Keywords: laser procedure, steroid injection, silicone gel, keloidal scar, keloids, hypertrophic scar, Saint Cesareo, collagen, scar tissue, umbilical cord, amniotic sac, uterus, surgery, spinal block, epidural, regional anesthesia, vaginal after birth caesarian, placental abruption, high blood pressure, pregnancy, scar, C-section, compound presentation, Caesarian scars   
  
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