Cesarean Section: You Asked, We Answered!

How long after a Cesarean Section should I wait to try for a second pregnancy? 

This all depends on your goals for the subsequent delivery. If you've had a Cesarean section and you're hoping for a trial of labor after cesarean (TOLAC) to aim for a vaginal delivery, the recommendation is to wait at least 18 months from your C-section to the next delivery.

Realistically, to account for the possibility of preterm labor, adding an extra month or so, making it about 19 months, ensures proper healing of the scar. If you're considering a repeat elective Cesarean section, timing is less critical, but it's essential to allow your body to heal from the major surgery of a C-section, which often takes a considerable amount of time - usually a minimum of six months, with full healing potentially extending up to a year. 

The reason behind this is that scarring occurs not just on the skin but also on the uterus itself. Since we cut into the uterus during the surgery, the strength and integrity of the uterine scar tissue is vital, particularly because the lower half of the uterus stretches and thins during pregnancy and needs to withstand the frequent contractions of labor. If you're torn between a trial of labor after Cesarean or a repeat elective Cesarean, check out our episode on To TOLAC or not to TOLAC… That is the question!!!

How do I know if an elective repeat is the best choice or should do a trial of labor? What's the best option for me?

First off, listen to our podcast on ___ mentioned above! Secondly, there are a few factors to consider. If in your first pregnancy you had a c-section due to placenta previa, because the baby was breech, or you didn’t labor, then chances of having a successful vaginal birth are the same as somebody who's never had a Cesarean section before. 

But if you've previously labored and your cervix didn't dilate, or the baby wouldn't come down, then there is an increased chance that that may happen again, but it's not always the case. Have a consultation with your OB/GYN that can examine you, examine your baby, and look at surgical records from your previous c-section to really give you an informed decision. Last but not least, what does your gut tell you? Try to listen and make the right choice for you!

Is it common for first time Moms or pregnant people to require a Cesarean birth?

Statistically speaking, there is about a 30% Cesarean section rate, meaning 30% of all births are Cesarean, and that can include repeat c-sections, or those required for medical indications such as placenta previa, baby’s placement, or a mano twin pregnancy. For more info on twin pregnancy, listen to our podcast on Twin Pregnancies! Double the fun and double the trouble!

If you remove all the repeated and medically indicated c-sections, we guesstimate there is about a 20% risk of needing a Cesarean section after going into a planned, vaginal delivery. That is about 1 in 5 people - or 80% of vaginal deliveries going according to ‘plan’ (so to speak)! We also have a great podcast on the Top 5 Reasons for Cesarean Birth, so be sure to check that out too!

What determines what kind of closure is used after a C-Section?

First of all, stitches that are used on the inside of the body, to close up the uterus and fascia, are always dissolvable. When it comes to the skin, there are typically two options: sutures that dissolve, or staples. Generally speaking, the reason for the Cesarean section will influence the type of closure needed.

If there's an infection in the uterus, like chorioamnionitis, causing a fever or the baby's heart rate to rise, doctors usually use staples to close the incision. Staples make it easier to deal with any small infections in the incision, reducing the risk of bigger problems.

While infections after delivery are very rare, using staples is a practical way to help the incision heal better and avoid complications, whereas a dissolvable stitch is essentially one continuous stitch and would make dealing with potential issues more difficult. Most people tolerate stitches super well and there is no difference between the different closures from a healing point of view.

Staples just need to be removed three to four days after the procedure. Tune in to the episode for more details on what to ask your providers about scaring and learn even more about scars by listening to our episode on C-Section Scar Recovery with Janette Yee. Another helpful tool in recovery are these Silicone Scar Sheets found in our Amazon shop!

What are the main reasons pregnant people choose to have an elective Cesarean Section if it is not medically required?

Electing to have a Cesarean section is a personal decision influenced by various factors. Some pregnant people may opt for a Cesarean due to past trauma, such as a history of abuse or sexual assault, fearing triggers during childbirth. Discussing your apprehensions with an obstetrician can help provide clarity and empower you to make the right choice for yourself. 

Another common concern is the valid fear of vaginal trauma during childbirth, including tears. While tear prevention techniques and physiotherapy can help (such as perineal massage, download our FREE Perineal Massage Guide here!), some may still prefer the certainty of a Cesarean. Timing considerations, like a partner's military deployment, can also sway a decision, especially as timing around induction can still be unpredictable.

Each person's reasons for choosing a Cesarean are valid, and we emphasizes the importance of respect, empathy, and informed decision-making in childbirth discussions, as both Cesarean and vaginal births carry risks that should be carefully considered. It’s all about making informed choices!

Consider downloading our Birth Preferences Guide or signing up for our free Birth Preferences Mini Course! For a deeper dive into all things pregnancy, birth & labour, postpartum and those first few weeks with your newborn, consider signing-up for our Pregnancy to Parenthood Masterclass, which includes 5 modules, bonus materials with subject matter experts, inside looks into birthing spaces, and so much more!