#EMMAseries: An Indepth Series on Caesarean Sections by Dr Uche Iwuh (PART 2)

Q: What are some complications that may arise after the surgery?

A: Complications that may arise could be grouped under those of anaesthesia and those of the surgery itself. Complications of anaesthesia could be a reaction to the drugs administered or may result from technique. They range from post spinal headaches to hypotension and even death. Complications of the surgery may be early or late. It includes haemorrhage (bleeding excessively), injury to surrounding structures such as the bladder or the intestines. At a later date, infection and possibly wound breakdown and still much later adhesions (unnatural gumming together of structures). Pulmonary emboli and deep vein thrombosis (blood clots) in the lungs and legs are also possible complications, as is placenta praevia in future pregnancies. For the baby, there is the risk of getting cut mistakenly during the surgery and also breathing problems following a caesarean delivery. The risk of complications is higher in emergency c/s than elective c/s. However, in the hands of specialists, most of these complications can be satisfactorily managed (and some, prevented).

Q: Does taking cold liquids affect a woman’s body after a c/s?

A: No. There is no conclusive scientific evidence that it does.

Q: Most women complain of big tummies after a c/s. In your opinion, is it ok to bind ones tummy after a c/s? If yes, how soon? If not, why not? Is it based on a case by case basis?

A: In my opinion, once the skin wound has healed, a woman may bind her tummy if she so desires. Binding gives support to the abdomen and should not be too tight or it may become counterproductive. Some people have advocated binding before the skin wound heals though.

Q: When is it medically safe for a woman to resume sex after a c/s?

A: At the six week post natal (post delivery) clinic visit, the doctor checks that a woman’s body has returned to its pre-pregnancy state and that there are no persisting ill effects either of the pregnancy or the mode of delivery. After this, sex can safely be resumed. It is however expected that the lochia (blood loss/discharge from the vagina after delivery should have stopped before sex is resumed. For those who can’t or will not wait till the six week visit, remember that you can get pregnant so think about family planning!

Q: It is commonplace to see that caesarean sections are carried out via a horizontal incision, but there are still a few cases where doctors still perform the surgery via a vertical incision. What is the implication of this medically? Is one method safer than the other?

A: I guess that you are describing the incisions on the skin. On the skin, the horizontal incision is more common now. The advantages are that it heals faster, is less prone to infections, and aesthetically, more pleasing to see (i.e. better cosmetically). It is called the ‘bikini cut’ in some places since a woman can wear a bikini and no one would know she has had a surgery (rightfully so, since it is no one’s business). The vertical incision is thought to be faster in gaining entry into the abdomen, so is often used in emergencies. My personal experience though is that any surgeon that is used to the horizontal incision, the commonest of which is the pfannenstiel incision can gain entry as fast as is necessary. The incision on the uterus (womb) is a completely different thing altogether. A low transverse (horizontal) incision is the standard incision presently worldwide. It heals better, and is safer. The vertical incision however is more prone to rupturing (tearing) in future pregnancies/labours. There are few indications for a vertical incision in contemporary obstetric practice, for example when access to the lower part of the front of the uterus is not possible maybe because of uterine fibroids, (in which case an attempt should still be made to have as much of the incision in the lower part of the uterus), or when the membranes are ruptured and the baby is lying across in the uterus.

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