QuestionWe are having another C-section in July. This will be our fourth. We would love to have 10 children with this spacing. All have been naturally spaced 2 years apart. I have had no complications except that my babies never descend into my hips (even after 26 hours of labor and at 7cm.) My chiropractor said that one of my hips was tilted but now is settled into a normal position after numerous adjustments. Everyone is pushing us to stop having babies because they fear for my future health. I have never had a pregnancy related complication other than anemia which is not a problem as long as I take my iron. I am 29 years old and have no other health conditions.
Our current OB has offered to let my husband see my uterus before opening it during this C-section to decide whether or not we will have more children. What should he look for? Is it normal at 39 1/2 weeks to be able to see through the uterine wall? What does a normal uterus look like after 4 pregnancies? What are the dangers of adhesions? Do they get worse with every C/S or is does it just depend on the job that was done last time or my health? Would a VBAC be out of the question?
What would be the things to look for and consider before we decide whether or not to have more?
Thank you so much!- Robin
AnswerI am concerned that your OB wants to allow your husband's non-professional opinion on the appearance of your interior organs sway your reproductive decisions, and I wonder what comments the OB will make in conjunction with what your husband sees to sway you in one direction or the other. Even with my own research and education, I would be hesitant to make a snap judgement based on a single viewing, without having some experience to back it up. I do know that it IS fairly normal for the uterus to be "paper thin" and "transparent" (as described by surgeons) at full-term, even in a normal, unscarred uterus. This is simply a result of the extensive stretching of the uterus at term, and is not a defect.
First off, a VBAC is NOT out of the question for you, even if you have had 3 c-sections already. If all your incisions were low tranverse incisions, you are still an excellent candidate. Your risk of uterine rupture does go up slightly after 3 c-sections, as compared to 1 or 2; however, the risks of continued c-sections are significant and well-documented. If you can have a successful VBAC now, you will absolutely reduce your risks for future pregnancies, as well as pave the way for future VBACs by having a "proven" uterus and pelvis.
You mentioned adhesions as one risk factor of further c-sections. This depends more on your body's style of healing than anything else. You could have the best surgeon in the world, and end up with an abdomen full of adhesions causing your bladder to stick to your uterus to stick to your bowels, etc. Your risk of adhesions and related complications does increase with each successive c-section.
In addition to adhesions, you face dramatically elevated risks of placenta previa, placenta accreta or percreta (where the placenta grows into or through the scar line), and placental abruption, all dangerous complications that cannot be directly prevented. You also face increased risks of miscarriage and ectopic pregnancy.
You say that you initially began having c-sections because your babies do not descend, even after 26 hours of labor. Babies do not need to "descend" until you are fully dilated. Every woman's body is different, and every baby is different. Some labors are fast, and some are slow. If you were sectioned simply because you weren't moving along fast enough, this is a failure to wait on your doctor's part, not a failure of your body.
You may have some difficulty in finding a provider to attend you for a VBAC after 3 c-sections. You need to remember that most doctor's viewpoints on VBAC are tainted by medical malpractice insurance coverage, hospital policy, and ACOG recommendations that are not based in science. The science would still be in your favor, and you would be within your rights to refuse the c-section and show up to the hospital in labor, regardless of what your doctor says is "allowed." You also have the right to switch providers, right up until the point where your body is cut open. If you are within 30 days of your due date, your current doctor cannot drop you for refusing a repeat c-section, under patient abandonment laws.
You may want to visit ICAN's website at www.ican-online.org for more information and resources. Good luck whichever you choose!
