QuestionAfter a long labour with my second child, I was taken to have a C-section (1st child was vaginal birth), during which I suffered a uterine bleed, I was told there are two types, mine was the not so bad one(?!). My uterus was massaged and the bleeding stopped. We are now trying for another child and have suffered an early miscarriage a few months ago but have been trying for 18 months. Could the bleed be causing problems and could it happen again in a future pregnancy? Also, would I be best to opt for a planned C-section if we are successful in conceiving? Thank you for reading this, I hope you can help.
AnswerBleeding is a common complication of invasive surgery, and is even more of a risk when you are dealing with surgery on an internal organ that is getting ready to begin bleeding on its own anyway. Hemorrhage is one of the major risks of c-section, and is usually the reason emergency hysterectomies are performed during c-sections. However, once the bleeding itself was resolved, there should not be any long-term effects.
The c-section itself, even without bleeding, does leave a scar on the inside of your uterus that could cause future fertility problems. It is well documented that having a c-section history leads to a higher risk of secondary infertility, ectopic pregnancy, miscarriage, and placental problems such as placenta accreta or percreta, placental abruption, and placenta previa. This is why it is so important to avoid c-sections whenever possible, especially since the risks increase with each additional c-section scar.
To increase your chances of conceiving again, you may want to look into natural family planning techniques to pinpoint your fertile periods and optimize the timing of intercourse. There are free online charting tools available at www.fertilityfriend.com. If you have another miscarriage, you may want to consult with your doctor as to the possible causes.
Once you do get pregnant again, your safest option is to pursue a VBAC, or Vaginal Birth After Cesarean. Although many doctors and hospitals are no longer allowing their patients to have a VBAC, this is primarily for insurance and malpractice reasons. The only increased risk of a VBAC birth is the risk of uterine rupture. In a normal, physiological birth, this risk is approximately 0.5%, much lower than the risk of many other common birth complications such as cord prolapse and shoulder dystocia. The risk of several complications or death resulting from a uterine rupture is only 0.0025%. For comparison, the risk of miscarriage following amniocentesis, a commonly recommended testing procedure, is as high as 2%. With a planned repeat c-section, you run an increased risk of infant breathing problems, NICU hospitalization, and three times the risk of death in the first month, in addition to all the surgical risks to yourself and the increased risk to future pregnancies. Shop around to find a supportive provider, and check out your local ICAN chapter (www.ican-online.com) for support.
