Uterus Adhesion & Pregnancy: Understanding Risks & Concerns

Question
Hi.  I'm getting increasingly concerned.  I am 25 weeks pregnant.  Last year, before I got pregnant, I had a laproscopic appendectomy, where they noticed my uterus is attached to my abdomen wall, at the site where my incision was made for my last c-section (I've had two c-sections, in '99' and '03).  My doctor tells me there's nothing to worry about.  But being pregnant, and knowing that my uterus is stuck to my abdomen, instaed of floating freely in my pelvis, really worries me.   I'm also concerned about it causing complications during delivery.  BTW, is it imperitive that I have another c-section, or would it be possible to try to have a natural birth with these circumstances?  Right now, I just keep picturing my uterus breaking open from the pulling and stretching as it grows bigger for the baby.  But my doctor doesn't seem the least bit concerned, and doesn't even ask me any questions to check on it at the regular doctor visits.  BTW- in case it's necessary info, I'm 37.  Thanks,

Answer
These types of scar adhesions are very normal after c-sections.  Not only can the uterus stick to the abdominal wall, but the bladder can stick to the uterus, the intestines can get stuck together...in fact, the whole area can become a mass of scar tissue!  This does not necessarily increase your risk of rupture, though.  As your uterus continues to grow, you may feel pulling, tugging, or even sharper, more painful sensations.  These are all caused by the adhesions breaking up and pulling loose as your uterus grows, and can be felt even by women who do not have this kind of adhesion where their uterus is stuck to the abdominal wall.

It is absolutely okay for you to have a vaginal birth now, and in fact it is much safer for you.  Another c-section will only increase the amount of scar tissue in your abdomen.  Also, with all those adhesions, a c-section now will likely take much longer, possibly resulting in greater blood loss, increased healing time, and an increased risk of infection.  With a vaginal birth, you won't have to worry about any of that.