Pregnancy and childbirth after caesarean section

Advances in modern medicine have resulted in an increasing percentage of pregnancies being terminated by caesarean section.
As a result, obstetricians face challenges in managing subsequent pregnancies, as well as complications of the course of labour in pregnant women with previous caesarean sections.

Marta Zastawny: These challenges are primarily due to the fact that after a caesarean section procedure, a scar forms on the uterine muscle that takes time to heal. What’s important, proper observation and evaluation of such a scar during subsequent pregnancies and deliveries is necessary.

What are the dangers and symptoms of concern?

The main risk for the pregnant woman and the child comes from the weakening of the uterine wall after the previous caesarean section, especially when the interval between the caesarean section and the next pregnancy is too short for the postoperative wound to heal.  In a situation where the strength of the uterus at the site of the postoperative scar is insufficient, the uterus may be dissected or even ruptured during the growth of the uterus during pregnancy or during contraction during labour, which may lead to many serious complications.

In most cases the disturbing symptoms are non-specific, therefore in every case when a pregnant woman after previous caesarean section reports pain in the lower abdomen, malaise, weaker feeling of the baby’s movements, bleeding and other uncharacteristic, worrying symptoms it is very important to implement further diagnostics as soon as possible.

What tests should be performed in pregnancy after caesarean section?

During pregnancy, apart from routine obstetric examination, the pregnant woman should undergo ultrasound evaluation of the morphology and thickness of the uterine scar after a previous caesarean section. Such examinations are performed even before the period of planned pregnancy, and then also at the 6th week of pregnancy, during the third trimester of pregnancy and during the perinatal period. It is also important to assess the parameters of foetal well-being, i.e. to perform tests that determine the well-being of the developing baby in the womb. These are ultrasound examinations and later, in the third trimester of pregnancy, systematic cardiotocographic examinations (CTG).

Natural childbirth or another C-section?

A pregnant woman who has had a caesarean section has the option of deciding how to terminate her pregnancy. If no worrisome symptoms are found during the tests performed during pregnancy, then she may decide to attempt a natural childbirth. The condition of a natural childbirth is the absence of medical contraindications and full acceptance and consent of the mother in labour.  Such a birth is carefully monitored and if there are any signs of danger or abnormalities, the doctor decides to intervene quickly, i.e. to perform an immediate caesarean section. A pregnant woman who has had a caesarean section, or even one who is in labour (who initially wished to have a natural birth), may decide right away to complete the pregnancy by caesarean section again, given the concerns, stresses, or other inconveniences of the situation.

However, if you decide to have another caesarean section, you need to keep in mind the risks and possible complications resulting from another surgery such as:  intraoperative and postoperative haemorrhage, abdominal organ damage, thromboembolic complications, and infections. It is also important to note that the number of complications increases with repeated caesarean section procedures.

Pregnancy after caesarean section requires increased supervision and should be managed by an experienced obstetrician with high-end ultrasound and OCG equipment. Deciding how to give birth is often complex and requires the cooperation of both the obstetrician, the future mother and the delivery team.  It should be remembered that a natural childbirth after a previous caesarean section is not impossible and requires only supervision, but sometimes, despite the desire of the pregnant woman to have a natural childbirth, it is absolutely necessary to decide on another operation.