Cesarean Section for a Previous Uterine Operation

What is a cesarean section?

A cesarean section is an operation that delivers a baby through a cut in your lower abdomen and uterus. The uterus is the muscular organ at the top of the vagina. Babies develop in the uterus, and menstrual blood comes from the uterus.

This procedure is also called a C-section.

When is it used?

If you have had a previous operation on your uterus, such as a C-section or surgery to remove fibroids (myomectomy), your uterus has a scar. Because scar tissue is weaker than muscle, the scar from your previous operation might open during labor, especially if the incision went through the inside lining of your uterus. If it opens, it endangers you and your baby.

It is very rare for a scar to open if it is from a previous C-section in which the cut was made across the lower section of the uterus. In such cases you can usually try to deliver the baby vaginally (using the birth canal). However, if you had a C-section with a vertical (up and down) cut in your uterus, or other surgery on your uterus, the risks are higher. In these cases a C-section may be scheduled. You should ask your healthcare provider about these choices. Your healthcare provider should review the reports of any type of surgery performed on your uterus.

You and your healthcare provider should discuss C-section delivery during the early part of your pregnancy. This will help you prepare for it if it suddenly becomes necessary.

How do I prepare for a cesarean section?

Plan for your care and recovery after the operation, especially if you are to have general anesthesia. Allow for time to rest and try to find other people to help you with your day-to-day duties.

Follow instructions provided by your healthcare provider. If you are to have general anesthesia, eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight and the morning before the procedure. Do not even drink coffee, tea, or water.

If you go into labor, call your healthcare provider.

What happens during the procedure?

You are given a regional or general anesthetic. A regional anesthetic numbs part of your body while you remain awake. It should keep you from feeling pain during the operation. A general anesthetic relaxes your muscles, puts you to sleep, and prevents you from feeling pain.

Your healthcare provider makes a cut below your bellybutton and into the lower part of the uterus to remove the baby. Your provider removes the baby, placenta, and birth sac. Your provider then sews the uterus and abdomen closed.

What happens after the procedure?

Your abdomen will be sore. You may need help with positioning your baby comfortably for feeding. Walking and standing will be painful for the first few days. Since you will probably be in the hospital for just 2 to 4 days, try to have some help at home for the first week or two.

Avoid heavy lifting for 6 weeks. After 6 weeks you may begin an exercise program to regain abdominal muscle tone. Ask your healthcare provider what other steps you should take and when you should come back for a checkup.

The cuts made in the abdomen to deliver the baby are usually horizontal, or across the womb. This allows the muscles in the womb to safely stretch for future childbirth. Many women are able to deliver the next baby through the birth canal.

What are the benefits of this procedure?

Delivering a baby by C-section may prevent rupture of the uterus, and may be safer for you and the baby. You may be able to schedule the time of the delivery.

What are the risks associated with this procedure?

• There are some risks when you have general anesthesia. Discuss these risks with your healthcare provider.
• A regional anesthetic may not numb the area quite enough and you may feel some minor discomfort. Also, in rare cases, you may have an allergic reaction to the drug used in this type of anesthesia. In most cases regional anesthesia is considered safer than general anesthesia.
• A blood vessel may rupture or be cut and bleed inside the body.
• A piece of blood clot may break off, enter the bloodstream, and damage the lungs.
• The cut in the wall of the uterus may leave a weak part in the wall.
• Any future children may need to be delivered by C-section, based on how this C-section was done.
• You may develop an infection or bleeding.
• The baby might be injured during the surgery.

You should ask your healthcare provider how these risks apply to you.

When should I call my healthcare provider?

Call your provider right away if:

• You develop a fever over 100°F (37.8°C).
• You have drainage from your incision, or the incision separates.
• You have heavy bleeding from the vagina.
• You become dizzy or faint.
• You have leg pain, especially if your leg is also swollen and red.
• You have nausea and vomiting.
• You have chest pain.
• You become short of breath.

Call your provider during office hours if:

• You have questions about the procedure or its result.
• You want to make another appointment.