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Multiple Cesareans and Long-Term Maternal Health

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In response to this guest post by Henci Goer on the ICAN blog, one Facebook fan left this comment yesterday:

From the study: “It is also important to recognize that this study focused on nulliparous women with no prior uterine scar. If a nulliparous woman chose to have an elective CS, morbidity with subsequent pregnancies could be higher because of reported increases of abnormal placentation with the presence of a uterine scar.”

IMO it is also necessary to consider the impact of multiple abdominal surgeries on maternal health. Risk for excessive scar tissue causing surgical complications, risk of hysterectomy, risk of requiring transfusion, etc., all go up with each cesarean delivery.

I have no doubt this study will be widely used to encourage women to believe cesarean delivery is the selfless way to safely birth your baby. It makes me angry that so many experts seem to look at each birth in a vacuum and completely disregard the impact on a woman’s reproductive life as a whole.


Coincidentally, I received the following e-mail from a reader last night:


I was born by C-section due to a legitimate emergency.  Because it was done in a hurry in the 1970s, it involved a vertical cut and thus my younger brother “had to” be delivered the same way; in an effort to minimize scarring the OB went in through the existing incision.

Twenty or so years later, I had to rush my mother to the emergency room, and then consent to surgery (she was already comatose) to address what turned out to be a direct result of her two C-sections.  The scar had opened up on the inside and her small intestine got tangled into the incision, causing a blockage severe enough that she nearly died.

A year later, it happened again with a different part of the incision.  At that point, the surgeon elected to go ahead and open the entire incision back up and then re-sew it with a reinforcing plastic-type mesh to prevent it from opening again.

So my mother’s two major surgeries for having children ultimately resulted in two *more* major surgeries, when she was twenty years older and thus less able to bounce back.   It was the beginning of a downhill spiral in her overall health.

My point is that a Ceasarean can lead to complications decades after it’s done, as it did with my mother.  So a non-emergency Caesarean is opening up a lot more possibilities for problems down the road, than it may seem at the time, for *no good reason*.  I wish more women knew that.


Of the 4,317,119 babies born in the United States in 2007, 1,372,844 were delivered via Cesarean section.  Are we ready for the long-term effects of that many surgeries?



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Reader Comments (10)

I would also like to see research into Cesareans and the Long-Term Health of the Child into Adulthood. Has any such been done or started?

November 29, 2009 | Unregistered CommenterKaren Law

Sometimes I just despair. Seriously.

November 29, 2009 | Unregistered CommenterLori

I'm afraid that as having more complications becomes the norm, it will further lead to the "birth is dangerous" belief system. I can just see a woman who is convinced by her doctor that she can't birth normally having a c-section, having complications with a future pregnancy and then thinking "I guess my dr. was right...my body is broken". Its a vicious cycle!

November 29, 2009 | Unregistered CommenterKrista

Wow, that story describes the exact kind of outcome that will not be captured even in immaculately designed cohort studies. It's in these cases that we need to take case studies and anecdotes seriously and count them as "evidence."

Scary stuff...

November 29, 2009 | Unregistered CommenterAmy Romano

Adam Murdock, M.D.
November 29, 2009

A scientific dictatorship occurs when this willingness to follow the data is disregarded and replaced with political correctness, consensus, economic motives, or personal hopes and aspirations. This dictatorship which attempts to suppress alternative viewpoints or theories is merely an attempt to make a scientist’s own selfish view preeminent at the expense of the scientific process and sometimes the truth. Inevitably, this dictatorship uses tactics like vilification, name calling, discrimination, and sometimes even threats of physical incarceration or violence in order to enforce the accepted dogma.

November 29, 2009 | Unregistered CommenterAnon

Jill - the email you received reminds me of the quilt for Karen Flaherty on Ina May Gaskin's "Safe Motherhood Quilt Project". Her death was due to a bowel obstruction 25 years after her second cesarean. The quilt isn't specifically part of the project since it's outside of the parameters of the project itself, but it's always stuck with me.

November 29, 2009 | Unregistered CommenterPampered Mom

I think of this often...all that scar tissue...it happens a lot where the scar tissue adheres organs together and they stop functioning properly. Then off to surgery you go, however many years later, to fix scar tissue complications from c-sections. I read once that (don't quote me exactly) that if you had zero or one c-section, your chances of a complete hysterctomy by around age 50 were like 1 in 17,000. If you have 2 or more cs's, the rate goes to 1 in 222...again, probably not the exact numbers but it was something exponential like that....

November 29, 2009 | Unregistered CommenterKiki

To Karen Law, I know of at least one study that is in the works looking at c-section effects in adults, unfortunately right now I can't remember the doctor's name! I believe the study was mentioned in the book 'Pushed' by Jennifer Block.
Along other lines...I'm currently fighting to avoid a c-section with my second pregnancy because, due to a genetic condition (Ehlers-Danlos Hypermobility), if I have a c-section I run a very high risk of never being able to carry a child again. That same genetic condition, however, is the reason I'm having to fight the doctor's to avoid one. Its rare and none of the OBs in town have heard of it. On first blush it would appear that a c-section would make sense given the disorder (I run an increased risk for dislocation or other injury to myself during the birth), but a full understanding of the disorder makes it very apparent that a c-section is the last thing that is medically indicated. Problem is, none of the OBs want to take the time to do the research into the disorder, they just want to shuffle me off to a high risk OB for a scheduled c-section. Hoping the high risk OB can be convinced to do the research, declare me 'low risk' (disorder does not notably impact pregnancy and nearly all Ehlers-Danlos Hypermobility prengnacies are low risk) so I can legally go with a midwife. But I've had so much pressure for a c-section when I know (knowing about my disorder far more than the doctor's recommending a c-section do) it will likley keep me from ever being able to carry again.

November 29, 2009 | Unregistered CommenterJessica

I am just now hearing, from various friends with c/sec experiences, the outstanding long-term effects of cesareans. A friend who just had a hysterectomy (two c/secs, 9 and 6 years ago) was told by her doctor that the majority of hysterectomies done today are a result of scar tissue issues from previous cesareans. No one ever told her this when they were explaining c/sections. This needs to be shared.

November 29, 2009 | Unregistered CommenterAmy

Some women may be more prone to adhesions than others, which could further complicate matters. One of my friends had an appendectomy a few months before she got pregnant the first time. It was ectopic, and the doctor said that the scar tissue from the appendectomy had caused the blockage in the fallopian tube. S/he was surprised at how quickly it spread, from my friend's only (abdominal) surgery. But I bet there's no way to find out prior to surgery which people will recover with little problem, and which will have major problems with adhesions. :-(

November 30, 2009 | Unregistered CommenterKathy
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