• Physical therapy for c-section scar?
• Insurance coverage for elective C-section?
• Electing to have a C-section - yea or nay?
• C-section scheduling and spacing sibling birthdays
• Still not fully healed from C-section
• Keloid scar still hurts after 14 months
• See also: Vaginal Birth after a Cesarean (VBAC)
• Related page: Stomach Exercise after C-section

Physical therapy for c-section scar?

Hi I had a c-section a few months ago and I heard that you can go to a physical therapist who can help w/ the scar. Can anyone recommend a physical who specializes in this and is in the Alta Bates medical group or Hills Physicians medical group? thanks anon

With massage oil on your fingers/scar, press down on one end and gently stroke the length of your scar. Aim for a slight stretch, no pain. Then stabilize the other side, and stroke in the opposite diection. Due to recent news regarding harmful chemicals in personal care products containing scents, use a scent free oil.

You can also massage across the length of your scar, gently rolling up and down. After your scar has become more elastic, you can lift the scar off you skin a bit, and roll the scar around you fingertips. Scar mobilization techniques help eliminate adhesions, which eases discomfort, and helps to speed healing. Because the skin has been cut, it's normal to feel tenderness around the incision site. As to scar fading creams, they do work, but ask your OBGYN if they are safe for nursing moms. BeFit-Mom, www.befitmom.com

Don't assume that any PT office is capable of addressing your issue. The early postpartum stage is a specialty area and not all PT offices are experienced with this patient population. Ask questions about Women's Health experience and specialty areas when contacting an office.

Postpartum treatment plans for C-section include gentle mobilizations of the abdomen, therapetic exercises to the deep abdominal muscles and pelvic floor education. If it is only incisional considerations, you will not need many visits and should be given a detailed home exercise program.

You can also check out www.partummemom.com for details. Suzanne

Insurance coverage for elective C-section?

Hello, I am 35 and trying to get pregnant for the first time. After reading most studies available from reputable institutes, discussing with two ob/gyns and speaking with about 7 different friends that have had babies in the last few years I have decided that my choice for giving birth is by a c-section. After initial counseling my ob/gyn is very willing to do this but my insurance will not cover it which for me pretty much means that the option doesn't exist. Does anyone have any recommendations for health insurance providers what are willing to cover at least the amount they would have spent on a vaginal birth? I hear that this is how it works in Taiwan, if you request a c-section in the absence of a medical complication, you pay the difference in the cost of a c- section and a vaginal birth out of pocket. With all due respect, I am not looking for advice on the method of delivery (vaginal Vs a c-section), just information about health insurance. Particularly, does anyone know which major health insurance provider in California covers the costs, at least partly? Thanks!! Melissa

Electing to have a C-section - yea or nay?

I am pregnant with my first child and am seriously considering a primary elective c-section for a variety of reasons. I have read the other posts and they all seem to focus on VBACs and mandatory C/S's. I am looking for advice from those who have had only a C/S, those who have had an elective C/S, and those who have had both vag deliveries and C/S's. Would you have the C/S again if given the choice, and what were the pros and cons for you? I am a NICU registered nurse, have attended hundreds of deliveries of both types, and am well aware of the risks of both types of deliveries. Therefore, i'm not looking for statistics or education from laypeople, just for stories and advice. Thanks!
Big fan of western medicine

You will get a lot of opinions on this subject, but I have gone through both types of deliveries and I know the experience is very different. I felt really disconnected to the birth process with the C-section. I know that I gave birth to my first child, but I never felt like I did. My experience with the vaginal delivery was the exact opposite. It was intense, incredible, empowering and actually bringing a little life in to the world was amazing.

If you are having a healthy, normal pregnancy I would strongly encourage you to seriously consider why you are thinking about an elective C-section. There are risks involved with either delivery and your role as a NICU nurse has given you a unique perspective, I know because I am in health care too and have spent time in the nurseries. It is important to remember that the majority of vaginal deliveries turn out just fine. Good luck with your decision and your new family. Jennifer

I had relatively easy pregnancies and births (c-section not withstanding) and generally good recoveries - no horror stories. But I would never have a c-section unless there is a really compelling medical reason to. I found my recovery much slower after a c-section and the fact that both my husband and I had to focus so much energy on my recovery that we would rather be focusing on the new baby.

And it really is an incredible experience to bring your child into the world with as little outside intervention as possible. I was never fanatical about it and had all mine in the hospital. But in many ways - the last one which was completely natural - was the best . It is one of the proudest accomplishments of my life. Mom of 3

My VBAC on the other hand, was incredible. I actually tore pretty badly but I felt fine in a week. Walking was difficult at first b/c of my stitches, but once they dissolved I was able to function pretty much as usual. I recovered far, far faster. Not to mention the joy I felt at birthing my baby naturally and being well able to take care of him and breastfeed immediately. The benefits of the vbac far outweighed the 'convenience' of c- section, which was not convenient at all. just my experience

My doctor suggested that if we were to have more children, that I should probably elect to have another C-section. I would strongly consider it again because some of the reasons that necessisitated the first C-section would probably present themselves again.

It sounds like you have witnessed lots of births but I wished I had heard more positive C-section stories when I was in labor. Ultimately what matters most is the health of mom and baby. Be well.

Fast forward two and a half years from her birth and I was pregnant with baby #2. I lost this baby at 14 weeks in which the baby basically just fell out of me. Everyone, including my doctor, told me that it was ''just one of those things,'' but the way my miscarriage happened seemed so different from any other miscarriage I heard about or read about on the web. Mine was painless, no contractions, with the baby just falling out. Finally I read on the web about miscarriage due to incompetent cervixes and the stories were all just like mine. I had an ultra sound to check my cervix and sure enough, my cervix had shrunk (which they call ''incompetent.'') This is REALLY strange and uncommon after having a non-eventful, full term pregnancy. The only thing that could've caused this was the SUCTION devise that they used to try to get my baby out. This can, and did in my case, cause stress to the cervix and the cervix doesn't recover. I WISH I had known about this before they used suction on me. I would've said, forget the suction, let's do the C NOW. Now we're looking at a very tough pregnancy (cerclage and bedrest) if we do decide to have another child. You don't know about most of these things until you go through them and yes, there are, I'm sure, hundreds of women who have assistance from suction and their cervixes recover. I just wasn't one of them.

I think you should do whatever feels right for you. My recovery from the c-section was great and my scar is tiny. I don't regret the c-section at all. I regret the suction hugely.

Good luck... anon

The c-section was not thus entirely scheduled or elective, but it wasn't an emergency c-section either. I had several hours to wait until the operation, and I think it went as well as a c-section could go. I loved my anesthesiologist and my doctor, they were both very supportive and I felt the c-section was a good birth experience. I got to see my baby soon after she was born and had her with me as soon as they made sure she was allright (as she wasn't yet term).

BUT, if I had had a choice I think I would have liked to try a (medicated) vaginal birth. I'm sorry that I don't know (and probably will never know) what it's like to go into labor. I'm sure I wouldn't have liked the contractions, but I miss not having had the experience.

In all, it doesn't matter much, but I think if I had had the choice (if the baby had been in positioned, for example) I would have opted for the induction. anon

I had planned to give birth at home. My daughter was instead born in a bright room and bathed against my will. After a pregnancy free of medication, caffeine, sugar and alcohol, my body and that of my daughter's was inundated with three very powerful drugs within a matter of an hour (antibiotic, epidural, post-surgical painkiller.) Our placenta was thrown away as medical waste. My uterus was removed from my body, turned inside out, scrubbed, turned right side in and put back inside me, which, while standard, felt like a huge violation. Because it was so early in the morning, regular recovery was not yet open and I was put in ICU recovery instead. I overreacted to the epidural and couldn't wake up. When I did wake up, no one was there. I was hoarse from 14 hours of labor, there was no call button, and I couldn't get anyone's attention. It was three hours after her birth that I was finally able to hold my baby. My scar still aches and to this day, three and half years later, I still don't feel like I gave birth, maybe because I didn't feel myself give birth. Because of the incision carrying my baby like I wanted to (in a sling) was painful for months. If I were to have a 2nd child I'd try for a VBAC, no ifs, ands or buts.

Now, you should of course take all of this with a large handful of salt. Like I said, it saved our lives. And a lot of my anger and pain about her birth is because it isn't what I wanted. But that's my input. Christine

My friend, as you, works in the hospital. As an anaesthesist, she showed up at hundreds, maybe thousands of birth. However, as staticians figured out during the 20th century, a huge number of observations does not garanty a good estimator. If there is a bias in the first place, a large sample size will only help the wrong picture to come out really sharp. There is the summer visitor in San Francisco who takes photographs of the Golden Gate bridge every single morning of his July/August stay. He'll conclude that no entire bridge exists, only parts ending in clouds. No matter how many pictures of this sort he takes, no matter how many pixels he's got in his camera, he'll never get it to see the whole. He may further be lead to assume that other people's photographs showing the full bridge must have been manipulated.

It may be completely different in your case, but I experienced myself how my professional life shaped my approach to pregnancy and birth in a specific way. For my friend, her profession seems to have made her approach to giving birth harder rather than easier (what I had naively expected). In her job, she'd never witness a normal onset of labor and the typical many hours of moderate pain, but she'd be called in during the hardest moment. She'd simply never seen how women overcome the challenge of active labor in any other ways and with other support than epidurals or C-sections, since in these cases she simply wasn't called into the delivery room. She'd leave the place as soon as the little warm and wet body left the uterus one way or another, still to become ''the parent's baby''. She would certainly not witness how the different physical ways of transitioning into parenthood affect the health and the bond between parents and baby in the first year and beyond.

Instead, shaped by her professional experience, my friend went for what she was familiar to her, rather than ''the unknown'' - the one garantied riskfactor at any birth - which later caught up with her in this terrible way.

Don't get me wrong, I have the deepest respect for many of the outcomes of Western medicine - just as you do, as you hint in your signature. (I am actually working in medical research myself, on the scientific end, both very Western and very high-tech.) However, we are not eating our soup with a fork. The tools of Western medicine are as good as the appropriateness of the cases we choose to apply them to.

Lacking the details of your case I can only guess that the cruel part of your decision is, as it was for some of my friends who agonized over C-sections, that, at the end of the day, you have to choose between a little more risk for you or a little more risk for the baby. There is the sheer impossibility for parents to accept any risk for the baby at all that could have been avoided, whatever sacrifices is takes from the mother's side. It helps to keep in mind that we are talking small risks all together, for which we even lack appropriate words to describe - other than ''1 in 86,311'' or 0.000059 and such figures. Another issue is in which sense we can actually separate the well-being of the mother and the well-being of the baby in the first place. Here I'm hinting at other C-section friends trouble with nursing, bonding, recovery from surgery, feelings of helplessness/incompleteness/lost control, downward spirale of self- esteem and postpartum depression, as well as very recent research on higher miscariage risk in pregnancies following a C-section (as you may have already came across yourself). All of this has an enourmous effect on the health of the entire young family in this period of highest joy as well as highest vulnerability.

My best wishes for your birth and beyond, Julia

My personal opinion is that it depends on how well you recover from surgery. From several minor procedures under general anesthesia I knew that I didn't have much problem recovering. And of course the C-section isn't under a general, but it is surgery. The first two days were very painful, especially getting to the bathroom, but after that it went from manageable to quite easy by the end of seven days. (I do know at least one other woman that took a full six weeks to recover, however. Her C-section was much more complicated than mine, took more than 2 hours, and followed a 24-hour stalled labor. Worst of both worlds!)

The only thing I didn't like about it was not being able to hold the babies for long just after the birth. I was spreadeagled on the table and they just placed them near my face for a minute. My husband and best friend who attended the birth spent much more time with them than I did. We tried breastfeeding within an hour of birth but they didn't latch on right then, so off they went again with my husband and friend until all my numbness wore off.

Good luck on your decision.
Can't see my scar anymore, but the stretch marks are still there!

Though it wasn't exactly a pleasure, I am glad I have had the experience of labor. My recovery from the section was fairly fast and easy, as C-sections go, and I had a lot of help at home in the first few weeks, but I cannot imagine having a C-section by *choice*. I am now expecting my second and intend to do everything I possibly can to ensure a normal delivery this time around. If I can avoid it, I do not want to feel like a cog in a medical machine rather than like a thinking person caught up in a powerful biological process, I do not want to have to think about what might or could happen if there were surgical complications, I do not want to be separated from my newly born baby for an hour while my body is stapled back together, I do not want to deal with being unable to get out of bed for several days or even just sit up without help for a week, I do not want to be unable to drive or walk a normal distance or change a diaper without abdominal pain for several weeks.

Of course, if I'd had a normal delivery, I suppose I might feel the same way about perineal pain and greater lochia. But the risks *are* greater with C-sections and there is no getting around that fact.

I do have friends who've had a difficult vaginal delivery and an easier C-section. But that's the exception rather than the rule. I'm not exactly a natural-birth fanatic, but here's how I look at it: A good normal delivery is always better and easier than even a good C-section; a bad normal delivery is usually better and easier than a bad C-section. A bad normal delivery may not be better and easier than a good C-section, but in most cases it's impossible to predict that those are your choices. So if you have a choice to make, it's more sensible to choose the normal delivery. Your chances of having a better outcome and easier recovery are considerably higher that way.
Intended VBAC mom

My first was a difficult vaginal birth. No major complications, but long labor and antibiotics due to a high fever. This resulted in baby being in the NICU for 2 days. I had a bad tear that resulted in weekly follow-up visits to my OB and more antibiotics.

When #2 was on the way, she measured very big. Given my history and the risks outlined by my OB, we opted for a scheduled C- section. I couldn't have been more pleased. My recovery was much easier and more ''controlled'' than with my first. I didn't need lots of pain meds. I couldn't drive after #1 either, so that wasn't a big difference.

That said, I was amazed/horrified by the insensitivity of some friends and family members who implied that I was failing or ''giving up before trying'' by scheduling my C-section. One even said, ''How will you feel if the baby is only 9 pounds and you ended up having a C-section?'' For my husband and me the only choice was to minimize risk for both baby and mother.

Good luck with your decision and congratulations!
Another fan

Pros:
- Delivery would be quick and you'd be able to pick the date.
- There would be no labor pain, although there is plenty of other pain involved.
- Your vagina isn't stretched out so much.
- You don't have to worry about a rip episiotomy.

Cons:
- You feel like a train hit you when the epidural wears off. I can't imagine that the pain after a regular delivery is anything like the pain after abdominal surgery. The other moms were walking around the hospital while I was still drugged up.
- Recovery is really difficult--I was still feeling it 10 weeks later.
- Breastfeeding was a challenge--I don't know if the drugs made my milk slow or my daughter less interested, but she was slow to latch.
- You don't get to see what's happening because you're strapped to a table with fabric wall up--I felt disconnected from the birth. It was being done to me, not by me. I hear you can negotiate on this point, but I wouldn't count on it.
- If the epidural doesn't work, you end up with general anesthesia. This happened to me and it was very upsetting. My husband wasn't allowed in the room and NO ONE got to see the birth. I know this is rare, but what an awful feeling. It took me awhile to get over that. I knew it was baby intellectually, but it was weird.
- The baby doesn't get the benefit of the pressure squeezing liquid out of the lungs. My daughter coughs alot and I've often wondered why.
- Intercourse still hurts for awhile after. They don't change the recommended six weeks of waiting. My sister who had a vaginal delivery thought this wouldn't be the case, so I thought I'd mention it. There was really no difference in the after affects down there.
- I still had trouble with leaking bladder. This is often cited as a reason for c-sections, but my experience was that the damage was already done during pregnancy and the c-section made no difference.
- Depending on the hospital, you aren't guaranteed a private room. I wouldn't dare take the chance of a c-section if I had to share a room after.

Good luck. anon

I have to say the second one was FABULOUS!!!! I loved being able to walk into the delivery room. I was much more conscious of what was going on. We had a great time joking with the drs while they were doing all the prep. My husband was more relaxed and able to think of my needs during the surgery. Since no one was in a rush they let my husband and the baby sit next to me during the closing, and I held the baby's hand... plus they let me put my glasses on so I could see him.

BUT...The best part was the super quick recovery. By the time I was to be moved into my postpartum bed I felt mobile enough to scoot myself off the guerney. (The orderly was horrified.) I was up and walking the next day and felt ready to go home by the second day. (After the first c-section I didn't even feel ready when they sent me home on the 5th day!) I am sure that this is all due to the fact that I had a good night's sleep the night before the baby came, and I had far fewer drugs with the scheduled c-section than I had the first time around.

Would I go the vaginal route? Well, I tried the first time around, I really did... but it was not happening for me. I chose not to do VBAC for many different reasons, but did consider it. If we decide to have more kids... well, knowing what I know now about my body, VBAC isn't an option, but even if it were an option, I probably wouldn't bother. I really liked my scheduled c-section. But SHhhh... don't tell... I know that is not PC. where do I sign up?

However, I now feel I had a great childbirth experience and will gladly have another c-section when or if I have a second child. Although I don't have anything else to compare it to, I felt my birth experience was great. I have absoluteley no regrets or disappointments. I ended up feeling very involved in the birth with my husband and the anethesiologist giving me the blow by blow and basically my husband did the initial bonding/caring for our baby right after birth. I was surprised at how quickly I was stiched up and sent to recovery (I think it was only about 15 minutes after he was born) and once there the recovery nurse at Alta Bates put my son to my breast and we got him to start nursing. And we were not separated after that.

I was not tired afterwards since I had a decent night's sleep the night before and my recovery really did not seem that bad. I definitely was uncomfortable when the spinal wore off and I did take pain medication for about a week. And I was really grateful to have the three days in the hospital and all the support I got there so that by the time I went home breast-feeding was going well. I know c-sections are dreaded and get a bad-rap, but that did not end up being my experience. I did lay low for a few weeks on the advice of a friend, to make sure I didn't overdue it, but I felt like I could up and go out before that.

Anyway, just my two-cents that while I was dreading a c-section, I now sing a very different tune. I am certainly now a strong believer that how a baby comes into the world is not what is critical -- it's that the baby and mom come out of it healthy. That is all that really matters in the end. Take whichever route you determine takes you closest to that goal.
Whitney

C-section scheduling and spacing sibling birthdays

I have an unusual dilemma and am looking for input from parents whose kids' birthdays are very close together and/or who have birthdays very close to their own siblings.

I have a son who will turn two on January 20. I am also pregnant with a girl whose due date is January 25. I am going to have a scheduled c-section for this birth and my OB suggested scheduling it a week before the due date or somewhere around January 17. When I expressed some hesitation about the birthdate being so close to my son's birthday (three days apart), my OB offered that he would be comfortable to do the c-section anytime the previous week as well (-- that the baby is considered full- term after thirty-seven weeks and he would not be worried about the baby's health, etc.)

So, I'm kind of confused because I have this option and not sure of the best choice. I feel like it would be preferable (given that we have this choice) to make the kids' birthdays at least a week apart, but then also feel like it is somewhat odd and kind of rude to take my daughter out of her protective womb a week earlier (and two weeks before her due date) just to accomodate birthdates.

So, do parents with kids whose birthdays are only days apart wish they had more space between them? Did you like or dislike having a birthday only days from your siblings? Would nine days apart be much better than three days apart?

Or, should I listen to my father, who has a December birthday, and advises to forget about the closeness of the sibling birhtdays and to just get the birthday as far from Christmas as possible!!

Thanks in advance. Should have thought about this nine months ago

Still not fully healed from C-section

I had an unexpected c-section 2 1/2 years ago. The operation itself and the healing was very difficult and seemed to take much longer for me than those I spoke with at the time who'd also had one. Even now, when I lean against something (like a changing table) or something presses against my stomach, it hurts. I feel like if I get pregnant again (which I want to) that the ''stretching'' will be very painful-I can't imagine how the uterus wouldn't rupture. I had a checkup recently and the nurse practitioner said that everything ''seemed fine'' to her. Is this feeling normal, or could something be wrong? anon

And, to the second person who's worried about her scar, you should ask your doctor about it, but it sounds within the range of normal--some people heal better than others. You may form keloids, which are thickened scars. I think the promise of ''wouldn't be able to tell [you'd] been operated on'' is an exaggeration--everyone ends up with a visible scar, though sometimes it's covered by pubic hair. Scarred but happy

If this is the case, adhesions will not case uterine rupture in a subsequent pregnancy. However, if you do become pregnant again, carefully weigh your options with your OBGYN. VBAC's are not risk free. A small number of women do experience uterine rupture when attempting a VBAC and this complication is life threatening. For the ''C'' scar that is still raised after one year, massage and scar mobilization techniques will help a lot. Very often adhesions (again) form between the scar and underlying tissues. Oil your fingers and/or your scar, so that you can massage the area without friction. Start very gently, massaging your scar lengthwise. You can work from the middle out, and then holding one side down, stroke the scar from one end to the other. Then massage in the other direction, across your scar, gently rolling it up and down.

After repeated massage, your scar should begin to feel looser, and then you can begin to pick it up off the underlying tissue and roll it back and forth between your fingers. To get the idea of how to do these techniques, practice the movements on the seam of of a piece of clothing. Don't work to the point of pain. This is a slow and steady process. Also, you could look into some of the post surgical creams that plastic sugeons use on their patients. that might be a good option too. Helene Byrne author, ''Exercise After Pregnancy: How to Look and Feel Your Best''

I worry not only that another pregnancy may stretch the scar to the point of pain but also that it may lead to MORE scarring. Ive heard tales told both ways, that a repeat c-section is easier because of the original scar and that it can be more difficult. I dont mind the look of it so much, I just wish it wasnt so uncomfortable. Rebecca

Keloid scar still hurts after 14 months

After trying my best to avoid a cesarean to deliver my breech baby, I not only ended up with the c-section, but with an ever- worsening keloid scar as a result. I have so far received three rounds of steroid injections, which haven't helped at all. After 14 months, the scar is huge, bright red, and very, very itchy. I am also still nursing, and my daughter frequently kicks the scar, which is really painful. Has anyone else had a keloid scar from a c-section (or from anything else)? Can you recommend any doctors or treatments? Tawnya