C-Section for a Previous Uterine Operation

What is a C-section?

A C-section is an operation that delivers a baby through a cut in your abdomen and uterus. The uterus, also called the womb, is the muscular organ at the top of the vagina. Babies grow in the uterus, and menstrual blood comes from the uterus.

This procedure is also called a cesarean section or cesarean delivery.

When is it used?

If you have had a previous operation on your uterus, such as certain types of C-sections or surgery to remove fibroids (myomectomy), your uterus has a scar. Because scar tissue is weaker than normal uterus muscle, the scar from your previous operation might open during labor, especially if the incision went through the inside lining of your uterus. If the scar opens, it could endanger 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 (through the birth canal). However, if you had a C-section with a vertical cut (up and down) in your uterus, or other surgery on your uterus, your risk of tearing the uterus are higher. In these cases a C-section may be scheduled. You should ask your healthcare provider about your choices. Your healthcare provider may ask for copies of the reports of any previous surgery performed on your uterus.

How do I prepare for a C-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 and the care of your newborn baby.

You should not smoke when you are pregnant because it can hurt the baby. However, if you have been smoking during your pregnancy and know you will have a C-section, you should quit at least 2 weeks before the procedure. Smokers heal more slowly after surgery and have more risk for infections. They are also more likely to have breathing problems during surgery.

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 or have contractions or bleeding, call your healthcare provider right away.

What happens during the procedure?

You are given a regional or general anesthetic. A regional anesthetic numbs the lower half of your body while you stay 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 (incision) below your belly button 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 uncomfortable for the first few days. Since you will probably be in the hospital for only 2 to 4 days, try to have help at home for the first week or two.

Your healthcare provider may give you an antibiotic to take after the surgery to help stop infection.

Here are some other things you can do to help take care of yourself after a C-section.

• Avoid heavy lifting for 6 weeks. Usually 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.
• Keep the wound clean and dry. Bathe by shower and gently pat dry with a soft towel.
• Wear loose fitting clothing to keep from irritating the incision.
• Itching around the scar is usually a sign of normal healing. Try not to scratch the area to avoid damaging the incision.
• While most creams, lotions, and powders are unlikely to seriously harm a healing scar, they are not usually recommended because they don’t help the healing and may irritate the area.

What are the benefits of this procedure?

Delivering a baby by C-section may prevent tearing of the uterus, and may be safer for you and the baby. You may be able to schedule when your baby is born.

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 tear or be cut and bleed inside the body.
• A piece of blood clot may break off, get into the bloodstream, and damage the lungs.
• The cut in the wall of the uterus may weaken that part of the wall.
• Any future children you have may need to be delivered by C-section, depending on how this C-section was done.
• You may have an infection or bleeding.
• The bowel, bladder, or ureter may be injured.
• The baby might be hurt 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 have a fever over 100.5° F (38° C).
• You have drainage from your incision, or the incision separates.
• You have heavy bleeding from the vagina.
• You get 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 have worsening abdominal pain.
• You get short of breath.

Call during office hours if:

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