Savvy advertisers are jumping on the bandwagon about risks of c-sections. One common complication of surgical birth, adhesions, consists of scar tissue that grows over the surgical incision on the uterus and other tissue layers, and may attach to other tissues or organs. Upon repeat surgery, the adhesions can be so thick that it literally involves meticulously peeling, cutting, and burning the sticky scar tissue out of the way so the uterus can be opened. Picture a thick cobweb inside your body, and you are visualizing adhesions. Severe adhesions can significantly increase bleeding and the amount of time the woman must be under anesthetic. But now, many concerned health care providers are seriously considering how they can reduce the problems associated with repeat surgeries.
Consider this advertisement, for a product called Gynecare Interceed®. The manufacturer, Ethicon, tells healthcare providers:
“You can play a part in preventing adhesions from happening the first time.”
Yes, I can play a part in preventing adhesions from happening the first time–by making sure that I give my client the optimal support to be able to deliver her baby vaginally.
Picture a soft-focus photograph of a cute pregnant belly, with the mom’s hands caressing her unborn baby. The bold headline of this advertisement reads: “She’s likely to come back for another C-Section. Minimize her risk of adhesions.” The miracle product? Gynecare Interceed® again.
And why is “she” likely to come back for another C-Section, even after the American College of Obstetricians and Gynecologists recommends supporting VBAC? Could it be that the physician who performed her first c-section is encouraging her to come back for another c-section next time around? Maybe a better way to minimize her risk of adhesions would be to minimize her risk of c-section.
The November issue of the American Journal of Obstetrics and Gynecology (AJOG) features a multi-page article on placenta accreta, the new darling diagnosis of OBs. The rapid rise in the incidence of this potentially life-threatening complication of pregnancy can be largely attributed to the corresponding rise in cesarean births.
The more cesarean births a woman has, the higher her risk of a placenta accreta, or one of its cousins, placenta percreta and placenta increta. All are variations of the location and growth of the placenta, most involving a low-lying placenta that is over the old uterine scar and grows into the placenta to varying degrees. In its worst form, the placenta actually invades other body organs such as the bowel and the bladder, necessitating major surgery to remove the damaged tissue.
The AJOG article highlighted a chart outlining the frequency of placenta accreta according to the number of cesarean deliveries and the presence of placenta previa, where the placenta is partially or fully covering the cervix. Incidence of placenta accreta remains low through the fifth c-section in all women who did not have placenta previa, too.
The story is dramatically different for women who do have placenta previa. The first c-section carries a 3% risk of placenta accreta complicating the placenta previa. The second c-section carries an 11% risk. It is at the third c-section that we see a dramatic increase in risk, to 40% of women. The fourth through sixth c-sections remain fairly consistent in the 61-67% range.
The rest of the article is filled with management tips for obstetricians: help in identifying an accreta, and preparing for the risky surgery that it requires.
Not once in the article is there even a hint of a suggestion that a simple solution to this problem might be a decrease in the c-section rate. Ladies, this is a very serious danger to repeat c-sections, and one that is often not discussed with women in the informed consent process. Here is where we must speak up and protect ourselves and our future babies.
If you have had prior cesarean births, a VBAC should be offered to you. You should be given clear information about the risks of placenta accreta and the fact that you are at greater risk for this complication with every additional c-section. The best prevention for placenta accreta/percreta/increta and surgical adhesions is avoiding the first (or second, or third) c-section.