C-section births are becoming increasingly common in Singapore. In fact, 1 in 3 mums in Singapore undergo a C-section! Even then, many mums still find the idea of a C-section, or more specifically, the thought of the C-section recovery rather daunting.
While the C-section itself is a safe procedure, there are possible complications. One such complication that isn’t as widely discussed is that of internal scarring, also known as adhesions. We spoke to Dr. Here’s Dr. Claudia Chi, specialist in Obstetrics and Gynaecology (O&G) at Astra Women’s Specialist.
Here’s Dr Chi’s advice on what you need to know about adhesions and the preventive steps you can take.
Possible C-Section Complications
In a nutshell, a caesarean delivery (C-section) is a surgical procedure used to deliver a baby through incisions in the abdomen and uterus. This type of delivery may be done due to medical reasons or upon the request of a mum-to-be to avoid vaginal birth or for the convenience of a planned delivery¹.
However, mums are discouraged from choosing a c-section delivery if there is no necessity for it, especially if you plan to have a few children. Dr. Chi cautions that there are several C-section complications that can occur. These include:
- Formation of blood clots
- Wound infection or inflection in the uterus
- Trouble urinating or urinary tract infection
- Injury to the bladder or bowel
- Increased risks for future pregnancies
- Longer recovery time compared with vaginal birth
- Adhesions, hernia, and other complications of abdominal surgery
Mums, while this may cause you some anxiety, the good news is that you can take some preventive measures such as:
- Judicious use of antibiotics
- Early mobilisation after surgery
- Good surgical techniques
- Consideration for the use of adhesion barriers
However, Dr. Chi stresses that the most important preventive measure you can take is to avoid unnecessary C-section delivery. Do it if you must, but otherwise, let nature take its course!
What are adhesions?
You’ve probably heard of the more common C-section complications such as bleeding and longer recovery time. But adhesions are a hidden complication that not many mums are aware of. Yet they are common. In fact, up to 46% of women develop adhesions after their first C-section and the risk rises up to 75% by their third c-section2.
But what are these adhesions and what risk do they pose?
Dr. Chi explains that abdominal adhesions are a common complication of a C-section surgery. When your body undergoes the surgery, tough tissue bands known as adhesions may form between your abdominal tissues and organs. They may appear like spider webs or nylon strands that surround the organs of your body.
The scar tissue may cause the organs to stick to each other and the strands may cause disruption in their functions.
The peritoneum is a clear membrane that covers the abdominal organs. But when this protective and slippery lining gets damaged during a C-section, the body’s immune system gets rolling and starts healing itself. This leads to the formation of sticky scar tissue, which is also known as fibrin matrix and inflammation.
In most cases, these scar tissues, or bands, dissolve with the help of a biochemical process, which is also known as fibrinolysis. But during a surgical procedure, fibrinolysis may not happen that effectively because of low levels of blood chemicals that are required for the process. This means the tissues or bands do not dissolve but instead they develop into adhesions.
This may occur a few weeks, few months or even years after you may have undergone a C-section. Most abdominal surgeries can cause the risk of abdominal adhesions. However, C-section poses a much higher risk.
What Complications do Adhesions Cause?
As mentioned earlier, when the scar tissue causes the internal organs to stick, the strands may cause disruption in their functions. This leads to other complications such as:
- Pelvic pain
- Complications and difficulties in further abdominal surgeries
- Dyspareunia – pain during sexual intercourse
- In some cases – infertility
Dr. Chi warns that the presence of adhesions increases the difficulty in performing repeat C-sections and can prolong the operating time. She adds that it also increases the risk of injury to adjacent organs such as the bladder. Bladder adhesion complications can cause the bladder to stick to the uterus, inadvertent injury to the bladder in future C-sections and issues with your bladder not emptying itself properly. This might lead to pain and increased frequency of urination, which can be mistaken for cystitis².
How to Prevent Adhesions from Forming
Mums, the complications of adhesions do pose significant risk and Dr. Chi acknowledges that it is difficult to prevent adhesions from forming. But good surgical techniques and potentially the use of adhesion barriers can help to decrease the risk of adhesion formation.
That begs the question – what are adhesion barriers? Dr. Chi describes them as absorbable agents that act as a mechanical barrier between adjacent tissues to attempt to reduce adhesion formation while healing takes place. Your surgeon can place this on the uterus or under the incision upon delivering your baby.
Are Adhesion Barriers Safe?
It’s understandable that you might be concerned about the safety of using adhesion barriers. Dr. Chi assures that the use of adhesion barriers has been shown to be safe. Adhesion barriers have been used in abdominal and pelvic surgeries to help reduce the risk of adhesion formation.
There you go, mums, important information on C-section delivery and its lesser known complications. A C-section is something that can be inevitable under certain circumstances. But that’s not to say that you should be fearful of it. Empower yourself with knowledge of the potential C-section complications, especially the lesser-known ones. Speak to your doctor and take the necessary steps to protect yourself. In conclusion, Dr. Chi emphasizes that a C-section is an important life-saving operation for both mother and child. However, it does carry risks and should be done for the right reasons!