Dr Gauri Lowe has been dedicated to practicing gentle conscious birth and women's healthcare for over 10 years. She is a trained medical doctor, has worked with homebirth midwives, and studied herbalism.
She wishes for every woman to have the opportunity for a powerful, enlightening start to motherhood.
Her work is to bring a sacred awareness to being Womban in all facets of life. She is dedicated to nurturing the Sacred wholeness and vitality in pregnancy, birth, motherhood, and women's healthcare, and does so in her talks and articles. She also offers online health consultations, and courses. The latest course Preconception Preparation is starting soon!
A cesarean section is not benign.
I am going to put this out there first, cesarean section (C-section) as a form of medical intervention is a valuable and necessary procedure. I am a medical doctor and have performed these medical procedures countless times to save lives.
I am fully supportive of appropriate medical interventions. But when they are over-used, misused and abused, I have a problem.
A Grim Reality
Presently, the numbers, stories, and expectations surrounding the c-section represent a seriously mal-aligned society that is heading for trouble. We need serious reform of approaches, procedures, care, and attitude towards C-section.
What concerns me most is the market.
Why is there a market for caesarean sections? Why are women accepting this sentence from their doctors, or even asking for it?
A cesarean section is not benign.
I think of a distant family member of mine who recently told me she was booking her caesarean for 3 months’ time, wanting to “preserve her vagina.”
The risk of prolapse and urinary incontinence stems from pregnancy weight and forced or timed pushing during labor, not vaginal birth itself.
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You Should be 100% Informed
An old doctor with whom I did anaesthetics also comes to mind.
When we worked together, he showed me how to take full informed consent. He sat with the pregnant mother and explained ALL the risks of surgery and anaesthetics to her, up to and including death. He is a leading example – this is how it should be, every time.
Often, doctors don’t do more than wave a paper in front of the patient while she sits for her spinal, or is threatened with unsubstantiated fears of her baby dying. Some doctors even ask the receptionist to do it! This has to change.
Women deserve to be aware of the risks they are taking so they are able to make an honest, informed decision.
I work with women and families, and I can see how the truths about how we birth affect us. I can see how we birth matters; I understand the way mothers are treated during their pregnancy and birth has long-lasting imprints on our relationships, our perceptions.
When your doctor tells you, “Your baby is too big, and you are too small. There is no way you can have a vaginal delivery,” what are the risks?
Risks For You
#1 Placenta Accreta
This occurs when the placenta grows adherently into the wall of the uterus. After the baby’s birth when the placenta is born, a part of it may stay stuck inside the uterus.
It’s also possible for the entire placenta to get stuck behind, as part of it may have grown completely into the wall of the uterus, needing to be surgically removed.
This situation can be life threatening.
It is well known that surgery carries a risk of haemorrhage (Bleeding). In a caesarean section, when a surgeon opens the abdomen to get to the womb, it is possible for them to nick the Uterine Artery or blood vessels that lie there.
A hysterectomy is a final, life-saving procedure for haemorrhaging during C- section. This needs to be consented to before surgery, as during surgery action needs to be fast. It is not a distant reality, I have seen women lose their uteri several times.
#3 Intra-abdominal Adhesions
Adhesions occur when scar tissue connects two parts of tissue that are not normally joined and are the most common complication of pelvic surgery. They can cause bowel obstruction, chronic pain, and complications for subsequent abdominal surgery.
I’ve seen second and third C- sections that are really messy and really tough.
This is because the organs and muscles grow adhesions that stick to each other like long threads, needing to be very carefully isolated so both ends may be identified and often cut or tied off, as they can make the space for the baby to come out very limited. Sometimes they can grow in very dangerous places, presenting problems experienced surgeons need to navigate. They can make surgery longer, trickier, and riskier.
#4 Poor Abdominal Muscle Healing
During a C- section, an incision is made through the skin, adipose tissue, and muscle fibres of about 3 muscle layers. Often, the muscles are torn apart to create adequate space for the baby to come through. There is no absolute standard for best healing, and surgeons mostly put a loose, absorbable stitch in – if any – to align the muscles so they can heal in time.
Therefore, rest without any straining of the muscles for about six months after the surgery is advised.
Straining includes coughing and constipation, as well as picking up and carrying any weight.
If the rest isn’t sufficient or for other reasons healing is inadequate, weak abdominal muscles can arise, causing backaches, extra weight, poor muscle control, and hernias.
#5 Healing and Wound Infection
In the hospital where I previously worked, there were always one or two ladies admitted about two weeks postpartum with an infected wound (from the incision to the skin).
This is just awful. Different surgical methods, sterility, postsurgical healing, nutrition, and resting are some factors that influence postsurgical wound infections.
Infection can cause you to become septic, often leading to long hospital stays, antibiotics, a lot of pain, requires numerous wound washing and dressings, and sometimes, surgery.
It is a common enough occurrence that it needs to be mentioned in every informed consent discussion (with any surgery).
Risks for Baby
There are risks for the baby which are more likely to happen during a C- section than a vaginal birth.
#1 Wet Lung Syndrome
This occurs when the baby’s lungs –normally squeezed from pressure on the chest during the birthing process – are not squeezed in a C- section. The squeezing normally allows the fluid filling the lungs (the lungs are naturally filled with fluid during pregnancy) and respiratory areas to escape so the baby can breathe more easily.
Symptoms involve respiratory distress, with a possible need for oxygen and breathing assistance.Wet lung syndrome may result in baby’s admission to ICU with breathing support and monitors. Normally, babies respond to support and are breathing normally within 2-3 days.
Prior to a cesarean, a mother will usually receive a dose of intravenous antibiotics to prevent infection, as well as antacids and anti-nausea medication to prevent vomiting during the operation.
Once medication is given, doctors will want to deliver the baby as quickly as possible to limit the amount of time the medications have to cross the placenta into the baby’s circulation. For these reasons, they typically avoid giving medications like morphine before the baby is born, but some medications are unavoidable.
Your Future Risks
Did anyone ever tell you that after your first cesarean you will always be a high-risk pregnancy patient?
That doctors may monitor you more closely, and you will probably have to attend a high-risk clinic or hospital?
That even if they have said to you, “You can always try for a vaginal delivery next time,” that you would be more closely monitored in labour with an IV line, fetal monitoring, a urinary catheter, and that your time would be far more limited to labour and gestate?
No one told me anything of the after effects and no one ever said anything about scar tissue forming, or that it might cause problems with later fertility. I struggled for 3 years after my 2nd c- section and when they did a laparoscopy my ovaries were all overgrown with scar tissue. They had to cut them loose and now I only have one working ovary left.
This and the simple physical recovery time after a caesarean is critical in terms of your long-term health and healing. Controlling pain with medication, navigating your physical limitations due to surgery, and looking after a newborn all at the same time is challenging.