July 20, 2017 7426
GetDoc: Are C-sections pain-free ? Is it an easier choice for a mother to give birth via C-section rather than vaginally?
Dr Lim: Yes & No. Yes, cesarean section is pain-free while the anesthesia is still in place and the procedure is on-going. However, as the anesthesia wears off, pain may set in and oral medication will be given to the mother. Shortsightedly, yes, as she need not do much work during the ‘birthing’ process as the obstetrician delivers the baby via cesarean. However, she may need to go through the aftermath of cesarean section that ranges from the short-term surgical wound pain and longer recuperation to the longer term risk of scar rupture in the subsequent pregnancies.
GetDoc: Is it true that a mother won’t be able to have skin-to-skin contact after a C-section delivery?
Dr Lim: Not absolutely. With some arrangements with the doctors and nurses, skin-to-skin contact between mother and child is still possible, albeit for a shorter duration. This is due to the fact that the operating table is rather narrow and there is the concern of handling the baby safely by the mother especially if she is mildly sedated. Moreover, the environment in the operating theatre is cold and it may not be too suitable for a newborn baby to be exposed in such cold environment for a prolonged period of time.
GetDoc: Would the pregnant woman be completely unconscious while giving birth?
Dr Lim: Almost all cesarean section cases are performed under regional (spinal) anesthesia in Malaysia. This kind of anesthesia only numbs the lower half of the body and leaves the sensation of the upper body intact. Therefore the mother is still able to converse and moves their upper limb freely. In some rare cases, some mothers are given some medications for sedation as they may be too anxious to go through the procedure fully conscious.
GetDoc: Is it true that the epidural doesn’t hurt?
Dr Lim: Some amount of pain may need to be borne during the administration of the local anesthetic drugs and insertion of the epidural needle. Once the epidural anesthesia is administered and works efficiently, most mothers would claim an “almost pain-free” birth. In any humble experience, on the pain scale of 1 to 10, a general pain score of 2-3 out of 10 may be achieved for the mother once the epidural anesthesia is administered.
GetDoc: Would there be problems in breastfeeding post-delivery?
Dr Lim: As mentioned before, the space in the operation theatre is limited therefore limiting the ease of breastfeeding or latching right after cesarean section delivery. In view of the surgical wound pain during the immediate post-operation period, the post-cesarean section mother may need more support by the medical staff nurses for breastfeeding.
GetDoc: Is it true that the mother may have less feeling (numbness) and have swelling around the incision area for a while?
Dr Lim: At some nerves under the skin, subcutaneous are inevitably cut, mother may experience numbness at around the cesarean section wound that may last for weeks to years. As for mild painless swelling, it may be caused by oedema / accumulation of bodily fluid in the immediate post-op period. However, should the swelling persist more than 48 hours or begins to cause pain, wound hematoma (bleeding) or infection may need to be excluded.
GetDoc: Once a C-section, Always a C-section – is this true? Is there a limit to the number of C-sections that one can have ? And is VBAC (vaginal birth after caesarean) possible after a C-section delivery?
Dr Lim: The notion of “once a cesarean section, always a cesarean section” is untrue. VBAC is a safe option under most circumstances. VBAC is widely practiced by many obstetricians and is definitely most welcomed by a large number of post-cesarean section mothers. Under the right guidance of your obstetrician, the success rate of VBAC ranges between 70-80% after the first cesarean. In most countries, Malaysia included, mothers are not recommended to undergo more than 3 cesarean in their childbearing age. However, under certain special circumstances, some obstetricians may agree with the mother’s wish to have more than 3 cesarean.
GetDoc: Does a C-section mum not feel the same connection to her baby as opposed to a mother who has given birth vaginally?
Dr Lim: I personally do not agree to this. The initial bonding may be delayed due to certain limitations but mother “recognize” her baby immediately the moment she lays her eyes on her new bundle of joy. I have personally witnessed post-cesarean mothers having the same story bonds or connections with their babies just like their vaginal birth counterparts.
GetDoc: Complications and risks from C-section aren't that much different from vaginal birth. How true is this statement?
Dr Lim: Cesarean section is a risky procedure and should not be undertaken without much thought of its risks and complications. Cesarean section poses intraoperative complications such as bleeding injuries to the surrounding organs/tissues and fetal injury. During the post-operative period, the risks of wound infection, bleeding, deep vein thrombosis (DVT) and pain are all too familiar to some mother. Besides, children born via cesarean may experience ‘wet lungs’/ respiratory distress syndrome (RDS), especially those below 38 completed gestational weeks. Having said that, vaginal birth is not without its own complications. They include severe perineal tear, fetal injuries and obstructed birth.
That was very interesting! We thank Dr Lim for this enlightening interview, we hope some myths have been dispelled. If you have any doubts or concerns, you can make an appointment with our O & G specialists in Malaysia and Singapore at GetDoc.
by Hridya Anand
A biochemist by education who could never put what she studied to good use, finally found GetDoc as a medium to do what she loved - bring information to people using a forum that is dedicated to all things medical. View all articles by Hridya Anand.