International Cesarean Awareness Network

Education, Support, & Advocacy for Birth Justice & Healing

Plastic Surgery After a Cesarean Section

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Jamie Costello is a medical student in the U.K. that is focusing his education on cosmetic and plastic surgery. Mr. Costello has written a piece for us on cesarean scar repair. Some repairs are needed due to poor healing, or poor surgical technique. Others may be due to a need to remove the “cesarean pouch”, or to remove as much of the scar as possible. Thank you, Mr. Costello, for sharing your knowledge of cesarean scar repair with us.

*Disclaimer: The information in this article is not meant to be a recommendation. Consumers should discuss the risks, benefits, and alternatives of all procedures with their healthcare provider in order to make an informed decision.

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Plastic Surgery After a Cesarean Section

For some, pregnancy and childbirth can leave long-term physical effects, such as scarring, weight gain, and if you’ve had a cesarean section, adhesions and excessive skin caused by the surgical procedure.

A common result of having a c-section surgery is gaining a puffy pouch of skin which occurs just below the scar. This is more commonly known as the ‘cesarean pouch’. The procedure of a c-section involves the cutting of skin and subcutaneous skin, which is a layer of fat beneath the skin. There’s also the fascia, which is a fibrous tissue in the abdomen which holds vital organs together. This is the main cause of the cesarean pouch as unlike the skin that’s been cut, the fascia is left to heal naturally. How this heals is dependent on the individual, and in some cases,  women are left without scarring or excessive skin, but this is quite rare.

Exercising and having a good diet will not remove the cesarean pouch. It would require a surgical procedure such as an abdominoplasty or another form of scar removal. There are several forms that scar removal can take such as laser scar removal, dermabrasion and injections. Over time, during your recovery period, there can be reduced bulging of the pouch or find that scarring begins to deteriorate but this is no guarantee. This is because natural fat can be reduced from a good diet and regular exercise but scar tissue isn’t acted upon.

With this being the case, there are several options available that can help to resolve the c-pouch that you have. Which surgical procedure is suitable depends on the cesarean pouch and the nature of the scar. Below is a list of options available:

Abdominoplasty (Tummy Tuck): This is a popular option for many women that go through a c-section. It can help to reduce the fat in the belly and can also remove the scars depending on where the surgery took place in the abdominal region.

Mini-Tummy Tuck: This is similar to a normal tummy tuck except the procedure focuses more on the lower abdominal region. This would be more ideal for patients who came through the procedure without too much excess skin and had already lost weight after the c-section.

Scar Removal: If the c-pouch occurs around where the incision took place, it would be a possible option to simply remove the scar entirely. This will allow the scar to heal or blend the scar around the tissue.

It’s worth noting that during the tummy tuck procedure scarring can also occur. This raises the question of whether it is worth having a tummy tuck considering you’ll still have scarring. The difference between the c-section scar and the abdominoplasty surgery is that the abdominoplasty procedure can remove the excess c-pouch skin. This means the scar will appear less visible compared to the one received from a c-section procedure and the skin around your stomach will appear tighter.

As well as the abdominoplasty surgery having many benefits to your skin it can also have some drawbacks too. One point to consider is your pain threshold, especially soon after the c-section has taken place. With a c-section, there is an intra abdominal component which is cut. In order for the tummy tuck to be successful, this component is required to be tucked/folded that causes tightness in the area. This can lead to discomfort and pain for some depending on their pain threshold, so it’s important to treat pain promptly.

The recovery period from the tummy tuck surgery is also worth pointing out. Considering a c-section has been performed, the area will feel extremely sensitive to any further surgery that’s being conducted, which is likely to encourage further pain and a slower healing rate. You’ll need to make sure that you’re able to take the required time to rest and allow your scars to heal.

Further complications include blood clots, the ability to retain fluids and infections around the uterus and abdominal wall which could be extremely detrimental to health.

Risks of surgery include: Surgical removal of the cesarean pouch is a lengthy procedure that requires several hours to complete, but if you wish to have your cesarean pouch removed, surgery is an option to consider. Weigh out the pros and cons of having plastic surgery and the reasons why you wish to have it performed. It is important to consult with your doctor beforehand to discuss your individual history, needs and expectations.

Author Bio: Jamie Costello is a medical student based at the University of Manchester, United Kingdom. He’s looking to build a portfolio to express his knowledge of the various topics taught in his course, “Burns, Plastic and Reconstructive Surgery”. He’s had previous work experience with a cosmetic surgery Manchester based, which has allowed him to increase his knowledge in surgery topics. In his spare time when he’s not studying, he enjoys cycling and playing several sports including Football.

ICAN’s April Volunteer of the Month!

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ICAN’s April Volunteer of the Month is Nicole Goddard!

Nicole is the Western Regional Coordinator for ICAN.

How long have you been an ICAN member?
 9 years

How did you first find ICAN?
My first birth ended in an unnecessary cesarean, and I suffered from PPD due to the way my birth ended up. I googled all sorts of stuff pertaining to VBACs and support with my depression issues. I found ICAN and got directed to our local Phoenix chapter which at the time was pretty dormant. I didn’t receive anything back for a few months and again lost hope in future dreams for a better birth. Finally I received an email from a gal who was trying to get the chapter started up again. I attended my first meeting shortly after that and remained active in the Phoenix chapter for four years and was the Treasurer for two of those years. I then was asked to help out at a National level and became the Southwest Regional Coordinator, in which I’ve been doing for 6 years now.

What motivates you as a volunteer?
Giving back has always been a big deal for me and to give back to an organization who has done so much for me and so many other families makes me feel very good. I’m motivated by the resilience and strength of others. I’m also motivated by my own personal experiences and the challenges I’ve had to overcome to get to where I am today. Many of us have experienced challenges or moments that have shaped us into who we are today and the work to which we choose to dedicate our lives.

Do you have a profession or any other passions outside of ICAN?
I’m a happy mother to three beautiful kiddo’s. My first baby Ashlee is 8 and she’s my cesarean baby. My second Reagan is 6 and she’s my 1st vbac baby. My third is our little boy Nash who will be 2 in August and he is my 3rd vbac baby. I’ve been happily married to my husband for 10 years. We live in Parker Colorado which is a suburb of Denver.

My other job is at Southwest Airlines as a flight attendant, which I’ve been doing for 17 years. My hubby is also a flight attendant and that is obviously where we met (smile). In my spare time, I enjoy snow skiing, water skiing, hiking, camping and spending time with my family.

What was your proudest moment as an ICAN volunteer? What about your hardest?
I have had countless proud moments as an ICAN volunteer, from helping place a very discouraged mom with the right support in her community to a chat on the phone with a mom who thought she was out of options. I was there once and to know I tried my hardest to make a difference, made me very satisfied and proud.
I truly enjoy helping people get to the place I am today.

 

Thank you for your continued dedication, Nicole! We appreciate everything you do for ICAN, and for the community!

 

ICAN introduces new chapter leader April Henry of ICAN of Central Florida!

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ICAN is excited to announce April Henry as our newest chapter leader! She has completed training and will be leading ICAN of Central Florida!

Tell us about the birth climate in your area.

"People deserve to know the true facts and risks involved relative to other options." ~ April Henry, ICAN of Central Florida
“People deserve to know the true facts and risks involved relative to other options.” ~ April Henry, ICAN of Central Florida
ICAN of Central Florida serves Orange, Seminole, Volusia, and Lake counties. It’s a wonderful natural birth community with many wonderful midwives and doulas. We could use more real hospital VBAC options, more breech and twin birth options, and more hospitals offering family-centered cesarean options.
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Why get involved with ICAN?
I found out about ICAN through a desperate internet search after I ended up with a somewhat surprise planned cesarean with my first daughter who was transverse/footling breech at 41 weeks (only discovered at 40 weeks). I wanted to know the possibilities of having a vaginal birth after a cesarean because the cesarean was very difficult for me physically but also emotionally mostly due to hospital policies and logistics that made it a more difficult experience.  ICAN is 100% volunteer and is making a big difference in communities all across the country and internationally. I’m passionate about birth and evidence-based medicine and I enjoy supporting women and research.
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Please share a little about yourself!
My friends would describe me as honest, loyal, analytical, and deeply caring. My first child was a planned C-section for persistent breech in 2007. My second child was a somewhat long HBAC in 2010, and my third surprise baby was a nice HBAC in 2016. I work part time as an HR professional for a nonprofit Wycliffe Bible Translators. I have bachelor’s degrees in economics and international business and am also certified as a senior HR professional.
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Congrats, April!
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Samantha Wall is ICAN’s Volunteer of the Month!

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The International Cesarean Awareness Network is powered by the selfless efforts of our numerous volunteers. We cannot thank our dedicated volunteers enough for their cooperation and service in assisting ICAN with accomplishing its mission. In an effort to acknowledge some of our amazing volunteers who work tirelessly behind the scenes to offer support, education, and advocacy for the mothers in their area, the International Cesarean Awareness Network is pleased to announce Samantha Wall as the June 2017 Volunteer of the Month. Samantha is a dedicated volunteer out of ICAN of Omaha who’s been with ICAN for two years. We appreciate the work she does!

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samantha-wall-june-2017
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How did you first find ICAN?
I was reading a blog post from ‘Birth Without Fear’ and they mentioned ICAN. I immediately looked it up and knew it was something I wanted to be a part of!
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What motivates you as a volunteer?
Hearing about our members having empowered births, no matter the mode of delivery.
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Do you have a profession or any other passions outside of ICAN?
I work full-time as a Research Technologist in a Flow Cytometry Research Facility and I will be pursuing my Masters in Public Health in the next year. I am also obsessed with cloth diapers!
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What was your proudest moment as an ICAN volunteer? What about your hardest?
The hardest moments for me are meeting first-time moms and struggling to get through to them just how important the issues of ICAN are. Unfortunately, for some women, it never sets in until they live it, which I can find very discouraging. My proudest moment was the first time I had two different businesses contact me independently in the same week to discuss collaborating on cesarean/VBAC events. This was the moment I realized our contributions to the cesarean community were reaching beyond just our Facebook group, our efforts were stemming into our birth community as a whole.
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Thank you for all you do, Samantha!

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Is your care provider VBAC-friendly? Here’s how to tell.

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is-your-care-provider-vbac-friendlyWith the rate of cesarean births in the United States holding at a little over one in three, many women face an important decision when having subsequent children: plan a vaginal birth after cesarean (VBAC) or schedule a repeat C-section? Since 2010, the guidelines issued by the American Congress of Ob/Gyns (ACOG) assert that a VBAC is “a safe and appropriate choice for most women who have had a prior cesarean birth, including for some women who have had two previous cesareans.”* So not surprisingly, more and more women are choosing VBAC.

Even with these guidelines in place, many mothers unfortunately still find themselves in an uphill battle to find a care provider who truly supports VBAC. A care provider who says that he or she supports VBAC birth but puts strict limits on the labor and birth process may be “VBAC tolerant” but not exactly “VBAC friendly.” So how can a mother know if her care provider is truly VBAC-friendly? Here are three important questions to ask:

What is that care provider’s track record?

One of the most telling factors in determining whether your care provider is truly VBAC friendly, rather than someone who just pays lip service to the idea without any real plans of follow through, is to look at VBAC success rates for both the provider as well as the location(s) where he or she attends births. How many successful VBACs has the provider attended? How does that rate compare to his or her repeat cesarean rate? These are important questions to know and important questions for your care provider to address. It should be a major red flag if a care provider bristles at these questions or dismisses such questions as irrelevant.

What “requirements” does he or she have for a VBAC candidate?

There are several factors that are encouraging to both mothers and providers because they increase the chance of VBAC success. These are:

  • Spontaneous onset of labor, but not necessarily by 40 weeks
  • Carefully considered use of intervention to speed or strengthen labor
  • The reason for a prior cesarean is unlikely to be repeated (such as a baby in the breech position)
  • A supportive and patient care provider
  • Giving birth in a setting that routinely supports VBACs
  • Having had previous vaginal deliveries, either before or after cesarean birth

However, a VBAC, as in any birth, should be treated as its own experience with its own unique characteristics. VBAC success can be achieved without needing to pass a “checklist” of requirements. Even in this list, there are considerable gray areas.  For example, while spontaneous onset of labor contributes to VBAC success, a provider who “requires” that a mother go into labor before 40 weeks is not truly VBAC-friendly. Another example would be under the criteria of how likely a reason for the prior cesarean is to be repeated, such as a mother whose prior cesarean was for suspected cephalopelvic disproportion, or CPD (when the mother’s pelvis is too small to allow for the baby to pass through). A provider who determines early in pregnancy that such a scenario is likely to be repeated is also raising a red flag. Actual cases of CPD are exceedingly rare, yet CPD is often cited as the cause for a cesarean, deemed “failure to progress.”**

What about the other care providers in the practice?

If a care provider shares the responsibility of attending births with others in his or her practice – and there is a chance that one of the other providers may attend your birth – it’s important to consider their track records and stances, as well. It doesn’t do much good if your provider truly supports VBAC but the others, who are just as likely to attend your birth, do not.

Nothing in life is without risk. Surgical birth and VBAC both involve certain risks, and a VBAC-friendly care provider will counsel a mother on the potential benefits and risks of both options. These risks will vary greatly between individuals. So when considering a VBAC, it’s important to find a provider who will look at each mother as an individual and work with her to determine what will be best for both the mother and her baby. The chances of a successful VBAC birth increase greatly with a care provider who is truly supportive.

*“Ob/Gyns Issue Less Restrictive VBAC Guidelines.” ACOG

**“Cephalopelvic Disproportion.” American Pregnancy Association

Reblogged with permission from www.PlumtreeBaby.com. By Jennifer Stutzman, Freelance Writer.