Q: I had a caesarean 2 months ago and the scar isn’t healing well. Is there anything I can do to help it heal and make it less noticeable?
A: My advice depends on whether your scar is really not healing or if it’s healed but is very prominent. If there is continued oozing of blood or any liquid from the scar, or any continued scabbing, or gaping of the skin, then it hasn’t healed and you need to see your GP quickly. These symptoms are likely to be due to infection, and your scar is also likely to be sore and possibly hot to the touch. You may also feel unwell in yourself.
Your skin should have healed enough for scabbing or discharge to go within a couple of weeks of your operation. For several weeks after this, it may carry on looking red and puffy. However, in time, the scar will fade and become less obvious. You’re also likely to find that the skin around the scar is numb, because tiny nerves in the skin have to be cut in the operation. This too should improve, although it will take several months.
Some studies suggest that using creams containing vitamin E, or including plenty of vitamin E in your diet (sources include nuts, vegetable oils, eggs, and green vegetables) can help with healing. However, you need to be aware that for some people, such creams can also cause skin irritation or allergy which can actually delay healing.
Finally, be patient. Almost all caesarean section scars these days are below your bikini line that means once your hair has grown back properly, it should be almost invisible.
Q: When should I expect my baby’s head to engage and is this a sign that labour is on its way?
A: Pregnant women seem to get preoccupied over this question. When you baby’s head engages, it means he has moved down through your pelvis so that the widest part of his head has passed through the narrowest part of your pelvis.
In a first pregnancy, this usually happens some time in the last 4 weeks, while in later pregnancies it’s not uncommon for your baby’s head not to engage until you’re actually in labour. Don’t worry either way. I’m afraid it’s not a sign that labour is on the way – although in your first pregnancy, it does increase the chances that you’ll be able to have a normal vaginal delivery, since you know that your pelvis is big enough for the baby’s head. However, many women go on to have a normal vaginal delivery even without engagement before they go into labour.
Q: People keep talking about ‘a show’ as an indication that labour is on its way. Can you tell me what this is? How long before labour starts does it occur, and does everyone have one?
A: No, you’re not up for a pair of West End tickets! A ‘show’ is a blood-tinged discharge from your vagina. It’s usually a mixture of mucus and blood, but it’s different from the mucus ‘plug’. This is a clear gelatinous blob which can (but doesn’t always) come out of your vagina any time up to 3 weeks before you go into labour. A show on the other hand, is a pink or brownish sticky discharge – most, but not all, women have one just before labour.
The show is a sign that your cervix is starting to flatten out and dilate in preparation for letting the baby through. Once you’ve had one, you’re likely to be in full labour, with regular contractions, within 24 – 48 hours. However, you can go into labour as little as an hour or as much as 4 or 5 days after you get your show.
Remember, this pink or brownish discharge is nothing to worry about. If your discharge is bright red, on the other hand, it can suggest a complication, such as separation of the placenta from the wall of the womb – so contact the hospital immediately if this is the case.
Q: It’s my first pregnancy and I’m really scared about labour. I asked my midwife about a home birth, but she said it was safer to have my first baby in hospital – and that it was normal to have students present. Is this true?
A: It’s completely natural to feel nervous about your first delivery. Fear of the unknown lies at the root of this natural anxiety – which is why it’s essential that you do everything you can to feel in control. For instance, you should be able to visit the labour ward before you go into labour and you’ll be invited to antenatal appointments and classes, which are great places to ask questions. I’d also encourage you to write a birth plan. If you feel very strongly that you don’t want any student midwives present, you have the right to refuse to have them there. It is just worth pointing out though, that having enough competent midwives to deliver hundreds of thousands of babies born in this country every year depends on each of them getting enough experience as students – so it would be a disaster if everyone said no! You’ll usually be assigned a single midwife who will provide most of your care during labour – and if she has to go off duty at the end of her shift, you should be assigned another named midwife so you get as much continuity as possible. As for home births, they aren’t necessarily more unsafe than hospital deliveries, particularly if you’re in a group that is at low risk of complications during labour. Unfortunately, one of the most important factors to work out if you belong to a low risk group is having an uncomplicated delivery before. So in your case, I’d suggest that your midwife is probably right and it would be safer to have your delivery in hospital.
Q: Is there a sure-fire way of bringing on labour? I’ve heard lots of stories about raspberry-leaf tea, bumpy car journeys and lots else, but I’d really like to be able to plan the timing of my labour, so want the most reliable method.
A: I wish! Its funny how much more common this question is than it used to be. I suspect that’s because most women are sp busy, and used to being in control of all areas of life.
The theory of raspberry-leaf tea is that it’s supposed to co-ordinate the contractions of your uterus. Unfortunately, there is little evidence that it works. The same goes for bumpy car rides, vindaloo and most of the other myths. The only one which might possible hold some water (pardon the pun!) is sex. We don’t know whether it’s prostaglandin in the semen (prostaglandin is the hormone used to ‘ripen’ your cervix if you’re having labour induced) or oxytocin produced when you orgasm (oxytocin is used to speed up labour), or something else altogether. Anyway, it’s worth a try – but don’t hold your breath. Babies have a habit of coming out when they’re good and ready!
Q: What are the risks to my baby if I have an epidural or pethidine? I’m not sure I’ll be able to cope without pain relief but I wonder why so many women aim for a ‘natural birth’?
A: The aim of a natural birth is just that – an aim, because we don’t know what kind of labour we are going to get. Women who want a drug-free approach do feel confident about their ability to birth and believe their mind and body are designed to cope with what is ahead. Pethidine, if given too close to delivery, can affect the baby’s breathing, leaving him feeling groggy, which makes feeding tricky. Epidurals can lower the mum’s blood pressure which could cause the baby some distress. An epidural also raises the chance of needing a ventouse or forceps delivery.
However, you must make the birth choices that feel most comfortable for you. If you try other safer pain relief methods such as a TENS machine and gas and air, you’ve at lease given yourself a chance to find out whether the natural approach is all you need.