The Women's Health Podcast with Kim and Dr. C
The Women's Health Podcast with Kim and Dr. C
Part 2 - C-Section Risks: The Long-Term Complications Nobody Warns You About
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You survived your C-section. You healed. You moved on.
But what if the back pain that showed up years later is connected to it? What if the pelvic floor issues you're dealing with now started in that operating room? What if nobody ever told you, because the system never linked it either?
In Part 2 of this conversation, Dr. Leroy Campbell (Dr. C) and co-host Kimberly Hoffman Reid go beyond the surgery itself and into the long-term complications that most women are never warned about and never get the rehabilitation they need to prevent.
This is the conversation that happens years too late for too many women. We're having it now.
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🎙️ IN THIS EPISODE
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00:00 — Welcome back: picking up where we left off
01:00 — Low risk does NOT mean no risk, why Dr. C says this every time
02:30 — Bleeding, blood clots, and organ injury risks during C-section surgery
05:00 — Nerve damage after C-section, why some women can't wear jeans years later
07:30 — Baby risks: respiratory distress, NICU admissions, and the microbiome
09:30 — The long-term complication nobody talks about: back pain and core dysfunction
12:30 — Why C-sections do NOT prevent pelvic floor dysfunction
15:00 — The physiotherapy gap, 42 days average wait, and that's in countries where it's offered
17:30 — Scar tissue: healed and functioning are not the same thing
19:00 — Pain avoidance is not a reason to choose a C-section, here's why
20:00 — So is a C-section safer? The honest answer: it depends
21:00 — Final thoughts and wrap up
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📌 KEY TAKEAWAYS
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✔ Low risk does NOT mean no risk, a C-section is major abdominal surgery, every single time
✔ Nerve damage from a C-section can last years, numbness, shooting pains, and sensitivity are all common and rarely discussed
✔ Your C-section does not protect your pelvic floor, the baby rested on it for nine months regardless
✔ Back pain years after a C-section is often linked to core dysfunction, not coincidence
✔ The average woman waits 42 days for pelvic floor physiotherapy after a C-section and in most countries, she never gets it at all
✔ Healed and functioning are two very different things
✔ The right birth decision is the one made with full information, not fear, not culture, not pressure
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🔗 CONNECT WITH US
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Follow us on Instagram: @drcwomenshealthdoc
Listen on Spotify & Apple Podcasts: Women's Health Podcast with Kim and Dr. C
👉 Missed Part 1? Watch it here: https://youtu.be/OtNE1tzpwBc?si=SdWbKPY57WR1hmG5
#WomensHealth #CSection #CesareanSection #MaternalHealth #PelvicFloor #PostpartumRecovery #CaribbeanWomen #WomensHealthPodcast #CaymanIslands #PregnancyEducation #CoreHealth #PostpartumPhysio #WomenDeserveBetter
Follow Dr C on Instagram @drc_thewomenshealthdoc.
Follow Kim on Instagram @thewomenshealthphysio
Also check out Beyond the diagnosis with Kim and Dr C. Mondays at 8pm on Nationwide90fm (Youtube)
Hey, welcome back, guys, to the Women's Health Podcast. Kim and Dr. C. Dr. C here. Kim, when before we went out on break, where were we? We were talking about the benefits, potential advantages, isn't it?
SPEAKER_01Right.
SPEAKER_00Of cesarean delivery, right?
SPEAKER_01Mm-hmm. So we're going to get into the complications of caesarean sections or risk associated with caesarean sections.
SPEAKER_00Yeah, so we probably prefer to use the word risks because not every risk is a complication. There's something inherent to that. So the first thing is to understand that this is a major abdominal surgery.
SPEAKER_01Eight layers deep. Let's start there.
SPEAKER_00We trivialize it. You know, so like I tell patients that, you know, we talk about cesium section, and the risk of major complications is relatively low. But low risk does not mean no risk.
SPEAKER_01Thank you.
SPEAKER_00You see? So which one you mean low risk?
SPEAKER_01Just put it on a shirt.
SPEAKER_00Should, right? So low risk does not mean no risk. Okay. So every time you know I go into a surgery, I know that there is a potential of complications. No matter how many times you know you do surgery, there is always the risk of complications. And it's a major abdominal surgery. So for example, once you make an incision, it's going to bleed, right? It's not a question of is there going to be bleeding, it's a question of how much.
SPEAKER_01Right.
SPEAKER_00So the right, so the one of the most important things is the risk of bleeding. And most times it's not enough to compromise the woman's health, but you can have significant hemorrhage from a cesarean section, and certainly the risk of postpartum hemorrhage is higher with cesarean sections than it is with vagina dilemma. And then you understand the fact that even though we're operating in a specific space and we're removing the baby through an incision in the uterus, the bladder is right in front of the uterus, especially if we're doing a low segment caesarean section, which is the most common. The tubes that carry urine from the kidney to the bladder on either side are right lateral or right, you know, not far from where we make our incisions. The bowel is behind the uterus and above the uterus. So there is a risk of all of these structures being injured. And even though the baby, you know, we said that it tends to be safer for the baby in terms of trauma, baby can be injured. Um, there have been cases where incision is being made in the uterus and the baby gets cut.
SPEAKER_01Yeah, you know, I've thought about that of like, can't just accidentally cut the baby well, make it an incision. I've got that.
SPEAKER_00It happens. It happens really, it happens fairly um not frequently, but it can happen. You know, I can't remember exactly what the quoted risk is, but we're looking at somewhere it's under one under one percent, but it's still significant. Most times, however, it's not anything major, but it can happen. So you do have the risk of injury to the baby from the in the scalpel, or even while we're extracting the baby can be injured. So even though the risk is lower, it's still there. Uh, and then you talk about issues even after surgery. So infections came. Risk of infections is greater. You have a bigger incision there, you have the risk of blood clots, which is greater. So, so blood clots, when we talk about blood clots, we're not talking about clotted blood, we're talking about like um deeping thrombosis, put no embolism where blood where you have clocks in the circulation. Right. And that risk is high with cesarean sections, partly because of the surgery, but also after what happens afterwards, because you're not moving around as much, right? Remember, we said that you know you said that after delivery, you can get up and you can walk around. It takes a little while. You know, most women have to c-section by the following day, we expect them out of bed. But while you're doing the C-section, you're laying down on a table, not moving, you know, and then afterwards, especially if you got spinal, and so it's gonna take a while for you to regain function. So you're actually laying down for a longer time, right? Right. And so the risk of clots is higher. Although there are things that we can do to mitigate those risks, which we'll talk about. So there are risks, there are risks, there those are you know some of the risks that we'll speak of, which are complications, but then you have non-complicated risks. So, for example, we know that it's a faster, it takes a longer time to recover. We understand that they're you know, during that period of time, even though when your tummy is healed, heal and feeling and function are two different things, right? Two different things. So you know that. So you injure a muscle, even when the muscle is healed, it doesn't behave the same way.
SPEAKER_01Right.
SPEAKER_00You may have stiffness, you're gonna have soreness. You know, it's gonna take a while to get back to where you were before.
SPEAKER_01Sensitivity issues, right? You know, one of the biggest complaints I get from C-section women, it's that they can't wear jeans pants after, like the sensation of having jeans against their tummy, it's they can't manage it at all.
SPEAKER_00That's interesting.
SPEAKER_01That's one of the biggest complaints.
SPEAKER_00That's interesting, and it makes sense because you know, after you've had an incision in the you know, any kind of major incision, when we cut through the skin, we cut through the fat, we cut through the muscles. We don't real, you know, we realize, but patients don't realize that they cut through the nerves as well because they're the nerve endings are running in the skin.
SPEAKER_01Right, right.
SPEAKER_00So what happens is you have a situation where when and the tissues heal, you know, but nerve tissues heal, nerve fibers heal very slowly. Right, very that's why when somebody has spinal injuries, a lot of times they become paralyzed because yeah, it doesn't hit nerve tissue, it's the slowest to heal of all our body tissues, you know, like two millimeters per week or something like that. I don't remember how much, but it's a slow, it's very slow. Slow. And so sometimes even years after a cesarean section, you may have numbness in and around the site of the surgery, you may have some occasional discomfort, some people may experience some equation or shooting pains in the area. So you're right, and I can imagine if you're having something like you know, genes that's coarse rubbing on the area, it might be a little bit annoying, a little irritating.
SPEAKER_01Yeah.
SPEAKER_00Interesting. Yeah and the risk related to the for the baby as well. We mentioned before about the fact that respiratory distress tends to be a little bit more common in babies born by cesium section, especially if the cesium section occurs before 39 weeks. And um, and so therefore there's a higher rate of neonatal nursery care unit admissions.
SPEAKER_01Right.
SPEAKER_00And then, of course, we spoke about the microbiome in the previous episode.
SPEAKER_01So, yeah, they have quite a few risks, as well as you have quite a few positives as well. But you know what I want to talk about that's often not spoken about is long-term complications. Like, what are the long-term implications? Well, I guess I can speak on that, the long-term implications of your muscles in your tummy not functioning properly. What are the long-term implications of that? So, some of the long-term implications of that are like severe back pain because you don't have your abdominal muscles, you don't have your abdominal muscles functioning in the capacity that it needs to be functioning to help support your core. So then you now have more pressure on your back. So severe back pain that can sometimes lead to surgery, it's one of it's a very high complications for c-section, actually. And because we don't have persons after C-section getting rehab, that education has never passed on. It's in a lot of cases, it's not even linked. It's now when we have pelvic fluorophysiotherapies, we're seeing all these patients years after C-section and doing studies that we're even making that link that a lot of these women is coming from the C-section that they did previously. Then when we see them with the dysfunction with the pelvic floor and they're like, oh, but I had a C-section, why am I having pelvic floor dysfunction? Because the baby still was resting on your pelvic floor for nine months. It does not eliminate damage to the pelvic floor at all. Yes, it does minimize some of the complications because you can push the baby through the pelvic floor, but the baby was still resting. The baby was resting on the pelvis for as much as nine months in most instances. So that can cause some amount of complication as well. Couple that with the fact that a lot of these women after C-section, their abdominal muscles are not working the same. So basically, your core, it would consist of the anterior part would be your abdominal muscles, the posterior part would be your back muscles, and then the lower part would be your pelvic floor. So if you have two out of those three sections not working effectively for years, you can see you have weak muscles of pelvic floor compensating, you have weak pelvic floor, weak abdominal muscles, so back compensating for years, you can see where that will become a problem later on, right? And these can lead to other things like prolapse. So that's when the organs like falling through the pelvic floor. So the thing is, when you're thinking now in your 30s or your 20s about making a decision about c-section, you're not thinking about 60-year-old you. And that's why we're having this conversation so that you can think about all the things. So when you're making a decision, a c-section might still be the best option for you, even if it's not medical. Even if you just believe that this is a safe option and want to go with that, that can that is completely fine. But now you'll know that if I choose a C-section, later on there might be risks and complications if I don't receive proper rehab. Um, and if in most instances women who are making decisions, they're usually in countries where they pay for C-sections, they usually have more money. So they have access to better care. That's just unfortunately how the world works. So they can seek out these cares for themselves so that they don't end up with these issues. And then for women who they don't have a choice but to do a c-section, they will know that okay, I can still choose this choice and I can still be okay. They don't have to have the fear that, oh my gosh, keep my doctor C said there's so much complications from C-section and now I don't want to do it. No, you can still have your C-section and you can still know the options that are available to you to mitigate these risks. Because risks don't mean that these things are going to happen to you if you have the information you can take the preventative actions to not let these things happen. But we can't do that without education, and that's why we're here, right, Dr. C?
SPEAKER_00I think so. Absolutely, absolutely, Kim. And I I love that. There are three things I probably want to pick up from what you're saying. The first place I'd probably start is at the end, because you're pointing out the fact that ultimately it's not about whether or not you have a C-section or vagina delivery, it's about making the best decision for you. Right. And for your baby at the time. It's understanding that you know a well-performed C-section is not a failure, and vaginal delivery is not in any way superior to someone having a Cesuran section. The goal is really identifying what's the right birth plan, what's the right birth strategy for the right patient and having the right indication for making that decision. Because regardless of the decision you make, there are going to be advantages and there are going to be disadvantages. You know, and so it's very important to grasp that. And what we're really trying to do is to empower you with the information to help you to understand the pros and the cons and also make the decisions that would be in your best interest, of course, under with the guidance and support of your caregiver, right? You know, your obstetrician, your midwife, etc. Um, the other point I wanted to piggyback on was the first point you made about the back pain issue. Back pain is a very, very interesting phenomenon because there are so many factors that can cause back pain. And you know, you're mentioning about the effects of having, you know, the abdominal wall dysfunction, abdominal wall issues which can then lead to back pain. Because as you and I have spoken on many times before we came to the body, it's all connected. You know, we we make this assumption that, oh, there's a problem here in my belly, it's not nothing to do with my back. Or we don't realize that there's a connection between our organ systems. If there's abdominal dysfunction, it's going to lead to pelvic floor, it's going to lead to back pain. I've had, and I want to ask you how many times you've seen this, because I've had patients who will say to me, Doc, they don't want to do a spinal because they're told that doing a spinal causes back problems. Spinal meaning spinal anesthesia.
SPEAKER_01Yeah, yeah.
SPEAKER_00Which is the most common form of anesthesia used for caesarean sections. So the question now is, you know, and it's and there's no evidence to indicate that being spinal anesthesia causes back pain.
SPEAKER_01Right.
SPEAKER_00But could it be that the back pain is really a function of the a result of the muscular dysfunction?
SPEAKER_01Yeah.
SPEAKER_00That arises from and then the and then you're added, they really are making association with the spinal anesthesia, not necessarily with the cysturian section, or what do you think?
SPEAKER_01I would lean more to it being because of the abdominal dysfunction, or we call it functional core dysfunction. I would lean more to that than it being because of the spinal directly. And I've had women say that too. And I don't dismiss it because right now we don't have the data, but years down the line, we might have data that supports this. So I don't dismiss it. But working on even for women who they come in and say that's the reason, working on core strength, working on the pelvic floor does seem to cause some relief. So I would still lean more towards thinking that's the reason versus the actual injection.
SPEAKER_00Yeah, that's interesting, you know, and it's very important. So, what really and truly, what we really need to be talking about is what we've been saying all along that women who had cesium sections are needed physiotherapy early so that they can we can mitigate against muscular dysfunction.
SPEAKER_01Absolutely. The average time a woman gets pelvic for physiotherapy after the C-section is 42 days.
SPEAKER_00That's over and that's in countries where that's provided, Kim. And that's because in most countries around the world, women are not provided with physiotherapy.
SPEAKER_01In Jamaica, I was not seeing women until like Years later we have problems.
SPEAKER_00That's true for most countries. I would submit to you, especially developing countries. That's true. That physiotherapy is not a part of the management at all.
SPEAKER_01At all.
SPEAKER_00You know, until problems develop.
SPEAKER_01To be fair, in the Jamaican public system, I did see probably three or four women while still on the ward, just delivery. But that's rare. That's rare. And now I'm in a I'm in a first world country, and I've seen probably five in a year.
SPEAKER_00Whoa so it's not not a bigger difference anyway.
SPEAKER_01No, it's not, but that's in hospital, so I don't know what's happening once they leave, but that's in hospital. So and it's usually because, and the only reason they call physio is because they need the bed. They don't call you because oh, women should get physio getting home faster. It's like this mom had her baby three days ago and she's not walking. Now we're calling physio.
SPEAKER_00We need to get you, we need to get you mobilized so we can get you home.
SPEAKER_01Yeah.
SPEAKER_00I mean, which is good, but we want to do a little bit better than that.
SPEAKER_01We need to do a little bit better than that. Yeah.
SPEAKER_00The third thing that that because we're gonna have to wrap up soon. So the third thing that you had mentioned, which I wanted to just highlight on, is the fact that cesare insection does not prevent pelvic fluoride dysfunction. You know, because one of the things that drove certainly back in the early 2000s, this move towards women selecting to do elective cesarean sections was the idea that they could reduce the risk of pelvic organ prolapse and reduce the risk of ish continence issues down the road by doing a cessere and section. And there are aspects of it that may reduce the risk of certain things because, as we mentioned before, you're not gonna have the tears and so forth. But it doesn't eliminate, it's very important for me to understand, it doesn't eliminate the possibility of having pelvic flow dysfunction because as Kim just said, there is still that effect of the pregnancy in and of itself that affects how the pelvic floor works. You have a you're carrying this weight on your pelvic floor for the entire for nine months. Nine months, yeah. Pelvic floor literally holding up everything, the compressive effects do have a long-term impact. So, very important that you made that point, Kim.
SPEAKER_01And then we want to also point out the scar tissues, the scar tissues from the incision, as well as the impact implication on the abdominal muscles. So to Yeah.
SPEAKER_00For C sections you're referring to. Yeah, scar tissue. I said that you know, I said this to patients all the time. Healing doesn't mean function. So a lot of the times we'll say, okay, six to eight weeks, you know, you'll be well healed up on the inside, you can start doing everything you'd normally do before. But that's not always true because when you start to doing what you normally do, you're gonna find that you can't do it the same way. Yeah, and you may have some soreness, you may have some, you may, you know, because stiffness, because there's carotid that needs to be broken down and needs to be mobilized, and it takes time for your body to do that, especially without physiotherapy.
SPEAKER_01And it changes how you move, and once you change your movement pattern, then you have the risk of pain and complications elsewhere. Yeah. So these are things that you also need to consider, and not in a way like no, I'm not gonna do it because of this, but in a way of, oh, because this can happen, I can now seek that help out.
SPEAKER_00Absolutely. You're empowered, you know, you know how to prepare, you know how to plan. Yeah, one of the last things I'll do before we wrap up is in reference to the young lady who wrote in um that started this conversation, and thanks to her once again because that was you know, sharing her stories, really, um, really giving us the opportunity to talk about this issue. But one of the things that she mentioned was that her mother was saying if she's running from pain in choosing to do a cesarean section, is that you're afraid of some pain. You know, the vaginal delivery is a lot different in the 21st century than it used to be. I mean, we have very effective means of managing pain during labor. So avoidance of pain should not be a reason in this day and age to decide to do a C-section because we have very effective pain. And another time we can do a show where we talk about pain management during labor kim.
SPEAKER_01Yeah, yeah, we can do that.
SPEAKER_00Um, but there are options there that you can literally labor most of your labor without pain at all in this day and age. So it should not be a reason. And you also have to remember that with a cesarean section, you may not have pain during labor, you may not have pain during surgery, but you have pain afterwards. We are gonna have pain afterwards, and then you're gonna have pain during your recovery. So let it not be that that's just the only reason, yeah.
SPEAKER_01Yeah, and to answer the final question isn't a C-section safer? It depends.
SPEAKER_00It depends.
SPEAKER_01That is the truth.
SPEAKER_00Absolutely. We can answer, yes. I love that. The answer is it depends.
SPEAKER_01It depends, and it's this is not just A versus B. This is medical options for delivering a baby. There are treatment options, and treatment options are based on the individual's condition. That is it, not your culture. You can't have dead people bullying you into choosing an option because for centuries they've been choosing this option, and you can't just run away from an option just because it seems scary without the facts, without the information, without what's available to you. So if pain is the fair, then we talk about pain mitigations. You might still not choose, and you might still choose a C-section, but at least you would have done so with knowing the facts. That's all we ask. And yeah, that's it.
SPEAKER_00Well, it was great, Kim. I lend I enjoyed that show. I enjoyed that discussion. So we're gonna provide some information for you guys. We're probably gonna put something in the link below, some probably a handout or something that you can rebound to to get an idea of some of the points that we have discussed here. But thank you so much for tuning in. And we wanna wish you all the best. Until next time, stay happy, stay healthy. Goodbye from Locke C and from the King Black.