Have You Ever Heard of a Caesarean Scar Defect?

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Hint: A caesarean scar defect does not mean there is an issue with the visible scar on your tummy. It means there is something wrong with how the incision to your uterus healed.

C-section woes

Emergency c-sections are scary, I’m not going to lie. I had one with my second baby due to a prolapsed umbilical cord. He had to be born immediately, and I was put under anaesthesia. It had to happen that fast. I remember being in a lot of pain after he was born, and slowly regaining the ability to do anything one day at a time. For me, it was a lot harder to recover from the c-section than a vaginal delivery. I celebrated success in moving my legs to the side of the bed, leaning over to stand, and finally taking a step to go to the bathroom. Everything seemed to be happening slower than usual.

I left the hospital a day earlier than I had to and started adjusting to life at home with a toddler and a newborn. I went to my postpartum check-ups and everything seemed to be healing just fine. Until I found out that everything was not fine.

My symptoms

About a year after my c-section, I started spotting. I was on birth control at the time, trying to avoid pregnancy during the pandemic while juggling watching my children and working from home. At first, I thought it was breakthrough bleeding or had something to do with the fact that I had just stopped breastfeeding. I thought nothing of it. The spotting disappeared. But then it returned. I started to grow concerned as days went by and the spotting continued. Sometimes it was light and sometimes it was heavy. It would appear in the morning, afternoon, or evening, making it random and unpredictable. And, it was driving me crazy.

It took me three weeks to get the nerve to call my doctor. The spotting was so unpredictable, and it would come and go. I’d have spotting for a few days and tell myself that I would call the doctor the next day. When that day came, the spotting disappeared and I decided not to call. What would I even say? I spent so many nights during that time Googling, Why can’t I stop bleeding? So I just decided to call and say, “I can’t stop bleeding. It’s been three weeks. What’s wrong with me?”

Getting a diagnosis

My doctor arranged for a pelvic ultrasound to start. In the beginning, it seemed like a normal pelvic ultrasound. But halfway through, the technician started peppering me with questions:

  • “How many pregnancies have you had?”
  • “How many babies?”
  • “Did you have a c-section?”
  • “When was your c-section?”
  • “Were both your children born via c-section?”

Then, “Hm. I’ll be right back.”

I waited a long time for the technician to return. And she came back with a doctor, who held his hands behind his back and asked me all the same questions the technician had asked. Then he said that they were seeing blood pooling at my c-section scar, and that might be causing the spotting. He said that my doctor would call me with more information once he’s had a chance to look at the images. I felt like I was getting somewhere!

Finding out about the caesarean scar defect

Based on everything I had Googled in the past 3 weeks, I was almost certain that I had a caesarean scar defect. Out of all the options I had read about, that was the most likely. It was also the rarest option, and one I was hoping wasn’t even a real thing. Luckily, my doctor didn’t wait too long to give me a call with the diagnosis. I hadn’t even reached my front door when my cell phone rang and my doctor gave me the news. Yes, he thought it was a caesarean scar defect. He said they needed more information and imaging, but it was likely that the spotting would stop only if I chose from three options. I could stay on birth control forever, have surgery to repair the defect, or have my uterus removed. He helped me schedule an appointment for a few weeks later to go over my options.

So what is a caesarean scar defect?

When that appointment came, I met the doctor who would eventually be the one to make everything better. But at the time, I was nervous and not excited to be there. We talked about caesarean scar defects, and the conversation with my doctor confirmed what I had researched. A caesarean scar defect happens when the uterine wall does not fully close after it’s sewn up during a c-section.

In most cases, the full thickness of the uterine wall does not close, so the uterine wall is thinner at the site of the scar. This sometimes causes the wall to balloon out and fill with menstrual blood, which causes the blood to drain more slowly out of the uterus — hence, random spotting. A thinner spot in the uterus also signals to the body that the uterus is irritated as it would be during a period. This signal causes the body to think that the uterus is shedding its lining all the time, and signals to the ovaries not to release eggs. It’s nearly impossible to get pregnant with this condition, which means that caesarean scar defects cause secondary infertility.

An unexpected diagnosis

While the spotting was driving me crazy (by the time of this appointment, I had been spotting for about two months), secondary infertility was a sad diagnosis. My husband and I had talked about having more children and now would have been the time. Receiving a secondary infertility diagnosis due to a caesarean scar defect was not what I was expecting or hoping for.

caesarean scar defect
Photo by John Looy on Unsplash

Choosing Surgery to Repair the Caesarean Scar Defect

Out of the three options I was given, I opted to have surgery to repair the defect. Being on birth control forever wasn’t appealing to me, and it wasn’t clear that it would even control the spotting. I was already on birth control and spotting all the time. Having my uterus removed completely seemed too final. I wasn’t ready for that. But surgery to repair the defect wasn’t a sure thing either. Doctors do not know why some women get caesarean scar defects, and there was no way to know for sure that getting stitched up again would mean it would heal like it’s supposed to. But I was willing to take that chance.

My surgery was scheduled 4 months after the spotting presented itself. I was spotting the entire time right up until surgery. When surgery day came, I just hoped and wished that the spotting would someday come to an end.

My surgery lasted 5 hours. It turned out that my defect was a full-thickness defect. That means that I had an actual hole in my uterus. My bladder was holding the hole together.

After my surgery, my doctor told me that he was surprised that I hadn’t been in more pain. The trouble is, with a c-section, I had no idea how much pain was normal and how much pain wasn’t. I was in so much pain after my c-section, and I was adamant about it with my nurses and doctors to the point where I could tell they were annoyed with me. Yet their response to me then was always the same — that this pain was normal, that it would go away.

After my c-section, I was given a blood transfusion. Since I got better with the transfusion and iron pills, the doctors did not look into why I had lost so much blood. At the time, I wondered if they were sure that they had stitched up my uterus, but I thought that the doctors and nurses would think I was crazy for asking.

It’s hard not knowing why I had a caesarean scar defect

For many nights after my surgery, I couldn’t sleep. I would think about why this happened to me. What could I have done to prevent this? Couldn’t my doctors have figured this out before releasing me into the world before I left the hospital after my c-section? Did my stitches open up because I took a walk with my family a week after my c-section? I called my doctor a few weeks after my surgery to get some answers.

He told me that when mothers receive blood transfusions after c-sections, they don’t look into why unless the mother is not improving. Also, it would be hard to detect if there was a problem with the uterine scar in the first few days of recovery. There was also no indication of long-term internal bleeding when he did the surgery. So there would be no way to tell how long the defect existed.

It’s hard to think about what I will never know about what happened to me. But as far as I know, right now, my uterus is stitched up, I’m no longer spotting randomly, and I am cleared to try for another child. My surgery has delayed my ability to try for another child by a year, which would be no big deal if I was a little younger. But at 39, I’m hesitant to try again. I know I’ll need another c-section — and knowing what the recovery for a c-section is like now, it’s something to think through and not rush into.

Have you had a caesarean scar defect? Share your experience in the comments below.

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