How long should I wait before conceiving after CS?

Dear Dr Murage,

I had a baby 4 months ago via caesarean Section but he died a day later. I am desperate for another baby but I have been given conflicting advice about how long I should wait before conceiving again. Please advise me.

Karen

Dear Karen,

I am really sorry to hear about the loss of your newborn shortly after birth. I hope you have found a way of coping, and are on your way to some sort of recovery. It is not unusual to crave for another pregnancy immediately after the loss of a wanted baby.

You are right about seeking advice on how long to wait prior to conceiving following a Caesarean Section (CS). Many factors need to be considered. Why did you require a caeserean delivery?

Were there any complications during the CS, or even during the recovery period? Consideration should also be given to potential factors that may have contributed to the baby’s death. Your prevailing health should also be taken into account, informing on the ideal birth spacing for you as an individual.

Following an uncomplicated CS, you are well into full recovery within months. Your capacity to conceive returns as soon as your monthly periods resume. There have been concerns though about the integrity of the uterine CS scar, especially if conception occurs within a very short interval.

But there are reassuring observations showing that the uterine scar heals pretty quickly in uncomplicated caesarean deliveries. Your scar may be as good as it will ever be within 6 months.

As four months have already elapsed, and if all goes well in other respects, you could consider taking preparatory steps to prepare for another pregnancy.

Arrange to see your Gynecologist for a pre-pregnancy assessment. A detailed review of what transpired before will need to be done.

It may be that you might require some additional precautions to optimise outcomes for the subsequent pregnancy. This is on top of routine recommendations like taking folic acid supplements well before conception.

Once you have agreed on an individualised plan with your gynecologist, go ahead and conceive. Remember to start your antenatal clinic within the first 12 weeks.

The frequency of your antenatal visits will be defined by how the pregnancy progresses, in attempts to negate any potential complications.

Towards the end of the pregnancy, you should discuss with your obstetrician about how to deliver this time round. You may be suitable for a trial of vaginal delivery. But there may also be reasons to mandate delivery via Caesarean yet again.

Don’t allow others to set arbitrary limits as to how long you should wait without some scientific justification. You will hear many unsubstantiated myths about what not to do after a Caesarean delivery. You can ignore such advice, most of it has no merit.

Dr Alfred Murage is a consultant obstetrician and gynaecologist