Ugly Caesarean Scar

Dear Dr. Jason,

您好。我是YL.

我在去年十二月剖腹后至现在已差不多六个月了。外表伤口从起初密得蛮漂亮，但这两个月伤口处就凸出小小的小肉块。我听别人说这肉会随着时间越长越多。请问这消息是真的吗？我需要回去你哪儿再复诊吗？ 您的回复我感激不尽。


谢谢


-------------------------------------------------------------


One of the common problems faced by the patients with caesarean delivery is scar keloid formation.

Keloid is referred to the thickening of the surgical scar and formation of a layer of thick tissue on top of the scar.

Because of keloid, the surgical scar looks very prominent and ugly.

Thickened and ugly caesarean scar due to keloid

Not all the patients develop keloid after the surgery.

Your body genetic composition is the main factor in developing this problem. You are inherited with the gene that promote keloid formation.

Many patients mistakenly blame the doctors for poor surgical skills, but in fact the problem is primarily caused by your skin condition.

A better surgical scar with less keloid




A good skin healing without keloid

For my past 13 years of practice as a doctor in Malaysia, I noticed that the Indian patients generally recovered better with less keloid problem.

Malay and Chinese patients tend to face more keloid problem after the caesarean delivery.

Typically, the keloid will appear after 3 months of the surgery and it will progressively worsen until about 1 year after the surgery.

Luckily, many of them the keloid will slowly disappear and become less prominent after 2 to 3 years.

There are many preventive steps you can take to prevent this problem :

1) Avoid unneccessary ceasarean delivery if you know that keloid is a family inheritance problem within your family, or your past surgical experience which left a prominent keloid.

2) Apply tight compression to the surgical wound 1 month after the surgery. Wearing a tight body bandage or tight underwear to compress the scar may prevent the keloid.

3) DON"T scratch the scar eventhough you feel itchy. The more you scratch, the worse it becomes.

4) Applying silicone gel or steroid scream to top of the scar 1 month after the surgery may reduce the severity.

5) Steroid injection into the scar after 1 month of the surgery may prevent and treat this problem. Monthly steroid injection into the scar will make the keloid slowly disappear.

Steroid injection into the keloid scar

6) Laser treatment is also effective and useful in this situation.

Bad Experience in The Confinement Centre

Anonymous said:

Good Day Doctor

i agree with u based on my own experience.during my 1st pregnancy,due to both of our parents are not able to take care of me n baby during my confinement, my husband and i hv decided to stay at confinement centre after delivery of the baby. i agreed to do so because is convenience to everyone.

finally,is time for my delivery.after discharge, i was sent to centre. i started feel sad as i was away from my husband. i can't control myself and keep crying when i m alone.i discussed with my husband and luckily we managed to employ a confinement lady who is my mum in law's friend in short notice. i was sent back to my own house after staying at centre for few days and my deposit are forfeited.

i feel so lucky that i hv make a right decision during that moment eventhough i hv lost some money.if not i will suffer with depression and no one will know what is the impact....

i m jz sharing my experience. different ppl will hv different opinion on this new trend. anyway home care will be my only choice in my next pregnancy.

--------------------------------------------------------------------------

Hi, Anonymous,

Thank you for sharing your bad experience with all the readers.

I usually advise my patients to think twice before making the decision to stay in the confinement home.

I have seen many bad experiences from my patients who stayed in the confinement centre.

For Examples :

1) About 2 years ago, one of my patient successfully delivered a baby boy and after being discharged from the hospital, she was transferred to a confinement centre nearby my hospital. After staying there for 2 days, she noticed that the baby's head was swollen. The baby was crying persistently and refused breast milk.

She felt something went wrong and the baby was brought back to the hospital for further examination. After the X ray examination, we found that the baby had a fracture in the skull.

Upon further investigation, the confinement lady in the confinement centre said that the baby fell down from the sleeping cot with the head hitting the floor. The sleeping cot was about 1 meter in height from the floor !!

As a result, the baby suffered from head injury and skull fractured.

Apparently, the confinement centre employed mainly the Indonesian maids to take care of the babies.

2) About 1 year ago, there was an outbreak of infection to the newborn babies and one of the newborn baby was infected with the germs after delivery. The baby was admitted to hospital for treatment.

Upon discharged from hospital, the baby was transferred to a confinement centre because the mother was staying there.

Unfortunately, this sick baby brought the germs to the confinement centre and all the healthy babies in the confinement centre were subsequently transmitted with the disease.

3) I need to treat more cases of post partum blue ( Depression ) from the confinement centre.

You need to have plenty of family support during the confinement period to avoid the risk of depression.

Staying away from the family members is not a good idea !

4) Few of my patients were admitted to hospital because of food poisoning in the confinement centre.

The above mentioned examples are based on my personal experience and it is not my intention to run down the service in the confinement centre.

Reply To HooiHooi

Dr,
HooiHooi again. :D
A lot thanks for my safe delivery process!

I decided to breastfeed my baby since pregnant. And I manage to do so after came back from hospital. But during baby 13th days old, his jaundice level, bilirubin reading still 13+mg/dl. Paediatrician suggested I admitted baby for phototherapy and stop breastmilk for 2 days. And my baby bilirubin level drop to 9+mg/dl and discharged yesterday. BUT, paediatrician suggests me to only give baby breastmilk twice a day, others meal give formula milk for 1 week untill next follow-up. I am not so agree with this decision. May I know your opinion on the point of a gynae?

My baby can drink well, pee and poo well, awake and play 2-3 intervals a day, for me, is consider quite active.

.......................................................................................

Hi, HooiHooi,

It is quite unusual for a doctor to make recommendation of stop breastfeeding because of jaundice.

There are many reasons a newborn baby developing jaundice. Although breastfeeding itself is a contributing factor, the jaundice caused by breastfeeding is usually mild and not serious.

Personally, I advise you to continue for the reasons as stated below:

1) By now your baby should be more than 2 weeks old now. It is very rare for the jaundice to persist beyond 2 weeks.

2) Your baby had received phototherapy and jaundice was subsiding. Once the level went down, it is very rare for it to go up again, except if the baby has other hidden causes.

3) Your baby is a full termed baby. The jaundice level of 13 mg/dl is not considered seriously high.

4) Reducing frequency of breastfeeding will cause reduction in breast milk production.

5) Breast engorgement is also a problem if you don't feed the baby frequently. Breast engorgement may cause fever to you.

6) Exclusive breastfeeding means you only supply breast milk to your baby. By adding formula milk will defeat the purpose of exclusive breastfeeding. The baby may refuse your breast milk later due to formula milk.

7) This is probably your last pregnancy. Breastfeeding is good to you to reduce risk of breast cancer.

Anyway, it is not my purpose to criticise your paediatrician, who is also my colleague. Maybe you should discuss with him to know why he made this recommendation.

Reply to Kellyy

Kellyy said :

Hi Dr Jason,

FYI, I'm currently on my 2nd pregnancy and about to deliver in 3weeks time. I'm planning to breast feed my baby as what i have done for my 1st one. The problem that I have previously is very low milk supply although I breastfeeded my son oftenly and right after birth. After a friend introduce fenugreek, my milk supply had slightly increased. My question is can i have the fenugreek right after labour? Will there be any side effect? I have constipation and piles problem. Will fenugreek worsen that?

Thanks,

Kellyy.

------------------------------------------------------------------------

Low breast milk production is a common problem faced by some of the new mothers who keen to breastfeed their babies.

Among the reasons contributing to low breast milk production :

1) Infrequent feeding resulting in low breast milk production. A regular 2 to 3 hours feeding interval is important to maintain the breastmilk production.

2) Delay in latching after the delivery to stimulate the breast milk production. This problem is commonly happened among the mothers with complicated labour and require caesarean delivery.

3) Inverted nipples which causes poor latching during feeding.

4) Poor suction from the baby to stimulate the breastmilk production.

There are few steps can be taken to help the production of breast milk:

1) Drink adequate amount of water during confinement period. The chinese traditional taboo believe that you should restrict the water intake during confinement. This practice is harmful and you are not encouaged to practice.

2) Increase the protein and calcium diet.

3) Learn a proper technique in breastfeeding. Improper feeding technique will cause poor suction from the baby. Please refer to this link to learn the proper techniques of breastfeeding.

http://drjasonong.blogspot.com/2009/12/breastfeeding-positions.html

4) Breast pump is helpful to extract and stimulate the breast mlik production.

If the above mentioned steps are still not helpful to increase the breast milk production, you need to consider medications:

1) Fenugeek is a traditional herbal medicine which may be helpful to stimulate the production. While Fenugreek is generally considered to be safe when used moderately, there have been reports of a few minor side-effects. Nausea is one common side effect, while other people have reported diarrhoea and stomach gastric pain. Apparently Fenugeek is safe to the baby as well.

2) Maxolon ( metochlorpromide ) can be used to increase the milk production. You need to see a doctor for consultation before taking this medicine.

You need to have a lot of determination and preseverance in order to succeed in breastfeeding. However, this sacrifice is worth taking because both mother and baby will eventually enjoy a lot of benefits from the breastfeeding.