It's a pretty good bet that another c-section will make your adhesion problems worse, so getting pregnant means that you are taking the risk of needing another c-section. It's definitely something to think about. The probability of having a repeat c vs a vbac is surely affected by the opinions and attitudes of your caregivers -- compare a midwife or ob with a strong committment to vbacs to an ob who thinks you are cute and delusional for wanting one and will circle vulture-like just waiting for an excuse to do another c-section.
As for specific things that can physically go wrong with a pregnancy or labor because of adhesions, there I only have my own opinions. With my vbac I had a grueling 52-hour non-progressing back labor because my daughter was "sunnyside up." The "right" position for labor is not only head down, but with the baby facing your spine. (Actually, the ideal position is turned slightly to one side, I don't remember which) The way that the baby gets into this position is that the uterus has a particular shape and the baby fits best in that particular spot. If the uterus' shape is not right, then the baby can be more or less out of the best position, and the labor contractions do not put the maximum force in exacty the right spot and the right direction in order to work most efficiently in getting the cervix to dilate. There are a whole bunch of "tricks" that some midwifes and very few doctors know that will help to get a posterior baby to turn, which I found a good year after my daughter was born. In my case an epidural administered 48 hours after I started labor weakened the contractions enough to let the baby back up a bit and she turned as she came back down and I went from 5.5 to 10 cm in basically one contraction. I was unusually lucky, though. What usually happens when the baby is wedged in there like that is that they give you pitocin and the baby has no chance to move at all and after the labor stalls for awhile then they move you to the OR and give you a fresh batch of adhesions to go with your new baby...
My first child was NOT sunnyside up -- my membranes ruptured before my cervix was ready to dilate and after 24 hours the doc declared "times up" and I went to the OR. I have no proof, but I believe that the adhesions from the c-section pulled my uterus out of shape and caused my 2nd child to be posterior. And I was just really lucky that the epidural had the effect it did, because after 48 hours of labor, delirious from the pain from about hour 42 to hour 48, I was definitely on the c-section fast-track, and that was really my last shot.
So I would say that yes, there is a good chance that another pregnancy will be complicated by your adhesions, but on the other hand there are millions of women out there every year who are pregnant, with severe adhesions, and they do just fine and go on to have uncomplicated vaginal deliveries. Your odds are not as good as the mom with no adhesions, but they aren't bad odds, either.
At Wed, 20 Mar 2002, Rose wrote:
>
>If you could please respond to my one question I have? Women who have
>mild or severe pelvic adhesions, can they carry a fetus to full term and
>if so could it be painful during the pregnancy or cause more adhesions
>if a cesarean is performd?
>I'm 24 and had a cesarean with my daughter four years ago and had a
>revision done on my incision (to heal inside out), that's when my
>problems started with adhesions. They did laparoscopic surgery and
>diagnosed me with mild pelvic adhesion disease. The pain came back much
>worse within six months. Today my pain is getting the best of me. I
>would like to have another chid but am afraid of the pain I may have
>during or after the pregnancy. If you have the time to respond I would
>greatly appreciate your opinion.
>
>With great thanks,
>Rose
-- cathy :-)