You Are Conducting a Postpartum Visit with a 19-Year-Old Woman $\bullet$

You are conducting a postpartum visit with a 19-year-old woman who gave birth by cesarean 4 weeks ago, following induction of labor at term for gestational hypertension. During your visit today she reports scant lochia, exclusive breastfeeding, and some pain on the outer aspect of her left breast. She wants to review her experience of labor and birth with you, and asks whether it is true that, "once a cesarean, always a cesarean."
Chart review reveals BMI of 39, gestational diabetes with diet control, laboratory tests normal, no history of Pap screening.
During your visit you note that her blood pressure is 148/92, with a pulse of 88 and 14 respirations per minute. Your physical exam reveals the following:
$\bullet$ Breasts: Soft and nontender, no palpable masses, and intact everted nipples
$\bullet$ Abdominal exam: No guarding, fundus firm and central halfway between the umbilicus and symphysis pubis. Nontender except at palpation of surgical incision where no erythema or exudates was observed.
$\bullet$ Pelvic exam: No cervical motion tenderness on bimanual exam, which confirmed uterine size estimated by abdominal exam. Moderate pelvic muscle tone, lochia alba noted.In this case the uterus is enlarged and medical treatment is indicated.