When a vertical incision is made for a caesarean section. Caesarean section: from preparation for surgery to discharge from the hospital. Risks for mom after caesarean section

It is not always possible for a woman to give birth to a baby herself.

If the life of a woman or fetus is at risk, natural history childbirth is replaced by cesarean section.

The operation of caesarean section is not modern and has its roots in the distant past.

It is believed that Caesar was born thanks to this method.

200 years ago, surgery to remove the fetus was used only after the death of the mother in labor in order to save the life of the child.

Caesarean section is a method of delivery that brings a baby into the world through surgery. The operation is performed by a surgeon using special instruments, cutting the walls abdominal cavity patients. On the way to the baby, you will have to make another incision on the uterus and only after that the baby will be delivered.

In case of emergency caesarean section, it is necessary to perform gastric lavage using a tube and cleansing enema. A woman drinks 30 ml of sodium citrate to prevent food from entering the Airways. Before anesthesia is administered, a catheter is inserted into the pregnant woman.

It is important to listen to the fetal heartbeat at the beginning of the operation and confirm that there is no head in the birth canal. Otherwise, the feasibility of cesarean delivery is reduced to zero.

Operation process

This method has several advantages:

• takes less time
• easily,
• minimal trauma,
• minimal blood loss,
• damage to the bladder is excluded,
• rapid appearance of the baby,
• small percentage of complications
• more painless.

The disadvantages include its visibility compared to the first option (along the suprapubic fold).

But performing a vertical type of seam is very rare today and is performed when:

• placenta previa;
• adhesions of the uterus (pronounced);
• indications for hysterectomy;
• transverse position of the fetus;
• a dying mother and a living child.

After operation

After stitches are placed, an ice heating pad is placed on the young mother’s stomach. Within 2 hours, it avoids bleeding due to the cold and improves uterine contractions.

After this period, the woman in labor is sent from the labor room to a special ward intensive care for 24 hours. During this time, blood pressure is regularly measured, pulse is checked, bladder function is checked, and vaginal discharge is monitored.

In the postoperative period, antibiotics, uterotonics and painkillers are prescribed. During the first 24 hours, the woman receives infusion and transfusion therapy. After 24-48 hours, the body is cleansed with an enema and a drug for the intestines is prescribed. You can walk 6 hours after surgery.

Where's the child? After extraction, some procedures are carried out: the umbilical cord is cut, an examination by a neonatologist, the nasal passages are cleared, and height and weight are measured. If the woman in labor is accompanied by close person, then the child is transferred to him for the next 6 hours. And only then will mom be able to meet her miracle.

Rehabilitation period

Rehabilitation after surgery consists of:

1. Power control. What can you eat after a caesarean section, and what can you not? It is forbidden to eat fatty, fried, smoked, salty foods for a day. It is better to fast for the first half of the day. It is better to start eating with cereals and broths. Avoid foods that are prohibited during breastfeeding.
2. Seam care. Immediately after a caesarean section, postoperative sutures are sealed with an aseptic sticker for 24 hours.

A control ultrasound is performed a few days later. If the result is good, then after 2 days you can go home. At home, under no circumstances should situations be allowed in which the seam could come apart.

The seam is usually treated with brilliant green or potassium permanganate. As a rule, during a caesarean section, the suture is placed with absorbable sutures and does not require their removal, but if this is not the case, then about a week after discharge you need to see a doctor to remove the sutures.

Consequences of surgery

Modern medicine tries to reduce the risk of postoperative situations that arise, but they still occur.

The most common:

• Problems with the mother's gastrointestinal tract.
• After a cesarean section, recovery is longer.
• Pain after caesarean section at the suture site.
• Risk of failure to deliver naturally during subsequent pregnancies.

In addition, complications of a cesarean section are possible, for example:

1. Problems internal organs. These include: blood loss, formation of adhesions, thrombophlebitis, endometritis. The most dangerous thing is peritonitis.
2. After the operation, the sutures become separated and an inflammatory process develops.
3. Complications after anesthesia. These include: cardiac and vascular problems mothers, problems with nervous and respiratory function in a newborn, aspiration.

Pros and cons of caesarean section

The advantages include:

Minuses:

• long recovery period;
• risk of inflammatory processes;
• problems with breastfeeding;
• complications in subsequent pregnancies;
• neurological pathologies in the baby;
• the risk of increased intracranial pressure in the child in the future;
• risk of developing obesity in the future;
• the risk, although very small, of damage to the child’s soft tissues during the operation.

Today, many children are born by caesarean section. This happens because something is wrong with the mother's health. Or some other emergency situation arose.

Preparing for a caesarean section

Day of surgery

Next, according to the plan, is a conversation with an anesthesiologist who will tell you all the details of pain management during a caesarean section. Today, spinal anesthesia is the usual choice. In this case, the woman will be able to see her baby immediately after it is removed from the uterus. But this option is only possible if the woman has no contraindications. The method of anesthesia chosen will need to be recorded in writing.

Caesarean section, how the operation works

A screen is usually placed between the operation site and the woman's face. In some maternity hospitals, it is the practice that a woman’s relative may be behind the screen during such an operation. The entire operation takes no more than ten minutes. First, the baby is removed and the umbilical cord is cut. Then the doctor carefully cleans and examines the uterus, after which it and the abdominal wall are sutured. The seam is treated again with an antiseptic and a bandage is applied, and ice wrapped in a cloth is placed on top. In this way, bleeding can be reduced, and the uterus will contract more actively. Then the woman is transferred to the intensive care ward.

After operation

The first day you can drink only water, and on the second day you can already have low-fat chicken broth or liquid porridge, V to a greater extent oatmeal This diet should be maintained for approximately three weeks. After a few days, if there are no complications, the mother is sent to the postpartum ward, where she can take care of the baby.

A week later, the woman is prescribed a blood and urine test, and is also sent for an ultrasound of the uterine scar and genital organs. If no complications are found during this examination, then after a few days the mother and child can go home.

At home after CS

Caesarean section is one of the oldest abdominal surgery operations. This delivery operation, in which the fetus and placenta are removed through an artificially made incision in the uterus, is currently a common surgical intervention, its frequency ranges from 25 to 17%. This operation went through many stages in its development. In ancient times, this operation was performed on a dead woman by people without medical education. In 1521, Rousseau (France) substantiated the performance of this operation on a living woman. The first reliably known cesarean section operations on a living woman were performed by the Italian surgeon Christian Bayon in 1540 and the German surgeon Trautmann in 1610, but the incision on the uterus was not sutured; the outcomes of the operation were always fatal. Since the end of the 16th and beginning of the 17th centuries, issues of cesarean section have been developed in Germany, France, Italy, the Netherlands, etc. In Russia, the first cesarean section was performed in 1756 by Erasmus, the second in 1796 by Sommer - both with a favorable outcome. The third caesarean section was performed by Richter in Moscow in 1842. Until 1880 (according to A.Ya. Krassovsky), there were only 12 caesarean sections in Russia. This operation was resorted to as a last resort, when the pathology during childbirth went very far, women died in 100% of cases from bleeding and septic infection. This was before the antiseptic period in obstetrics. In those years, there were no clearly developed indications and contraindications for surgery, and no anesthesia was used. Due to an unsutured wound on the uterus, its contents entered the abdominal cavity, causing peritonitis and sepsis, which were the reason for such a high mortality rate. Kehrer was the first to use uterine wound suturing in 1881

Advances in surgery and anesthesiology, improvements in blood transfusion techniques and the discovery of new effective antibiotics led to a sharp decline in maternal mortality. The operation has become firmly established in the daily practice of obstetricians and gynecologists.

Maternal morbidity and mortality depend to a greater extent on the factors leading to surgical intervention than from the operation itself. The maternal mortality rate is 0.2%.

Perinatal mortality. Low level perinatal mortality is recorded in countries where doctors widely use cesarean section, especially for low fetal weight (700-1500 g). Factors contributing to the reduction of perinatal mortality:

Monitoring the condition of the fetus;

The use of steroid hormones and tocolytic agents;

Modern equipment;

-qualified personnel.

INDICATIONS

The risk to a woman’s life and health during a caesarean section is 12 times higher than during a vaginal birth birth canal. Therefore, caesarean section is performed strictly according to indications. Indications for this operation are divided intoabsolute And relative. Absolute indications include situations where it is impossible to extract the fetus through the natural birth canal, or childbirth poses a danger to the mother’s life due to complications of pregnancy and childbirth. TO relative indications include situations in which the birth of a living and healthy child through the natural birth canal is considered doubtful.

Absolute readings

- Full presentation placenta.

Absolutely narrow pelvis.

Clinical discrepancy between the sizes of the woman’s pelvis and the fetal head.

Incomplete placenta previa with unprepared birth canal and heavy bleeding.

Premature abruption of a normally located placenta with unprepared birth canal and bleeding.

Tumors of the pelvic organs that prevent the birth of a child.

Gross scarring of the cervix and vagina.

Threatening or incipient uterine rupture.

Severe gestosis with ineffective conservative treatment and unprepared birth canal.

Incompetence of the uterine scar.

Extragenital cancer and cervical cancer.

Serious extragenital pathology (for example, retinal detachment, complicated myopia, serious illnesses of cardio-vascular system).

Relative readings

- Abnormalities of labor with ineffective conservative therapy.

Breech presentation in combination with another obstetric pathology, the age of the primigravida over 30 years, or a burdened obstetric history.

Transverse position of the fetus in the absence of conditions for vaginal delivery.

Incorrect insertion and presentation of the fetus.

Malformations of the uterus.

Intrauterine fetal hypoxia, ineffective conservative therapy

Presentation and prolapse of the umbilical cord.

Long-term infertility in combination with another pathology.

Post-term pregnancy when the first-time mother is over 30 years old in combination with obstetric pathology.

Artificial insemination in combination with any pathology.

Multiple pregnancy with a transverse position of the first or both fetuses, breech presentation of both fetuses or intrauterine hypoxia.

CONTRAINDICATIONS

- Intrauterine fetal death.

Terminal state.

Deformity or severe prematurity of the fetus.

Acute infection in a woman.

Prolonged labor (more than 24 hours).

A large number of vaginal examinations.

It is not recommended to perform a caesarean section after a failed attempt obstetric forceps and vacuum extraction due to high risk birth traumatized child and maternal infections.

CONDITIONS FOR CESAREAN SECTION

- The fetus is alive and viable (not always feasible with absolute indications).

The woman agrees to the operation (if there are no vital indications).

The pregnant woman has no signs of infection.

There are two types of cesarean section operations with abdominal access.

Extraperitoneal caesarean section used for amnionitis to avoid infection of the abdominal cavity. This method was practically abandoned after the introduction of effective antibiotics and due to frequent cases of damage to the bladder and ureters during this intervention.

Trans-(intra)peritoneal caesarean section . Currently this is the main access.

Preparing the patient

If the patient's Ht is less than 30%, infusion therapy is performed to compensate for fluid deficiency. It is necessary to prepare for a possible blood transfusion during surgery. The woman's bladder must be emptied. Antibiotic prophylaxis is often carried out. To reduce the acidity of the stomach contents, antacids are used (to alleviate the consequences of possible aspiration of vomit during anesthesia). It is necessary to inform the patient in detail about pain relief and the nature of the operation and obtain her consent.

Anesthesia

Can be general or regional (spinal or epidural). General anesthesia often leads to a significant deterioration in the condition of the fetus, therefore, when performing general anesthesia, the time interval from the onset of anesthesia to the extraction of the fetus should not exceed 10 minutes. The degree of deterioration of the child’s condition is directly proportional to the duration general anesthesia. In this regard (to reduce the duration of labor), preparation surgical field should be carried out before the start of general anesthesia.

Progress of the operation

Palpation of the uterus and fetus

Abdominal wall dissection

The abdominal wall incision can be in the midline (inferomedian) or suprapubic in the transverse direction (Pfannenstiel incision). The latter provides a better cosmetic effect, but requires more time to perform, provides less opportunity for wide access and is accompanied by greater blood loss. The next stage is separation of the vesicouterine fold of the peritoneum, exposure of the lower uterine segment. An incision of the uterus is made according to indications or at the choice of the surgeon.

Incision into the wall of the uterus

Section along Kerr - Gusakov(low transverse) are currently used most widely. The incision is made on the non-contracting part of the uterus (lower segment), which reduces the likelihood of rupture or divergence of the edges of the scar during subsequent pregnancies. The seam runs parallel muscle fibers, located immediately behind the vesicouterine fold of the peritoneum. The disadvantage is the risk of damage to the vessels running along the edge of the uterus.

Longitudinal section along Selhaaymu(isthmicocorporal) begin in the lower segment of the uterus and continue to the body of the uterus.

Section along Sanger(classical, or corporal, is now rarely used) - a longitudinal incision on the anterior surface of the uterus. Indications: cervical cancer and pathological formations in the lower segment of the uterus (fibroids); sometimes used for transverse position of the fetus, failure of the longitudinal scar on the uterus after a previous corporal cesarean section, if subsequent removal of the uterus is necessary, and during surgery on a dying woman. This is the simplest and fastest cut, but when using it there are frequent complications: postoperative adhesions; bleeding; poor healing wounds; scar divergence during subsequent pregnancies and births.

Delivery of the baby and separation of the placenta

The child is carefully removed by hand or using forceps or a vacuum extractor. The uterus is often removed from the abdominal cavity for the purpose of massage, examination of the appendages, and visualization of the incision when suturing. To reduce blood loss, uterine contracting agents (oxytocin, methylergometrine, etc.) are injected into the uterine muscle. After separation of the placenta, manual examination of the uterine cavity is necessary to diagnose submucosal fibroids or to remove remnants of the fertilized egg. Instrumental examination is carried out for amnionitis, pregnancy up to 28 weeks, etc.

Stitching up an incision on the uterus

A very common method of suturing with a two-story seam is Eltsov-Strelkov using absorbable suture material. The first suture is placed alternately on the right and left in the corners of the wound. The first row of sutures is applied by inserting a needle from the side of the mucous membrane and capturing a small layer of myometrium from one edge of the wound. Then, from the other edge, an injection is made from the side of the myometrium and a needle is poked into the uterine cavity, capturing the endometrium. This ensures that when tying the threads of the knots, they remain in the uterine cavity, and not between the comparable edges of the wound (a channel of “molten” catgut is not formed in the thickness of the myometrium). The next row (musculoskeletal is applied traditionally). The vesicouterine fold of the peritoneum is sutured with a continuous absorbable suture.

Suturing the anterior abdominal wall

The parietal peritoneum is sutured with a continuous catgut suture. Usually the same thread is used to connect the rectus abdominis muscles. The aponeurosis is sutured with stronger threads, or with a continuous suture or separate silk (lavsan) sutures. Separate catgut sutures on the subcutaneous fat. On the skin - continuous subcutaneous catgut suture or separate silk sutures along Donati .

In the last 4-5 years, a number of innovations have been proposed in the technique of caesarean section. The prerequisite for this was several works that clearly prove, in particular, that non-suturing of the visceral and parietal peritoneum during production gynecological operations does not entail any additional postoperative complications, and even, moreover, significantly reduces the likelihood of adhesions in the abdominal cavity. Other prerequisites were wide application in surgical practice of synthetic absorbable suture material, and, in connection with this, more frequent use when suturing an incision on the uterus during a caesarean section using a single-row continuous suture.

McKinney and Young in their study provide the following data: the average surgeon with 30 years of experience operating in a population with an HIV infection rate of 0.01% has a 1% risk of being infected. In this regard, surgery welcomes any modifications of surgical techniques that reduce the time of surgery and work with piercing and cutting objects.

All of the above, as well as the well-known traditional aspirations to reduce the duration of the operation, became the basis for the development in 1994 of a modification of cesarean section, now known as the cesarean section operation. Stark. When considering the individual stages of this operation, we will not find anything new, and only a combination of several well-known techniques and the exclusion of some optional stages allow us to speak of this operation as a new modification that has whole line advantages compared to conventional methods. These include rapid fetal extraction, a significant reduction in the duration of the operation, a decrease in blood loss, the need for postoperative painkillers, the incidence of intestinal paresis, a decrease in the frequency and severity of other postoperative complications, earlier discharge and savings in suture material. Due to these advantages, as well as the simplicity of the Stark method itself, this operation is quickly gaining popularity.

COMPLICATIONS

Complications occur in less than 5% of all caesarean sections. At elective surgery the number of postoperative complications is 2-5 times less than with emergency surgery. Possible complications – endometritis, peritonitis, salpingitis, wound infection, bleeding, pulmonary atelectasis, deep vein thrombosis, embolism pulmonary artery, complications of anesthesia (for example, Mendelssohn's syndrome).

Long-term consequences of cesarean section

A scar on the uterus resulting from a cesarean section complicates the course of subsequent pregnancies and births. The incidence of uterine rupture after cesarean section (1957) was 8.3% for a low transverse incision, 12.9% for an isthmic-corporal incision, and 18.2% for a classic incision. Currently, uterine ruptures occur with the following frequency: with a cut in the lower segment of the uterus - 1%, with a classic cut - 2%.

CHILDREN THROUGH THE NATURAL BIRTH CHANNEL AFTER CESAREAN SECTION IN THE HISTORY

The relative safety of cesarean section, monitoring of the condition of the fetus, and the level of modern surgical technology allow patients with a history of cesarean section to give birth through the vaginal birth canal.

ANTIBIOTICOPROPHYLAXIS

It is common practice to prescribe antibiotics for caesarean sections. for preventive purposes. Antibiotics can be administered both before birth and after cord ligation. In cases of elective caesarean section, antibiotics are not usually used. But when the membranes rupture, the risk of postoperative infectious complications increases sharply; in such cases, the use of antibiotics is indicated. Penicillins and cephalosporins are most often used due to their low toxicity and wide spectrum of action.

POSTOPERATIVE MANAGEMENT

1st day - diet 0, cold on the stomach, breathing exercises, allowed to sit in bed.

2nd day- diet 0, allowed to get up. In order to prevent intestinal paresis, 40 ml is administered intravenously hypertonic solution Once a day, 1 ml of 0.05% solution of prozerin subcutaneously 2 times a day, hypertensive enema, cerucala (2 ml), ubretida.

3rd day- diet 1, you can walk, make a toilet seam.

During 6-7 days antibacterial therapy, symptomatic therapy, infusion therapy according to indications. Discharge for 8-9 days with appropriate recommendations.

A caesarean section is a surgical procedure that allows the baby to be delivered through an incision in the abdomen rather than through the vagina. Recently, about 30% of births occur by caesarean section. In some cases, this is done electively due to pregnancy complications or because the woman has already had a caesarean section. Some women prefer a caesarean section to a regular birth. However, in many cases the need for a cesarean section becomes apparent only during labor.

Knowing what to expect will help you be better prepared if surgery is necessary.

Caesarean section is a method surgical intervention, allowing the child to be removed from the mother's womb. In this case, he is not born naturally, but takes his first look at the world through the incision that is made when the uterus is opened. In Germany, 20 to 30 percent of babies are born by caesarean section every year.

Indications for caesarean section

Indications for cesarean section can be absolute and relative. But for the most part, the decision to undergo surgery arises from many reasons at once, such as a combination medical assessments on the part of the doctor and midwife, personal wishes on the part of the mother in labor. Fortunately, pregnant women have plenty of time to think things through and figure out exactly how they would like to give birth. Emergency situations where a caesarean section becomes unavoidable are rare.

If you decide to have a caesarean section, you must confirm your consent to the operation in writing. But first, the doctor will give you the most detailed explanations. During this conversation, everything should be discussed in detail possible risks so that you really feel well prepared. Therefore, do not hesitate to ask again if something is not clear to you.

Medical indications for cesarean section include:

• transverse or pelvic presentation of the child;
• placenta previa;
• discrepancy in the size of the maternal pelvis
• child's size;
• severe maternal illness;
• threat of child hypoxia;
• premature birth;
• pathology of child development.

Partial anesthesia for caesarean section

Local anesthesia is now the generally accepted standard. The operation is performed using spinal anesthesia or, for a planned caesarean section, epidural-spinal anesthesia (see page 300). General anesthesia is recommended only in cases where other anesthesia is not possible for medical reasons.

When is a caesarean section performed?

There are many reasons why a caesarean section is performed. Sometimes this is due to the health of the mother, sometimes due to concerns for the child. Sometimes surgery is done even if both mother and baby are fine. This is an elective caesarean, and there are mixed feelings about it.

Childbirth is not going well. One of the main reasons why a caesarean section is performed is because labor is not progressing normally - too slowly or stopping altogether. The reasons for this are manifold. The uterus may not contract vigorously enough to fully dilate the cervix.

The child's heart function is impaired. In most cases, the baby's heart rate allows us to expect a successful outcome of the birth. But sometimes it becomes obvious that the child does not have enough oxygen. If there are such problems, the doctor may recommend a cesarean section.

Heart problems can occur if the baby is not getting enough oxygen, the umbilical cord is pinched, or the placenta is not functioning well. Sometimes violations heart rate occur, but nothing indicates a real danger to the child. In other cases, serious danger is obvious. One of the most difficult decisions for doctors is deciding how great this danger is. The doctor can try different methods, for example, massage the head, and see if the heart function improves.

The decision to have a caesarean section depends on many factors, such as how long labor will continue or how likely there are complications other than heart problems.

Unfortunate position of the child. If the baby enters the birth canal legs or buttocks first, it is called breech presentation. Most of these babies are born by caesarean section, as there is a high risk of complications with normal childbirth. Sometimes the doctor is able to move the baby into the correct position by pushing it through the abdomen before labor begins, thereby avoiding surgery. If the baby lies horizontally, this is called transverse presentation and is also an indication for cesarean section.

The baby's head is positioned poorly. Ideally, the baby's chin should be pressed to the chest so that the part of the head with the smallest diameter is in front. If the chin is lifted or the head is turned so that the smallest diameter is not in front, the larger diameter of the head should pass through your pelvis. Some women have no problems with this, but others may have difficulties.

Before performing a cesarean section, the doctor may ask you to get on all fours - in this position, the uterus drops forward and the baby can turn around. Sometimes the doctor may want to turn the head during a vaginal examination or using forceps.

You serious problems with health. A caesarean section may be done if you have diabetes, diseased heart, light or high blood pressure. With such diseases, a situation may arise when it is preferable to give birth to a child at a later date. early stage pregnancy. If labor cannot be induced, a caesarean section may be necessary. If you have serious health problems, discuss your prospects with your doctor well before the end of your pregnancy.

Occasionally, a caesarean section is performed to prevent the baby from contracting a herpes infection. If a mother has herpes in her genitals, it can be passed on to her baby and cause serious illness. Caesarean section avoids this complication.

You multiple pregnancy. About half of twins are born by Caesarean section. Twins can be born in the usual way, depending on weight, position and stage of pregnancy. With triplets it's a different story. Most triplets are delivered by caesarean section.

Each multiple pregnancy is unique. If this is your case, discuss your birth prospects with your doctor and decide together what is best for you. Remember that everything is changeable. Even if both babies are lying head first, the situation may change after the first one is born.

There are problems with the placenta. In two cases, a cesarean section is necessary: ​​placental abruption and placenta previa.

Placental abruption occurs when the placenta separates from the wall of the uterus before labor begins. This can pose a threat to both your life and your child's. If electronic monitoring shows that there is no immediate danger to the baby, you will be hospitalized and closely monitored. If the baby is in danger, an urgent delivery is necessary and a caesarean section will be used.

The placenta cannot be born first, because then the baby will lose access to oxygen. Therefore, a cesarean section is almost always done.

There are problems with the umbilical cord. When your water breaks, the umbilical cord may slip out of your cervix before the baby is born. This is called umbilical cord prolapse and poses a great danger to the baby. As the baby pushes through the cervix, pressure on the umbilical cord can cut off oxygen supply. If the umbilical cord slips out when your cervix is ​​fully dilated and labor has begun, you can give birth normally. Otherwise, only a caesarean section can save the situation.

Also, if the umbilical cord is wrapped around the baby's neck or between the head and pelvic bones, if the water has broken, each contraction of the uterus will compress the umbilical cord, slowing down the blood flow and reducing the supply of oxygen to the baby. In these cases, caesarean section - best option, especially if the umbilical cord is compressed for a long time or very strongly. This is a common cause of heart problems, but it is usually impossible to know for sure how the umbilical cord is positioned until labor begins.

The child is very big. Sometimes the baby is too big to be successfully delivered in the normal way. Baby size can be an issue if you have an abnormally narrow pelvis that the head cannot fit through. Occasionally, this may be a consequence of a pelvic fracture or other deformities.

If you develop diabetes during pregnancy, your baby may gain heavy weight. If the baby is too big, a caesarean section is preferable.

Child's health problems. If a child is diagnosed with a defect such as spina bifida while still in the mother's womb, the doctor may recommend a cesarean section. Discuss the situation in detail with your doctor.

You've already had a caesarean section. If you've had a C-section before, you may have to do it again. But this is optional. Sometimes a normal birth is possible after a caesarean section.

How does a caesarean section happen?

Before your planned cesarean section, your gynecologist or anesthesiologist will talk to you about the procedure and anesthesia in advance. If something is unclear to you, clarify and ask again! On the appointed day, you must arrive at the hospital in advance. It is best to avoid eating: You should not eat for six hours before surgery.

First of all, the doctor and midwife will check your baby’s condition using ultrasound and CTG. Take this opportunity to express your wishes and ideas for the upcoming birth. Then preparations for the operation will begin: your hair will be shaved off in the incision area, and a compression stockings and will be given spinal anesthesia. Later, in the operating room, the surface of the abdomen will be disinfected and a catheter will be inserted into the bladder. Before the operation begins, your entire body, except for your abdomen, will be covered with sterile drapes. To prevent you from seeing what is happening and to prevent infection, the nurses will pull a sheet over your upper abdomen. Although you will be able to see the heads of the operating team members, you will not be able to understand what they are doing with their hands. After the anesthesia begins to take full effect, the doctor will make the first incision.

For cosmetic reasons and also for better healing wounds, skin incision is made directly above the symphysis (pubic joint) along a vertical line, the length of the incision is 10 cm. Subcutaneous adipose tissue splits down the middle. Above the abdominal muscles there is a very elastic and strong connective tissue membrane (fascia), which the surgeon opens with a scalpel in the center. Then he pulls the abdominal wall upward with his hand and moves the abdominal muscles to the side. To open the peritoneum, the doctor uses only his fingers. At the same time, he must make sure that he does not injure either the intestines or the bladder. Finally, the doctor uses a scalpel to make a transverse incision in the lower segment of the uterus. Now all that remains is to get the baby out of the womb and you can say hello to your baby. After the placenta is separated and removed, the operating team sutures the wound. Meanwhile, your partner is already accompanying the child to the first examination. In total, the operation lasts from 20 to 30 minutes.

Misgav Ladakh Method

The method described on the previous pages, the so-called “soft” surgical technique, developed at the Israeli hospital Misgav Ladach, is used today, with minor deviations, in all maternity clinics.

Risks of caesarean section

A caesarean section is a major operation. Although it is considered completely safe, as with any surgery, there are certain risks. It is important to remember that caesarean sections are often done to avoid life-threatening complications. However, certain complications may also arise after surgery.

Risks for you. Having a child is always a risk. With a caesarean section it is higher than with a normal birth.

• Increased bleeding. On average, blood loss during a caesarean section is twice as much as during a normal birth. However, blood transfusions are rarely required.
• Reactions or anesthesia. Medicines used during surgery, including painkillers, can sometimes cause unintended consequences, including breathing problems. In rare cases, general anesthesia can cause pneumonia if a woman inhales stomach contents. But general anesthesia is rarely used for caesarean sections, and precautions are taken to avoid such complications.
• Bladder or bowel damage. Such surgical injuries are rare, but they do occur during caesarean sections.
• Endometritis. This is a complication inflammatory and infection of the membrane lining the uterus, most commonly after cesarean section. This happens when bacteria normally found in the vagina enters the uterus. Urinary tract infection.
• Slowing intestinal activity. In some cases, painkillers used during surgery can slow down bowel movements, causing bloating and discomfort.
• Blood clots in the legs, lungs and pelvic organs. The risk of developing a blood clot in the veins is 3-5 times higher after a cesarean section than after a normal birth. If left untreated, a blood clot in the leg can travel to the heart or lungs, cutting off circulation, causing chest pain, shortness of breath, and even death. Blood clots can also form in the veins of the pelvis.
• Wound infection. The possibility of such an infection after a cesarean section is higher if you drink alcohol heavily, have type 2 diabetes, or are overweight.
• Seam rupture. If the wound becomes infected or does not heal well, there is a risk of rupture of the sutures.
• Placenta accreta and hysterectomy. Placenta accreta is attached too deeply and too firmly to the wall of the uterus. If you've already had a caesarean section, you're much more likely to have placenta accreta in your next pregnancy. Placenta accreta is the most common reason for hysterectomy during caesarean section.
• Readmission to hospital. Compared with women who gave birth vaginally, women who had a caesarean section were twice as likely to be hospitalized again within the first two months after birth.
• Fatal outcome. Although the likelihood of death after a caesarean section is very low - approximately two cases in 100,000 - it is almost twice as high as after a vaginal birth.

Risk to the child. A caesarean section is also potentially dangerous for the baby.

• Premature birth. If a caesarean section is your choice, the baby's age must be determined correctly. Premature birth can lead to breathing problems and low birth weight.
• Breathing problems. Babies born by Caesarean section are more likely to have mild breathing problems - breathing abnormally quickly during the first few days after birth.
• Injury. Occasionally, the child may be injured during surgery.

What to expect with a caesarean section

Whether your caesarean section is planned or done as needed, it will go something like this:

Preparation. Some procedures will be done to prepare you for surgery. In urgent cases, some steps are shortened or skipped altogether.

Methods of pain relief. An anesthetist may come to your room to discuss anesthesia options. For a caesarean section, spinal, epidural and general anesthesia are used. With spinal and epidural anesthesia, the body loses sensation below the chest, but you remain conscious during the operation. In this case, you practically do not feel pain, and practically no medicine reaches the child. There is little difference between spinal and epidural anesthesia. For spinal pain, a pain reliever is injected into the fluid surrounding the spinal nerves. With an epidural, the agent is injected from the outside of the fluid-filled space. Epidural anesthesia lasts 20 minutes and lasts a very long time. Spinal is done faster, but lasts only about two hours.

General anesthesia, in which you are in unconscious, can be used for emergency caesarean section. Some of the medicine may reach your child, but this usually does not cause problems. Most children are not affected by general anesthesia because the mother's brain absorbs the medicine quickly and efficiently. large quantities. If necessary, the child will be given medications to relieve the effects of general anesthesia.

Other preparations. Once you, your doctor, and the anesthesiologist have decided which type of pain relief to use, preparations will begin. Typically they include:

• Intravenous catheter. An intravenous needle will be placed in your arm. This will ensure that you receive the fluids and medications you need during and after surgery.
• Blood analysis. Your blood will be drawn and sent to a laboratory for analysis. This will allow the doctor to assess your condition before surgery.
• Antacid. You will be given an antacid to neutralize stomach acids. This simple step greatly reduces the risk of lung damage if you vomit during anesthesia and stomach contents leak into your lungs.
• Monitors. Your blood pressure will be monitored continuously during the operation. You may also be connected to a heart monitor, with sensors placed on your chest to monitor your heart function and rhythm during surgery. A special monitor may be attached to the finger to monitor the level of oxygen in the blood.
• Urinary catheter. A thin tube will be inserted into your bladder to drain urine to keep the bladder empty during surgery.

Operating room. Most caesarean sections are performed in operating rooms specifically designed for this purpose. The atmosphere may be different from that of the birthplace. Since operations are a group effort, there will be many more people here. If you or your child have serious medical problems, doctors from various specialties will be present.

Preparation. If you are having an epidural or spinal anesthesia, you will be asked to sit with your back rounded or lie on your side curled up. The anesthesiologist will wipe your back with an antiseptic solution and give you an anesthetic injection. He will then insert a needle between the vertebrae through the dense tissue surrounding the spinal cord.

You may be given one dose of pain medication through a needle and then have it removed. Or a thin catheter will be inserted through the needle, the needle will be removed, and the catheter will be covered with adhesive tape. This will allow you to receive new doses of pain medication as needed.

If you require general anesthesia, all preparations for surgery will be made before you receive pain relief. The anesthesiologist will administer pain medication through intravenous catheter. You will then be placed on your back with your legs secured. A special pad may be placed under your back on the right side so that your body tilts to the left. This shifts the weight of the uterus to the left, which ensures good blood supply.

The arms are extended and fixed on special pillows. The nurse will shave off any pubic hair if it might interfere with the operation.

The nurse will wipe the stomach with an antiseptic solution and cover it with sterile wipes. A tissue will be placed under the chin to keep the surgical site clean.

Abdominal wall incision. When everything is ready, the surgeon makes the first incision. This will be an incision in the abdominal wall, about 15 cm long, cutting through the skin, fat and muscle to reach the lining of the abdominal cavity. Bleeding vessels will be cauterized or bandaged.

The location of the incision depends on several factors: whether your C-section is an emergency and whether you have any other scarring on your abdomen. The size of the baby and the location of the placenta are also taken into account.

The most common types of cuts:

• Low horizontal cut. Also called a bikini cut, which runs in the lower abdomen along the line of an imaginary bikini panty, is preferred. It heals well and causes less pain after surgery. It is also preferred for cosmetic reasons and allows the surgeon to clearly see the lower part of the pregnant uterus. b Low vertical section. Sometimes this type of incision is preferable. It provides quick access to the lower part of the uterus and allows you to remove the baby faster. In some cases, time is of the essence.
• Uterine incision. After completing the incision into the abdominal wall, the surgeon pushes back the bladder and cuts through the wall of the uterus. The uterine incision may be the same or a different type as the abdominal wall incision. It is usually smaller in size. Just as with an abdominal incision, the location of the uterine incision depends on several factors, such as the urgency of the operation, the size of the baby, and the location of the baby and placenta inside the uterus. A low horizontal incision in the lower part of the uterus is the most common and is used in most caesarean sections. It provides easy access, bleeds less than higher incisions, and is less likely to damage the bladder. A durable scar is formed on it, reducing the risk of rupture during subsequent births.
• In some cases, a vertical incision is preferable. A low vertical incision - in the lower part of the uterus, where the tissue is thinner - can be made when the baby is positioned feet first, buttocks forward, or across the uterus (breech or transverse presentation). It is also used if the surgeon believes it will have to be extended to a high vertical incision - sometimes called a classic incision. A potential advantage of the classic incision is that it allows easier access to the uterus to remove the baby. Sometimes a classic incision is used to avoid injury to the bladder or if the woman has decided that this is her last pregnancy.

Birth. When the uterus is open, next step is the opening of the amniotic sac so that the child can be born. If you are conscious, you may feel some tugging and pressure as the baby is pulled out. This is done in such a way as to keep the incision size to a minimum. You won't feel pain.

Once the baby is born and the umbilical cord has been cut, he will be given to a doctor who will check that his nose and mouth are free of fluid and that he is breathing well. In a few minutes you will see your baby for the first time.

After birth. Once the baby is born, the next step is to separate and remove the placenta from the uterus and then close the incisions, layer by layer. Sutures on internal organs and tissues will dissolve on their own and do not require removal. For the skin incision, the surgeon may place sutures or use special metal clips to hold the edges of the wound together. You may feel some movement during these activities, but no pain. If the incision is closed with clamps, they will be removed with special forceps before discharge.

When you see the baby. The entire cesarean section operation usually takes 45 minutes to an hour. And the baby will be born in the first 5-10 minutes. If you are conscious and willing, you can hold your baby while the surgeon closes the incisions. Or you might see the baby in your partner's arms. Before giving the baby to you or your partner, doctors will clean the baby's nose and mouth and perform an initial Apgar score, a quick assessment of the baby's appearance, pulse, reflexes, activity and breathing one minute after birth.

Postoperative ward. There you will be monitored until the anesthesia wears off and your condition stabilizes. This usually takes 1-2 hours. During this time, you and your partner can spend a few minutes alone with your child and get to know him.

If you decide to breastfeed, you can do so for the first time in the recovery room if you wish. The sooner you start feeding, the better. However, after general anesthesia, you may not feel well for several hours. You may want to wait until you are completely awake and have pain relief before you start feeding.

After a cesarean section

In a few hours you will be moved from the recovery room to the birthing room. Over the next 24 hours, doctors will monitor your well-being, the condition of the stitches, the amount of urine excreted and postpartum hemorrhage. Your condition will be closely monitored throughout your hospital stay.

Recovery. Typically, you will spend three days in the hospital after a caesarean section. Some women are discharged after two. It is important that you take good care of yourself both in the hospital and at home to speed up your recovery. Most women usually recover from a cesarean section without any problems.

Pain. You will receive pain medication at the hospital. You may not like it, especially if you plan to breastfeed. But painkillers are necessary after the anesthesia wears off to make you feel comfortable. This is especially important in the first few days, when the incision begins to heal. If you are still in pain when you are discharged, your doctor may prescribe pain medication for you to take at home.

Food and drink. In the first hours after surgery, you may only be given ice cubes or a sip of water. Once your digestive system starts functioning normally again, you may be able to drink more fluids or even eat some easy-to-digest foods. You'll know you're ready to eat when you can pass gas. This is a sign that your digestive system is awakened and ready to get started. You can usually eat solid food the day after surgery.

Walking. You will most likely be asked to walk around a few hours after surgery, if it is not yet overnight. You may not want to, but walking is beneficial and makes important part your recovery. It will help clear your lungs, improve blood circulation, speed up healing, and bring your digestive and urinary systems back to normal. If you are bothered by bloating, walking will bring relief. It also prevents blood clots, a possible post-operative complication.

After the first time, you should take short walks at least twice a day until you are discharged.

Vaginal discharge. After your baby is born, you will have lochia, a brownish or colorless discharge, for several weeks. Some women after a cesarean section are surprised by the amount of discharge. Even if the placenta is removed during surgery, the uterus must heal and discharge is part of the process.

Healing of the incision. The bandage will most likely be removed the day after surgery, when the incision has healed. Your wound will be monitored while you are in the hospital. As the incision heals, itching will occur. But don't scratch it. It's safer to use lotion.

If the incision was connected with clamps, they will be removed before discharge. At home, shower or bathe as usual. Then dry the cut with a towel or hairdryer on low heat.

The scar will be tender and painful for several weeks. Wear loose clothing that does not chafe. If clothing irritates your scar, cover it with a light bandage. Sometimes you will feel twitching and tingling in the area of ​​the incision - this is normal. While the wound is healing, it will itch.

Restrictions. When returning home after a caesarean section, it is important to limit your activity for the first week and focus primarily on yourself and your newborn.

• Don't lift weights or do anything that strains your still-unhealed belly. Maintain correct posture when standing or walking. Support your stomach during sudden movements such as coughing, sneezing, or laughing. Use pillows or rolled up towels when feeding.
• Take the necessary medications. Your doctor may recommend pain medication. If you have constipation or bowel pain, your doctor may recommend an over-the-counter stool softener or mild laxative.
• Check with your doctor about what you can and cannot do. Exercise can be very tiring for you. Give yourself time to recover. You had an operation. Many women, when they begin to feel better, find it difficult to adhere to the necessary restrictions
• As long as fast movements cause pain, do not drive. Some women recover faster, but usually the period when you shouldn't drive lasts about two weeks.
• No sex. Refrain until your doctor gives permission - usually after a month and a half. However, intimacy should not be avoided. Spend time with your partner, at least a little in the morning or evening, when the baby is already asleep.
• When your doctor allows it, start doing exercise. But don't go too hard. Hiking and swimming are the best choices. Within 3-4 weeks after discharge you will feel able to lead a normal normal life.

Possible complications.

Tell your doctor right away if these symptoms appear while you are at home:

• Temperature above 38 °C.
• Painful urination.
• Too much vaginal discharge.
• The edges of the wound diverge.
• The incision site is red or wet.
• Severe abdominal pain.

Emergency caesarean section

An emergency caesarean section is performed only if the life of the mother or child is threatened.

The decision on an emergency operation or a secondary caesarean section is made only when there is really no other choice, since this is associated with a high risk for the pregnant woman (intubation, bleeding, damage to neighboring organs, infection).

Indications for emergency surgery:

• acute hypoxia of a child;
• complications that threaten the life of the mother (uterine rupture, premature separation of the placenta).

If one of these complications unexpectedly occurs, you need to act very quickly. If the supply through the umbilical cord is disrupted, the doctor has only a few minutes to prevent significant harm to the baby's health. The obstetric team must take all measures to ensure that the birth takes place in the next 20 minutes. An interruption in oxygen supply that lasts longer than 10 minutes can damage the baby's brain.

Once the doctor decides on an emergency caesarean section, the induction of anesthesia and the operation are performed without delay and without long preparation. The surgical intervention can also be carried out in the maternity ward, if there is enough space and the necessary equipment is available.

Women always hope that they will give birth while maintaining dignity, will be able to endure pain, sometimes even smile when they push for the last time, giving life to the child. Many people try very hard to give birth naturally, choosing doctors who have had few cesarean sections in their practice, go to courses for pregnant women, play sports during pregnancy, trying to gain only required weight, sometimes even hiring a doula to be with you in the delivery room. However, there are a lot of caesarean sections, more than ever before.

How to deal with anxiety

It doesn't matter how hard you tried, whether you had normal pregnancy without complications, you may need an emergency caesarean section. You will be disappointed. You might feel like a failure. However, it is important to stay ahead of the curve. Caesarean sections do carry risks, just like regular operations, such as internal bleeding, blood clots, infection or damage to internal organs. Some babies experience minor breathing problems after a cesarean section. But because surgical techniques and pain management have improved, there are very few dangers associated with a caesarean section, and of course, giving birth to a healthy baby is much more important than trying to give birth naturally.

Reasons for emergency caesarean section

Most often, the indication for an emergency cesarean section is an unexpected abnormal position of the baby (if he is positioned with his legs or buttocks forward) or lateral presentation. Another reason is that it occurred before childbirth heavy bleeding and suspicion of premature abruption or placenta previa. The most common reason for caesarean sections is the risk that the baby may not survive the birth; if the child's cardiogram shows possible deviations, caesarean section will be safe and in a fast way give a birth to a baby.

Emergency caesarean section procedure

It may happen that everything will happen quickly and chaotically. Bottom part the abdomen will be prepared for surgery. Your stomach will be washed, your hair may be shaved, you will be given antibiotics and other fluids intravenously. The anesthesia will be either epidural (with a dose adjusted for caesarean section), or spinal, and maybe even general. If a woman has an epidural or spinal anesthesia, she will not feel anything from her toes to her chest; at the same time, she will be conscious, but will not feel the doctor making the incision. Most likely, she will not see this, because a special fence will be placed between her and the doctor, or maybe because the baby will be born very quickly.

Caesarean section by woman's choice

Some healthy women prefer caesarean section for the first birth - usually to avoid pain and possible complications during childbirth. Sometimes the doctor suggests a caesarean section so that the baby is born at a time that is more convenient for the woman, the doctor, or both.

This caesarean section is not done due to health problems. The reason is fear or a desire to avoid difficulties. And these are not the best reasons for a caesarean section.

However, women are increasingly choosing a caesarean section, and this raises a number of questions.

Is there a limit?

Many women successfully undergo up to three operations. However, each subsequent caesarean section is more difficult than the previous one. For some women, the risk of complications - such as infection or heavy bleeding - increases only slightly with each C-section. If you had a long and difficult labor before your first cesarean section, a repeat cesarean section will be physically easier, but the healing process will take just as long. For other women - who have large internal scars - each subsequent C-section becomes more and more risky.

Many women have a repeat cesarean section. But after the third, you need to weigh the possible risks and your desire to have more children.

Facing the unexpected

The unexpected news that you need a caesarean section can be a shock to both you and your partner. Your ideas about how you will give birth will suddenly change. To make matters worse, this news may come when you are already exhausted from long hours of contractions. And the doctor no longer has time to explain everything and answer your questions.

Of course, you will have concerns about what it will be like for you and your baby during surgery, but don't let those concerns overwhelm you completely. Most mothers and children undergo surgery safely with a minimum of complications. Although you may have preferred to have a natural birth, remember that the health of you and your baby is more important than how it is delivered.

If you have concerns about a planned repeat caesarean section, discuss this with your doctor and your partner. This will help you worry less. Tell yourself that you've already been through this once - and you can do it again. This time you will have an easier time recovering from surgery because you already know what to expect.

Caesarean section: partner involvement

If the caesarean section is not urgent and requires general anesthesia, your partner can come to the operating room with you. Some hospitals allow this. Some people like the idea, others may be afraid or disgusted. It is generally difficult to be present during an operation, especially when it is performed on a loved one.

If your partner decides to attend, they will be given a surgical gown. They can watch the procedure or sit at the head of the room and hold your hand. Perhaps his presence will make you feel calmer. But there are also difficulties: men sometimes faint, and doctors have a second patient who needs immediate help.

In most maternity hospitals, the baby is photographed and doctors can even take pictures for you. But in many places this is not allowed. Therefore, you should ask permission to take photos or videos.

Caesarean section by choice

Some women who have a normal pregnancy choose to give birth by Caesarean section even though they have no complications or problems with the baby. Some of them find it convenient to accurately plan the due date. If you're used to planning everything in your life down to the minute, waiting until the unknown day your baby arrives can seem impossible.

Other women choose a caesarean section due to fear:

• Fear of the birth process and the pain that accompanies it.
• Fear of damaging the pelvic floor.
• Fear of sexual problems after childbirth.

If this is your first child, childbirth is something unknown and it's scary. You may have heard horror stories about childbirth and women suffering from urinary incontinence when coughing or laughing after giving birth. If you've already had a vaginal birth and it didn't go smoothly, you may be worried about a repeat.

If you are inclined to choose a caesarean section, discuss this openly with your doctor. If your main motivator is fear, having a frank conversation about what to expect and attending a birthing school can help. If they start telling you about the horrors of childbirth, politely but firmly say that you will listen about it after your baby is born.

If your previous natural childbirth really was such a terrible story, remember that every birth is different and this time everything could be completely different. Think about why labor was so difficult and discuss this with your doctor or partner. Perhaps something needs to be done to make the experience more positive this time.

If your doctor agrees with your choice, the final decision is yours. If the doctor does not agree and will not perform a cesarean section, he may refer you to another specialist. Learn more about the pros and cons of both birth methods and discuss them with experts, but don't let fear be the deciding factor.

What should you consider?

Elective caesarean section is controversial. Those in favor say that a woman has the right to choose how she wants to give birth to her child. Those against it believe that the dangers of caesarean section outweigh any positive benefits. Currently in medical literature there is no convincing evidence that choosing a caesarean section is preferable. good medical practice generally rejects procedures - especially surgical ones - that do not provide undoubted benefit to the patient. In addition, there is little research on this issue.

Because everything is ambiguous, you may find that doctors' opinions differ widely. Some are ready to have surgery. Others refuse, believing that a caesarean section could be dangerous and thus contrary to their oath to do no harm.

The best way to make a decision is to collect as much as possible more information. Ask yourself why you are attracted to this option. Study the issue, consult with experts and carefully weigh the pros and cons.

Benefits and risks

Many experts believe that when modern level developments in surgical technology, a cesarean section is no more dangerous than a normal birth if this is your first child. If this is already the third birth, the situation is different. A caesarean section is more likely to cause complications than a normal birth. Here is a list of the benefits and dangers of this operation:

Benefits for the mother. Positive consequences Elective caesarean sections may include:

• Protection against urinary incontinence. Some women fear that the effort required to push the baby through the birth canal can lead to urinary or fecal incontinence and damage the muscles and nerves of the pelvic floor.
• Medical evidence has shown that women who have had a caesarean section have a lower risk of urinary incontinence in the first months after birth. However, there is no evidence that this risk is lower 2-5 years after birth. Some women also fear that natural childbirth may cause pelvic organ prolapse, which is when organs such as the bladder or uterus protrude into the vagina. There is currently no clear medical evidence linking cesarean section to a reduced risk of prolapse. pelvic organs. But an elective caesarean section is not a guarantee that problems with incontinence and prolapse will not arise at all. The baby's weight during pregnancy, pregnancy hormones, and genetic factors can weaken the pelvic muscles. Such problems can arise even in women who have never had children.
• Guarantee against emergency caesarean section. An emergency Caesarean section, which is usually done for difficult labor, is much more dangerous than an elective Caesarean section or a normal birth. With an emergency caesarean section, infections, internal organ damage and bleeding are more likely.
• Guarantee against difficult births. Sometimes difficult labor requires the use of forceps or vacuum suction. These methods are usually not dangerous. Just as with caesarean section, the success of their use depends on the individual skill of the doctor performing the procedure.
• Less problems with the child. In theory, a planned cesarean section can reduce the baby's risk of some problems. For example, the death of an infant during childbirth, pathology of childbirth due to incorrect position of the fetus, birth injuries - which is especially important when the child is very large - and inhalation of meconium, which occurs if the child begins to defecate before birth. The risk of paralysis is also reduced. However, it is important to remember that the risk of all these complications is quite low during normal childbirth, and a caesarean section is not a guarantee that these problems will not arise.
• Less risk of transmitting infections. With a caesarean section, the risk of transmission from mother to child of infections such as AIDS, hepatitis B and C, herpes and papilloma virus is reduced.
• Establishment exact date childbirth If you know exactly when the baby is coming, you can be better prepared. This is also convenient for planning the work of the medical team.

Risk to the mother immediately after surgery

There are certain inconveniences and dangers associated with a caesarean section. You will have to stay in the hospital longer. The average length of stay in the hospital after a cesarean section is three days, and after a normal birth it is two.

Increased chance of infection. Because this surgery, the risk of infection after a cesarean section is higher than after a normal birth.

Postoperative complications

Since caesarean section is abdominal surgery, there are certain risks associated with it, such as infection, poor healing of sutures, bleeding, damage to internal organs, and blood clots. There is also a higher risk of complications after anesthesia.

Reducing opportunity early establishment bonding with the baby and starting breastfeeding. For the first time after surgery, you will not be able to care for your child or breastfeed him. But this is temporary. You will be able to bond with your baby and breastfeed once you recover from surgery.

Payment for insurance

Your insurance may not cover elective C-sections, and they will cost more than a normal birth. Before making a decision, check whether this surgery is covered by your insurance.

Risks for the mother in the future

After a cesarean section, the following troubles are possible in the future:

Future complications. With multiple pregnancies, the likelihood of complications increases with each subsequent one. Repeat caesarean sections further increase this likelihood. Most women can safely have up to three surgeries. However, each subsequent one will be more difficult than the previous one. For some women, the risk of complications such as infection or bleeding increases only slightly. For others, especially those with large internal scars, the risk of complications with each subsequent caesarean section increases significantly.

Uterine rupture in the next pregnancy. Having a Caesarean section increases your risk of uterine rupture in your next pregnancy, especially if you decide to have a normal birth this time. The likelihood is not very high, but you should discuss this with your doctor.

Problems with the placenta. Women who have had a Caesarean section have a higher risk of placenta-related problems, such as breech, in subsequent pregnancies. In case of previa, the placenta closes the opening of the cervix, which can lead to premature birth. Placenta previa and other related problems caused by cesarean section greatly increase the risk of bleeding.

Increased risk of hysterectomy. Some placenta problems, such as accreta, where the placenta is too deeply and firmly attached to the wall of the uterus, may require removal of the uterus (hysterectomy) at birth or shortly after.

Damage to the intestines and bladder. Serious bowel and bladder injuries are rare during a caesarean section, but they are much more likely to occur than during a normal birth. Complications related to the placenta can also lead to bladder damage.

Dangers to the fetus

Dangers to the baby associated with a cesarean section:

• Breathing disorders. One of frequent violations in a child after a cesarean section, this is a slight breathing disorder called tachypnea (rapid shallow breathing). This happens when there is too much fluid in the baby's lungs. When a baby is in the womb, his lungs are normally filled with fluid. During a normal birth, movement through the birth canal compresses the chest and naturally pushes fluid out of the baby's lungs. With a caesarean section this compression does not occur and fluid may remain in the baby's lungs after birth. This results in increased breathing and usually requires pressurized oxygen to remove fluid from the lungs.
• Immaturity. Even slight immaturity can have a major negative impact on a child. If the due date is inaccurate and the caesarean section is performed too early, the baby may have complications associated with prematurity.
• Cuts. During a caesarean section, the baby may get cuts. But this happens rarely.

Decision-making

If your doctor doesn't accept your request for a C-section, ask yourself why. Physicians and surgeons are required to avoid unnecessary medical interventions, especially if they could be dangerous. The lack of scientific evidence to support elective caesarean section makes this procedure unnecessary. Although, from a physician's perspective, ease of scheduling, efficiency, and financial rewards favor a cesarean section, a physician you trust should be at least cautious about the procedure.

In many cases, cesarean section is performed according to absolute indications. These are conditions or diseases that represent mortal danger for the life of mother and child, for example placenta previa - a situation when the placenta blocks the exit from the uterus. Most often, this condition occurs in multipregnant women, especially after previous abortions or postpartum diseases.

In these cases, during childbirth or in the last stages of pregnancy, bright colors appear from the genital tract. bloody issues, which are not accompanied by pain and are most often observed at night. The location of the placenta in the uterus is determined ultrasound examination. Pregnant women with placenta previa are observed and treated only in an obstetric hospital. Absolute indications also include:

Umbilical cord prolapse: this situation occurs during the rupture of amniotic fluid with polyhydramnios in cases where the head is not inserted into the inlet of the small pelvis for a long time (narrow pelvis, large fetus). With the flow of water, the umbilical cord loop slips into the vagina and may even end up outside the genital slit, especially if the umbilical cord is long. The umbilical cord is compressed between the walls of the pelvis and the fetal head, which leads to impaired blood circulation between mother and baby. In order to promptly diagnose such a complication, a vaginal examination is performed after the rupture of amniotic fluid.

Transverse position of the fetus: a baby can be born through the vaginal birth canal if it is in a longitudinal (parallel to the uterine axis) position with its head down or pelvic end down towards the entrance to the pelvis. Transverse position of the fetus is more common in multiparous women due to decreased tone of the uterus and anterior abdominal wall, with polyhydramnios, and placenta previa. Usually, with the onset of labor, the fetus spontaneously turns into the correct position. If this does not happen and external techniques fail to turn the fetus into a longitudinal position, and also if the waters break, then childbirth through the natural birth canal is impossible.

Preeclampsia: this is a serious complication of the second half of pregnancy, manifested by high blood pressure, the appearance of protein in the urine, edema, maybe headache, visual impairment in the form of flickering “floaters” before the eyes, pain in upper sections abdomen and even cramps, which requires immediate delivery, since with this complication the condition of the mother and child suffers.

Premature abruption of a normally located placenta: Normally, the placenta separates from the wall of the uterus only after the baby is born. If the placenta or a significant part of it separates before the baby is born, sharp pains in the abdomen, which may be accompanied heavy bleeding and even the development of a state of shock. In this case, the oxygen supply to the fetus is sharply disrupted; urgent measures must be taken to save the lives of mother and baby.

However, most operations are performed for relative indications - such clinical situations in which the birth of a fetus through the vaginal birth canal is associated with a significantly greater risk for the mother and fetus than for a cesarean section, as well as for a combination of indications - a combination of several complications of pregnancy or childbirth, which individually may not have significant, but in general pose a threat to the condition of the fetus during vaginal delivery.

An example is breech presentation of the fetus. Birth in breech presentation is considered pathological, because There is a high risk of injury and oxygen deprivation of the fetus during vaginal delivery. The likelihood of these complications especially increases when a combination of breech presentation of the fetus with its large size (more than 3600 g), distortion, excessive extension of the fetal head, and anatomical narrowing pelvis

Primipara age over 30 years: age itself is not an indication for caesarean section, but in this age group often meets gynecological pathology - chronic diseases genital organs, leading to long-term infertility and miscarriage. Non-gynecological diseases accumulate - hypertonic disease, diabetes, obesity, heart disease.

Pregnancy and childbirth in such patients occur with a large number of complications, with great risk for the child and mother. Indications for caesarean section in women in late reproductive age with breech presentation and chronic hypoxia fetus

Uterine scar: it remains after removal of myomatous nodes or suturing of the uterine wall after perforation during an artificial abortion, after a previous cesarean section. Previously, this indication was absolute, but now it is taken into account only in cases of defective scar on the uterus, in the presence of two or more scars on the uterus after cesarean section, reconstructive operations for uterine defects and in some other cases.

It allows you to clarify the condition of the scar on the uterus ultrasound diagnostics, the study must be carried out from 36-37 weeks of pregnancy. On modern stage The technique of performing the operation using high-quality suture material contributes to the formation of a healthy scar on the uterus and gives a chance for subsequent births through the natural birth canal.

There are also indications for caesarean section that arise during pregnancy and childbirth. Depending on the urgency of performing a cesarean section, it can be planned or emergency. Caesarean section during pregnancy is usually performed as planned, less often - in in case of emergency(bleeding due to placenta previa or premature abruption of a normally located placenta and other situations).

A planned operation allows you to prepare, decide on the technique of performing it, anesthesia, as well as carefully assess the woman’s health status, and, if necessary, carry out corrective therapy. During childbirth, a caesarean section is performed for emergency reasons.

Also, a woman may have to face some difficulties when breastfeeding, which most often occur after a planned cesarean section. Surgical stress, blood loss, late breastfeeding due to adaptation disorders or drowsiness of the newborn are the causes of late development of lactation; In addition, it is difficult for a young mother to find a position for feeding; if she sits, the baby puts pressure on the seam. However, this problem can be overcome by using a lying position for feeding.