The cesarean section operation is one of the most ancient operations. It is a surgical delivery: the baby is removed from the uterine cavity through an incision in the wall. This intervention became widespread only in the mid-twentieth century, after the introduction of antibacterial agents into practice.

8 direct indications for caesarean section - in what cases is caesarean section prescribed?

A caesarean section can be performed as in in a planned manner, and by emergency indications. for the patient, only the doctor decides.

In total, there are 8 main absolute indications for intervention:

1. Placenta previa
   In this case, the exit from the uterus is closed by a low-lying placenta. This location of the “baby spot” is diagnosed in advance during an ultrasound scan in late pregnancy.
2. Premature placental abruption
   This complication threatens the life of the fetus due to the resulting hypoxia, and the life of the mother due to possible heavy bleeding.
3. Threatened uterine rupture
   Most often, the cause of this complication is failed scar on the uterus after previous operations. Also, a rupture can occur as a result of thinning of the organ wall after numerous births or abortions.
4. Absolutely narrow pelvis(III-IV degrees of narrowing anatomically or clinically)
   In this case, there is a clear discrepancy between the size of the pelvis and the presenting part of the fetus: the child cannot pass through the natural birth canal even if additional obstetric techniques are performed.
5. Mechanical obstacles in the birth canal
   Most often, uterine fibroids in the isthmus area interfere with birth. This indication in most cases is detected during a standard examination of a pregnant woman, and allows you to plan in advance C-section.
6. Severe gestosis in the second half of pregnancy
   Childbirth can threaten a woman’s life, as vascular complications are likely.
7. Severe varicose veins of the vagina and perineum
   Childbirth through natural ways can lead to thrombosis, embolism, bleeding.
8. Some comorbidities
   Complicated myopia high degree, heart failure, epilepsy, vascular and blood system diseases.

Absolute indications for cesarean section make it the only possible choice for delivery.

There are also relative indications for surgical delivery . Doctors carefully evaluate everything possible risks for mother and child before deciding on surgery.

IN modern world the choice in favor of a cesarean section is being made more and more often, as progress in medicine makes the operation quite safe.

Relative indications for cesarean section

• Relatively narrow pelvis (anatomical narrowing of degrees I-II).
• Incorrect position of the fetus (transverse, pelvic).
• Large fruit size.
• Developmental defects of the uterus.
• Age over 30 years in a primigravida.
• Post-term pregnancy.
• Long-term history of infertility.

If a woman has a combination of several complications, then the decision in favor of surgery is natural.

How a caesarean section is performed - operation plan, stages, video

Strict adherence to the generally accepted surgical technique allows you to reduce intervention time to a minimum and reduce blood loss.

Caesarean section operation plan:

You can find a video of a caesarean section on the Internet.

All steps of a caesarean section take about half an hour . From the start of the operation to the birth of the newborn, there is a only 5-7 minutes .

Caesarean section, in the vast majority of cases, is performed under regional anesthesia (epidural, spinal). The woman is conscious. Sometimes anesthesia may be performed during an emergency caesarean section.

Recovery after caesarean section – postoperative period

First day after the operation the woman is in the ward intensive care under constant medical supervision.

From the second day She is transferred to the postpartum ward. From now on, early activation is recommended. The woman gets out of bed, walks around the department, and takes care of the baby as best she can.

Nutrition in the postoperative period limited. The first day you can only drink water, then on days 2-3 add chicken broth, fruit juice, low-fat cottage cheese. The body's need for nutrients satisfied by intravenous administration glucose solution, special parenteral mixtures. Only on days 4-5 the patient’s menu expands significantly.

Restoring bowel function happens gradually. Independent stool occurs 3-5 days after surgery.

Every day during the week postoperative suture treatment , changing the bandage. Catgut threads are removed 7-10 days after surgery.

Caesarean section is not a contraindication to breastfeeding . Due to the fact that the hormonal background after surgery is somewhat different compared to natural childbirth, milk appears a little later (on days 3-5).

In the postoperative period some complications may develop . Doctors monitor their appearance in the maternity hospital until the patient is discharged. Further observation is carried out by a gynecologist at the place of residence.

Possible complications of the postoperative period:

• Pain syndrome.
• Adhesive process in the abdominal cavity.
• Infectious complications in the uterus and abdominal wall.
• Anemia.
• Postoperative pneumonia.
• Postoperative thromboembolism, etc.

In order to recovery period The procedure went well, the woman should follow the doctors’ recommendations and regularly visit the gynecologist.

Within 2 months The patient should not be sexually active, lift weights, or engage in physical exercise.

The next pregnancy is not advisable before in 2-3 years after caesarean section.

• Mom, how are babies born?” asks four-year-old Nastya.
• “The uncle cuts the belly, takes out the baby doll and that’s it,” the mother answers, deciding not to initiate her young daughter into all the intricacies of a real birth. But there is still some truth in her story, because huge amount babies on the planet were born this way - through a caesarean section.

Why does a woman have a caesarean section? Firstly, there are cases when this is required by conditions that have arisen spontaneously, related to the health of the mother or baby, or some emergency situations. Secondly, there are planned operations, the need for which women know long before giving birth. We will talk about them in this article.

How should you prepare for a planned caesarean section?

First of all, morally. A woman should, throwing away all emotions and worries, calm down and tune in only to the best. You need to trust your doctor (after all, for him, unlike the patient, this is not the first, but a “new” operation) and rejoice in the fact that very soon the long-awaited baby will be snoring sweetly next to you. If, nevertheless, the worries are very strong, you should talk to your husband, girlfriend, or even a psychologist.

When the date of the operation is already very close, 1-2 weeks in advance, the expectant mother, having collected everything she needs, goes to maternity hospital. This is necessary in order to thoroughly conduct examinations to assess the condition of the fetus (ultrasound and cardiotocography), as well as the mother (blood and urine tests, degree of vaginal cleanliness (smear test)). In addition, even if a woman has already done similar tests, her blood will still be taken to determine her blood type and Rh factor. If doctors find any abnormalities, the woman will be treated with medication.

The doctor will also set the exact date of the operation. As a rule, this day is chosen as close as possible to the expected date of birth, taking into account the condition of the woman and the fetus, as well as the wishes of the expectant mother.

Sometimes, if nothing interferes and the condition of both the mother and the child is satisfactory, so as not to be in the maternity hospital long time, the examination can be completed before hospitalization, and you can be admitted to the hospital the day before a planned cesarean section or even directly on the day of the operation.

What happens on the day of a planned caesarean section?

As a rule, such operations are carried out in the morning. Less often - during the day. Therefore, in the evening, a woman should take a shower and, if necessary, shave her pubic hair. The food a woman takes for dinner should be light. You can't eat at all in the morning. In the hospital, the nurse will help you, as before any abdominal surgery, to cleanse the intestines.

After this, an anesthesiologist will have a conversation with the woman, who will talk about what and how will happen to her during the operation in terms of pain relief. Most likely, this will be spinal anesthesia, that is, when the operation is performed while the woman is conscious. But, if there are any contraindications, the patient will be offered general anesthesia. Consent for surgery and certain type anesthesia is recorded in writing.

How is a planned caesarean section performed?

Before entering the operating room, the woman is given shoe covers and a cap, and is also asked to wear elastic bandages. The latter are necessary to protect a woman from developing thrombosis. A woman lies naked on the table. First, the anesthesiologist administers medicinal product, then the medical staff puts in an IV and connects a machine to measure blood pressure. A catheter is also installed to drain urine. When all this is ready, the place where the incision will be made is treated with an antiseptic drug.

Since a screen is placed between the woman’s face and the operation site, next to her, if the woman is conscious, there may be a loved one: husband, mother, friend. True, this practice is not allowed in all maternity hospitals, so the possibility of having a “support group” present at such births must be clarified in advance.

The procedure for removing the child itself lasts no more than 10 minutes. This time is enough to cut the abdominal wall and uterus, remove the baby and cut the umbilical cord. Then the “cleaning” begins. The doctor separates the placenta, examines the uterine cavity and stitches it up. Then he goes to the abdominal wall. This seam is processed and a bandage is applied. On top is an ice pack. This will reduce bleeding and stimulate uterine contractions. At this point the operation ends, and the new mother is transferred to the intensive care unit.

Postoperative period

In the intensive care ward, a woman is under close attention doctors. In order to quickly return to normal and avoid various complications, she is given various drugs. First of all, these are antibiotics and various painkillers. The latter begin to be administered as soon as the anesthesia wears off. To normalize functioning gastrointestinal tract, and also better reduction the muscle tissue of the uterus also provides the necessary medications. And to replenish fluid loss, saline solution is injected into the new mother’s body. At first, a woman may feel pain in the lower abdomen, general weakness, and dizziness. Chills and increased thirst are possible.

In the first 6-8 hours, the patient is not allowed to not only get up, but even sit down. After this time, with the help of relatives or medical staff, you can sit up on the bed. not particularly chic. At first, on the first day, you can only drink water. Already for the second time you can treat yourself to low-fat chicken broth(during cooking, the first water is drained) and liquid porridges (oatmeal is especially suitable). So-called “normal” food can be consumed from the third week, but for now you need to love dietary food.

A day later, the woman is transferred from the intensive care ward to the postpartum ward. There she is with the baby. If there are no complications, the mother can easily cope with simple tasks: feeding the baby, washing him, changing him. But, even if you feel good, you still shouldn’t overwork.

Approximately 2-3 days after the planned one, pain relief is stopped. But the seam area is carefully treated every day disinfectant solution. Sometimes a woman begins to have intestinal problems. In such cases, the doctor will prescribe laxatives. This can be either a regular enema or glycerin suppositories. After 4-6 days, the woman needs to undergo blood and urine tests, undergo an ultrasound scan of the scar, uterus, as well as appendages and adjacent organs. The gynecologist will conduct an external examination to make sure everything is in order. If the health workers have no complaints about the health of the mother and baby, they will be discharged home approximately.

Woman's behavior at home after PCS

While at home, such a woman especially needs help, because she is simply contraindicated to do a lot of work. You especially need to think about an assistant if there is already a child in the family. If the eldest is 2-3 years old, he will demand his mother’s attention and care with extreme persistence. A woman should try to pay attention to her first child, avoiding picking him up. It is especially contraindicated to be nervous.

When switching to a more familiar diet, you still need to monitor your diet. In this regard, you should consult not only your doctor, but also your pediatrician.

After a planned caesarean section, you can shower after 1-2 weeks. But a bath (not a hot one!) - only after 1.5 months.

It is necessary to explain to the husband that, for at least 2 months, large physical activity and sexual intercourse. Last but not least, you need to think about contraception. The next pregnancy can be planned no earlier than in 2 years.

Especially for Olga Rizak

From Guest

Hello everyone, my first caesarean section was an emergency, although I was preparing to give birth, I went through contractions myself, then the doctor came, looked at the chair and said urgently to the operating table - the umbilical loops had prolapsed, they held it for me with their hands, the operation went quickly, the anesthesia was good, but the postoperative period was difficult, it was difficult for everything to heal ....then 2 years later I had a planned cesarean section due to the fact that the speed was small between the first and second... unlike the first, everything healed quickly and very well... and now another 4 years have passed, now I’m waiting for the 3rd I think the baby will also have a planned cesarean section... but of course it’s better to give birth yourself, especially if you don’t have any complications...))))

Natural childbirth is a complex physiological process. And, unfortunately, not every woman is able to endure it without severe consequences. How is a caesarean section performed?

Caesarean section: from preparation for surgery to discharge from the hospital

What is a planned caesarean section? This is a surgical procedure to remove the baby through an incision in the uterus due to the inability to give birth on your own. The woman in labor is examined and goes to the maternity ward in advance.

The doctor who will guide you throughout your pregnancy will tell you.

As a rule, the operation is scheduled for 40 weeks. During this period, the fetus gains sufficient weight and begins to breathe.

If a cesarean section is performed a second time, it is scheduled a little earlier to prevent contractions. Then there will be no complications during the operation.

A woman does not have to go to the hospital in advance. She can wait at home for the due date if she and the child do not have any negative indications.

When a caesarean section is performed can occur emergency situation and blood may be needed, so before the operation the woman donates plasma. In addition, all necessary tests are performed.

You cannot eat or drink directly on the day of the event. It is also necessary to install a catheter in the ureter.

The operation cannot be performed without anesthesia. The woman in labor is offered two options for anesthesia: general and epidural, when she can see and hear the birth of the baby.

How long does a caesarean section last? , depends on the woman’s condition and the method of operation.

Most often, a transverse incision is made on the abdominal wall and uterus. This method allows the operation to be performed much faster, and the patient will lose less blood.

The scar is effectively tightened, becomes rich and looks aesthetically pleasing.

If there are no complications, the woman is discharged on the 4th day after surgery.

At home, she should observe and care for her stitch. Maintain simple body hygiene.

If suppuration occurs, pain and other discomfort, it is better to immediately contact the clinic.

Indications for caesarean section

When for some reason a mother cannot give birth to a child herself, she is prescribed an operation.

Can be observed on the mother's side when labor activity threatens her life, and from the child.

Preparation for a planned caesarean section begins when symptoms are present:

• • if the placenta is the placenta, its entrance is blocked, this is fraught with bleeding and serious consequences for the woman and child;
  • . IN in good condition this should happen after childbirth;
  • weak scar on the uterus after various types of surgical interventions. An ultrasound of the scar is performed to diagnose its condition. Uneven contours connective tissue and scar thickness less than 3 mm are indications;
  • several operations. In this case, natural birth is contraindicated due to the possibility of uterine rupture during childbirth;

• • anatomical structure of a woman. II-IV degrees;
  • the presence of neoplasms and pelvic defects that interfere with the normal passage of the child;
  • the presence of pathology and a large fetus, starting from 4 kg;
  • V acute form;
  • , which cannot be treated, causes diseases severe symptoms with consequences for the baby and mother;
  • , vessels with pronounced manifestations, myopia;
  • cicatricial narrowings that interfere with the normal passage of the child;

• • plastic surgery;
  • severe perineal rupture in previous births;
  • , during natural childbirth bleeding may occur;
  • transverse presentation of the fetus;
  • fused double;
  • finding a fetus weighing more than 3600 g and less than 1500 g in the pelvis;
  • artificial insemination of the mother in the presence of other complications;
  • hypoxia or malnutrition of the fetus in chronic form;
  • incompatibility ;
  • carrying a child longer than expected in combination with another illness;
  • cancerous tumors;
  • with external blisters on the genitals.

Also present are those that develop during labor.

How is the operation performed and what happens after it?

The operation begins with anesthesia. Possible general anesthesia, with local, a special partition is placed on the chest so that the process, which lasts from 20 to 40 minutes, is not visible.

Remove the baby immediately, no later than 5 minutes.

How is a caesarean section performed?

• • the abdominal cavity is cut, then the uterus and bladder;
  • the doctor immediately removes the baby;

• while the midwife holds the baby, the doctor squeezes out the place;
• with special threads for operations that spontaneously resolve, the uterus is sutured. Then the abdominal cavity;
• the uterus must actively contract; for this, cold is placed on the stomach;
• The woman in labor is taken to her room.

After surgery you need recovery. A woman is prescribed painkillers because she is experiencing pain.

Antibiotics and anti-bloating medications are also possible. Constipation and gas formation after cesarean section are quite common.

After surgery, a diet is required. On the first day, only water is allowed. Then only light and liquid food.

If bowel function has been established for 3 days, the mother switches to normal nutrition, which is allowed during breastfeeding.

Is natural childbirth possible after cesarean?

After two months, the body fully recovers after the operation. Intimate relationships are allowed again, but doctors advise using protection for a couple more years.

Afterwards you can become pregnant and possibly give birth on your own. It all depends on how well the scar has healed, what condition the uterus is in, and so on.

During pregnancy, the doctor will monitor the condition of the mother and fetus.

In the absence of contraindications, the likelihood of natural childbirth is high.

Pros and cons

Of course, the most important advantage is the birth of a baby, while natural childbirth is impossible.

In addition, we can highlight:

1. The genitals remain intact, there are no tears or seams.
2. The genitourinary system is not affected.
3. Childbirth occurs faster than the normal birth process.

Except positive points Mom needs to be prepared for negative consequences, namely:

1. A feeling of alienation towards the baby, the maternal instinct can wake up much later than during natural childbirth.
2. Recovery after surgery is longer.
3. Physical activity is excluded; for the first days you cannot hold the child in your arms.
4. Scar on the body.
5. Possible pain in the stitches.

Important! If you're thinking about having a surgical birth, talk to your doctor and learn all about cesarean section. Do not rule out the possibility of a natural birth just because of pain.

Consequences of the operation

The consequences after cesarean section for the mother include:

• stitches after surgery. Possible complications, discrepancies between the rectus muscles;
• restoration of menstruation. If the operation went without complications, then menstrual cycle quickly becomes the same as it was, otherwise it takes a long time;
• sex life at best, you can start after 2 months, with contraception. In the worst case, with the permission of the gynecologist after consultation. Abortions and other operations on the uterus cannot be performed for 2-3 years;
• full physical activity can be started no earlier than after 8 weeks;
• After surgery, various drugs and antibiotics are often injected. They influence breast milk, so babies are not immediately put to the breast. Subsequently, it is difficult for the mother to establish lactation.

For a child, surgery is also stressful. It does not pass through the birth canal, so it is believed that its adaptation occurs much later.

In rare cases, anesthetic substances enter the child’s bloodstream, which inhibit nervous system newborn and develop some diseases.

Complications

The most common complications after childbirth surgery:

• the appearance of adhesions;
• bleeding;
• inflammatory process, increase in temperature;
• purulent discharge on the sutures;
• swelling and redness, scar separation;
• the appearance of compactions.

Some complications can be avoided by following a postoperative regimen. But most of them depend on a successful caesarean section.

Useful video: caesarean section - pros and cons

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. IN lately 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 its first look at the world through the incision that is made during the opening of the uterus. 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 cases 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, all possible risks should be discussed in detail so that you really feel well prepared. Therefore, do not hesitate to ask again if something is not clear to you.

TO medical indications for caesarean 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

Currently local anesthesia is a universally 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 real danger for a child. In other cases it is obvious serious danger. 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 transfer the child to correct position, 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 have serious problems with health. A caesarean section may be done if you have diabetes, sick 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 are having a multiple pregnancy. About half of twins are born by Caesarean section. Twins can also be born in the usual way, depending on the weight, position and duration 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 admitted to the hospital and will be 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 is great danger for a child. 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 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 common reason problems with the heart, 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 not necessary. 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 they will do spinal anesthesia. Later, already 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, as well as for better wound healing, a skin incision is made directly above the symphysis (pubic joint) along a vertical line, the length of the incision is 10 cm. The subcutaneous adipose tissue is divided in 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 separation and removal of the placenta operating team sews up 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

Caesarean section is major surgery. 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 cesarean 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 small - 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 cause breathing problems and low weight at birth.
• 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 unconscious, may be used for an 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 test. 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. Anesthesiologist will wipe your back antiseptic solution and will give you a painkiller 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 napkins. A drape will be placed under your 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. Once the uterus is open, the next step is to open the membranes so that the baby 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 your stitches, the amount of urine you produce, and postpartum bleeding. 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. When your digestive system will start working normally again, you will be able to drink more fluids or even eat some easy to digest food. 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. Hold correct posture while 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 it. physical exercise. But don't go too hard. Hiking and swimming - best choice. 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 to perform an emergency operation or a secondary caesarean section is made only when there is really no other option, since this is associated with a high risk for the pregnant woman (intubation, bleeding, damage to the neighboring organs, infection).

Indications for emergency surgery:

• acute hypoxia 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 have a natural birth, choosing doctors who have had few cesarean sections in their practice, taking classes for pregnant women, playing sports during pregnancy, trying to gain just the right weight, sometimes even hiring a doula to be nearby 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 very important to remain forward-thinking. Caesarean sections do carry risks, just like regular operations, for example, they can start internal bleeding blood clots, infection or damage internal organs. Some babies experience minor breathing problems after a caesarean 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 heavy bleeding that occurred before childbirth and suspicion of premature detachment 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 birth to a child.

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 caesarean 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 developed 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. What's worse, this news may come when you're already exhausted long hours 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 birth really was such a horror story, remember that every birth is different and this time it 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 a controversial thing. Those who are in favor say that a woman has the right to choose how she wants to give birth to her child. Those who are against believe that the dangers of a caesarean section outweigh any positive aspects. On at the moment V 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 with the current level of development of 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 of an elective caesarean section 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. Baby's weight during pregnancy, pregnancy hormones and genetic factors may 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 a baby 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 began 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 it is a surgical procedure, the risk of infection after a caesarean 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 the possibility of early connection with the baby and initiation of 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 covers 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 baby after a cesarean section, there 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 normal childbirth, progress through birth canal squeezes 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.

Making a decision

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

Childbirth is a process for which a woman’s body is fully adapted. But sometimes, for one reason or another, natural childbirth can pose a danger to the health or even the life of both the child and the mother. In such cases, surgical delivery is performed - a caesarean section.

Caesarean section may be planned And urgent. A planned caesarean section is prescribed during pregnancy: according to indications or at the request of the expectant mother. The decision for an emergency caesarean section is made if complications arise already during childbirth, or dangerous situations requiring urgent intervention (acute fetal hypoxia, placental abruption, etc.).

Indications for caesarean section are divided into absolute And relative. Absolute births are those on the basis of which the doctor unconditionally prescribes an operation, and natural childbirth is out of the question. Such indications include the following.

Narrow pelvis of a woman in labor. Because of this anatomical feature a woman simply will not be able to give birth on her own, as there will be problems with the passage of the child through the birth canal. This feature is revealed immediately upon registration, and the woman is prepared and prepared for operative delivery from the very beginning;

Mechanical obstruction, preventing the fetus from passing naturally. It could be:

• defragmentation of the pelvic bones;
• ovarian tumors;
• placenta previa (the placenta is not located where it should be, blocking the fetus’s path to the cervix);
• isolated cases of uterine fibroids.

Probability of uterine rupture. This indication for cesarean section occurs if there are any sutures or scars on the uterus, for example, after previous cesarean sections and abdominal surgeries.

Premature placental abruption. The pathology is expressed in the fact that the placenta is separated from the uterus even before the onset of labor, depriving the baby of nutrition and access to oxygen.

Relative indications for caesarean section suggest the possibility of natural childbirth, but with a risk for the baby or mother. In such a situation, all individual factors are carefully weighed and considered. Relative indications include:

• visual impairment in the mother (this is due to the high load on the eyes when a woman giving birth pushes);
• kidney failure;
• cardiovascular diseases;
• pathologies of the nervous system;
• oncological diseases, etc.

As you can see, these diseases are not related to pregnancy, but the intense stress on the mother’s body during childbirth can cause various complications.

In addition, the indication for caesarean section is gestosis– disturbance in the blood flow and vascular system.

To the testimony threatening the child's health include various sexually transmitted infections in the mother, since the child can become infected while passing through the birth canal.

As for an emergency caesarean section, it is prescribed if labor is very weak or has stopped altogether.

How is a caesarean section performed and what happens before and after it?

1. At what date do I perform a planned caesarean section? The date of the operation is determined individually and depends on the condition of the woman and child. If there are no special indications, then a caesarean section is scheduled for the day closest to the expected date of birth. It also happens that the operation is performed with the onset of contractions.

2. Preparation. Typically, an expectant mother awaiting a planned cesarean section is placed in the maternity hospital in advance in order to conduct an examination to determine that the baby is full-term and ready for birth, and to monitor the woman’s condition. As a rule, a caesarean section is scheduled for the morning, and the last meal and drink is possible no later than 18 hours the night before. The stomach of the patient must be empty to prevent its contents from entering the respiratory tract. In the morning, on the day of surgery, hygiene procedures: do an enema, shave the pubis. Next, the woman changes into a shirt and is taken or taken on a gurney to the operating room.

Immediately before the operation, anesthesia is administered, a catheter is inserted into the bladder (it will be removed a couple of hours after the operation), the abdomen is treated disinfectant. Next, a small screen is installed in the woman’s chest area so that she cannot see the progress of the operation.

3. Anesthesia. There are two types of anesthesia available today: epidural and general anesthesia. Epidural anesthesia involves inserting a thin tube through a needle into the exit site of the nerve roots. spinal cord. This sounds quite scary, but in fact, the woman experiences discomfort for only a few seconds when the puncture is performed. Then she stops feeling pain and tactile sensations in the lower part of the body.

General anesthesia. This type of anesthesia is used in in case of emergency when there is no time to wait for the effects of epidural anesthesia. First, a so-called pre-anesthesia drug is injected intravenously, then a mixture of anesthetic gas and oxygen is supplied through a tube in the trachea, and lastly a drug that relaxes the muscles is injected.

4. Operation. After the anesthesia has taken effect, the operation begins. How is a caesarean section performed? First, an incision is made in the abdominal wall. During the operation, 2 types of incisions are possible: longitudinal (vertical from the pubis to the navel; done in emergency cases, because it is faster to reach the baby through it) and transverse (above the pubis). Next, the surgeon spreads the muscles, makes an incision in the uterus and opens amniotic sac. Once the baby is delivered, the placenta is removed. Then the doctor first sews up the uterus with threads, which dissolve after a few months - after the tissues have grown together, and then the abdominal wall. A sterile bandage is applied and ice is placed on the abdomen so that the uterus contracts intensively, as well as to reduce blood loss.

Typically the operation takes from 20 to 40 minutes, with the baby being delivered within 10 minutes, or even earlier.

5. Postoperative period. For another day after a cesarean section, the woman remains in the intensive care unit or intensive care unit so that doctors can monitor her condition. Then the new mother is transferred to a regular ward. To reduce pain she is prescribed painkillers, drugs for contraction of the uterus and normalization of the gastrointestinal tract. Sometimes antibiotics are prescribed, but this is decided on an individual basis. Gradually, the doses of medications are reduced and they are abandoned altogether.

If the operation went without complications, stand up for the first time a woman is allowed after at least 6 hours. First you need to sit on the couch, and then stand for a while. Under no circumstances should you strain or experience even minimal physical exertion, as this may cause the seams to split.

It is highly advisable to purchase in advance postoperative bandage, wearing it will greatly ease movement and discomfort in the first days after a cesarean section, especially when you need to lie down or get out of bed.

On the first day after surgery, it is recommended to drink only still water, and you will need to drink a lot to replenish fluid loss. You will also need to empty your bladder on time. It is believed that full bubble prevents uterine contraction.

On the second day, liquid food (porridge, broth, etc.) is allowed. If everything is in order, then from the third day after surgery you can return to the normal diet recommended for nursing women, however, after giving birth, many mothers complain of constipation, and in order to alleviate the situation, it is advisable not to eat solid food for several days.

This problem can also be solved with enemas, suppositories (usually suppositories with glycerin are used; when you put such a suppository, try to lie down for a while) and eating foods that have a laxative effect (kefir, dried fruits, etc.).

7. After discharge from the maternity hospital. For the first month and a half after a cesarean section, you will not be allowed to take a bath, swim in the pool or reservoirs, you will only be able to wash in the shower.

Active physical activity must be postponed for at least two months. At this time, you will need the help of relatives and husband. Although completely abandon physical activity it is forbidden. Ideally, after surgery, the doctor should tell you about exercises that will speed up the recovery of the body, at least you can ask about it yourself.

Resume sex life It is recommended no earlier than one and a half months after surgery. Be sure to take care of contraception. Experts advise planning your next pregnancy only after 2 years, during which time the body will fully recover and be able to ensure the full development of the unborn baby.

Is natural childbirth possible after cesarean?

Contrary to popular belief, a woman can give birth to a child herself if her previous pregnancy ended with a caesarean section. If the sutures have healed, no complications have arisen, reproductive system has successfully recovered and there are no indications for another cesarean section.

Pros and cons of caesarean section

Surgical delivery is possible both for medical reasons and for at will women. However, doctors usually oppose such a decision, dissuading the expectant mother from surgery. If you are also considering surgery, provided that both normal birth are not contraindicated for you, carefully weigh all the positive and negative aspects question.

Pros of caesarean section

• During the operation, injuries to the genital organs, such as ruptures and incisions, are impossible;
• Delivery by caesarean section takes a maximum of 40 minutes, while with natural childbirth a woman is often forced to endure contractions for several hours.

Cons of caesarean section

• psychological aspect: mothers complain that at first they do not feel a connection with the child, they do not have the feeling that they gave birth to him themselves;
• limitation of physical activity and pain at the suture site;
• scar. Read more about this in the article

Consequences of a caesarean section

The consequences can be divided into 2 types: for mother, in connection with surgical intervention, And for a child, due to unnatural birth.

Consequences for mom:

• pain in the stitches, resulting in a scar on the abdomen;
• restrictions on physical activity, inability to take a bath and resume intimate relationships for several months;
• psychological state.

Consequences for the child:

• psychological; There is an opinion that children born through surgery adapt less well to the world around them. It is worth noting that the opinions of scientists on this matter differ, and the experience of mothers shows that in most cases, fears about children falling behind in mental development are far-fetched, and there is no need to worry about this. However, one cannot deny the fact that the child does not follow the path prepared for him by nature, which helps him prepare for a new environment of existence;
• the possibility of residual amniotic fluid in the lungs of the newborn;
• penetration of anesthetic drugs into the child’s blood. Read more about the consequences of a caesarean section and watch the video in

Complications after caesarean section

Complications after anesthesia. If you are having a Caesarean section with an epidural, here's what you need to remember. After the operation, the catheter with an anesthetic is left in the back for some time, and drugs are injected through it to numb the sutures. Therefore, after the operation is completed, the woman may not feel both or one leg, and may not be able to move.

There are cases when, when a woman is transferred to the couch, her legs get tucked in, and since the operated woman does not feel anything, this fact may for a long time remain unnoticed.

What does this mean? Due to the limb being in an unnatural position, it develops long-term positional compression syndrome. In other words, soft tissues are without blood supply for a long time. After neutralization of the compression, shock, severe swelling, and impairment develop motor activity limbs and, not always, but quite often, renal failure, all this is accompanied by severe pain that continues for several months.

Be sure to ask the maternity hospital staff to check that you were placed on the couch correctly. Remember that compartment syndrome can sometimes be fatal.

In addition, anesthesia is often accompanied by headaches and back pain.

Complications after caesarean section

One of the most common complications is adhesions. Loops of intestines or other abdominal organs grow together. Treatment depends on individual characteristics women: the matter may be limited to ordinary physical procedures or may lead to the need for surgical intervention.

Endometritis- inflammatory process in the uterus. To prevent it, a course of antibiotics is prescribed immediately after surgery.

Bleeding also refer to complications after cesarean section and, in rare cases, lead to the need to remove the uterus.

Complications may also arise during the process. healing of sutures, up to their divergence.

So, a caesarean section is a guarantee of life for mother and child in cases where natural childbirth is impossible or dangerous. Every year this operation is improved, and the number of complications decreases. However, the human factor cannot be excluded, therefore, if you know about the main features of the operation and post-operative care, this will help you avoid complications and enjoy the joys of motherhood without unnecessary grief.

Video of a caesarean section

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