Is a caesarean section prescribed? Caesarean section without indications: does the woman in labor have the right to choose?

Natural childbirth is the usual way of birth provided by nature. But sometimes, for a number of reasons, giving birth naturally can be dangerous for the life and health of a woman and her child. In this case, doctors solve the problem surgically and resort to a method such as a planned caesarean section. This is the name for a delivery operation, common in obstetric practice. Its meaning is that the child is removed through an incision in the uterus. Despite the fact that it is performed frequently and saves the lives of thousands of children, complications after it also occur.

Sometimes the operation is performed urgently. Emergency surgical delivery is resorted to if complications arise during natural childbirth that threaten the life and health of the child or mother.

A planned caesarean section is an operation that is prescribed during pregnancy. It is carried out only for serious indications. When is a planned caesarean section prescribed, at what time is the operation performed and how to avoid complications?

Indications are divided into absolute, that is, those in which the possibility of spontaneous childbirth is excluded, and relative.

List of absolute indications:

fruit whose weight exceeds 4,500 g;
previous cervical surgery;
the presence of two or more scars on the uterus or failure of one of them;
deformation of the pelvic bones due to previous injuries;
breech presentation of the fetus, if its weight exceeds 3600 g;
twins, if one of the fetuses is in a breech position;
the fetus is in a transverse position.

List of relative indications:

uterine fibroids;
high myopia;
diabetes;
the presence of malignant or benign tumors;
weak labor activity.

As a rule, a decision on a planned cesarean section is made if there is at least one absolute indication or a combination of relative ones. If the indications are only relative, it is necessary to weigh the risk of surgery and the risk of complications that may occur during natural childbirth.

When is the operation performed?

At what time a planned caesarean section is performed is decided by the doctor in each specific case, but there are still certain recommended limits. It is necessary to compare the date of the last menstruation, how many weeks the fetus is developed, and what condition the placenta is in.

Based on this information, they decide when exactly to start delivery.

Sometimes doctors in the maternity hospital, when asked by a patient when a planned caesarean section is performed, answer that it is advisable to wait until the first light contractions begin. In this case, the woman is hospitalized in the maternity hospital in advance so as not to miss the onset of labor.

A pregnancy is considered full term when it reaches 37 weeks. Therefore, it is too early to perform surgery before this time. On the other hand, after 37 weeks, contractions can start at any time.

They try to bring the date of a planned caesarean section as close as possible to the expected date of birth. But, since by the end of the term the placenta ages and begins to perform its functions worse, in order to prevent it from occurring in the fetus, the operation is prescribed for a period of 38-39 weeks.

It is at this time that the woman is hospitalized in the antenatal department of the maternity hospital to undergo all the necessary tests before the operation.

The surgical method of childbirth is not a contraindication to repeated pregnancies. But if a woman already has a scar on the uterus, it means that the second child will be born in the same way. Monitoring the pregnant woman in this case is especially careful.

A second planned cesarean section is also performed at 38-39 weeks, but if the doctor has doubts about the consistency of the first scar, he may decide to operate on the patient earlier.

Preparing for a planned caesarean section

It is necessary to prepare for the arrival of a baby in this unusual way. Usually, when a planned caesarean section is performed, the pregnant woman is hospitalized a couple of weeks before the expected date of birth. To prepare for a planned caesarean section, she will have urine and blood tests, her blood type and Rh factor will be determined, and a vaginal smear will be checked for purity. It is also necessary to monitor the condition of the fetus. For this purpose, ultrasound and cardiotocography (CTG) are performed. Based on these studies, conclusions are drawn about the well-being of the child in the womb.

The specific date and time of the operation is determined by the doctor, having in hand the results of all tests and studies. Usually all planned operations are carried out in the first half of the day. The day before the appointed date, the anesthesiologist meets with the patient to discuss what type of anesthesia will be used and find out if the woman is allergic to any medications.

On the eve of a caesarean section, the diet should be light, and after 18-19 hours it is forbidden not only to eat, but also to drink.

In the morning, a cleansing enema is performed and the pubic hair is shaved. Care must be taken to prevent deep vein thrombosis. For this purpose, the legs are bandaged with an elastic bandage or the woman in labor is asked to wear special ones.

The patient is wheeled into the operating room on a gurney. A catheter is inserted into the urethra on the operating table and removed in the recovery room. The lower abdomen is treated with an antiseptic solution, and a special screen is installed at chest level to block the woman’s view of the surgical field.

Progress of the operation

To reduce anxiety before surgery, it is helpful to know how a planned caesarean section is performed. After administering anesthesia, the surgeon makes two incisions. The first incision is to cut through the abdominal wall, fat, and connective tissue. The second incision is the uterus.

The incision can be of two types:

Transverse (horizontal). Produced slightly above the pubis. With this method of incision, there is a low probability that the intestines or bladder will be touched by the scalpel. The recovery period is easier, the formation of hernias is minimized, and the healed suture looks quite aesthetically pleasing.
Longitudinal (vertical). This incision extends from the pubic bone to the navel, providing good access to the internal organs. The abdominal cavity is dissected longitudinally if the operation needs to be performed urgently.

A planned caesarean section, no matter how long it is performed, provided there is no threat to the life of the fetus, is performed more often using a horizontal incision.

The surgeon removes the placenta from the uterus, and the incision is sutured using synthetic materials. The integrity of the abdominal wall is restored in the same way. A cosmetic stitch remains in the lower abdomen. Afterwards it is disinfected and a protective bandage is applied.

If no complications arise during the surgeons’ work, the operation lasts from 20 to 40 minutes, after which the patient is transferred to the recovery room.

Possible complications and their prevention

Complications may occur during surgical childbirth and in the postoperative period. They do not depend on the period at which a planned caesarean section is performed.

Common complications are the following:

Major blood loss. If a woman gives birth on her own, 250 ml of blood is considered acceptable blood loss, and during surgical delivery a woman can lose up to one liter of it. If the blood loss is too great, a transfusion will be required. The most dangerous consequence of heavy bleeding that cannot be stopped is the need to remove the uterus.
Formation of adhesions. This is the name for seals made of connective tissue that “fuse” one organ with another, for example, the uterus with the intestines or intestinal loops with each other. After abdominal surgery, adhesions almost always form, but if there are too many of them, chronic pain in the abdominal region occurs. If adhesions form in the fallopian tubes, the risk of developing an ectopic pregnancy increases.
Endometritis is an inflammation of the uterine cavity caused by the entry of pathogenic bacteria into it. Symptoms of endometritis can manifest themselves both on the first day after surgery and on the 10th day after childbirth.
Inflammatory processes in the suture area due to infection entering the suture. If antibiotic therapy is not started promptly, surgery may be required.
Seam divergence. It can be triggered by a woman lifting weights (over 4 kilograms), and the dehiscence of the seam is a consequence of the development of infection in it.

To prevent complications, doctors take measures even before operations begin. To prevent the development of endometritis, the woman is given an antibiotic injection before the operation.

Antibacterial therapy continues for several days after. You can prevent the formation of adhesions by attending physiotherapy and doing special gymnastics.

Recovery period

After childbirth, the uterus returns to its previous state after 6-8 weeks. But the recovery period after surgical childbirth lasts longer than after natural childbirth. After all, the uterus is injured, and the suture does not always heal safely.

In many ways, the recovery period depends on how the planned caesarean section went and how successfully it was done.

At the end of the operation, the patient is moved to the recovery room or intensive care unit. To prevent the occurrence of infectious complications, antibacterial therapy is carried out.

Surgical birth (caesarean section) is carried out according to indications when there is a threat to the health and/or life of the mother or baby. However, today many women in labor, out of fear, think about an auxiliary option for delivery, even in the absence of health problems. Is it possible to have a cesarean section at will? Is it worth insisting on surgical birth if there is no indication? The expectant mother needs to learn as much as possible about this operation.

A newborn baby who was born through surgery

A CS is a surgical method of delivery that involves removing the baby from the uterus through an incision in the abdominal wall. The operation requires certain preparation. The last meal is allowed 18 hours before surgery. Before the CS, an enema is given and hygiene procedures are carried out. A catheter is inserted into the patient’s bladder, and the abdomen is necessarily treated with a special disinfectant.

The operation is performed under epidural anesthesia or general anesthesia. If the CS is done according to plan, then doctors are inclined to use an epidural. This type of anesthesia assumes that the patient will see everything that is happening around, but will temporarily lose tactile and pain sensations below the waist. Anesthesia is given through a puncture in the lower back where the nerve roots are located. General anesthesia during surgical childbirth is used urgently, when there is no time to wait for regional anesthesia to take effect.
The operation itself consists of the following steps:

Abdominal wall incision. It can be longitudinal and transverse. The first is intended for emergency cases, because it makes it possible to get the baby as quickly as possible.
Muscle extension.
Uterine incision.
Opening of the amniotic sac.
Extraction of the baby, and then the placenta.
Suturing the uterus and abdominal cavity. For the uterus, self-absorbable threads must be used.
Applying a sterile dressing. Ice is placed on top of it. This is necessary to increase the intensity of uterine contractions and reduce blood loss.

In the absence of any complications, the operation does not last long - a maximum of forty minutes. The baby is taken out of the mother's womb in the first ten minutes.

There is an opinion that caesarean section is a simple operation. If you don’t delve into the nuances, it seems that everything is extremely easy. Based on this, many women in labor dream of a surgical method of delivery, especially considering the effort natural childbirth requires. But you should always remember that a coin cannot have one side.

When is a CS necessary?

The attending gynecologist will decide whether the woman in labor needs surgery

In most cases, a CS is planned. The doctor determines whether there are any threats to the mother and baby if the birth takes place naturally. The obstetrician then discusses delivery options with the mother. A planned CS is performed on a predetermined day. A few days before the operation, the expectant mother should go to the hospital for a follow-up examination. While the pregnant woman is scheduled to be in the hospital, the doctor monitors her condition. This allows us to predict the likelihood of a successful outcome of the operation. Also, the examination before the CS is aimed at determining the full-term pregnancy: using various diagnostic methods, it is revealed that the baby is ready for birth and there is no need to wait for contractions.

The operation has a number of indications. Some factors leave room for discussion about the method of delivery, others are absolute indications, that is, those in which ER is impossible. Absolute indications include conditions that threaten the life of the mother and baby during natural delivery. CS must be done when:

absolutely narrow pelvis;
presence of obstructions in the birth canal (uterine fibroids);
failure of the uterine scar from previous CS;
thinning of the uterine wall, which threatens its rupture;
placenta previa;
foot presentation of the fetus.

There are also relative indications for CS. With such factors, both natural and surgical childbirth are possible. The delivery option is selected taking into account the circumstances, the health and age of the mother, and the condition of the fetus. The most common relative indication for CS is breech presentation. If the position is incorrect, the type of presentation and the gender of the baby are taken into account. For example, in the breech-foot position, ER is acceptable, but if they are expecting a boy, the doctor insists on a cesarean section to avoid damage to the scrotum. With relative indications for cesarean section, the correct decision regarding the method of birth of the baby can only be suggested by an obstetrician-gynecologist. The parents’ task is to listen to his arguments, because they will not be able to assess all the risks on their own.

Caesarean section can be performed on an emergency basis. This happens if labor began naturally, but something went wrong. An emergency CS is performed if bleeding begins during natural delivery, premature placental abruption occurs, or acute hypoxia is detected in the fetus. An emergency operation is performed if labor is difficult due to weak contractions of the uterus, which cannot be corrected with medication.

Elective CS: is it possible?

Happy mother with long-awaited daughter

Whether it is possible to perform a CS at the request of a woman in labor is a controversial issue. Some believe that the decision on the method of delivery should remain with the woman, while others are confident that only a doctor can determine all the risks and choose the optimal method. At the same time, the popularity of elective caesarean section is growing. This trend is especially noticeable in the West, where expectant mothers actively choose the method of giving birth to their own baby.

Mothers in labor prefer surgical childbirth, guided by fear of pushing. In paid clinics, doctors listen to the wishes of expectant mothers and leave them the right to choose. Naturally, if there are no factors under which CS is undesirable. The operation has no absolute contraindications, however, there are conditions that increase the risk of infectious and septic complications after surgical childbirth. These include:

infectious diseases in the mother;
diseases that disrupt blood microcirculation;
immunodeficiency states.

In the CIS countries, the attitude towards elective CS differs from the Western one. Without indications, it is problematic to perform a cesarean section, because the doctor bears legal responsibility for each surgical intervention. Some women in labor, considering surgical childbirth a painless way to give birth to a baby, even invent diseases for themselves that could serve as relative indications for a CS. But is the game worth the candle? Is it necessary to defend the right to choose the way in which a child is born? To understand this, the expectant mother must understand the intricacies of the operation, compare the pros and cons, and study the risks that exist with any surgical intervention.

Advantages of CS at will

Why do many expectant mothers want to have a cesarean section? Many people are motivated to “order” surgery by fear of natural childbirth. The birth of a baby is accompanied by severe pain; the process requires a lot of effort from the woman. Some expectant mothers fear that they will not be able to complete their mission and begin to persuade the doctor to perform a cesarean procedure on them, even if there are no indications for surgical birth. Another common fear is that the passage of the baby through the birth canal is difficult to control and may pose a threat to his health or even life.

Fear of EP is common. But not all expectant mothers can cope with it. For patients who see a lot of threats in natural childbirth, the advantages of a “custom” CS are obvious:

An additional bonus is the ability to choose the baby’s date of birth. However, this alone should not push the woman in labor to insist on a CS, because, in fact, the date does not mean anything, the main thing is the health of the baby.

The reverse side of a “custom” CS

Many expectant mothers do not see anything wrong with a caesarean section if the woman wishes. The operation appears to them as a simple procedure, where the woman in labor falls asleep and wakes up with a baby in her arms. But those women who have gone through surgical childbirth are unlikely to agree with this. The easy path also has a downside.

It is believed that CS, unlike ER, is painless, but this is not true. In any case, this is an operation. Even if anesthesia or anesthesia “turns off” the pain during surgical delivery, it returns afterwards. Departure from the operation is accompanied by pain at the suture site. Sometimes the postoperative period becomes completely unbearable due to pain. Some women even suffer from pain for the first couple of months after surgery. Difficulties arise in “maintaining” oneself and the child: it is difficult for the patient to get up, take the baby in her arms, and feed him.

Possible complications for the mother

Why is caesarean section performed in many countries solely according to indications? This is due to the possibility of complications after surgery. Complications affecting the female body are divided into three types. The first type includes complications that may appear after surgery on internal organs:

Major blood loss. With CS, the body always loses more blood than with EP, because when tissue is cut, blood vessels are damaged. You can never predict how the body will react to this. In addition, bleeding occurs due to pregnancy pathology or disruption of the operation.
Spikes. This phenomenon is observed during any surgical intervention; it is a kind of protective mechanism. Usually adhesions do not manifest themselves, but if there are a lot of them, then a malfunction of the internal organs may occur.
Endometritis. During the operation, the uterine cavity “comes into contact” with air. If pathogenic microorganisms enter the uterus during surgical childbirth, a form of endometritis occurs.

After a CS, complications often appear on the sutures. If they appear immediately after the operation, the doctor who performed the CS will notice them during the examination. However, suture complications do not always make themselves felt immediately: sometimes they appear only after a couple of years. Early suture complications include:

Late complications after cesarean section include ligature fistulas, hernias, and keloid scars. The difficulty in determining such conditions lies in the fact that after some time women stop examining their stitches and may simply miss the formation of a pathological phenomenon.

disruptions in the functioning of the heart and blood vessels;
aspiration;
throat injuries from insertion of a tube through the trachea;
a sharp decrease in blood pressure;
neuralgic complications (severe headache/back pain);
spinal block (when using epidural anesthesia, severe spinal pain occurs, and if the puncture is incorrect, breathing may even stop);
poisoning by toxins from anesthesia.

In many ways, the occurrence of complications depends on the qualifications of the medical team that will perform the operation. However, no one is immune from mistakes and unforeseen situations, so a woman in labor who insists on a caesarean section without indication should be aware of the possible threats to her own body.

What complications can a child have?

Caesar babies are no different from babies born naturally

Doctors do not undertake to perform a caesarean section at will (in the absence of indications) due to the likelihood of complications in the baby. CS is a proven operation that is often resorted to, but no one has canceled its complexity. Surgical intervention can affect not only the female body, but also affect the health of the baby. Complications of cesarean section concerning the child can be of varying degrees.

With the natural method of birth, the baby goes through the birth canal, which is stressful for him, but such stress is necessary for the baby to adapt to the conditions of a new life - extrauterine. With CS there is no adaptation, especially if the extraction occurs according to plan, before the onset of contractions. Violation of the natural process leads to the fact that the baby is born unprepared. This is a huge stress for a fragile body. CS can cause the following complications:

depressed activity from drugs (increased drowsiness);
breathing and heartbeat disturbances;
low muscle tone;
slow healing of the navel.

According to statistics, “caesareans” often refuse to breastfeed, plus the mother may have problems with the amount of milk. We have to resort to artificial feeding, which leaves its mark on the baby’s immunity and its adaptation to the new environment. Children born by cesarean section are more likely to suffer from allergic reactions and intestinal diseases. “Caesareans” may lag behind their peers in development, which is due to their passivity during labor. This manifests itself almost immediately: it is more difficult for them to breathe, suck, or scream.

Weigh everything

The CS has truly rightfully earned the title of “easy delivery.” But at the same time, many people forget that surgical childbirth can have consequences for the health of both “participants in the process.” Of course, most complications in a baby can be easily “removed” if you pay maximum attention to this issue. For example, a massage can correct muscle tone, and if the mother fights for breastfeeding, the baby’s immunity will be strong. But why complicate your life if there is no reason for this, and the expectant mother is simply driven by fears?

You should not do a caesarean section on your own. Naturally, a woman should have the right to choose, but it is not without reason that this operation is performed according to indications. Only a doctor can determine when it is advisable to resort to cesarean section and when natural delivery is possible.

Nature has thought of everything itself: the process of childbirth prepares the baby as much as possible for extrauterine life, and although the mother in labor bears a heavy load, recovery occurs much faster than after surgery.

When there is a threat to the fetus or mother and the doctor insists on a cesarean section, refusing the operation is strictly prohibited. The doctor always determines the risks taking into account what is safer for the life of the mother and baby. There are situations when cesarean section is the only option for delivery. If the method is negotiable, it is always recommended to seize the possibility of a natural birth. The momentary desire to “cut” in order to avoid pain must be suppressed. To do this, just talk to your doctor about the possible risks and likelihood of complications after surgery.

It is one hundred percent impossible to predict how the CS will go in each specific case. There is always a possibility that something will go wrong. Therefore, doctors advocate for natural childbirth whenever possible.

If the expectant mother herself cannot overcome her own fears associated with the upcoming moment of the baby’s birth, she can always turn to a psychologist. Pregnancy is not a time for fear. You need to let go of all bad thoughts, not be led by momentary desires, and clearly follow the recommendations of the gynecologist - from correcting the regimen to the method of delivery.

When childbirth cannot be carried out through the natural birth canal, one has to resort to surgery. In this regard, expectant mothers are concerned about many questions. What are the indications for a caesarean section and when is the operation performed for emergency reasons? What should a woman in labor do after surgical delivery and how is the recovery period going? And most importantly, will a baby born through surgery be healthy?

Caesarean section is a surgical operation in which the fetus and placenta are removed through an incision in the abdominal wall and uterus. Currently, between 12 and 27% of all births are performed by caesarean section.

Indications for caesarean section

The doctor can make the decision to perform surgical delivery at different stages of pregnancy, which depends on the condition of both the mother and the fetus. In this case, absolute and relative indications for caesarean section are distinguished.

TO absolute indications include conditions in which vaginal delivery is impossible or is associated with a very high risk to the health of the mother or fetus.

In these cases, the doctor is obliged to carry out the birth by cesarean section and no other way, regardless of all other conditions and possible contraindications.

In each specific case, when deciding whether to perform a cesarean section, not only the current condition of the pregnant woman and the child is taken into account, but also the course of the pregnancy as a whole, the state of the mother’s health before pregnancy, especially in the presence of chronic diseases. Also important factors for deciding on a caesarean section are the age of the pregnant woman, the course and outcomes of previous pregnancies. But the desire of the woman herself can be taken into account only in controversial situations and only when there are relative indications for a cesarean section.

Narrow pelvis that is, an anatomical structure in which the child cannot pass through the pelvic ring. The size of the pelvis is determined during the first examination of a pregnant woman; the presence of a narrowing is judged by its size. In most cases, it is possible to determine the discrepancy between the size of the mother’s pelvis and the presenting part of the child even before the onset of labor, but in some cases the diagnosis is made directly during childbirth. There are clear criteria for the normal size of the pelvis and narrow pelvis according to the degree of narrowing, however, before entering labor, only a diagnosis of anatomical narrowing of the pelvis is made, which allows only with some degree of probability to assume a clinically narrow pelvis - a discrepancy between the sizes of the pelvis and the presenting part (usually the head) of the child. If during pregnancy it is discovered that the pelvis is anatomically very narrow (III-IV degrees of narrowing), a planned cesarean section is performed; with II degrees, the decision is most often made directly during childbirth; with I degrees of narrowing, childbirth is most often carried out through the natural birth canal. Also, the cause of the development of a clinically narrow pelvis can be incorrect insertion of the fetal head, when the head is in an extended state and passes through the bony pelvis with its largest dimensions. This happens with frontal, facial presentation, while normally the head passes through the bony pelvis bent - the baby’s chin is pressed to the chest.

Mechanical obstacles preventing vaginal delivery. A mechanical obstacle can be uterine fibroids located in the isthmus region (the area where the body of the uterus meets the cervix), ovarian tumors, tumors and deformities of the pelvic bones.

Threat of uterine rupture. This complication most often occurs if the first ones were performed using a cesarean section, or after other operations on the uterus, after which a scar remained. With normal healing of the uterine wall with muscle tissue, the uterus does not threaten to rupture. But it happens that the scar on the uterus turns out to be insolvent, that is, it threatens to rupture. The failure of the scar is determined by ultrasound data and the “behavior” of the scar during pregnancy and childbirth. A caesarean section is also performed after two or more previous caesarean sections, because this situation also increases the risk of uterine rupture along the scar during childbirth. Numerous births in the past, leading to thinning of the uterine wall, can also create a threat of uterine rupture.

Progress of caesarean section operation

During a planned cesarean section, a pregnant woman enters the maternity hospital several days before the expected date of the operation. In the hospital, additional examination and drug correction of identified deviations in the state of health are carried out. The condition of the fetus is also assessed; Cardiotocography (registration of fetal heartbeats) and ultrasound examination are performed. The expected date of surgery is determined based on the condition of the mother and fetus, and, of course, the gestational age is taken into account. As a rule, elective surgery is performed at 38-40 weeks of pregnancy.

1-2 days before the operation, the pregnant woman must be consulted by a therapist and an anesthesiologist, who discusses the pain management plan with the patient and identifies possible contraindications to various types of anesthesia. On the eve of the birth, the attending physician explains the approximate plan of the operation and possible complications, after which the pregnant woman signs consent to perform the operation.

The night before the operation, the woman is given a cleansing enema and, as a rule, is prescribed sleeping pills. On the morning of surgery, the bowels are cleaned again and a urinary catheter is then inserted. On the day before the operation, a pregnant woman should not have dinner, and on the day of the operation she should neither drink nor eat.

Currently, when performing a cesarean section, regional (epidural or spinal) anesthesia is most often performed. The patient is conscious and can hear and see her baby immediately after birth and attach him to the breast.

In some situations, general anesthesia is used.

The duration of the operation, depending on the technique and complexity, averages 20-40 minutes. At the end of the operation, an ice pack is placed on the lower abdomen for 1.5-2 hours, which helps to contract the uterus and reduce blood loss.

Normal blood loss during spontaneous childbirth is approximately 200-250 ml; this volume of blood is easily restored by a woman’s body prepared for this. During a caesarean section, the blood loss is somewhat greater than physiological: its average volume is from 500 to 1000 ml, therefore during the operation and in the postoperative period, intravenous administration of blood replacement solutions is performed: blood plasma, red blood cells, and sometimes whole blood - this depends on the amount lost during the time of the blood operation and the initial condition of the woman in labor.

Emergency caesarean

An emergency caesarean section is performed in situations where childbirth cannot be quickly carried out through the natural birth canal without compromising the health of the mother and child.

Emergency surgery requires minimal preparation. For pain relief during emergency surgery, general anesthesia is used more often than during planned operations, since with epidural anesthesia the analgesic effect occurs only after 15-30 minutes. Recently, during emergency caesarean section, spinal anesthesia has been widely used, in which, just like with epidural, an injection is given in the back in the lumbar region, but the anesthetic is injected directly into the spinal canal, while with epidural anesthesia - into space above the dura mater. Spinal anesthesia takes effect within the first 5 minutes, allowing the operation to begin quickly.

If during a planned operation a transverse incision is often made in the lower abdomen, then during an emergency operation a longitudinal incision from the navel to the pubis is possible. This incision provides greater access to the abdominal and pelvic organs, which is important in a difficult situation.

Postoperative period

After surgical delivery, the woman in labor spends the first 24 hours in a special postpartum ward (or intensive care ward). She is constantly monitored by an intensive care unit nurse and an anesthesiologist, as well as an obstetrician-gynecologist. During this time, the necessary treatment is carried out.

In the postoperative period, painkillers are prescribed; the frequency of their administration depends on the intensity of pain. All drugs are administered only intravenously or intramuscularly. Typically, anesthesia is required in the first 2-3 days, then it is gradually abandoned.

It is mandatory to prescribe drugs for better uterine contractions (Oxytocin) for 3-5 days to contract the uterus. 6-8 hours after the operation (of course, taking into account the patient’s condition), the young mother is allowed to get out of bed under the supervision of a doctor and nurse. Transfer to the postpartum department is possible 12-24 hours after surgery. The child is currently in the children's department. In the postpartum ward, the woman herself will be able to begin caring for the baby and breastfeeding it. But in the first few days she will need help from medical staff and relatives (if visits are allowed in the maternity hospital).

For 6-7 days after a cesarean section (before the stitches are removed), the procedural nurse daily treats the postoperative suture with antiseptic solutions and changes the bandage.

On the first day after a cesarean section, you are only allowed to drink water with lemon juice. On the second day, the diet expands: you can eat porridge, low-fat broth, boiled meat, sweet tea. You can completely return to a normal diet after the first independent bowel movement (on the 3-5th day); foods that are not recommended for breastfeeding are excluded from the diet. Usually, to normalize intestinal function, a cleansing enema is prescribed about a day after surgery.

When you can be discharged home, the attending physician decides. Typically, an ultrasound examination of the uterus is performed on the 5th day after surgery, and the staples or sutures are removed on the 6th day. If the postoperative period is successful, discharge is possible on the 6-7th day after cesarean section.

Alexander Vorobyov, obstetrician-gynecologist, Ph.D. honey. sciences,
MMA im. Sechenov, Moscow

Each pregnancy in a woman proceeds in a new way, different from the previous one. Childbirth, accordingly, also goes differently. If the baby was born for the first time with the help of gynecological surgeons, this does not mean that now everything will happen according to the same scenario. What to do if you have a second caesarean section? What is important for a woman to know? Is it possible to avoid surgery? Today's article will answer these and some other questions. You will learn about the period at which a planned second caesarean section is performed, how the body recovers after manipulation, whether it is possible to plan a third pregnancy and whether it is actually possible to give birth on your own.

Natural birth and caesarean section

Let's find out how a second caesarean section is performed and what indications it has. What is important to know? The natural birth of a child is a process intended by nature. During childbirth, the baby goes through the appropriate paths, experiences stress and prepares for existence in the new world.

Caesarean section involves the artificial birth of a child. Surgeons make an incision in the woman’s abdomen and uterus, through which they remove the baby. The baby appears abruptly and unexpectedly, he does not have time to adapt. Let us note that the development of such children is more difficult and complex than those born during natural childbirth.

During pregnancy, many expectant mothers are afraid of the cesarean section procedure. After all, preference has always been given to natural childbirth. A few centuries ago, a woman had no chance of survival after a Caesarean section. At an earlier time, manipulation was carried out only in patients who had already died. Now medicine has made a big breakthrough. Caesarean section has become not only a safe intervention, but in some cases necessary to save the life of the child and mother. Now the operation lasts only a few minutes, and the capabilities of anesthesia allow the patient to remain conscious.

Second caesarean section: what is important to know about the indications?

What does the doctor pay attention to when choosing this route of delivery? What are the indications for a second intervention in the natural process? Everything is simple here. The indications for the second cesarean section are the same as for the first operation. The manipulation can be planned or emergency. When prescribing a planned caesarean section, doctors rely on the following indications:

poor vision in a woman;
varicose veins of the lower extremities;
heart failure;
chronic diseases;
diabetes;
asthma and hypertension;
oncology;
traumatic brain injury;
narrow pelvis and large fetus.

All these situations are a reason for the first intervention. If after the birth of the child (the first) the diseases have not been eliminated, then the operation will be performed during the second pregnancy. Some doctors are inclined to this opinion: the first cesarean section does not allow the woman to give birth again on her own. This statement is wrong.

Is it possible to give birth on your own?

So, you are recommended for a second cesarean section. What is important to know about him? What are the real indications for surgery if the woman’s health is fine? Repeated manipulation is recommended in the following cases:

the child has ;
less than two years have passed since the first caesarean section;
the suture on the uterus is incompetent;
During the first operation, a longitudinal incision was made;
abortions between pregnancies;
the presence of connective tissue in the scar area;
location of the placenta on the scar;
pregnancy pathologies (polyhydramnios, oligohydramnios).

An emergency operation is performed in case of unexpected scar divergence, weak labor, a woman’s serious condition, and so on.

You can give birth yourself if a second caesarean section is recommended. What is important to know? Modern medicine not only allows a woman the natural process of childbirth, but also welcomes it. It is important that the expectant mother is thoroughly examined. The conditions for natural childbirth after cesarean section are the following circumstances:

More than three years have passed since the first operation;
the scar is wealthy (muscle tissue predominates, the area stretches and contracts);
thickness in the seam area is more than 2 mm;
no complications during pregnancy;
a woman's desire to give birth on her own.

If you want your second child to appear naturally, then you should take care of this in advance. Find a maternity hospital that specializes in this issue. Discuss your condition with your doctor in advance and get examined. Attend your appointments regularly and follow your gynecologist's recommendations.

Pregnancy management

If the first birth took place via cesarean section, then the second time everything can be exactly the same or completely different. Expectant mothers after such a procedure should have an individual approach. As soon as you find out about your new situation, you need to contact a gynecologist. A special feature of managing such a pregnancy is additional research. For example, in such cases, ultrasound is done not three times during the entire period, but more. Diagnosis before childbirth is becoming more frequent. The doctor needs to monitor your condition. After all, the entire outcome of the pregnancy depends on this indicator.

Be sure to visit other specialists before delivery. You need to see a therapist, ophthalmologist, cardiologist, neurologist. Make sure there are no restrictions on natural childbirth.

Multiple and regular caesarean section

So, you are still scheduled for a second cesarean section. At what time is such an operation performed, and is it possible to give birth on your own during a multiple pregnancy?

Let's assume that the previous delivery was performed surgically, and after that the woman became pregnant with twins. What are the forecasts? In most cases, the outcome will be a second cesarean section. The doctor will tell you at what time it is done. In each case, the individual characteristics of the patient are taken into account. Manipulation is prescribed for the period from 34 to 37 weeks. In case of multiple pregnancy, they do not wait longer, as a rapid natural birth may begin.

So, you are pregnant with one child, and a second cesarean section is scheduled. When is the operation performed? The first manipulation plays a role in determining the deadline. Repeated intervention is scheduled 1-2 weeks earlier. If the first time a cesarean was performed at 39 weeks, now it will happen at 37-38.

The seam

You already know at what time a planned second caesarean section is performed. The cesarean section is repeated using the same suture as the first time. Many expectant mothers are very concerned about aesthetic issues. They worry that their entire stomach will be covered in scars. Don't worry, that won't happen. If the manipulation is planned, then the doctor will make an incision where it was made the first time. Your number of external scars will not increase.

The situation is different with the incision of the reproductive organ. Here, with each repeat operation, a new area for the scar is selected. Therefore, doctors do not recommend giving birth using this method more than three times. For many patients, doctors offer sterilization if a second cesarean section is scheduled. When admitted to the hospital, gynecologists clarify this issue. If the patient wishes, tubal ligation is performed. Don’t worry, doctors will not carry out such a manipulation without your consent.

After surgery: recovery process

You already know when a second caesarean section is indicated and at what time it is done. Reviews from women report that the recovery period is practically no different from what it was after the first operation. A woman can stand up on her own in about a day. A new mother is allowed to breastfeed her baby almost immediately (provided that no illegal drugs were used).

Discharge after the second operation is the same as during natural childbirth. Within one or two months, the discharge of lochia is observed. If you had a caesarean section, it is important to monitor your well-being. Consult a doctor if unusual discharge appears, temperature rises, or general condition worsens. They are discharged from the maternity hospital after the second cesarean section approximately 5-10 days later, the same as the first time.

Possible complications

With repeated surgery, the risk of complications certainly increases. But this does not mean that they will definitely arise. If you give birth on your own after a cesarean section, then there is a possibility of scar dehiscence. Even if the suture is strong, doctors cannot completely exclude this possibility. That is why in such cases artificial stimulation and painkillers are never used. This is important to know.

When performing a second cesarean section, the doctor faces difficulties. The first operation always has consequences in the form of an adhesive process. Thin films between organs make the surgeon's work difficult. The procedure itself takes longer. This could be dangerous for the child. Indeed, at this moment, potent drugs used for anesthesia penetrate into his body.

A complication of a repeat cesarean can be the same as the first time: poor contraction of the uterus, its inflection, inflammation, and so on.

Additionally

Some women are interested: if a second caesarean section is performed, when can they give birth for the third time? Experts cannot answer this question unambiguously. It all depends on the condition of the scar (in this case two). If the suture area is thinned and filled with connective tissue, then pregnancy will be completely contraindicated. With sufficient scars, it is quite possible to give birth again. But, most likely, this will be the third caesarean section. The possibility of natural childbirth decreases with each subsequent operation.

Some women manage to give birth to five children by caesarean section and feel great. Much depends on the individual characteristics and technique of the surgeon. With a longitudinal incision, doctors do not recommend giving birth more than twice.

Finally

A caesarean section performed during the first pregnancy is not a reason for a repeat procedure. If you want and can give birth on your own, then this is only a plus. Remember that natural childbirth is always a priority. Talk to your gynecologist about this topic and find out all the nuances. Best wishes!