C-section. Pros and cons of caesarean section, main questions about it and recovery after surgery When operative delivery is indicated

Discuss your situation with your obstetrician or other qualified healthcare professional. For most women, vaginal delivery is the best way to give birth. Most doctors recommend avoiding unnecessary caesarean sections because natural childbirth allows for longer childbearing and reduces recovery time for the mother. However, if you are in one of the following situations, you need to decide if a caesarean section might be the best choice.

• Your baby is placed in a difficult birth position - when the baby is turned with the legs or lower torso toward the birth canal, your birth can become more prolonged and difficult, with an increased risk of injury to you and the baby. In this case, you should discuss with your doctor how likely you are to have your baby safe and sound. In some cases, a caesarean section is simply necessary to safely remove the baby.
• The umbilical cord may become tangled or partially pass into your cervix before the baby is born. In the event that the umbilical cord becomes compressed due to contractions or wraps around the baby's neck during delivery, a caesarean section may be necessary to give the baby immediate access to oxygen.
• If you give birth to twins, triplets, or more - in most cases, even if you give birth to your first child naturally, the risk of difficult births increases for the rest of the children. At least one of the twins is often in an abnormal position, further increasing the inevitability of surgery. If the first baby was born normally, you can wait and see how the second baby goes and decide to have a caesarean section just to ensure the safety of the baby. It is possible to give birth safely naturally to more than one baby.
• If there are problems with the placenta or your delivery is not going well, in some cases your placenta may detach before delivery or cover your cervix, in which case a caesarean section may be a safe option for your baby. Also, if you're having a vaginal birth and have experienced several hours of steady, strong contractions with very little expansion to propel the baby forward, a caesarean section may be the only way to ensure your baby is delivered securely.
• You've had a caesarean section before - in some cases, a previous caesarean section was so done and sewn up that the next vaginal birth is dangerous or undesirable. If you have had a previous caesarean section, your doctor may recommend another K-section for your safety. However, many women successfully give birth vaginally a second time after a caesarean section.
• You have high blood pressure, diabetes, heart disease, or another serious medical condition - these conditions can pose risks to your health and the health of your baby, and your doctor may recommend a caesarean section to reduce the risk of dangerous complications during childbirth. Many doctors find that it is easier to control and guide the delivery process with surgery, and they may try to schedule a caesarean just before the due date. If possible, your doctor may advise you to wait until your labor pains start. But if your situation is difficult or life-threatening, he may recommend a caesarean section despite the incomplete pregnancy.
• Your baby has serious medical complications such as hydrocephalus (excess fluid in the brain) - if your doctor feels that the baby could be injured during a vaginal birth due to a possible worsening of the medical condition, a caesarean section is the safest option. Similarly, if your baby's head is too big to squeeze through the birth canal without problems, your doctor may recommend a caesarean section.

The doctor makes the final decision on how to give birth to a woman at the 37-38th week of pregnancy, after all examinations. Among those who went through natural childbirth are not only women with a scar on the uterus, but also those who were over forty when they decided on their first child, as well as those who dared to endure and give birth to twins on their own.

Dear Irina!

Caesarean section is a complex surgical operation, which is primarily carried out strictly for medical reasons. However, more and more women prefer this method of delivery, guided only by their own desire. Often, women simply want to avoid the pain that accompanies natural childbirth, forgetting that postoperative pain is no less intense than childbirth. In addition, as with any other operation, there is a risk of complications.

Another reason that encourages women in labor to have a caesarean section is the desire to independently choose the date of birth of the child, so that the doctor is not on vacation, and the child's father is not on a business trip. Thus, a situation arises of forced delivery, when neither the woman's body nor the child is ready for this. It can also have a number of negative consequences for the health of mother and baby.

Some mothers believe that a baby born by caesarean section is spared the stress of going through the birth canal. However, nature knowingly came up with just such a way of birth. Thanks to the advancement through the narrow birth canal, excess fluid is removed from the baby's lungs, which is artificially sucked out in case of surgery.

Indications for caesarean section

There are absolute indications for surgery, when it is indispensable, as well as relative indications, when the decision is made by a council of doctors, after analyzing the condition of the woman in labor and the child. Absolute indications are anatomically narrow pelvis (constriction degree 3 - 4 with a true conjugate less than 9 cm), complete placenta previa, incomplete placenta previa, but with a risk of serious bleeding, premature detachment of the placenta, onset or threatening uterine rupture, defective scar on the uterus, the presence of two or more scars on the uterus, severe preeclampsia in the absence of readiness of the birth canal for delivery, heart disease in the stage of decompensation, pathology of the nervous system, severe thyroid disease, diabetes mellitus, hypertension, grade 3 myopia, retinal detachment, tumors of the cervix, vagina or ovaries, abnormal position of the fetus, acute intrauterine hypoxia, prolapse of the umbilical cord.

Relative indications include large fetus with a narrow pelvis, divergence of the pubic symphysis during childbearing, weakness of birth forces, post-term pregnancy, IVF or artificial insemination, chronic fetal hypoxia, hemolytic disease of the fetus, the presence of three or more fetuses, severe varicose veins of the vulva and vagina .

Sometimes, if the age of the primipara has exceeded 30 years, due to the risk of perineal ruptures and anomalies of the birth forces, childbirth by caesarean section may be indicated, especially in the presence of extragenital diseases or obstetric pathology.

Cesarean section on your own

In many parts of the world, a woman has the legal right to choose her own way of giving birth. The first caesarean sections of their own free will began to be practiced in Japan, South Korea and China. In Venezuela, 60% of births end in surgery. In Russia, there is no legal framework prohibiting a doctor from performing a caesarean section at the request of a woman in labor, even if there are no indications for the operation. Moreover, a number of experts believe that a woman should choose how her child will be born. Nevertheless, officially the desire of a woman in labor is not an indication for a caesarean section. Everything will depend on the doctor and on the prerequisites for surgical intervention, because the obstetrician-gynecologist is obliged to report for each case when a caesarean section was performed. In many maternity hospitals, the request of the woman in labor is taken into account if there are any relative indications.

Sincerely, Xenia.

I have a medical background. Of course there was practice in the maternity ward. Having seen enough of natural childbirth with and without perineal incisions, I decided for myself that my pregnancy would end only through a caesarean section. With this review, I would like to help those girls who are also considering only this option. Having successfully become pregnant, I began to visit various paid clinics so that I could manage my pregnancy with competent doctors and know exactly when, who and where, would perform the cherished operation on me. But it was not there! Every doctor was ready to conduct a pregnancy. But about the caesarean... first I had to sign a contract for the management of pregnancy (the cost of which is in the region of 60 - 90 thousand) and only at the end of the third trimester the doctor calls the familiar mythical doctor in the mythical maternity hospital and agrees. I originally needed guarantees. And so, we found Lapino Hospital on the Internet. Of course, for an average income, this is a rather expensive institution. But for the sake of the birth of a child (an event that happens once or several times in a lifetime, if you like it), you can and will spend it. At that time, an action was taking place in the hospital: a free consultation on pregnancy management. They called. The operator picked up the phone immediately, without a five-minute wait, as in other medical institutions. Signed up. We've arrived. Gorgeous clinic. Pass entry. There are no queues, although there are plenty of patients. Everywhere beauty and cleanliness. Came in and explained the situation. The doctor said that she perfectly understands our desire and everything will be as we want. The only thing is that they will gather a council on this matter (apparently they wanted to check my mental health). They appointed a day and time. After the consultation, they gave me a paper that said that I would have the coveted operation! Then we quietly went to observe. The doctor left her contact number. And then one night, I realized that it was time! I called the doctor and told them to prepare the operating room, as we were leaving. The contract includes the departure of an ambulance, but we decided to drive on the sly. In the end, we could call her along the way. Security was already aware that we were going. We were immediately opened and told that everyone was waiting for us. The operation went perfect! After the operation, my child and I stayed in this wonderful place for 5 days. It is difficult to call a chamber a chamber. Rather, it is the number of a five-star Turkish hotel. The room has a TV, internet, air conditioning, toilet, shower with all kinds of personal hygiene products. You don't need to take anything with you, everything is there. The rise of the bed is regulated by light pressure. There are emergency call buttons everywhere. I accidentally clicked on one at night, so the nurse was in the ward in 20 seconds! The staff knocks before entering the room. You can also put a "do not disturb" sign on the door. Great food. Brought in beautiful plates with lids. First, second, compote, dessert. Even if you don't want to eat, you will. Before discharge, my child and I underwent various ultrasounds. The children's clinic was surprised. Why did you have an ultrasound? Have you had health problems? Our health is excellent. It turns out that ultrasound is not done in state institutions. Patients breathe well, they can go home. The scar after cesarean is very neat, as thick as a hair. Sometimes I even miss this wonderful place. Of course for me a little expensive, but you have to pay for the comfort. And according to my calculations (I monitored prices in state-owned family houses), it turns out not much cheaper, and the conditions, care, and equipment are not so good. For the second child only in Lapino!

Is it possible to do a caesarean at will?

C fucking before childbirth is quite natural and understandable, but is it worth it to voluntarily go under the knife because of this? Let's take a look at the pros and cons of an elective caesarean section.

The right to choose

Whether the expectant mother has the right to choose the method of delivery is a moot point. Many believe that only the mother should decide how her child will be born. Most doctors reserve the prerogative to prescribe caesarean, although the number of obstetricians who listen to the opinion of patients is growing.

In the West, paid caesarean sections of their own accord have become fashionable. Moreover, to draw up a contract with the clinic, the patients do not take their husbands with them, but lawyers. The signed list of all possible consequences has full legal force and “unties” the hands of doctors who are happy to undertake to operate on everyone for a round sum.

In Russia, the situation is different: it is rather problematic for our women to officially procure without evidence. Refusal of natural childbirth, which a woman signs on the threshold of the operating room, is just a formal piece of paper, so doctors do not risk being led by patients even for decent money. Some even invent diseases for themselves that can serve as at least relative indications for surgery.

Advantages of a "custom" caesarean section

Irresistible fear of childbirth in agony, fear of injuries to the perineum and vagina, fear for the health of the child due to the unpredictability of the birth process. What is guided by a woman who is able to give birth herself when she persuades the attending physician to perform a planned operation on her? For many women in labor, the advantages of caesarean are obvious:

• quick and painless removal of the child;
• confidence in the life and health of the baby;
• hope for a favorable outcome due to modern advances in medicine;
• no damage to the genitals;
• the ability to choose the date of birth of the child.

The other side of the easy way

Cesarean delivery has become so commonplace that it is perceived as an absolutely safe procedure. In the eyes of many women, it looks like this: “fell asleep, woke up, got a baby.” However, a woman who has gone through such an operation is unlikely to agree with this.

1. According to the woman, the operating table is an “easy” method of childbirth, but intense pain after it for several days will be akin to natural contractions.
2. Caesarean section is an abdominal operation, which means that none of the surgical risks can be ruled out. Unpredictable consequences during manipulations, complications and even mortality during caesarean section are not a myth, but a harsh reality.
3. The abrupt removal of a newborn unprepared by contractions, sometimes sleeping, is too much shock for the child, in contrast to the natural birth process, which for the baby is a stressful situation with a “plus” sign.
4. “Caesarites”, who have not passed through the birth canal and are separated from their mother during the most important hours of life, are more prone to intestinal and allergic diseases, and the mother may have problems with breastfeeding.
5. It is difficult to care for a baby without outside help: every movement is difficult and causes concern for the integrity of the seam.
6. Recovery after surgery takes many months, after childbirth, the woman comes to her senses in a few days.
7. There may be difficulties with subsequent pregnancies and childbirth.

The risk is high, so the decision to have an elective caesarean section should be made by the woman and her doctor in a balanced way, and not under the influence of momentary desires.

Home " Food " Cesarean section without indications: if the woman in labor has the right to choose. Childbirth and caesarean section.

Caesarean babies: easy to be born, but difficult to survive "Do me!" - obstetricians hear such a request very often. Especially in the prenatal ward, when expectant mothers endure very painful ones. It would seem as good: during the operation, the baby sleeping in the mother’s tummy will be carefully removed, gently slapped on the ass - and now he is shouting indignantly: “I was born!”. But if the woman and the fetus are healthy, the doctors are relentless: "I'll have to do it myself." After all, Caesarean children often require the active help of doctors and special care.

Try to wake up!

The reason is in stress hormones, forcing the body of the crumbs to cling to life.. During the time of the mother's contractions and the passage of the baby through the birth canal, a huge amount manages to stand out. The birth of the baby perceives with relief and quickly calms down in the first gentle embrace of the mother. And with a caesarean section, the extraction of the fetus occurs very quickly, and the woman may not have contractions at all. Therefore, the hormones necessary for adaptation to life are extremely small. The very fact of birth becomes a terrible stress for the cesarean, from which it is very difficult for him to recover. And the mother often cannot help: she is sleeping, and “someone else's hands” are swaddling the baby.

In cesarean babies, the level of stress hormones still gradually increases, reaching the required value by 3-5 days. Therefore, the process of adaptation to independent existence is delayed by about a week. This time the baby is psychologically very vulnerable and extremely susceptible to infections. He may have digestive problems: poor appetite, sluggish suckling, and difficult stools. And in body weight, consistently good increases begin a week later.

The neonatologist of the maternity hospital will closely monitor the period of adaptation of the crumbs. At this time, the child, more than ever, needs a mother. Gentle unhurried care, soft stroking, affectionate words, frequent persistent attachment to the chest will work a miracle: by the time the child is discharged, it will not differ in any way from babies born naturally.

Help me breathe

Lung problems in caesarean children are the most common. If during the operation the mother is “under anesthesia”, the apparatus “breathes” for her. And the baby may not have enough strength to take the first independent breath. Then the doctor will help him by performing artificial respiration with a bag connected to oxygen with a mask. The same situation occurs with the syndrome of "inferior vena cava".

But that's not all. A weak short cry immediately after birth, a long sleep and general lethargy do not allow the lungs to open "in full force". And low levels of stress hormones lead to the accumulation of fluid in the alveoli. As a result, caesareans often experience pulmonary edema in the first days. They breathe often, spending a lot of energy on it. Fortunately, respiratory failure is rarely severe and usually resolves on its own. All this time, the doctor is watching the children so as not to miss the occurrence of complications, such as pneumonia.

Young mothers need not worry: the child will be discharged home only when the neonatologist is absolutely sure that everything is in order with the lungs of the baby. It will only be necessary to protect him from contact with cold adults.

Features of breastfeeding

After a caesarean section, the mother is away from the child for the first day or two - in the intensive care unit. All this time, the baby has to eat an adapted mixture from the nipple. If the operation took place under general anesthesia, then the crumbs most likely will not have to taste the precious first drops of colostrum. Pain, weakness and the absence of a baby nearby do not contribute to good lactation in the mother. Therefore, problems with the start of breastfeeding often occur.

How to help mom and baby? If possible, put the baby to the breast immediately after birth. The colostrum was produced much earlier than the operation began, so the risk that the child will receive the medicines administered to the woman with it is extremely low. In addition, a few drops of milk are so few that there is no danger. But the benefits are huge, because it is a concentrate of proteins useful for immunity. The problem of intestinal colic and frequent colds will disappear immediately. After spinal anesthesia, you can breastfeed your baby from birth. A cesarean who has experienced general anesthesia with his mother should be given a nipple with a minimum hole diameter. This will make it easier for him to transition to breastfeeding. The puerperal, in order to stimulate lactation, in intensive care it will be necessary to express regularly. How to persuade yourself? Imagine how the delicate velvet skin of a child becomes red and rough due to the mixture. Like having to carry a child in your arms at night, bursting into screams due to colic and constipation. Lying on your side, watching the baby greedily sucking with a smile, is much more pleasant! Moreover, the movements of his rough tongue on the nipples are a pleasure. A little effort - and everything will work out!

About neurological and psychological problems in cesareans

It is not uncommon to hear the opinion that almost half of the caesarean children require treatment by a neurologist. The most common diagnosis in this case is perinatal CNS damage. This is partly true. But the term "perinatal" means "around childbirth", that is, before, during and after birth. It is important to understand that doctors go to the operation because of the diseases of the woman, identified even before the birth of the pathology in the fetus, complicated or childbirth. Therefore, it is impossible to associate the neurological problems that have arisen only with caesarean. The main thing is to identify them in time and treat them correctly. Then the thankful for attention baby will quickly recover. In addition, it has been proven that there are no differences in the frequency of detection of severe neurological diseases in children born surgically and through natural routes. But birth injuries in cesareans are recorded an order of magnitude lower.

Psychologists note that by nature children born promptly, indecisive, too compliant, weak-willed. And in adulthood, they show little initiative and avoid responsibility. Reading this can make you upset. And you can remember one of the first Caesars - Julius Caesar. That other psychologists find in them perseverance, fearlessness, self-confidence and a strong spirit. But what about inherited traits of character? And most importantly: the absence of the first bodily contact with the mother immediately after birth can later be compensated for by great love for the baby, endless hugs and proper upbringing.

Surgical childbirth (caesarean section) is carried out according to indications, when there is a threat to the health and / or life of the mother or baby. Today, however, many women in childbirth, out of fear, think about an assisted delivery option, even in the absence of health problems. Is it possible to have a caesarean section on request? Is it worth insisting on surgical delivery if there are no indications? The expectant mother needs to learn as much as possible about this operation.

A newborn baby who was born through surgery

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

The operation is performed under epidural anesthesia or under general anesthesia. If the CS is done according to plan, then the doctors tend to the 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 done by puncturing the lower back, where the nerve roots are located. General anesthesia for surgical delivery is used urgently when there is no time to wait for the action of regional anesthesia.
The operation itself consists of the following steps:

1. Section of the abdominal wall. It can be longitudinal and transverse. The first is designed for emergencies, because it makes it possible to get the baby as quickly as possible.
2. Muscle extension.
3. Incision of the uterus.
4. Opening of the fetal bladder.
5. Removing the baby, and then the placenta.
6. Stitching of the uterus and abdominal cavity. For the uterus, self-absorbable threads must be used.
7. 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 is a simple operation. If you do not 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 how much effort natural childbirth requires. But you must always remember that a coin cannot have one side.

When is CS required?

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

In most cases, COPs are planned. The doctor determines whether there are threats to the mother and the baby if the birth takes place naturally. The obstetrician then discusses delivery options with the woman in labor. Scheduled CS is carried out on a pre-arranged day. A few days before the operation, the expectant mother should go to the hospital for a control examination. While the pregnant woman is planned to be in the hospital, the doctor monitors her condition. This allows you to predict the likelihood of a successful outcome of the operation. Also, the examination before the COP is aimed at determining the full-term pregnancy: using various diagnostic methods, it is revealed that the baby is ready for birth and you can not 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 EP is not possible. Absolute indications include conditions that threaten the life of the mother and baby during natural delivery. CS must be done when:

• absolutely narrow pelvis;
• the presence of obstructions in the birth canal (uterine fibroids);
• insolvency of the uterine scar from past CS;
• thinning of the uterine wall, which threatens to rupture it;
• 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 chosen taking into account the circumstances, the health and age of the mother, the condition of the fetus. The most common relative indication for CS is breech presentation. If the position is incorrect, the type of presentation, the sex of the baby is taken into account. For example, in the gluteal-leg position, EPs are acceptable, but if a boy is expected, the doctor insists on a caesarean section in order to avoid damage to the scrotum. With relative indications for caesarean section, only an obstetrician-gynecologist can tell the right decision regarding the way the baby is born. The task of parents is to listen to his arguments, because they will not be able to assess all the risks on their own.

A cesarean may be performed on an emergency basis. This happens if childbirth began naturally, but something went wrong. Emergency CS is carried out if bleeding has begun in the process of natural release, premature placental detachment has occurred, acute hypoxia has been recorded in the fetus. An emergency operation is performed if labor is difficult due to weak contraction of the uterus, which cannot be corrected with medication.

Elective CS: is it possible?

Happy mother with a long-awaited daughter

Whether it is possible to do a CS at the request of a woman in labor is a moot point. Some believe that the decision on the method of delivery should remain with the woman, others are sure that only a doctor can determine all the risks and choose the best method. At the same time, the popularity of elective cesarean is growing. This trend is especially noticeable in the West, where expectant mothers are actively choosing the way to give birth to their own baby.

Women in labor prefer surgical childbirth, guided by fear of attempts. 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 delivery. These include:

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

In the CIS countries, the attitude towards the elective CC differs from the Western one. Without evidence, it is problematic to perform a caesarean section, because the doctor is legally responsible for each surgical intervention. Some women in labor, considering surgical childbirth as a painless way to give birth to a baby, even come up with diseases for themselves that could serve as relative indications for CS. But is the game worth the candle? Is it necessary to defend the right to choose the way of having a child? 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.

Benefits of CS at will

Why do many expectant mothers want to have a cesarean? “Order” the operation of many pushes the fear of natural childbirth. The birth of a baby is accompanied by severe pain, the process requires a lot of effort from a woman. Some expectant mothers are afraid that they will not cope with their mission and begin to persuade the doctor to procaesare them, even if there are no indications for surgical delivery. Another common fear is that the passage of the baby through the birth canal is difficult to control, and there may be a threat to his health or even life.

Fear of EP is common. But not all expectant mothers can handle it. For patients who see a lot of threats in natural delivery, the advantages of a "custom" CS are obvious:

An additional bonus is the ability to choose the date of birth of the baby. However, only this should not push a 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 the "custom" COP

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

It is believed that CS, unlike EP, is painless, but this is not true. In any case, this is an operation. Even if anesthesia or anesthesia “turns off” pain during surgical delivery, it returns after. 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 the "service" of herself 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 in many countries performed exclusively on indications? This is due to the possibility of complications after surgery. Complications concerning the female body are divided into three types. The first type includes complications that may appear after surgery on the internal organs:

1. Big blood loss. With CS, the body always loses more blood than with EP, because when tissues are cut, blood vessels are damaged. You never know how your body will react to it. In addition, bleeding opens with the pathology of pregnancy, disruption of the operation.
2. 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 in the work of internal organs may occur.
3. Endometritis. The uterine cavity during the operation "contacts" with the air. If pathogens enter the uterus during surgical delivery, then one of the forms of endometritis occurs.

After CS, there are often complications at the sutures. If they appear immediately after the operation, then they will be noticed by the doctor who did the CS 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 caesarean include ligature fistulas, hernias, keloid scars. The difficulty in determining such conditions lies in the fact that after some time women stop examining their seam and can simply miss the formation of a pathological phenomenon.

• malfunctions of the heart and blood vessels;
• aspiration;
• throat injuries from the introduction 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, even respiratory arrest can occur);
• poisoning with toxins from anesthesia.

In many ways, the appearance 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 without indications should be aware of the possible threats to her own body.

What complications can a child have?

Caesareas are no different from babies born naturally

Caesarean section at will (in the absence of indications), doctors do not undertake to carry out because of the likelihood of complications in the baby. CS is a well-established operation, which 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 a caesarean section affecting a child can be of varying degrees.

With a natural birth method, 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 start 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 organism. CS can provoke the following complications:

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

According to statistics, “caesarites” often refuse to breastfeed, plus the mother may have problems with the amount of milk. You have to turn to artificial feeding, which leaves its mark on the immunity of the crumbs and getting used to the new environment. Children born by caesarean section are more likely to suffer from manifestations of allergic reactions, intestinal diseases. "Kesaryata" may lag behind their peers in development, which is due to their passivity in labor activity. This manifests itself almost immediately: it is more difficult for them to breathe, suck, scream.

weigh everything

The CS really rightfully deserved the title of "easy delivery". But at the same time, many 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, massage can correct muscle tone, and if a mother fights for breastfeeding, then 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?

A caesarean section of your own free will is not worth it. Naturally, a woman should have the right to choose, but it is not for nothing that this operation is performed according to indications. Only a doctor can determine when it is appropriate to turn to a caesarean section, and when a natural delivery is possible.

Nature has thought of everything by itself: the process of childbirth prepares the baby for extrauterine life as much as possible, and although the body of the woman in labor has a big load, recovery is much faster than after surgery.

When there is a threat to the fetus or mother and the doctor insists on a cesarean, it is strictly forbidden to refuse the operation. The doctor always determines the risks, taking into account the fact that it is safer for the life of the woman in labor and the baby. There are situations when caesarean is the only option for delivery. If the method is subject to discussion, it is always recommended to grasp the possibility of natural childbirth. The momentary desire to "caesare" in order to avoid pain must be suppressed. To do this, it is enough to talk with the doctor about the possible risks and likelihood of complications after the operation.

It is 100% impossible to predict how the CS will pass in each specific case. There is always the possibility that something will go wrong. Therefore, doctors advocate natural childbirth whenever possible.

If the expectant mother herself cannot overcome her own fears associated with the upcoming moment of the baby's appearance, she can always turn to a psychologist. Pregnancy is not the time for fears. You need to let go of all bad thoughts, not be led by momentary desires, and clearly follow the recommendations of a gynecologist - from regimen correction 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 cesarean section and when is the operation performed according to urgent indications? What should a woman in labor do after an operative delivery and how does the recovery period go? And most importantly - will the baby born through surgery be healthy?

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

Indications for caesarean section

The doctor may decide to conduct an operative delivery at various stages of pregnancy, which depends on the condition of both the mother and the fetus. At the same time, absolute and relative indications for caesarean section are distinguished.

To absolute indications include conditions in which vaginal delivery is not possible or is associated with a very high risk to the health of the mother or fetus.

In these cases, the doctor is obliged to deliver by caesarean section and nothing else, regardless of all other conditions and possible contraindications.

In each case, when deciding on a caesarean section, not only the current state of the pregnant woman and the child is taken into account, but also the course of pregnancy in general, the state of health of the mother 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 caesarean section.

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

Mechanical obstacles that interfere with childbirth through the natural birth canal. A mechanical obstacle may be uterine fibroids located in the isthmus (the area where the body of the uterus passes into the cervix), ovarian tumors, tumors and deformities of the pelvic bones.

Threat of uterine rupture. This complication most often occurs when the first one was performed using a caesarean section, or after other operations on the uterus, after which a scar remained. With normal healing of the uterine wall by muscle tissue, uterine rupture does not threaten. But it happens that the scar on the uterus turns out to be insolvent, that is, it has a threat of 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 done after two or more previous caesarean sections, because this situation also increases the risk of uterine rupture along the scar in childbirth. Numerous births in the past, which led to thinning of the uterine wall, can also create a threat of uterine rupture.

The progress of the caesarean section

With a planned caesarean section, a pregnant woman enters the maternity hospital a few days before the expected date of the operation. An additional examination and medical correction of the identified deviations in the state of health is carried out in the hospital. The condition of the fetus is also assessed; cardiotocography (registration of fetal heartbeats), ultrasound examination is performed. The expected date of the operation is determined based on the condition of the mother and fetus, and, of course, the gestational age is taken into account. As a rule, a planned operation is performed at the 38-40th week of pregnancy.

1-2 days before the operation, the pregnant woman is necessarily consulted by the therapist and anesthesiologist, who discusses the anesthesia 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 the consent to the operation.

On the night before the operation, the woman is given a cleansing enema and, as a rule, is prescribed sleeping pills. In the morning before the operation, the intestines are again cleaned and then a urinary catheter is placed. On the day before the operation, a pregnant woman should not have dinner; on the day of the operation, you should neither drink nor eat.

Currently, regional (epidural or spinal) anesthesia is most often performed during caesarean section. At the same time, the patient is conscious and can hear and see her baby immediately after birth, attach it to the chest.

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, such a volume of blood is easily restored by a woman's body prepared for this. With cesarean section, 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-substituting solutions is performed: blood plasma, erythrocyte mass, and sometimes whole blood - this depends on the amount lost during time of blood operation and from the initial state of the woman in labor.

emergency cesarean

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 involves the necessary minimum preparation. For pain relief during an emergency operation, general anesthesia is used more often than during planned operations, since with epidural anesthesia, the analgesic effect occurs only after 15-30 minutes. Recently, spinal anesthesia has also been widely used for emergency caesarean section, in which, as with epidural anesthesia, an injection is made in the back in the lumbar region, but the anesthetic is injected directly into the spinal canal, while with epidural anesthesia - in space above the dura mater. Spinal anesthesia begins to work within the first 5 minutes, which allows you to quickly start the operation.

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. Such an incision provides wider access to the organs of the abdominal cavity and small pelvis, which is important in a difficult situation.

Postoperative period

After operative delivery, the puerperal during the first day is in a special postpartum ward (or intensive care unit). 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 without fail, the frequency of their administration depends on the intensity of pain. All drugs are administered only intravenously or intramuscularly. Usually anesthesia is required in the first 2-3 days, in the future it is gradually abandoned.

Without fail, drugs for better uterine contraction (Oxytocin) are prescribed for uterine contraction for 3-5 days. After 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 a nurse. Transfer to the postpartum department is possible 12-24 hours after the operation. The child at this time is in the children's department. In the postpartum department, the woman herself will be able to start caring for the child, breastfeeding him. But in the first few days, she will need help from medical staff and relatives (if visits are allowed in the maternity hospital).

Within 6-7 days after the caesarean section (before removing the sutures), the procedural nurse daily treats the postoperative suture with antiseptic solutions and changes the bandage.

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

When you can go home, the attending physician decides. Usually, on the 5th day after the operation, an ultrasound examination of the uterus is performed, and on the 6th day, the staples or sutures are removed. With a successful course of the postoperative period, discharge is possible on the 6-7th day after cesarean section.

Alexander Vorobyov, obstetrician-gynecologist, Ph.D. honey. Sciences,
MMA them. Sechenov, Moscow