Caesarean section options. After a caesarean section. Description of the caesarean section

In many cases, a caesarean section is performed according to absolute indications. These are conditions or diseases that pose a mortal danger to the life of the mother and child, such as placenta previa - a situation where the placenta closes the exit from the uterus. Most often, this condition occurs in multi-pregnant women, especially after previous abortions or postpartum diseases.

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

Cord prolapse: this situation occurs during the outflow of amniotic fluid with polyhydramnios in cases where the head is not inserted into the pelvic inlet for a long time (narrow pelvis, large fetus). With the flow of water, the loop of the umbilical cord slips into the vagina and may even be outside the genital gap, especially if the umbilical cord is long. There is a compression of the umbilical cord between the walls of the pelvis and the head of the fetus, which leads to impaired blood circulation between mother and baby. In order to timely diagnose such a complication, after the outflow of amniotic fluid, a vaginal examination is performed.

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

Preeclampsia: this is a serious complication of the second half of pregnancy, manifested by high blood pressure, the appearance of protein in the urine, edema, there may be a headache, blurred vision in the form of flickering "flies" before the eyes, pain in the upper abdomen and even convulsions, which requires immediate delivery, so how the condition of the mother and child suffers with this complication.

Premature detachment of a normally located placenta: Normally, the placenta separates from the uterine wall only after the baby is born. If the placenta or a significant part of it is separated before the birth of the child, then there are sharp pains in the abdomen, which can be accompanied by severe bleeding and even the development of a state of shock. At the same time, the supply of oxygen to the fetus is sharply disrupted, it is necessary to urgently take measures to save the life of the mother and baby.

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

An example is pelvic presentation of the fetus. Births in the breech presentation are pathological, because. there is a high risk of injury and oxygen starvation of the fetus during childbirth through the natural birth canal. The likelihood of these complications increases especially when the breech presentation of the fetus is combined with its large size (more than 3600 g), distortion, excessive extension of the head of the fetus, with anatomical narrowing of the pelvis.

Primiparous age over 30 years: age itself is not an indication for caesarean section, but in this age group gynecological pathology is common - chronic diseases of the genital organs, leading to prolonged infertility, miscarriage. Non-gynecological diseases are accumulating - hypertension, diabetes mellitus, obesity, heart disease.

Pregnancy and childbirth in such patients occur with a large number of complications, with a high risk for the child and mother. The indications for caesarean section in women of late reproductive age with breech presentation and chronic fetal hypoxia are expanding.

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

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

There are also indications for cesarean section that occur during pregnancy and childbirth. According to the urgency of performing a caesarean section, it can be planned and emergency. Caesarean section during pregnancy is usually carried out in a planned manner, less often in emergency cases (bleeding with placenta previa or with premature detachment of a normally located placenta and other situations).

A planned operation allows you to prepare, decide on the technique of its implementation, anesthesia, as well as carefully assess the state of a woman’s health, and, if necessary, conduct corrective therapy. In childbirth, a caesarean section is performed according to emergency indications.

Also, a woman may have to face some difficulties in breastfeeding, which are most often encountered after a planned caesarean section. Surgical stress, blood loss, late attachment to the breast due to impaired adaptation or drowsiness of the newborn is the cause of late lactation; in addition, it is difficult for a young mother to find a position for feeding, if she sits, then the baby presses on the seam. However, this problem can be overcome by using the lying position for feeding.

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

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

Indications for caesarean section are divided into absolute and relative. Those are considered absolute, on the basis of which the doctor unconditionally prescribes the operation, and there can be no talk of natural childbirth. These indications include the following.

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

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

• defragmentation of the pelvic bones;
• ovarian tumors;
• placenta previa (the placenta is not located where it should be, blocking the fetus from entering the cervix);
• individual cases of uterine fibroids.

Chance of uterine rupture. This indication for caesarean section occurs if there are any sutures and scars on the uterus, for example, after previous caesarean sections and abdominal operations.

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

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

• visual impairment in the mother (this is due to the high load on the eyes when the woman giving birth is straining);
• malfunctions of the kidneys;
• cardiovascular diseases;
• pathology of the nervous system;
• oncological diseases, etc.

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

In addition, an indication for caesarean section is preeclampsia- a violation in the system of blood flow and blood vessels.

to the testimony, endangering the health of the child include various sexually transmitted infections in the mother, as the child can become infected while passing through the birth canal.

As for the urgent caesarean section, it is prescribed if the labor activity is very weak or has stopped altogether.

How does a caesarean section work, what happens before and after it

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

2. Preparation. Usually, a future mother awaiting a planned caesarean section is placed in the hospital in advance in order to conduct an examination - to determine that the child is full-term and ready for birth, and to monitor the condition of the woman. As a rule, a caesarean section is scheduled for the morning, and the last meal and drink is possible no later than 18 hours the night before. The stomach of the operated patient must be empty to prevent its contents from entering the respiratory tract. In the morning, on the day of the operation, hygienic procedures are performed: an enema is given, the pubis is shaved. Next, the woman changes into a shirt, and she is taken away or taken on a gurney to the operating room.

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

3. Anesthesia. Today, 2 types of anesthesia are available: epidural and general anesthesia. Epidural anesthesia involves the insertion of a thin tube through a needle into the exit site of the nerve roots of the spinal cord. It sounds pretty scary, but in fact, a woman experiences discomfort for only a few seconds when a puncture is performed. Further, she ceases to feel pain and tactile sensations in the lower body.

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

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

Usually the operation takes from 20 to 40 minutes, while the child is taken into the world as early as 10 minutes, or even earlier.

5. Postoperative period. Another day after the caesarean section, the woman is in the intensive care unit or intensive care unit so that doctors can monitor her condition. Then the newly-made mother is transferred to a regular ward. To reduce pain, she is prescribed painkillers, drugs to reduce the uterus and normalize the state of the gastrointestinal tract. Sometimes antibiotics are prescribed, but this is decided on an individual basis. Gradually, the doses of drugs are reduced, and they are completely abandoned.

If the operation went without complications, get up for the first time a woman is allowed after at least 6 hours. First you need to sit down on the couch, and then stand for a while. In no case should you strain, experience at least minimal physical exertion, as this threatens with divergence of the seams.

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

On the first day after the operation, it is recommended to drink only water without gas, and you will need to drink a lot to make up for the loss of fluid. You will also need to empty your bladder on time. A full bladder is believed to prevent uterine contractions.

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

Also, this problem is solved by enemas, candles (candles with glycerin are usually used; when you put such a candle, try to lie down for a while) and eating foods that have a laxative effect (kefir, dried fruits, etc.).

7. After discharge from the hospital. The first month and a half after the caesarean section, you will not be able to take a bath, swim in the pool and ponds, you will be able to wash only in the shower.

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

Renew sexual life It is recommended not earlier than one and a half months after the operation. Be sure to take care of contraception. Experts advise planning the next pregnancy only after 2 years, during which time the body will fully recover and will be able to ensure the full development of the unborn baby.

Is natural childbirth possible after caesarean?

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

Pros and cons of a caesarean section

Surgical delivery is possible both for medical reasons and at the woman's own request. However, doctors usually oppose such a decision, discouraging the future mother from surgical intervention. If you are also considering surgery, provided that normal delivery is not contraindicated for you, carefully weigh all the positive and negative aspects of the issue.

Advantages of a caesarean section

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

Cons of a caesarean section

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

Consequences of a caesarean section

Consequences can be divided into 2 types: for mother in connection with surgery, and for a child due to unnatural birth.

Consequences for mother:

• pain in the seams, as a result of a scar on the abdomen;
• restrictions on physical activity, the inability to take a bath and resume intimate relationships for several months;
• psychological condition.

Consequences for the child:

• psychological; there is an opinion that children who were born through surgery adapt worse to the world around them. It is worth noting that the opinions of scientists on this matter differ, and the experience of mothers shows that in most cases fears of children lagging behind in mental development are far-fetched, and one should not worry about this. However, one cannot deny the fact that the child does not go through the path prepared for him by nature, and helping to prepare for a new environment of existence;
• the possibility of residual amniotic fluid in the lungs of the newborn;
• entry into the child's blood of anesthetic drugs. Read more about the consequences of caesarean section and watch the video in

Complications after caesarean section

Complications after anesthesia. If you are going to have a caesarean section with an epidural, you need to remember the following point. After the operation, the catheter with anesthetic is left in the back for some time, and drugs are injected through it to anesthetize the stitches. Therefore, after the operation is over, the woman may not feel both or one leg, and may not be able to move around.

There are cases when, when shifting a woman to a couch, her legs are twisted, and since the operated woman does not feel anything, this fact can go unnoticed for a long time.

What does it threaten? Due to the fact that the limb is in an unnatural position, it develops prolonged positional pressure syndrome. In other words, soft tissues are without blood supply for a long time. After neutralization of compression, shock develops, severe edema, impaired motor activity of the limb and, not always, but quite often, renal failure, all this is accompanied by severe pain that lasts for several months.

Be sure to ask the staff at the hospital to check that you have been placed on the couch correctly. Remember that sometimes crush syndrome is fatal.

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

Complications after caesarean section

One of the most common complications is adhesions. Loops of the intestines or other organs of the abdominal cavity grow together. Treatment depends on the individual characteristics of the woman: the case may be limited to the usual physiotherapy or reach the need for surgical intervention.

endometritis- inflammation in the uterus. To prevent it, a course of antibiotics is prescribed immediately after the operation.

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

Complications may also arise during suture healing until they diverge.

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

Video of a caesarean section

Answers

In this article, we will consider what types of incisions are made during a caesarean section. We will also consider in detail how repeated incisions are made for caesarean section.

Types of incisions for caesarean section

The first incision, external, is an incision in the abdominal wall (skin of the abdomen, subcutaneous fat, connective tissues).

The second incision is directly incision on the uterus.

It is clear that the first incision is visible, it is he who turns into a "scar after a caesarean section." And the second incision is not visible, more precisely, it is visible only on ultrasound. These cuts may or may not coincide (in the direction of the cut line). Let's list the "basic combinations".

1. Classic (aka corporal, aka vertical) external cut. It can be combined with the same vertical incision in the uterus, or, more commonly, with a transverse incision in the uterus.
2. The transverse external incision is arched, located immediately above the pubis, in the skin fold. This type of incision can be combined with the same transverse incision on the uterus, or with a vertical incision on the uterus.

Consequences of different types of incisions for caesarean section

1. It depends on the type of external incision whether it will be cosmetic or not. If the suture is transverse (option 2, above), then it is usually performed with a self-absorbable suture and a cosmetic suture is performed. Subsequently, the scar from such an incision is practically not noticeable. If the outer seam is vertical, then a cosmetic seam cannot be performed, since the load on the gap in this place is large. Therefore, a well-defined scar remains.
2. It depends on the type of incision on the uterus whether a woman, in principle, can give birth naturally in the next birth. With vertical incisions on the uterus, further natural childbirth is contraindicated. With a transverse (horizontal) incision on the uterus, the possibility of natural childbirth will depend on how well the scar has healed. This can be seen on an ultrasound. The specialist will talk about the "consistency of the scar", and according to its condition, recommend natural childbirth, or a caesarean section.

It should be noted that the most common combination today is a transverse external and transverse internal incision. A vertical external incision is now extremely rare. For this, it is necessary that doctors do not have time at all (with the threat of the death of a woman in labor or a fetus, with a living child and a dying woman).

Indications for a vertical incision on the uterus

I will list when a vertical incision is made on the uterus (in this case, the external incision is transverse, horizontal).

• Pronounced adhesive process in the lower segment of the uterus.
• Lack of access to the lower segment of the uterus.
• Severe varicose veins in the lower segment of the uterus.
• Failure of a longitudinal scar on the uterus after a previous caesarean section.
• The need for subsequent removal of the uterus.
• A living fetus in a dying woman.
• Complete with its transition to the anterior wall of the uterus.

Re-sutures for caesarean section

According to statistics, most often the first caesarean section means that the second (third) birth will also be caesarean. But this is not necessarily the case. You can read more about when natural childbirth after cesarean is possible in the article. If you have indications for the second or third birth (after the first cesarean), then the question almost always arises: what will happen to my scar? How many will there be?

Let's consider this question. During repeated cesarean section operations, the old external scar (scar) is excised (cut out). And there is one, a new scar.

In the Mom's Shop there is for healing and tissue repair after a cesarean section.

Note. Return of food and cosmetics is possible only if the packaging is intact.

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An incision on the uterus is made along the previous scar, if the scar is thinned, it is excised so that the next pregnancy is born well. The scar on the uterus, therefore, also remains alone.

Note. From my own experience, I can say that the second scar (after the second cesarean) bothered me less and looks better than the first. And there is practically no overhanging of the skin over it (and after the first one it was). Perhaps the skin is tightened as a result of excision of the first scar. My girl friend with the third caesarean (same surgeon) has the same story. Each subsequent one is better than the previous one. In addition, it seems to me that medicine is developing, and the further, the easier such a procedure becomes for a woman.

When natural childbirth is not possible for medical reasons, an alternative delivery option is used - a caesarean section. It should be borne in mind that this is not an easy way to bypass the pangs of natural childbirth, but a serious procedure that has a number of negative consequences.

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CS is a surgical operation to remove the fetus from the uterus through an abdominal incision. Depending on the development of pregnancy, the procedure may be prescribed in a planned manner. If no complications were observed during the development of pregnancy, but there were complications during the birth process, then an emergency operation is performed.

According to statistics, every ninth baby in Russia is born with the help of. Despite the fact that the operation is considered simple and often practiced, the likelihood of complications increases by more than 12 times.

Indications for a planned caesarean section

Planned CS is indicated in the following cases:

• diabetes mellitus and Rhesus conflict;
• retinal detachment and myopia;
• physiological features of the mother: a narrow pelvis, malformations of the uterus or vagina;
• the presence of scars on the uterus remaining;
• breech presentation of the fetus or other incorrect position - frequent indications for caesarean section;
• in post-term pregnancy, in which the size of the fetus is above normal;
• at ;
• the presence or exacerbation of genital herpes;
• with placenta previa.

Anyway, the operation is performed with the consent of the mother. This consent must be recorded in writing.

In the practice of doctors, there are cases when a woman in labor, without medical indications for surgery, decides to give birth by caesarean section. The reasons are psychological in nature: fear of pain or physiological changes in the genitals. However, the World Health Organization recommends giving preference to natural childbirth, since the operation leaves certain imprints on the health of the baby and mother.

An emergency caesarean section is indicated in the following cases:

• Prolonged labor process, leading to oxygen starvation of the fetus. In this case, there is a real threat to the life of the baby;
• Loss of strength in childbirth. For the normal development of the birth process, physical strength and psychological determination are necessary.;
• Incorrect position of babies during multiple pregnancy;
• Childbirth that occurred before the natural period;
• Premature discharge of amniotic fluid. In this case, there is a high risk of infection;
• Detachment of the placenta in a woman in labor. This is fraught with bleeding;
• Presentation or prolapse of the fetal loop. Threatens with hypoxia and death for the baby;
• At ;
• Rarely, but still there are cases of uterine rupture.

Each birth process is individual. Therefore, this list does not reflect all complications that may require urgent action. A woman in labor should always be under the close supervision of an obstetrician in order to prevent certain deviations from the birth process.

Algorithm of preparation in the maternity hospital

When carrying out a planned operation, a woman in labor must prepare in advance for the procedure. What week is a planned caesarean section? In practice, the operation is prescribed at the end - 38-39 weeks of pregnancy. 8-10 days before the appointed date, the gynecologist writes out a referral to the clinic where the operation is planned. A woman must be hospitalized in advance with everyone, as she:

• General analysis of blood and urine;
• Rh factor analysis;
• cytological smear;
• Doppler of vessels.

These tests help to assess the degree of preparation of the body for delivery.

What is the best anesthesia for CS?

general and regional. General anesthesia has a number of negative consequences, among which, respiratory failure of the mother and child or the ingress of fluid from the gastrointestinal tract into the respiratory tract can be noted. The substances themselves contained in the composition of anesthesia can have a depressing effect on the baby's neurological system. The "gold standard" for caesarean section in this case is the spinal and epidural type of anesthesia.

The spinal method is carried out by a single injection into the cerebrospinal fluid. Epidural anesthesia is injected through a catheter into the spinal cord. Both types of injections are administered in a horizontal or sitting position. The procedures are painless, occasionally accompanied by discomfort in the lower part of the peritoneum.

Each of these types has its own characteristics. The effect of anesthesia in the first case occurs within 10-15 minutes, for the epidural it will take 20-30 minutes.

Sometimes regional anesthesia may not provide the appropriate level of pain relief. In such cases, if spinal anesthesia is initially administered, then general anesthesia is administered. If epidural anesthesia initially took place, then the operation will be continued by increasing the dose of the drug through the inserted catheter.

According to the consequences, the advantages of spinal anesthesia can be noted. With it, mild headaches are possible in the postoperative period. are extremely rare, but can be more tangible.

On the eve of the operation

CS is usually done in the morning. The night before, the woman in labor should prepare for it. In particular, the anesthesiologist conducts an explanatory conversation. As a result, he must find out the previous facts of taking anesthetics, previous diseases, the weight of the woman and other factors. The data obtained will help to choose an individual dose of painkillers.

Hygienic preparation is also carried out: showering and epilation of the genitals. Lunch on this day should be limited to the first course, and dinner should consist of kefir or tea, drunk before 18:00.

On the day of surgery, be sure to refrain from eating and drinking liquids. A couple of hours before the caesarean section, the intestines are cleansed with an enema.

How is the operation going?

The woman in labor lies on the operating table in shoe covers and a hygienic cap. The mother's legs are tied with an elastic bandage. This measure is necessary as a prevention of thrombosis. The operating area and the woman's face are separated by a screen. It should be borne in mind that in the absence of other indications, local anesthesia is practiced. After the anesthesia procedure, a dropper is introduced to compensate for blood loss. Cuffs are put on the arms to control pressure and pulse. A catheter is placed in the urinary tract. The peritoneum is sterilized and covered with a sterile sheet. The doctor starts the procedure.

How long does a caesarean section take? Herself The operation takes on average about an hour. unless there are additional difficulties during its implementation. But the process of extracting the fetus during caesarean section takes no more than 10 minutes. The umbilical cord is cut and the baby is transferred for postpartum procedures. The process ends with the removal of the placenta and suturing the incision.

After the operation, the woman in labor spends about a day in the intensive care unit, then she is transferred to the postpartum unit. During the day, a number of measures are taken to restore the woman in labor:

• measures to reduce the muscles of the uterus;
• stop bleeding;
• fluid compensation in the body;
• anesthesia.

Although seemingly simple, caesarean section carries a number of risks for both the mother and the baby.

The consequences for the woman in labor are divided into two types according to the duration of manifestation:

• Late;
• Postoperative.

Late effects are:

• The formation of ligature fistulas - an inflammatory process around the seams;
• Vertebral hernia;
• Keloid scar - a scar after surgery. Rather, it plays an aesthetic role. The scar is absolutely safe for health.

Postoperative complications include the following:

• Pain syndrome after surgery. The process of discharge may be accompanied by headaches, dizziness, intense thirst and general weakness;
• During the operation, the woman in labor loses 4 times more blood than during natural childbirth;
• Adhesions may form in the internal organs;
• Upon contact with air, there is a risk of developing endometritis - inflammation of the uterine cavity;
• Hematomas may form on the seams or purulent processes develop;
• Rarely, but there may be cases of divergence of the seam;
• Inability to care for a child for several days.

The consequences for the child are also significant.

In the process of natural childbirth, the baby's body must adapt to a new form of life. In this regard, at the beginning of the birth process in his body, the concentration of the hormone catecholamine sharply increases. It is necessary in order to throw out fluid from the lungs and start the baby's respiratory system as soon as he "comes out into the light." During the operation, the baby's body will not have time to collect the required amount of hormones. The lungs are not ready to breathe, and the heart suffers significant stress. This can cause dystrophic phenomena in the heart.

In addition, before the baby enters a period of hibernation, in which all physiological processes slow down. This phenomenon is a preparation for the transition to a new environment. Surgery involves a sharp change in pressure drop. This grossly violates the natural process of preparing the baby for life and is fraught with small hemorrhages in the brain. These children often have evidence of minimal brain dysfunction.

It has been observed that children born by caesarean section also have psychological characteristics. This can be expressed in apathy of character, increased dependence on the mother and a pronounced desire to manipulate adults.

Let's summarize:

With an adequate assessment of the risks of surgery, even women in labor with indications can come to the decision to give birth naturally. The doctor in this case can only warn about the possible development of events. However, the task of medicine is to save the life of the baby and mother. If natural childbirth is impossible for objective reasons, then one should not persist, thereby endangering two lives.

Pregnancy planning, a healthy lifestyle, and sufficient physical activity and a positive attitude towards childbirth help to minimize the risks of complications and possibly help to avoid surgery and give a new life in a natural way.
Read some testimonials from women who have undergone CS surgery:

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If the doctor conducting the pregnancy has found serious abnormalities in the woman or the unborn child, he may decide to perform a planned caesarean section. When the operation is scheduled in advance, the patient has the opportunity to properly prepare for it, including psychologically.

To whom and at what time is a planned caesarean section performed?

The timing of a caesarean section is determined strictly individually, but doctors try to bring them as close as possible to the time of physiological birth, i.e. to 39-40 weeks. This avoids the development in the newborn, due to hypoplasia (underdevelopment) of his lungs. When setting the date of intervention, several factors are taken into account, the main of which are the state of health of the pregnant woman and the development of the fetus. A pregnancy is considered full-term when the gestational age reaches 37 weeks.

It is believed that the ideal time to start a caesarean section is the period of the first contractions, but if the placenta is not previa, they are not expected.

In case of multiple pregnancy or detection in the patient, the operation is performed at 38 weeks. With monoamniotic twins, a caesarean section is carried out much earlier - at 32 weeks.

There are certain indications for surgery.

note

If there is at least one absolute indication or a combination of two or more relative indications, natural delivery is excluded!

Absolute indications include:

• history of corporal caesarean section;
• transferred operations on the uterus;
• large fruit (≥ 4500 g);
• monoamniotic twins;
• complete placenta previa;
• anatomically narrow pelvis;
• post-traumatic deformity of the pelvic bones;
• transverse presentation of the child;
• after 36 weeks of gestation and weight > 3600 g;
• multiple pregnancy with incorrect presentation of one fetus;
• growth retardation of one of the twins.

Relative indications are:

A planned caesarean section is necessarily carried out if a diaphragmatic hernia, non-closure of the anterior abdominal wall or teratoma is detected in the unborn child, as well as in the case of twin fusion.

note

In some situations, the operation can be performed without special indications at the request of the woman. Some mothers-to-be choose to have a caesarean section under anesthesia because they are afraid of pain during natural childbirth.

The process of preparing for a planned caesarean section

If the doctor has informed you about the need for a planned caesarean section, do not hesitate to ask him all the questions you are interested in. Specify the date of hospitalization, and find out if everything is in order with your tests. A number of measures to improve the condition of the body must be taken in advance, that is, during pregnancy.

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During the examination of the expectant mother, it is necessary to get advice from a neurologist, an ophthalmologist (or ophthalmologist), a general practitioner and an endocrinologist. If necessary, medical correction of diagnosed disorders is carried out.

It is advisable to attend special courses for women in labor who are being prepared for CS.

Try to eat right and spend more time outdoors. Be sure to take daily walks - physical inactivity can harm both you and the baby.

Get regular check-ups at the antenatal clinic. Be sure to report any changes in your condition to your doctor.

What to take with you to the hospital?

List of documents and necessary things:

Don't forget to bring diapers, diapers, and baby powder for your newborn.

Preoperative preparation a few days before CS

Be sure to check if you need to shave your pubic area yourself. It is better to entrust this manipulation to health workers (to avoid cuts, infection and inflammation), but some institutions recommend preparing this area in advance.

After admission to the antenatal unit (usually 2 weeks before the intervention), a series of tests will be required so that doctors can objectively assess the condition of their patient at the present time.

List of required tests:

• blood group and Rh factor;
• vaginal swab.

Additionally, a hardware examination is carried out - and CTG - cardiotocography.

For 48 hours you need to give up solid food. On the eve of the CS, you can not eat after 18-00, and on the day of the operation it is highly undesirable even to consume liquid. In the morning before the intervention, you need to clean the intestines, if necessary, using an enema.

The method of anesthesia is discussed in advance. Local anesthesia (spinal or) is recommended for those who want to see their child in the first moments of his life. Besides, It must be borne in mind that anesthesia can adversely affect the condition of the baby. In any case, the procedure will not be associated with pain.

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In most specialized maternity hospitals, mothers are allowed to take their newborn in their arms for a short time immediately after the CS.

The patient is taken from the ward to the operating room on a stretcher.

Already on the table, a catheter is inserted into the bladder. Be sure to put a dropper with a solution or an injection of drugs.

The operating field (lower abdomen) is carefully treated with an antiseptic solution. If it is assumed that the patient will remain conscious, then a screen is placed in front of her at chest level in front of her, covering the view (in order to avoid mental trauma).

After anesthesia, two incisions (most often transverse) are performed in the lower abdomen. At the first, the skin, a layer of fiber and the abdominal wall are dissected, and at the second, the uterus. The baby is removed, and after cutting the umbilical cord, they are transferred to a neonatologist. The mouth and nasal passages of the newborn are cleaned. The assessment of his condition is carried out according to the generally accepted ten-point APGAR scale.

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If the caesarean section is not performed for the first time, then the incision is usually made along the line of the old seam.

The longest step is suturing. It requires jewelry precision from the obstetrician, since not only the severity of the cosmetic defect, but also the healing process of soft tissues will depend on the quality of suturing. Neat transverse seams are practically invisible in the future, because they are hidden under the hairline.

The advantage of a horizontal incision above the pubis is that it virtually eliminates the chance of accidentally piercing the bladder or intestinal wall. In addition, the risk of hernia formation is minimized, and healing proceeds faster. An incision in the vertical direction from the navel to the pubic bone is more often made during an emergency caesarean section, when the need to save the mother and child comes to the fore, rather than aesthetic considerations.

At the final stage of a planned caesarean section, which, in the absence of complications, lasts only 20-40 minutes, the suture is treated with an antiseptic and covered with a sterile bandage.

Postoperative period

The baby can be put on the breast immediately after the operation is completed.

At the end of the procedure, the woman is usually transferred to the intensive care unit, where she stays for 24-48 hours (provided there are no complications). However, now in many maternity hospitals, already 2 hours after the operation, a woman with a child from the operating room is immediately transferred to the cohabitation ward.

Drugs are administered intravenously to the mother to stabilize and improve the condition.

A woman is allowed to get out of bed 12 hours after the operation.(in the absence of complications).

Both general and spinal (spinal) anesthesia negatively affect intestinal motility, so on the first day you can only drink liquid (clean water); the recommended volume is at least 1.5 liters. On the second day, you can drink low-fat kefir or yogurt without chemical dyes and flavors, as well as consume chicken broth with crackers.

At least for 1 week, you need to refrain from fatty and fried foods, as well as seasonings and spices.

Measures must be taken, as excessive straining increases the risk of suture divergence. It is advisable to consume foods with laxative properties, and if they do not give the expected effect, you will have to resort to laxatives.

The treatment of the seam and the change of the sterile dressing is carried out daily.

If the patient complains of pain, analgesics are administered as needed.

Until healing and removal of sutures, physical activity is excluded. Weight more than 3 kg is strictly forbidden to lift in the next 2-3 months.

The recovery period after CS lasts somewhat longer than after natural childbirth. The uterus returns to its physiological state on average after one and a half to two months.

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The resumption of sexual activity is permissible after two months from the date of the operation.

Possible complications after caesarean section

The CS technique has now been perfected to perfection. The likelihood of complications when the woman in labor fulfills all the prescriptions of the attending physician is minimized.

In rare cases, it is possible:

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In severe cases (in particular, with massive bleeding), doctors have to resort to extirpation of the uterus to save the life of the mother.

Previously, there was an opinion that a child who was born with the help of CS does not produce some hormones and protein compounds that are natural adaptogens. In this regard, violations of the process of adapting the baby to the environment and certain disorders of the mental sphere are not excluded. Now this statement is considered erroneous.

After discharge from the hospital, the disinfection of the suture can and should be carried out independently, using solutions of hydrogen peroxide and brilliant green for this. If a bloody or purulent discharge and (or) pain of a “shooting” or “tugging” character appears, it is urgent to seek help from a doctor - these may be symptoms of an infectious inflammation that has begun.

Plisov Vladimir, doctor, medical commentator