When can you get pregnant after a caesarean? "Thin ice": what to do if you got pregnant earlier. When self-delivery is not desirable

Many women are worried about pregnancy after a caesarean section, because not everyone knows how long to wait before conceiving a child. A woman may want to get pregnant again. That is why it is useful to know how long it takes to get pregnant after a cesarean, how long to wait. It is important to remember that when planning a future pregnancy, several important factors must be taken into account, as this should be safe not only for the health of the woman, but also for the unborn baby. It is worth considering the fact that during the first pregnancy, the body experienced severe stress, while a thorough restructuring takes place in the body, and in order for it to return to its previous form, it is necessary to give it some time. That is why, when you plan to become pregnant, it is recommended to plan 3 months after the new birth, as the body is not yet ready for such tests.

There are no absolute contraindications to a new pregnancy after cesarean, and about 30% of women plan to have more children in the future. It is believed that a more favorable period for the onset of pregnancy and childbirth is after 2-3 years, since it is during this time that muscle tissue is restored in the area of the scar on the uterus. At this time, very reliable contraception is necessary, because with an early onset of pregnancy, a weak scar can disperse and cause tearing of the uterine wall. Abortion during this period also cannot be done, any mechanical stretching or impact on the wall of the uterus can weaken it and provoke a rupture or inflammation.

Natural childbirth after caesarean section

The rule "one caesarean - always caesarean" has long lost its force. In itself, the presence of a scar on the uterus is not an indication for surgery. Moreover, expert organizations in Europe and the US assure that natural childbirth is desirable for women who have had a caesarean section. As a rule, natural childbirth is possible after one caesarean section. After two cesareans, the doctor will insist on an operation.

The chance of a successful natural birth after a caesarean section is about 60 - 70%. This largely depends on the reason for the previous operation. It is worth trying if the reasons for caesarean were associated only with the course of the previous pregnancy, and did not recur in the next one:

breech presentation of the child;

toxicosis of the second half;

pathological condition of the fetus;

active stage of genital herpes.

In the case of a "clinically narrow pelvis" in a previous pregnancy, it is also possible to give birth without the help of a surgeon. This diagnosis often hides simply the weakness of labor, so there is a chance that it will not happen again.

The most important thing is to adhere to one important rule, from the moment of cesarean section to the next pregnancy, at least 18 months must pass. In addition, this period of time is recommended to wait even if the birth took place naturally.

The course of childbirth after caesarean section

In Russia, doctors are still reluctant to undertake vaginal delivery after a cesarean. Especially if the minimum period after cesarean is not observed.

Often there are a number of stringent requirements for pregnancy:

The time between the first caesarean and the second pregnancy should be at least 3 and not more than 10 years;

The incision on the uterus is preferably horizontal (transverse);

The placenta should be located high enough, preferably along the back wall;

The fetus must be in head presentation;

The condition of the seam according to ultrasound should be good.

If all these conditions are met and there are no contraindications, then you are likely to be allowed a natural birth. During natural childbirth after cesarean, stimulation and anesthesia should not be done. This can increase uterine contractions and increase the chance of rupture.

There are times when a woman simply cannot wait the recommended 18 months and wants to give birth again. Therefore, before pregnancy, you must first consult with a gynecologist, since the body may simply not be ready for a new test.

Should I try to give birth on my own?

Is it worth the pain of trying to give birth a second time after CS, if in the end you still have to cut? This question can be answered like this: your baby would thank you for your efforts. Firstly, in order for everything to work out, you always need to tune in to the best. Secondly, children born by caesarean section, but after the onset of contractions, are easier to adapt to the environment than their peers who were born before the onset of childbirth. They have much better breathing after childbirth and better hormonal levels.

Pregnancy 6 months after caesarean section

After a caesarean section is done, a characteristic scar will remain on the uterus, which can disperse during a new pregnancy, and this is a real disaster, which as a result leads to the inevitable death of the fetus, and in the most severe cases of the woman. That is why it is recommended to refrain from a second pregnancy for some time (preferably two years, since it is during this time that a full-fledged scar tissue is formed). After a cesarean section, it is necessary that the second pregnancy is planned, and of course, proceeds correctly, so that undesirable consequences can be avoided. Even before the second pregnancy occurs, a woman needs to consult with a specialized specialist who can conduct an objective assessment of the resulting scar. Today, research methods such as hysteroscopy and hysterography can be used.

Hysteroscopy - is a visual examination, during which the study of the scar formed on the uterus is carried out. For this procedure, an endoscope is used, which is inserted directly into the uterine cavity approximately 8 or 12 months after the operation.

Hysterography is a procedure for taking x-rays, both in lateral and frontal projections. To do this, a special contrast agent is injected into the uterus. However, this study can be carried out not earlier than six months after the last operation, and in some cases even at a later date.

It is advisable to undergo such a procedure no earlier than six months after the last operation, while these two studies are important. A year later, the scar will not change. It is important to remember that before planning a new pregnancy, it is imperative to undergo a hysteroscopy procedure, as soon as after that it becomes possible to establish as accurately as possible the favorable time for pregnancy, or it is worth waiting a little longer.

A favorable time comes at a time when there is practically no scar visible on the uterus, which is the main sign of body recovery. Other indicators will also be evaluated, for example, the tissue from which the formation of the scar itself occurred. It is desirable that not mixed or connective, but muscle tissue prevail here.

Pregnancy one year after caesarean section

Childbirth is a completely natural process, but at the same time, there are situations when you simply cannot do without a caesarean section. However, do not worry, because even after such an unconventional method of childbirth, in the future it will be possible to give birth to a baby again, but for this it is worth waiting a little.

Without fail, after the second pregnancy, it is necessary to plan a new one and consult with your doctor. In the event that the child was born by caesarean section, it is advisable to plan a second pregnancy no earlier than two years later, but in some cases it is possible even earlier.

First of all, this is due to the fact that after a caesarean section, a scar is formed, which must be fully formed. It is worth remembering that if pregnancy occurs about a year later, after the first pregnancy, when the muscle tissue did not have time to completely heal, then there is a threat of a scar rupture. This situation is dangerous not only for the unborn baby, but also for the pregnant woman herself. After a caesarean section, pregnancy planning should begin with a visit to a doctor who can examine the condition of the scar on the uterus. This examination is carried out approximately six months or a year after the operation.

The doctor can give permission for a second pregnancy, after a caesarean section, only if the scar itself has completely formed from the muscle tissue and has become almost invisible. A little worse may be the situation when the scar was formed directly from mixed fibers. In the case when it is the connective tissue that significantly predominates in the scar, it is considered insolvent, therefore, a second pregnancy is strictly prohibited, since the risk of scar divergence increases significantly.

Rupture of the uterus

The main reason for refusing natural childbirth after caesarean is the fear of uterine rupture. In Russia, only 30% of women give birth after a caesarean section by natural means (for comparison, in some clinics in the West, the number of such women approaches 70%). However, this risk is largely exaggerated. There are cases when women gave birth naturally even after two operations on the uterus. The fact is that many years ago, an incision in the uterus was made longitudinally in its upper part, that is, where the probability of rupture during childbirth is greatest. Now almost always it is done transversely in the lower part and almost cannot cause a rupture.

According to official data, the risk of uterine rupture in the case of a transverse incision is only 0.2%, respectively, the probability of a successful outcome of childbirth is 99.8%! In addition, no woman or child in our time dies from a uterine rupture, no matter what the incision was. Fortunately, the threat of an incipient rupture can be easily detected by ultrasound and CTG, its condition is determined at 36-38 weeks and before delivery.

How many times can you have a second caesarean section?

Usually, doctors undertake to do a caesarean section no more than three times, but sometimes you can meet women with a fourth. After how many years can you give birth again? There is no exact answer. Each operation weakens and thins the uterine wall. If you are planning a third caesarean, then it is worth talking with your doctor about the possibility of surgical contraception using tubal ligation right during the operation. This method will reliably protect against subsequent pregnancy and possible surgery on the uterus.

Sex after caesarean section

Before we talk about how long you can have sex after a caesarean, let's find out why gynecologists advise women in labor to temporarily abstain from sexual intercourse. It is worth noting that sex after a cesarean section is rarely prohibited, however, a woman who has undergone an operation will not be able to enjoy her sexual life at first due to pain in the wound area and not only. Even if the operation was successful, and the suture on the abdomen heals quickly, the internal suture that is placed on the uterus is tightened much later. That is why many women experience discomfort during sex even after the wound on the skin of the abdomen no longer bothers. The second possible reason for delaying sex is complications after surgery. In such cases, doctors will not be able to tell the woman in labor exactly when it is possible to have sex after a caesarean, and sexual intercourse is “prohibited”. Everything here will depend on the results of control examinations.

Gynecologists answer the question “How long can you not have sex after a cesarean?” They answer that at least a month. And then sex a month after cesarean is possible only for those who quickly heal the wound on the uterus, which is more common in young mothers. Mature women in labor, those over 30, are allowed to have sex no earlier than one and a half months after the operation. As all mothers know, after childbirth, women have bloody discharge, which is called “lochia”. So all doctors unanimously recommend that women abstain from sexual relations for a while until they are completely over. In addition, if the wound on the uterus has not yet healed, then during sexual contact it can become infected. In order to find out about the condition of the scar, it is necessary to be routinely examined in the uzist's office, who will be able to tell you when it is already possible to have sex after a cesarean. Thinking about how long you can have sex after a cesarean, a woman needs to understand that hormonal changes have occurred in her body during pregnancy and childbirth, and the body needs to be restored. The first sex after a cesarean for a woman can be painful, not only because of the wound on the uterus. Hormonal disorders can cause dryness in the vagina, and therefore, during sexual intercourse at first, care must be taken.

Recovery after a caesarean section will take a woman a long time. But the period during which rehabilitation will take place can be divided into two segments.

Caesarean section: first days

While the first period lasts, a woman who has given birth by caesarean section will have to lie in bed, because her task is to recover from the operation. And even the simplest actions will be difficult for her, for example, she will not just clear her throat, but a deep breath will be hard for her. At this time, the mother is usually forced to be in the intensive care unit, where nurses look after her, watching how the rehabilitation after the operation goes.

The woman's condition is monitored by a doctor who pays attention to the fact that all indicators (pressure, pulse, temperature) are normal. The doctor also monitors how quickly the recovery progresses, how the uterus contracts after a cesarean section, how intense the vaginal discharge is. The seam of a woman deserves special attention. In the postoperative period, it is necessary to change the dressings on it regularly.

What to do after the procedure?

During the caesarean section procedure, anesthesia is mandatory. In this regard, a woman should never sit on the bed for a long time after the operation - up to 12 hours. And you can get out of bed in the postoperative period only 3 days after the caesarean section. This will have to be done very carefully. In this case, sudden movements and haste are contraindicated, it is desirable that relatives or medical staff help mom to get up.

But you can climb only after the attending physician has allowed it to do so. Don't be surprised if you feel dizzy after getting up - this is normal, although recovery is in full swing. And the feeling of weakness and slight malaise is connected with the fact that the woman underwent an abdominal operation under anesthesia. Although it seems to many to be a fairly simple surgical intervention, this does not negate all the “charms” accompanying the procedure. Do not forget that in the process, all layers of the abdominal wall are cut.

Learning to get up

It is important to remember that the doctor's advice primarily determines how the recovery period after a cesarean section goes. And the doctor will give you the following recommendations regarding the first attempt to stand up:

before you sit on the edge of the bed, you need to roll over to one side, after that you can hang your legs and slowly sit down
now you need to “work” with your legs - for this it is enough to do any light exercises. Avoid sudden movements, after all, you had a caesarean section a few days ago
then put your feet on the floor and ask someone to help you get up. An important nuance - you need to get up with a straight back, it is also desirable to stand. Only in this case, your postoperative suture will be safe, even if you feel a slight pull.
do not immediately try to take a step - first, wait
after you feel ready to take a step, take a small step

This instruction must be followed during the postoperative period. After a couple of days, you will notice that it is becoming easier for you to get out of bed. As soon as you stop experiencing discomfort during the rises, know that you will soon have to fully recover. After that, it is desirable to gradually increase the “pacing” time, but not sharply, so that the seam does not begin to diverge - after this, the second period of the woman’s rehabilitation begins after the cesarean section procedure.

We cough correctly

For mothers who have gone through a caesarean section, it is important to learn how to cough correctly in order to recover faster. The fact is that the postoperative period in this case is different in that during the application of general anesthesia (if it was used), mucus has accumulated in the lungs, which will gradually leave, so that a cough will appear in any case. At first, it will cause pain - the area where the postoperative suture is located will ache.

To begin with, it is advisable to put your palms on your stomach, as if holding the seam that you had after the caesarean section (you can tie yourself with a towel). Then draw air into your chest - now exhale sharply, trying to keep your stomach drawn in. A proper cough should ideally resemble the barking of a dog. You will need to exercise several times within an hour if you complain of a buildup of mucus in your chest during the postpartum period. If not, then the procedure can be done rarely. An important point - if you know in advance that you are going to have a caesarean section, it is better to learn the technique before the procedure.

Dealing with delicate issues

You should be prepared for the fact that after a caesarean section you will have several delicate problems - in particular, intestinal gases will make themselves felt. For abdominal surgery, this is a typical consequence, because due to surgery and anesthesia, peristalsis slows down. The problem can be dealt with using a number of methods. For example, learn to breathe deeply, try rocking while sitting in a chair, and give up food that can cause increased gas formation.

Another nuisance that can be encountered after a caesarean is problems with urination. They can be provoked by the catheter that is used during the operation, as well as the anesthesia itself. If you encounter this "disaster", do not worry. First of all, drink more to make you want to urinate. If you are unable to do this, try again in the shower with the sound of running water.

The main thing is to relax and not start to panic. However, remember that in cases where, after a caesarean section, you were unable to go to the toilet “in a small way”, you must definitely warn the doctor about this, because it is vital for you to empty the bladder of urine accumulated in it. Most likely, you will have to use the catheter again, and then undergo an additional examination by a nephrologist. This will somewhat complicate the recovery of a woman in the postoperative period.

Diet

In the first two days after a caesarean section, a woman is given all the nutrients intravenously. The reason is that food is prohibited due to abdominal surgery - the organs must have time to rest. Thus, they will be able to recover faster. These days you can drink only water without gas, if you wish, you can add lemon to it. On the third day, the woman already has the opportunity to eat on her own. To begin with, it is allowed to drink chicken broth - it is he who usually becomes the first dish that is allowed to be consumed during the period when mommy's recovery begins.

Gradually, meat, soufflé, cereals, liquid curds are introduced into the diet of those who have had a caesarean section. You need to eat little by little (100 ml at a time), it is also advisable to drink a little bit. During this period, the abdominal organs should work so that they have to strain to a minimum in order to speed up recovery. It is desirable that the food is not too dense and heavy, because the first stool should "happen" on the 5th day after the caesarean section. Then the diet should become less strict. Ideally, a diet that distinguishes the postoperative period should gradually “reborn” into a diet for nursing mothers.

breastfeeding

But what about feeding if a woman had to go through a caesarean section? If recovery is progressing quickly, ask for the baby to be brought to you as soon as possible. It is very important for you to establish breastfeeding now, but it will be very problematic to do this if the baby is given to you three days after the caesarean section. The fact is that the baby must constantly stimulate the mammary glands - only in this case the breast will be filled with milk. If recovery after a caesarean section is delayed or the baby needs additional medical care, you will have to learn how to express yourself.

Despite the fact that the caesarean section is performed under anesthesia, if it is local, ask to attach the baby to the breast immediately after he is born. Usually maternity hospitals use medicines that are allowed while breastfeeding, so there is no need to be afraid that you will harm the baby. Even if the baby falls asleep, offer him to make the first test - reflexes can work even in this case. Remember that breast milk will help the baby recover if he was born at an early stage. But if you still fail to feed the baby, just press him to your chest - he should feel that his mother is still there. And he recognizes you by the beating of the heart, which he constantly listened to while in the uterus.

However, remember that in the first days after the cesarean section, it is undesirable to take the baby in your arms very often at the moment when you are standing. Thus, you save your seam, which can partially disperse from a strong load. You will have to limit yourself in this sense for a long time - up to six months, although it all depends on how the recovery is going. At home, you will have to ask your family for help more often, especially when you decide to go for a walk for the first time. Also, ideally, it is better not to do household chores for at least the first month - after a cesarean section, it is important for you to recover completely, like your baby. Therefore, this time should be given to yourself and the crumbs.

seam care

If you had a caesarean section, then the postoperative period is simply unthinkable without taking care of the sutures. It is clear that they require special care - during the first week after the caesarean section, they are treated daily, changing the bandages each time. After the stitches are removed, you can safely take a shower, only it is better not to use a washcloth yet, although by this time the scar has already formed.

It is obvious that the seam after the operation and during the recovery period will hurt - at first, painkillers help the young mother to cope with the pain. Gradually, with a decrease in discomfort, they stop giving them to a woman; from that moment on, she is recommended to wear special bandages. Remember that doctors do not allow new mothers to lift more than 2 kg for at least 60 days.

In modern obstetrics, caesarean section is the most frequently performed delivery operation. It is done under general or regional anesthesia (spinal or epidural anesthesia - with these types of anesthesia, the anesthetic is injected into the spinal canal at the level of the lower back). During such anesthesia, only the lower part of the body is anesthetized. The expectant mother is conscious during the operation, can hear and see her child immediately after his birth. After the baby is removed, the woman is often given medication to keep her asleep for the rest of the operation. In this case, surgery is easier to tolerate. Awakening takes place on the operating table. At the same time, as a rule, a woman feels good, does not feel a sense of weakness and faintness. And when using general anesthesia, a woman comes to her senses within 30-60 minutes after the operation.

Doesn't hurt at all
Before the operation, a catheter is inserted into the woman's bladder, as well as a catheter (thin tube) into the vein of the arm. The bladder catheter is usually removed at the end of the first day, this procedure is completely painless. The catheter in the vein of the elbow is as long as there is a need for intravenous administration of drugs.

The first day after caesarean section - intensive care unit

After the operation, the woman is transferred to the intensive care unit, where she is under the supervision of medical personnel. The ward is equipped with equipment that makes it possible to constantly monitor the condition of a young mother, and, most importantly, her well-being is monitored by an obstetrician-gynecologist and an anesthesiologist-resuscitator.

After the end of the operation, an ice pack is applied to the lower abdomen for 1.5–2 hours in order to prevent bleeding and the formation of postoperative hematomas (hemorrhages), improve uterine contraction, and relieve postoperative tissue edema.

2-3 hours after the operation, a woman needs to start moving her arms and legs, turning in bed. It is allowed to sit down and walk around the ward within 5-6 hours after the operation.

After a cesarean section, a woman is given a number of medications:

carry out intravenous infusion of fluids to make up for blood loss and restore fluid and electrolyte balance. After the operation, as a rule, an intravenous catheter (a tube inserted into the cubital vein) remains. Through this catheter, with the help of a dropper, fluid enters. If the caesarean section went without complications, then the dropper remains for 2-3 hours;
narcotic analgesics are prescribed, since the pain in the suture area can be quite strong. These drugs are administered 1-2 times a day for the first 2-3 days, and then gradually canceled. They provide the necessary degree of pain relief;
uterine contracting agents (oxytocin) are administered intravenously in a dropper or intramuscularly 2 times a day;
prevention of infectious postoperative complications after caesarean section with the help of antibacterial drugs. The first dose of the antibiotic is administered intravenously immediately after the ligation of the umbilical cord and again after 6-12 hours during the first day after the operation. If a woman belongs to a high-risk group for the development of infectious and inflammatory complications after cesarean (for example, if urinary tract infections were detected during pregnancy, more than 12 hours have passed since the outflow of water before surgery, etc.), administration of antibacterial drugs continue for 5-7 days. If the operation was planned, went without complications, then a single administration of antibiotics during the operation is possible. In any case, the use of antibiotics during and after surgery, as a rule, does not affect the possibility of breastfeeding. If it is necessary to use antibacterial drugs that are incompatible with breastfeeding, the doctor will definitely tell the young mother about this and explain how to behave in order to maintain the possibility of breastfeeding the baby after the end of treatment.

On the first day after cesarean, therapy is carried out aimed at restoring bowel function. For this, stimulants of the contractile activity of the intestine (potassium preparations, etc.) must be added to the injected solutions. At the end of the first - the beginning of the second day after the operation, a cleansing enema is prescribed to activate the work of the intestines.

On the day after the caesarean section, you can only drink, you can not eat. This restriction is necessary in order to minimize the load on the gastrointestinal tract. You can drink water with lemon juice or mineral water without gas.

In the early postoperative period, prevention of blood clots in the vessels of the lower extremities is carried out: drugs are introduced that prevent the formation of blood clots, it is recommended to bandage the legs before surgery or use special compression stockings - this measure improves venous outflow from the legs, helping to move blood through the veins. It is advisable to wear elastic bandages or stockings for at least seven days after childbirth.

If the operation went well, the mother and baby do not have any complications, then for the first time the child can be brought to the intensive care unit for feeding, however, this is not accepted in most maternity hospitals, and more often the baby is brought to the mother already in the postpartum department.

After caesarean section: postpartum ward

At the end of the first - on the second day after the caesarean section, the woman is transferred to the regular ward of the postpartum department. She is allowed to sit and walk around the room. Also on the 2nd day, the introduction of infusion solutions continues. In the case of the use of drugs that can have a negative effect on the newborn, it is recommended to start breastfeeding later, after the end of their action.

Within 6–7 days, the attending physician examines the postoperative suture, and the nurse bandages it once a day and treats it with antiseptic solutions. The sutures are removed, as a rule, on the 5-7th day after the operation.

To assess the condition of a young mother, various blood tests are prescribed. On the 5-6th day after the operation, an ultrasound examination of the pelvic organs is performed, which allows you to judge the size of the uterus, the condition of the postoperative sutures, the presence of hematomas, blood clots, the size and contents of the uterine cavity.

After childbirth, the uterus is an extensive wound. The healing process is accompanied by the presence of secretions from the genital tract - lochia. After a caesarean section, as well as after a natural birth, the lochia first comes out bloody, then sanious (brownish-pink) and they will stand out within 6-8 weeks after birth. A woman is recommended to use the toilet of the external genital organs after each urination, defecation, change the sanitary pad every 2-4 hours.

Features of nutrition after cesarean

The load on the gastrointestinal tract in the postoperative period should be increased gradually. On the second day, you can eat boiled meat, cereals, low-fat broth, drink sweet tea. Starting from the third day, the mother can already afford a more complete diet, taking into account breastfeeding.

Support for the abdomen after cesarean

Immediately after transfer to the postpartum unit, you can start wearing a postoperative bandage. It is worn over an aseptic dressing. The postoperative bandage fixes the sutures, abdominal muscles, reduces pain in the suture area, and the likelihood of hernias. It is necessary to wear a bandage for 2 months after the operation.

Breastfeeding after caesarean section

Breastfeeding is allowed depending on the traditions of the institution, the condition of the mother and child on the 1-3rd day after the operation. The development of lactation after a caesarean section is almost the same as in women who have given birth naturally. If the operation was planned (carried out before the development of spontaneous labor), then milk may come not on the 3-4th, but on the 4-5th day, but colostrum begins to be released immediately after the operation.

It is most convenient in the first days after a cesarean section to feed the baby lying on its side. In this position, the postoperative suture will be least affected. In the future, it is possible to feed the baby in a sitting or standing position.

In the normal course of the postoperative period, the mother is discharged from the maternity hospital on the 6-7th day.

After returning home

10-12 days after discharge from the hospital, it is advisable to visit an obstetrician-gynecologist in the antenatal clinic to make sure that the recovery after the operation is normal.

Final recovery after caesarean section

The final healing of the postoperative wound on the uterus and the formation of the scar occur within 8 weeks after birth. During these periods, it is recommended to visit the obstetrician-gynecologist again. In this case, it is imperative to do a control ultrasound examination of the pelvic organs in order to check the condition of the uterine cavity and the postoperative scar.

Menstruation after a caesarean section is restored in the same way as after natural childbirth. If a woman is breastfeeding, then menstruation returns 6-12 months after birth, in cases where the baby is bottle-fed - usually 8 weeks after birth.

When resuming sexual relations, it is necessary to use contraceptives, which the doctor will help you choose. An abortion performed within 1-2 years after surgery significantly worsens the prognosis of subsequent pregnancies. It is believed that the optimal state of the scar (complete restoration of the muscle layer) on the uterus reaches 2-3 years after the operation. It is through this period of time that it is recommended to plan a subsequent pregnancy.

After a caesarean section, sexual rest is recommended for 2 months after the operation.
Within 2 months after the operation, it is undesirable to lift weights of more than 3-4 kg (child's weight).
Be sure to follow the rules of personal hygiene: it is advisable to take a shower at least 2 times a day, while the seam area should not be rubbed with a washcloth. After a shower, once a day, it is recommended to treat the area of the postoperative scar with antiseptic solutions (brilliant green, 70% ethanol solution). After treatment, a disposable antiseptic dressing is applied to the suture area to prevent rubbing of the suture against clothing. After the complete disappearance of the crusts (on average, 10-14 days after the operation) in the area of the postoperative suture, the bandage can no longer be applied.
The menu of a woman who has undergone a cesarean section and is breastfeeding should have a sufficient amount of proteins, since they are the main building material for the synthesis of immunity factors and hemoglobin. Also, proteins in large quantities are part of breast milk. A lot of protein is found in meat, fish, cottage cheese, milk, cheese. At the same time, meat and fish should be lean, boiled or steamed. Cheese should be chosen mild.
Within 2 months after the operation, you can not pump the abdominal muscles, as there is a possibility of suture divergence. But after 1 month, you can start light physical exercises aimed at restoring the overall tone of the body. To begin with, you can practice for 15-20 minutes, then increase the time of classes up to 40 minutes a day.

Breathing exercises

Already 2 hours after the operation, it is possible to carry out breathing exercises, aimed primarily at the prevention of congestive processes and inflammatory complications in the lungs, which may occur due to the fact that the woman has been lying down for a relatively long period. These exercises are especially relevant during general anesthesia, when a tube is inserted into the airways, it irritates the airways, they form an increased amount of mucus, which is a breeding ground for pathogenic microbes. Breathing exercises are performed by a nurse. It consists in combining the phases of breathing (inhalation and exhalation) with a certain frequency. You can also use balloon inflation for this purpose.

Caesarean section should be performed only in cases where natural childbirth is associated with a high risk to the health and life of the fetus or mother. However, in recent years, the number of planned operations has become more frequent. Some time passes, and many women who want to once again experience the happiness of motherhood begin to wonder if natural childbirth after a caesarean section is possible.

Doctors do not give a definite answer to this question. The second and subsequent births can take place both vaginally and with the help of a second operation. Consider when a second birth after a caesarean section is allowed, under what conditions a second operation is mandatory, and how high are the risks of natural childbirth after a few years after a caesarean section.

What you need to know about caesarean section

Despite the fact that, according to statistics, the number of children born as a result of surgery is steadily growing, many women do not know well what indications surgery is performed for and what risks and complications it causes. The first caesarean section is performed exclusively for medical reasons. One desire of a pregnant woman is not enough.

The following indications are distinguished:

the presence of severe chronic diseases (diabetes mellitus, hypertension, cardiovascular pathologies, endocrine diseases);
malposition;
multiple pregnancy;
weakness of labor activity;
in severe form;
premature detachment of the placenta, high risk of fetal hypoxia;
various infections of the genital organs;
anatomical defects of the uterus and other genital organs.

With a caesarean section, the child is removed through the dissected anterior wall of the uterus. In this case, not only the external scar on the skin remains, but also the internal one, on the uterus. It is the presence of a scar that can become an obstacle to further gestation and delivery in a natural way.

The healing of the external scar occurs in a fairly short time, about a week or two after the operation. As for the restoration of the integrity of the tissues of the uterus, much more time is required here. Full healing should take from six months to a year.

Most often, it is planned, but a decision can be made to carry it out urgently with the threat of uterine rupture, sudden cessation of contractions, and early placental abruption.

Two types of incision are possible: classic (longitudinal) and transverse (incision along the bikini line). The second type of access is more preferable, since it is less noticeable and allows for the possibility of giving birth on your own in the future.

Planning for subsequent pregnancies

The most important question in this situation remains: how long can you give birth after a cesarean section. Regardless of whether a woman is planning a natural birth or through a second operation, the period between birth and the next conception should not be less than two years. Such terms are quite justified: during this time, the complete healing of the uterine scar and the restoration of the integrity of the tissues of the organ must pass.

Pregnancy, which occurred a year after caesarean section, is associated with a very high probability of scar softening. During contractions, a rupture of the scar can occur and, accordingly, the death of the child, and sometimes the death of the mother.

In the two-three-year period between pregnancies, a woman should approach the issue of protection very responsibly. Your doctor will help you choose the best contraceptive. The application allows not only to avoid premature pregnancy, but also to restore the hormonal background.

Abortion at this time is also highly undesirable. Such an intervention always negatively affects the condition of the uterus, especially if there is a postoperative scar on it.

When planning pregnancy after 2 years after cesarean, the patient should consult a doctor to assess the condition of the uterine scar. For this, the following diagnostic methods are used:

Hysterography is an examination of the organ cavity with the help of a special radiopaque agent introduced.
Hysteroscopy is the study of the state of scar tissue using an endoscope.

If the scar is practically invisible, this allows us to talk about its complete healing and maximum recovery of the body. It is considered wealthy subject to the predominance of muscle tissue. In this case, a woman may be allowed to plan a new pregnancy. If the scar forms connective tissue, a new pregnancy is contraindicated.

When is self-delivery possible?

As already mentioned, the most optimal period is 2 years after the operation. However, the principle “the later the better” does not work in this situation either. If the period between births is significant, and the second pregnancy occurs after 10 years, natural delivery is unlikely to be acceptable. Given the age of the mother, which was no longer young at that time, a second operation is likely to be needed.

After the operation, the woman should take an extract from the history of the course of childbirth, which will indicate the reasons for the operative delivery, the method of suturing the incision, the suture material used, and other features of the operation. In the future, these indications will be taken into account when deciding on the possibility of vaginal delivery.

Independent childbirth after caesarean section is possible in the following cases:

the presence of a transverse incision of the uterus;
the previous operation was performed for indications related to the characteristics of the first pregnancy (for example, multiple pregnancy, malposition of the fetus, premature detachment of the placenta);
the recovery postoperative period passed without complications;
the course of a new pregnancy without severe pathologies;
satisfactory condition of the uterine scar;
head presentation of the fetus;
lack of attachment of the placenta in the area of scar tissue;
the weight of the child is not more than 3.8 kg;
psychological readiness of the mother for natural childbirth.

Be sure to take into account the viability of the scar. It is considered as such with a thickness of at least 3 mm.

Repeated independent childbirth has a number of advantages for both the mother and the baby. They increase the possibility of natural childbirth in the future, allow a woman to return to normal much faster and, without causing difficulties with breastfeeding, contribute to a faster adaptation of the baby to the outside world.

When self-delivery is not desirable

In the presence of a narrow pelvis, chronic severe pathologies, an increased risk of hypoxia and fetal death. The suture material that was used during the previous operation is taken into account. A positive point is the use of modern synthetic materials (vicryl, polyamide).
If the recovery process was difficult, with an increase in body temperature, the development of an inflammatory process and a prolonged contraction of the uterus.

How possible independent childbirth after 2 caesarean sections?

Doctors usually say that this is unlikely. In this case, the risk of developing various complications is very high, including:

oxygen starvation of the fetus;
rupture of the body of the uterus;
further development of the adhesive process in the fallopian tubes or ovaries;
the appearance of postoperative hernia.

If a few decades ago, women were forbidden to become pregnant after two cesarean, today such restrictions no longer exist, but it is unlikely that it will be possible to avoid surgery during the third and subsequent births. Each subsequent operation significantly increases the risk of complications.

Preparing for childbirth

When planning a second and further pregnancies, the patient must pass, which allows to determine the condition of the scar and readiness for conception and bearing the fetus. It is necessary to treat diseases that can become an obstacle to self-delivery.

A new pregnancy after the surgery proceeds without deviations from the norm. In a third of pregnant women, there may be a threat of miscarriage due to the thinning of the walls of the uterus. Regular examination of the uterine scar is necessary, especially during the last weeks before the expected birth. The final decision on the readiness of the mother for conventional childbirth is made by the doctor no earlier than the 35th week of gestation.

Hospitalization usually occurs at 37-38 weeks of gestation. There is no single point of view regarding the method of initiation of labor. As a rule, they are called artificially in the daytime, so that in case of an increased risk, an emergency surgical intervention is still carried out.

But this practice has many opponents. In their opinion, any external interference and artificial can only cause harm. The natural course of childbirth without artificial stimulation of their onset is usually longer, but it is safe for the mother and baby. The most optimal solution in this situation is an individual approach to each specific case.

The course of childbirth

According to statistics, only a third of women decide to have a second birth without surgery. This is due to the fear of complications and unwillingness to risk the health of the child. Meanwhile, in the absence of negative indications, the second birth after caesarean section, taken by an experienced gynecologist, is successful.

When making the final decision, they pay attention to how the prenatal period went, the timeliness of the discharge of water, the normal dynamics of the opening of the cervix, the positive state of the fetus and mother.

During the birth period, the following rules are followed:

They are allowed only in specialized medical institutions.
It is undesirable to use uterine stimulants based on prostaglandins (for example, Dinoprostone).
A woman in labor is forbidden to push prematurely.
When trying, you can not press on the abdomen.
Pain relief procedures are excluded due to the risk of missing the sensation of pain as a symptom of scar destruction.
Take into account the need for constant monitoring of the state of the uterine scar.
A thorough examination of the body of the uterus after the birth of a child is necessary.

Feeling the walls of the uterus and the healed suture after the release of the placenta is necessary in order to finally exclude ruptures. Symptoms of a violation of the integrity of the seam can be a sharp weakness in labor pains, the appearance of vomiting and nausea, as well as pain in the navel. Palpation of the uterine cavity is performed under intravenous anesthesia and takes about five minutes.

With the appearance of these symptoms and a sharp deterioration in the well-being of the woman in labor, an emergency surgical intervention is indicated.

The physiological recovery period lasts from 6 to 8 weeks. It is easier and more harmonious than the rehabilitation period as a result of a caesarean section. The main advantage is the ability to establish full lactation.

And at this time, it is important for a woman to know many little things in order to recover faster and avoid mistakes that will entail disastrous consequences. Thanks to the analysis of women's thematic forums, we have identified the main questions about the recovery period after caesarean section.

What can you eat after the operation?

Like every abdominal surgery, caesarean section is performed under general or epidural anesthesia. The speed of recovery after anesthesia depends on many factors. First of all, from the chosen type of medicine, the correctness of the calculation by the anesthesiologist of the dose and the characteristics of the patient's body.

On the first day after this operation, you can drink water without gas, it is allowed to slightly acidify it with lemon juice. All nutrients to a woman so far enter the blood vessels with the help of droppers.

The patient is transferred from the intensive care unit to the postpartum on the second day after cesarean. What can you eat? As after another abdominal operation, broths, unsweetened fruit drinks, tea, ground boiled meat, low-fat cottage cheese, yogurt without fruit fillers, grated vegetable purees are allowed. Solid food is not recommended, as it is still necessary to spare the digestive organs.

After three days and in the future, the usual diet is gradually introduced, taking into account the diet for a mother who is breastfeeding. Pediatricians in the maternity hospital will tell you about what you can eat after a cesarean section for high-quality lactation. Milk porridges, vegetable side dishes and broths, fruit jelly, boiled meat and fish, steamed cutlets are useful. It is necessary to exclude fried, fatty, floury, salty, sweet, carbonated drinks and other foods that are difficult for the body in the postoperative period. It is allowed to fully resume the usual menu after the first independent stool, which, as a rule, should be 3-5 days after the operation.

When can I move actively after a caesarean?

How long you can resume activity after a cesarean depends on the individual characteristics of your body. Listen to the recommendations of doctors. And start moving only with their permission. Already on the second day after the surgical delivery, you will need to get out of bed on your own. Further, slow walking is allowed. You can sit down, starting only from the third day. In the first month after discharge from the hospital, you should not lift weights that exceed the weight of your baby.

Starting sports after surgery

Again, it all depends on your body. But regular sports are usually recommended by doctors not to start earlier than six weeks after surgery. Many women, puzzled by the restoration of their figure, are interested in when it is possible to pump the press after a cesarean section. Loads on the muscles of the peritoneum are recommended no earlier than a month later. Otherwise, you can cause deformations in the area of the scar and even a hernia on it.

Swimming in the pool, for example, after a caesarean section is allowed only after the discharge has stopped.

When is sex allowed after a caesarean?

There is no single answer to this intimate question. Naturally, it is necessary that the discharge from the woman in labor should stop. And it should be understood that the postoperative uterus is an extensive wound surface and an early return to sexual activity can not only lead to pain, but also threatens the risk of infection of the mucosa. It is necessary to resume sexual relations no earlier than one month after operative delivery.

As a standard, gynecologists, when asked when it is possible to become pregnant after a cesarean, recommend that at least 18 months should elapse between the operation and subsequent pregnancy. Therefore, even if you are breastfeeding a newborn and the menstrual cycle has not yet resumed, do not forget about contraception. After all, pregnancy soon after the operation is dangerous for both the fetus and its mother. And abortion in this case can also adversely affect the condition of an already weakened uterus and may lead to infertility in the future.

When can I give birth after surgery

When can you give birth to the next baby after cesarean is a question that worries many women. As a result of the operation, a scar remains on the uterus, which can disperse during a new pregnancy, which poses a huge threat to the life of the mother and fetus. Therefore, ideally, at least 2-3 years should elapse between childbirth by surgery and the next pregnancy, so that the scar tissue has time to fully form.

But too much interval between pregnancies is not desirable, because it will be a weighty argument in favor of repeated operative childbirth. It is important that the pregnancy after the previous caesarean section is planned and proceeds under the careful examination of the doctor. First you need to assess the condition of the scar, for which methods such as hysteroscopy and hysterography are used.

First of all, it depends on the reason for the caesarean section. And if it has not yet been eliminated (for example, vision problems in the mother), then only operative delivery is possible in the future. Is it possible to give birth after a caesarean section in other cases? If during a previous pregnancy the baby simply lay incorrectly in the womb, which is why the operation had to be performed, then subsequent vaginal births are possible. But this takes into account the condition and type of scar (longitudinal or transverse), as well as the course of a new pregnancy. With a longitudinal seam in a woman, natural childbirth is usually excluded.

With a transverse scar after cesarean, you can give birth yourself, if there are no more contraindications for this. But the final verdict on the possibility of vaginal delivery after previous surgeries is made after 35 weeks of pregnancy. This takes into account factors such as the size of the fetus, its presentation and position in the womb, the location of the placenta relative to the internal uterine os and suture, as well as the viability of the scar itself. Only then will the woman be told whether it is possible to give birth herself after a caesarean section.

Regarding how much you can give birth after cesarean, there is also no single answer. All this is individual and depends on the state of health of the woman. Since pregnancy with a scar on the uterus is dangerous for both the mother and the fetus, and each new operation is more difficult than the previous one, surgeons advise the permissible number of caesarean sections to be no more than three.