Indications for caesarean section - list. When is a planned caesarean section done? When is a caesarean section performed? Childbirth through caesarean section - indications and types, preparation for surgery, conduct and postoperative care

A caesarean section is an operation in which a viable baby and baby's place is removed from a woman through an incision in the abdomen. At the moment, this operation is not an innovation and is well spread: every 7 woman goes into labor by caesarean section. Surgical intervention can be prescribed in a planned manner (according to indications during pregnancy) and in an emergency (in case of complications in natural childbirth).

What is a caesarean section

Childbirth by caesarean is an obstetric operation that belongs to emergency care. Every obstetrician-gynecologist should know the technique of execution. This is, first of all, salvation, in case of complicated pregnancy and childbirth, which helps to save the life of mother and child. In the process, it is not always possible to preserve the health of the child, especially with fetal hypoxia, infectious diseases, severe prematurity or post-term pregnancy. Caesarean section is performed only for serious indications - the decision is made by the surgeon of the maternity ward.

Even with new technologies, high quality suture material, the procedure can cause complications, such as:

• bleeding;
• embolism with amniotic fluid;
• development of peritonitis;
• thromboembolism of the pulmonary arteries;
• divergence of postoperative sutures.

Why is it called

The word "caesar" is a form of the Latin word "caesar" (i.e. ruler). There are suggestions that the name refers to Gaius Julius Caesar. According to an old legend, the emperor's mother died during childbirth. The doctors of that era had no choice but to cut the belly of a pregnant woman in order to save the child. The operation was successful and the baby was born healthy. Since then, according to legend, this operation has been called that.

According to another theory, the name may be associated with a law (published in the time of Caesar) which read: upon the death of a woman in labor, save the child by dissecting the anterior abdominal wall and layers of the uterus, removing the fetus. For the first time, an operation to give birth to a baby, with a happy ending for mother and child, was performed by Jacob Nufer to his wife. All his life he performed operations - castration of boars. With a long and unsuccessful birth of his wife, he asked permission to make her an incision with his own hand. The birth by caesarean was successful - mother and child survived.

Indications

The main indications for the procedure are as follows:

• complete and incomplete placenta previa;
• premature, rapid placental abruption with intrauterine fetal suffering;
• failed scar on the uterus after previous births or other operations on the uterus;
• the presence of two or more scars after caesarean;
• anatomically narrow pelvis, tumor diseases or severe deformities of the pelvic bones;
• postoperative conditions on the pelvic bones and joints;
• malformations of the female genital organs;
• the presence of tumors in the pelvic cavity or in the vagina that block the birth canal;
• the presence of uterine fibroids;
• the presence of severe preeclampsia, and the lack of effect from treatment;
• severe diseases of the heart and blood vessels, diseases of the central nervous system, myopia and other extragenital pathology;
• conditions after stitching fistulas of the genitourinary system;
• the presence of a perineal scar of the 3rd degree, after previous births;
• varicose veins of the vagina;
• transverse arrangement of the fetus;
• multiple pregnancy;
• pelvic presentation of the fetus;
• large fruit (more than 4000 g);
• chronic hypoxia in the fetus;
• the age of primiparous older than 30 years, having diseases of the internal organs, which can aggravate childbirth;
• prolonged infertility;
• hemolytic disease in the fetus;
• post-term pregnancy with unfinished birth canal, lack of labor activity;
• cervical cancer;
• the presence of the herpes virus with exacerbation.

Indications for emergency caesarean section

In some cases, surgery is necessary on an emergency basis. The indications will be:

• severe bleeding;
• clinically narrow pelvis;
• amniotic fluid poured out prematurely, but there is no labor activity;
• anomalies of labor activity that are not amenable to the action of medicines;
• placental abruption and bleeding;
• situation threatening uterine rupture;
• prolapse of umbilical cord loops;
• incorrect insertion of the fetal head;
• sudden death of a woman in labor, but the fetus is alive.

The choice of a woman

In some clinics and states, they practice the operation at will. With the help of a caesarean section, a woman in labor wants to avoid pain, increase the size of the pelvic floor muscles, and avoid vaginal incisions. Having avoided some unpleasant sensations, women in labor face others, which in most cases need to be much more afraid - a violation of the baby's nervous system, difficulty in lactation, divergence of postoperative sutures, the inability to give birth naturally in the future, etc. Before planning the operation yourself, weigh everything pros and cons.

Caesarean section: pros and cons

Many women in labor see the obvious positives of the operation, but do not weigh the pros and cons of a caesarean section. From the pros:

1. removal of the baby without pain and in a short period;
2. confidence in the health of the fetus;
3. no damage to the genitals;
4. you can choose the date of birth of the baby.

Moms are not even aware of the disadvantages of such a procedure:

1. pain after the operation is very intense;
2. there is a possibility of complications after surgery;
3. possible problems with breastfeeding;
4. it is difficult to care for the baby, the risk of seam divergence;
5. long recovery period;
6. possible difficulties in subsequent pregnancies.

Kinds

Cesarean is: abdominal, abdominal, retroperitoneal and vaginal. Laparotomy is performed to remove a viable infant, for a non-viable infant, vaginal and abdominal wall surgery is possible. Types of cesarean section differ in the localization of the uterine incision:

• Corporal caesarean - a vertical incision of the body of the uterus along the midline.
• Isthmicocorporal - the incision of the uterus is located along the midline, partly in the lower segment and partly in the body of the uterus.
• A cesarean section incision in the lower segment of the uterus, transverse with detachment of the bladder.
• In the lower segment of the uterus, a transverse incision without detachment of the bladder.

How is it happening

The procedure for or how a caesarean is done for planned hospitalization is described below:

1. Before the operation, anesthesia is performed (spinal, epidural or general anesthesia), the bladder is catheterized, the abdominal area is treated with a disinfectant. There is a screen on the woman's chest to block access to the examination of the operation.
2. After the onset of anesthesia, the procedure begins. Initially, an abdominal incision is made: longitudinal - goes vertically from the pubic joint to the navel; or transverse - above the pubic joint.
3. After that, the obstetrician pushes the abdominal muscles, cuts the uterus and opens the fetal bladder. After the newborn is removed, the placenta is delivered.
4. Next, the doctor sews up the layers of the uterus with special absorbable threads, then the abdominal wall is also sutured.
5. Impose a sterile bandage on the abdomen, an ice pack (for intensive contraction of the uterus, reducing blood loss).

How long does a caesarean section take

Normally, the operation lasts no more than 40 minutes, while the fetus is removed approximately at the tenth minute of the process. A large amount of time is taken by layer-by-layer suturing of the uterus, peritoneum, especially when applying a cosmetic suture, so that the scar is not noticeable in the future. If complications arise during the operation (long-term anesthesia, acute blood loss in the mother, etc.), the duration may increase up to 3 hours.

Anesthesia methods

Methods of anesthesia are chosen depending on the condition of the woman in labor, the fetus, planned or emergency surgery. Means that are used for anesthesia must be safe for the fetus and mother. It is advisable to conduct conduction anesthesia - epidural or spinal. Rarely resort to the use of general endotrachial anesthesia. In general anesthesia, a preliminary anesthesia is first introduced, after which a mixture of oxygen and a drug that relaxes the muscles is used, with anesthetic gas.

During epidural anesthesia, a substance is injected into the nerve roots of the spinal cord through a thin tube. A woman feels pain only during a puncture (a few seconds), then the pain in the lower body disappears, after which the condition is relieved. Throughout the procedure, she is conscious, fully present during the birth of the child, but does not suffer from pain.

Care after caesarean section

The entire period of the woman's stay in the maternity hospital, the processing of sutures is carried out by the medical staff. To replenish the fluid in the body for the first day, you need to drink plenty of water without gas. There is an opinion that a full bladder prevents the muscles of the uterus from contracting, so you need to go to the toilet often, without retaining fluid in the body for a long time.

On the second day, it is already allowed to take liquid food, and from the third day (in the normal course of the postoperative period), you can resume the normal diet, which is allowed for nursing. Due to possible constipation, it is not recommended to eat solid food. This problem is easily dealt with with enemas or glycerin suppositories. You should eat more dairy products and dried fruits.

In the first months, it is not recommended to visit pools or open water, take baths, you can only wash in the shower. It is recommended to start active physical activity not earlier than two months after the operation to restore the form. You should start having an active sex life only two months after a cesarean. In case of any deterioration in the condition, it is necessary to consult a doctor.

Contraindications

When performing a caesarean section, contraindications should be taken into account. At the same time, if the procedure is prescribed for vital indications for a woman, they are not taken into account:

• Fetal death in utero or developmental anomalies that are incompatible with life.
• Fetal hypoxia, without urgent indications for caesarean section by a pregnant woman, with confidence in the birth of a viable baby.

Effects

With surgery, there is a risk of such complications:

• pain may appear near the seam;
• long recovery of the body;
• possible infection of the scar;
• the presence of a scar on the abdomen for life;
• limitation of physical activity for a long time;
• the impossibility of normal hygiene procedures for the body;
• limiting intimate relationships;
• the likelihood of psychological shock.

What is dangerous for a child

Unfortunately, the surgical process does not pass without a trace for the child. Possible negative consequences for the baby:

• Psychological. There is an opinion that in children there is a decrease in the reactions of adaptation to the environment.
• It is possible that there is amniotic fluid in the lungs of the baby, which remained after the operation;
• Anesthesia drugs enter the baby's blood.

When can I have a baby after a caesarean section?

It is recommended to plan the next pregnancy after 5 years. This time is enough for complete scarring and restoration of the uterus. To prevent pregnancy before this period, it is recommended to use various methods of contraception. Abortions are not recommended, since any mechanical intervention can provoke the development of inflammatory processes in the uterine wall or even its rupture.

Video

Every pregnant woman has two delivery options - natural and artificial or surgical, that is, with the help of an operation. The second is performed only under strict indications because it is potentially life-threatening.

What is a caesarean section: a bit of history

A cesarean is an operation that helps a child to be born when his mother has difficulties with self-delivery. Despite the development of medicine and medical care for women, including regular observations in antenatal clinics and ultrasound examinations, the frequency of these operations is not decreasing. And there are several reasons for this.

Now it is much easier to diagnose various pathologies (and in fact indications for surgery). And this is a plus - more healthy babies are born and fewer expectant mothers die. In addition, the number of women giving birth after 30-35 years of age has sharply increased. They are at risk for various chronic diseases and usually have more indications for operative delivery than young women.

The history of caesarean section is interesting. This operation has been performed since ancient times. But first, only on ... dead women. It was believed that it was impossible to bury women with a fetus in the womb.

In the late 16th and early 17th century, operations began to be performed on living women to save children. However, in 100% of cases they led to the death of mothers, since the wound was not sewn up. This led to huge blood loss and sepsis, not to mention pain shock. There were no antiseptics or painkillers back then.

In Russia, the first successful operations, as a result of which women and children remained alive, were carried out in the 18th century. And in total, until 1880, 12 caesarean sections were performed (this is almost 100 years).

Every year the number of operations grew. Primitive antiseptics and painkillers appeared, they began to suture the uterus. And thus, by the end of the 19th century, maternal mortality due to surgery had dropped to 20 percent.

Indications for a planned caesarean

A planned operation is called because it is performed at the time scheduled by the doctors after a little preliminary preparation. Usually, this preparation includes an ultrasound scan, a series of tests and hospitalization in a maternity hospital. There, she can be given antibiotics and droppers with saline a few hours before the operation. Planned caesarean section is mandatory in the following cases.

1. Too low location of the placenta to the internal os of the uterus. A rather rare complication, since in most cases the placenta rises high in the uterus due to its increase, growth. Nevertheless, this pathology is very dangerous, as it threatens with severe bleeding. Well, a woman, for obvious reasons, cannot give birth naturally. Therefore, it is necessary to be admitted to the hospital early.

2. Incorrect position of the fetus in the uterus. Normally, babies are located in the last month of pregnancy or earlier, head down. If the baby is head up, obliquely in the uterus or across - this is not the norm. But if with an oblique and transverse position of the fetus, a planned operation is always performed, then with the gluteal it is possible to give birth to yourself. A breech caesarean is usually performed if the woman has had a surgical delivery in the past, there are other reasons for the operation. As one of the options - preeclampsia, as well as age after 30 years, if the birth is the first, the sex of the child is a boy, the estimated weight is more than 3.6 kg, etc. With a breech presentation, a cesarean section takes place as close as possible to the date of the expected birth.

3. An inconsistent scar on the uterus. The quality and reliability of the scar is checked by ultrasound. But if the scar is problematic, the woman, as a rule, also feels it in the form of pain. Now only the fact of operative delivery in the past is not a reason for surgery in the next pregnancy. Doctors should look for other indications for surgery and for the visible state of the suture on the uterine wall.

4. Several scars on the uterus. Then natural childbirth is impossible. after multiple caesareans.

5. Narrow pelvis from birth (2-3 degree of narrowing). It usually occurs in women below 150 cm.

6. Tumors of the uterus, located in its lower part. Most often benign fibroids. During pregnancy, the position of the fibroids may change, it rises higher in the uterus. Look at the position of the fibroids before childbirth. If it is low - vaginal probe.

7. Curvature of the pelvic bones as a result of injuries, operations, etc.

8. Congenital malformations of the genitals and internal genital organs.

9. Multiple uterine fibroids or a very large node - more than 8 cm. With caesarean section, it is sometimes possible to simultaneously remove the nodes. But in a difficult situation and if the patient has other children and there are no reproductive plans for the future, sometimes the uterus is removed immediately.

10. Severe pathologies of the heart, blood vessels, nervous system, very poor vision and a tendency to decrease it.

11. Operations on the cervix in the past or its cicatricial changes.

12. Tears of the third degree in previous natural childbirth.

13. Significant dilatation of the veins (varicose veins) of the perineum.

14. Conjoined twins. Siamese twins.

15. Multiple pregnancy (three or more fetuses). With two fetuses, natural childbirth is possible if they lie heads down and there are no other contraindications for independent labor.

16. Long-term infertility, IVF, artificial insemination- as an additional reason for the operation.

17. Cancer of the pelvic organs in the mother. Often the cervix.

18. Post-term pregnancy and the inability to stimulate labor. Sometimes even medical stimulation does not help. Often this happens in primiparas.

19. Chronic fetal hypoxia, significant intrauterine growth retardation. Delay of 3 weeks or more.

20. Recurrence of genital herpes at 38 weeks or later. The baby can become infected by passing through the mother's vagina.

21. Age of nulliparous over 30 years+ other relative indications for surgery.

It should be noted that now more than half of the operations are planned.

Video of a caesarean section:

How is a cesarean section performed with a breech presentation, under general anesthesia, epidural anesthesia.

Indications for emergency caesarean section

Sometimes the operation needs to be performed urgently. Such a need may arise if labor activity began in a woman who was already supposed to have an operation, but later.
Or directly during fights in the following situations.

1. The condition of a woman with preeclampsia worsened sharply. For example, blood pressure has risen to critical values ​​and does not go astray.

2. The condition of the fetus has deteriorated sharply. There are significant changes in heart rate. Diagnosed with an obstetric stethoscope and CTG.

3. Bleeding has begun - premature detachment of the usually located placenta has occurred. Sometimes it happens. A very dangerous pathology, which in a matter of minutes can lead to the death of the fetus, and in a few more minutes - to the woman in labor due to severe blood loss. It can happen to every woman. For this reason, doctors do not advise giving birth at home, even with experienced midwives and an impeccable obstetric history.

4. There was a discrepancy between the size of the pelvis and the diameter of the fetal head. The cervix has already fully opened, but the woman in labor cannot push the baby out.

5. A real threat of uterine rupture, failure of the scar. This sometimes happens if you give birth on your own after a caesarean section.

6. Deviations during labor- if there are no contractions and it is impossible to cause them, or they are, but do not lead to the opening of the cervix.

7. Too weak labor activity a few hours after the discharge of amniotic fluid. Without water, the fetus suffers and is susceptible to infection by the ascending route (from the vagina).

8. Prolapse of the umbilical cord. May lead to acute hypoxia. For this reason, doctors perform special manipulations after the discharge of the anterior waters, so that the baby's head falls lower into the pelvis and the umbilical cord cannot fall under it. If this happens, the fetus may die due to acute hypoxia. If the umbilical cord is already compressed, an emergency caesarean section must be performed within the next few minutes to save the baby's life. Even a short oxygen deficiency is very dangerous, it will affect his health in the future.

9. Incorrect position of the head in the pelvis of the mother e.g. frontal, anterior facial, etc.

An emergency operation is always potentially more dangerous than a planned one. After it, complications occur more often, including an infectious plan, in the child and mother.

When the operation is planned, everything starts with preoperative preparation. The woman spends the day before the operation in the hospital, where she is given a light supper. Before going to bed, they put an enema and give sleeping pills. At 6 a.m., the enema is repeated, the legs are bandaged, or they are told to wear elastic stockings. Before the operation, the condition of the fetus is checked - its heartbeat, CTG is done and a urinary catheter is placed.

In the case of an emergency caesarean section, the main task is to find out if the patient ate and when exactly. If so, she may have her stomach emptied with a tube, as stomach contents may enter her lungs during the operation. And this is very dangerous. So, it is not in vain that during childbirth they are not advised to eat. You never know, suddenly you have to urgently do an operation? In addition, if possible, put an enema.

There are two main methods of operation. They differ in the type of cut. Doctors used to make a vertical incision in the uterus. For this reason, he was very visible. Adhesions often occurred, the scar healed poorly, and during the next pregnancy, its failure occurred. And there was no need to talk about natural childbirth in the future.

Now, as a rule, a caesarean section is performed according to Stark - the incision is made at the bottom of the uterus, transverse. The benefits of this type of cut are many. Not only cosmetic. The scar is formed wealthy and thin, neat. That is, the next pregnancy proceeds favorably, and even independent childbirth is possible if there are no other indications for surgical delivery.

Blood loss during Stark surgery is minimal, even if the incision touches the placenta, which is located on the anterior wall of the uterus. The risk of adhesion formation between the uterine wall and the abdominal wall is minimal.

However, sometimes doctors are forced to make a vertical incision from the navel to the womb. Such a need arises when the fetus is located transversely in the uterus, Siamese twins, the placenta overlaps the internal os with its transition to the anterior wall, a large myoma at the very bottom, the need to immediately remove the uterus, etc.

The next stage of the caesarean section is the extraction of the fetus. An important condition is that the incision must be such that it is possible to extract the fetus with high quality and not damage it, including with a scalpel.

While the operating doctor takes out the baby, the anesthesiologist injects a strong antibiotic intravenously into the woman - this practically eliminates the possibility of an infectious process.

After the baby is removed from the uterus, a hemostatic drug is injected into it, and a dropper with oxytocin is placed on the puerperal. Next, the doctor usually manually separates the placenta and sutures it.

How long does a caesarean section take approximately? 30-60 minutes. But the child is removed already at 4-5 minutes, so that the minimum amount of medications administered to the mother gets into the body. The rest of the time is taken by revision of the uterus, suturing and other surgical procedures.

How is a caesarean section performed under general anesthesia or epidural anesthesia?

The doctor chooses anesthesia depending on the state of health of the pregnant woman and the fetus, the presence of an anesthesiologist-resuscitator on site. But be that as it may, this anesthesia does not threaten the mother and child.

Elective caesarean now takes place most often under epidural or spinal anesthesia, in 90% of cases. And emergency - under endotracheal anesthesia (mask + administration of psychotropic and painkillers), since it is technically easier to use. With general anesthesia, there is one important rule - a maximum of 10 minutes should pass from the beginning of its supply to the removal of the child.

Recovery after caesarean section

After the end of the operation, cold is placed on the uterus for 2 hours. This is necessary so that the uterus quickly returns to its previous size and less bloodshed. The oxytocin drip remains for the same purposes. In the first two days, saline is also administered intravenously.

Anesthesia is carried out within 1-3 days with analgin, baralgin, promedol or omnopon.

Often after surgery, there are problems with urination and stool. In the first case, a catheter helps, and in the second - an enema, it is put on the third day. Instead of a classic water enema, you can use a microlax microclyster or a glycerin suppository.

In order for the uterus to contract well and to reduce the risk of postpartum endometritis, for 3 days, 2 times a day, a woman is given intramuscular injections of oxytocin. If the operation was performed before the onset of labor, in some cases, a no-shpu is placed before the oxytocin injection.

You can get up at the end of the first day after the operation. And go on the second day. Moving is very important. This is the prevention of thromboembolism, problems with the bladder and intestines, pneumonia. Recovery after an emergency section is much faster if a woman does not lie in bed for days on end.
Within 2-3 days, nurses treat the seam with alcohol and seal it with a special antiseptic sticker.
Approximately 24 hours after the operation, you can put the baby to the breast. On the second day, a number of tests are given - urine and blood.
On the fifth day, an ultrasound is done to assess the condition of the uterus and the suture. And if the operation was successful, the woman is discharged home after a week.

Today, many children are born by caesarean section. This is due to the fact that something is wrong with the health of the mother. Or some other emergency has arisen.

Preparing for a caesarean section

Operation Day

Further, according to the plan, a conversation with an anesthesiologist, who will tell you all the details of anesthesia during a cesarean section. Today spinal anesthesia is usually chosen. In this case, the woman will be able to see her child immediately after he is taken out of the uterus. But this option is possible only if the woman has no contraindications. Which method of anesthesia will be chosen will need to be recorded in writing.

Caesarean section, how is the operation

A screen is usually placed between the site of the operation and the woman's face. In some maternity hospitals, it is practiced that during such an operation, a relative of the woman may be behind the screen. The whole operation takes no more than ten minutes. First, the baby is removed and the umbilical cord is cut. Then the doctor carefully cleans and examines the uterus, and then sews it up and the abdominal wall. The seam is treated again with an antiseptic and a bandage is applied, and ice wrapped in a cloth is placed on top. Thus, bleeding can be reduced, and the uterus will contract more actively. Then the woman is transferred to the intensive care unit.

After operation

The first day you can drink only water, and on the second you can already have low-fat chicken broth or liquid cereals, mostly oatmeal. This diet should be observed for approximately three weeks. After a few days, if there are no complications, the mother is sent to the postpartum ward, where she can already take care of the baby.

A week later, a woman is prescribed a blood test, urine test, and is also sent for an ultrasound scan of the uterine scar and genital organs. If no complications are found during this examination, then in a few days the mother and child can go home.

At home after CS

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.), the introduction 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. To do 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 one 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 maternity 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.

1. After a caesarean section, sexual rest is recommended for 2 months after the operation.
2. Within 2 months after the operation, it is undesirable to lift weights of more than 3-4 kg (child's weight).
3. 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.
4. The menu of a woman who has undergone a caesarean 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.
5. 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 for 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.

A caesarean section is a surgical procedure that removes the baby through an incision in the abdomen rather than through the vagina. Recently, about 30% of births occur by caesarean section. In some cases, this is done as planned due to pregnancy complications or because the woman has already had a caesarean section. Some women prefer a caesarean section to a conventional birth. However, in many cases, the need for a caesarean section becomes apparent only during childbirth.

Knowing what to expect will help you better prepare if surgery is needed.

A caesarean section is a surgical procedure to remove a baby from the mother's womb. In this case, he is not born naturally, but takes his first look at the world through the incision that is made when the uterus is opened. In Germany, every year, 20 to 30 percent of children are born by caesarean section.

Indications for caesarean section

Indications for caesarean section can be absolute and relative. But for the most part, the decision to have surgery stems from many factors at once, such as a combination of medical assessments by the doctor and midwife, and personal wishes on the part of the woman in labor. Fortunately, pregnant women have enough time to think things over and understand exactly how they would like to give birth. Emergencies, when a caesarean section becomes inevitable, are rare.

If you decide to have a caesarean section, you must confirm your consent to the operation in writing. But first, the doctor will give you the most detailed explanations. During this conversation, all possible risks should be discussed in detail, so that you really feel well prepared. So don't hesitate to ask if you don't understand something.

Medical indications for a caesarean section include:

• transverse or pelvic presentation of the child;
• placenta previa;
• maternal pelvis size mismatch
• the size of the child;
• severe illness of the mother;
• the threat of hypoxia of the child;
• premature birth;
• developmental pathology of the child.

Partial anesthesia for caesarean section

Currently, local anesthesia is the universally accepted standard. The operation is performed under spinal anesthesia or in a planned caesarean section with epidural-spinal anesthesia (see page 300). General anesthesia is recommended only in cases where other anesthesia is not possible for medical reasons.

When is a cesarean section done?

There are many reasons why a caesarean section is done. Sometimes this is due to the health of the mother, sometimes with fears for the child. Sometimes surgery is done even if both mother and child are fine. This is a cesarean by choice, and the attitude towards it is ambiguous.

The birth is not going well. One of the main reasons why a caesarean section is done is that labor does not go well - too slowly or even stops. The reasons for this are manifold. The uterus may not contract forcefully enough to fully dilate the cervix.

The child's heart is broken. In most cases, the baby's heart rate allows you to expect a successful outcome of childbirth. But sometimes it becomes obvious that the child does not have enough oxygen. If there are such problems, the doctor may recommend a caesarean section.

Heart problems can occur if the baby is not getting enough oxygen, the umbilical cord is clamped, or the placenta is not functioning well. Sometimes heart rhythm disturbances occur, but nothing indicates a real danger to the child. In other cases, a serious danger is obvious. One of the most difficult decisions for doctors is deciding how big this danger is. The doctor may try different methods, such as glans massage, and see if heart function improves.

The decision to have a caesarean depends on many factors, such as how long the birth will continue or how likely it is to have complications other than heart problems.

The unfortunate position of the child. If the baby enters the birth canal with the legs or buttocks forward, this is called a breech presentation. Most of these babies are born by caesarean section, because conventional births are more likely to have complications. Sometimes the doctor is able to move the baby into the correct position by pushing it through the abdomen before labor begins, thereby avoiding surgery. If the baby lies horizontally, this is called a transverse presentation and is also an indication for a caesarean section.

The baby's head is in the wrong position. Ideally, the baby's chin should be pressed against the chest so that the part of the head that has the smallest diameter is in front. If the chin is raised or the head is turned so that the smallest diameter is not in front, the larger diameter of the head should pass through your pelvis. Some women do not have any problems in this case, but others may have difficulties.

Before having a caesarean, your doctor may ask you to get on all fours - in this position, the uterus drops forward and the baby may turn. Sometimes the doctor may be able to turn the glans during a vaginal examination or with forceps.

You have serious health problems. A caesarean section may be done if you have diabetes, heart disease, lung disease, or high blood pressure. With such diseases, a situation may arise when it is preferable to give birth to a child at an earlier stage of pregnancy. If induction of labor fails, a caesarean section may be necessary. If you have serious health problems, discuss your outlook with your doctor well in advance of your pregnancy.

Rarely, a caesarean section is done to prevent the baby from contracting a herpes infection. If a mother has herpes in her genitals, it can be passed on to a newborn baby and cause serious illness. Caesarean section avoids this complication.

You have a multiple pregnancy. Approximately half of twins are born by caesarean section. Twins can also be born in the usual way, depending on the weight, position and gestational age. Triplets and more are a different story. Most triplets are delivered by caesarean section.

Every multiple pregnancy is unique. If this is your case, discuss the prospects for childbirth with your doctor and decide together what is best for you. Remember that everything is changeable. Even if both babies are head first, the situation may change after the first is born.

There are problems with the placenta. In two cases, a caesarean is necessary: ​​placental abruption and placenta previa.

Placental abruption occurs when the placenta separates from the wall of the uterus before labor begins. This can pose a threat to the life of both you and the child. If the electronic monitoring shows that there is no immediate danger to the baby, you will be admitted to the hospital and will be closely monitored. If the baby is in danger, an urgent delivery is necessary and a caesarean section will be used.

The placenta cannot be born first, because then the child will lose access to oxygen. Therefore, almost always a caesarean is done.

There are problems with the umbilical cord. When the water has broken, the cord can slip out of the cervix before the baby is born. This is called cord prolapse and is very dangerous for the baby. As the baby squeezes through the cervix, pressure on the umbilical cord can cut off oxygen. If the umbilical cord slips out when the cervix is ​​fully dilated and labor has already begun, you can give birth normally. Otherwise, only a caesarean section can save the situation.

Also, if the umbilical cord is wrapped around the baby's neck or between the head and the pelvic bones, if water comes out, each uterine contraction will squeeze the umbilical cord, slowing down blood flow and reducing the oxygen supply to the baby. In these cases, a caesarean section is the best option, especially if the umbilical cord is compressed for a long time or very hard. This is a common cause of heart problems, but it's usually impossible to know exactly where the umbilical cord is located before labor begins.

The child is very big. Sometimes the baby is too big to be successfully born in the normal way. The size of the baby can be a problem if you have an abnormally narrow pelvis that the head cannot pass through. Occasionally, this may be a consequence of a pelvic fracture or other deformities.

If you develop diabetes during pregnancy, your baby may gain a lot of weight. If the baby is too large, a caesarean section is preferable.

Child health problems. If a defect such as spina bifida is diagnosed in a child in the mother's womb, the doctor may recommend a caesarean section. Discuss the situation in detail with your doctor.

You've already had a cesarean. If you've had a caesarean before, you may need to do it again. But this is optional. Sometimes, after a caesarean section, a normal birth is possible.

How is a caesarean section

Before a planned caesarean section, the gynecologist or anesthesiologist will tell you in advance about the operation and methods of anesthesia. If you don't understand something, please clarify and ask again! On the appointed day, you must arrive at the hospital in advance. It is best to refrain from eating: you cannot eat for six hours before the operation.

First of all, the doctor and midwife will check your baby's condition with the help of ultrasound and CTG. Take this opportunity to express your wishes and ideas about the upcoming birth. Then the preparation for the operation will begin: you will shave off the hair in the incision area, put on compression stockings and give you spinal anesthesia. Later, already in the operating room, the surface of the abdomen will be disinfected and a catheter will be inserted into the bladder. Before the operation begins, your entire body, with the exception of the abdomen, will be covered with sterile wipes. To prevent you from seeing what is happening and to prevent infection, the nurses will pull the sheet up to the level of your upper abdomen. Although you will be able to see the heads of the members of the operating team, you will not be able to understand what they are doing with their hands. After the anesthesia begins to operate in full force, the doctor will make the first incision.

For cosmetic reasons, as well as for better wound healing, the skin is incised directly above the symphysis (pubic articulation) along a vertical line, the length of the incision is 10 cm. The subcutaneous adipose tissue is divided in the middle. Above the abdominal muscles is a very elastic and strong connective tissue sheath (fascia), which the surgeon opens with a scalpel in the center. Then he pulls the abdominal wall up with his hand and takes the abdominal muscles to the side. To open the peritoneum, the doctor uses only his fingers. At the same time, he must make sure that he does not injure either the intestines or the bladder. Finally, the doctor makes a transverse incision in the lower segment of the uterus with a scalpel. Now it remains only to get the baby out of the uterus, and you can say hello to your baby. After separation and removal of the placenta, the operating team sews up the wound. Meanwhile, your partner is already accompanying the child for the first examination. In total, the operation lasts from 20 to 30 minutes.

Misgav Ladakh Method

The so-called “soft” surgical technique described on the previous pages, developed in the Israeli hospital Misgav Ladakh, is used today, with minor deviations, in all maternity clinics.

Risks of a caesarean section

A caesarean section is a major operation. Although it is considered quite safe, as with any operation, there are certain risks. It is important to remember that a caesarean section is often done to avoid life-threatening complications. However, after the operation, certain complications can also occur.

Risks for you. Having a baby is always a risk. With caesarean section, it is higher than with conventional childbirth.

• Increased bleeding. On average, blood loss during a caesarean section is twice as much as during a conventional birth. However, a blood transfusion is rarely required.
• Reactions or anesthesia. Medicines used during surgery, including painkillers, can sometimes cause unintended effects, including breathing problems. In rare cases, general anesthesia can cause pneumonia if a woman inhales stomach contents. But general anesthesia is rarely used for caesarean sections, and care is taken to avoid such complications.
• Injury to the bladder or intestines. Such surgical injuries are rare, but they do occur during caesarean section.
• Endometritis. This is a complication that causes inflammation and infection of the membrane lining the uterus, most commonly after a caesarean section. This happens when bacteria normally found in the vagina enters the uterus. Urinary tract infection.
• Slow down bowel activity. In some cases, the pain medications used during surgery can slow down the bowels, causing bloating and discomfort.
• Blood clots in the legs, lungs and pelvic organs. The risk of a blood clot in the veins is 3-5 times higher after a caesarean section than after a conventional birth. If left untreated, a blood clot in the leg can travel to the heart or lungs, disrupt circulation, causing chest pain, shortness of breath, and even death. Blood clots can also form in the veins of the pelvis.
• Wound infection. The possibility of such an infection after a caesarean section is higher if you drink alcohol, have type 2 diabetes, or are overweight.
• Rupture of seams. If the wound is infected or does not heal well, there is a risk of rupture of the stitches.
• Placenta accreta and hysterectomy. Placenta accreta is attached too deeply and too firmly to the wall of the uterus. If you've already had a caesarean section, your next pregnancy is much more likely to have a placenta accreta. Placenta accreta is the most common cause of hysterectomy for caesarean section.
• Rehospitalization. Compared with women who gave birth vaginally, women who had a caesarean section were twice as likely to be admitted to the hospital a second time within the first two months after giving birth.
• Fatal outcome. Although the chance of death after a caesarean section is very low - about two per 100,000 - it is almost twice as high as after a natural birth.

risk for the child. A caesarean section is potentially dangerous for the baby as well.

• premature birth. If the caesarean is of your choice, the child's age must be determined correctly. Premature birth can lead to respiratory failure and low birth weight.
• Breathing problems. Babies born by caesarean section are more likely to have a slight breathing problem - they breathe abnormally frequently during the first days after birth.
• Injury. Rarely, the child may be injured during surgery.

What to Expect During a Cesarean Section

Whether you have a caesarean section planned or done out of necessity, it will go something like this:

Training. To prepare you for the operation, some procedures will be done. In urgent cases, some steps are reduced or skipped altogether.

Anesthesia methods. An anesthesiologist may come to your room to discuss anesthesia options. Spinal, epidural and general anesthesia are used for caesarean section. With spinal and epidural anesthesia, the body loses sensation below the chest, but you remain conscious during the operation. At the same time, you practically do not feel pain, and the drug practically does not get to the child. There is little difference between spinal and epidural anesthesia. In spinal cord surgery, an anesthetic is injected into the fluid surrounding the spinal nerves. With an epidural, the agent is injected outside the fluid-filled space. Epidural anesthesia is carried out within 20 minutes and lasts a very long time. Spinal is done faster, but only lasts about two hours.

General anesthesia, in which you are unconscious, can be used for an emergency caesarean section. Some of the drug may pass to the child, but this usually does not cause problems. Most children are not affected by general anesthesia, because the mother's brain absorbs the drug quickly and in large quantities. If necessary, the child will be given medication to relieve the effects of general anesthesia.

Other preparations. Once you, your doctor, and anesthesiologist have decided which type of pain relief to use, preparations will begin. They usually include:

• intravenous catheter. An intravenous needle will be placed in your arm. This will allow you to get the fluids and medicines you need during and after your surgery.
• Blood analysis. Your blood will be drawn and sent to a laboratory for analysis. This will allow the doctor to assess your condition before surgery.
• Antacid. You will be given an antacid to neutralize stomach acids. This simple measure greatly reduces the risk of lung damage if you vomit during anesthesia and the contents of your stomach enter your lungs.
• Monitors. During the operation, your blood pressure will be continuously monitored. You may also be connected to a heart monitor with sensors on your chest to monitor your heart and rhythm during surgery. A special monitor can be attached to the finger to monitor the level of oxygen in the blood.
• urinary catheter. A thin tube will be inserted into the bladder to drain urine to keep the bladder empty during surgery.

Operating room. Most caesarean sections are done in operating rooms specifically designed for this purpose. The atmosphere may differ from the one that was in the family. Since operations are a group work, there will be many more people here. If you or your child has a serious medical problem, a variety of medical specialties will be present.

Training. If you are going to have an epidural or spinal anesthetic, you will be asked to sit with your back rounded or lie on your side with your body curled up. The anesthetist will wipe your back with an antiseptic solution and give you an injection of pain medication. Then he will insert a needle between the vertebrae through the dense tissue surrounding the spinal cord.

You may be given one dose of pain medication through a needle and then removed. Or a thin catheter is inserted through the needle, the needle is removed, and the catheter is glued with a plaster. This will allow you to receive new doses of pain medication as needed.

If you require general anesthesia, all preparations for the operation will be made before you receive pain medication. The anesthesiologist will administer pain medication through an intravenous catheter. You will then be placed on your back with your legs fixed. A special pad may be placed under your back on the right so that your body leans to the left. This shifts the weight of the uterus to the left, which ensures its good blood supply.

Hands are pulled out and fixed on special pillows. The nurse will shave off the pubic hair if it might interfere with the operation.

The nurse will wipe the stomach with an antiseptic solution and cover it with sterile wipes. A tissue will be placed under the chin to keep the surgical field clean.

Section of the abdominal wall. When everything is ready, the surgeon makes the first incision. This will be an incision in the abdominal wall, about 15 cm long, cutting through the skin, fat, and muscle to reach the lining of the abdomen. Bleeding vessels will be cauterized or ligated.

The location of the incision depends on several factors: whether your caesarean section is an emergency and whether you have other scarring on your abdomen. The size of the baby and the location of the placenta are also taken into account.

The most common types of incisions:

• Low horizontal cut. Also called a bikini slit and runs in the lower abdomen along the line of an imaginary bikini panty, is preferred. Heals well and causes less pain after surgery. It is also preferred for cosmetic reasons and allows the surgeon to have a good view of the lower part of the pregnant uterus. b Low vertical cut. Sometimes this type of incision is preferred. It provides quick access to the lower part of the uterus and allows you to remove the baby faster. In some cases, time is the most important thing.
• Incision of the uterus. After completing the incision in the abdominal wall, the surgeon pushes back the bladder and cuts the wall of the uterus. The uterine incision may be the same or different type as the abdominal wall incision. It is usually smaller in size. As with an abdominal incision, the location of the uterine incision depends on several factors, such as the urgency of the operation, the size of the baby, and the location of the baby and placenta within the uterus. A low horizontal incision at the bottom of the uterus is the most common, used in most caesarean sections. It provides easy access, bleeds less than higher incisions, and is less likely to damage the bladder. A strong scar is formed on it, which reduces the risk of rupture during subsequent births.
• In some cases, a vertical incision is preferable. A low vertical incision - in the lower part of the uterus, where the tissues are thinner - can be done with the baby in the legs, buttocks, or across the uterus (breech or transverse presentation). It is also used if the surgeon believes it will have to be extended to a high vertical incision - sometimes referred to as the classic. The potential advantage of the classic incision is that it allows easier access to the uterus to remove the baby. Sometimes a classic incision is made to avoid trauma to the bladder or if the woman thinks this is her last pregnancy.

Birth. Once the uterus is open, the next step is to open the amniotic sac so that the baby can be born. If you are conscious, you may feel some twitching and pressure as the baby is pulled out. This is done in such a way as to keep the cut size as small as possible. You won't feel pain.

When the baby is born and the umbilical cord has been cut, the baby will be given to a doctor who will check that his nose and mouth are free of fluid and that he is breathing well. In a few minutes, you will see your baby for the first time.

After birth. Once the baby is born, the next step is to separate and remove the placenta from the uterus, and then close the incisions, layer by layer. The stitches on the internal organs and tissues will dissolve themselves and do not require removal. For a skin incision, the surgeon may suture or use special metal clips to hold the edges of the wound together. During these activities, you may feel some movement, but no pain. If the incision is closed with clamps, they will be removed with special tweezers before discharge.

When you see the child. The entire caesarean section usually takes 45 minutes to an hour. And the baby will be born in the first 5-10 minutes. If you are awake and willing, you can hold the baby while the surgeon closes the incisions. Or you may be able to see the baby in your partner's arms. Before giving the baby to you or your partner, doctors will clean his nose and mouth and perform the first Apgar score - a quick assessment of the child's appearance, pulse, reflexes, activity and breathing one minute after birth.

Postoperative ward. There, you will be monitored until the anesthesia wears off and your condition stabilizes. This usually takes 1-2 hours. During this time, you and your partner will be able to spend a few minutes alone with the child and get to know him.

If you choose to breastfeed your baby, you can do so for the first time in the recovery room if you feel like it. The sooner you start feeding, the better. However, after general anesthesia, you may not feel well for several hours. You may want to wait until you are completely awake and receive pain medication before feeding.

After caesarean section

In a few hours, you will be transferred from the recovery room to the delivery room. Over the next 24 hours, doctors will monitor your condition, stitches, urine output, and postpartum bleeding. Throughout your stay in the hospital, your condition will be closely monitored.

Recovery. Usually, after a caesarean section, they stay in the hospital for three days. Some women are discharged after two. It is important that you take good care of yourself both in the hospital and at home to speed up your recovery. Most women usually recover from a caesarean section without any problems.

Pain. In the hospital, you will receive pain medication. You may not like it, especially if you are going to breastfeed. But painkillers are needed after the anesthesia wears off to make you feel comfortable. This is especially important in the first few days, when the incision begins to heal. If you are still in pain when you are discharged, your doctor may prescribe pain medication for you to take at home.

Food and drink. In the first hours after surgery, you may only be given ice cubes or a sip of water. Once your digestive system is working properly again, you will be able to drink more fluids or even eat some easily digestible food. You will know that you are ready to start eating when you can pass gases. This is a sign that your digestive system is awake and ready to get to work. You can usually eat solid food the day after surgery.

Walking. You will most likely be asked to walk around a few hours after the operation, if it is not yet night. You won't want to, but walking is healthy and an important part of your recovery. It will help clear your lungs, improve circulation, speed up healing, and get your digestive and urinary systems back on track. If you are bothered by bloating, walking will bring relief. It also prevents blood clots, a possible postoperative complication.

After the first time, you should take short walks at least twice a day until discharge.

Vaginal discharge. After your baby is born, you will have lochia, a brownish or colorless discharge, for several weeks. Some women after a caesarean section are surprised by the amount of discharge. Even if the placenta is removed during surgery, the uterus must heal, and discharge is part of the process.

Incision healing. The bandage will most likely be removed the day after the operation, when the incision has already healed. While you are in the hospital, the condition of the wound will be monitored. As the incision heals, it will itch. But don't scratch it. It is safer to use lotion.

If the incision was connected with clamps, they will be removed before discharge. At home, take a shower or bath as usual. Then dry the incision with a towel or hair dryer on low heat.

Within a few weeks, the scar will be sensitive and painful. Wear loose clothing that doesn't chafe. If clothing irritates the scar, cover it with a light bandage. Sometimes you will feel twitching and tingling around the incision area - this is normal. While the wound heals, it will itch.

Restrictions. After returning home after a caesarean section, it is important to limit your activities in the first week and take care of yourself and your newborn first of all.

• Don't lift heavy things or do anything that strains your belly that hasn't healed yet. Maintain correct posture when standing or walking. Support your belly when you cough, sneeze, or laugh. Use pillows or rolled towels when feeding.
• Take necessary medications. The doctor may recommend pain medication. If you have constipation or bowel pain, your doctor may recommend an over-the-counter stool softener or mild laxative.
• Check with your doctor about what you can and cannot do. Physical exercise can be very tiring for you. Give yourself time to recover. You also had an operation. Many women, when they start to feel better, find it difficult to adhere to the necessary restrictions.
• While fast movements hurt, don't drive. Some women recover faster, but usually the period when you should not drive a car lasts about two weeks.
• No sex. Abstain until the doctor allows - usually after a month and a half. However, closeness should not be avoided. Spend time with your partner, at least a little in the morning or in the evening when the baby is already asleep.
• When the doctor allows, start doing physical exercises. But don't be too zealous. Hiking and swimming are the best choices. 3-4 weeks after discharge, you will feel that you are able to lead a normal normal life.

Possible complications.

Tell your doctor right away about these symptoms if they appear while you are at home:

• The temperature is above 38 °C.
• Painful urination.
• Too much vaginal discharge.
• The edges of the wound diverge.
• The incision site is red or wet.
• Severe pain in the abdomen.

emergency caesarean section

An emergency caesarean section is performed only in case of a threat to the life of the mother or child.

The decision on an urgent operation or a secondary caesarean section is made only when there really is no other way out, since this is associated with a high risk for the pregnant woman (intubation, bleeding, damage to neighboring organs, infection).

Indications for emergency surgery:

• acute hypoxia of the child;
• complications that threaten the life of the mother (rupture of the uterus, premature separation of the placenta).

If one of these complications occurs unexpectedly, you need to act very quickly. In the event of a disruption in the supply through the umbilical cord, the doctor has only a few minutes to prevent significant damage to the child's health. The obstetric team must take all measures to ensure that the birth takes place in the next 20 minutes. An interruption in oxygen supply that lasts longer than 10 minutes can damage the baby's brain.

As soon as the doctor decides on an emergency caesarean section, the introduction of anesthesia and the operation are carried out without delay and without long preparation. Surgical intervention can also be carried out in the delivery room, if there is enough space and the necessary equipment.

Women always hope that they will give birth with dignity, that they will be able to endure pain, sometimes even smile when they push for the last time, giving the child life. Many try very hard to give birth naturally by choosing doctors who have few caesarean sections in their practice, go to courses for pregnant women, play sports during pregnancy, trying to gain only the right weight, sometimes even hiring a doula to be nearby in the delivery room. However, there are a lot of caesarean sections, more than ever before.

How to deal with anxiety

No matter how hard you tried, whether you had a normal pregnancy without complications, it may happen that you need an emergency caesarean section. You will be disappointed. Maybe you will feel like a failure. However, it is very important to remain far-sighted. Cesarean section is indeed a risk, like conventional operations, for example, during it internal bleeding, blood clots, infection or damage to internal organs can occur. Some babies have minor breathing problems after a caesarean section. But because surgical techniques and pain management have improved, there are very few dangers associated with a caesarean section, and of course giving birth, a healthy baby, is much more important than trying to give birth naturally.

Reasons for an emergency caesarean section

The most common indication for an emergency caesarean section is an unexpected incorrect position of the child (if it is located legs or buttocks forward) or lateral presentation. Another reason is heavy bleeding before childbirth and suspicion of premature detachment or placenta previa. The most common reason for caesarean sections is the risk that the baby may not be able to deliver; if the baby's cardiogram shows possible abnormalities, a caesarean section will be a safe and quick way to have a baby.

Emergency caesarean section procedure

It may happen that everything will happen quickly and chaotically. The lower abdomen will be prepared for the operation. Your stomach will be washed, your hair may be shaved off, and you will be given antibiotics and other intravenous fluids. Anesthesia will be either epidural (with a dose adjusted for caesarean section) or spinal, or maybe even general. If a woman is given an epidural or spinal anesthetic, she will feel nothing from her toes to her chest; while she will be conscious, but will not feel how the doctor makes an incision. Most likely, she will not see this, because a special fence will be placed between her and the doctor, or maybe because the baby will be born very quickly.

Caesarean section of the woman's choice

Some healthy women choose to have a caesarean section at their first birth, usually to avoid pain and possible complications during childbirth. Sometimes the doctor will suggest a caesarean section so that the baby will be born at a time that is more convenient for the woman, the doctor, or both.

This caesarean section is not done because of health problems. The reason is fear or a desire to avoid difficulties. And these are not the best reasons for a caesarean section.

However, women are increasingly opting for a caesarean section, and this raises a number of questions.

Is there a limit?

Many women successfully undergo up to three surgeries. However, each next cesarean is more difficult than the previous one. For some women, the risk of complications - such as infection or heavy bleeding - increases only slightly with each caesarean section. If you had a long and difficult labor prior to your first C-section, a second C-section will be physically easier, but the healing process will take just as long. For other women - who have developed large internal scarring - each subsequent caesarean becomes more and more risky.

Repeated cesarean is done by many women. But after the third, you need to weigh the possible risks and your desire to have more children.

Facing the Unexpected

The unexpected news that you need a C-section can be a shock to both you and your partner. Your ideas about how you will give birth will suddenly change. Even worse, this news may come when you are already exhausted from long hours of contractions. And the doctor no longer has time to explain everything and answer your questions.

Of course, you will have concerns about what it will be like for you and your child during the operation, but do not let these fears completely control you. Most mothers and children successfully undergo surgery with a minimum of complications. While you might prefer to have a natural birth, remember that the health of you and your baby is more important than how it was born.

If you have concerns about a planned repeat caesarean section, discuss this with your doctor and partner. This will help you worry less. Tell yourself that you have been through this once before and you can do it again. This time it will be easier for you to recover from the operation because you already know what to expect.

Caesarean section: partner involvement

If the caesarean section is not urgent, requiring general anesthesia, your partner may come into the operating room with you. Some hospitals allow this. Some like the idea, others may be afraid or disgusted. It is generally difficult to be present during the operation, especially when it is done to a loved one.

If the partner decides to attend, he will be given surgical clothes. He can observe the procedure or sit at the head of the bed and hold your hand. Perhaps his presence will make you feel calmer. But there are also difficulties: men sometimes faint, and doctors have a second patient who needs immediate help.

In most maternity hospitals, the baby is photographed and the doctors can even take pictures for you. But in many it is not allowed. Therefore, you should ask permission to take photos or videos.

Cesarean section of choice

Some women who have a normal pregnancy choose to give birth by caesarean section even though they have no complications or problems with the baby. For some of them, it is convenient to precisely plan the date of birth. If you're used to planning everything in your life down to the minute, waiting for an unknown day for your baby's arrival may seem impossible.

Other women choose to have a caesarean section out of fear:

• Fear of the birth process and the pain that accompanies it.
• Fear of damaging the pelvic floor.
• Fear of sexual problems after childbirth.

If this is your first child, childbirth is something unknown and scary. You may have heard horror stories about childbirth and about women who, after childbirth, suffer from urinary incontinence when coughing or laughing. If you've had a vaginal birth before and it didn't go very smoothly, you may be wary of a repeat.

If you are inclined to choose a caesarean section, discuss this frankly with your doctor. If fear is your main motive, talking frankly about what to expect and going to prenatal school can help. If you are told about the horrors of childbirth, politely but firmly say that you will hear about it after your baby is born.

If your previous natural births have been such a terrible story, remember that all births are different and this time may be very different. Think about why the birth was so difficult and discuss it with your doctor or partner. Perhaps something needs to be done to make the experience more positive this time.

If your doctor agrees with your choice, the final decision is yours. If the doctor does not agree and will not perform a caesarean section, he may refer you to another specialist. Learn more about the advantages and disadvantages of both birth methods and discuss them with experts, but don't let fear be the deciding factor.

What should be taken into account?

Elective caesarean section is a tricky thing. Those who are in favor say that a woman has the right to choose how she wants to give birth to her child. Those who oppose believe that the dangers of a caesarean section outweigh any positives. At this point in the medical literature, there is no convincing evidence that the choice of caesarean section is preferable. Good medical practice generally rejects procedures - especially surgical ones - that do not provide undoubted benefit to the patient. Moreover, there is little research on this subject.

Since everything is ambiguous, you may find that the opinions of doctors differ greatly. Some are ready for surgery. Others refuse, believing that a caesarean section could be dangerous and thus goes against their vow to do no harm.

The best way to make a decision is to collect as much information as possible. Ask yourself why this option appeals to you. Study the issue, consult with experts and carefully weigh the pros and cons.

Benefit and risk

Many experts believe that with the current level of development of surgical technology, a caesarean section is no more dangerous than a conventional birth if this is your first child. If this is the third birth, the situation is different. Caesarean section is more fraught with complications than conventional childbirth. Here is a list of the benefits and dangers of this operation:

Benefits for the mother. Benefits of an elective caesarean section may include:

• Protection against urinary incontinence. Some women fear that the effort required to push the baby through the birth canal can lead to urinary or fecal incontinence and damage to the muscles and nerves of the pelvic floor.
• Medical evidence has shown that women who have had a caesarean section have a lower risk of urinary incontinence in the first months after childbirth. However, there is no evidence that this risk is lower 2–5 years after birth. Some women also fear that natural childbirth can cause pelvic organ prolapse, when organs such as the bladder or uterus protrude into the vagina. At the moment, there is no clear medical evidence linking caesarean section and reducing the risk of pelvic organ prolapse. But a caesarean section of choice is no guarantee that problems with incontinence and prolapse will not arise at all. The baby's weight during pregnancy, pregnancy hormones, and genetic factors can weaken the pelvic muscles. Such problems can occur even in women who have never had children.
• Emergency caesarean section guarantee. An emergency caesarean section, which is usually done during a difficult birth, is much more dangerous than an elective caesarean section or conventional birth. An emergency caesarean is more likely to cause infections, damage to internal organs, and bleeding.
• Warranty against difficult childbirth. Sometimes difficult labors require the use of forceps or vacuum suction. Usually these methods are not dangerous. Just as with caesarean section, the success of their use depends on the individual skill of the doctor performing the procedure.
• Less problems with the child. In theory, a planned caesarean section could reduce the risk of some problems in the baby. For example, the death of an infant during childbirth, the pathology of labor due to the incorrect position of the fetus, birth trauma - which is especially important when the child is very large - and inhalation of meconium, which occurs if the child began to defecate before birth. It also reduces the risk of paralysis. However, it is important to remember that the risk of all these complications is quite low even with a conventional birth, and a caesarean section is no guarantee that these problems will not occur.
• Less risk of transmission of infections. A caesarean section reduces the risk of mother-to-child transmission of infections such as AIDS, hepatitis B and C, herpes, and papillomavirus.
• Establishing the exact date of birth. If you know exactly when the baby will arrive, you can better prepare. It is also convenient for planning the work of the medical team.

Risk to the mother immediately after surgery

Certain inconveniences and dangers are associated with caesarean section. It will take longer to stay in the hospital. The average length of stay in the hospital after a caesarean is three days, after a normal birth - two.

Increased chance of infection. Because it is a surgical operation, the risk of infection after a caesarean is higher than after a conventional birth.

Postoperative complications

Since a caesarean section is an abdominal operation, certain risks are associated with it, such as infection, poor healing of stitches, bleeding, damage to internal organs, and blood clots. The risk of complications after anesthesia is also higher.

Reducing the possibility of early bonding with the baby and initiation of breastfeeding. For the first time after the operation, you will not be able to take care of the child and breastfeed him. But this is temporary. You will be able to bond with your baby and breastfeed as soon as you recover from the surgery.

Insurance payment

Your insurance may not cover a caesarean section of choice, and it will cost more than a conventional birth. Before making a decision, check if this operation is covered by your insurance.

Risks for the mother in the future

After a caesarean section, the following troubles are possible in the future:

future complications. With multiple pregnancies, the likelihood of complications increases with each successive pregnancy. Repeated caesarean sections further increase this likelihood. Most women can safely have up to three surgeries. However, each subsequent one will be more difficult than the previous one. For some women, the risk of complications such as infection or bleeding increases only slightly. For others, especially those who have large internal scarring, the risk of complications with each subsequent caesarean section increases very significantly.

Rupture of the uterus in the next pregnancy. A caesarean section increases the risk of uterine rupture in the next pregnancy, especially if you choose to have a normal birth this time. The probability is not very high, but you should discuss this with your doctor.

Problems with the placenta. Women who have had a caesarean section have a higher risk of placental disorders, such as presentation, in subsequent pregnancies. In previa, the placenta closes the opening of the cervix, which can lead to preterm labor. Placenta previa and other related disorders caused by caesarean section greatly increase the risk of bleeding.

Increased risk of hysterectomy. Some problems with the placenta, such as accretion, where the placenta is attached too deeply and firmly to the wall of the uterus, may require removal of the uterus (hysterectomy) at birth or soon after.

Damage to the intestines and bladder. Serious damage to the intestines and bladder during caesarean section is rare, but they are much more likely than during conventional births. Complications associated with the placenta can also lead to bladder damage.

Dangers for the fetus

Dangers for the child associated with a caesarean section:

• Respiratory disorders. One of the common problems in a child after a caesarean section is a slight breathing disorder called tachypnea (rapid shallow breathing). This happens when there is too much fluid in a child's lungs. When the baby is in the uterus, her lungs are normally filled with fluid. In a normal birth, progression through the birth canal compresses the chest and naturally pushes fluid out of the baby's lungs. With a caesarean section, this compression does not occur, and fluid may remain in the baby's lungs after birth. This results in increased breathing and usually requires a pressurized supply of oxygen to remove fluid from the lungs.
• Immaturity. Even a little immaturity can have a very negative impact on the child. If the due date is inaccurate and the caesarean section is too early, the baby may have complications associated with prematurity.
• Cuts. During a caesarean section, the baby may get cut. But this rarely happens.

Decision-making

If your doctor does not accept your request for a caesarean section, ask yourself why. Physicians and surgeons have a duty to avoid unnecessary medical interventions, especially if they may be dangerous. The lack of scientific evidence to support elective caesarean section makes this operation unnecessary. Although, from the doctor's point of view, ease of planning, efficiency, and financial rewards favor a caesarean section, a doctor you trust should be at least reticent about this operation.