How is a caesarean section done? Planned caesarean section. What you need to know about caesarean section with detailed video

Each pregnancy in a woman proceeds in a new way, not like the previous one. Childbirth, respectively, also goes differently. If for the first time the baby was born with the help of gynecological surgeons, this does not mean that now everything will happen according to the same scenario. What if there is a second caesarean section? What is important for a woman to know? Can surgery be avoided? These and some other questions will be answered in today's article. You will learn about how long a planned second caesarean section is, how the body recovers after manipulation, whether it is possible to plan a third pregnancy, and whether it is realistic to give birth on your own.

Natural childbirth and caesarean section

We will find out how it is carried out and what indications the second caesarean section has. What is important to know? The natural appearance of a child is a process conceived by nature. During childbirth, the baby goes through the appropriate paths, experiences stress and prepares for existence in the new world.

Caesarean section involves the artificial appearance of a child. Surgeons make an incision in the woman's abdomen and uterus, through which the baby is taken out. The baby appears abruptly and unexpectedly, he does not have time to adapt. Note that the development of such children is more difficult and more difficult than those that appeared during natural childbirth.

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

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

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

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

All these situations are the reason for the first intervention. If after the birth of the child (the first) the diseases were not eliminated, then the operation will be performed during the second pregnancy. Some doctors are inclined to this opinion: the first caesarean section does not allow a woman to give birth herself anymore. This statement is erroneous.

Can you give birth on your own?

So, you are recommended a second caesarean section. What is important to know about it? What are the real indications for the operation, if the woman's health is all right? Re-manipulation is recommended in the following cases:

child has;
after the first caesarean section, two more years have not passed;
the suture on the uterus is untenable;
during the first operation, a longitudinal incision was made;
abortions between pregnancies;
the presence of connective tissue in the scar area;
the location of the placenta on the scar;
pathology of pregnancy (polyhydramnios, oligohydramnios).

An emergency operation is performed with an unforeseen divergence of the scar, weak labor activity, a serious condition of the woman, and so on.

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

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

If you want a second child to appear naturally, then you should take care of this in advance. Find a maternity hospital that specializes in this matter. Discuss your condition with your doctor in advance and undergo an examination. Attend scheduled consultations regularly and follow the recommendations of the gynecologist.

Management of pregnancy

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

Be sure to visit other specialists before delivery. You need to address to the therapist, the oculist, the cardiologist, the neurologist. Make sure there are no restrictions on natural childbirth.

Multiple and conventional caesarean section

So, you still scheduled a second caesarean section. At what time is such an operation performed, and is it possible to give birth to yourself with a multiple pregnancy?

Suppose that the previous delivery was performed surgically, and after that the woman became pregnant with twins. What are the predictions? In most cases, the outcome will be a second caesarean section. At what time do it - the doctor will tell. In each case, the individual characteristics of the patient are taken into account. Manipulation is prescribed for a period from 34 to 37 weeks. With multiple pregnancies, they do not wait longer, as rapid natural childbirth can begin.

So, you are carrying one child, and a second caesarean section is scheduled. When is the operation done? The first manipulation plays a role in determining the term. Re-intervention is scheduled 1-2 weeks earlier. If for the first time a caesarean was performed at 39 weeks, now it will happen at 37-38.

The seam

You already know at what time a planned second caesarean section is made. The caesarean is re-performed along the same suture as the first time. Many expectant mothers are very concerned about the aesthetic issue. They worry that the whole belly will be covered with scars. Don't worry, it won't happen. If the manipulation is planned, then the doctor will make an incision where he passed for the first time. The number of external scars you will not increase.

Otherwise, the situation is with the incision of the reproductive organ. Here, with each repeated operation, a new area for the scar is selected. Therefore, doctors do not recommend giving birth by this method more than three times. For many patients, doctors offer sterilization if a second caesarean section is scheduled. When they are admitted to the hospital, gynecologists clarify this issue. If the patient wishes, the fallopian tubes are ligated. Do not worry, without your consent, doctors will not carry out such a manipulation.

After surgery: recovery process

You already know about when the second caesarean section is shown, at what time it is done. Reviews of women report that the recovery period is practically no different from that which was after the first operation. A woman can stand up on her own in about a day. A newly-made mother is allowed to breastfeed a baby almost immediately (provided that illegal drugs were not used).

The discharge after the second operation is the same as during natural childbirth. Within one or two months, there is a discharge of lochia. If you have had a caesarean section, then it is important to monitor your well-being. Consult your doctor if you experience unusual discharge, fever, deterioration in general condition. They are discharged from the maternity hospital after the second caesarean section for about 5-10 days, as well as for the first time.

Possible Complications

With a second operation, the risk of complications certainly increases. But this does not mean that they will definitely arise. If you give birth on your own after a caesarean section, then there is a chance of a scar divergence. Even if the suture is well-founded, doctors cannot completely exclude such a possibility. That is why in such cases, artificial stimulation and painkillers are never used. It's important to know about this.

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

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

Additionally

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

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

Finally

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

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.

2013-06-05T00:00:00

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, arterial pressure has increased 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 put 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.

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In some cases, natural delivery is not possible, and doctors have to remove the baby from the mother's womb through surgery.

- this is an operative intervention through the abdominal wall, as a result of which a newborn is born. This operation was performed in ancient Rome and ancient Greece, but in those days it was done only for the dead.

Medieval doctors attempted to operate on living women, but this venture was not crowned with success: only the child could be saved.

Only in the 19th century did doctors learn to save the life of the mother, and in the middle of the 20th century, with the advent of the era of antibiotics, caesarean section became a standard procedure that carries minimal risks for a woman.

Indications for caesarean section (list)

Despite the fact that a caesarean section is quite common, it is prescribed only if there are certain indications, see the list.

Absolute readings:

Complete placenta previa - suggests that the baby's place was implanted so close to the entrance to the cervix that, as it enlarged, it began to block the child's exit through the natural birth canal.
An anatomically narrow pelvis is an absolute contraindication to conventional childbirth. Such a diagnosis is made if the woman's pelvic bones have grown together in such a way that they do not allow the child to go out.
Transverse presentation of the fetus - if before the onset of childbirth the child could not stand in the head or at least in the breech presentation, then he will not be able to be born on his own.
The presence of more than two caesarean sections in history. It is believed that natural childbirth in this case creates a threat of uterine rupture and intra-abdominal bleeding, which can be fatal for the expectant mother.

Relative readings:

Incomplete placenta previa - in some cases, according to the results of ultrasound, doctors decide that the baby will be able to be born on its own, since the entrance to the uterus is not completely blocked.
Breech presentation of the fetus - caesarean section is performed in the presence of additional risk factors (for example, multiple entanglement of the umbilical cord).
The presence of fibroids - the operation is indicated only when the size of the tumor is large or if the fibroids are located in the cervix and block the natural birth canal.
Multiple pregnancy - the doctor decides on a caesarean section if the condition of the mother and children is alarming.
- surgery is mandatory in cases of preeclampsia and eclampsia. The stages of late toxicosis that precede these two states are not always an indication for caesarean section.
Mother's illnesses that were before pregnancy - the doctor should assess whether natural childbirth will lead to a worsening of the course of chronic diseases of the expectant mother, and if the threat to her health is obvious, then she will be prescribed an obstetric operation.

The decision on surgical intervention is not made by the patient at will, but by the doctor, based on medical indications.

Conventionally, the operation can be divided into four phases: anesthesia, dissection of the abdominal wall, walls of the uterus and placenta, extraction of the fetus, stitching of the walls of the uterus and abdominal cavity.

Choice of anesthesia

Currently, most caesarean sections are performed under epidural anesthesia. Anesthesia of the lower part of the body is performed, and the woman in labor is conscious. In the event that an emergency caesarean section (ECS) is performed, the woman is given general anesthesia.

Throughout the entire period of surgical intervention, an anesthesiologist is present, who controls the effect of general or epidural anesthesia on the woman's well-being. The question of how long a caesarean section lasts is difficult to answer definitively. Usually it takes no more than 40 minutes, but it can be completed earlier. The effect of anesthesia ends after the surgeon sews up the incisions.

Tissue dissection

Surgical manipulations are performed in several stages:

1. A catheter is inserted into the bladder for timely drainage of urine, the pubic area is shaved - this is an additional guarantee of the hygiene of the upcoming intervention.
2. A screen is placed between the upper and lower parts of the body, thus delimiting the operable zone.
3. The incision site is pre-marked, and then the edges of the marked area are manually pulled together to make sure that the skin is sufficiently stretched so that the edges of the wound can subsequently be sewn together.
4. If there is an old scar from a previous caesarean, then it is first excised with a scalpel.
5. The surgeon makes a transverse or longitudinal incision of the abdominal wall with smooth translational movements. He has to carry out a scalpel along the marked lines several times, slightly deepening the instrument into the thickness of the skin and fat layer.
6. When dissecting the muscles, the doctor makes an effort to manually push them apart and get to the uterus.
7. The edges of the wound are fixed by an assistant and parted to provide the surgeon with more complete access to the body of the uterus.
8. The same transverse incision is made on the uterus in several stages as on the abdominal cavity.

Until the moment of dissection of the genital organ, the operation is almost bloodless and the help of an assistant in terms of stopping bleeding is minimal.

Fruit extraction

As little time as possible should elapse from the moment the uterus is incised to its suturing. Therefore, the child is removed quickly, if there are loops of the umbilical cord on his neck, then they are removed, and the umbilical cord itself is cut off.

For several minutes, doctors wait for the placenta to separate from the walls of the uterus on its own. Then it is removed and the accumulated blood and clots are removed.

Tissue suturing

The edges of the wound of the body of the uterus are fixed and sutured. At the same time, the assistant ensures the elimination of the released blood with the help of cotton pads.

The uterus itself is located outside the abdominal cavity, it is set after the suture is applied. Then the skin, together with the fat layer, is pulled apart and fixed, and the surgeon at this time sutures the abdominal muscles. Unlike the uterus and skin, they are cut vertically.

The skin layer is stitched last, after which the operated surface is treated with an antimicrobial solution.

After a caesarean section

If the delivery was made by surgical intervention, this does not mean that the woman will not have bleeding from the uterus.

The reproductive organ, as in the situation with natural childbirth, will shrink, which will provoke the appearance of discharge after a cesarean section, but how many days they will go depends on how successful the operation was. Normally, lochia is abundant for the first 5-6 days, and then, within a month, it gradually stops. If there were any postoperative complications, the duration of bleeding may increase.

6 hours after surgery, the woman is allowed to get up.

Many are concerned about the question of how many days after a cesarean section can I be discharged from the hospital? Typically, such patients are under observation for a little longer than those who had a natural birth. But on the 7th - 10th day, as a rule, most women are ready for discharge.

At first, you should pay increased attention to the condition of the seam. If it is found that it has become edematous, inflamed, festered, or its soreness does not decrease, but rather intensifies, it is necessary to urgently consult a doctor to avoid the development of an infection.

To prevent muscle strain after a caesarean section, a bandage should be worn. The fact is that in the first few weeks it is necessary to eliminate the load on the press, so the sagging stomach needs to be supported.

Pregnancy and childbirth after caesarean section

The suture on the uterus needs to be given time to heal. This means that in the first few months, uterine distention should not be allowed. Excessive load on a suture that has not yet healed can result in a rupture of the reproductive organ, peritonitis and the death of a woman.

The earliest term that will be relatively safe for a woman in labor is a caesarean section performed one year after the first caesarean section. And even in this case, a woman exposes her body to a serious risk - for a long time, the suture on the uterus may begin to diverge, so the doctor should regularly monitor its condition and thickness according to the results of ultrasound.

In such a situation, there is no chance to give birth to a second child naturally. Doctors will not take risks and will not let the woman in labor into natural childbirth - the risk of rupture of the reproductive organ is too great. Of course, the uterus can be urgently amputated, but the woman will not survive due to extensive internal hemorrhage.

Normally, the next pregnancy can be planned no earlier than one year after the caesarean section. The most ideal is in one and a half to two years. During this time, the seam will finally heal, but before planning the conception, it is imperative to assess its condition using ultrasound.

There are cases when the seam after the operation has grown together extremely unsuccessfully, and it is very dangerous for a woman to bear the next pregnancy.

In Soviet times, there was nothing to think about natural delivery, with a history of caesarean section. Such experiments have not been practiced. Now the situation has changed, and in recent years, many mothers, when planning a second child, are thinking about how he would appear not on the operating room, but on the birth table.

In large clinics in Russia, such a difficult task is taken up, there was even a case of spontaneous birth after two obstetric operations in history (which is a reckless risk from the point of view of doctors).

Therefore, natural childbirth after a caesarean section is now possible, however, the doctor will give permission for this only if the suture from the previous operation was in good condition and at least 3 years have passed since.

When can I have sex after a caesarean section?

As with natural delivery, you should have sex only 2 months after the baby is born. Even though the vagina itself was not torn as a result of the passage of the baby through the birth canal, there is a possibility of infection, which will cause the suture on the uterus to become inflamed.

In addition, in the first month after childbirth, spotting will occur, which will only interfere with sexual activity. In the first weeks, the seam after a caesarean section heals: it is very painful and sensitive, so it is worth postponing intimacy until a more appropriate time.

From the depths of centuries

According to information that has come down to us from time immemorial, caesarean section is one of the most ancient operations. The myths of Ancient Greece describe that with the help of this operation, Asclepius and Dionysus were extracted from the womb of dead mothers. In Rome, at the end of the 7th century BC, a law was issued according to which the burial of a dead pregnant woman was carried out only after the child was removed by ablation. Subsequently, this manipulation was performed in other countries, but only for dead women. In the 16th century, Ambroise Pare, the court physician of the French king, first began performing caesarean sections on living women. But the outcome was always fatal. The mistake of Pare and his followers was that the incision on the uterus was not sewn up, relying on its contractility. The operation was performed only to save the child, when the mother's life could no longer be saved.

It was only in the 19th century that it was proposed to remove the uterus during surgery, the mortality rate as a result decreased to 20-25%. Five years later, the uterus began to be sewn up with a special three-story suture. Thus began a new phase of the caesarean section. It began to be performed not only for the dying, but also in order to save the life of the woman herself. With the beginning of the era of antibiotics in the middle of the 20th century, the outcomes of the operation improved, and deaths during it became rare. This was the reason for the expansion of indications for caesarean section both on the part of the mother and the fetus.

Indications

Planned caesarean section

A planned caesarean section is an operation, the indications for which are determined before the pregnancy is resolved. This category also includes optional caesarean section. In a planned CS, the incision is made horizontally. The indications are:

Mismatch between the size of the pelvis of a woman and the size of a child (“narrow pelvis”)
Placenta previa - the placenta is located above the cervix, blocking the exit route for the baby
Mechanical obstructions that interfere with natural childbirth, such as fibroids in the cervix
Threatened rupture of the uterus (scar on the uterus from a previous birth)
Diseases not related to pregnancy, in which natural childbirth poses a threat to the health of the mother (diseases of the cardiovascular system, kidneys; history of retinal detachment)
Complications of pregnancy that pose a threat to the life of the mother during childbirth (severe preeclampsia - eclampsia)
Breech presentation or transverse position of the fetus
Multiple pregnancy
genital herpes at the end of pregnancy (the need to avoid contact of the child with the genital tract)

emergency caesarean section

An emergency caesarean section is an operation performed when complications arise during natural childbirth that threaten the health of the mother or child. In an emergency CS, the incision is usually made vertically. Possible reasons:

Slow labor activity or its complete cessation
Premature abruption of a normally located placenta (the supply of oxygen to the fetus is cut off and potentially fatal bleeding)
(Threatening) uterine rupture
Acute hypoxia (lack of oxygen in a child)

Contraindications

Intrauterine fetal death.
Presence of infections.
Fetal malformations incompatible with life.

Anesthesia

Caesarean section is usually (up to 95% of cases) performed under regional (epidural or spinal anesthesia, or a combination of them) anesthesia. In this case, only the lower part of the body is anesthetized, a woman can immediately take the child from the uterus in her hands and attach it to her chest.

In the case of an emergency caesarean section, sometimes general anesthesia has to be resorted to.

Operation

Before surgery, the pubis is shaved and a catheter is inserted into the bladder in order to avoid kidney problems later. After anesthesia, the woman is placed on the operating table and the upper part of the body is fenced off with a screen.

After operation

Seam after surgery

The day after the operation, round-the-clock monitoring of the woman's condition is carried out. An ice pack is placed on the abdomen to contract the uterus and stop bleeding, and painkillers, drugs that promote uterine contraction, and drugs to restore the function of the gastrointestinal tract are prescribed. Antibiotics are also sometimes prescribed. Currently, it is believed that if there is no ongoing bleeding, then intravenous fluids are not needed and even harmful, as they cause swelling of the intestinal wall. The earliest possible activation (up to 4-6 hours after surgery) with sufficient pain relief, early start of fluid and food intake (Fast Track Recovery concept) has been proven to reduce the rehabilitation time after surgery and several times reduce the number of postoperative complications. Early attachment of the baby to the breast is especially important for better contraction of the uterus and stimulation of lactation.

Advantages and disadvantages of caesarean section

Baby after caesarean section

Advantages

Relatively safe childbirth in women with a clinically narrow pelvis
In cases where natural childbirth threatens the health / life of the mother or child, the harm from a caesarean section is much less than from (possible) complications
The vagina does not stretch, there are no stitches on the perineum (from episiotomy), so there are no problems with sexual life
Avoidance of hemorrhoids and pelvic organ prolapse
There is no deformation of the baby's head when passing through the birth canal
After natural childbirth, the woman's vagina becomes more capacious, easily changing size, the hymen is preserved in the form of myrtle papillae due to overstretching, the vestibule of the vagina becomes insensitive to pain. All these factors worsen the quality of sexual life.

Flaws

Possibility of infection in the abdominal cavity
The probability of serious, including fatal complications for the mother is about 10 times higher than with vaginal delivery
Difficulty initiating lactation - in some cases
A scar on the uterus after a cesarean section causes the need for a long break between the occurred and the next birth (if any are planned), since during contractions at the next birth, the contractions of the muscular layer of the uterus are so strong that the scar in some cases, according to statistics of 1-2 percent, does not endure and break. This problem can be solved if the doctor immediately after the caesarean section starts the necessary therapy for the rapid healing of the site of the uterine incision, that is, you need to take care of the next pregnancy already in the first hours after the birth
The likelihood of stress in the mother with the development of psychosis due to the "incompletion" of the physiological process of natural childbirth
The lack of contact of the child's face with the mother's perineum does not allow the child's gastrointestinal tract to be "seed" with the mother's Escherichia coli, the child will still receive E. coli from the environment, along with other microflora, but this threatens the development of dysbacteriosis. Also, for girls, the transfer of the vaginal microflora is important, due to which the likelihood of developing vulvovaginitis is reduced.

Story

The first reliable caesarean section on a living woman was performed in 1610 by the surgeon I. Trautmann from Wittenberg. The baby was retrieved alive, but the mother died 4 weeks later (cause of death not related to surgery). In Russia, the first caesarean section was performed in 1756 by I. Erasmus. One of the first caesarean sections in Russia began to be practiced by the surgeon E. H. Ikavits.

origin of name

There are three theories.

Pliny Sr. claims that one of Caesar's ancestors was born in this way (it is unlikely that it was Julius - then the operation was used only if the mother dies).
According to one of the Roman imperial laws (lat. Lex Caesarea- royal law), the child of a dying mother was supposed to be saved by caesarean section.
from lat. Caedere- cut.

Whichever theory is correct, in many languages the name of this operation has a connection with the king or Caesar (eng. Caesarean section, German Kaiserschnitt).

Literary heroes who were born by caesarean section

Macduff, character in Shakespeare's Macbeth

Notes

Wikimedia Foundation. 2010 .

Synonyms:

See what "Caesarean section" is in other dictionaries:

An incision on the side of the abdomen of a pregnant woman, made in order to take out the baby. It got its name from the fact that Julius Caesar was born as a result of such an operation. Explanation of 25,000 foreign words that have come into use in Russian ... Dictionary of foreign words of the Russian language

CAESAREAN SECTION, obstetric surgery for the extraction of the fetus (through an incision in the abdominal wall and uterus) in case of impossibility of childbirth through the birth canal (for example, a narrowed pelvis, a severe general illness of a woman), as well as in case of fetal asphyxia ... Modern Encyclopedia

C-section- This is an operation in which the child and the placenta are removed from the uterine cavity through an incision in the anterior abdominal wall. The frequency of caesarean section is on average 25 - 30%, but these values can vary significantly depending on the region of the country and the medical institution. In some European countries there is elective caesarean section, that is, the operation is performed only at the request of the woman.

Information In Russia and Belarus, operative delivery is performed only for strict medical indications. Currently, there are relative and absolute indications for surgery. Let's see how they differ.

Indications for a caesarean section

Absolute readings mean that with this pathology, childbirth in a natural way is impossible, or pose a threat to the life of the mother or her child:

Anatomically narrow pelvis II - IV degree;
Pelvis deformed by bone tumors and fractures;
Tumors of the genital organs of large sizes (uterine fibroids in the lower segment and cervical region, ovarian tumors);
Complete (the placenta completely covers the cervical canal) or partial (the placenta covers part of the uterine os) placenta previa;
- the placenta separates from the wall of the uterus before the birth of the fetus, and the baby experiences acute hypoxia (oxygen deficiency);
Acute fetal hypoxia;
Threatened uterine rupture;
The failure of the postoperative scar on the uterus. His condition is determined by ultrasound during pregnancy;
Significant cicatricial changes in the cervix and vagina. In this situation, the cervix will not be able to open up enough, and the vagina will not fully stretch, so that the birth goes well;
Transverse position of the fetus;
Eclampsia is a severe complication of preeclampsia, in which convulsions and loss of consciousness are observed;

Relative readings- technically independent childbirth is possible, but their outcome will be less favorable than after the operation:

Anatomically narrow pelvis I degree;
Large fetus (estimated weight of the fetus is more than 4000 g in cephalic presentation and more than 3600 g in breech presentation);
(with foot view and extensor position of the head);
. Since the bones of the fetal head are compacted and it is more difficult for them to configure when passing through the birth canal;
Severe varicose veins of the vulva and vagina;
Persistent weakness of labor activity;
Malformations of the uterus;
Postoperative scar on the uterus;
Diseases of a woman not associated with pregnancy, in which excessive stress during natural childbirth can aggravate the condition (cardiovascular disease, kidney disease, diabetes mellitus, high myopia);
The age of the pregnant woman is over 35;
Aggravated obstetric history (prolonged infertility, in vitro fertilization, miscarriages, stillbirths);
preeclampsia;
genital tract infections;
HIV infection of the mother (to reduce the risk of infection of the child);
Symphysitis - an excessive increase in the cartilage of the pubic joint (more than 11 - 12 mm) is detected on;
Chronic fetal hypoxia.

dangerous Most often, the operation is performed according to combined indications, and the need to preserve the life and health of the child is always taken into account.

Contraindications for surgery:

Intrauterine fetal death;
Congenital malformations incompatible with life;
Infectious diseases of the skin of the abdomen.

Some women want to give birth promptly, wanting to avoid painful ones. However, most often they do not think about the fact that, as with any operation, there is a risk of complications. Maternal and child mortality in elective surgery is 4-5 times higher, and in emergency caesarean section 8-10 times higher than in natural childbirth.

Operation progress

If the operation is performed as planned, then the pregnant woman is hospitalized a few days before the expected date for the examination. The day before the operation, together with the anesthetist, choose the method of anesthesia . Epidural anesthesia gives a woman the opportunity to be conscious and see her baby and even attach him to her breast. An anesthetic drug is injected into the epidural space of the spine and it has no effect on the child. In emergency operations, more often give general anesthesia because in such situations every minute counts. But you should not be afraid of this, because from the moment of giving anesthesia to the birth of a child, an average of up to 5 minutes passes, and the minimum concentration of the drug is delivered to the baby.

There are two types of abdominal skin incision:

Inferomedian laparotomy - the skin is cut down from the navel along the midline. This access allows you to quickly get the baby out of the uterine cavity and is used in emergency operations.
Pfannenstiel incision - an incision is made transversely above the pubis along the hairline. Currently performed during elective operations, if there is no, for example, a scar in the midline from a previous operation.

After the skin has been dissected, the muscles, peritoneum (a thin film covering the intestines), ligaments are opened in layers, and then an incision is made in the lower segment of the uterus and the child is removed. During the operation, they do not wait for the placenta to separate by itself, but it is isolated by hand and the doctor additionally examines the entire uterine cavity. Special substances (oxytocin, methylergometrine) are injected into the myometrium (muscles of the uterus), which contribute to its contraction. A continuous incision is made on the uterus, the peritoneum, ligaments and muscles are sutured. On the skin, depending on the situation, either separate sutures are applied or an intradermal continuous cosmetic suture is used (it is used much more often because of the better aesthetic effect).

On average, the operation lasts 30-40 minutes. Then the woman in labor is transferred to the intensive care unit, where doctors will observe her on the first day. The baby is examined by a pediatrician, the midwife processes it and transfers it to the children's department.

Features of the course of the postpartum period

In intensive care, a woman is corrected for violations that occurred during the operation. Blood loss during natural childbirth normally does not exceed 250 - 300 ml and the body is able to replenish it itself. During a caesarean section, a woman in labor loses up to 900 ml of blood. And it is necessary to replenish blood loss with blood-substituting solutions, plasma or red blood cells. To prevent infectious complications, especially during emergency surgery, a course of antibiotics is prescribed. And to stimulate uterine contractions, oxytocin is administered for 3 to 5 days. appointed for the first three days.

Nutrition after caesarean section

Nutrition after surgery:

Eat first nothing can be done for a day and therefore nutrient solutions containing all the necessary substances are administered intravenously. You can drink only mineral water without gases with lemon juice.
On the second day add low-fat chicken broth, pureed meat, thin porridge, unsweetened fruit drink.
On the third day, the menu expands - you can already eat cottage cheese, yogurt, drink unsweetened tea.
Starting from the fourth day, you can eat everything that is not forbidden to nursing young mothers.

It is advisable to eat small meals 5-6 times a day.

After the operation, intestinal motility is disturbed (due to a violation of the integrity of the peritoneum) and, if there is no independent stool on the third day, then a cleansing enema or laxative is prescribed.

Feeding

Immediately after the transfer to the postpartum department, you can pick up the baby from the nursery and be with him all the time. From personal experience, I will say that early cohabitation speeds up recovery after surgery, because your baby is the best analgesic.

And on-demand breastfeeding improves uterine contractions and stimulates milk production better than hourly breastfeeding. But, if the condition does not allow, then until the third day the child can only be brought in for feeding 5-6 times a day. However, it is worth remembering that on the third day narcotic painkillers are canceled, and the seam still hurts and it is more difficult to adapt to your baby and take care of him than immediately.

After the operation, milk can arrive on the 4th - 5th day, which is somewhat later than during natural childbirth. But do not be upset, rich in nutrients and with frequent application at the request of the baby, this will be enough for him. In the first week, the weight of the child is allowed to decrease to 10% of body weight at birth. This is due to adaptation to new living conditions.

additionally The postoperative suture is treated with brilliant green every day, and on the 7th - 8th day the skin scar has already formed and the suture material can be pulled out.

Consequences of the operation

Possible complications of the postoperative period:

endometritis- inflammation of the uterus, due to the open wound of a large wound surface, the risk of inflammation is higher than with conventional childbirth.
Subinvolution of the uterus- violation of the process of uterine contraction and reduction of its size. During elective operations, there is no production of internal oxytocin, which causes the uterus to contract, so it is injected from the outside. Blood clots can linger in the uterus and sometimes it is necessary to carry out the so-called "cleansing of the uterus" to prevent the development of further complications.
formed between the loops of the intestine due to a violation of the integrity of the peritoneum. Usually there are few of them and they are not felt at all. But it happens that adhesions interfere with the normal functioning of the intestines and pain occurs, then drug treatment or an operation to dissect the adhesions is prescribed.

Sex after cesarean

They are usually discharged from the hospital on 8-9 days. At home, you should try not to lift anything heavier than a child for at least the first three months. You should also refrain from sexual activity at this time, since the uterine mucosa has not yet fully recovered. It is necessary to think in advance about the method of contraception, because the body needs at least 2 years to recover from surgical delivery.