Vertical caesarean. Postoperative recovery period after caesarean section. Consequences for the child

Caesarean section is one of the few medical procedures that have retained their name from time immemorial. He is associated with the name of Gaius Julius Caesar ("Caesar" - "king"), who is said to have been born in this way. We will not dispute the truth of this fact, especially since it is unlikely to ever be confirmed.

In modern medicine, a caesarean section is a surgical operation to remove the fetus from the mother's womb by excising the abdominal wall and uterus. Why take a detour when there is a direct way? The fact is that natural childbirth in some cases can be dangerous for both the mother and the child. Therefore, there is only one way out: “caesarean”.

Preparation for caesarean section The frequency of such operations is about 15% of the total number of births. To perform a caesarean section, the mother’s desire alone is not enough; it is performed according to certain indications. The first births in life through caesarean section predetermine a similar mechanism in subsequent births, although the natural way cannot be ruled out, everything is individual here. Age (over 30 years old) "primogeniture" - these are the main "clients" of surgeons of maternity hospitals. It should be noted that the risk for a woman in labor with caesarean section is naturally higher than with vaginal delivery.

As for the children who are born in the “bypass” way, they do not differ in the slightest from children who have gone through fire, water and ... fallopian tubes.

Indications for caesarean section

The operation of caesarean section can be both planned and emergency, force majeure. The latter is carried out in case of a threat to the life or health of the mother or child during childbirth.

Indications for a planned caesarean section

• with concomitant bleeding;
• incorrect orientation of the fetus in the uterus (the pelvic part of the fetus faces the exit from the uterus () or the fetus is located across the uterus);
• the anatomical narrowness of the pelvis of the woman in labor, in combination with the large size of the fetus itself;
• multiple pregnancy;
• Rhesus conflict between mother and fetus;
• the presence of concomitant diseases and pathological conditions (hypertension, heart disease, kidney disease, a high degree of myopia);
• tumors of the soft birth canal (fallopian tubes, uterus, vagina);
• previous operation on the uterus (in poor condition of the scar).

Indications for an emergency caesarean section

• violations of labor activity (, strong or discoordinated labor activity);
• acute fetal hypoxia with palpitations;
• early discharge of amniotic fluid in the absence of uterine response to stimulation;

Contraindications for caesarean section

• infectious diseases of the birth canal;
• purulent inflammation of the abdominal wall;
• inflammation of the germinal membrane (amnionitis);
• deep prematurity of the fetus;
• severe fetal deformities incompatible with life or intrauterine death of the fetus.

On the night before the operation, it is possible to use sedatives for a full normal sleep. On the day of the operation, the mother should not drink or eat. For hygienic purposes, a shower is required. Immediately before the operation, a catheter is inserted into the bladder, a bandage is applied to the legs, applied (most often epidural) - and good luck.

How is a caesarean section performed?

Recovery after caesarean section

As for the gastronomic aspect, the first day after the operation should be without food, because. the intestines have not yet restored their work. Subsequently, you can eat cereals, low-fat broths, drink tea, kefir. On the 5th day, a transition to the usual diet is possible.

Possible complications after caesarean section:

• bleeding;
• inflammation of the peritoneum due to damage to the wall of the bladder and the ingress of urine on it;
• inflammation of the muscular (myometritis) or mucous membrane (endometritis) of the uterus in case of infection;
• thrombus formation, separation of a blood clot and blockage of the vessel;
• adhesions (in the uterus, intestines, peritoneum);
• (stopped by taking iron supplements);
• underhealing of the scar on the uterus, due to which it may disperse during the next pregnancy.

And in conclusion, I would like to answer one of the most pressing questions for women who have undergone a caesarean section: When is the next time to give birth? Not earlier than 2-3 years after the operation. And during this period is also undesirable. There is a risk of perforation of the uterus at the incision site. Therefore, more attention should be paid to the issue

For many decades, this operation - caesarean section - allows you to save the life and health of the mother and her baby. In the old days, such a surgical intervention was performed extremely rarely and only if something threatened the life of the mother in order to save the child. However, caesarean section is now being used more and more frequently. Therefore, many specialists have already set themselves the task of reducing the percentage of births carried out by surgical intervention.

Who should perform the operation?

First of all, you should figure out how a caesarean section is done and what consequences await a young mother. By themselves, childbirth by the surgical method is quite safe. However, in some cases, operations are simply inappropriate. After all, no one is immune from risk. Many expectant mothers ask for a caesarean section only because of fear of severe pain. Modern medicine offers in this case epidural anesthesia, which allows a woman to give birth without pain.

Such births are performed - caesarean section - by a whole team of medical workers, which includes specialists of a narrow profile:

• Obstetrician-gynecologist - directly extracts the baby from the uterus.
• Surgeon - performs an incision in the soft tissues and muscles of the abdominal cavity to reach the uterus.
• A pediatric neonatologist is a doctor who takes in and examines a newborn baby. If necessary, a specialist in this profile can provide the child with first aid, as well as prescribe treatment.
• Anesthesiologist - performs anesthesia.
• Nurse anesthetist - helps to administer anesthesia.
• Operating nurse - assists doctors if necessary.

The anesthesiologist should talk to the pregnant woman before the operation to determine which type of pain relief is best for her.

Types of caesarean section

Indications for caesarean section can be completely different, and the operation is performed in certain cases in different ways. To date, there are two types of childbirth carried out with the help of surgical intervention:

Emergency surgery is performed if any complication occurs during childbirth that requires urgent removal of the baby from the uterus. A planned caesarean section is performed in situations where the doctor is concerned about the progress of childbirth due to complications that arose during pregnancy. Let's take a closer look at the differences between the two types of operations.

Planned caesarean section

A planned operation (caesarean section) is performed with epidural anesthesia. Thanks to this method, a young mother has the opportunity to see her newborn baby immediately after the operation. When carrying out such a surgical intervention, the doctor makes a transverse incision. The child usually does not experience hypoxia.

emergency caesarean section

For an emergency caesarean section, general anesthesia is usually used during the operation, since the woman may still have contractions, and they will not allow an epidural puncture. The incision in this operation is mainly longitudinal. This allows you to remove the baby from the uterine cavity much faster.

It is worth noting that during an emergency operation, the child may already experience severe hypoxia. At the end of the cesarean section, the mother cannot immediately see her baby, as they do a cesarean section in this case, as already mentioned, most often under general anesthesia.

Types of incisions for caesarean section

In 90% of cases, a transverse incision is made during the operation. As for the longitudinal one, they are currently trying to do it less often, since the walls of the uterus are greatly weakened. In subsequent pregnancies, they can simply overstrain. A transverse incision made in the lower part of the uterus heals much faster, and the sutures do not break.

A longitudinal incision is made along the midline of the abdominal cavity from the bottom up. To be more precise, to a level just below the navel from the pubic bone. Making such an incision is much easier and faster. Therefore, it is he who is usually used for emergency cesarean section in order to extract the newborn baby as quickly as possible. The scar from such an incision is much more noticeable. If doctors have the time and opportunity, then during the operation a transverse incision can be made slightly above the pubic bone. It is almost invisible and heals beautifully.

As for the second operation, the seam from the previous one is simply excised.
As a result, only one seam remains visible on the woman's body.

How is the operation going?

If the anesthesiologist performs epidural anesthesia, then the site of the operation (incision) is hidden from the woman by a partition. But let's see how a caesarean section is done. The surgeon makes an incision in the wall of the uterus, and then opens the fetal bladder. Then the child is removed. Almost immediately, the newborn begins to cry a lot. The pediatrician cuts the umbilical cord, and then performs all the necessary procedures with the child.

If the young mother is conscious, then the doctor shows her the baby right away and can even let her hold it. After that, the child is taken to a separate room for further observation. The shortest period of the operation is the incision and removal of the child. It takes only 10 minutes. These are the main advantages of a caesarean section.

After that, doctors must remove the placenta, while treating all the necessary vessels with high quality so that bleeding does not start. The surgeon then sews up the cut tissue. A woman is put on a dropper, giving a solution of oxytocin, which accelerates the process of uterine contraction. This phase of the operation is the longest. From the moment the baby is born to the end of the operation, it takes about 30 minutes. In time, this operation, a caesarean section, takes about 40 minutes.

What happens after childbirth?

After the operation, the newly-made mother is transferred from the operating unit to the intensive care unit or intensive care unit, as a caesarean section is performed quickly and with anesthesia. The mother should be under the vigilant supervision of doctors. At the same time, her blood pressure, respiratory rate, and pulse are constantly measured. The doctor must also monitor the rate at which the uterus is contracting, how much discharge and what character they have. It is mandatory to monitor the functioning of the urinary system.

After a caesarean section, the mother is prescribed antibiotics to avoid inflammation, as well as painkillers to relieve discomfort.

Of course, the disadvantages of a caesarean section may seem significant to some. However, in some situations, it is precisely such childbirth that allows a healthy and strong baby to be born. It is worth noting that a young mother will be able to get up only after six hours, and walk on the second day.

Consequences of surgery

After the operation, stitches remain on the uterus and abdomen. In some situations, diastasis and suture failure may occur. If such effects occur, you should immediately consult a doctor. Comprehensive treatment of the divergence of the edges of the suture located between the rectus muscles includes a set of exercises specially developed by many specialists that can be performed after a cesarean section.

The consequences of this surgical intervention, of course, are available. The very first thing to highlight is an ugly seam. You can fix it by visiting a beautician or a surgeon. Usually, to give the seam an aesthetic appearance, procedures such as smoothing, grinding and excision are carried out. Keloid scars are considered quite rare - reddish growths form above the seam. It should be noted that the treatment of this kind of scars lasts a very long time and has its own characteristics. It must be carried out by a professional.

For a woman, the state of the suture that is made on the uterus is much more important. After all, it depends on him how the next pregnancy will go and what method the woman will give birth to. The suture on the abdomen can be corrected, but the suture on the uterus cannot be corrected.

Menstruation and sexual life

If there are no complications during the operation, then the menstrual cycle begins and passes in the same way as after natural childbirth. If a complication nevertheless arose, then the inflammatory can proceed for several months. In some cases, menstruation can be painful and heavy.

You can start having sex after childbirth with a scalpel after 8 weeks. Of course, if the surgical intervention went without complications. If there were complications, then you can start having sex only after a thorough examination and consultation with a doctor.

It should be borne in mind that after a cesarean section, a woman should use the most reliable contraceptives, since she cannot become pregnant for about two years. It is undesirable to carry out operations on the uterus for two years, as well as abortions, including vacuum ones, since such an intervention makes the walls of the organ weaker. As a result, there is a risk of rupture during a subsequent pregnancy.

lactation after surgery

Many young mothers who have undergone surgery worry that it is difficult to breastfeed after a cesarean. But this is absolutely not true.

Milk from a young mother appears at the same time as women after natural childbirth. Of course, breastfeeding after surgery is a little more difficult. This is primarily due to the characteristics of such genera.

Many doctors fear that the baby may get part of the antibiotic in the mother's milk. Therefore, in the first week, the baby is fed with a formula from a bottle. As a result, the baby gets used to it and it becomes much more difficult to accustom him to the breast. Although today babies are often applied to the breast immediately after surgery (on the same day).

If you do not have indications for delivery by caesarean section, then you should not insist on an operation. After all, any surgical intervention has its consequences, and it is not for nothing that nature has come up with a different way for the birth of a child.

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.

A caesarean section is a delivery method in which the fetus is removed through an incision in the anterior abdominal wall and uterus. Surgery always entails a difficult recovery period, and in some cases complications. Therefore, a caesarean section is performed only when natural childbirth becomes unsafe for the mother and child.

The first caesarean section was performed by the German surgeon I. Trautmann in 1610. In those days, it was an emergency measure when natural childbirth was impossible. Antiseptics were not used in medicine, the incision on the uterus was not sewn up. In 100% of cases, the woman died after the operation. With the introduction of broad-spectrum antibiotics, the risk of complications has decreased to a minimum.

“According to Rosstat, in 2010, 22% of pregnancies in Russia ended in a caesarean section. In the West, this figure is 25-28%.»

Indications for caesarean section are divided into absolute and relative. One of the absolute indications is enough for the operation. If there are relative indications, the doctor decides on the operation, based on their combination.

Absolute readings

• Complete placenta previa.
• Premature detachment of the placenta.
• Anatomically narrow pelvis III and IV degree.
• 2 caesarean sections or 1 corporal in history.
• An inconsistent scar on the uterus (in case of damage during an abortion).
• Incipient uterine rupture.
• A scar on the perineum of the III degree after a gap in childbirth.
• Acute fetal hypoxia.
• The transverse position of the fetus after the outpouring of water.

Relative readings

• Severe form of gestosis.
• Fracture of the pelvis and lumbar bones in history.
• The pelvic position of the fetus weighing more than 3500 g.
• Multiple pregnancy with the pelvic position of one fetus.
• Diseases of the brain, kidneys, cardiovascular system, retinal detachment.
• Prolapse of the umbilical cord.

Indications for caesarean section are detected even during pregnancy. Then the woman is prepared for a planned operation. She needs to go to the hospital in advance to prepare for childbirth. But sometimes it happens that a woman is preparing for natural childbirth, but complications are found in the course of labor. In this case, doctors perform an emergency caesarean. The photo below clearly demonstrates the operation process.

Preparing for the operation

With a planned caesarean section, a woman in labor is given a referral to a hospital 1-2 weeks before delivery. During this time, she takes tests, undergoes examinations. If necessary, doctors correct the woman's health. They also monitor the condition of the child: they check the blood flow in the mother-placenta-fetus system using dopplerometry, do CTG, ultrasound.

If desired, a woman can donate plasma to a blood bank. If needed during the operation, the mother will be infused with native blood components, not donor ones. Usually donate about 300 ml of plasma. The blood is restored in 2-3 days.

A planned operation is usually performed at 38-39 weeks of gestation, based on the indicators of the child's condition. Although the best moment for operative delivery is the beginning of labor. Then the cervix is ​​open and the postpartum discharge flows out better. Involution of the uterus is faster, lactation occurs on time.

Caesareans are usually performed in the morning. In the evening they put a cleansing enema, shave the pubis, give sleeping pills at night. In the morning, the enema is repeated.

Schematic photo of childbirth by caesarean section

How is a caesarean section performed in stages

At the beginning of the operation, the body is prepared for anesthesia and a catheter is placed in the urinary canal to drain urine. During the operation, the bladder must be empty to make it easier for the doctor to access the uterus.

Anesthesia

The doctor chooses the method of anesthesia based on the circumstances and health of the woman in labor. General anesthesia is used in emergency cases. This type of anesthesia has a negative effect on the body of the mother and child: it causes respiratory depression in the child, gastric contents can enter the mother's respiratory tract and cause pneumonia. For a planned caesarean section, regional anesthesia is selected: spinal, epidural, or a combination of both. For pain relief in the lower back, an injection is given. With spinal anesthesia, the drug is injected into the fluid surrounding the back of the brain, and the needle is removed. With an epidural, a tube is inserted under the skin along with a needle, through which the medicine enters, and the needle is removed. The anesthesia procedure is painless, as the injection site is anesthetized beforehand.

Spinal anesthesia during surgery

After anesthesia, the woman in labor is fenced off with a screen and immediately proceed to extract the child. During the operation with regional anesthesia, the woman in labor is conscious. Immediately after birth, the baby is placed on the breast.

Operation progress

The caesarean section lasts 30-40 minutes. At 15-20 minutes, the child is removed from the uterus.

• Cut the skin in the lower abdomen with a cross section 15 cm long.
• The subcutaneous fat, muscles, and peritoneum are cut in layers.
• An incision is made in the lower segment of the uterus.
• Open the fetal bladder.
• The child is taken out.
• Cross the umbilical cord.
• Remove last.
• An incision in the wall of the uterus is sutured.
• Restore the layers of the abdominal cavity.
• Sew up the seam on the skin with absorbable or silk threads.

The seam

Currently, caesarean section is performed using an incision in the lower segment of the uterus. This is the thinnest place on the uterus, which has a small amount of muscle fibers. Due to this, after the involution of the uterus, this area becomes the smallest, the scar also decreases in size. With this option for the location of the scar, the incision on the uterus and on the anterior abdominal wall does not match, and the risk of adhesions between the uterus and peritoneum is minimal.

A corporal cesarean is performed with a vertical incision in the anterior abdominal wall, which coincides with the scar on the uterus. This arrangement of incisions provokes inflammatory processes in the abdominal cavity, adhesions. It is performed only in emergency cases, when there is a question of saving the life of the mother and child.

Types of incisions for caesarean section

Possible Complications

In the early postpartum period on the first day after surgery, complications such as peritonitis, endometritis, inflammation of deep veins may occur. In the late postpartum period: divergence of the suture on the uterus,.

Spinal anesthesia often leaves unpleasant consequences. An error in the injection leads to a puncture of the dura mater. Cerebrospinal fluid leaks into the epidural region. This causes headaches and back pains that can last for months or even years.

Often, difficulties arise due to the banal inattention of obstetricians. When a woman in childbirth is placed on a couch after surgery, the medical staff sometimes does not straighten her legs, and they remain bent. But a woman does not feel the lower body after anesthesia and can spend several hours in this position. This leads to impaired circulation. Tissue compression occurs, severe edema develops, and muscle atrophy develops. After the operation, it is better to pay the nurse's attention to this moment.

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, 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.