Scheduled caesarean section terms, duration and course of the operation. Cesarean section Is it possible to choose a caesarean at will

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

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

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

Absolute indications for caesarean section

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

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

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

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

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

Relative indications for caesarean section

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

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

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

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

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

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

Kinds

By urgency, caesarean section can be of the following types:

• planned;
• emergency.

According to the execution technique, they distinguish:

• abdominal caesarean section - the incision is made through the anterior abdominal wall;
• vaginal caesarean section - an incision through the anterior fornix of the vagina.

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

How is a cesarean section performed?

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

How to prepare for a caesarean section

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

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

Anesthesia

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

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

The progress of the caesarean section

After the anesthesia has taken effect, the operation begins. How is a caesarean section performed? First, an incision is made in the abdominal wall. During the operation, 2 types of incisions are possible: longitudinal (vertical from the womb to the navel; done with an emergency caesarean section, because it is faster to get the baby through it) and transverse (above the womb).

Next, the surgeon pushes the muscles apart, makes an incision in the uterus and opens the fetal bladder. After removing the baby, the placenta is removed. Then the doctor sews up the uterus first with threads that dissolve after a few months - after the tissues grow together, and then the abdominal wall. A sterile bandage is applied, ice is placed on the abdomen so that the uterus contracts intensively, and also in order to reduce blood loss.

The duration of a caesarean section usually takes from 20 to 40 minutes, while the child is already born at 10 minutes, or even earlier.

Postoperative period

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

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

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

Care, diet and stool

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

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

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

After discharge from the hospital

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

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

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

Is natural childbirth possible after caesarean?

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

Pros and cons of a caesarean section

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

Advantages of a caesarean section:

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

Cons of a caesarean section:

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

Consequences of a caesarean section

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

Consequences for mother:

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

Consequences for the child:

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

Complications after caesarean section

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

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

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

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

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

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

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

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

Complications may also arise during suture healing until they diverge.

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

Video of a caesarean section

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Around the world, there is a clear trend towards gentle delivery, which allows you to save the health of both mother and child. A tool to help achieve this is the caesarean section (CS). A significant achievement has been the widespread use of modern methods of anesthesia.

The main disadvantage of this intervention is the increase in the frequency of postpartum infectious complications by 5-20 times. However, adequate antibiotic therapy significantly reduces the likelihood of their occurrence. However, there is still debate about when a caesarean section is performed and when physiological delivery is acceptable.

When is operative delivery indicated?

A caesarean section is a major surgical procedure that increases the risk of complications compared to normal natural childbirth. It is carried out only under strict indications. At the request of the patient, CS can be performed in a private clinic, but not all obstetrician-gynecologists will undertake such an operation without the need.

The operation is performed in the following situations:

1. Complete placenta previa - a condition in which the placenta is located in the lower part of the uterus and closes the internal pharynx, preventing the baby from being born. Incomplete presentation is an indication for surgery when bleeding occurs. The placenta is abundantly supplied with blood vessels, and even a slight damage to it can cause blood loss, lack of oxygen and fetal death.

2. Occurred ahead of time from the uterine wall - a condition that threatens the life of a woman and a child. The placenta detached from the uterus is a source of blood loss for the mother. The fetus ceases to receive oxygen and may die.

3. Previous surgical interventions on the uterus, namely:

• at least two caesarean sections;
• a combination of one CS operation and at least one of the relative indications;
• removal of intermuscular or on a solid basis;
• correction of the defect in the structure of the uterus.

4. Transverse and oblique positions of the child in the uterine cavity, breech presentation (“booty down”) in combination with the expected weight of the fetus over 3.6 kg or with any relative indication for operative delivery: a situation where the child is located at the internal os not in the parietal region , and forehead (frontal) or face (facial presentation), and other features of the location that contribute to birth trauma in a child.

Pregnancy can occur even during the first weeks of the postpartum period. The calendar method of contraception in conditions of an irregular cycle is not applicable. The most commonly used condoms are mini-pills (progestin contraceptives that do not affect the baby during feeding) or conventional (in the absence of lactation). Use must be excluded.

One of the most popular methods is . Installation of a spiral after a caesarean section can be performed in the first two days after it, but this increases the risk of infection, and is also quite painful. Most often, the spiral is installed after about a month and a half, immediately after the onset of menstruation or on any day convenient for a woman.

If a woman is over 35 years old and has at least two children, if she wishes, the surgeon can perform surgical sterilization during the operation, in other words, tubal ligation. This is an irreversible method, after which conception almost never occurs.

Subsequent pregnancy

Natural childbirth after caesarean section is allowed if the formed connective tissue on the uterus is wealthy, that is, strong, even, able to withstand muscle tension during childbirth. This issue should be discussed with the supervising physician during the next pregnancy.

The likelihood of subsequent births in a normal way increases in the following cases:

• a woman has given birth to at least one child through natural means;
• if CS was performed due to malposition of the fetus.

On the other hand, if the patient is over 35 years old at the time of the next birth, she is overweight, has comorbidities, mismatched fetal and pelvic sizes, it is likely that she will undergo surgery again.

How many times can a caesarean section be done?

The number of such interventions is theoretically unlimited, however, to maintain health, it is recommended to do them no more than twice.

Usually, the tactics for re-pregnancy are as follows: a woman is regularly observed by an obstetrician-gynecologist, and at the end of the gestation period, a choice is made - surgery or natural childbirth. In normal childbirth, doctors are ready to perform an emergency operation at any time.

Pregnancy after caesarean section is best planned with an interval of three years or more. In this case, the risk of insolvency of the suture on the uterus decreases, pregnancy and childbirth proceed without complications.

How soon can I give birth after surgery?

It depends on the consistency of the scar, the age of the woman, concomitant diseases. Abortions after CS adversely affect reproductive health. Therefore, if a woman nevertheless became pregnant almost immediately after a CS, then with a normal course of pregnancy and constant medical supervision, she can bear a child, but delivery will most likely be operative.

The main danger of early pregnancy after CS is suture failure. It is manifested by increasing intense pain in the abdomen, the appearance of bloody discharge from the vagina, then signs of internal bleeding may appear: dizziness, pallor, drop in blood pressure, loss of consciousness. In this case, you must urgently call an ambulance.

What is important to know about the second caesarean section?

A planned operation is usually performed in the period of 37-39 weeks. The incision is made along the old scar, which somewhat lengthens the operation time and requires stronger anesthesia. Recovery from CS can also be slower because scar tissue and adhesions in the abdomen prevent good uterine contractions. However, with the positive attitude of the woman and her family, the help of relatives, these temporary difficulties are quite surmountable.

Childbirth is not just the most important and responsible event in the life of a pregnant woman, but, what is there, sometimes frankly frightening. From the first months, especially suspicious expectant mothers are studying forums, looking for advice on how to give birth without pain. Read reviews of women who have experienced various techniques. And more and more people are convinced that childbirth without pain is almost unbelievable. And as salvation, the following thought creeps into my head: why not choose a caesarean section? After all, it seems that it is so simple, no more dangerous than an operation to remove appendicitis. All you need to do is get on the operating table, and there ... I fell asleep, woke up, got a squeaky lump in my arms, and that's all - you are a mother! Miracles, and nothing more. But is everything really so rosy, or is a caesarean section a serious surgical intervention? What are the indications for a caesarean section?

There are several reasons why the operation to remove the fetus through an incision in the mother's abdomen was called a caesarean section. According to one of the legends, this is how Gaius Julius Caesar was born. According to another, the name comes from the Latin version "sectio caesaria", which literally translates as "I cut the cut."

In any case, in those distant times, it was almost impossible for a woman in labor to survive after a caesarean section. At the same time, the difficulties of natural childbirth often ended in the death of a child or mother. Therefore, in difficult cases, they tried to save at least a child. And only with the development of medicine in the 19th century did it finally become possible for both of them to survive, but even in those days the mortality rate was a quarter of all operated women.

With the widespread use of antibiotics in the middle of the 20th century, mortality during operative delivery was reduced to isolated cases, and caesarean sections began to be performed not only according to strict indications, but also in some countries at the request of a woman. For example, in Brazil, according to data for 2015, more than half of the children were born surgically. However, cesarean delivery is not as harmless as it is commonly thought. It has its own causes and complications, which can be dangerous for both mother and child.

What are the indications for a caesarean section?

Each operation has its own reasons - indications that led to its necessity. Caesarean section is no exception in this regard. If the absence of surgical intervention carries a certain risk to the life of the mother or fetus, then this is called absolute indications. If a woman can give birth on her own, but this is fraught with a high danger to her or the child, then such indications will be relative.

The increase in the number of surgical deliveries in the world is mainly due to the unwillingness of doctors to take risks in the presence of relative indications. In a controversial situation, caesarean sections are increasingly being performed in order to reduce the possibility of adverse consequences.

Like any medical intervention, caesarean section has its contraindications. These include: intra- or perinatal fetal death, fetal deformities, severe prematurity. If there is no confidence in the viability of the fetus, doctors try not to leave a scar on the uterus.

Absolute from the side of the woman in labor ...

One of the absolute indications is a change in the configuration of the pelvis. If a woman in labor has one or more pelvic sizes reduced, this is considered an anatomically narrow pelvis. With an anatomically narrow pelvis of the third or fourth degree of severity, natural delivery is impossible. This situation occurs in 5-7% of all births. Also, the cause of a cesarean section will be pelvic deformities after previous diseases, bone tumors, injuries of the pubic joint after previous births. There are five more absolute indications on the part of the mother.

1. Obstacles for the child during the passage of the birth canal. These may include cicatricial deformities of the cervical region of the uterus and vaginal walls, tumors of unfavorable localization (large uterine fibroids, ovarian tumors), pronounced varicose veins in the genital area, fistulas in the perineum. The main reason for operative delivery in such cases is the threat of extensive ruptures of scar tissue, as it is less elastic. Tumors, in addition, can be compressed during the passage of the fetus and become necrotic, and large uterine fibroids can also be a mechanical obstacle to the fetus. Varicose veins are dangerous with the possibility of ruptures, followed by profuse bleeding, threatening the woman in labor with death.
2. Premature detachment of a normally located placenta. If the detachment occupies more than a third of the entire area or progresses rapidly, while the woman cannot give birth naturally, then the fetus will quickly die under conditions of increasing hypoxia. In addition, detachment threatens the woman in labor with severe bleeding. The cause of placental abruption can be abdominal trauma, stress, preeclampsia, rapid emptying of the uterus when water breaks in conditions of polyhydramnios, multiple pregnancy.
3. Placenta previa. If the placenta completely covers the cervix at the bottom of the uterus, it is a complete presentation. Accordingly, with an incomplete presentation, the cervix is ​​\u200b\u200bpartially blocked. The absolute indication is complete presentation, as well as the combination of incomplete placenta presentation with any other complications of pregnancy.
4. Threat of uterine rupture. A very dangerous situation. In the absence of emergency surgical intervention, the woman in labor is threatened with death. The probability of uterine rupture increases in the presence of risk factors: an inconsistent scar after a previous caesarean section, multiple births, a large fetus, multiple pregnancy against the background of a pathologically altered muscular layer of the uterus.
5. Pre-eclampsia and exlampsia. Complications of preeclampsia from the central nervous system, requiring immediate delivery, regardless of the gestational age.

... and from the side of the fetus

The need for surgery arises if the position of the fetus is disturbed. We are talking about the transverse, oblique location of the child. When the child lies with the buttocks down, a caesarean section is performed in case of a suspected large fetus (estimated fetal weight is more than 3500 g) or in combination with pathologies on the part of the woman in labor. There are four more indications.

1. Incorrect insertion of the head. With extensor positions (when the baby’s neck is unbent and instead of the back of the head, the forehead and crown are adjacent to the birth canal), childbirth is naturally extremely dangerous even with a small fetus and a good size of the woman’s pelvis.
2. Presentation and prolapse of parts of the umbilical cord. The reason is the extremely high risk of fetal death during childbirth due to compression of the umbilical cord.
3. Acute respiratory failure (hypoxia) of the fetus. It is diagnosed during childbirth for various reasons. For example, placental abruption, weakness of labor, abnormal presentation of the fetus and insertion of the head. In acute hypoxia on CTG and during auscultation, certain changes are observed in the fetal heartbeat. If conservative treatment is unsuccessful, the only way to save the fetus is a caesarean section.
4. The death or terminal state of a woman with a live fetus. Caesarean section makes it possible to deliver a woman in a coma, in agony, who died in childbirth, thereby saving the life of a child.

Relative from the side of the woman in labor ...

Relative indications for cesarean delivery on the part of the mother include the following six conditions.

1. Clinically narrow pelvis. In 1-2% of births, there may be a discrepancy between the size of the presenting part of the fetus and the pelvis of the woman in labor. This situation is called a clinically narrow pelvis. The prognosis is possible on ultrasound at the end of pregnancy after examining the size of the fetus, but the final diagnosis is made during childbirth. With the wrong tactics of childbirth for the mother and fetus, serious complications are possible, up to the death of the fetus, so it is advisable to perform the operation without waiting for injuries.
2. Preeclampsia. A long atypical course, a weak effect of treatment is not the best companion of a woman in natural childbirth. The danger lies in the adverse effects of preeclampsia on the body of the mother and child, as well as the likelihood of developing complications - preeclampsia and eclampsia.
3. The presence of diseases of the reproductive system. For example, infertility, habitual miscarriage. In addition to the fact that the underlying disease can interfere with effective labor, a woman who has not been able to get pregnant for a long time most often fears the possibility of losing a child in childbirth, and this does not give her the opportunity to tune in to the natural and productive course of childbirth.
4. Severe extragenital pathology. Decompensated diseases of the cardiovascular, respiratory, endocrine systems. Uncomplicated kidney disease in itself is not an indication for caesarean section, but is very often complicated by obstetric pathology (preeclampsia, placental insufficiency, placental abruption), therefore, such pregnant women are often delivered promptly. Eye diseases also often progress during pregnancy. The indication for caesarean section for vision is the pathology of the retina. If the problem was detected in advance during pregnancy, then the retina can be "welded". Then childbirth in a natural way is possible. If the problem has not been resolved during pregnancy, then it will be safer to give birth operatively to avoid retinal detachment and possible blindness.
5. Persistent weakness of labor activity. If it does not respond to drug therapy and threatens with protracted labor and hypoxia to the fetus.
6. Primiparous woman over 30 years old. In the realities of the modern world, there is a strong tendency to postpone childbirth until a later age, when a career has already been built and parents can fully provide financially for the unborn child, so that the first birth “over 30” will not surprise anyone. But the physiology of the female body remains unchanged ... Over time, the tissues lose their elasticity and ability to stretch, the risk of ruptures of the birth canal is higher. The older the woman, the more often chronic diseases that complicate the course of pregnancy are detected. However, no one will recommend a caesarean just because of age. The indication for surgery will be the presence of concomitant complications of the current pregnancy.

... and from the side of the fetus

Contrary to popular belief, twins are not an indication for a caesarean section. If the babies are well positioned (both children lie with their heads down), then the expectant mother may well give birth on her own. But if the babies have a problematic location or there are risk factors in the current pregnancy (the age of the mother, a scar on the uterus, abnormalities in the life and development of children), then surgery will be the best option to give birth without problems. There are three more conditions that can cause a caesarean.

1. Large fruit. The predicted body weight of the baby is more than 4000 g, together with any pathology of pregnancy, will serve as a relative reason for a caesarean section.
2. Chronic FPI (fetoplacental insufficiency). Pathology of pregnancy, in which the blood supply between the placenta and the fetus is disturbed. As a result, the child does not receive sufficient nutrition necessary for its development. Approximately one fifth of pregnancies complicated by placental insufficiency end in the birth of a dead child. The causes of this disease can be obstetric diseases, infectious processes (most often chlamydia), concomitant kidney diseases. With severe decompensation, it is necessary to deliver the woman prematurely in order to give the child a chance to develop outside the uterus.
3. With breech presentation of the fetus. Breech presentation together with premature rupture of amniotic fluid, a large fetus, a narrowed pelvis of the first or second degree is the reason for childbirth by caesarean section.

So, in obstetrics, there are many problems when the advantages of a caesarean section are obvious: the operation helps to avoid injuries to the child and mother during childbirth, makes it possible to quickly remove the baby, stop bleeding and save the woman's life. If for some reason a woman in labor needs an operative delivery, then refusing it is dangerous for life and health.

Surgical delivery tactics

At the same time, it is important to know how a caesarean section takes place and for how long it is performed.
Depending on the urgency, two types of operation are distinguished.

1. Planned caesarean section. If the indications are known even during pregnancy or even before it, a specific date is selected and an operation is scheduled. It is not always possible to say exactly at what time a caesarean section is performed. Usually, doctors allow pregnancy to be carried to the optimal time (39-40 weeks, ideally after the onset of labor on its own). But there are situations when it is impossible to wait: with gestosis, a thin scar on the uterus, fetoplacental insufficiency, the dates can be shifted four to six weeks ago, and sometimes, unfortunately, even earlier. Preparation includes a cleansing enema, food and water intake is prohibited 12 hours before the operation.
2. Emergency caesarean section. It is carried out in emergency situations that have arisen in the process of childbirth. Emergency intervention does not leave time for the preparation of the woman in labor. There is also less choice of anesthesia and incision type.

Choice of anesthesia

The operation is attended by a team of doctors (two obstetrician-gynecologists and an anesthesiologist) and an operating nurse. Choice of anesthesia for caesarean section
depends on the urgency of the operation. An emergency caesarean is often performed under general anesthesia. The desire of the woman in labor is taken into account during the planned operation.

Until recently, endotracheal general anesthesia was predominantly used. With its convenience in relation to the woman in labor, especially in critical situations, it has a significant drawback - it acts depressingly on the respiratory and nervous systems of the fetus. Therefore, no more than ten minutes should pass from the administration of anesthesia to the extraction of the fetus.

In the conditions of modern medicine, a safer type of anesthesia is increasingly being used - regional anesthesia. It includes spinal and epidural anesthesia for caesarean section. An “injection” in the back makes it possible to anesthetize a woman, while she remains conscious, sees the birth of a child, and can even breastfeed him immediately after extraction. For a child, the harm is negligible, since anesthetics act locally, and only a minimal amount enters the bloodstream. The only drawback of this type of anesthesia is the speed of the onset of the effect, therefore, in critical situations, general anesthesia still occupies a significant proportion.

Cutting method

The method of incision also depends on the reasons for the operation. For planned cesarean delivery, a transverse incision in the lower uterine segment is preferred, and absorbable suture material is increasingly used. In an emergency difficult situation, they can resort to a longitudinal incision, it gives good access to the uterus, but its disadvantage is a pronounced cosmetic defect.

In terms of time, a caesarean section lasts about an hour, this includes the removal of the child, revision of the uterine cavity, layer-by-layer suturing of tissues. After the operation, the woman is transferred to the intensive care unit, where she is observed for 12 hours-days with an uncomplicated postoperative period. Then the next three or four days before discharge, the newly-made mother spends in the ward together with the child.

Possible Complications

A caesarean section has a number of complications. With an emergency caesarean, they are observed two to five times more often than with a planned one. But even in this case, their frequency does not exceed 5% of all operative births.

In the postoperative period, one should be wary of bleeding due to slow contraction of the uterus, inflammatory complications are also common - endometritis, peritonitis, inflammation of the appendages. Possible thrombosis, embolism. Complications after anesthesia are considered separately.

Consequences of the operation

With a favorable course of the postoperative period, the woman is discharged from the maternity hospital on the fourth or fifth day. But the long-term consequences of a caesarean section can make themselves felt years later. One of them is adhesive disease. Adhesions can form after surgery in the pelvic cavity, the degree of their prevalence depends on the genetic tendency of the woman's tissues to scarring, as well as on the presence of inflammation in the postoperative period. In this case, a caesarean section is dangerous with the possibility of secondary infertility, and the risk of ectopic pregnancy also increases.

In addition, a scar remains on the uterus. His condition plays a huge role in the further reproductive plans of a woman. Childbirth through the natural birth canal is also possible with a scar, but it is very important to consider its viability. Ultrasound monitoring of subsequent pregnancy allows you to determine the optimal tactics for re-delivery of a woman with a history of caesarean section.

Complications and long rehabilitation are the main disadvantages of caesarean section. The task of the medical staff is to give the right recommendations, and the women in childbirth are to follow them relentlessly.

Recovery period

The early postoperative period includes a diet, antibiotic prophylaxis, and drugs are also prescribed for better uterine contraction. It is very important to get up and try to walk six hours after the operation - this is how the development of adhesive disease is prevented. It is equally important for recovery to start breastfeeding as soon as possible. In addition to the obvious benefits for the child, prevention of postpartum hemorrhage is achieved (in response to sucking, the hormone oxytocin is produced, which stimulates the contractile activity of the uterus).

After discharge, it is very important to establish regular bowel movements - with the help of a diet rich in fiber, you also need to remember to drink plenty of water, because the fluid loss of a nursing mother is enormous.

Intimacy with your beloved husband is possible no earlier than two months later, in the absence of contraindications. Sports activities - in six months. The pain in the incision area goes away for everyone individually, but in most cases, after a month, the discomfort ceases to bother the woman. An important rule: in the postoperative period, you can not lift more weight than your child's weight. Feel free to ask for help, because difficult recovery is one of the features of a caesarean section.

The main thing is not the way in which a new little man will be born, but the fact that he is born healthy, and the birth goes without complications. Do not be afraid to give birth by surgery, if there are indications for that. But remember: the question of which is better - caesarean or natural childbirth - can only be answered on the basis of a specific situation, and the price of a mistake is too high.

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The operation of caesarean section is a topic that does not leave indifferent any expectant mother. From its inception to the present day, surgical delivery has been a source of fear, confusion, and heated debate.

Recently, a large number of supporters of caesarean section have appeared. Many pregnant women seriously believe that the operation is just one of the options for childbirth that they can choose on their own, such as vertical birth or childbirth in water. Some even argue that a caesarean section is a more modern, easy and painless version of the birth of a child, it is supposedly easier and safer for mom and baby than a long and complicated process of natural childbirth. In fact, this is not true; operative delivery is a special type of obstetric care, indispensable in cases where natural childbirth is impossible for a number of reasons or even dangerous to the life of the mother or fetus. However, neither the less painful nor the safer way of giving birth "caesarean" can not be called. Like any other surgical intervention, operative delivery is associated with significant risks to the health of the mother, both during the operation itself and in the postoperative period. That is why a caesarean section is never performed simply "at the request" of the patient, without real medical indications.

Indications for caesarean section

Indications for operative delivery are divided into absolute and relative. Absolute indications include situations in which childbirth through the birth canal is in principle impossible or dangerous to the life of the mother and / or fetus. Here are the most common absolute indications for delivery by caesarean section:

Complete placenta previa- attachment of a child's place in the lower segment of the uterus, in which it completely covers the area of ​​\u200b\u200bthe internal os of the cervix. In this case, childbirth through the natural birth canal is impossible: the placenta simply closes the baby's exit from the uterus. In addition, at the very first contractions, accompanied by the opening of the cervix, the placenta will begin to exfoliate from the area of ​​\u200b\u200bthe internal pharynx; this can lead to the development of massive bleeding, which poses a real threat to the life of the mother and baby.

Transverse position of the fetus- such an arrangement of the baby, in which its progress through the birth canal becomes impossible. In the transverse position, the fetus is located in the uterus horizontally, perpendicular to the mother's spine. In this case, there is no presenting part of the fetus - the head or buttocks - which normally should put pressure on the cervix during contractions, helping it to open. As a result, during childbirth in the transverse position of the fetus, the cervix practically does not open, and the walls of the contracting uterus put pressure on the transverse spine of the baby, which is fraught with severe birth injuries.

narrow pelvis is an absolute indication for operative delivery if a third or fourth degree of a uniformly narrowed pelvis is detected (a decrease in all sizes by more than 3 cm) or an oblique pelvis - a narrowing of the internal dimensions with a mutual displacement of the bones that form the small pelvis due to injury or rickets. With such a degree of narrowing, childbirth through the birth canal is impossible, regardless of the size and location of the fetus.

large fruit is not always an absolute indication for operative childbirth: with normal pelvic sizes, even a large baby can be born naturally. Newborns with a weight of more than 3600 g are considered large. However, with a fetal weight of more than 4500 g, even a normal pelvis may be too narrow for the fetus, and childbirth in a natural way can be risky for health.

Multiple entanglement of the umbilical cord leads to a significant shortening of its length and deterioration of the blood supply to the fetus. In addition, numerous, more than three, loops of the umbilical cord interfere with the normal location of the fetus in the uterus and prevent the movements necessary for the normal biomechanism of childbirth. Biomechanism is the totality of the baby's own movements during birth, helping him to adapt to the size and shape of the mother's pelvis. If the fetus does not have the ability to make the necessary movements - for example, bend, unbend and turn the head, birth injuries are inevitable even with the normal size of the pelvis and the fetus itself.

Maternal illnesses accompanied by a violation of muscle tone and nervous regulation of the pelvic organs. There are few such diseases, and they are quite rare. Childbirth through the natural birth canal in this case is impossible, since with these pathologies productive labor activity does not develop. An example of such an absolute indication for "caesarean" are paralysis and paresis (partial paralysis) of the pelvic organs, as well as multiple sclerosis - a lesion of the nervous system, characterized by a violation of the transmission of nerve impulses to organs and muscles.

Complications of pregnancy and childbirth, which pose a real threat to the life of the mother and fetus, are the main absolute indications for emergency operative delivery.

Actually, the operation, called "caesarean section", was first carried out precisely for the purpose of saving lives. The "vital" indications include an acute violation of the cardiac activity of the mother and fetus, placental abruption, severe forms of late toxicosis (preeclampsia), impaired placental blood flow of the 3rd degree, the threat of uterine rupture or an old postoperative scar on the uterus.

Relative indications include situations in which operative delivery is preferable to natural childbirth:

• the woman's age is under 16 or, on the contrary, over 40;
• pathology of vision, cardiovascular and neuroendocrine systems;
• slight narrowing of the pelvis or an increase in fetal weight;
• breech presentation - the location of the baby in the uterus, in which the buttocks or legs are located below;
• complicated course of pregnancy - late toxicosis, impaired placental blood flow;
• the presence of general and gynecological chronic diseases.

To decide on the need for surgical intervention, one absolute or a combination of several relative indications is sufficient.

Operation or childbirth?

Why is a caesarean section done only according to indications? After all, the operation is much faster than natural childbirth, it is completely anesthetized and eliminates the risk of birth injuries for mother and baby. To answer this question, you need to learn more about the features of operative delivery.

1. Cesarean section is an abdominal operation; this means that doctors need to open the abdomen to remove the fetus. Of all types of surgical interventions, abdominal operations are associated with the greatest number of risks to the life and health of the patient. This is the risk of developing intra-abdominal bleeding, and the risk of infection of the abdominal organs, and the risk of divergence of postoperative sutures, rejection of the suture material, and many others. In the postoperative period, the puerperal experiences significant abdominal pain, requiring medical anesthesia. The recovery of the mother's body after surgical delivery takes longer than after natural delivery, and is associated with a significant limitation of physical activity. If we compare the traumatism of "natural" and "artificial" childbirth, then, of course, abrasions, a perineal incision and even ruptures of the birth canal are incomparable with the traumatism of abdominal surgery.

2. To extract the fetus, doctors have to dissect the anterior abdominal wall, the aponeurosis is a wide tendon plate that connects the abdominal muscles, the peritoneum is a thin translucent serous membrane that protects the internal organs of the abdominal cavity and the wall of the uterus. After extraction of the fetus, the uterus, peritoneum, aponeurosis, subcutaneous fat and skin are sutured. Modern suture material is hypoallergenic, aseptic, i.e. does not cause suppuration, and eventually completely resolves, however, the consequences of surgery still remain forever. First of all, these are scars - areas of connective tissue formed at the site of the seam; unlike true cells of an organ, connective tissue cells do not perform any specific functions necessary for the normal functioning of an organ. The tissue formed at the site of the suture is less durable than the organ's own tissue, therefore, subsequently, if stretched or injured, a rupture may occur at the site of the scar. The risk of rupture of the scar on the uterus is always preserved in all subsequent pregnancies and childbirth. Throughout pregnancy, in the presence of a postoperative scar on the uterus, a woman is under especially careful medical supervision. In addition, surgery limits the ability to have more than three children: during each subsequent operation, the tissue of the old scar is excised, which reduces the area of ​​​​the anterior wall of the uterus and creates an even higher risk of rupture in the next pregnancy. Another unpleasant consequence of any surgical intervention in the abdominal cavity is the formation of adhesions; These are connective tissue strands between the organs and walls of the abdominal cavity. Adhesions can disrupt the patency of the fallopian tubes and intestines, causing secondary infertility and serious digestive problems.

3. The main disadvantage of operative delivery for a baby is that during a caesarean section, the fetus does not pass through the birth canal and does not experience a pressure difference to the extent that it needs to “start” autonomous life processes. With various pathologies of the fetus and mother, this fact is the advantage of caesarean section and determines the choice of doctors in favor of the operation: pressure drops for a long time become an additional burden for the crumbs. When it comes to saving the lives of mothers and babies, surgical delivery is also preferable due to the temporary advantage: from the start of the operation to the extraction of the fetus, an average of no more than 7 minutes passes. However, for a healthy fetus, this difficult path through the birth canal, oddly enough, is preferable to a quick extraction from the surgical wound: the baby is genetically “programmed” for just such a birth scenario, and surgical extraction is additional stress for him.

In the process of moving through the birth canal, the fetus experiences increased pressure from the birth canal, which contributes to the removal of fetal - intrauterine - fluid from its lungs; this is necessary for uniform spreading of the lung tissue during the first breath and the beginning of a full pulmonary respiration. No less important is the difference in pressure that the baby experiences during natural childbirth, and for the start of independent work of his kidneys, digestive and nervous systems. Of great importance is the passage of the crumbs through the tight birth canal and for the full start of the work of the cardiovascular system: in many respects, the launch of the second circle of blood circulation and the closure of the oval window, the opening between the atria, functioning in the fetus during pregnancy, depend on this.

The caesarean section is an additional surgical intervention of the maximum volume for obstetrics and is associated with a significant risk to the health of the mother, it is never performed at the request of the patient. Caesarean section cannot be considered as an alternative delivery option; this is an additional intervention in the natural process, produced strictly for medical reasons. The final decision on the need for surgery can only be made by a doctor who observes the expectant mother during pregnancy and during childbirth.

Terms, duration and course of the operation

All pregnant women experience fear of childbirth. And even worse, if the birth will take place not in a natural way, but by caesarean section. But to make it not so scary, let's figure out why a caesarean section is done, how long the operation is usually performed, how long it takes and consider the entire course of the operation.

During pregnancy monitoring, the doctor makes a recommendation on how the birth should go. If a woman's pregnancy is proceeding normally, then most likely, childbirth will take place naturally. If there are any abnormalities during the course of pregnancy or during the birth itself, then doctors may decide to carry out the birth using a caesarean section.

Distinguish between emergency and planned caesarean section:

• given during pregnancy. In this case, the woman in labor prepares for the operation in advance, undergoes all the necessary examinations and, at a predetermined period of pregnancy, goes to the pathology department. The most common indications for a planned caesarean section are:
• premature detachment of the placenta;
• hemolytic disease of the fetus;
• multiple pregnancy;
• severe form of preeclampsia;
• absolutely narrow pelvis;
• transverse position of the fetus, etc.
• emergency caesarean section is carried out with unforeseen complications directly during childbirth that threaten the health of the mother or child. The health of both the child and the mother may depend on the timeliness of the decision to perform the operation. In such situations, the qualifications of the doctor and the determination of the woman in labor are very important (after all, the operation cannot be performed without her consent).

Optimal timing

A planned caesarean section is usually done at 40 weeks pregnant. This is the optimal time for the operation - with a sufficient mass, the fetus is already considered full-term, and the child's lungs are sufficiently developed so that he can breathe on his own.

With a second cesarean section, the timing of the operation is shifted down - it is done a couple of weeks earlier than the planned delivery date, usually this is the 38th week of pregnancy.

This approach avoids the onset of contractions, which reduces the risk of various complications during the operation. Remember that only a doctor can correctly determine how long to do a caesarean section in each case.

Preparing for the operation

A woman in labor scheduled for a planned caesarean is usually referred to the hospital about a week before the operation. If a woman wants to stay at home, then she can come to the hospital on the day when the operation will take place. But this is permissible only in the absence of severe complications and with good health of the mother and child.

Postoperative period

After the operation, painkillers are usually prescribed, as a woman experiences severe pain after a caesarean section. Also, depending on the condition of the woman, the doctor may prescribe various medications, such as antibiotics, or supplements that improve the functioning of the gastrointestinal tract.

You can get up after the operation no earlier than six hours later. It is also recommended to buy a postoperative bandage, which will greatly facilitate the condition when walking.

Nutrition after the operation should be special - on the first day after a cesarean section, you can drink only plain water.

On the second day, a woman can try soups, cereals and other liquid foods.

On the third day, with proper recovery, you can eat any food that is allowed during lactation.

If you are still scheduled for a planned caesarean section, then do not be afraid. Most often, the fear of a caesarean is due to a lack of awareness about the progress of the operation. Knowing what exactly she has to go through, it is much easier for a woman to psychologically prepare herself for the upcoming events.