Cesarean section. Caesarean section: from preparation for surgery to discharge from the hospital What you need to have a cesarean section

Caesarean section is one of the hottest topics among expectant mothers. There are pregnant women who are panicky afraid of this operation, while others, on the contrary, believe that Caesarean is easier and safer than spontaneous childbirth. There are also women who believe that a caesarean section can be done at will.

What are the myths about caesarean section? And where is the truth hiding?

Myth number 1. Caesarean section can be done at the request of a woman

This is a very common misconception and completely unfounded. The doctor performs a cesarean section only when independent childbirth is impossible or dangerous for the woman or fetus. Caesarean section is not performed if desired.

Indeed, during and after the operation, complications may arise. For example, there is a high risk of bleeding, infection, dehiscence, etc. After a cesarean, the stomach hurts and pulls in the area of ​​the seam, the body recovers longer than after independent childbirth.

The operation also affects the fetus not in the best way. Nature provides for independent childbirth, and a cesarean section for a baby is an additional stress. During the operation, the fetus does not pass through the birth canal and does not experience the pressure difference, which is so necessary for the full start of breathing, "switching on" the work of the digestive system, etc.

Myth number 2. Long before the cesarean section, you need to go to the hospital

If the doctors decided that a cesarean section is indicated for the expectant mother, then, of course, it is necessary to prepare for the operation. But long before the cherished date, there is no need to go to the hospital, as before. All tests and examinations that are needed can be done at the antenatal clinic. It is necessary to arrive at the hospital the day before the operation.

The pregnant woman should do general and biochemical blood tests, general, ultrasound, (CTG) and electrocardiogram (ECG). To ensure that the tests are not "overdue", you need to start taking them between 36 and 38 weeks of pregnancy.

Myth number 3. If a pregnant woman has myopia, then she will undergo a cesarean section

This is nothing more than a myth, since myopia itself is not an indication for a cesarean section. The operation is needed for completely other "vision problems": increased intraocular pressure and retinal pathology. Pregnant women should not push in such cases, as stress can lead to a decrease in vision or even loss of it.

But if the problems with the retina are minor, and there were no worsening during pregnancy, then the ophthalmologist may even allow you to give birth on your own. True, it is still impossible to push fully. In order for a woman not to strain while the fetus is moving along the birth canal, they do it for her. After this injection, the entire lower body is anesthetized in the lumbar region, and the woman in labor does not feel any pushing.

Caesarean section operation is a topic that will not leave indifferent any expectant mother. From its inception to the present day, the surgical method of delivery has been a cause for fear, delusion and heated debate.

Recently, a large number of supporters of cesarean section have appeared. Many pregnant women seriously believe that surgery is just one of the options for childbirth that can be chosen at will, such as a vertical birth or a water birth. Some even argue that a cesarean section is a more modern, easy and painless option for giving birth to a child, it is supposedly easier and safer for mom and baby than the long and difficult process of natural childbirth. In fact, this is not the case; operative delivery is a special type of obstetric care, indispensable in cases where natural childbirth for a number of reasons is impossible or even dangerous to the life of the mother or fetus. However, neither the less painful nor the safer way of childbirth can be called "cesarean". 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 cesarean section is never carried out simply "at the request" of the patient, without real medical indications.

Indications for cesarean, list

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

Complete placenta previa- attachment of a child's place in the lower segment of the uterus, in which it completely overlaps the area of ​​the 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 ​​the internal pharynx; this can lead to the development of massive bleeding, which poses a real threat to the life of mom and baby.

Transverse position of the fetus- such an arrangement of the baby, in which its progress along 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 press 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 exert pressure on the transversely located 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 a small pelvis due to trauma or rickets. With this degree of narrowing, birth through the vaginal 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 weighing more than 3600 g are considered large. However, if the fetus weighs more than 4500 g, even a normal pelvis may be too narrow for the fetus, and natural childbirth 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, the numerous, more than three, loops of the umbilical cord interfere with the normal position of the fetus in the uterus and impede the movement necessary for the normal biomechanism of childbirth. A biomechanism is called the totality of the baby's own movements during birth, which help it adapt to the size and shape of the mother's pelvis. If the fetus is unable to perform the necessary movements - for example, bending, unbending and turning the head, birth trauma is inevitable even with the normal size of the pelvis and the fetus itself.

Diseases of the mother, accompanied by a violation of muscle tone and nervous regulation of the pelvic organs. Such diseases are few and far between. In this case, childbirth through the natural birth canal is impossible, since with these pathologies productive labor does not develop. An example of such an absolute indication for "cesarean" are paralysis and paresis (partial paralysis) of the pelvic organs, as well as multiple sclerosis - damage to the nervous system, characterized by impaired transmission of nerve impulses to organs and muscles.

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

Actually, the operation, called "cesarean section", was first performed with the aim of saving life. The "vital" indications include acute disturbance of the cardiac activity of the mother and the fetus, placental abruption, severe forms of late toxicosis (gestosis), impaired placental blood flow of the 3rd degree, the threat of rupture of the uterus 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 years old;
• 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 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.

Surgery or childbirth?

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

1. Caesarean section is an abdominal operation; this means that doctors need to open the abdomen to retrieve 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 suture material, and many others. In the postoperative period, the postoperative woman experiences significant abdominal pain, requiring medical pain relief. Recovery of the mother's body after an operative delivery takes longer than after a natural delivery, and is associated with a significant limitation of physical activity. If we compare the trauma of "natural" and "artificial" childbirth, then, of course, abrasions, 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, aponeurosis - a wide tendon plate connecting the abdominal muscles, the peritoneum - a thin translucent serous membrane that protects the internal organs of the abdominal cavity and the wall of the uterus. After removing the fetus, sutures are applied to the uterus, peritoneum, aponeurosis, subcutaneous fat and skin. Modern suture material is hypoallergenic, aseptic, i.e. does not cause suppuration, and over time it completely dissolves, 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 real organ cells, connective tissue cells do not perform any of the specific functions required for normal organ function. The tissue formed at the site of the suture is less durable than the organ's own tissue, therefore, subsequently, with stretching or injury at the site of the scar, a rupture may occur. The risk of rupture of the scar on the uterus always persists for all subsequent pregnancies and childbirth. Throughout pregnancy, in the presence of a postoperative scar on the uterus, a woman is under particularly careful medical supervision. In addition, surgery limits the ability to have more than three children: in the course of 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 cords between the organs and the walls of the abdominal cavity. Adhesions can interfere with 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 cesarean 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, it is this fact that is the advantage of a cesarean 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 life of the mother and baby, operative delivery is also preferable due to a temporary advantage: from the beginning of the operation to the extraction of the fetus, it takes no more than 7 minutes on average. However, for a healthy fetus, this difficult path through the birth canal, oddly enough, is preferable to a quick extraction from a surgical wound: the baby is genetically "programmed" with just such a scenario of birth, and prompt 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 elimination of fetal - intrauterine - fluid from its lungs; this is necessary for even expansion of the lung tissue during the first breath and the start of full pulmonary respiration. Equally important is the difference in pressure that a 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 cramped birth canal and for the full start 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 that functions in the fetus during pregnancy depend on this.

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 should not be considered an alternative delivery option; this is an additional intervention in the natural process, made strictly for medical reasons. The final decision on the need for surgery can only be made by a doctor who supervises the expectant mother during pregnancy and during childbirth.

Childbirth using a caesarean section is an actual way of having a baby today. Despite the fact that this practice has many disadvantages (for example, low adaptability of the newborn to the external environment, a difficult recovery period for the mother), in some cases it is irreplaceable. We are talking about situations when, without surgery, the mother and (or) her baby will inevitably die. We will talk about the indications for a cesarean section further.

Natural childbirth has always been and will be a priority: in the birth of a new life, according to the idea of ​​nature, only two should participate - a mother and a child. But the doctors did not hesitate to intervene in the sacred sacrament, and figured out how to help a woman if, for some physiological reason, she cannot give birth on her own. It is reliably known that the practice of dissecting the anterior abdominal wall for obstetrics began to be mastered in the distant past. It is known from the myths of Ancient Greece that Asclepius and Dionysus were born artificially when their mothers died during childbirth. Up to the 16th century. This method of delivery was called the Caesar operation, and the term familiar to us appeared only in 1598.

You can often hear that this operation is called royal families. Indeed, in translation from Latin "caesarea" is translated as "royal", and "sectio" means "cut". Today, the concept has been somewhat distorted: some believe that with the help of a surgical scalpel, women who imagine themselves as queens give birth - with complete anesthesia and without the slightest effort of their own. Despite the fact that the operation is resorted to mainly in the absence of the ability to give birth naturally, many women ask doctors whether it is possible to use cesarean without indications.

In some European countries, a woman independently decides how she will give birth. In Russia, doctors insist on the need to carry out a caesarean section solely according to indications, but there is no official law that would prohibit the "abuse" of the operative procedure in the absence of good reasons. Perhaps that is why some expectant mothers choose this method of delivery.

List of indications for caesarean section

The reasons for the operation are absolute and relative:

• they say about absolute readings if the life of a woman in labor and her child is at stake. In this case, doctors have no choice and only one way out - surgical intervention;
• we are talking about relative indications when a woman can give birth to a baby herself, but the risk of developing certain complications still exists. Then the doctors weigh the pros and cons, after which they make the final decision on the method of delivery.

Also, there are emergencies for fetal or maternal reasons, when doctors quickly change the course of natural childbirth to an operative one.

Absolute indications for caesarean section

There are many factors that can be identified as indications for a planned cesarean.

The pelvic bone is too narrow.

With this anatomical feature, the course of labor depends on how much the bone is narrowed. So, a degree exceeding the indicators 3 - 4 is dangerous with negative consequences for the woman in labor and the baby. A narrow pelvis is associated with such complications in childbirth:

• extinction of contractions;
• premature rupture of amniotic fluid;
• intrauterine infection of the fetus;
• development of endometritis and chorioamnionitis;
• oxygen starvation of the child in the womb.

As a result of pushing, a woman in labor with a narrow pelvis may experience:

• rupture of the uterus;
• trauma to the baby during childbirth;
• damage to the joints of the pelvis;
• the appearance of fistulas in the genitourinary and intestinal tract;
• severe bleeding after childbirth.

Overlapping with the placenta of the internal pharynx.

Usually, when the placenta is located in the uterus, in its back or front wall, no problems arise. When the baby seat is attached too low, it completely covers the internal pharynx and, accordingly, prevents the baby from coming out in a natural way. The same difficulties arise if there was an incomplete overlap, side or edge. In this case, during the contractions, bleeding may begin, the intensity of which doctors cannot predict.

Premature detachment of a normally located placenta.

If the placenta exfoliates prematurely, bleeding begins, which can take various forms. With closed bleeding, blood accumulates between the wall of the uterus and the placenta without visible signs, with open bleeding, blood is released from the genital tract. Mixed bleeding is a combination of open and closed forms. The problem that threatens the life of the mother and child is solved with the help of an emergency caesarean section.

Rupture of the uterus.

In this dangerous situation, the answer to the question of why caesarean is done becomes obvious. Without surgery, both the mother and the child will die. The reason for the rupture of the uterus can be a large fetus, the actions of an inexperienced obstetrician, an incorrect distribution of the force with which the expectant mother is pushing.

Incorrect suturing.

When, after any surgery, an incorrect scar remains on the uterus, a cesarean section is performed for obstetrics. The features of the scar will be learned during an ultrasound scan.

Two or more scars on the uterus.

Two or more operations on the uterus are a serious obstacle to the natural birth of a baby. With normal delivery, tears may appear at the site of postoperative scars. By the way, the number of operative deliveries is also limited. When asked how many times a cesarean can be done, doctors are unanimous - without a significant risk to a woman's health, two cesarean sections are performed in a lifetime. In isolated cases, if there are good reasons, a third operation can be performed.

Unsuccessful treatment of seizures.

With late toxicosis, in some cases, convulsions occur, which enter a woman into a coma. If the therapy of such a condition is unsuccessful, they resort to an emergency caesarean section within two hours, otherwise the woman in labor will die with the baby.

Severe illness during pregnancy.

We list in what cases a cesarean is done:

• heart disease;
• diseases of the nervous system in an exacerbated stage;
• diseases of the thyroid gland with a severe course;
• diseases associated with pressure disorders;
• diabetes;
• eye surgery or a greater degree of myopia.

Abnormalities in the development of the uterus and birth canal.

Due to the weak contractile activity of the uterus and obstruction of the birth canal, the child is deprived of the opportunity to move forward, therefore, needs outside help. This situation is most often due to the presence of tumors in the pelvic organs that block the birth canal.

Late pregnancy.

With age, the muscles of the vagina become less elastic, which with independent childbirth is fraught with serious internal tears. This is one of those cases when you can do a cesarean, even if all the health indicators of the woman in labor are normal.

Relative indications for caesarean section

• Narrow pelvis.

This reason for carrying out a cesarean is found during natural childbirth, when the doctor sees that the circumference of the fetal head does not correspond to the size of the pelvic entrance. This happens if the baby is very large or the labor is too weak.

• Divergence of the pelvic bones.

Every expectant mother faces this phenomenon. Divergence of the pelvic bones is expressed by pain in the pubic region, edema, change in gait, and clicking sounds while walking. But if the pelvic bones do not disperse enough, and in addition to this, the woman has a physiologically narrow pelvis and a large fetus, a cesarean section is inevitable.

• Weak labor activity.

When the labor force of a woman in labor is small, the fetal bladder is artificially pierced to stimulate the process. However, even if such a measure is not enough to activate natural delivery, a decision is made to perform a caesarean section. This is the only way out, otherwise the baby will suffocate or be seriously injured during childbirth.

• Postterm pregnancy.

The operation is indicated in case of unsuccessful stimulation of labor, weak contractions, if a pregnant woman has gynecological problems and diseases in the acute stage.

• Pregnancy after artificial insemination or prolonged infertility.

If a woman, after numerous unsuccessful attempts, manages to become pregnant and bear a child, she undergoes a full diagnosis of indications so that doctors can make a verdict on the method of delivery. If in the past the woman in labor has had abortions, cases of stillbirth or spontaneous abortion, she will have a cesarean section.

• Hypoxia or intrauterine growth retardation.

In this case, the expectant mother will also have an operation. The question of how long a planned cesarean is done for such indications depends on how long the child has not received enough oxygen and whether this problem has been solved with the help of drug treatment.

In addition, the woman in labor will certainly have an artificial delivery if at least one of the factors is present:

• pubic varicose veins;
• large fruit;
• immature cervix;
• multiple pregnancy.

Child-specific reasons for caesarean section

If the mother herself has no grounds for surgical intervention, but the fetus has them, delivery will be prompt. Indications can be:

• improper location of the baby. If the baby is located head down to the mother's pelvic bones, everything is in order. Any other position of the fetus is considered a deviation from the norm. This is especially dangerous for male infants: being in the wrong position and moving along the mother's not yet expanded birth canal, boys can transmit the testicles, which will lead to infertility. Will suffer from excessive pressure and the baby's head;
• hypoxia. With a diagnosed oxygen deficiency, an immediate operation is indicated, otherwise the contractions will only aggravate the baby's well-being, and he may suffocate;
• prolapse of the umbilical cord. With this pathology, the loops of the umbilical cord often clasp the baby so tightly that he dies from suffocation. Only an emergency caesarean section will correct the situation, but, unfortunately, it is not always possible to save the child;
• the life of the fetus after the death of the woman in labor. When the mother dies, the child's vital activity persists for some time, then the operation is done to save the baby.

Limitations to Caesarean Section

Physicians, of course, always try to save both lives, but in some cases, circumstances do not turn out the way they would like, so doctors are forced to save a woman or a child. There are several situations in which you have to make a difficult choice:

• severe prematurity;
• intrauterine fetal death;
• serious infection of the baby;
• chorioamnionitis in combination with a high fever during childbirth;
• prolonged labor (more than one day).

How is caesarean done?

The most optimal time to start the operation is to activate labor. In this case, the contractile activity of the uterus will facilitate the manipulation of specialists and help the baby to adapt to external irritating factors. For how long a planned cesarean section is performed depends mainly on the doctor's decision, but this does not happen earlier than 37 weeks of pregnancy. Ideally, the expectant mother is admitted to the hospital at 38 weeks of "interesting" position.

Almost all artificial delivery operations are accompanied by epidural anesthesia. In this case, the analgesic effect extends to the lower part of the body, so that the mother can attach the baby to the breast immediately after his birth. An emergency caesarean section is done under general anesthesia.

At the moment when the baby should be born, the doctor cuts the abdominal wall and uterus of the woman in labor to help him to be born. After removing the child, the incisions are sutured with a continuous suture and staples are placed on top for reliability. They are removed 6 - 7 days after the operation, before sending the happy parents home with the heir.

How is a cesarean section done? Video

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 the life of both the child and the mother. In such cases, an operative delivery is performed - a cesarean section operation.

Caesarean section can be planned and urgent... A planned cesarean 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 requiring urgent intervention (acute fetal hypoxia, placental abruption, etc.).

Indications for caesarean section are divided into absolute and relative... Absolute are those on the basis of which the doctor unconditionally prescribes an operation, and natural childbirth is out of the question. These indications include the following.

Absolute indications for caesarean section

Narrow pelvis of a woman in labor... Because of this anatomical feature, a woman simply cannot give birth on her own, as there will be problems with the passage of the child through the birth canal. This feature is revealed immediately upon registration, and the woman from the very beginning prepares and tunes in for an operative delivery.

Mechanical obstacle that prevent the fetus from passing naturally. This could be:

• defragmentation of the pelvic bones;
• ovarian tumors;
• placenta previa (the placenta is not where it should be, blocking the fetus's path to the cervix);
• isolated cases of uterine fibroids.

The likelihood of uterine rupture... This indication for childbirth through a cesarean section occurs if there are any stitches and scars on the uterus, for example, after previous cesarean section and abdominal operations.

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

Relative indications for caesarean section

Relative indications for a caesarean section suggest the possibility of natural childbirth, but at risk for 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 in labor is pushing);
• malfunctioning 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 stress on the mother's body during childbirth can cause various complications.

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

To the testimony, threatening the health of the child carry various genital infections in the mother, since the child can become infected by passing through the birth canal.

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

Views

By urgency, a cesarean section can be of the following types:

• planned;
• emergency.

According to the technique of execution, they are distinguished:

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

How is the operation of a cesarean section, what happens before and after it

How is a cesarean section

For how long do I have a planned cesarean section? The date of the operation is assigned on an individual basis and depends on the condition of the woman and the child. If there are no special indications, then a cesarean section is prescribed on 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, the expectant mother awaiting a planned cesarean section is placed in the maternity hospital in advance in order to conduct an examination - to determine that the baby is full-term and ready for birth, and to monitor the woman's condition. As a rule, a caesarean section is scheduled in the morning, and the last meal and drink is possible no later than 6 pm 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, they carry out hygienic procedures to prepare for a caesarean section: they do an enema, shave their pubis. Then 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), and the abdomen is treated with a disinfectant. Further, in the area of ​​the woman's chest, a small screen is installed so that she cannot see the course of the operation.

Anesthesia

There are 2 types of anesthesia available today: epidural and general anesthesia. Epidural anesthesia involves inserting 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, the woman experiences discomfort for only a few seconds when the 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 epidural anesthesia. First, a drug of the so-called preliminary anesthesia is injected intravenously, then a mixture of anesthetic gas and oxygen enters the trachea through a tube, and the last drug is injected to relax the muscles.

The course of the caesarean section

After the anesthesia has worked, 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 bosom to the navel; done with an emergency caesarean section, since it is faster to get the baby through it) and transverse (above the bosom).

Next, the surgeon spreads the muscles, makes an incision in the uterus and opens the fetal bladder. After the baby is removed, the placenta is removed. Then the doctor first sews up the uterus with threads, which 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, as well as in order to reduce blood loss.

The duration of a caesarean section usually takes from 20 to 40 minutes, while the child is removed into the light already 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 assigned pain relievers, 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 the 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 yourself, experience at least minimal physical activity, as this threatens with seam discrepancies.

It is highly advisable 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 replenish the loss of fluid. You will also need to empty your bladder on time. It is believed that a full bladder prevents the uterus from contracting.

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 mitigate the situation, it is advisable not to eat solid food for several days.

Also, this problem is solved by enemas, candles (usually candles with glycerin are 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

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

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

To renew sex life recommended not earlier than a month and a half 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 cesarean?

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

Pros and cons of caesarean section surgery

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

Pros of a cesarean section:

• during the operation, injuries to the genital organs, such as tears and incisions, are not possible;
• Delivery by caesarean section takes a maximum of 40 minutes, while vaginal delivery often requires a woman to endure contractions for several hours.

Cons of Caesarean section:

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

Consequences of a caesarean section

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

Consequences for mom:

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

Consequences for the child:

• psychological; there is an opinion that children born through surgery are less adaptable 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 about the mental retardation of children are far-fetched, and one should not worry about this. However, it cannot be denied that the child does not follow the path prepared for him by nature, and that helps to prepare for the new environment of existence;
• the possibility of a residual amniotic fluid in the lungs of a newborn;
• getting into the child's blood of drugs of anesthesia. Read more about the consequences of a cesarean section and watch the video in

Complications after a cesarean section

Complications after anesthesia. If you are about to have a caesarean section with an epidural, you need to remember the following point. After the operation, a catheter with an 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 is unable to move.

There are times when, when the woman is shifted to the couch, her legs twist, and since the operated woman does not feel anything, this fact can go unnoticed for a long time.

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

Be sure to ask the hospital staff to check if you have been properly laid on the couch. Remember that sometimes the pinch syndrome is fatal.

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

One of the most common complications is adhesions... The bowel loops or other abdominal organs grow together. Treatment depends on the individual characteristics of the woman: the matter may be limited to the usual physiotherapy or the need for surgical intervention.

Endometritis- an inflammatory process in the uterus. To prevent it, a course of antibiotics is prescribed immediately after the operation.

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

Complications can arise in the process healing stitches, up to their discrepancy.

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 being improved, and the number of complications is decreasing. However, the human factor cannot be excluded, 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 frustration.

Video, how is a cesarean section

I like!

In this article, we will consider what types of cesarean section exist, how the date of the operation is determined, when to go to the hospital, if you are planning a cesarean section.

In addition, we will analyze in detail the question of whether it is possible to perform a cesarean section at the request of a woman (without medical indications), and whether it is worth doing so.

Planned and emergency caesarean section

I will briefly list what is the difference between a planned and an emergency caesarean section.

• Planned and emergency caesarean sections are done for different medical reasons. Read more about the indications for planned cesarean in the article. About indications for emergency, - in the article.
• As a rule, both the woman in labor and the doctor know about the indications for a planned cesarean section long before childbirth, sometimes even before the start of pregnancy. Conversely, the indications for emergency surgery arise, as a rule, right in the process of childbirth or shortly before.
• At the moment this happens less and less, but sometimes it does happen. With planned and emergency caesarean, the type of incision may differ (later, the surgical suture). Read more about this in the article.

The type of anesthesia (anesthesia) may differ, more on this in the article.

You can read how the caesarean section operation proceeds in the article. .

When to go to the hospital for a caesarean section

Only your doctor, who fully knows your situation, indications for surgery, and so on, will answer you exactly this question. If we consider the general case, then they put in the hospital 1-2 weeks before the expected date of birth (PDD), so that the date of the operation will be tried to be appointed closer to this date. But this is a general option. And in each case it can be different. In any case, at least 2 weeks before the PDD (and if there are certain indications even earlier), the woman should be examined. The following directions are being investigated (this is the minimum, there may be more examinations depending on the indications):

• The general condition of the pregnant woman (pressure, blood tests, urine tests);
• If there is already a scar on the uterus, then the condition of the scar;
• Condition of the cervix, assessment of readiness for childbirth;

If the woman's condition and the course of pregnancy are good, then these studies can be done on an outpatient basis. After that, the date of the operation will be set. Then the woman can stay in the hospital until the operation, or maybe at home (if all is well according to analyzes, research, etc.).

For example, in my first birth, the doctor recommended me to lie down two days just before the date of the operation. And in the second birth, I myself asked to go to bed 2 weeks before the birth, even the doctor resisted that it was early, and there were no indications. And it seemed to me that so I was under supervision, and it was calmer. I went through all the tests and studies, even the date of the operation has not yet been appointed, they said "go for another week, we'll see." And it’s good that I went to bed earlier, because the water suddenly broke away, and I had to quickly do the operation.

In general, you can say so. 2 weeks before the PDD, you need to undergo all the necessary examinations (the main ones are listed above) in the maternity hospital. Further - according to the results and your condition. Either go home and come to the hospital before the operation, or stay in the hospital until the operation.

How is the date of surgery determined for a planned caesarean section?

There is a concept of PDD (estimated date of birth). This date is determined by the following parameters:

• by the date of the last menstruation,
• by the estimated date of conception;
• according to the results of the first ultrasound;
• according to the first recorded intrauterine fetal movements.

You can read more about how the estimated due date is determined in the article.

Given this date, and normal, doctors will try to carry out the operation as close to the intended one as possible. Most of the sources assure that doctors "will certainly take into account the wishes of the woman in childbirth regarding the date." Here we need to clarify. The doctors, of course, will take into account your wishes, but only after they have taken into account all the really important factors. The final date of the planned operation is set on the basis of preliminary research in the hospital. As a rule, these studies are carried out 1-2 weeks before the PDD. The parameters listed below are investigated (in the general case).

• The state of health of the mother, for what indications the cesarean section was planned. It depends on how close to the DA it will be possible to “approach”. In some cases, doctors can wait until the onset of labor (but not until the water leaves), and only then do the operation. In the case of multiple pregnancies, for example, their indications can be performed there, under certain indications, for a period of 36-37 weeks and even 32 weeks for monoamniotic twins. In HIV-infected women, a caesarean section is performed at 38 weeks prior to labor and discharge.
• If there is already a scar on the uterus, then the condition of the scar is examined.
• The state of the cervix, assessment of readiness for childbirth.
• Fetal condition (ultrasound, CTG, dopplerometry in the vessels of the mother, placenta and fetus).

According to these parameters, the doctor can appoint a date. From experience, we can say that as a choice for a woman, one or two days of difference are given. That is: Do you want Monday or Tuesday? There is no particularly wide choice in this situation.

Is it possible to do a cesarean at will

In recent years, cases have become more frequent when women ask to have them caesarean, without medical indications for surgery. The most common reasons for such requests are as follows:

• Fear of. This is the fear of the process itself, pain, and fear of the consequences (for example).
• The fear that changes will occur in the genitals (in the size of the vagina, labia, for example), and this will negatively affect sexual activity.
• The belief that natural childbirth is bad for the baby.

What can be said about this. Several points.

If you decide that you only need a cesarean section, and you absolutely do not want to give birth naturally, then you are guaranteed to find a doctor who will do it. Despite the fact that it is written everywhere that the decision on the need for an operation is made by doctors. There are many doctors, and there will certainly be a doctor who will perform the operation without indications for it, for the agreed amount. To urgently perform a cesarean, if all indications for natural childbirth, most likely will not work. But finding a doctor and agreeing on a planned operation will most likely work. I am writing all this to the point that no matter how many people write that “only doctors make a decision about a planned operation,” you will still achieve your goal if you really want to.

Another question is whether it is worth insisting on a caesarean section if it is not necessary. Our opinion is not worth it. Let me explain what we are based on (specifically, the authors of these materials have experience of both natural childbirth and childbirth by caesarean section).

1. Yes, natural childbirth is a painful thing, no one argues here. But, women who have experienced both caesarean and natural childbirth, say that in terms of pain it is quite comparable. Only in natural childbirth does it hurt during childbirth, and in Caesar childbirth it hurts after childbirth.

Mom's Store has for healing and tissue repair after cesarean section.

Note. Food and cosmetic products can only be returned if the packaging is intact.

In general, in our opinion, such a comparison is correct here. If we compare natural childbirth without complications, of average duration, without "surprises" and an average cesarean section, then according to most opinions (women who have experienced both), natural childbirth is better and easier. In most cases, the following are given as arguments:

• After a normal natural birth, it is much easier to recover.
• In the first days after childbirth, you need strength. You get used to a new role (especially when the child is the first). It's not easy for you anyway. So, these first days in general can be remembered as continuous pain (in comparison with the first days after a normally passed natural birth).
• After a natural birth, milk comes faster, and this greatly facilitates the first days. After a caesarean section, milk comes later, and for the first three to four days it may not be enough, and the baby may be very restless. The hungry child is crying, the mother is nervous, and it also hurts. What can be done in this situation, we will consider in detail in the article.

Prepare thoroughly for breastfeeding and spending a few days to a week in the hospital. Buy from Mom's Store:

• (according to the testimony of a doctor);
• and for comfortable feeding.

About whether your genitals will be "the same" after a natural birth. Now we will dwell on this briefly, and we will analyze this issue in more detail in a separate article. We can say that with normally passed natural childbirth, your genitals have every chance to recover by 80-95% (in relation to their previous size).

In general, we can say the following. If you have all the indications for natural childbirth, then doing a cesarean "just like that" is not worth it.

In this connection, another question arises. It often happens that a woman gets so used to the idea that she will give birth naturally that she simply cannot accept the need for a cesarean (if it suddenly arises).

For example, one friend of mine even naturally ran away from the hospital when she was told that she would have to operate. Of course, she did not run far, she felt bad on the street, and in an ambulance they returned her to the same maternity hospital, and cured her. Everything worked out, and mom and baby are healthy. But, is the question of how exactly to give birth is worth taking such a risk? In my opinion - not worth it.

In addition, after giving birth with the help of a cesarean section, a woman (except for postoperative discomfort) is faced with the fact that she is being judged by her birth, no matter how ridiculous it may sound. It turns out something like this: she gave birth herself, - well done, a real woman and mother, and so on. And prokesarili, - well .. and so it happens .. well, the second time, let's do it myself .. well, it's not your fault, and so on. So, dear girls. I want to tell you that it is categorically impossible to let all this nonsense come to you. You are going to have a baby. And how exactly you give birth to him - it does not matter.

Your goal is to give birth without harm to your health, your own and your child. You are not going to give birth in order to get a "good grade for the process of childbirth." Therefore, whether you gave birth naturally or with the help of a cesarean, in any case, you are a real woman and a mother. And believe me, your baby's life is just beginning with childbirth. This is just a starting point. Both the child himself and you and the child still have so much ahead of them that the peculiarities of his birth do not really matter as much as they might be given immediately after childbirth. In general, we would advise you not to tune in categorically to the fact that "in any case, I will give birth myself." Anything can happen. The installation is much more correct: I will give birth to a healthy child and everything will be fine with us.

When shopping in we guarantee a pleasant and fast service .