The cesarean section. Cesarean section: from preparation for surgery before discharge from the hospital

Nowadays, the cesarean section is a common way of delivery. Modern doctors have impressive experience in carrying out this operation, and the maternity hospital and clinics are equipped with high-quality equipment. Births by caesarean section are lighter and faster than 10-20 years ago. But this does not mean that operational delivery is preferable to natural. In addition, the Caesarean operation has its pros and cons.

Up to 25% of children are born using cesarean sections. However, according to the World Health Organization, a share of 10-15% is considered optimal. Surgical labor should be carried out only as a last resort, if the mother for health conditions cannot give birth to a child naturally.

Cesarean section is a surgical operation, during which the child appears on the cut in the abdominal cavity of the mother. In recent years, the number of women who cannot give birth to naturally by health, by virtue of age or because of the wrong fetus, is growing. In such situations, traditional childbirth is considered risky, as they can cause irreparable damage to the health of the mother and the child. Therefore, doctors insist on conducting cesarean sections.

At first glance, the operational childbirth looks like a safe and easy way to born the child, as the woman does not have to pass through painful contractions and sweeps, and the baby is through the birth rod.

Compared to other extensive operations, Caesarean section is quite safe intervention. The operation passes quickly and predictably if it was planned. In addition, during surgery, the woman is under the influence of anesthesia, so it does not feel pain.

All this makes a cesarean section a rather attractive way out of the situation for many birthdayrs who are afraid of pain, waiting period and other unpleasant moments of natural genera.

But with a more detailed study, there can be a lot of serious shortcomings in operational childbirth, due to which it is desirable to limit the number of operations carried out to a minimum, leaving only situations where the birth is naturally unsafe or impossible.

Cesarean section increases the likelihood of problems with the anesthesia, the development of bleeding and infections. In addition, the woman is hospitalized for a longer period. Due to the long rehabilitation after surgery, the appointment of antibiotics and analgesics often suffers from lactation and the subsequent breastfeeding of the child. In addition, a young mother will not be able to immediately begin to care for the kid who need it so much.

Thus, the cesarean section has a lot of "for" and "against", which before carrying out the operation you need to carefully weighed.

How is the cesarean section?

In the process of operation, the doctor produces two surgical cuts - the abdominal wall and the uterus. Cuts can be both vertical and horizontal, at the discretion of the doctor. After that, the fetal bubble is revealed and a child is extracted. The doctor conducts manipulations with the umbilical cord and the last, removing it from the uterus.

The uterus is then sewn with a special absorbing suture material. Seams or brackets are also superimposed on the skin, which will be removed on the 7th day. The operating wound closes with a sterile bandage. In general, the operation lasts about 40 minutes, it can be planned and emergency.

A planned caesarean section is appointed by a woman during pregnancy, while the patient will know the date of hospitalization for childbirth. Indications for the planned caesarean section can be a woman, and much more.

With a planned operation, a woman is hospitalized before the estimated date of delivery, less often - in the occurrence of contractions. In the presence of testimony, hospitalization is carried out with 37 weeks of pregnancy, when there is a need to further examine the feminine and check the condition of the child.

During the planned caesarean section, epidural anesthesia is usually carried out, that is, a woman during the operation is in full consciousness and sees her baby immediately after extracting it from the uterine cavity. At the same time, the doctor carries out a transverse, so-called cosmetics.

The decision on an emergency operation is usually accepted by a doctor with the beginning of a generic activity if a real threat to the life of the mother and the child appeared. Emergency Caesarean section is carried out if the female has been noted, the fruit suffers from, it cannot go through the generic paths, the bleeding began and the premature extension of the placenta or the loops of the umbilical uterine from the uterus together with the infringement waters.

That is, the cesarean section is carried out in an emergency against the background of unexpectedly arising complications during natural genera. In this case, the anesthesia is usually given a common, and the incision is made vertically, thanks to which the newborn is extracted faster and is less suffering from hypoxia.

Arguments for"

1. Minimizing the probability of complications.If a woman in the past had an unsuccessful experience of natural childbirth, if her pregnancy occurred due to if she or her husband had been treated for a long time from infertility, the risk of complications in the process of childbirth is considered elevated. Operational childbirth make it possible to minimize the likelihood of complications from the mother and the child. The date of operation in this case is assigned in advance, the woman falls in the hospital, the additional pre-soda survey is held. Also complications may also arise from primary femininers, whose age exceeds 30 years if the weight of the fetus is more than 4 kg or it is incorrect.
2. A sufficient amount of oxygen at the birth of a child. If pregnancy proceeds with serious complications, the fruit may suffer from hypoxia for some time. In order not to exacerbate this condition and prevent the development of asphyxia in natural childbirth, doctors recommend to conduct a cesarean section.
3. The muscles of the pelvic bottom will remain in the same condition as before pregnancy. Stretching of vaginal muscles is a serious minus of natural genera, which in the future one way or another will reflect on women's health. Muscles stretch and weaken in all women who gave birth naturally. Some of them with the help of special workouts return to the former elasticity, but most of the stretched pelvic bottom muscles lead to urine incontinence and dissatisfaction with intimate life.
4. The date is known for the birth of a child.This information is relevant for women who give birth not for the first time. In this case, it appears the opportunity to discuss in advance the care of older children with grandmothers or nanny, solve other problems. Natural childbirth always begin suddenly.
5. Painlessness. Generic pain is what all women are afraid without exception. Natural childbirth is not without pain. During the cesarean section, a woman is anesthesia, which will save a woman from pain during the operation.

Arguments against"

1. Caesarean section is a weighty operation.Operational bodies are actually a real surgical intervention, which is dangerous by their risks for every person. As a result of the cesarean section, the woman's body is subject to real stress, especially if the operation is carried out against the background of general anesthesia. Like any other operation, a caesarean section can turn into such surgical complications as thrombosis, inflammatory processes in tissues, fistulas, spikes, an unattractive postoperative scar and much more.
2. Long postoperative period. After the operation, a woman needs a lot of strength to restore. While the pain in the seam area remains, a woman is difficult to pay due attention to the newborn, she needs help. If the woman is spent antibiotic therapy, then she cannot feed the child with breasts, which can negatively affect the formation of lactation.
3. Too fast birth.The transition of a child from one environment to another is taking too sharply. This causes discharges in the pressure or the so-called atmospheric blow that has a negative impact on the breath of the newborn, can cause microcharging in the brain.

Cesarean sections have their pros and cons, but at the same time the advantage towards minuses is more. If a woman wants to have more children in the future, care for them from the first days of birth and practicing breastfeeding - you need to report this to the doctor. In a similar situation, in the absence of absolute medical testimony, you can taste natural childbirth.

Caesarean section is a surgical procedure that allows you to remove the child through a cut on the stomach, and not through the vagina. Recently, about 30% of childbirth occur with cesarean section. In some cases, this is done according to plan due to complications of pregnancy or because the woman had already a cesarean section. Some women prefer Cesarean section in common childbirth. However, in many cases, the need for cesarean section becomes apparent only during labor.

Knowing what to expect, you can better prepare if the operation is necessary.

Cesarean section is a method of operational intervention that allows you to extract a child from the mother's womb. In this case, it is not born in a natural way, but throws his first look at the world through the incision, which is performed when opening the uterus. In Germany, every year from 20 to 30 percent of children appear on the light of cesarean sections.

Testimony for cesarean sections

Indications for cesarean sections can be absolute and relative. But for the most part, the decision on the operation flows immediately from many reasons, such as a combination of medical evaluations by the doctor and midwives, personal wishes from the feminine. Fortunately, pregnant women have enough time to think about and understand exactly how they would like to give birth. Emergency situations where cesarean cross-section becomes inevitable, rarely happen.

If you decide on a cesarean section, then you must confirm your consent to the operation in writing. But the doctor first will give you the most detailed explanations. During this conversation, it should be detailed to discuss all possible risks so that you really feel well prepared. Therefore, feel free to write if something is incomprehensible to you.

The medical testimony for cesarean section includes:

• transverse or pelvic preservation of the child;
• prelation of the placenta;
• non-compliance of the size of the maternal pelvis
• child sizes;
• severe mother's disease;
• the threat of hypoxia of the child;
• premature childbirth;
• pathology of child development.

Partial anesthesia with cesarean section

Currently, local anesthesia is a commonly adopted standard. The operation is carried out with the use of spinal anesthesia or with a planned caesarean section of epidural spinal anesthesia (see page 300). General anesthesia is recommended only in cases where other anesthesia is impossible for medical testimony.

When do caesarean section?

There are many reasons why caesarean cross-section. Sometimes it is associated with the health of the mother, sometimes with fears for the child. Sometimes the operation is done, even if both mother, and the child is fine. This is Cesarean, and the attitude towards him is ambiguous.

Births do not go fine. One of the main reasons why the cesarean cross section is done is that childbirth do not go fine - too slow or stop at all. The reasons for this are diverse. The uterus can be reduced not enough to fully open the neck.

The child has broken down the work of the heart. In most cases, the heart rhythm of the child allows you to expect a prosperous outcome of childbirth. But sometimes it becomes obvious that the child lacks oxygen. If there are such problems, the doctor can recommend Cesarean.

Disturbances in the work of the heart may occur if the child does not receive enough oxygen, the cord is shifted or the placenta is poorly functioning. Sometimes heart rate disorders occur, but nothing indicates a real danger to the child. In other cases, serious danger is obvious. One of the most difficult solutions for doctors is a decision on how great this danger is. The doctor can try different methods, for example, head massage, and see if the work of the heart will improve.

The decision on the need for cesarean depends on many moments, for example, on how long the generations will continue or how large the likelihood of other complications, besides the impairment of the heart.

Unsuccessful child's position. If the child is included in the generic canal with legs or buttocks ahead, this is called a berium preview. Most of these children are born with the help of cesarean section, since with ordinary births the likelihood of complications is great. Sometimes a doctor manages to translate the child to the correct position, pushing it through the belly before the start of childbirth, thereby avoiding the operation. If the child is horizontally, it is called cross-preview and is also an indication for cesarean sections.

The head of the child is unfortunate. Ideally, the chin of the child should be pressed to the chest, so that there is a part of the head, having the smallest diameter. If the chin is raised or the head is rotated so that the smallest diameter is not ahead, the larger diameter of the head must go through your pelvis. In some women in this case, no problems arise, but others may have difficulties.

Before making Cesarean, the doctor may ask you to get up on all fours - in this position the uterus goes forward, and the child can turn. Sometimes a doctor can pop to turn the head with a vaginal inspection or using forceps.

You have serious health problems. Caesarean section can be done if you have diabetes, sore heart, lightweight or high blood pressure. With such diseases, there may be a situation where it is preferable to give birth to a child at an earlier stage of pregnancy. If you cannot stimulate childbirth, it may be necessary to make a caesarean section. If you have serious health problems, discuss prospects with your doctor in advance, long before the end of pregnancy.

Occasionally Caesarean section is done to prevent the child's infection with herpes infection. If the mother has herpes in the genitals, he can pass a born child and cause a serious illness. Cesarean section avoids such a complication.

You have multiple pregnancy. Approximately half of the twins is born using cesarean sections. Twin can be born in the usual way, depending on the weight, position and period of pregnancy. With triples and more another story. Most labor of Troen occur with the help of cesarean section.

Each multiple pregnancy is unique. If this is your case, discuss the perspectives of childbirth with your doctor and decide together, which is better for you. Remember that everything is changeable. Even if both children lie head forward, after birth, the first situation may change.

There are problems with the placenta. In two cases, Kesarean is needed: this is a detachment of placenta and the prelation of the placenta.

The placenta detachment occurs when the placenta is separated from the uterus wall before the birth. This may pose a threat to life and your child. If electronic monitoring shows that there is no immediate danger to a child, you are hospitalized and will be carefully observed. If the child is in danger, urgent childbirth is needed and the cesarean section will be used.

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

There are problems with umbilical cord. When the water moved away, the loop of the umbilical cord can slip out of the cervix even before the child's birth. This is called the fallout of the umbilical cord and represents a greater danger to the child. When the child is squeezed through the cervix, the pressure on the umbilodin can overlap the flow of oxygen. If the umbilical umbilies will slip down when the neck is completely disclosed and the birth has already gone, you can give birth in the usual way. Otherwise, only caesarean section can save position.

Also, if the Pupovina turned around the neck of the child or was between the head and pelvic bones, if the water came out, each contraction of the uterus will squeeze the umbilical cord, slowing down the bloodstream and reducing the intake of oxygen to the child. In these cases, the cesarean section is the optimal option, especially if the uteros is squeezed for a long time or very much. This is a frequent cause of violations in the heart of the heart, but it is usually impossible to know for sure how the Pupovina is located before the start of childbirth.

The child is very big. Sometimes the child is too large to be successfully born in the usual way. The size of the child can become a problem if you have an abnormally narrow pelvis, through which the head cannot pass. Occasionally this can be the consequence of a pelvic fracture or its other deformations.

If you have developed diabetes during pregnancy, the child can gain a very large weight. If the child is too large, the cesarean section is preferable.

Health problems in a child. If the child still in the maternal womb is diagnosed with such a defect as the cleft of the spine, the doctor may recommend to make Cesarean. Discuss the situation in detail with your doctor.

You have already done Cesarean. If you have already done a cesarean cross section before, maybe you have to do it again. But this is optional. Sometimes, after cesarean section, ordinary childbirth is possible.

How is the cesarean section

Before the planned caesarean section, a gynecologist or anesthesiologist will advise you in advance about the operations and methods of anesthesia. If you are unclear something, check and ask! On the appointed day you must come to the hospital in advance. It is best to refrain from food: within six hours before the start of the operation you can not eat.

First of all, the doctor and midwife with ultrasound and KTG will check the condition of your child. Take advantage of this opportunity to set out your wishes and ideas about the upcoming births. Then the preparation for the operation will begin: the hair will roll in the cut zone, compression stockings will be put on and will make spinal anesthesia. Later, already in the operating room, the surface of the abdomen is disinfected and the catheter will be introduced into the bladder. Before starting operation, all your body, with the exception of the abdomen, will cover sterile napkins. So that you yourself cannot see what is happening and to prevent infection, nurses stretch the sheet at the top of the abdomen. Although you will be visible head of the members of the operating brigade, you will not be able to understand what they are doing with their hands. After ^ anesthesia will begin to act in full force, the doctor will make the first incision.

From cosmetic considerations, as well as for better wound healing, the dissection of the skin is made directly over the symphysome (pubic joint) along the vertical line, the cut length is 10 cm. Subcutaneous adipose tissue is divided in the middle. Abdominal muscles is very elastic and strong connective tissue shell (fascia), which the surgeon opens the scalpel in the center. Then he pulls the abdominal wall with his hand up and takes the abdominal muscle. To open the peritoneum, the doctor only uses his fingers. At the same time, he must make sure that it does not injure nor the intestines or the bladder. Finally, the doctor produces a scalpel of the transverse section in the lower segment of the uterus. Now it remains only to get a child from the uterus, and you can say hello to your baby. After separation and removal of the placenta, the operating brigade sews the wound. And at this time, your partner already accompanies the child to the first inspection. In total, the operation lasts from 20 to 30 minutes.

Mety Mission Ladakh

The so-called "soft" surgical technique described in the previous pages, developed in the Israeli Hospital, Movie Ladakh, is applied today, with minor deviations, in all maternity clinics.

Casarean Risks

Cesarean section is a serious operation. Although it is considered quite safe, as with any operation, there are certain risks. It is important to remember that caesarean section is often done to avoid dangerous for the life of complications. However, after surgery, certain complications may also occur.

Risks for you. The birth of a child is always a risk. With a cesarean section, it is higher than with ordinary childbirth.

• Enhanced bleeding. On average, the loss of blood at the cesarean section is twice as much as with ordinary births. However, blood transfusion is rarely required.
• Reactions are neither anesthesia. Medicines used in operation, including painkillers, can sometimes cause unforeseen effects, including breathing problems. In rare cases, the overall anesthesia can cause inflammation of the lungs if the woman is inhaling the contents of the stomach. But with cesarean section, general anesthesia is rarely used, and measures are taken to avoid such complications.
• Damage to the bladder or intestines. Such surgical injuries are rare, but they happen in cesarean sections.
• Endometritis. This complication that causes inflammation and infection of the membrane, lining the uterus, is most often after the cesarean section. This happens when bacteria usually dwelling into the vagina fall into the uterus. Urinary tract infection.
• The slowdown in the intestinal activity. In some cases, the anesthetics used in operation can slow down the intestinal activity, which causes the bloating and discomfort.
• Frames in the legs, lungs and pelvis organs. The risk of blood cloth in veins is 3-5 times higher after the cesarean section than after ordinary genera. If you do not accept measures, the thrombus, which formed in the leg, can walk to the heart or lungs, disrupt blood circulation, which will cause chest pain, shortness of breath and even can lead to death. Troms may also form in the pelvis veins.
• Wound infection. The possibility of such an infection after cesarean section is higher if you are abusing alcohol, you have a 2-type diabetes or overweight.
• Split seams. If the wound is infected or heals badly, there is a risk of rupture superimposed seams.
• Assembly placenta and removal of the uterus. The precipitated placenta is attached too deep and too firmly to the wall of the uterus. If you have already done a cesarean section, with the next pregnancy, the probability of the placenta increases significantly. Increased placenta - the most common reason for removing the uterus during cesarean section.
• Repeated hospitalization. Compared to women who have given birth naturally, women who made a cesarean section, two times more often in the hospital again during the first two months after childbirth.
• Fatal outcome. Although the probability of death after the cesarean section is very small - about two cases per 100 ooo, it is almost twice as high than after natural genera.

Risk for a child. Cesarean section is potentially dangerous for a child.

• Premature childbirth. If Kesarean is done according to your choice, the child's age should be defined correctly. Premature birth can lead to a disruption of respiratory and low weight at birth.
• Breathing problems. In children born with the help of a cesarean section, a slight respiratory disorder occurs - they breathe abnormally often during the first days after birth.
• Injury. Occasionally, the child may cause damage to the child.

What to expect with cesarean sections

Does you have a cesarean section or it is done as necessary, it will happen like this:

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

Distribution methods. Anesthesiologist can come to your chamber to discuss the possibilities of anesthesia. With a cesarean section, spinal, epidural anesthesia and general anesthesia are used. With spinal and epidural anesthesia, the body is deprived of sensitivity below the chest, but you remain in consciousness during the operation. At the same time, you practically do not feel pain, and the drug practically does not fall into the child. The difference between spinal and epidural anesthesia is small. When a spinal analgesic means is introduced into the liquid surrounding the spinal nerves. When the epidural means is introduced outside the space filled with liquid. Epidural anesthesia is carried out for 20 minutes and acts for a very long time. The spinal is done faster, but only works about two hours.

General anesthesia, in which you are in an unconscious state, can be used with an urgent caesarean section. A certain amount of drug can get to the child, but usually it does not cause problems. The majority of children do not affect the majority of children, since the mother's brain absorbs the medicine quickly and in large quantities. If you need, the child will give medicines that remove the consequences of common anesthesia.

Other cooking. When you, your doctor and anesthesiologist decided how to use the pain relief, the corresponding preparations will begin. Usually they include:

• Intravenous catheter. An intravenous needle will be installed on your hand. This will allow you to get the necessary fluids and medicines during and after surgery.
• Blood test. You will be taken blood and sent to the laboratory for analysis. This will allow the doctor to evaluate your condition before the operation.
• Antacid. You will be given an antacid to neutralize gastric acids. This simple measure significantly reduces the risk of damage to the lungs, if you break into the anesthesia and the contents of the stomach will fall into the lungs.
• Monitors. During operation, your pressure will be continuously monitored. You can also connect to a heart monitor by setting sensors on the chest to keep track of the work of the heart and the rhythm during the operation. The special monitor can be connected to the finger to control the oxygen level in the blood.
• Urinary catheter. In the bladder, the thin tube will be introduced to the urine flow, so that the bubble remains empty during the operation.

Operating. Most cesarean sections are made in operating, specially intended for this purpose. The atmosphere may differ from the one that was in the generic. Since operations are group work, people here will be much more. If you have or have serious medical problems, doctors of different specialties will be present.

Training. If you are making epidural or spinal anesthesia, you will be asked to sit down, rounding your back, or lie on the side, curled. Anesthesiologist protects the back with an antiseptic solution and will make an anesthetic injection. Then he introduces a needle between the vertebrae through a dense fabric, the surrounding spinal cord.

You can enter one dose of anesthetic through the needle, and then remove it. Or a thin catheter will be introduced through the needle, the needle is removed, and the catheter will stick with the plaster. This will allow as need to receive new doses of anesthetic.

If you need a common anesthesia, all preparations for the operation will be made before you get analgesic. An anesthesiologist will introduce an anesthetic through an intravenous catheter. Then put you on your back, fixing the legs. Under the back on the right can put a special substrate so that your body bent left. It shifts the weight of the uterus to the left, which ensures its good blood supply.

Hands pull and fix on special with pillows. Sanitary will score hair on the pubic if they can interfere with operations.

Sanitary protected stomach with antiseptic solution and stero sterile napkins. The napkin is placed under the chin to keep the operating field clean.

The cut of the abdominal wall. When everything is ready, the surgeon makes the first incision. It will be a cut of the abdominal wall, about 15 cm long, cutting skin, fat and muscles to get to the cavity cavity. Bleeding vessels will be touched or repulsed.

The cut location depends on several factors: is your cesarean section urgent and do you have other scars on your stomach. The size of the child and the location of the placenta are also taken into account.

The most common types of cuts:

• Low horizontal cut. It is also called a bikini incision and passes at the bottom of the abdomen on the imaginary bikini panties, is preferred. Heals well and after surgery causes less pain. It is also preferable for cosmetic reasons and allows the surgeon to see the lower part of the pregnant uterus. L Low vertical cut. Sometimes this type of cut is preferable. It provides quick access to the bottom of the uterus and allows you to extract the child rather. In some cases, time is the most important thing.
• Incision of the uterus. Having finished the incision of the abdominal wall, the surgeon moves the bladder and cuts the wall of the uterus. The incision of the uterus can be the same or other type that the cut of the abdominal wall. It is usually smaller in size. Just as in the case of a cut of the abdominal wall, the arrangement of the uterine cut depends on several factors, such as the urgency of the operation, the size of the child and the location of the child and the placenta inside the uterus. Low horizontal incision at the bottom of the uterus is the most common, used in most cesaric sections. It provides easy access, bleeding less than the higher cuts, it is less dangerous to damage the bladder. It forms a durable scar, which reduces the risk of rupture upon subsequent birth.
• In some cases, the vertical incision is preferable. Low vertical incision - at the bottom of the uterus, where the fabric is thinner, it can be done when a child is located forward with legs, buttocks or across the uterus (berium or -pric). It is also used if the surgeon believes that it will have to be extended to a high vertical section - sometimes it is called classic. The potential advantage of the classic cut is that it provides easier access to the uterus to extract the child. Sometimes a classic incision is used to avoid injury to the bladder or if a woman decided that this is her last pregnancy.

Birth. When the uterus is open, the next step is to open the fetal bubble so that the child can appear on the light. If you are conscious, you can feel some jerking and pressure when the child is pulled out. This is done to keep the minimum cut size. Pain you will not feel.

When the child was born and the umbilical cord is cut, he will give him a doctor who will check whether his nose and mouth are free from the liquid and is well breathing well. A few minutes later you will see your child for the first time.

After birth. When the child was born, the next step is the branch and removal of the placenta from the uterus, and then the closure of the cuts, layer behind the layer. Seams on internal organs and tissues will solve themselves and do not require removal. As for the cut on the skin, the surgeon can impose seams or use special metal clamps to connect the edges of the wound. During these actions, you can feel some movements, but not pain. If the incision is closed with the clips, they will be removed by special tweezers before discharge.

When you see a child. The entire cesarean section is usually ranked from 45 minutes to an hour. And the child will appear in the first 5-10 minutes. If you are conscious and you have a desire, you can hold a child until the surgeon sews cuts. Or you can see the child on your partner's hands. Before you give a child to you or a partner, doctors clear his spout and mouth and hold the first assessment on the apgar scale - this is a quick assessment of the spring, pulse, reflexes, activity and child breathing one minute after birth.

Postoperative Chamber. There they will be observed for you until the anesthesia and your condition stabilizes. Usually it takes 1-2 hours. During this time, you and your partner will be able to spend alone with a child for a few minutes and meet him.

If you decide to feed the baby with breasts, you can do it for the first time in the postoperative chamber, if you have such a desire. The sooner you begin to feed, the better. However, after a common anesthesia, you may not know yourself for several hours. You can wait until you finally come to yourself and get a painkiller before starting feeding.

After the operation of cesarean sections

A few hours later you will be transferred from the postoperative to the ward for your birth. Over the next 24 hours, doctors will control your state of health, the state of the seams, the amount of urine allocated and postpartum bleeding. Throughout your stay in the hospital, your condition will be under thorough control.

Recovery. Usually after the cesarean section in the hospital there are three days. Some women are discharged after two. It is important that in the hospital and at home you carefully cared for yourself to speed up recovery. Most women are usually restored after cesarean sections without any problems.

Pain. In the hospital you will receive an anesthetic. You may not like it, especially if you are going to breastfeed. But the painkillers are needed, after anesthesia passes, so that you feel comfortable. This is especially important in the first few days when it starts to heal the cut. If you still feel pain when you are written out, the doctor can register you an anesthetic so you can take it at home.

Food and drink.In the first hours after surgery, only pieces of ice or a sip of water can give. When your digestive system again starts working fine, you can drink more liquid or even eat a little easily digesory food. You will understand that you are ready to start to eat when you can produce gases. This is a sign that your digestive system has awakened and ready to get started. Usually every other day after the operation you can eat hard food.

Walking. Most likely you will be offered a little later after the operation, if not even night. It does not want this at all, but walking is useful and makes up an important part of your recovery. It will help to clean the lungs, improve blood circulation, will accelerate healing and lead your digestive and urinary system to normal. If you annoy the bloating, walking will bring relief. It also prevents the formation of thrombus, a possible postoperative complication.

After the first time you should make short walks at least twice a day until the date of statement.

Allocation from the vagina. After the child's birth, you will have Lochi - brownish or colorless allocations for several weeks. Some women after cesarean sections are surprised by the number of secretions. Even if the placenta is removed during the operation, the uterus must heal, and the selection is part of the process.

Healing the cut. The dressing is most likely removed every other day after the operation, when the incision has already been delayed. While you are in the hospital, the wound will follow. When the incision is healing, itching will appear. But do not cake him. Season use lotion.

If the incision was connected using clips, they will be removed before discharge. At home, take a shower or bath, as usual. Then dry the cut by a towel or hairdryer at low temperatures.

For several weeks, the scar will be sensitive and painful. Wear loose clothing that does not rub. If clothes are annoying the scar, cover it with a light bandage. Sometimes in the area of \u200b\u200bthe cut, twitching and tingling will be felt - this is normal. While the wound will heal, it will be hung.

Restrictions. Returning home after the cesarean section, it is important to limit its activity in the first week and take up first of all with its newborn.

• Do not lift gravity and do not do anything that strains has not yet heal the stomach. Keep the correct posture when you stand or go. Support your belly with sharp movements when coughing, sneeze or laugh. When feeding, put pillows or rolled towels.
• Take the necessary medicines. The doctor can recommend anesthetic. If you have a constipation or a bowel hurts, the doctor can advise the non-pressed stool softener or a light laxative.
• Specify from the doctor that you can and what can not. Exercise can be very tedious to you. Give yourself a time to recover. You had an operation. Many women when they start feeling better, difficult to adhere to the necessary restrictions
• While fast movements cause pain, do not get drunk. Some women are restored faster, but usually a period when you should not drive a car, it lasts about two weeks.
• No sex. Recompaning until the doctor is permitted - usually in a month and a half. However, proximity should not be avoided. Take time with your partner, at least a little in the morning or evening, when the child is already sleeping.
• When the doctor is allowed, start doing exercise. But do not dilute too. Hiking and swimming is the best choice. After 3-4 weeks after the statement, you will feel that you can lead the usual normal life.

Possible complications.

Immediately inform the doctor about these symptoms if they appear when you are already at home:

• Temperature above 38 ° C.
• Painful urination.
• Too many vaginal discharge.
• The edges of the wound diverge.
• The place of the cut blushed or mocking.
• Strong abdominal pain.

Emergency Caesarean section

Emergency Caesarean Section is made only in the event of a threat to the life of a mother or child.

The decision on an urgent operation or the secondary cesarean section is accepted only when there is really no other way out, as it is associated with a large risk for pregnant (intubation, bleeding, damage to neighboring organs, infection).

Indications for emergency operation:

• acute hypoxia child;
• complications, threatening Mother's life (uterus break, premature placenta separation).

With an unforeseen occurrence of one of these complications, it is necessary to act very quickly. In case of violation of the supply through the umbilical cord, the doctor has only a few minutes to prevent significant damage to the health of the child. Anniversal brigade must take all measures to make births in the next 20 minutes. Interruption of oxygen supply, which continues longer than 10 minutes, can lead to damage to the child's brain.

As soon as the doctor decides on an emergency cesarean section, the introduction into anesthesia and the operation is carried out without delays and without long preparation. Operational intervention can be carried out in the maternity ward, if there is enough space and there is a necessary instrument.

Women always hope that they will give birth, keeping the dignity, they will be able to endure pain, sometimes even smile when they are touched last time, giving a child life. Many are very trying to give birth to naturally by choosing doctors, in the practice of which there were little cesaric sections, go to courses for pregnant women, are engaged in sports during pregnancy, trying to gain only the necessary weight, sometimes even hiring a dream so that it is nearby in the maternity) chamber. However, cesaric sections are very much, more than ever.

How to cope with excitement

It doesn't matter how you tried if you had a normal pregnancy without complications, it could happen that you need an emergency caesarean section. You will be disappointed. Maybe you will feel a loser. However, it is very important to remain a far-sighted caesarean section is indeed a risk of, as well as ordinary operations, for example, during it can begin inner bleeding, thrombus appear, an infection or damage to internal organs occur. Some children have small breathing problems after cesarean sections. But due to the fact that surgical techniques and pain relief improved, Cesarean section accompanies a very small number of any dangers, and, of course, rhodium, a healthy child is much more important than trying to give birth naturally.

Causes of Emergency Caesarean section

Bowl of all the indication for emergency cesarean section is an unexpected misconception of a child (if it is located with legs or buttocks ahead) or lateral preview. Another reason is a heavy bleeding before childbirth and suspicion of premature detachment or placenta prediction. The most common cause of cesaric sections is the danger that the child may not transferring childbirth; If the child's cardiogram shows the possible deviations, the cesarean section will be safe and quickly give birth to a child.

Emergency Caesarean Procedure

It may happen that everything will happen quickly and chaotically. The lower part of the abdomen will prepare for the operation. The belly will wash, perhaps will score hair you will begin to introduce antibiotics and other fluids intravenously. Anesthesia will either epidural (with a dose adjusted for cesarean section), or a spinal, and maybe even common. If a woman does epidural or spinal anesthesia, she will not feel anything from the tips of the fingers to the chest; At the same time, it will be conscious, but does not feel like a doctor makes a cut. Most likely, she will not see it, because between her and the doctor will put a special fence, and maybe because the child will be born very quickly.

Cesarean Section of Woman

Some healthy women prefer a cesarean section in the first birth - usually to avoid pain and possible complications during childbirth. Sometimes the doctor proposes to make Cesarean, so that the child appears at the moment, more convenient for a woman, for a doctor or for both.

Such a caesarean cross section is not done because of health problems. The reason is the fear or the desire to avoid difficulties. And this is not the best base for cesarean section.

However, women are increasingly choosing a cesarean section, and it causes a number of questions.

Is there a limit?

Many women are safely made up to three operations. However, each next cesarean is more difficult than the previous one. For some women, the risk of complications - such as infection or severe bleeding - with each caesarean section increases only slightly. If you had long and heavy bodies before the first caesarean, the re-caesarean section will be physically easier, but the healing process will take at least time. For other women - who have formed large inner scars - every next Cesarean is becoming more and more risky.

Repeated caesarean make many women. But after the third it is necessary to weigh the possible risks and your desire to have more children.

Collision with unexpected

The unexpected news that you need Cesarean can become shock and for you, and for your partner. Your ideas about how you will give birth, suddenly change. What is even worse, this news can come when you are already exhausted by long clock fights. And the doctor no longer has time to explain and answer your questions.

Of course, you will have concerns about what you will have to and for your child during surgery, but do not allow these fears to fully master you. Most moms and children have safely transferring an operation with a minimum of complications. Although you may prefer to give birth to a natural way, remember that your health and child is more important than the way it is to appear on the light.

If you have concerns about the planned re-caesarean sections, discuss it with your doctor and with a partner. It will help you worry less. Tell me, that one day you have already passed through it - and you can repeat. This time you will be easier to recover after the operation, as you already know what to expect.

Cesarean section: Partner participation

If a cesarean section is not an urgent, requiring general anesthesia, your partner can come to operational with you. In some hospitals it is allowed. I like this idea, others may be afraid or experience disgust. In general, it is generally difficult to attend, especially when it makes a close person.

If the partner decides to attend, he will give him surgical clothing, it can observe the procedure or sit at the head of the head and keep your hand. Perhaps his presence will allow you to feel calmer. But there are difficulties: men sometimes faint, and doctors appear a second patient who needs immediate assistance.

In most baby maternity hospitals, physicians can even take pictures for you. But this is not allowed in many. Therefore, you should ask permissions on a photo or video.

Cesarean section

Some women who have a pregnancy goes fine, want to give birth with the help of cesarean section, although they have no complications or problems with the child. Some of them are conveniently accurately planning the delivery time. If you are accustomed to plan everything in your life up to a minute, waiting for the unknown day of the appearance of your child may seem impossible.

Other women prefer Cesarean section due to fear:

• Fear before the process of childbirth and accompanying him pain.
• Fear damage the pelvic bottom.
• Fear of sexual problems after childbirth.

If this is your first child, childbirth is something unknown, and it scares it. Perhaps you heard terrible stories about childbirth and women, after childbirth, suffering from urinary incontinence during coughing or laughter. If you have already been giving birth naturally and everything went not very smoothly, you can fear repetition.

If you tend to choose a cesarean section, discuss it frankly with your doctor. If the main motive is fear, a frank conversation about what to expect, and training at school preparation for childbirth can help. If you start talking about the horrors of childbirth, politely, but firmly tell me that listen about it after your child will appear.

If your previous natural gods really were such a terrible story, remember that all the births pass differently and this time everything can be quite different. Think why the childbirth was hard, and discuss it with a doctor or partner. Perhaps you need to do something that this time the experience was more positive.

If your doctor agrees with your choice, the final decision is yours. If the doctor does not agree and the cesarean cross sections will not be done, he can direct you to another specialist. Learn more about the advantages and disadvantages of both ways of childbirth and discuss them with specialists, but do not let fear be a decisive factor.

What should be considered?

Cesarean selection by choice - it is ambiguous. Those who are for, say that the woman is entitled to choose what way she wants to give birth to her child. Those who are opposed that the dangers of cesarean sections outweigh any of his positive parties. At the moment, there are no convincing evidence in medical literature that the choice of cesarean section is preferable. Good medical practice is generally rejecting procedures - especially surgical, non-giving undoubted benefits for the patient. In addition, research on this issue is a bit.

Since everything is ambiguous, you may find that the opinions of doctors differ greatly. Some are ready to do the operation. Others refuse, believing that the cesarean section can be dangerous and thus contradicts their oath to harm.

The best way to make a decision is to collect as much information as possible. Ask yourself what this option is attracted. Explore the question, consult with experts and carefully weigh everything for and against.

Benefit and risk

Many specialists believe that with the current level of development of surgical techniques, Caesarean section is not more dangerous than ordinary delivery, if this is your first child. If this is the third childbirth, the situation is different. Caesarean section is more fraught with complications than ordinary childbirth. Here is a list of what benefits and what hazards is this operation:

Benefit for mother. The positive consequences of Cesarean sections on the choice may include:

• Protection against urinary incontinence. Some women fear that the efforts required to push the child through labor pathways can lead to urinary incontinence or feces, damage the muscles and nerves of the pelvic bottom.
• Medical certificates have shown that in women after Cesarean section, the risk of urinary incontinence in the first months after the birth is lower. However, there is no evidence that such a risk is below 2-5 years after childbirth. Some women are also afraid that natural childbirth can cause loss of small pelvis organs when such organs as a bladder or uterus perform in the vagina. At the moment there are no clear medical certificates of cesarean coupling and reducing the risk of loss of pelvic authorities. But caesarean selection of choice is not a guarantee that problems with incontinence and falling will not arise at all. The weight of the child during pregnancy, pregnancy hormones and genetic factors can weaken the pelvic muscles. Such problems may even have women who have never had children.
• Guaranteed from urgent cesarean section. The urgent caesarean section, which is usually done in severe childbirth, is much more dangerous than the cesarean section of the choice or ordinary childbirth. With urgent caesarean, infection is more likely, damage to internal organs and bleeding.
• Guaranteed from heavy childbirth. Sometimes severe births require the use of forceps or vacuum suction. Usually these methods do not pose a danger. Just as with a cesarean section, the success of their application depends on the individual skill of the doctor producing the procedure.
• Less problems with the child. Theoretically planned caesarean section can reduce the risk of some problems in a child. For example, the death of a baby during childbirth, the pathology of childbirth because of the wrong position of the fetus, generic injuries - which is especially essential when the child is very large, - and inhalation of the Mekony, which is happening if the child began to be used before birth. The risk of paralysis is also reduced. However, it is important to remember that the risk of all these complications is quite low and under normal childbirth, and the cesarean section is not a guarantee that these problems will not arise.
• Less risk of transmission of infections. With a cesarean section, the danger of transmission from mother of such infections such as AIDS, hepatitis B and C, herpes and papilloma virus are reduced.
• Setting the exact date of delivery. If you know exactly when a child appears, you can better prepare. It is also convenient for planning the work of a medical brigade.

Risk for mother immediately after surgery

Caesarean cross sections are associated with certain inconvenience and dangers. We'll have to be in the hospital longer. On average, the stay in the hospital after Cesarean is three days, after ordinary births - two.

Increased likelihood of infection. Since this is a surgical operation, the risk of infection after cesarean is higher than after ordinary delivery.

Postoperative complications

Since Caesarean section is a bandwidth operation, certain risks are associated with it, such as infection, poor sewage, bleeding, damage to internal organs, the formation of thromboms. Also above the risk of complications after anesthesia.

Reducing the possibility of early establishing communication with the child and early breast feeding. At first after the operation, you will not be able to engage in a child and feed it with breasts. But it is temporary. You can establish a connection with the child and breastfeeding, as soon as recover after the operation.

Payment of insurance

Your insurance may not cover the cesarean section on the choice and it will cost more than ordinary delivery. Before deciding, check whether this operation is covered with your insurance.

Risks for the mother in the future

After the cesarean section, such trouble may be possible:

Future complications. With numerous pregnancies with each subsequent probability of complications increases. Repeated cesareans cross sections further increase this probability. Most women can safely do up to three operations. However, each subsequent will be more difficult than the previous one. In some women, the risk of such complications as infection or bleeding increases only slightly. In others, especially those who have large inner scars formed, the risk of complications with each subsequent cesarean section increases very significantly.

Tarve the uterus at the next pregnancy. Cesarean section increases the risk of uterus breaks for the next pregnancy, especially if you decide this time to give birth in the usual way. The probability is not very high, but it should be discussed with a doctor.

Problems with the placenta. In women who made a cesarean section, with subsequent pregnancies above the risk of violations associated with the placenta, for example, preview. When prepaying the placenta closes the cervical hole, which can lead to premature birth. The preview of the placenta and other disorders associated with it caused by the cesarean cross section strongly increase the risk of bleeding.

Increased risk of hysterectomy. Some problems with the placenta, for example, increment, when the placenta is attached to the wall of the uterus too deeply and firmly, may require the removal of the uterus (hysterectomy) during childbirth or shortly after.

Damage to the intestine and bladder. Serious damage to the intestines and bladder with cesarean sections are rare, but their probability is much higher than in ordinary births. Complications associated with the placenta can also lead to bladder damage.

Danger for the Poda

Dangers for a child associated with a cesarean section:

• Breath disorders. One of the frequent violations of the child after the cesarean section is a small disruption of breathing, called Tahipne (rapid superficial breathing). It happens when there is too much liquid in the lungs. When a child is in the uterus, its lungs are normal filled with liquid. With ordinary childbirth, the progress of the generic paths squeezes the chest and naturally pushes the liquid from the lungs of the child. With a cesarean section of such compression, it does not occur, and fluid may remain in the lungs of the child after birth. This leads to increased breathing and usually requires the supply of oxygen under pressure to remove the fluid from the lungs.
• Immaturity. Even a little immaturity can adversely affect the child. If the date of labor is established inaccurate and caesarean section is done too early, the child may have complications associated with prematurity.
• Cuts. With cesarean section, the child can get cuts. But it rarely happens.

Decision-making

If your doctor does not accept your cesarean sections, ask yourself why. Doctors and surgeons are obliged to avoid unnecessary medical interventions, especially if they can be dangerous. The lack of scientific data in support of the cesarean section on the choice makes this operation optional. Although, from the point of view of the doctor, the convenience of planning, efficiency and financial rewards speak in favor of Cesarean section, the doctor whom you trust should treat this operation at least restrained.

It is assumed that the name of the operation is associated with the name of the Roman emperor Gaya Julia Caesar, whose mother died during childbirth, and he was removed from her womb through operational intervention. There is information that the law has been adopted during Cesar, indicating that in the event of a woman's death in childbirth, an attempt to save the child should be taken by disseminating the abdominal wall and the uterus with the extraction of the fetus. For a long time, Cesarean section was carried out only when the mother died during childbirth. And only in the XVI century, there were reports of the first cases when the operation allowed not only to survive the child, but also the mother.

When is the operation?

In many cases, the cesarean section is carried out in absolute indications. These are states or diseases that represent the deadly danger to the life of the mother and the child, for example prelation of placenta - The situation when the placenta closes the output from the uterus. Most often, this state is found in recreational, especially after previously transferred abortions or postpartum diseases. In these cases, during childbirth or in the last periods of pregnancy, bright bleeding, which are not accompanied by pain and are most often observed at night. The location of the placenta in the uterus is clarified by an ultrasound study. Pregnant women with the prelationship of the placenta are observed and are treated only in an obstetric hospital.

Absolute testimony also includes:

Premature detachment of a normally located placenta.Normally, the placenta is separated from the wall of the uterus only after the birth of the child. If a placenta or a significant part is separated to the birth of a child, there are sharp abdominal pains that may be accompanied by strong bleeding and even the development of the state of the shock. At the same time, the supply of fetus with oxygen is sharply violated, it is necessary to emerge for measures to save the life of mom and baby.

Cross position of the Future. The child can be born through the natural generic paths, if it is in the longitudinal (parallel axis of the uterus) position with the head or pelvic end down to the entrance to the pelvis. The transverse position of the fetus is more common in repeated women due to the reduction of the tone of the uterus and the front abdominal wall, with multi-way, the prelation of the placenta. Usually, with the beginning of the generic activity, a spontaneous turn of the fetus is happening into the correct longitudinal position. If this does not occur and the outer methods cannot turn the fetus into the longitudinal position, and if water is disposed of, then the birth through natural generics are impossible.

Pup loop. This situation occurs during the influence of the amphibian waters with multi-ways in cases where the head is not inserted for a long pelvic insert (narrow pelvis, large fruit). With the current of water, the loop of the umbilical cord is slipped into the vagina and it can even be outside the sex gap, especially if the umbilical umbrellas. There is a compression of umbilical cord between the pelvis walls and the fetus head, which leads to a violation of blood circulation between the mother and the fruit. In order to diagnose such a complication in a timely manner, a vaginal study is made after expulsing the accumulating waters.

Gestosis. This is a serious complication of the second half of pregnancy, manifested by high arterial pressure, the appearance of a protein in the urine, edema, may be a headache, a violation of vision in the form of a flicker of "flies" before the eyes, pain in the upper parts of the abdomen and even convulsions, which requires immediate delivery, so As the condition of the mother, and the state of the fetus suffer from this complication.

However, most operations are carried out according to relative indications - such clinical situations in which the birth of the fetus through natural labor pathways is associated with a much greater risk for mother and fetus than during the operation of cesarean sections, as well as by a combination of testimony - the aggregate of several complications of pregnancy or childbirth, which individually may not have a significant value, but in general, create a threat to the state of the fetus in the vaginal delivery. As an example, you can bring pelvic preview fetal. Birth in pelvic prediction refer to pathological, because High risk of injury and oxygen starvation of the fetus during childbirth through natural generic paths. The probability of these complications is particularly increasing with the combination of the pelvic prelation of the fetus with its large sizes (more than 3,600 g), with a migration, excessive extension of the head in the fetus, with an anatomical narrowing of the pelvis.

Georid age more than 30 years. By itself, age is not an indication to Cesarean section, but in this age group, gynecological pathology is often found - chronic diseases of the genital organs, leading to long-term infertility, unbearably. Unchecheological diseases accumulate - hypertensive disease, diabetes, obesity, heart disease. Pregnancy and childbirth in such patients proceed with a large number of complications, with a big risk for a child and mother. Indications are expanding to cesarean section in women in a late reproductive age in the pelvic prelation of the fetus, chronic hypoxia of the fetus.

Scar in the uterus. It remains after removing myomatous nodes or stroke the uterus wall after perforation during an artificial abortion, after the previous operation of the cesarean section. Previously, this testification was absolute in nature, and now it takes into account only in cases of an infallible scar in the uterus, if there are two or more scars on the uterus after cesarean sections, reconstructive operations on the vita and in some other cases. To clarify the state of the scar in the uterus allows ultrasound diagnostics, the study is necessarily carried out from 36-37 weeks of pregnancy. At the present stage, the technique of performing an operation using high-quality suture facilitates the formation of a wealthy scar in the uterus and gives a chance for subsequent births through natural generic paths.

Allocate also indications for Cesarean section arising during pregnancy and in childbirth.

Understanding the implementation of caesarean section can be planned and emergency. Cesarean section during pregnancy is usually carried out in a planned manner, less often - in emergency cases (bleeding during the preservation of the placenta or with a premature detachment of a normally located placenta and other situations).

The planned operation allows to prepare, resolve the issue of its implementation, anesthesia, and also carefully assess the state of the health of the woman, if necessary, carry out corrective therapy. In childbirth, the cesarean section is made according to emergency testimony.

Clinically narrow pelvis. This complication occurs in the process of childbirth, when the size of the fetus head exceeds the inner size of the mother's pelvis. The complication is manifested by the lack of progressive promotion of the fetus head along the generic channel with the complete disclosure of the cervix, despite the energetic generic activity. In this case, a threat to breaking the uterus, the acute hypoxia of the fetus (oxygen starvation) and even its death. Such a complication may occur both with an anatomically narrow pelvis, and with normal sizes of the pelvis, if the fruit is large, especially when the fetal head is improved. In advance to correctly estimate the size of the master's pelvis and the size of the fetus head allow additional methods of research: ultrasound diagnostics and x-rayoelvimetry (study of the radiograph of the bones of the pelvis), allowing to predict the outcome of birth. With significant degrees of the escalation of the pelvis, it is considered absolutely narrow and is an absolute indication to the operation of cesarean section, as well as in the presence of bone tumors, coarse deformations in a small basin representing an obstacle to the passage of the fetus. Diagnosed in childbirth during a vaginal study, the incorrect insertion of the head (frontal, facial) is also an absolute indication for cesarean section. In these cases, the fruit head is inserted into the pelvis the greatest size, significantly exceeding the size of the pelvis, and the childbirth cannot happen.

Acute hypoxia fruit (oxygen starvation). This state arises due to insufficient oxygen intake to the fetus through the placenta and umbilical vessels. Causes can be the most different-shaped: detachment of the placenta, deposition of umbilical cord, protracted labor, excessive generic activities, etc. Diagnose the threatening state of the fetus on a par with auscultation (listening) with the help of an obstetric stethoscope help modern diagnostic methods: cardiotokography apparatus), ultrasound examination with dopplerometry (study of blood motion along vessels of placenta, fetus, uterus), amnioscopy (the study of the octal water, carried out using a special optical device introduced into the cervical cervical channel with the whole fetal bubble). When identifying signs of threatening hypoxia of the fetus and the absence of the effect of treatment, an urgent surgery is carried out.

Weakness of generic activity. The complication is characterized by the fact that the frequency, intensity and duration of bouts are insufficient to complete the generations of the naturally, despite the use of corrective drug therapy. As a result, there is no progress in the disclosure of the cervix and promoting the prerequisite part of the fetus by the generic paths. Birth may take a protracted nature, the risk of infection with an increase in anhydrous interval and hypoxia of the fetus occurs.

Course of operation

The incision of the front abdominal wall is carried out, as a rule, in the transverse direction above the pubic. In this place, the layer of subcutaneous fatty fiber is less pronounced, wound healing is better with the minimum risk of the formation of postoperative hernia, patients after surgery are more active, earlier rise. The aesthetic side is also taken into account when a small, almost imperceptible scar in the pubic area remains. The longitudinal cut between the pubic and the navel is performed if there was already a longitudinal scar on the front abdominal wall after the previous operation, or with a massive blood loss, when the top of the abdomen is required, with an unclear amount of operation with possible extension of the cut up.

An opening of the uterus is made in its lower segment in the transverse direction, in the late periods of pregnancy, the experiencies (part of the uterus between the neck and body) is significantly increased in size, forming a lower segment of the uterus. Muscular layers and blood vessels here are located in a horizontal direction, the thickness of the wall of the lower segment is significantly less compared to the uterine body. Therefore, the opening of the uterus in the transverse direction in this place along the vessels and muscle beams occurs almost bloodlessly. It is extremely rare to resort to the longitudinal method of opening the uterus in its body in cases where access to the lower segment of the uterus is difficult, for example, due to the scars after past operations, or the need to remove it after the cesarean section arises. This access was practiced earlier, it is accompanied by increased bleeding due to the intersection of a large number of blood vessels and the formation of a less full-fledged scar, as well as a large number of postoperative complications.

The fruit is removed by the head or for the pelvic end (for a groin folding or behind the leg) in the pelvic position of the fetus, the umbilical cord intersects between the clamps, and the child is transmitted to the obstetric and neonatologist. After removing the child, the last is removed.

The incision in the uterus invested, while ensuring proper comparison of the edges of the wound with minimal use of suture material. For embeding, modern synthetic resinking threads are used, which are sterile, durable, do not cause allergic reactions. All this contributes to the optimal healing process and the formation of a wealthy scar on the uterus, which is extremely important for subsequent pregnancies and childbirth.

When the front abdominal wall embarcates, individual seams or surgical brackets are usually superimposed on the skin. Sometimes intradermal "cosmetic" seams with absorbable threads, in this case there are no external removable seams.

Complications of cesarean sections and their prevention

Cesarean section is a serious extensive operation and, like any surgical intervention, should be made only in the presence of testimony, but not at the request of a woman. Before the operation with a pregnant woman (feminine) discusses the volume of the planned operation, possible complications. Required written consent of the patient for operation is required. With vital states - for example, if a woman is unconscious, the operation is carried out according to life testimony or with the consent of relatives if they accompany it.

And although the cesarean section at the present stage is considered a reliable and safe operation, complications of the surgical plan are possible: the worsening of the vessels due to a pro-launched cut on the uterus and the related bleeding; The injury of the bladder and intestines (more often occurs during repeated entry due to the adhesive process), the injury of the fetus. There are complications associated with anesthesiological benefit. In the postoperative period, a risk of uterine bleeding is possible due to a violation of the contractile ability of the uterus caused by the operating injury and the action of narcotic drugs. Due to the change in the physicochemical properties of blood, the rise of its viscosity is the formation of blood clots and the blockage of them of various vessels.

Purulent-septic complications for caesarean section are more common than after vaginal delivery. The prevention of these complications begins during the operation by the introduction of highly efficient wide spectrum antibiotics immediately after the intersection of the umbilicals to reduce their negative impact on the child. In the future, if necessary, antibiotic therapy continues in the postoperative period by a short rate. Most often, the wound infection is found (suppuration and discrepancy between the penetration walls), endometritis (inflammation of the inner shell of the uterus), adhesitis (inflammation of the appendages), paramissal (inflammation of the incomasure fiber).

Before and after surgery

The procedure for preparing for the operation, as well as the postoperative period, a certain discomfort is promoted, some restrictions will require effort, work on themselves.

With a planned operation on the eve of the evening and 2 hours before the operation, a cleansing enema is made, which will be repeated once again on the 2nd day after the operation in order to activate the peristaltic (motor activity) of the intestine. Credit with excitement and fear helps the reception at night tranquilizers who will appoint a doctor. Immediately before the operation, the urinary catheter is installed, which will remain in the bladder during the day.

After an abdominal delivery, a woman is both a pupil, and a postoperative patient. During the first day, it will be in the ward of intensive therapy under the close observation of the anesthesiologist and the obstetrician-gynecologist. There may be unpleasant sensations during the exit of the general anesthesia: the sore throat, nausea, vomiting, -post of epidural anesthesia can be dizziness, headache, back pain. For 2-3 days after the operation, infusion therapy is carried out by intravenous injection of solutions in order to reimburse the bloodsture, which is 600-800 ml at operation, i.e. 2-3 times more than with vaginal childbirth. The operating wound will be a source of pain in the sutures and at the bottom of the abdomen, which will require the introduction of painkillers.

In order to prevent postoperative complications, the early stack is practiced after 10-12 hours, carrying out respiratory gymnastics and self-massage 6 hours after surgery. Compliance with diet must for the first 3 days. In the first day it is recommended to starve, you can drink mineral water without gases, tea without sugar with lemon in small portions. On the second day, the low-calorie diet is observed: meat broth, liquid porridge, kissel. It is possible to return to conventional power after the activation of intestinal peristalsis and an independent chair. We will have to come to terms with some limitations of the hygienic plan: the knee wash in parts is carried out from 2 days, it will be possible to fully take a shower after removing the seams on the 5-7th day and discharge from the maternity hospital (as a rule, on the 7-8 days after operation). The gradual restoration of muscular fabric in the scar area on the uterus occurs within 1-2 years after surgery.

Perhaps a woman will have to face some difficulties in breastfeeding, which are more often found after the planned cesarean section. Surgical stress, blood loss, later the attachment of the child to the chest due to the violation of adaptation or sleepiness of the newborn is the cause of late formation of lactation; In addition, young mom is difficult to find a pose for feeding.

If she is sitting, then the baby presses on the seam, however, you can cope with this problem using the position lying.

When the cesarean section, the process of launching adaptation mechanisms, ensuring the transition of a newborn to the off-bus existence, is violated by the cesarean operation. Breathing disorders in the newborn arise much more often with a planned caesarean section, produced before the start of labor activity than with vaginal childbirth and at the cesarean section in childbirth. Therefore, the planned caesarean section should be carried out as close as possible to the date of the estimated delivery.

After the cesarean section, the heart of the child operates, below the level of glucose and the level of hormones regulating the activity of the thyroid gland, in the first 1.5 hours body temperature is usually lower. Muscular tone and physiological reflexes are reduced, the muscle tone and physiological reflexes are reduced, the healing of the umbilical wounds is sluggish, the immune system is worse, but at present medicine has all the necessary resources in order to minimize the difficulties that the baby is experiencing. Usually, the indicators of the physical development of the newborn come back to the norm, and a month later, the baby does not differ from children born through the natural generic paths.

Cesarean section: choice of anesthesia

In modern obstetrics, the following types of anesthesia are used in the Caesarean section of the section: Regional (epidural, sollin-brain) and general (intravenous, mask and endotracheal anesthesia). The greatest popularity is regional anesthesia, because With her, a woman remains conscious during the operation, which provides early contact with the child in the first minutes of life. There is a good condition of the newborn, because It is less susceptible to the influence of medicines that depress its livelihood. With spinal cerebral anesthesia, an anesthetic drug is introduced through a thin tube-terminal directly into the spinal cord channel, and during epidural anesthesia it is introduced more superficially under a solid brain sheath, thus pain sensitivity and motor nerves that control the body of the bottom of the body are blocked (in Anesthesia anesthesia time Woman can not move legs). With general anesthesia, endotracheal anesthesia is used. The analgesic drug is administered intravenously, and as soon as the muscles relax, a tube is introduced into the trachea, artificial ventilation of the lungs is carried out. This kind of pain relief is more often used in emergency operations.

Birth is a process to which the woman's body is fully adapted. But sometimes, for one reason or another, natural labor may be dangerous to health or even the life and child, and the mother. In such cases, operational delivery is carried out - the cesarean operation.

Caesarean section can be planned and urgent. A planned caesarean section is appointed during pregnancy: according to the testimony or at the request of the future mother. The decision on an urgent Cesarean section is accepted if complications arise already during childbirth, or dangerous situations requiring urgent intervention (acute hypoxia of the fetus, detachment of the placenta, etc.).

Indications for Cesarean section are divided into absolute and relative. Absolute are considered to be on the basis of which the doctor unconditionally appoints the operation, but there can be no speech about natural childbirth. Such indications are the following.

Absolute testimony to Cesarean section

Narrow pelvis. Because of this anatomical feature, a woman simply will not be able to give birth independently, as there will be problems with the passage of the child by the generic paths. This feature is revealed immediately when registered, and the woman from the very beginning is prepared and configured on the operational delivery.

Mechanical obstaclenot allowing the fetus to go naturally. It can be:

• defragmentation of pelvic bones;
• ovarian tumors;
• the presence of the placenta (the placenta is not located where it should, overlapping the fruit, the way out of the cervix);
• separate cases of misa of the uterus.

The probability of uterine breaks. This indication for childbirth through the cesarean section takes place if there are any seams and scars on the uterus, for example, after preceding cesarean operations and extensive operations.

Premature placent detachment. Pathology is expressed in the fact that the placenta is even before the start of labor activity is separated from the uterus, depriving the child's child and oxygen access.

Relative readings for Cesarean section

Relative readings for Cesarean section suggest the possibility of natural childbirth, but with a risk for baby or mom. In such a situation, all individual factors are carefully weighed. Relative readings are counted:

• mother visual impairment (this is due to the high eye load when the woman gives birth to);
• failures in the work 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 intensive load on the mother's body during childbirth can cause various complications.

In addition, the testimony to the cesarean section serves Gestosis - Violation in the system of blood flow and vessels.

To indications threatening child health Take various sex infections from the mother, as the child can get infected by passing by the generic paths.

As for the urgent cesarean section, he is prescribed if the generic activity is very weak or stopped at all.

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For urgency, cesarean section may be the following types:

• planned;
• emergency.

The implementation technique differences:

• abdominal caesarean section - incision is performed through the front abdominal wall;
• vaginal cesarean section - incision through the front arch of the vagina.

How is the operation of caesarean section, which is happening before and after it

How is the cesarean section

What time does the planned caesarean section do? The date of the operation is appointed individually and depends on the state of the woman and the child. If there are no special testimony, then the cesarean section is prescribed to the next birthday day. It also happens that the operation is carried out with the start of bruses.

How to prepare for Cesarean section

Usually, the future mother, waiting for the planned caesarean section, is placed in the maternity hospital in order to conduct a survey - to determine what the child is donas and is ready for birth and follow the state of the woman. As a rule, the Caesarean section is assigned to the morning, and the last meal and drinking is possible no later than 18 hours on the eve of the evening. The stomach operated must be empty to avoid its contents in the respiratory tract. In the morning, on the day of operation, hygienic procedures are carried out to prepare for Caesarean section: makes the belly, shave the pubis. Next, the woman is disguised into the shirt, and it is discharged or taken to the operating room.

Directly before the operation is conducted anesthesia, the catheter is introduced into the bladder (it will be removed in a couple of hours after the operation), the stomach is treated with a disinfectant. Next, in the chest area, a small screen is installed in the breast so that she cannot see the course of operation.

Anesthesia

Today 2 types of anesthesia are available: epidural and general anesthesia. Epidural anesthesia implies the introduction of a thin tube through the needle into the place of the yield of nerve spinal cord roots. It sounds rather scary, but in fact a woman is experiencing an unpleasant feeling of just a few seconds when puncture is carried out. Next, it ceases to feel pain and tactile sensations at the bottom of the body.

General anesthesia. This kind of anesthesia is used for an emergency cesarean section, when there is no time to wait for the impact of epidural anesthesia. At first, the drug is intravenously introduced the drug of the so-called pre-anesthesia, then a mixture of anesthetous gas and oxygen flows through the tube in the trachea, and the latter is introduced, relaxing muscles.

Kesarean cross section

After anesthesia has affected, the operation begins. How do cesarean section do? First make a cut on the abdominal wall. When surgery, 2 types of cuts are possible: longitudinal (vertical from the pub to the navel; it is done with an emergency caesarean section, since it is rapidly to get a baby in it) and transverse (above Lone).

Next, the surgeon spreads the muscles, makes a cut on the uterus and open the fetal bubble. After removing the child, a placenta is extracted. The doctor then sews first the uterus with threads, which are resolved after a few months - after the fabrics will grow up, and then the abdominal wall. A sterile bandage is superimposed, ice is put on the stomach so that the uterus is intensively reduced, as well as in order to reduce blood loss.

The duration of the cesarean section is usually engaged in 20 to 40 minutes, while the child is removed on the light for 10 minutes, and even earlier.

Postoperative period

Another day after the operation of the cesarean section, a woman is in the ward of resuscitation or intensive therapy so that the doctors can observe her condition. Then the new Mom is translated into the usual ward. To reduce pain, it is assigned to it package preparations Preparations to reduce the uterus and normalization of the state of the gastrointestinal tract. Sometimes antibiotics are prescribed, but it is solved individually. Gradually, the doses of drugs are reduced, and they refuse them at all.

If the operation has passed without complications, stand first time A woman is allowed after at least 6 hours. First you need to sit on the couch, and after you stand a little. In no case cannot be strained, to experience at least minimal physical exertion, as it threatens the discrepancies of the seams.

Extremely preferably to purchase in advance postoperative bandageHis wearing will greatly facilitate movement and discomfort in the first days after the cesarean section, especially when you need to lie down or get out of bed.

Care, diet and chair

On the first day after the operation, it is recommended to drink only water without gas, and you will need to drink much to fill the loss of the fluid. You will also need to empty the bladder in time. It is believed that the full bubble prevents the reduction of the uterus.

On the second day, liquid food (porridge, broths, etc.) are allowed. If everything is in order, then from the third to after the operation, you can return to a normal diet recommended by nursing women, however, after giving birth, many moms complain about constipation, and in order to mitigate the situation, it is advisable not to use solid food for several days.

Also, this problem is solved by cushions, candles (usually used candles with glycerin; when putting such a candle, try to lie down for some time) and eating foods that have a relaxing effect (kefir, dried fruits, etc.).

After discharge from the hospital

First a month and a half after the cesarean section of the section You can not take a bath, swim in the pool and reservoirs, it will be possible to wash only in the shower.

Active physical exercise It is necessary to postpone at least two months. At this time, you need help relatives and husband. Although it is impossible to completely refuse physical activity. Ideally, the doctor after surgery should tell you about the exercises that will speed up the restoration of the body, at least you can ask about it yourself.

Renew sex life Recommended no earlier than a month and a half after the operation. Be sure to take care of contraception. Specialists I advise you to plan the following pregnancy only after 2 years, during this time the body will fully recover and will be able to ensure the full development of the future kid.

Are natural childbirth after Cesarean possible?

Contrary to popular belief, a woman can give birth to a child if the previous pregnancy ended with the operation of Cesarean sections. If the seams healed, no complications arose, the reproductive system was successfully restored and there are no indications to another cesarean section.

Pluses and cons of cesarean operations

Operational delivery is possible both by medical testimony, and at their own desire of a woman. However, the doctors usually oppose such a decision, dissuading the future motley from surgical intervention. If you also consider the possibility of carrying out the operation, provided that the normal labor is not contraindicated, we carefully glue all the positive and negative sides of the question.

Pluses of cesarean sections:

• during operation, injuries of genital organs are impossible, such as breaks and cuts;
• rhodeworgation by caesarean section takes a maximum of 40 minutes, while in natural childbirth a woman is often forced to tolerate contractions for several hours.

Cons Kesarean section:

• psychological aspect: Mommies complain that first time does not feel connections with the child, they have no feeling that they gave birth to him;
• restriction of physical activity and pain in the place of applying seams;
• scar. Read more about this in the article.

Consequences of the cesarean section

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

Implications for mom:

• pain in the seams, in the consequence of the scar on the stomach;
• restrictions of physical activity, the inability to take a bath and secure intimate relationships for several months;
• psychological condition.

Consequences for a child:

• psychological; It is believed that children who have emerged by the operation, are worse adapting to the world around. It is worth noting that the opinions of scientists disagree on this occasion, and the experience of MAM shows that in most cases the concerns on the backlog of children in mental development are inflated, and it should not be worried about this. However, it is impossible to deny the fact that the child does not pass the way disagreened by him, and helps prepare for a new existence environment;
• the possibility of the residue of the oily fluid in the lightborn lungs;
• hitting the blood of the child drugs anesthesia. Read more about the consequences of cesarean sections, read and watch the video in

Complications after cesarean sections

Complications after anesthesia. If you have to operate caesarean sections using epidural anesthesia, you need to remember the next moment. After the operation, the catheter with anesthetic for some time is left in the back, and it is introduced to the drugs to anesthesia. Therefore, after the operation is over, a woman may not feel both or one leg, and it does not have the opportunity to move.

There are cases when when shutting up a woman on a couch, the legs are tested, and since the operated ones does not feel, this fact can remain unnoticed for a long time.

What threatens it? Due to the finding limb in an unnatural situation develops long positional squeezing syndrome. In other words, soft fabrics for a long time are without blood supply. After neutralization of squeezing, shock develops, the strongest edema, impaired motor activity of the limb and, not always, but quite often, renal failure, all this is accompanied by the strongest pains that are continuing for several months.

Be sure to ask the hospital staff to check whether you were maintained to the couch. Remember that sometimes squeezing syndrome leads to a fatal outcome.

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

One of the most common complications is spikes. Intestinal loops or other abdominal organs grow together. Treatment depends on the individual characteristics of the woman: the case may confine themselves to conventional physiotics or to reach the need for surgery.

Endometritis - Inflammatory process in the uterus. To prevent it and prescribe the course of antibiotics immediately after the operation.

Bleeding Also relate to complications after the cesarean section operation and, in rare cases, lead to the need to remove the uterus.

Complications may occur in the process healing seams, Up to their discrepancy.

So, the Caesarean section is a guarantee of life for mom and child in cases where natural labor is impossible or dangerous. Every year this operation is improved, and the number of complications decreases. However, the human factor cannot be excluded, therefore, if you know the main features of the operation and postoperative care - this will help you to avoid complications and without any disturbances to enjoy the joys of motherhood.

Video, how is the cesarean section

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Around the world, there is a clear tendency to a careful delivery, which allows to preserve health and mother, and a child. A tool that helps this is to achieve is the operation of the cesarean section (COP). A significant achievement was the widespread use of modern anesthesia techniques.

The main disadvantage of this intervention is the increase in the frequency of postpartum infectious complications of 5-20 times. However, adequate antibacterial therapy significantly reduces the likelihood of their occurrence. Nevertheless, there are still disputes about what cases make a cesarean cross section, and when the physiological delivery is permissible.

When the operational delivery is shown

Cesarean section - a serious operational intervention, which increases the risk of complications compared to normal natural genus. It is carried out only on strict indications. At the request of the patient, the COP can be produced in a private clinic, but not all obstetrics-gynecologists will take over such an operation without necessity.

The operation is performed in the following situations:

1. The complete prelation of the placenta is a condition in which the placenta is located in the lower portion of the uterus and closes the inner zev, without letting the child be born. Incomplete preview is an indication for operation when bleeding. The placenta is abundantly equipped with vessels, and even a small damage is able to cause blood loss, a lack of oxygen and fetal death.

2. There was ahead of time from the uterine wall - a condition that threatens the life of a woman and a child. The placenta referred from the uterus is a source of blood loss for the mother. The fruit ceases to get oxygen and can perish.

3. previously transferred operational interventions in the uterus, namely:

• at least two cesarean sections;
• a combination of one COP operation and at least one of the relative readings;
• removal of intertensive or on a solid base;
• correction of the uterine structure.

4. The transverse and oblique position of the child in the uterine cavity, pelvic presence ("boo down") in combination with the expected weight of the fetus over 3.6 kg or with any relative indication for the operational delivery: the situation when the child is located at the inner darkening area , and the forehead (frontal) or face (facial presentation), and other features of the location that contribute to the child's injury.

Pregnancy may occur even during the first weeks of the postpartum period. The calendar method of contraception in the conditions of the irregular cycle is not applicable. Condoms are most often used, mini-saw (gestagne contraceptives that do not affect the child during feeding) or ordinary (in the absence of lactation). Use must be excluded.

One of the most popular methods is. Installation of the spiral after cesarean section can be performed in the first two days after it, but it increases the risk of infection, moreover, quite painfully. Most often, the spiral is set after about a month and a half, immediately after the start of menstruation or in any convenient day for a woman.

If a woman is over 35 years old and she has at least two children, at wishes during operation surgeon can perform surgical sterilization, simply putting the dining of the uterine pipes. This is an irreversible way, after which the conception almost never comes.

Subsequent pregnancy

Natural childbirth after cesarean section is allowed if the formed connecting tissue on the uterus is consistent, that is, strong, smooth, able to withstand muscle tension during childbirth. This question for the next pregnancy should be discussed with a observatory doctor.

The probability of subsequent genera rises in a normal way in the following cases:

• a woman gave birth to at least one child through natural paths;
• if the COP was carried out due to the wrong position of the fetus.

On the other hand, if the patient is at the time of subsequent births for more than 35 years, it has extra weight, concomitant diseases that are inappropriate to each other the size of the fetus and the pelvis is likely that it will again be performed.

How many times can Caesarean cross-section?

The number of such interventions is theoretically not limited, but it is recommended to make them no more than two times to preserve health.

Usually tactics when re-pregnancy as follows: The woman is regularly observed at the obstetrician-gynecologist, and at the end of the service life is made a choice - operation or natural childbirth. With ordinary childbirth, doctors are ready at any time to carry out an emergency operation.

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

After how much can you give birth after surgery?

It depends on the vastity of the scar, the age of women, concomitant diseases. Abortions after the COP adversely affect reproductive health. Therefore, if the woman still became pregnant almost immediately after the COP, then with the normal course of pregnancy and constant medical supervision, it can endure a child, but the delivery will be most likely operational.

The main danger of early pregnancy after the COP is the failure of the seam. It is manifested by increasing intense abdominal pain, 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, it is necessary to urgently cause "ambulance".

What is important to know with the second cesarean section?

Planned operation is usually carried out on a period of 37-39 weeks. The incision is made according to the old header, which somewhat extends the operation time and requires stronger anesthesia. Recovery after the COP can also occur slower, as the scar tissue and spikes in the abdominal cavity impede a good cutting of the uterus. However, with a positive man and her family, the help of relatives, these temporary difficulties are completely overcome.