Delivery - Cesarean section or natural delivery? Caesarean section: when indicated, types and technique, postoperative period By cesarean section.

Content

A cesarean section is an operation in which a viable baby and child's place is removed from a woman by an incision in the abdomen. At the moment, this operation is not new and is well widespread: every 7 woman enters childbirth by cesarean. Surgical intervention can be prescribed in a planned manner (according to indications during pregnancy) and in an emergency (in case of complications in natural childbirth).

What is a cesarean section

Caesarean birth is an obstetric operation that is an emergency. Every obstetrician-gynecologist should know the procedure. This is, first of all, salvation, in case of complicated pregnancy and childbirth, which helps to save the life of mother and child. In the process, it is not always possible to preserve the health of the child, especially with fetal hypoxia, infectious diseases, a deep degree of prematurity or post-term pregnancy. Caesarean is carried out only for serious indications - the decision is made by the surgeon of the maternity ward.

Even taking into account new technologies, high quality suture material, the procedure can cause complications, such as:

• bleeding;
• amniotic fluid embolism;
• development of peritonitis;
• pulmonary embolism;
• divergence of postoperative sutures.

Why is it called so

The word "Caesar" is a form of the Latin word "Caesar" (ie, lord). There are suggestions that the name refers to Gaius Julius Caesar. According to an old legend, the mother of the emperor died during childbirth. The doctors of that era had no choice but to cut the belly of a pregnant woman in order to save the child. The operation was successful, the baby was born healthy. Since then, according to legend, this operation has been nicknamed.

According to another theory, the name may be associated with a law (published during the time of Caesar) which read: at the death of a woman in labor, to save the child by dissecting the anterior abdominal wall and layers of the uterus, removing the fetus. For the first time, the operation to give birth to a baby, with a happy ending for the mother and the child, was performed by Jacob Nufer to his wife. He spent all his life performing operations - castration of boars. With a long and unsuccessful birth of his wife, he asked for permission to make her an incision with his own hand. Childbirth by cesarean was successful - the mother and child survived.

Indications

The main indications for the procedure are as follows:

• complete and incomplete placenta previa;
• premature, rapid placental abruption with intrauterine fetal distress;
• a failed scar on the uterus after a previous birth or other operations on the uterus;
• the presence of two or more scars after cesarean;
• anatomically narrow pelvis, tumor diseases or severe deformities of the pelvic bones;
• postoperative conditions on the pelvic bones and joints;
• malformations of female genital organs;
• the presence of tumors in the pelvic cavity or in the vagina that block the birth canal;
• the presence of uterine fibroids;
• the presence of severe preeclampsia, and the lack of effect of treatment;
• severe diseases of the heart and blood vessels, diseases of the central nervous system, myopia and other extragenital pathology;
• conditions after suturing fistulas of the genitourinary system;
• the presence of a third-degree perineal scar after a previous birth;
• varicose veins of the vagina;
• transverse arrangement of the fetus;
• multiple pregnancy;
• breech presentation of the fetus;
• large fruit (more than 4000 g);
• chronic hypoxia in the fetus;
• the age of primiparous over 30 years old, with diseases of the internal organs that can aggravate childbirth;
• prolonged infertility;
• hemolytic disease in the fetus;
• post-term pregnancy with an unprepared birth canal, lack of labor;
• cervical cancer;
• the presence of the herpes virus with exacerbation.

Indications for emergency caesarean section

In some cases, the operation is necessary on an emergency basis. The indications will be:

• severe bleeding;
• clinically narrow pelvis;
• amniotic fluid poured out prematurely, but there is no labor;
• abnormalities of labor that do not respond to the action of medications;
• placental abruption and bleeding;
• situation threatening rupture of the uterus;
• loss of umbilical cord loops;
• incorrect insertion of the fetal head;
• the sudden death of the woman in labor, and the fetus is alive.

Woman's choice

In some clinics and states, the practice of surgery is carried out at will. With the help of a cesarean woman in labor, she wants to avoid pain, increase the pelvic floor muscles in size, and avoid incisions in the vagina. Having avoided some unpleasant sensations, women in labor are faced with others, which in most cases need to be much more afraid of - a violation of the baby's nervous system, difficulty in lactation, discrepancy of postoperative sutures, the inability to give birth naturally in the future, etc. Before planning the operation yourself, weigh everything pros and cons.

Caesarean section: pros and cons

Many women in labor see the obvious benefits of having surgery, but do not weigh the pros and cons of caesarean section. From the pros:

1. removing the baby without pain and in a short period;
2. confidence in the health of the fetus;
3. no damage to the genitals;
4. you can choose the date of birth of the baby.

Mommies do not even know about the disadvantages of such a procedure:

1. pain after surgery is very intense;
2. there is a possibility of complications after surgery;
3. possible problems with breastfeeding;
4. it is difficult to care for the baby, the risk of seam divergence;
5. long recovery period;
6. difficulties in subsequent pregnancies are possible.

Views

Caesarean is: abdominal, abdominal, retroperitoneal and vaginal. Laparotomy is performed to extract a viable baby, for a non-viable one, possibly vaginal and abdominal. Types of cesarean section differ in the localization of the uterine incision:

• Corporeal cesarean - a vertical section of the body of the uterus along the midline.
• Istmicocorporeal - the incision of the uterus is located along the midline, partly in the lower segment and partly in the body of the uterus.
• Incision for caesarean section in the lower segment of the uterus, transverse with bladder detachment.
• In the lower segment of the uterus, a transverse incision without bladder detachment.

How is it going

The procedure for or how a cesarean is done with a planned hospitalization is described below:

1. Before the operation, anesthesia is performed (spinal, epidural or general anesthesia), the bladder is catheterized, and the abdominal area is treated with a disinfectant. On the woman's chest there is a screen to close the access to the examination of the operation.
2. After the onset of anesthesia, the procedure is started. Initially, an abdominal incision is performed: longitudinal - goes vertically from the pubic joint to the navel; or transverse - above the pubic joint.
3. After that, the obstetrician pushes the abdominal muscles, cuts the uterus and opens the fetal bladder. After the newborn is removed, the placenta is delivered.
4. Next, the doctor sews up the layers of the uterus with special absorbent sutures, then the abdominal wall is also sutured.
5. Apply a sterile bandage to the abdomen, an ice pack (for intensive contraction of the uterus, reducing blood loss).

How long does a cesarean section take?

Normally, the operation lasts no more than 40 minutes, while the fetus is removed approximately at the tenth minute of the process. A large amount of time is taken by layer-by-layer suturing of the uterus, peritoneum, especially when applying a cosmetic suture so that the scar is not noticeable in the future. If complications arise during the operation (long-term effect of anesthesia, acute blood loss in the mother, etc.), the duration may increase up to 3 hours.

Anesthesia methods

Methods of anesthesia are chosen depending on the condition of the woman in labor, the fetus, planned or emergency surgery. The means that are used for anesthesia must be safe for the fetus and mother. It is advisable to carry out conduction anesthesia - epidural or spinal. Rarely resort to the use of general endotracheal anesthesia. With general anesthesia, a preliminary anesthesia is first administered, after which a mixture of oxygen and a drug that relaxes the muscles is used, with anesthetic gas.

During epidural anesthesia, a substance is injected into the nerve roots of the spinal cord through a thin tube. A woman feels pain only during a puncture (a few seconds), then pain in the lower body disappears, after which the condition is relieved. Throughout the procedure, she is conscious, fully present at the birth of the child, but at the same time does not suffer from pain.

Care after cesarean section

The entire period of a woman's stay in the hospital, the treatment of the stitches is carried out by the medical staff. To replenish fluid in the body the first day, you need to drink plenty of water without gas. It is believed that an overflowing bladder prevents the muscles of the uterus from contracting, so you need to go to the toilet often without retaining fluid in the body for a long time.

On the second day, it is already allowed to take liquid food, and from the third day (with the normal course of the postoperative period), you can resume a normal diet, which is allowed for nursing. Due to possible constipation, it is not recommended to eat solid foods. This problem can be easily dealt with with enemas or glycerin suppositories. You should eat more fermented milk products and dried fruits.

In the first months, it is not recommended to visit swimming pools or open reservoirs, take baths, you can only wash in the shower. It is recommended to start active physical activity, to restore the form, not earlier than two months after the operation. You should start to have an active sex life only two months after cesarean. In case of any worsening of the condition, it is necessary to consult a doctor.

Contraindications

When performing a cesarean, contraindications should be taken into account. Moreover, if the procedure is prescribed for vital indications for a woman, they are not taken into account:

• Fetal death in utero or developmental anomalies that are incompatible with life.
• Fetal hypoxia, without urgent indications for cesarean from a pregnant woman, with confidence in the birth of a viable baby.

Effects

With surgery, there is a risk of such complications:

• painful sensations may appear near the seam;
• long recovery of the body;
• scar infection is possible;
• the presence of a scar on the abdomen for life;
• limiting physical activity for a long time;
• impossibility of normal hygiene procedures for the body;
• limitation of intimate relationships;
• the likelihood of psychological shocks.

What is dangerous for a child

Unfortunately, the operational process does not pass without leaving a trace for the child. Such negative consequences for the baby are possible:

• Psychological. There is an opinion that in children there is a decrease in the reactions of adaptation to the environment.
• There may be amniotic fluid in the baby's lungs that remained after the operation;
• Anesthesia drugs enter the baby's blood.

When can you give birth after a cesarean section?

It is recommended to plan the next pregnancy after 5 years. This time is enough for complete scarring and restoration of the uterus. To prevent pregnancy earlier than this period, it is recommended to use various methods of contraception. Abortions are not recommended, since any mechanical intervention can provoke the development of inflammatory processes in the uterine wall or even rupture.

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Caesarean section is a common method of delivery these days. Modern doctors have an impressive experience in carrying out this operation, and maternity hospitals and clinics are equipped with high-quality equipment. Childbirth by caesarean section is easier and faster than 10-20 years ago. But this does not mean that operative childbirth is preferable to natural childbirth. In addition, the caesarean section has its pros and cons.

Up to 25% of babies are born by caesarean section. However, according to the World Health Organization, the optimal proportion is 10-15%. Surgical childbirth should only be performed as a last resort if the mother is unable to deliver the baby naturally for health reasons.

A cesarean section is a surgical procedure in which a baby is delivered through an incision in the mother's abdomen. In recent years, there has been an increasing number of women who are unable to give birth naturally for health reasons, age or because of an incorrect fetus. In such situations, traditional childbirth is considered risky, as it can cause irreparable harm to the health of the mother and child. Therefore, doctors insist on performing a caesarean section.

At first glance, operative childbirth looks like a safe and easy way to give birth to a child, since a woman does not have to go through painful contractions and attempts, and a baby does not have to go through the birth canal.

Compared to other abdominal surgeries, caesarean section is a completely safe procedure. The operation is fast and predictable if planned. In addition, during the surgical intervention, the woman is under the influence of anesthesia, so she does not feel pain.

All this makes a cesarean section quite an attractive way out of the situation for many women in labor who are afraid of pain, a persistent period and other unpleasant moments of natural childbirth.

But with a more detailed study, it is possible to consider many serious shortcomings in operative childbirth, due to which it is desirable to limit the number of operations performed to a minimum, leaving only situations when childbirth in a natural way is unsafe or impossible.

Caesarean section increases the likelihood of problems with anesthesia, 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, lactation and subsequent breastfeeding of the child often suffer. In addition, a young mother will not be able to immediately start caring for a baby who needs it so badly.

Thus, there are many pros and cons to caesarean section, which must be carefully weighed before the operation.

How is a cesarean section performed?

During the operation, the doctor makes two surgical incisions - the abdominal wall and the uterus. The incisions can be either vertical or horizontal, at the discretion of the physician. After that, the fetal bladder is opened and the child is removed. The doctor manipulates the umbilical cord and afterbirth, removing it from the uterine cavity.

The uterus is then sutured with a special absorbable suture material. Sutures or staples are also applied to the skin, which will be removed on the 7th day. The surgical wound is closed with a sterile dressing. In general, the operation lasts about 40 minutes, it can be planned and emergency.

A planned cesarean section is assigned to a woman during pregnancy, while the patient will know the date of hospitalization for childbirth. Indications for elective caesarean section can be women, and much more.

With a planned operation, a woman is hospitalized before the expected date of birth, less often when contractions occur. If there is evidence, hospitalization is carried out from the 37th week of pregnancy, when there is a need to additionally examine the woman in labor and check the child's condition again.

During a planned cesarean section, epidural anesthesia is usually performed, that is, the woman is fully conscious during the operation and sees her baby immediately after removing it from the uterine cavity. In this case, the doctor makes a transverse incision, the so-called cosmetic method.

The decision about emergency surgery is usually made by the doctor already at the beginning of labor, if there is a real threat to the life of the mother and child. An emergency caesarean section is performed if the woman in labor is noted, the fetus suffers from, cannot pass through the birth canal, bleeding and premature discharge of the placenta have begun, or the umbilical cord loops have fallen out of the uterus along with the outflow of amniotic fluid.

That is, a cesarean section is performed urgently against the background of unexpected complications during natural childbirth. In this case, general anesthesia is usually given to the woman in labor, and the incision is made vertically, due to which the newborn is removed faster and suffers less from hypoxia.

Arguments for"

1. Minimizing the likelihood of complications. If a woman in the past had a bad experience of natural childbirth, if her pregnancy was due to, if she or her spouse has been treated for infertility for a long time, then the risk of complications during childbirth is considered to be increased. Surgical delivery makes it possible to minimize the likelihood of complications for the mother and child. In this case, the date of the operation is set in advance, the woman goes to the hospital, and undergoes an additional prenatal examination. Also, complications can occur in primiparous women over 30 years old, if the weight of the fetus is more than 4 kg or it is located incorrectly.
2. Adequate oxygen supply at birth. If the pregnancy proceeds with serious complications, then the fetus may suffer from hypoxia for some time. In order not to aggravate this condition and prevent the development of asphyxia during natural childbirth, doctors recommend a cesarean section.
3. The pelvic floor muscles will remain in the same condition as before pregnancy. Stretching the vaginal muscles is a serious minus of natural childbirth, which in the future will somehow affect women's health. Muscles stretch and weaken in all women who have given birth naturally. Some of them, with the help of special training, return their former elasticity, but in most, stretched pelvic floor muscles lead to urinary incontinence and dissatisfaction in intimate life.
4. The date of birth of the child is known in advance. This information is relevant for women who have not given birth for the first time. In this case, it becomes possible to discuss in advance the care of older children with grandmothers or nannies, to solve other problems. Natural childbirth always begins suddenly.
5. Painlessness. Labor pain is something that all women, without exception, are afraid of. Natural childbirth is painless. During a cesarean section, a woman is given pain relief, which will save the woman from pain during the operation.

Arguments against"

1. Caesarean section is an abdominal operation. Surgical childbirth is actually a real surgical intervention, which is dangerous for every person with its risks. As a result of a cesarean section, a woman's body is exposed to real stress, especially if the operation is performed against the background of general anesthesia. Like any other operation, a cesarean section can result in such surgical complications as thrombosis, tissue inflammation, fistulas, adhesions, an unattractive postoperative scar, and much more.
2. Long postoperative period. After the operation, a woman needs a lot of strength to recover. As long as there is pain in the suture area, it is difficult for a woman to pay due attention to a newborn, she needs help. If a woman is given antibiotic therapy, then she cannot breastfeed, which can negatively affect the development of lactation.
3. Too quick birth. The child's transition from one environment to another is too abrupt. This causes a drop in pressure or the so-called atmospheric shock, which has a negative effect on the breathing of the newborn, and can cause microbleeding in the brain.

Caesarean section has its pluses and minuses, but at the same time, the preponderance towards minuses is greater. If a woman wants to have more children in the future, take care of them from the first days of birth and practice breastfeeding - you need to inform the doctor about this. In such a situation, in the absence of absolute medical indications, natural childbirth can be tried.

For many decades, this operation - a cesarean section - has been helping to preserve the life and health of a mother and her baby. In the old days, such a surgical intervention was carried out extremely rarely and only if something threatened the life of the mother in order to save the child. However, nowadays, cesarean section is being used more and more often. Therefore, many specialists have already set themselves the task of reducing the percentage of deliveries carried out by surgical intervention.

Who should perform the surgery?

First of all, you need to figure out how a cesarean section is done and what consequences await a young mother. Surgical childbirth itself is fairly safe. However, in some cases, operations are simply impractical. After all, no one is protected from risk. Many expectant mothers ask for a cesarean section only because of fear of severe pain. In this case, modern medicine offers epidural anesthesia, which allows a woman to give birth without pain.

Such childbirth is performed - cesarean section - by a whole team of medical workers, which includes narrow specialists:

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

The anesthesiologist should talk to the pregnant woman before surgery to clarify which type of pain relief is preferable for her.

Types of cesarean section

Indications for a cesarean section can be completely different, and the operation is performed in different ways in certain cases. Today, there are two types of surgical delivery:

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

Planned cesarean section

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

Emergency caesarean section

As for an emergency caesarean section, general anesthesia is usually used during the operation, since the woman may still have contractions, and they will not allow a puncture to be made for epidural anesthesia. The incision with such an operation is mainly longitudinal. This allows the baby to be removed from the uterus much faster.

It should be noted that during an emergency operation, the child may already experience severe hypoxia. At the end of the cesarean section, the mother cannot immediately see her baby, since the cesarean section is done in this case, as already mentioned, most often under general anesthesia.

Types of incisions for caesarean section

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

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

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

How is the operation going?

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

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

After that, doctors must remove the afterbirth, while processing all the necessary vessels with high quality so that bleeding does not start. The surgeon then sutures the cut tissue. A woman is given a dropper, giving a solution of oxytocin, which speeds up the process of uterine contraction. This phase of the operation is the longest. From the moment the baby is born and until the end of the operation, it takes about 30 minutes. By the time this operation, a cesarean section, takes about 40 minutes.

What happens after childbirth?

After the operation, the newly-made mother is transferred from the operating unit to the intensive care unit or the intensive care unit, since the cesarean section is performed quickly and with anesthesia. The mother should be under the watchful eye of doctors. At the same time, her blood pressure, respiratory rate, and pulse are constantly measured. The doctor must also monitor the rate at which the uterus contracts, how much discharge and what character they have. It is imperative that the urinary system be monitored.

After a caesarean section, the mother is prescribed antibiotics to avoid inflammation, and pain relievers to relieve discomfort.

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

Consequences of surgery

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

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

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

Menstruation and sex life

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

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

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

Lactation after surgery

Many young mothers who have undergone surgery are worried that after a cesarean it is difficult to establish breastfeeding. But this is absolutely not the case.

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

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

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

Caesarean section is a surgical procedure that allows your baby to be removed through an incision in the abdomen, rather than through the vagina. Recently, about 30% of births have taken place by caesarean section. In some cases, this is done as planned because of pregnancy complications or because the woman has already had a cesarean section. Some women prefer a caesarean section to a regular delivery. However, in many cases, the need for a cesarean section becomes apparent only during labor.

Knowing what to expect can help you prepare better if surgery is needed.

Caesarean section is a surgical procedure that allows you to remove the baby from the mother's womb. In this case, he is not born naturally, but casts his first glance at the world through the incision, which is made when the uterus is opened. In Germany, 20 to 30 percent of babies are born every year by caesarean section.

Indications for cesarean section

Indications for caesarean section can be absolute or relative. But for the most part, the decision to have an operation immediately follows from many reasons, such as a combination of medical assessments from a doctor and a midwife, personal wishes from a woman in labor. Fortunately, pregnant women have enough time to think things over and figure out exactly how they would like to give birth. Emergencies when a caesarean section becomes inevitable are rare.

If you decide to have a caesarean section, you must confirm your consent to the operation in writing. But first, the doctor will give you the most detailed explanations. During this conversation, you should discuss in detail all the possible risks so that you really feel well prepared. Therefore, do not hesitate to ask again if you do not understand something.

Medical indications for a cesarean section include:

• transverse or breech presentation of the child;
• placenta previa;
• inconsistency in the size of the maternal pelvis
• the size of the child;
• serious illness of the mother;
• the threat of child hypoxia;
• premature birth;
• pathology of child development.

Partial anesthesia for caesarean section

Local anesthesia is now a widely accepted standard. The operation is performed using spinal anesthesia or elective caesarean section with epidural-spinal anesthesia (see page 300). General anesthesia is recommended only when other anesthesia is not medically possible.

When is a cesarean section done?

There are many reasons for having a cesarean section. Sometimes this is due to the health of the mother, sometimes with fears for the child. Sometimes the operation is done even if both the mother and the baby are okay. This is a caesarean by choice, and the attitude towards it is ambiguous.

The birth is not going well. One of the main reasons a caesarean section is done is because labor is not progressing normally — it’s too slow or stops altogether. The reasons for this are manifold. The uterus may not contract vigorously enough to fully open the cervix.

The child has a broken heart. In most cases, the baby's heart rate allows you to expect a successful outcome of childbirth. But sometimes it becomes obvious that the child does not have enough oxygen. If there are such problems, the doctor may recommend a cesarean.

Heart problems can occur if the baby is not getting enough oxygen, the umbilical cord is pinched, or the placenta is not functioning well. Sometimes cardiac arrhythmias occur, but nothing indicates a real danger to the child. In other cases, a serious hazard is evident. One of the most difficult decisions for doctors is deciding how great the danger is. The doctor can try different methods, such as massage the head, and see if the heart improves.

The decision on the need for a cesarean depends on many points, for example, on how long the labor will continue or how likely it is that other complications, besides heart failure, are likely to occur.

Unfortunate position of the child. If the baby enters the birth canal with the legs or buttocks forward, this is called breech presentation. Most of these babies are born with a caesarean section, since complications are likely to occur during normal births. Sometimes the doctor manages to get the baby into the correct position by pushing the baby through the abdomen before labor begins, thereby avoiding surgery. If the baby is lying horizontally, this is called transverse presentation and is also an indication for a cesarean section.

The baby's head is not well positioned. Ideally, the baby's chin should be pressed against the chest so that the part of the head with the smallest diameter is in front. If the chin is up or the head is turned so that the smallest diameter is not in front, the larger diameter of the head should go through your pelvis. Some women do not have any problems in this case, but others may have difficulties.

Before doing a cesarean, the doctor may ask you to get on all fours - in this position, the uterus drops forward and the baby can turn. Sometimes the doctor may try to turn the head during a vaginal examination or with forceps.

You have serious health problems. A caesarean section can be done if you have diabetes, heart disease, lung problems, or high blood pressure. With such diseases, a situation may arise when it is preferable to give birth to a child at an earlier stage of pregnancy. If labor cannot be stimulated, it may be necessary to have a caesarean section. If you have serious health problems, discuss your prospects with your doctor well in advance of your pregnancy.

Occasionally, a caesarean section is done to prevent the baby from getting a herpes infection. If a mother has herpes in the genitals, it can be passed on to the baby being born and cause serious illness. Caesarean section avoids this complication.

You are having a multiple pregnancy. About half of twins are delivered by caesarean section. Twins can also be born in the usual way, depending on weight, position and gestational age. With triplets and more is another story. Most triple births occur by caesarean section.

Every multiple pregnancy is unique. If this is your case, discuss the prospects of labor with your doctor and decide together what is best for you. Remember that everything is changeable. Even if both babies are head-first, the situation may change after the first is born.

There are problems with the placenta. In two cases, a cesarean is necessary: ​​this is placental abruption and placenta previa.

Placental abruption occurs when the placenta is detached from the wall of the uterus before labor begins. This can be life threatening for both yours and your baby. If electronic monitoring shows that there is no immediate danger to the child, you will be hospitalized and closely monitored. If the baby is in danger, urgent labor is required and a caesarean section will be used.

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

There are problems with the umbilical cord. When the water has receded, the umbilical cord loop can slip out of the cervix even before the baby is born. This is called a prolapse of the umbilical cord and is very dangerous for the baby. When the baby squeezes through the cervix, pressure on the umbilical cord can cut off the oxygen supply. If the umbilical cord slips out when the cervix is ​​fully open and labor is in progress, you can give birth normally. Otherwise, only a cesarean section can save the day.

Likewise, if the umbilical cord is wrapped around the baby's neck or caught between the head and the pelvic bones, if water comes out, each contraction of the uterus will compress the umbilical cord, slowing blood flow and reducing the supply of oxygen to the baby. In these cases, a caesarean section is the best option, especially if the umbilical cord is compressed for a long time or very hard. This is a common cause of heart problems, but it is usually impossible to know for sure where the umbilical cord is located before labor begins.

The child is very big. Sometimes the baby is too big to be successfully born in the normal way. Baby size can be an issue if you have an abnormally narrow pelvis that the head cannot pass through. Occasionally, this can be a consequence of a fracture of the pelvis or other deformities of the pelvis.

If you develop diabetes during pregnancy, your baby can put on a lot of weight. If the baby is too large, a caesarean section is preferable.

Health problems in the child. If the child is still in the womb diagnosed with a defect such as spina bifida, the doctor may recommend a cesarean. Discuss the situation in detail with your doctor.

You've already had a caesarean. If you have had a cesarean section before, you may need to do it again. But this is optional. Sometimes after a cesarean section, a normal delivery is possible.

How does a cesarean section work?

Before your scheduled cesarean section, your gynecologist or anesthesiologist will advise you in advance about the operation and the methods of anesthesia. If you do not understand something, clarify and ask again! On the appointed day, you must arrive at the hospital in advance. It is best to abstain from food: you should not eat for the six hours before the operation.

First of all, the doctor and midwife will use ultrasound and CTG to check the condition of your child. Take this opportunity to state your wishes and ideas about the upcoming birth. Then the preparation for the operation will begin: your hair in the incision area will be shaved off, compression stockings will be put on you, and you will be given spinal anesthesia. Later, already in the operating room, they will disinfect the surface of the abdomen and insert a catheter into the bladder. Before the operation begins, sterile wipes will be applied to your entire body, with the exception of your abdomen. To prevent yourself from seeing what is happening and to prevent infection, the nurses will pull a sheet at the level of the upper abdomen. Although you will be able to see the heads of the members of the operating team, you will not be able to understand what they are doing with their hands. After the anesthesia is in full force, the doctor will make the first incision.

For cosmetic reasons, as well as for better wound healing, the skin is dissected directly above the symphysis (pubic joint) in a vertical line, the length of the incision is 10 cm. The subcutaneous adipose tissue is divided in the middle. Above the abdominal muscles is a very elastic and strong connective tissue sheath (fascia), which the surgeon opens with a scalpel in the center. Then he pulls the abdominal wall up with his hand and pushes the abdominal muscles towards the side. To open the peritoneum, the doctor uses only his fingers. At the same time, he must make sure that he does not injure either the intestines or the bladder. Finally, the doctor makes a transverse incision with a scalpel in the lower segment of the uterus. Now all that remains is to get the baby out of the uterus, and you can say hello to your baby. After separation and removal of the placenta, the operating team sutures the wound. Meanwhile, your partner is already accompanying the child to the first examination. In total, the operation takes 20 to 30 minutes.

The Misgav Ladakh Method

The method described on the previous pages, the so-called "soft" surgical technique, developed in the Israeli hospital Misgav Ladakh, is used today, with slight deviations, in all maternity clinics.

Risks of Caesarean Section

Caesarean section is a major operation. Although it is considered quite safe, as with any surgery, there are certain risks. It is important to remember that a cesarean section is often done to avoid life-threatening complications. However, after the operation, certain complications can also arise.

Risks to you. Having a baby is always a risk. With a caesarean section, it is higher than with a normal birth.

• Increased bleeding. On average, blood loss in a caesarean section is twice that in a normal birth. However, blood transfusion is rarely required.
• Reactions no anesthesia. Medications used during surgery, including pain relievers, can sometimes cause unintended consequences, including breathing problems. In rare cases, general anesthesia can cause pneumonia if a woman inhales stomach contents. But general anesthesia is rarely used in caesarean sections, and measures are taken to avoid such complications.
• Damage to the bladder or intestines. These surgical injuries are rare, but they do occur with a caesarean section.
• Endometritis. It is a complication that causes inflammation and infection of the membrane lining the uterus, most often after a cesarean section. This happens when bacteria normally found in the vagina enter the uterus. Urinary tract infection.
• Slowing down of bowel activity. In some cases, pain relievers used during surgery can slow down bowel movements, which can cause bloating and discomfort.
• Blood clots in the legs, lungs and pelvic organs. The risk of a blood clot in the veins is 3-5 times higher after a cesarean section than after a normal birth. If left untreated, a blood clot in the leg can reach the heart or lungs, disrupt circulation, causing chest pain, shortness of breath, and even death. Blood clots can also form in the veins of the pelvis.
• Wound infection. The chances of this infection after a cesarean section are higher if you are alcohol heavy, have type 2 diabetes, or are overweight.
• Rupture of seams. If the wound is infected or does not heal well, there is a risk of rupture of the sutures.
• Placenta accrete and removal of the uterus. The accreted placenta is attached too deeply and too firmly to the wall of the uterus. If you have already had a cesarean section, your next pregnancy is more likely to have a placenta accrete. Placenta accreta is the most common reason for removing the uterus during a cesarean section.
• Re-hospitalization. Compared to women who have given birth by vaginal delivery, women who have had a caesarean section are twice as likely to be admitted to the hospital for the second time within the first two months after giving birth.
• Fatal outcome. Although the likelihood of dying after a cesarean section is very small - about two cases per 100 000 - it is almost twice as high as after a natural birth.

Risk to the child. A caesarean section is potentially dangerous for a baby too.

• Premature birth. If the caesarean is done of your choice, the child's age must be correctly determined. Premature birth can lead to poor breathing and low birth weight.
• Breathing problems. Babies born with a caesarean section are more likely to have mild breathing problems - they breathe abnormally often during the first days after birth.
• Injury. Occasionally, a child may be injured during surgery.

What to expect with a caesarean section

Whether you have a cesarean section scheduled or is done as needed, it will go something like this:

Preparation. Several procedures will be done to prepare you for your surgery. In urgent cases, some steps are shortened or skipped altogether.

Pain relief methods. An anesthesiologist may come to your room to discuss the possibilities of anesthesia. For caesarean sections, spinal, epidural, and general anesthesia are used. With spinal and epidural anesthesia, the body loses sensation below the chest, but you remain conscious during the operation. At the same time, you practically do not feel pain, and the drug practically does not get to the child. There is little difference between spinal and epidural anesthesia. For spinal pain, a pain reliever is injected into the fluid surrounding the spinal nerves. With an epidural, the agent is injected outside the fluid-filled space. Epidural anesthesia lasts 20 minutes and lasts a very long time. The spinal cord is done faster, but only lasts for about two hours.

General anesthesia, in which you are unconscious, can be used for an urgent caesarean section. Some of the drug can be passed on to the child, but this usually does not cause problems. Most children are not affected by general anesthesia because the mother's brain absorbs the drug quickly and in large quantities. If necessary, the child will be given medication to relieve the effects of general anesthesia.

Other preparations. Once you, your doctor and anesthetist have decided what type of pain relief to use, the appropriate preparations begin. They usually include:

• Intravenous catheter. An intravenous needle will be placed on your arm. This will help you get the fluids and medications you need during and after your surgery.
• Blood test. Your blood will be taken and sent to a laboratory for analysis. This will allow the doctor to assess your condition before surgery.
• Antacid. You will be given an antacid to neutralize stomach acids. This simple measure significantly reduces the risk of lung damage if you vomit during anesthesia and stomach contents enter the lungs.
• Monitors. During the operation, your pressure will be continuously monitored. You can also be connected to a heart monitor by placing sensors on your chest to monitor your heart and rhythm during surgery. A special monitor can be connected to a finger to monitor the level of oxygen in the blood.
• Urinary catheter. A thin tube is inserted into the bladder to drain urine to keep the bladder empty during surgery.

Operating room. Most caesarean sections are done in operating rooms that are specifically designed for this purpose. The atmosphere may differ from that of the generic. Since operations are group work, there will be many more people here. If you or your child has serious medical problems, a variety of medical specialties will be present.

Preparation. If you are being given an epidural or spinal anesthetic, you will be asked to sit down with your back round, or lie on your side curled up. The anesthesiologist will wipe your back with an antiseptic solution and give you an injection of anesthetic. He will then insert a needle between the vertebrae through the dense tissue surrounding the spinal cord.

You may be given one dose of pain reliever through a needle and then removed. Or a thin catheter is inserted through the needle, the needle is removed, and the catheter is taped. This will allow you to receive new doses of pain reliever as needed.

If you require general anesthesia, all preparations for the operation will be made before you receive any pain medication. The anesthesiologist will administer pain reliever through an intravenous catheter. Then you will be laid on your back with your legs fixed. A pad may be placed under your right back to make your body tilt to the left. This shifts the weight of the uterus to the left, which ensures a good blood supply to the uterus.

Hands are pulled and fixed on special cushions. The nurse will shave the pubic hair if it might interfere with the operation.

The nurse will wipe the abdomen with an antiseptic solution and cover with sterile napkins. The tissue is placed under the chin to keep the surgical site clean.

Abdominal incision. When everything is ready, the surgeon makes the first incision. This will be an incision in the abdominal wall, about 15 cm long, cutting through the skin, fat, and muscle to reach the lining of the abdominal cavity. Bleeding vessels will be cauterized or bandaged.

The location of the incision depends on several factors: whether your caesarean section is urgent and whether you have other abdominal scars. The size of the baby and the location of the placenta are also taken into account.

The most common types of incisions are:

• Low horizontal cut. Also called a bikini cut and extending down the lower abdomen along the line of an imaginary bikini panties, is preferred. Heals well and causes less pain after surgery. It is also preferred for cosmetic reasons and allows the surgeon to see the lower part of the pregnant uterus clearly. B Low vertical cut. Sometimes this type of incision is preferable. It provides quick access to the lower part of the uterus and allows you to retrieve the baby more quickly. In some cases, time is the most important thing.
• Uterus incision. After completing the incision in the abdominal wall, the surgeon pushes back the bladder and cuts the wall of the uterus. The uterine incision can be of the same or different type as the abdominal incision. It is usually smaller in size. As with the abdominal incision, the location of the uterine incision depends on several factors, such as the urgency of the operation, the size of the baby, and the location of the baby and placenta within the uterus. A low horizontal incision in the lower part of the uterus is the most common one used in most caesarean sections. It provides easy access, bleeds less than higher incisions, and reduces the risk of bladder injury. A strong scar is formed on it, which reduces the risk of rupture in subsequent births.
• In some cases, a vertical cut is preferable. A low vertical incision - in the lower part of the uterus, where the tissue is thinner - can be made when the baby is positioned forward with the legs, buttocks, or across the uterus (breech or transverse presentation). It is also used if the surgeon thinks that it will need to be extended to a high vertical incision - sometimes referred to as the classic one. A potential advantage of the classic incision is that it allows easier access to the uterus to retrieve the baby. Sometimes a classic incision is used to avoid injury to the bladder or if the woman thinks this is her last pregnancy.

Birth. Once the uterus is open, the next step is to open the fetal bladder so the baby can be delivered. If you are awake, you may feel some twitching and pressure when the baby is being pulled out. This is done to keep the incision as small as possible. You will not feel pain.

When the baby is born and the umbilical cord has been cut, it will be handed over to a doctor who will check whether his nose and mouth are free of fluid and whether he is breathing well. In a few minutes, you will see your child for the first time.

After birth. When the baby is born, the next step is to separate and remove the placenta from the uterus and then close the incisions, layer by layer. The stitches on the internal organs and tissues will dissolve on their own and do not need to be removed. For an incision in the skin, the surgeon may suture or use special metal clamps to connect the edges of the wound. During these activities, you may feel some movement, but not pain. If the incision is closed with clamps, they will be removed with forceps before discharge.

When you see the child. The entire caesarean section usually takes 45 minutes to an hour. And the child will be born in the first 5-10 minutes. If you are conscious and willing, you can hold the baby while the surgeon sutures the incisions. Or you may be able to see the baby in your partner's arms. Before giving the baby to you or your partner, doctors will clean the nose and mouth and perform the first Apgar score - this is a quick assessment of the baby's appearance, pulse, reflexes, activity and breathing within one minute after birth.

Postoperative ward. There you will be monitored until the anesthesia passes and your condition stabilizes. This usually takes 1-2 hours. During this time, you and your partner can spend a few minutes alone with your child and get to know him.

If you decide to breastfeed your baby, you can do it for the first time in the recovery room if you so desire. The sooner you start feeding, the better. However, after general anesthesia, you may feel unwell for several hours. You may want to wait until you are fully awake and receive pain relief before starting breastfeeding.

After caesarean section

In a few hours, you will be transferred from the recovery room to the delivery room. Over the next 24 hours, doctors will monitor your health, stitches, urine output, and postpartum bleeding. Your condition will be closely monitored throughout your hospital stay.

Recovery. Usually, after a cesarean section, you are in the hospital for three days. Some women are discharged after two. It is important that you take good care of yourself both in the hospital and at home to speed up your recovery. Most women usually recover from a caesarean section without too many problems.

Pain. You will receive pain relievers at the hospital. You may not like this, especially if you are going to breastfeed. But pain relievers are needed after the anesthesia is over to make you feel comfortable. This is especially important in the first few days when the incision begins to heal. If you still feel pain when you are discharged, your doctor may prescribe pain medication for you to take at home.

Food and drink. In the first hours after surgery, you can only be given pieces of ice or a sip of water. When your digestive system starts working normally again, you can drink more fluids or even eat some easily digestible food. You will know that you are ready to start eating when you can release gases. This is a sign that your digestive system is awake and ready to start working. You can usually eat solid food the day after your surgery.

Walking. You will most likely be asked to walk around a few hours after surgery, if not overnight. You may not want to do this at all, but walking is beneficial and an important part of your recovery. It will help unclog your lungs, improve circulation, speed up healing, and normalize your digestive and urinary systems. If you're feeling bloated, walking can be a relief. It also prevents blood clots, a possible postoperative complication.

After the first time, you should take short walks at least twice a day until you are discharged.

Vaginal discharge. After the baby is born, you will have lochia - brownish or discolored discharge for several weeks. Some women after a cesarean section are surprised at the amount of discharge. Even if the placenta is removed during surgery, the uterus should heal and discharge is part of the process.

Healing the incision. The bandage will most likely be removed the day after surgery, when the incision has already tightened. While you are in the hospital, the wound will be monitored. Itching will appear as the incision heals. But don't scratch it. It is safer to use lotion.

If the incision is connected with clamps, they will be removed before discharge. At home, shower or bathe as usual. Then dry the incision with a towel or hairdryer at a low temperature.

The scar will be tender and painful for several weeks. Wear loose-fitting clothing that won't chafe. If clothing irritates the scar, cover it with a light bandage. Sometimes you will feel twitching and tingling around the incision area - this is normal. As the wound heals, it will itch.

Restrictions. Returning home after a cesarean section, it is important to limit your activity in the first week and take care of yourself and your newborn first of all.

• Do not lift weights or do anything that strains an unhealed belly. Maintain correct posture when standing or walking. Support your abdomen with sudden movements when coughing, sneezing, or laughing. Use pillows or rolled up towels when feeding.
• Take the necessary medications. Your doctor may recommend pain relievers. If you have constipation or bowel pain, your doctor may recommend an over-the-counter stool softener or mild laxative.
• Check with your doctor about what you can and cannot do. Exercise can be very exhausting for you. Give yourself time to recover. You had an operation. Many women find it difficult to adhere to the necessary restrictions when they begin to feel better.
• While fast movements are painful, do not drive. Some women recover faster, but usually the period when not driving a car lasts about two weeks.
• No sex. Refrain until your doctor tells you to - usually in a month or a month and a half. However, intimacy should not be avoided. Spend time with your partner, at least a little in the morning or evening, when the child is already asleep.
• When your doctor tells you to, start exercising. But don't be too zealous. Hiking and swimming are the best choices. 3-4 weeks after discharge, you will feel able to lead a normal, normal life.

Possible complications.

Tell your doctor right away about these symptoms if they appear when you are already at home:

• Temperature is over 38 ° C.
• Painful urination.
• Too much vaginal discharge.
• The edges of the wound diverge.
• The incision site is red or wet.
• Severe abdominal pain.

Emergency caesarean section

An emergency caesarean section is performed only in case of a threat to the life of the mother or child.

The decision about an urgent operation or about a secondary caesarean section is made only when there really is no other way out, since this is associated with a great risk for the pregnant woman (intubation, bleeding, damage to neighboring organs, infection).

Indications for emergency surgery:

• acute hypoxia of the child;
• complications that threaten the life of the mother (rupture of the uterus, premature separation of the placenta).

If one of these complications occurs unexpectedly, you need to act very quickly. In the event of a disruption in the supply through the umbilical cord, the doctor only has a few minutes to prevent significant damage to the baby's health. The obstetric team must take all measures to ensure that the birth takes place in the next 20 minutes. Interruption of oxygen supply for more than 10 minutes can damage the baby's brain.

As soon as the doctor decides about an emergency caesarean section, the introduction to anesthesia and the operation are performed without delay and without lengthy preparation. Surgery can also be performed in the delivery room if there is enough space and the necessary equipment.

Women always hope that they will give birth, preserving their dignity, they will be able to endure pain, sometimes even smile when they push for the last time, giving birth to a child. Many people try very hard to give birth in a natural way, choosing doctors in whose practice there were few cesarean sections, go to courses for pregnant women, play sports during pregnancy, trying to gain only the right weight, sometimes even hiring a muzzle to be nearby in the delivery room). However, there are more caesarean sections than ever before.

How to deal with anxiety

No matter how hard you tried, whether you had a normal pregnancy without complications, it may be that you need an emergency caesarean section. You will be disappointed. Maybe you will feel like a failure. However, it is very important to remain farsighted. Cesarean section is indeed a risk, like normal operations, for example, during it, internal bleeding may begin, blood clots appear, infection or damage to internal organs may occur. Some babies have mild breathing problems after a cesarean section. But due to the fact that surgical techniques and pain relief have improved, there are very few dangers associated with a cesarean section, and, of course, giving birth to a healthy child is much more important than trying to give birth naturally.

Causes of an emergency caesarean section

The most common indication for an emergency caesarean section is an unexpected abnormal position of the child (if it is located with the legs or buttocks forward) or lateral presentation. Another reason is heavy bleeding before childbirth and suspicion of premature detachment or placenta previa. The most common cause of caesarean sections is the danger that the baby may not be able to survive the delivery; if the baby's cardiogram shows possible abnormalities, a caesarean section will be a safe and quick way to have a baby.

Emergency caesarean section procedure

It may happen that everything happens quickly and chaotically. The lower abdomen will be prepared for surgery. Your stomach will be washed, your hair may be shaved, and you will be given antibiotics and other fluids intravenously. Anesthesia will be either epidural (with a dose adjusted for caesarean section) or spinal, or maybe even general anesthesia. If a woman is given an epidural or spinal anesthetic, she will feel nothing from the tips of her toes to her chest; at the same time, she will be conscious, but will not feel the doctor making an incision. Most likely, she will not see this, because a special fence will be put between her and the doctor, or maybe because the child will be born very quickly.

Caesarean section of the woman's choice

Some healthy women prefer a caesarean section at the first birth - usually to avoid pain and possible complications during labor. Sometimes the doctor suggests doing a cesarean so that the baby is born at a time more convenient for the woman, for the doctor, or for both.

This caesarean section is not done for health reasons. The reason is fear or a desire to avoid difficulties. And these are not the best reasons for a cesarean section.

However, women are increasingly opting for a cesarean section, and this raises a number of questions.

Is there a limit?

Many women safely undergo 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 heavy bleeding - increases only slightly with each C-section. If you had a long and difficult labor before your first cesarean, a repeat cesarean section will be physically easier, but the healing process will take just as long. For other women - who have large internal scars - each subsequent cesarean becomes more and more risky.

Re-cesarean is done by many women. But after the third, you need to weigh the possible risks and your desire to have more children.

Facing the unexpected

The unexpected news that you need a cesarean can be a shock to both you and your partner. Your ideas about how you will give birth will suddenly change. To make matters worse, this news can come when you are already exhausted by the long hours of contractions. And the doctor no longer has time to explain everything and answer your questions.

Of course, you will have fears about how you and the baby will have during the operation, but do not let these fears completely overwhelm you. Most mothers and children undergo surgery safely with a minimum of complications. While you might prefer to give birth naturally, remember that your and your baby's health is more important than the way they were born.

If you have concerns about a planned repeat cesarean section, discuss it with your doctor and your partner. This will help you worry less. Tell yourself that you've been through this once - and you can repeat it. This time, it will be easier for you to recover from your surgery because you already know what to expect.

Caesarean section: partner involvement

If your Cesarean section is not urgent and requires general anesthesia, your partner can come with you to the operating room. Some hospitals allow this. Some people like this idea, others may be afraid or disgusted. It is generally difficult to be present during the operation, especially when it is done to a loved one.

If the partner chooses to attend, they will be given surgical clothing. They can observe the procedure or sit at the head of the bed and hold your hand. Perhaps his presence will make you feel calmer. But there are also difficulties: men sometimes faint, and doctors have a second patient who needs immediate help.

In most maternity hospitals, the baby is photographed and doctors can even take pictures for you. But in many, this is not allowed. Therefore, you should ask permission to take photos or videos.

Optional caesarean section

Some women who have a normal pregnancy want to have a caesarean section, although they have no complications or problems with the baby. Some of them find it convenient to accurately schedule the due date. If you are used to planning everything in your life down to the minute, waiting for an unknown day for your baby to arrive may seem impossible.

Other women prefer a caesarean section out of fear:

• Fear of the childbirth process and the pain that accompanies it.
• Fear of damaging the pelvic floor.
• Fear of sexual problems after childbirth.

If this is your first child, childbirth is unknown and intimidating. You may have heard horror stories about childbirth and women who are incontinent after childbirth when coughing or laughing. If you have already given birth naturally and things have not gone very smoothly, you may be afraid of a recurrence.

If you are inclined to opt for a cesarean section, discuss it frankly with your doctor. If fear is your main motive, talking openly about what to expect and teaching in a childbirth school can help. If people start talking about the horrors of childbirth, politely but firmly say that you will hear about it after your baby is born.

If your previous natural birth was really such a terrible story, remember that all births are different and this time it could be very different. Think about why the birth was so difficult and talk to your doctor or partner about it. Perhaps something needs to be done to make the experience more positive this time.

If your doctor agrees with your choice, the final decision is yours. If the doctor disagrees and does not have a caesarean section, he may refer you to another specialist. Find out more about the advantages and disadvantages of both methods of childbirth and discuss them with professionals, but don't let fear be the deciding factor.

What should be considered?

Cesarean section by choice is a controversial thing. Those who are in favor say that a woman has the right to choose how she wants to give birth to her child. Those who oppose believe that the dangers of a caesarean section outweigh any of its benefits. To date, there is no conclusive evidence in the medical literature that the choice of caesarean section is preferable. Good medical practice generally rejects procedures - especially surgical ones - that are of little benefit to the patient. In addition, there are few studies on this issue.

Since everything is ambiguous, you may find that doctors' opinions differ greatly. Some are ready to undergo surgery. Others refuse, believing that a caesarean section can be dangerous and thus contradicts their vow of no harm.

The best way to make a decision is to gather as much information as possible. Ask yourself why this option appeals to you. Study the issue, consult with experts and carefully weigh the pros and cons.

Benefits and risks

Many experts believe that with the current level of development of surgical techniques, a cesarean section is no more dangerous than a regular delivery if this is your first child. If this is already the third birth, the situation is different. Caesarean sections are more complicated than regular labor. Here is a list of the benefits and dangers of this operation:

Benefits for the mother. Benefits of an elective caesarean section may include:

• Protection against urinary incontinence. Some women fear that the effort required to push the baby through the birth canal could lead to urinary or fecal incontinence and damage the muscles and nerves of the pelvic floor.
• Medical evidence has shown that women who have a caesarean section have a lower risk of urinary incontinence in the first months after giving birth. However, there is no evidence that this risk is lower 2-5 years after delivery. Some women also fear that vaginal labor could cause pelvic prolapse when organs such as the bladder or uterus protrude into the vagina. At the moment, there is no clear medical evidence linking caesarean section and reducing the risk of pelvic organ prolapse. But an optional cesarean section is not a guarantee that problems with incontinence and prolapse will not arise at all. Baby's weight during pregnancy, pregnancy hormones and genetic factors can weaken the pelvic muscles. Such problems can arise even in women who have never had children.
• Guaranteed against urgent caesarean section. An urgent caesarean section, which is usually done for a difficult birth, is much more dangerous than an optional caesarean section or a regular delivery. With an urgent caesarean, infections, internal organ damage, and bleeding are more likely.
• Guaranteed against difficult labor. Sometimes difficult labor requires the use of forceps or vacuum suction. Usually these methods are not dangerous. Just as with a cesarean section, the success of their use depends on the individual skill of the doctor performing the procedure.
• Less problems with the child. In theory, a planned caesarean section can reduce the risk of some problems in the baby. For example, infant death during childbirth, birth abnormalities due to incorrect fetal position, birth trauma - which is especially significant when the baby is very large - and inhalation of meconium, which occurs if the baby begins to defecate 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 in a normal delivery, and a caesarean section is not a guarantee that these problems will not arise.
• Less risk of transmission of infections. With a caesarean section, the risk of mother-to-child transmission of infections such as AIDS, hepatitis B and C, herpes and papilloma virus is reduced.
• Establishing the exact date of delivery. Knowing exactly when your baby is coming can help you prepare better. It is also useful for scheduling the work of the medical team.

Risk to the mother immediately after surgery

Certain inconveniences and dangers are associated with a cesarean section. You will have to stay in the hospital longer. On average, the length of stay in the hospital after a cesarean is three days, after a normal birth - two.

Increased likelihood of infection. Because it is a surgery, the risk of infection after a cesarean is higher than after a normal birth.

Postoperative complications

Since a cesarean section is an abdominal operation, certain risks are associated with it, such as infection, poor healing of stitches, bleeding, damage to internal organs, and blood clots. The risk of complications after anesthesia is also higher.

Reducing the possibility of early communication with the baby and the initiation of breastfeeding. For the first time after the operation, you will not be able to care for your baby or breastfeed. But this is temporary. You will be able to bond with your baby and breastfeed as soon as you recover from your surgery.

Insurance payment

Your insurance may not cover an optional caesarean section and will cost more than a regular birth. Before making a decision, check to see if the surgery is covered by your insurance.

Further risks to the mother

After a cesarean section, such troubles are possible in the future:

Future complications. With multiple pregnancies, the likelihood of complications increases with each subsequent one. Repeated caesarean sections further increase this likelihood. Most women can safely have up to three surgeries. However, each subsequent one will be more difficult than the previous one. For some women, the risk of complications such as infection or bleeding increases only slightly. For others, especially those with large internal scars, the risk of complications with each subsequent cesarean section increases dramatically.

Rupture of the uterus in the next pregnancy. Caesarean section increases the risk of uterine rupture in your next pregnancy, especially if you choose to give birth normally this time. The likelihood is not very high, but you should discuss this with your doctor.

Placenta problems. Women who have a caesarean section have a higher risk of abnormalities associated with the placenta, such as presentation, in subsequent pregnancies. In case of previa, the placenta closes the opening of the cervix, which can lead to premature birth. Placenta previa and other associated abnormalities caused by caesarean section greatly increase the risk of bleeding.

Increased risk of hysterectomy. Some problems with the placenta, such as an accretion where the placenta is attached too deeply and firmly to the wall of the uterus, may require removal of the uterus (hysterectomy) at delivery or soon after.

Bowel and bladder damage. Serious damage to the bowel and bladder from a caesarean section is rare, but much more likely than from a normal delivery. Complications associated with the placenta can also damage the bladder.

Dangers to the fetus

Dangers to the baby associated with a caesarean section:

• Respiratory disorders. One of the most common problems in a baby after a caesarean section is a small breathing disorder called tachypnea (rapid shallow breathing). This happens when there is too much fluid in the baby's lungs. When a baby is in the womb, its lungs are normally filled with fluid. In a normal birth, progression through the birth canal compresses the ribcage and naturally pushes fluid out of the baby's lungs. With a caesarean section, this compression does not occur, and fluid may remain in the baby's lungs after birth. This leads to increased breathing and usually requires pressurized oxygen to remove fluid from the lungs.
• Immaturity. Even a little immaturity can be very negative for a child. If the due date is inaccurate and the C-section is performed too early, the baby may have complications related to prematurity.
• Cuts. With a caesarean section, the baby can get cuts. But this rarely happens.

Decision-making

If your doctor doesn't accept your caesarean requirements, ask yourself why. Doctors and surgeons have a responsibility to avoid unnecessary medical interventions, especially if they can be dangerous. The lack of scientific evidence to support an optional caesarean section makes this operation unnecessary. While ease of scheduling, efficiency, and financial reward all favor a caesarean section from a doctor's perspective, a trusted doctor should at least be cautious about this operation.

All materials on the site have been prepared by specialists in the field of surgery, anatomy and specialized disciplines.
All recommendations are indicative and cannot be applied without consulting your doctor.

Caesarean section operation is considered one of the most frequent in the practice of obstetricians around the world, and the frequency of its performance is steadily increasing. At the same time, it is important to correctly assess the indications, possible obstacles and risks to operative delivery, its benefits for the mother and potential adverse consequences for the fetus.

Recently, the number of unjustified childbirth operations has increased, among the leaders in their implementation is Brazil, where almost half of women do not want to give birth on their own, preferring to have celiac disease.

The undoubted advantages of surgical delivery are the ability to save the life of both the child and the mother in cases where natural childbirth is a real threat or is impossible for a number of obstetric reasons, the absence of perineal ruptures, a lower incidence of hemorrhoids and prolapse of the uterus subsequently.

However, many disadvantages should not be ignored, among which are serious complications, postoperative stress, prolonged rehabilitation, therefore, a cesarean section, like any other abdominal operation, should be performed only for those pregnant women who really need it.

When is celiac disease necessary?

Indications for a cesarean section are absolute, when independent childbirth is impossible or involve an extremely high risk to the health of the mother and baby, and relative, and the list of both is constantly changing. Some of the relative reasons have already been transferred to the category of absolute ones.

The reasons for planning a cesarean section arise in the process of bearing a fetus or during labor that has already begun. Women are supposed to have a planned operation for indications:

Emergency gastrointestinal bleeding is performed with obstetric bleeding, previa or placental abruption, probable or incipient rupture of the fetus, acute fetal hypoxia, agony or sudden death of a pregnant woman with a living child, severe pathology of other organs with a worsening of the patient's condition.

When labor begins, circumstances may arise that force the obstetrician to decide on emergency surgery:

1. Pathology of uterine contractility that does not respond to conservative treatment - weakness of labor forces, discoordinated contractility;
2. Clinically narrow pelvis - its anatomical dimensions allow the fetus to pass through the birth canal, and other reasons make this impossible;
3. Prolapse of the baby's umbilical cord or body parts;
4. Threat or progressive rupture of the uterus;
5. Foot presentation.

In some cases, the operation is carried out due to a combination of several reasons, each of which in itself is not an argument in favor of surgery, but in the case of their combination, there is a very real threat to the health and life of the baby and the expectant mother during normal childbirth - prolonged infertility, miscarriages earlier , IVF procedure, age over 35 years.

Relative indications are considered severe myopia, kidney pathology, diabetes mellitus, genital infections in the acute stage, the age of a pregnant woman over 35 years in the presence of abnormalities during pregnancy or fetal development, etc.

In the case of the slightest doubt about the successful outcome of childbirth, and even more so if there are reasons for the operation, the obstetrician will prefer the safer way - gluttony. If the decision is in favor of independent childbirth, and the result will be serious consequences for the mother and baby, the specialist will bear not only moral, but also legal responsibility for neglecting the condition of the pregnant woman.

For surgical delivery there are contraindications, however, their list is much smaller than the testimony. The operation is considered unjustified in case of fetal death in the womb, fatal malformations, as well as hypoxia, when there is confidence that the child can be born alive, but there are no absolute indications from the pregnant woman. If the mother is in a life-threatening condition, the operation will be performed one way or another, and contraindications will not be taken into account.

Many expectant mothers who are going to have surgery worry about the consequences for the newborn. It is believed that children born by caesarean section are no different in their development from babies born naturally. At the same time, observations show that the intervention promotes more frequent inflammatory processes in the genital tract in girls, as well as type 2 diabetes and asthma in children of both sexes.

Varieties of gluttony surgery

Depending on the characteristics of the surgical technique, there are different types of cesarean section. So, access can be by laparotomy or through the vagina. In the first case, the incision goes along the abdominal wall, in the second - through the genital tract.

Vaginal access is fraught with complications, is technically difficult and is not suitable for delivery after 22 weeks of gestation in the case of a living fetus, therefore it is now practically not used. Viable babies are removed from the uterus only by a laparotomic incision. If the gestational age has not exceeded 22 weeks, then the operation will be called small cesarean section. It is necessary for medical reasons - serious defects, genetic mutations, a threat to the life of the expectant mother.

incision options for CS

The location of the incision on the uterus determines the types of intervention:

• Corporeal caesarean section - midline incision of the uterine wall;
• Istmicocorporeal - the incision goes below, starting from the lower segment of the organ;
• In the lower segment - across the uterus, with / without detachment of the bladder wall.

An indispensable condition for surgical delivery is a living and viable fetus. In case of intrauterine death or defects incompatible with life, a cesarean will be done in case of a high risk of death of a pregnant woman.

Preparation and methods of pain relief

The peculiarities of preparation for operative delivery depend on whether it will be carried out as planned or on an emergency basis.

If a planned intervention is prescribed, then the preparation resembles that for other operations:

1. Light diet the day before;
2. Intestinal cleansing with an enema in the evening before the operation and in the morning two hours before it;
3. Exclusion of any food and water 12 hours before the scheduled intervention;
4. Hygiene procedures (shower, shaving hair from the pubis and abdomen) in the evening.

The list of examinations includes standard general clinical tests of blood, urine, blood clotting, ultrasound and CTG of the fetus, tests for HIV, hepatitis, genital infections, consultations of a therapist and narrow specialists.

In case of emergency intervention, a gastric tube is inserted, an enema is prescribed, analyzes are limited to the study of urine, blood composition and coagulability. The surgeon in the operating room places a catheter into the bladder, inserts an intravenous catheter to infuse the necessary drugs.

The method of anesthesia depends on the specific situation, the preparedness of the anesthesiologist and the patient's wishes, if it does not go against common sense. Regional anesthesia is one of the best ways to relieve cesarean delivery.

Unlike most other operations, with a cesarean section, the doctor takes into account not only the need for anesthesia as such, but also the possible adverse consequences of the administration of drugs for the fetus, therefore, spinal anesthesia is considered optimal, which excludes the toxic effect of anesthesia on the baby.

spinal anesthesia

However, it is not always possible to perform spinal anesthesia, and in these cases, obstetricians undergo surgery under general anesthesia. It is mandatory to prevent the reflux of gastric contents into the trachea (ranitidine, sodium citrate, cerucal). The need to cut the abdominal tissue requires the use of muscle relaxants and a ventilator.

Since the operation of gluttony is accompanied by a rather large blood loss, then at the preparatory stage it is advisable to take blood from the pregnant woman herself in advance and prepare plasma from it, and return the erythrocytes back. If necessary, the woman will be given her own frozen plasma.

To replace lost blood, blood substitutes, as well as donor plasma, shaped elements can be prescribed. In some cases, if it is known beforehand about a possible massive blood loss due to obstetric pathology, washed erythrocytes are returned to the woman during the operation through the reinfusion apparatus.

If fetal pathology is diagnosed during pregnancy, in case of premature birth, a neonatologist should be present in the operating room who can immediately examine the newborn and perform resuscitation if necessary.

Anesthesia with a cesarean section carries certain risks. In obstetrics, as before, the bulk of deaths during surgical interventions occur during this operation, and in more than 70% of cases, it is the ingestion of stomach contents into the trachea and bronchi, difficulties with the introduction of an endotracheal tube, and the development of inflammation in the lungs.

When choosing a method of anesthesia, the obstetrician and anesthesiologist must evaluate all available risk factors (course of pregnancy, comorbidities, unfavorable previous births, age, etc.), the condition of the fetus, the type of proposed intervention, as well as the desire of the woman herself.

Caesarean section technique

The general principle of celiac surgery may seem quite simple, and the operation itself has been worked out for decades. However, it is still classified as an intervention of increased complexity. The most appropriate is a horizontal incision in the lower uterine segment and in terms of risk, and from the standpoint of aesthetic effect.

Depending on the characteristics of the incision, for a caesarean section, a lower midline laparotomy, a section according to Pfannenstiel and Joel-Cohen are used. The choice of a specific type of operation occurs individually, taking into account changes in the myometrium and abdominal wall, the urgency of the operation, the skills of the surgeon. During the intervention, self-absorbable suture material is used - vicryl, dexon, etc.

It should be noted that the direction of the incision of the abdominal tissues does not always and does not necessarily coincide with the dissection of the uterine wall. So, with a lower midline laparotomy, the uterus can be opened as desired, and the Pfannenstiel incision assumes isthmicocorporeal or corporal gluttony. The simplest method is considered to be the lower midline laparotomy, which is preferable for corporal section; it is more convenient to perform a transverse incision in the lower segment through the Pfannenstiel or Joel-Cohen access.

Corporeal Caesarean Section (CCS)

A corporal caesarean section is rarely performed when there are:

• Severe adhesive disease, in which the path to the lower segment is impossible;
• Varicose veins in the lower segment;
• The need to extirpate the uterus after removing the child;
• An insolvent scar after a previously performed corporal gluttony;
• Prematurity;
• Fused twins;
• Living fetus in a dying woman;
• The transverse position of the child, which cannot be changed.

Access for CCS is usually a lower midline laparotomy, in which the skin and underlying tissues are dissected to the aponeurosis at the level from the umbilical ring to the pubic joint, strictly in the middle. Aponeurosis is opened longitudinally over a short length with a scalpel, and then enlarged with scissors up and down.

suture of the uterus with corporal CS

The second caesarean section must be performed very carefully because of the risk of damage to the bowel, bladder... In addition, an existing scar may not be dense enough to maintain the integrity of the organ, which is dangerous for a ruptured uterus. The second and subsequent gluttony is more often carried out on the finished scar with its subsequent removal, and the rest of the operation is standard.

With CCS, the uterus is opened exactly in the middle, for this it is turned so that an incision of at least 12 cm in length is located at an equal distance from the round ligaments. This stage of the intervention should be carried out as quickly as possible due to the profuse blood loss. The fetal bladder is opened with a scalpel or fingers, the fetus is removed by hand, the umbilical cord is pinched and crossed.

To speed up the contraction of the uterus and the evacuation of the placenta, the appointment of oxytocin into a vein or muscle is indicated, and antibiotics of a wide spectrum are used intravenously to prevent infectious complications.

For the formation of a lasting scar, prevention of infections, safety in subsequent pregnancies and childbirth, it is extremely important to adequately match the edges of the incision. The first suture is applied at a distance of 1 cm from the corners of the incision, the uterus is sutured in layers.

After removing the fetus and suturing the uterus, an examination of the appendages, appendix and adjacent abdominal organs is mandatory. When the abdominal cavity is flushed, the uterus has contracted and became dense, the surgeon sutures the incisions in layers.

Istmicocorporeal cesarean section

Isthmicorporeal gastrointestinal surgery is carried out according to the same principles as CCS, with the only difference that before opening the uterus, the surgeon cuts the peritoneal fold between the bladder and the uterus transversely, and pushes the bladder itself downward. The uterus is dissected 12 cm in length, the incision goes longitudinally in the middle of the organ above the bladder.

Incision in the lower uterine segment

With a cesarean section in the lower segment, the abdominal wall is cut along the suprapubic line - according to Pfannenstiel. This access has several advantages: it is cosmetic, less often later gives hernias and other complications, the rehabilitation period is shorter and easier than after a median laparotomy.

incision technique in the lower uterine segment

The incision of the skin and soft tissues runs in an arcuate way across the pubic joint. Somewhat above the skin incision, the aponeurosis is opened, after which it exfoliates from the muscle bundles downward to the pubic symphysis and upward to the navel. The rectus abdominal muscles are pulled apart with the fingers.

The serous cover is opened with a scalpel at a distance of up to 2 cm, and then enlarged with scissors. The uterus is exposed, the folds of the peritoneum between it and the bladder are cut horizontally, the bladder is diverted to the womb by a mirror. It should be remembered that during childbirth the bladder is located above the pubis, so there is a risk of injury with careless actions with a scalpel.

The lower uterine segment is opened horizontally, carefully, so as not to damage the baby's head with a sharp instrument, the incision is enlarged with the fingers to the right and left to 10-12 cm, so that there is enough for the newborn's head to pass.

If the baby's head is low or large, the wound can be enlarged, but the risk of damage to the uterine arteries with heavy bleeding is extremely high, so it is more advisable to make the incision in an arched slightly upward direction.

The fetal bladder is opened together with the uterus or with a scalpel separately with dilution to the sides of the edges. With his left hand, the surgeon penetrates into the fetus, gently tilts the baby's head and turns it to the wound with the occipital region.

To facilitate the extraction of the fetus, the assistant gently presses on the fundus of the uterus, while the surgeon gently pulls the head, helping the baby's shoulders out, and then pulls it out by the armpits. With a breech presentation, the baby is removed by the groin or leg. The umbilical cord is cut, the newborn is handed over to the midwife, and the afterbirth is removed by traction by the umbilical cord.

At the final stage, the surgeon makes sure that there are no fragments of the membranes and afterbirth left in the uterus, there are no myomatous nodes and other pathological processes. After the umbilical cord is cut off, the woman is injected with antibiotics to prevent infectious complications, as well as oxytocin, which accelerates the contraction of the myometrium. The fabrics are sutured tightly in layers, matching their edges as accurately as possible.

In recent years, the technique of lower bladder sectioning without exfoliation of the bladder through the Joel-Cohen incision has gained popularity. It has many advantages:

1. The kid is removed quickly;
2. The duration of the intervention is significantly reduced;
3. Less blood loss than with detachment of the bladder and CCS;
4. Less soreness;
5. Lower risk of complications after the intervention.

With this type of cesarean section, the incision goes across 2 cm below the line conventionally drawn between the anterior superior spines of the iliac bones. The aponeurotic leaf is dissected with a scalpel, its edges are removed with scissors, the rectus muscles are pulled back, the peritoneum is opened with the fingers. This sequence of actions minimizes the risk of bladder injury. The wall of the uterus is cut for 12 cm simultaneously with the vesicouterine fold. Further actions are the same as for all other methods of gluttony.

When the operation is completed, the obstetrician examines the vagina, removes blood clots from it and the lower part of the uterus, rinses with sterile saline, which facilitates the recovery period.

Recovery after gluttony and possible consequences of the operation

If the delivery took place under spinal anesthesia, the mother is conscious and feeling well, the newborn is applied to her breast for 7-10 minutes. This moment is extremely important for the formation of the subsequent close emotional bond between mom and baby. The exception is severely premature babies and those born in asphyxiation.

After all wounds have been closed and the genital tract cleaned, an ice pack is placed on the lower abdomen for two hours to reduce the risk of bleeding. The introduction of oxytocin or dinoprost is indicated, especially for those mothers who have a very high risk of bleeding. In many maternity hospitals, after the operation, a woman spends up to a day in the intensive care unit under close supervision.

During the first days after the intervention, the introduction of solutions is shown that improve the properties of the blood and replenish the lost volume. According to indications, analgesics and means to increase uterine contractility, antibiotics, anticoagulants are prescribed.

To prevent intestinal paresis, cerucal, neostigmine sulfate, enemas are prescribed for 2-3 days after the intervention. You can breastfeed your baby already on the first day, if there are no obstacles to this from the mother or newborn.

The stitches from the abdominal wall are removed at the end of the first week, after which the young mother can be discharged home. Every day before discharge, the wound is treated with antiseptics and examined for inflammation or healing problems.

The suture after a caesarean section can be quite noticeable, going longitudinally along the abdomen from the navel to the pubic region, if the operation was carried out by means of a midline laparotomy. The scar is much less visible after the suprapubic transverse approach, which is considered one of the advantages of the Pfannenstiel incision.

Patients who have undergone a cesarean section will need the help of loved ones when caring for the baby at home, especially during the first few weeks, while the internal seams heal and soreness is possible. After discharge, it is not recommended to take a bath and visit the sauna, but a daily shower is not only possible, but also necessary.

suture after cesarean section

The caesarean section technique, even if there are absolute indications for it, is not without its drawbacks. First of all, the disadvantages of this method of delivery include the risk of complications such as bleeding, trauma to neighboring organs, purulent processes with possible sepsis, peritonitis, phlebitis. The risk of consequences is several times greater in emergency operations.

In addition to complications, among the disadvantages of a cesarean section is a scar, which can cause psychological discomfort to a woman if it runs along the abdomen, contributes to hernial protrusions, deformities of the abdominal wall and is noticeable to others.

In some cases, after surgical delivery, mothers experience difficulties with breastfeeding, and it is also believed that the operation increases the likelihood of deep stress up to postpartum psychosis due to the lack of a sense of completeness of the natural birth.

According to the reviews of women who have undergone operative delivery, the greatest discomfort is associated with severe pain in the wound area in the first week, which requires the appointment of analgesics, as well as with the formation of a noticeable skin scar later. The operation, which did not entail complications and was carried out correctly, does not harm the child, but the woman may have difficulties with subsequent pregnancies and childbirth.

Caesarean section is carried out everywhere, in any obstetric hospital with an operating room... This procedure is free and available to any woman who needs it. However, in some cases, pregnant women wish to carry out childbirth and surgery for a fee, which makes it possible to choose a specific attending physician, clinic and conditions of stay before and after the intervention.

The cost of an operative delivery varies widely. The price depends on the specific clinic, the comfort, the medicines used, the qualifications of the doctor, and the same service in different regions of Russia may differ significantly in price. State clinics offer a paid caesarean section in the range of 40-50 thousand rubles, private - 100-150 thousand and more. Abroad, operative delivery will cost 10-12 thousand dollars or more.

Caesarean section operation is performed in every maternity hospital, and, according to indications, it is free of charge, and the quality of treatment and follow-up does not always depend on financial costs. So, a free operation can go quite well, but a pre-planned and paid one - with complications. It is not for nothing that they say that childbirth is a lottery, so it is impossible to guess their course in advance, and expectant mothers can only hope for the best and prepare for a happy meeting with a little man.

Video: Dr. Komarovsky about caesarean section