Childbirth through caesarean section - indications and types, preparation for surgery, conduct and postoperative care. Cesarean section: pros and cons of the operation, consequences, indications, recovery By caesarean section

Content

A caesarean section is an operation in which a viable baby and baby's place is removed from a woman through an incision in the abdomen. On this moment this operation is not new and is well spread: every 7 woman goes into childbirth by caesarean section. 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 caesarean section

Birth by caesarean - obstetric surgery, which refers to emergency care. Every obstetrician-gynecologist should know the technique of execution. 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, severe prematurity or post-term pregnancy. Caesarean section is performed only for serious indications - the decision is made by the surgeon of the maternity ward.

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

• bleeding;
• embolism with amniotic fluid;
• development of peritonitis;
• thromboembolism of the pulmonary arteries;
• discrepancy postoperative sutures.

Why is it called

The word "caesar" is a form of the Latin word "caesar" (i.e. ruler). There are suggestions that the name refers to Gaius Julius Caesar. According to an old legend, the emperor's mother 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 and 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 in the time of Caesar) which read: at the death of a woman in labor, 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 mother and child, was performed by Jacob Nufer to his wife. All his life he performed operations - castration of boars. With a long and unsuccessful birth of his wife, he asked permission to make an incision in her with his own hand. The birth by caesarean was successful - 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 suffering;
• failed scar on the uterus after previous births or other operations on the uterus;
• the presence of two or more scars after caesarean;
• anatomically narrow pelvis, tumor diseases or severe deformities of the pelvic bones;
• postoperative conditions on the pelvic bones and joints;
• malformations of the 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 from treatment;
• severe diseases of the heart and blood vessels, diseases of the central nervous system, myopia and other extragenital pathology;
• conditions after stitching fistulas of the genitourinary system;
• the presence of a perineal scar of the 3rd degree, after previous births;
• varicose veins vaginal veins;
• transverse arrangement of the fetus;
• multiple pregnancy;
• pelvic presentation of the fetus;
• large fruit (more than 4000 g);
• chronic hypoxia in the fetus;
• the age of primiparous older than 30 years, having diseases of the internal organs, which can aggravate childbirth;
• prolonged infertility;
• hemolytic disease in the fetus;
• post-term pregnancy with unfinished birth canal, lack of labor activity;
• cervical cancer;
• the presence of the herpes virus with exacerbation.

Indications for emergency caesarean section

In some cases, surgery 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 activity;
• anomalies of labor activity that are not amenable to the action of medicines;
• placental abruption and bleeding;
• situation threatening uterine rupture;
• prolapse of umbilical cord loops;
• incorrect insertion of the fetal head;
• sudden death women in labor, and the fetus is alive.

The choice of a woman

In some clinics and states, they practice the operation at will. With the help of a caesarean section, a woman in labor wants to avoid pain, increase the size of the pelvic floor muscles, and avoid vaginal incisions. Avoiding some discomfort, women in labor are faced with others who in most cases need to be feared much more - a violation nervous system baby, difficulty in lactation, divergence of postoperative sutures, inability to give birth naturally in the future, etc. Before planning the operation yourself, weigh the pros and cons.

Caesarean section: pros and cons

Many women in labor see obvious positive sides operations, but do not weigh the pros and cons of a caesarean section. From the pros:

1. removal of 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.

Moms are not even aware of the disadvantages of such a procedure:

1. pain after the operation 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. possible difficulties in subsequent pregnancies.

Kinds

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

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

How is it happening

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

1. Before the operation, anesthesia is performed (spinal, epidural or general anesthesia), the bladder is catheterized, the abdominal area is treated with a disinfectant. There is a screen on the woman's chest to block access to the examination of the operation.
2. After the onset of anesthesia, the procedure begins. Initially, an abdominal incision is made: longitudinal - goes vertically from the pubic joint to the navel; or transverse - above the pubic joint.
3. After that, the obstetrician pushes abdominal muscles, cuts the uterus and produces an opening of 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 absorbable threads, then the abdominal wall is also sutured.
5. Impose a sterile bandage on the abdomen, an ice pack (for intensive contraction of the uterus, reducing blood loss).

How long does a caesarean 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 there are complications during the operation (long-term effect of anesthesia, acute blood loss in the mother, etc.), the duration can 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. Means that are used for anesthesia must be safe for the fetus and mother. It is advisable to conduct conduction anesthesia - epidural or spinal. Rarely resort to the use of general endotrachial anesthesia. In general anesthesia, a preliminary anesthesia is first introduced, after which a mixture of oxygen and a drug that relaxes the muscles is used, with anesthetic gas.

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

Care after caesarean section

The entire period of the woman's stay in the maternity hospital, the processing of sutures is carried out by the medical staff. To replenish the fluid in the body for the first day, you need to drink plenty of water without gas. There is an opinion that a full 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 a normal course postoperative period) you can resume the normal diet that is allowed for nursing. Due to possible constipation, it is not recommended to eat solid food. This problem is easily dealt with with enemas or glycerin suppositories. You should eat more dairy products and dried fruits.

In the first months, it is not recommended to visit pools or open water, take baths, you can only wash in the shower. It is recommended to start active physical activity not earlier than two months after the operation to restore the form. Start being active sexual life, follows only two months after caesarean. In case of any deterioration in the condition, it is necessary to consult a doctor.

Contraindications

When performing a caesarean section, contraindications should be taken into account. At the same time, 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 caesarean section by a pregnant woman, with confidence in the birth of a viable baby.

Consequences

With surgery, there is a risk of such complications:

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

What is dangerous for a child

Unfortunately, the surgical process does not pass without a trace for the child. Possible negative consequences for the baby:

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

When can I have a baby after a caesarean 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 before 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 its rupture.

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Today, caesarean section is a common way of delivery. Modern doctors have 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 surgical delivery is preferable to natural. In addition, the operation of a caesarean section has its pros and cons.

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

C-section is a surgical procedure in which a baby is born through an incision in the abdominal cavity mother. IN last years there is a growing number of women who are unable to give birth naturally due to health reasons, age or malformed fetuses. In such situations, traditional births are considered risky, as they can cause irreparable harm to the health of the mother and child. Therefore, doctors insist on a caesarean section.

At first glance, operative delivery appears to be safe and easy way the birth of a child, since the woman does not have to go through painful contractions and attempts, and the baby through the birth canal.

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

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

But with a more detailed study, one can consider many serious shortcomings in operational childbirth, because of which it is desirable to limit the number of operations performed to a minimum, leaving only situations where natural childbirth is unsafe or impossible.

A caesarean section increases the chance 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 breast-feeding child. In addition, a young mother will not be able to immediately start caring for a baby who needs it so much.

Thus, there are many pros and cons to a 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 doctor. After that, the fetal bladder is opened and the child is removed. The doctor performs manipulations with the umbilical cord and placenta, removing it from the uterine cavity.

Then the uterus is sutured with a special absorbable suture material. On skin stitches or staples are also applied, 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 caesarean section is assigned to a woman during pregnancy, while the patient will know the date of hospitalization for childbirth. Indications for a planned caesarean section can be women, and much more.

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

During a planned caesarean section, epidural anesthesia is usually performed, that is, the woman during the operation is fully conscious 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 on an emergency operation is usually made by the doctor already with the onset of labor, if there is a real threat to the life of the mother and child. An emergency cesarean section is performed if the woman in labor is noted, the fetus suffers from, cannot pass through the birth canal, bleeding and premature delivery of the placenta has begun, or loops of the umbilical cord have fallen out of the uterus along with outflow amniotic fluid.

That is, a caesarean 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 an unsuccessful experience of natural childbirth, if her pregnancy was due to, if she or her spouse was treated for infertility for a long time, then the risk of complications during childbirth is considered increased. Operative childbirth makes it possible to minimize the likelihood of complications in the mother and child. The date of the operation in this case is appointed in advance, the woman goes to the hospital, undergoes an additional prenatal examination. Complications can also occur in primiparous women over 30 years of age if the fetus weighs more than 4 kg or is not positioned correctly.
2. Sufficient amount of oxygen at the birth of a child. 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 caesarean section.
3. The pelvic floor muscles will remain in the same condition as before pregnancy. Stretching of the vaginal muscles is a serious disadvantage 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 for the majority, 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 give birth not for the first time. In this case, it becomes possible to discuss the care of older children with grandmothers or a nanny in advance, to solve other problems. Natural childbirth always starts suddenly.
5. Painlessness. Childbirth pain is something that all women, without exception, are afraid of. Natural childbirth is not without pain. During a caesarean section, a woman is given anesthesia, which will save the woman from pain during the operation.

Arguments against"

1. A caesarean section is abdominal operation. Operative childbirth is actually a real surgical intervention, which is dangerous for its risks for every person. As a result of a caesarean 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 caesarean section can result in such surgical complications like a thrombosis inflammatory processes in tissues, 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. While pain remains 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 her baby, which can adversely affect the development of lactation.
3. Too fast birth. The transition of the child from one environment to another occurs too abruptly. This causes pressure drops or so-called atmospheric shock, which Negative influence on the breath of a newborn, can cause microbleeding in the brain.

A caesarean section has its pros and cons, but at the same time, the advantage in the direction of the 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, you can try natural childbirth.

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

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

When is operative delivery indicated?

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

The operation is performed in the following situations:

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

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

3. Previous surgical interventions on the uterus, namely:

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

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

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

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

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

Subsequent pregnancy

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

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

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

On the other hand, if the patient is over 35 at the time of her next birth, she has excess weight, concomitant diseases, mismatched sizes of the fetus and pelvis, it is likely that she will again undergo surgery.

How many times can a caesarean section be done?

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

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

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

How soon can I give birth after surgery?

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

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

What is important to know about the second caesarean section?

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

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

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

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

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

Indications for caesarean section

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

Indications for a planned caesarean section

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

Indications for an emergency caesarean section

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

Contraindications for caesarean section

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

With a planned caesarean section, a pregnant woman is hospitalized somewhat earlier than with a natural birth: this happens one to two weeks before the “X Hour” (ie, 38-39 weeks of pregnancy). And then the process of preparation begins worse than that of astronauts. They take a general and biochemical blood test, a general urinalysis, a vaginal smear, fetal ultrasound, cardiotocography (registration heart rate fetus). The anesthesiologist, after a thorough history taking and the necessary examinations, is determined with anesthesia and drugs for it.

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

How is a caesarean section performed?

Carrying out a caesarean section The first step is to open the abdominal cavity to access the uterus. It can be a longitudinal or transverse incision, everything is decided by the surgeon. Then an incision is made in the wall of the uterus, on the edges of which clamps are applied. The last barrier for the surgeon's scalpel is the fetal bladder, from which the fetus itself is removed. After that, it remains to cut the umbilical cord and pass the small screaming lump to the midwife. Possible bleeding prevent the introduction of oxytocin or methylergometrine to the patient, which increase the tone of the smooth muscle skeleton of the uterus. For the umbilical cord, the so-called afterbirth is pulled out of the uterus - the placenta with the remnants of the membranes. That's all: you can sew up, apply an aseptic bandage and congratulate the woman in labor.

Recovery after caesarean section

Scar after caesarean section If everything ended well (ie without complications), then the next day you can sit down and carefully walk around the ward. And you can feed your child two hours after the operation. The stitches will be removed in a week, after which the young mother will finally be discharged home. But this does not mean that the operation can be forgotten. And a fresh scar will not let you do it. You should take care of yourself: in the first 2-3 months, do not lift anything heavier than your own child, and you should not take it, bending over three deaths, from a low crib or stroller. If a pulling pain in the lower abdomen is felt within a month, it's okay: this pain is associated with the healing of the scar and contraction of the uterus. As a rule, the seam heals without any problems. Only sometimes its inflammation is noted, which requires an immediate visit to the surgeon. Should also be cause for concern sharp pain, fever or profuse bloody vaginal discharge. In such cases, you should immediately contact the antenatal clinic.

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

Possible complications after caesarean section:

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

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

C-section - surgical procedure, which allows you to remove the child through an incision in the abdomen, and not through the vagina. Recently, about 30% of births occur by caesarean section. In some cases, this is done as planned due to pregnancy complications or because the woman has already had a caesarean section. Some women prefer a caesarean section to a conventional birth. However, in many cases, the need for a caesarean section becomes apparent only during childbirth.

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

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

Indications for caesarean section

Indications for caesarean section can be absolute and relative. But for the most part, the decision to have surgery stems from many factors at once, such as a combination of medical assessments by the doctor and midwife, and personal wishes on the part of the woman in labor. Fortunately, pregnant women have enough time to think things over and understand 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, all possible risks should be discussed in detail, so that you really feel well prepared. So don't hesitate to ask if you don't understand something.

TO medical indications for caesarean section include:

• transverse or pelvic presentation of the child;
• placenta previa;
• maternal pelvis size mismatch
• the size of the child;
• severe illness of the mother;
• the threat of hypoxia of the child;
• premature birth;
• developmental pathology of the child.

Partial anesthesia for caesarean section

Currently local anesthesia is the universally accepted standard. The operation is performed under spinal anesthesia or in a planned caesarean section with epidural-spinal anesthesia (see page 300). General anesthesia is recommended only in cases where other anesthesia is not possible for medical reasons.

When is a cesarean section done?

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

The birth is not going well. One of the main reasons why a caesarean section is done is that labor does not go well - it stops too slowly or stops altogether. The reasons for this are manifold. The uterus may not contract forcefully enough to fully dilate the cervix.

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

Heart problems can occur if the baby is not getting enough oxygen, the umbilical cord is clamped, or the placenta is not functioning well. Sometimes heart rhythm disturbances occur, but nothing indicates a real danger to the child. In other cases, a serious danger is obvious. One of the most difficult decisions for doctors is deciding how big this danger is. The doctor can try different methods, for example, massage the head, and see if the work of the heart improves.

The decision to have a caesarean depends on many factors, such as how long the birth will continue or how likely it is to have complications other than heart problems.

The unfortunate position of the child. If the baby enters the birth canal with the legs or buttocks forward, this is called a breech presentation. Most of these babies are born by caesarean section, because conventional births are more likely to have complications. Sometimes the doctor is able to move the baby into the correct position by pushing it through the abdomen before labor begins, thereby avoiding surgery. If the baby lies horizontally, this is called a transverse presentation and is also an indication for a caesarean section.

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

Before having a caesarean, your doctor may ask you to get on all fours - in this position, the uterus drops forward and the baby may turn. Sometimes the doctor may be able to turn the glans during a vaginal examination or with forceps.

You serious problems with health. A caesarean section may be done if you have diabetes, heart disease, lung disease, or high blood pressure. With such diseases, a situation may arise when it is preferable to give birth to a child for more early stage pregnancy. If induction of labor fails, a caesarean section may be necessary. If you have serious health problems, discuss your outlook with your doctor well in advance of your pregnancy.

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

You have a multiple pregnancy. Approximately half of twins are born by caesarean section. Twins can also be born in the usual way, depending on the weight, position and gestational age. Triplets and more are a different story. Most triplets are delivered by caesarean section.

Every multiple pregnancy is unique. If this is your case, discuss the prospects for childbirth 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 caesarean is necessary: ​​placental abruption and placenta previa.

Placental abruption occurs when the placenta separates from the wall of the uterus before labor begins. This can pose a threat to the life of both you and the child. If the electronic monitoring shows that there is no immediate danger to the baby, you will be admitted to the hospital and will be closely monitored. If the baby is in danger, an urgent delivery is necessary and a caesarean section will be used.

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

There are problems with the umbilical cord. When the water has broken, the cord can slip out of the cervix before the baby is born. This is called cord prolapse and is very dangerous for the baby. As the baby squeezes through the cervix, pressure on the umbilical cord can cut off oxygen. If the umbilical cord slips out when the cervix is ​​fully dilated and labor has already begun, you can give birth normally. Otherwise, only a caesarean section can save the situation.

Also, if the umbilical cord is wrapped around the baby's neck or is between the head and pelvic bones if water is out, each contraction of the uterus will compress the umbilical cord, slowing down blood flow and reducing oxygen supply to the baby. In these cases, a caesarean section best option, especially if the umbilical cord is squeezed for a long time or very hard. This common cause 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 usual way. The size of the baby can be a problem if you have an abnormally narrow pelvis that the head cannot pass through. Occasionally, this may be a consequence of a pelvic fracture or other deformities.

If you develop diabetes during pregnancy, your baby may gain very big weight. If the baby is too large, a caesarean section is preferable.

Child health problems. If the child is still mother's womb a defect such as spina bifida is diagnosed, the doctor may recommend a caesarean section. Discuss the situation in detail with your doctor.

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

How is a caesarean section

Before a planned caesarean section, the gynecologist or anesthesiologist will tell you in advance about the operation and methods of anesthesia. If you don't understand something, please clarify and ask again! On the appointed day, you must arrive at the hospital in advance. It is best to refrain from eating: you cannot eat for six hours before the operation.

First of all, the doctor and midwife will check your baby's condition with the help of ultrasound and CTG. Take this opportunity to express your wishes and ideas about the upcoming birth. Then the preparation for the operation will begin: your hair will be shaved off in the incision area, you will be put on compression stockings and spinal anaesthesia. Later, already in the operating room, the surface of the abdomen will be disinfected and a catheter will be inserted into the bladder. Before the operation begins, your entire body, with the exception of the abdomen, will be covered with sterile wipes. To prevent you from seeing what is happening and to prevent infection, the nurses will pull the sheet up to the level of your 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 begins to operate in full force, the doctor will make the first incision.

For cosmetic reasons, as well as for better wound healing, the skin is incised directly above the symphysis (pubic articulation) along 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 takes the abdominal muscles to 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 in the lower segment of the uterus with a scalpel. Now it remains only 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 sews up the wound. Meanwhile, your partner is already accompanying the child for the first examination. In total, the operation lasts from 20 to 30 minutes.

Misgav Ladach method

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

Risks of a caesarean section

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

Risks for you. Having a baby is always a risk. With caesarean section, it is higher than with conventional childbirth.

• Increased bleeding. On average, blood loss during a caesarean section is twice as much as during a conventional birth. However, a blood transfusion is rarely required.
• Reactions or anesthesia. Medicines used during surgery, including painkillers, can sometimes cause unintended effects, including breathing problems. In rare cases, general anesthesia can cause pneumonia if a woman inhales stomach contents. But general anesthesia is rarely used for caesarean sections, and care is taken to avoid such complications.
• Injury to the bladder or intestines. Such surgical injuries are rare, but they do occur during caesarean section.
• Endometritis. This is a complication that causes inflammation and infection of the membrane lining the uterus, most commonly after a caesarean section. This happens when bacteria normally found in the vagina enters the uterus. Urinary tract infection.
• Slow down bowel activity. In some cases, the pain medications used during surgery can slow down the bowels, causing 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 caesarean section than after a conventional birth. If left untreated, a blood clot in the leg can travel to 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 possibility of such an infection after a caesarean section is higher if you drink alcohol, 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 stitches.
• Placenta accreta and hysterectomy. Placenta accreta is attached too deeply and too firmly to the wall of the uterus. If you've already had a caesarean section, your next pregnancy is much more likely to have a placenta accreta. Placenta accreta is the most common cause of hysterectomy for caesarean section.
• Rehospitalization. Compared with women who gave birth vaginally, women who had a caesarean section were twice as likely to be admitted to the hospital a second time within the first two months after giving birth.
• Fatal outcome. Although the chance of dying after a caesarean section is very low - about two per 100,000 - it is almost twice as high as after a natural birth.

risk for the child. A caesarean section is potentially dangerous for the baby as well.

• premature birth. If the caesarean is of your choice, the child's age must be determined correctly. Premature birth can lead to respiratory failure and low birth weight.
• Breathing problems. Babies born by caesarean section are more likely to have a slight breathing problem - they breathe abnormally frequently during the first days after birth.
• Injury. Rarely, the child may be injured during surgery.

What to Expect During a Cesarean Section

Whether you have a caesarean section planned or done out of necessity, it will go something like this:

Preparation. To prepare you for the operation, some procedures will be done. In urgent cases, some steps are reduced or skipped altogether.

Anesthesia methods. An anesthesiologist may come to your room to discuss anesthesia options. Spinal, epidural and general anesthesia are used for caesarean section. 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. In a spinal anesthetic, an anesthetic is injected into the surrounding fluid. spinal nerves. With an epidural, the agent is injected outside the fluid-filled space. Epidural anesthesia is carried out within 20 minutes and lasts a very long time. Spinal is done faster, but only lasts about two hours.

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

Other preparations. Once you, your doctor, and anesthesiologist have decided which type of pain relief to use, preparations will begin. They usually include:

• intravenous catheter. An intravenous needle will be placed in your arm. This will allow you to get the fluids and medicines you need during and after your surgery.
• Blood analysis. Your blood will be drawn 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 greatly reduces the risk of lung damage if you vomit during anesthesia and the contents of your stomach enter your lungs.
• Monitors. During surgery, your blood pressure will be continuously monitored. You may also be connected to a heart monitor with sensors on your chest to monitor your heart and rhythm during surgery. A special monitor can be attached to the finger to monitor the level of oxygen in the blood.
• urinary catheter. A thin tube will be inserted into the bladder to drain urine to keep the bladder empty during surgery.

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

Preparation. If you are going to have an epidural or spinal anesthetic, you will be asked to sit with your back rounded, or lie on your side, curled up. The anesthetist will wipe your back with an antiseptic solution and give you an injection of pain medication. Then he will insert a needle between the vertebrae through the dense tissue surrounding the spinal cord.

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

If you require general anesthesia, all preparations for the operation will be made before you receive pain medication. The anesthesiologist will administer pain medication through an intravenous catheter. You will then be placed on your back with your legs fixed. A special pad may be placed under your back on the right so that your body leans to the left. This shifts the weight of the uterus to the left, which ensures its good blood supply.

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

The nurse will wipe the stomach with an antiseptic solution and cover it with sterile wipes. A tissue will be placed under the chin to keep the surgical field clean.

Section of the abdominal wall. 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 abdomen. Bleeding vessels will be cauterized or ligated.

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

The most common types of incisions:

• Low horizontal cut. Also called a bikini slit and runs in the lower abdomen along the line of an imaginary bikini panty, is preferred. Heals well and causes less pain after surgery. Also preferred for cosmetic reasons and allows the surgeon to clearly see the lower part of the pregnant uterus. b Low vertical cut. Sometimes this type of incision is preferred. It provides quick access to the lower part of the uterus and allows you to remove the baby faster. In some cases, time is the most important thing.
• Incision of the uterus. After completing the incision in the abdominal wall, the surgeon pushes back the bladder and cuts the wall of the uterus. The uterine incision may be the same or different type as the abdominal wall incision. It is usually smaller in size. As with an 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 at the bottom of the uterus is the most common, used in most caesarean sections. It provides easy access, bleeds less than higher incisions, and is less likely to damage the bladder. A strong scar is formed on it, which reduces the risk of rupture during subsequent births.
• In some cases, a vertical incision is preferable. A low vertical incision - in the lower part of the uterus, where the tissues are thinner - can be made with the baby positioned forward with legs, buttocks, or across the uterus (breech or transverse presentation). It is also used if the surgeon believes it will have to be extended to a high vertical incision - sometimes referred to as the classic. The potential advantage of the classic incision is that it allows easier access to the uterus to remove the baby. Sometimes a classic incision is made to avoid trauma 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 amniotic sac so that the baby can be born. If you are conscious, you may feel some twitching and pressure as the baby is pulled out. This is done in such a way as to keep the cut size as small as possible. You won't feel pain.

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

After birth. Once 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 themselves and do not require removal. For a skin incision, the surgeon may suture or use special metal clips to hold the edges of the wound together. During these activities, you may feel some movement, but no pain. If the incision is closed with clamps, they will be removed with special tweezers before discharge.

When you see the child. The entire caesarean section usually takes 45 minutes to an hour. And the baby will be born in the first 5-10 minutes. If you are awake and willing, you can hold the baby while the surgeon closes 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 his nose and mouth and perform the first Apgar score - a quick assessment of the baby's appearance, pulse, reflexes, activity and breathing one minute after birth.

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

If you choose to breastfeed your baby, you can do so for the first time in the recovery room if you feel like it. The sooner you start feeding, the better. However, after general anesthesia, you may not feel well for several hours. You may want to wait until you are completely awake and receive pain medication before feeding.

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 condition, stitches, urine output, and postpartum bleeding. Throughout your stay in the hospital, your condition will be closely monitored.

Recovery. Usually, after a caesarean section, they stay 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 any problems.

Pain. In the hospital, you will receive pain medication. You may not like it, especially if you are going to breastfeed. But painkillers are needed after the anesthesia wears off to make you feel comfortable. This is especially important in the first few days, when the incision begins to heal. If you are still in 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 may only be given ice cubes or a sip of water. When your digestive system starts working normally again, you will be able to drink more fluids or even eat some easily digestible food. You will know that you are ready to start eating when you can pass gases. This is a sign that your digestive system is awake and ready to get to work. You can usually eat solid food the day after surgery.

Walking. You will most likely be asked to walk around a few hours after the operation, if it is not yet night. You won't want to, but walking is healthy and an important part of your recovery. It will help clear your lungs, improve circulation, speed up healing, and get your digestive and urinary systems back on track. If you are bothered by bloating, walking will bring 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 discharge.

Vaginal discharge. After your baby is born, you will have lochia, a brownish or colorless discharge, for several weeks. Some women after a caesarean section are surprised by the amount of discharge. Even if the placenta is removed during surgery, the uterus must heal, and discharge is part of the process.

Incision healing. The bandage will most likely be removed the day after the operation, when the incision has already healed. While you are in the hospital, the condition of the wound will be monitored. As the incision heals, it will itch. But don't scratch it. It is safer to use lotion.

If the incision was connected with clamps, they will be removed before discharge. At home, take a shower or bath as usual. Then dry the incision with a towel or hair dryer on low heat.

Within a few weeks, the scar will be sensitive and painful. Wear loose clothing that doesn'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. While the wound heals, it will itch.

Restrictions. After returning home after a caesarean section, it is important to limit your activities in the first week and take care of yourself and your newborn first of all.

• Don't lift heavy things or do anything that puts strain on an unhealed belly. Maintain correct posture when standing or walking. Support your belly when you cough, sneeze, or laugh. Use pillows or rolled towels when feeding.
• Take necessary medications. The doctor may recommend pain medication. 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. Physical exercise can be very tiring for you. Give yourself time to recover. You also had an operation. Many women, when they start to feel better, find it difficult to adhere to the necessary restrictions.
• While fast movements hurt, don't drive. Some women recover faster, but usually the period when you should not drive a car lasts about two weeks.
• No sex. Abstain until the doctor allows - usually after a month and a half. However, closeness should not be avoided. Spend time with your partner, at least a little in the morning or in the evening when the baby is already asleep.
• When the doctor allows, start doing physical exercises. But don't be too zealous. Hiking and swimming - the best choice. 3-4 weeks after discharge, you will feel that you are able to lead a normal normal life.

Possible complications.

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

• The temperature is above 38 °C.
• Painful urination.
• Too much vaginal discharge.
• The edges of the wound diverge.
• The incision site is red or wet.
• Severe pain in the abdomen.

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 to have an urgent operation or a secondary caesarean section is made only when there really is no other way out, since this is associated with a high 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 has only a few minutes to prevent significant damage to the child's health. The obstetric team must take all measures to ensure that the birth takes place in the next 20 minutes. An interruption in oxygen supply that lasts longer than 10 minutes can damage the baby's brain.

As soon as the doctor decides on an emergency caesarean section, the introduction of anesthesia and the operation are carried out without delay and without long preparation. Surgical intervention can also be carried out in the delivery room, if there is enough space and the necessary equipment.

Women always hope that they will give birth with dignity, that they will be able to endure pain, sometimes even smile when they push for the last time, giving the child life. Many people try very hard to give birth naturally by choosing doctors who have few caesarean sections in their practice, go to pregnancy courses, play sports during pregnancy, trying to gain only the right weight, sometimes even hiring a doula to be nearby in the delivery room. However, there are a lot of caesarean sections, more than ever before.

How to deal with anxiety

No matter how hard you tried, whether you had normal pregnancy without complications, it may happen 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 far-sighted. Cesarean section is indeed a risk, like conventional operations, for example, during it, internal bleeding, blood clots appear, infection occurs or damage to internal organs occurs. Some babies have minor breathing problems after a caesarean section. But because surgical techniques and pain management have improved, there are very few dangers associated with a caesarean section, and of course giving birth, a healthy baby, is much more important than trying to give birth naturally.

Reasons for an emergency caesarean section

The most common indication for an emergency caesarean section is an unexpected incorrect position of the child (if it is located 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 reason for caesarean sections is the risk that the baby may not be able to deliver; if the child's cardiogram shows possible deviations, caesarean section will be safe and fast way give a birth to a baby.

Emergency caesarean section procedure

It may happen that everything will happen quickly and chaotically. The lower abdomen will be prepared for the operation. They will wash your belly, maybe shave your hair, and you will be given antibiotics and other intravenous fluids. Anesthesia will be either epidural (with a dose adjusted for caesarean section) or spinal, or maybe even general. If a woman is given an epidural or spinal anesthetic, she will feel nothing from her toes to her chest; while she will be conscious, but will not feel how the doctor makes 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 baby will be born very quickly.

Caesarean section of the woman's choice

Some healthy women choose to have a caesarean section at their first birth - usually to avoid pain and possible complications during childbirth. Sometimes the doctor will suggest a caesarean section so that the baby will be born at a time that is more convenient for the woman, the doctor, or both.

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

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

Is there a limit?

Many women successfully undergo up to three surgeries. 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 caesarean section. If you had a long and difficult labor prior to your first C-section, a second C-section will be physically easier, but the healing process will take just as long. For other women - who have developed large internal scarring - each subsequent caesarean becomes more and more risky.

Repeated 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 C-section can be a shock to both you and your partner. Your ideas about how you will give birth will suddenly change. Even worse, this news may come when you are already exhausted from long hours of contractions. And the doctor no longer has time to explain everything and answer your questions.

Of course, you will have concerns about what it will be like for you and your child during the operation, but do not let these fears completely control you. Most mothers and children successfully undergo surgery with a minimum of complications. While you might prefer to have a natural birth, remember that the health of you and your baby is more important than how it was born.

If you have concerns about a planned repeat caesarean section, discuss this with your doctor and partner. This will help you worry less. Tell yourself that you have been through this once before and you can do it again. This time it will be easier for you to recover from the operation because you already know what to expect.

Caesarean section: partner involvement

If the caesarean section is not urgent, requiring general anesthesia, your partner may come into the operating room with you. Some hospitals allow this. Some like the 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 decides to attend, he will be given surgical clothes. He can watch 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 the doctors can even take pictures for you. But in many it is not allowed. Therefore, you should ask permission to take photos or videos.

Cesarean section of choice

Some women who have a normal pregnancy choose to give birth by caesarean section even though they have no complications or problems with the baby. For some of them, it is convenient to precisely plan the date of birth. If you're used to planning everything in your life down to the minute, waiting for an unknown day for your baby's arrival may seem impossible.

Other women choose to have a caesarean section out of fear:

• Fear of the birth 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 something unknown and scary. You may have heard horror stories about childbirth and about women who, after childbirth, suffer from urinary incontinence when coughing or laughing. If you've had a vaginal birth before and it didn't go very smoothly, you may be wary of a repeat.

If you are inclined to choose a caesarean section, discuss this frankly with your doctor. If fear is your main motive, talking frankly about what to expect and going to prenatal school can help. If you are told about the horrors of childbirth, politely but firmly say that you will hear about it after your baby is born.

If your previous natural births have been such a terrible story, remember that all births are different and this time may be very different. Think about why the birth was so difficult and discuss it with your doctor or partner. 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 does not agree and will not perform a caesarean section, he may refer you to another specialist. Learn more about the advantages and disadvantages of both birth methods and discuss them with experts, but don't let fear be the deciding factor.

What should be taken into account?

Elective caesarean section is a tricky 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 positives. At the moment in medical literature there is no strong evidence that the choice of caesarean section is preferable. Good medical practice generally rejects procedures - especially surgical ones - that do not provide undoubted benefit to the patient. Moreover, there is little research on this subject.

Since everything is ambiguous, you may find that the opinions of doctors differ greatly. Some are ready for surgery. Others refuse, believing that a caesarean section could be dangerous and thus goes against their vow to do no harm.

The best way to make a decision is to collect 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.

Benefit and risk

Many experts believe that with the current level of development of surgical technology, a caesarean section is no more dangerous than a conventional birth if this is your first child. If this is the third birth, the situation is different. Caesarean section is more fraught with complications than conventional childbirth. 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 can lead to urinary or fecal incontinence and damage to the muscles and nerves of the pelvic floor.
• Medical evidence has shown that women who have had a caesarean section have a lower risk of urinary incontinence in the first months after childbirth. However, there is no evidence that this risk is lower 2–5 years after birth. Some women also fear that natural childbirth can cause pelvic organ 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 a caesarean section of choice is no guarantee that problems with incontinence and prolapse will not arise at all. The baby's weight during pregnancy, pregnancy hormones, and genetic factors can weaken the pelvic muscles. Such problems can occur even in women who have never had children.
• Emergency caesarean section guarantee. An emergency caesarean section, which is usually done during a difficult birth, is much more dangerous than an elective caesarean section or conventional birth. An emergency caesarean is more likely to cause infections, damage to internal organs, and bleeding.
• Warranty against difficult childbirth. Sometimes difficult labors require the use of forceps or vacuum suction. Usually these methods are not dangerous. Just as with caesarean 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 could reduce the risk of some problems in the baby. For example, the death of an infant during childbirth, pathology of labor due to the incorrect position of the fetus, birth trauma - which is especially important when the child is very large - and inhalation of meconium, which occurs if the child began to defecate before birth. It also reduces the risk of paralysis. However, it is important to remember that the risk of all these complications is quite low with conventional births, and a caesarean section is no guarantee that these problems will not occur.
• Less risk of transmission of infections. A caesarean section reduces the risk of mother-to-child transmission of infections such as AIDS, hepatitis B and C, herpes, and papillomavirus.
• Establishment exact date childbirth. If you know exactly when the baby is due, you can better prepare. It is also convenient for planning the work of the medical team.

Risk to the mother immediately after surgery

Certain inconveniences and dangers are associated with caesarean section. It will take longer to stay in the hospital. The average length of stay in the hospital after a caesarean is three days, after a normal birth - two.

Increased chance of infection. Because it is a surgical operation, the risk of infection after a caesarean is higher than after a conventional birth.

Postoperative complications

Since a caesarean 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 connection with the child and the beginning breastfeeding. For the first time after the operation, you will not be able to take care of the child and breastfeed him. But this is temporary. You will be able to bond with your baby and breastfeed as soon as you recover from the surgery.

Insurance payment

Your insurance may not cover a caesarean section of choice, and it will cost more than a conventional birth. Before making a decision, check if this operation is covered by your insurance.

Risks for the mother in the future

After a caesarean section, the following troubles are possible in the future:

future complications. With multiple pregnancies, the likelihood of complications increases with each subsequent pregnancy. Repeated cesarean 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 who have large internal scarring, the risk of complications with each subsequent caesarean section increases very significantly.

Rupture of the uterus in the next pregnancy. A caesarean section increases the risk of uterine rupture in the next pregnancy, especially if you choose to have a normal birth this time. The probability is not very high, but you should discuss this with your doctor.

Problems with the placenta. Women who have had a caesarean section have a higher risk of placental disorders, such as presentation, in subsequent pregnancies. In previa, the placenta closes the opening of the cervix, which can lead to preterm labor. Placenta previa and other related disorders caused by caesarean section greatly increase the risk of bleeding.

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

Damage to the intestines and bladder. Serious damage to the intestines and bladder during caesarean section is rare, but they are much more likely than during conventional births. Complications associated with the placenta can also lead to bladder damage.

Dangers for the fetus

Dangers for the child associated with a caesarean section:

• Respiratory disorders. One of the common problems in a child after a caesarean section is a slight breathing disorder called tachypnea (rapid shallow breathing). This happens when there is too much fluid in a child's lungs. When the baby is in the uterus, her lungs are normally filled with fluid. In normal childbirth, advancement along birth canal compresses the chest 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 results in rapid breathing and usually requires a pressurized supply of oxygen to remove fluid from the lungs.
• Immaturity. Even a little immaturity can have a very negative impact on the child. If the due date is inaccurate and the caesarean section is too early, the baby may have complications associated with prematurity.
• Cuts. During a caesarean section, the baby may get cut. But this rarely happens.

Decision-making

If your doctor does not accept your request for a caesarean section, ask yourself why. Physicians and surgeons have a duty to avoid unnecessary medical interventions, especially if they may be dangerous. The lack of scientific evidence to support elective caesarean section makes this operation unnecessary. Although, from the doctor's point of view, ease of planning, efficiency, and financial rewards favor a caesarean section, a doctor you trust should be at least reticent about this operation.