Caesarean section for the second time. List of relative indications

Before, then during new pregnancy you're probably worried about whether you'll have to have surgery again.

Keep in mind that about two-thirds of women who try after having a C-section have success. However, your doctor may recommend another cesarean section. Or perhaps you yourself prefer this option for some reason. This is called a planned repeat C-section.

From the point of view of specialists, a repeat cesarean section may be safer than a natural birth if:

You had complications during pregnancy such as breech birth or breech presentation.
During your previous caesarean section you had vertical section uterus. It is done if the child is lying heavily or lying across.
You have already had two cesarean sections or more.
You had it during a previous birth (RCOG 2008).

All of this makes natural childbirth riskier. However, they are still possible. (RCOG 2007) . If you really want to give birth yourself, talk to your doctor and ask for details about your options.

What are the disadvantages of a planned repeat cesarean?

Risks associated with a caesarean section, including quite a few serious complications, become higher with each operation performed. These include:

Adhesions are bands of scar tissue that appear during recovery from surgery. They can hold the pelvic organs together or attach them from the inside to the muscles abdominal wall. This can cause pain. Adhesions occur in half of women who have had a caesarean section. The probability increases to 75% if there were two cesareans and to 83% after three.
Scar tissue forms after every surgery. If there is a lot of it, it will be difficult for the obstetrician to make another cut in your uterus, so the operation may take longer. IN in rare cases the surgeon may accidentally cut bladder or intestines (NCCWCH 2011, RCOG 2008)
during future pregnancies. This complication occurs when the placenta partially or completely covers the cervix. As a result, another caesarean section is required. The risk of this complication increases with each operation performed.
Placenta accreta is a complication in which the placenta grows too deeply and does not detach from the wall of the uterus to be released after the baby is born. Removing the placenta in this case causes severe bleeding. Because of the potential threat to the life of mother and baby, this condition requires urgent treatment, Maybe - surgical intervention In some cases, surgery to remove the uterus (hysterectomy) is necessary. The risk of placenta accreta, which may require a blood transfusion or hysterectomy, increases with each C-section. However, placenta accreta is rarely found in women who have undergone less than three operations.
Babies born via Caesarean section often have breathing problems, especially if the operation was performed before 39 weeks. The baby may need medical care(RCOG 2008) . And this is more likely with a repeat cesarean than with a natural birth after a cesarean.

What are the benefits of a planned repeat cesarean?

Planned repeat caesarean section significantly reduces the risk (Guise et al 2010, RCOG 2008), dangerous to the child's life. This is very rare during planned repeat cesarean sections. However, this is an uncommon occurrence during natural childbirth after cesarean section.

Complications on later pregnancy in some cases can lead to. Probability stillbirth the baby is very small, but a timely planned repeat cesarean section can reduce it even further.

After a planned cesarean section, newborns are less likely to need artificial ventilation lighter than in the case natural birth after cesarean. In addition, during a cesarean section, a woman does not have to endure the pain of contractions, as during natural childbirth. However, after the operation a painful stitch remains, and my stomach hurts for some time.

If we talk directly about childbirth and the first time after, then a repeat cesarean section allows you to avoid the following troubles:

Pain in abdominal muscles And discomfort due to hematomas and stitches in the perineal area.
Heavy bleeding after childbirth.
Incontinence when you cough or laugh. (NCCWCH 2011)

In the long term, another caesarean section may reduce the small but very real risk of uterine prolapse. However, this depends on many factors:

Pregnancy can weaken muscles pelvic floor(NCCWCH 2012) and lead to nervous incontinence. Therefore, in any case, it is important to do exercises for the pelvic floor muscles, no matter how you plan to give birth.

If you are having a planned repeat cesarean section, then you know your baby's birthday in advance. It will be easier for you to prepare for the arrival of your baby and organize everything, especially if you need someone to help you in your absence. In addition, it will be easier for you and your husband to plan maternity leave and parental leave.

What if labor starts before cesarean?

If a caesarean section is scheduled for a specific day - for example, a week before the baby's birth date - labor may begin before then. This happens to one woman out of ten. If it is confirmed that this is indeed labor, an emergency caesarean section is usually performed.

If labor has already entered the active stage or the pregnancy is short (less than 37 weeks), you may be advised vaginal birth. Doctors will discuss with you possible options so that you understand what is happening to you and the child.

Is it possible to undergo sterilization during a planned caesarean section?

Before you decide to sterilization, you need to think about everything very carefully. This is a very big step. First of all, it is worth knowing about all the risks. You will need to consult with a specialist who can help you take the right decision. You need to inform about your intention at least a week before the caesarean section.

There are good reasons not to rush into sterilization, but to postpone it for a while and think it over carefully. You need to make sure that this is really what you want. In addition, the procedure is somewhat more effective if it is performed after childbirth.

Many expectant mothers have a stereotype in their heads - a caesarean section is done only in urgently, during childbirth, when nothing can be done. In fact, many contraindications to natural childbirth are identified early stages, and a woman can well prepare for such a development of events.

Naturally, you will have to prepare for such a serious step in advance, but everything is not as bad as you might think - modern medicine has stepped far forward, thanks to which the operation takes place without problems for the woman and the baby.

Before agreeing to an operation, it is worth finding out the answers to many questions: at what time is a planned caesarean section performed, how to prepare and what will happen after. It is advisable to focus on reliable sources, and not on reviews on forums - yes, you can find support on such resources, but in medical issues many of the mothers are incompetent, so it is better not to expose your unborn baby to danger again. Experienced doctors they know much better whether the patient needs surgery, and how best to carry it out so that everyone remains alive and healthy.

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About the conditions

Surgical intervention is not carried out for all women who have the causes from the lists below. On the contrary, they must undergo strict selection criteria, based on the results of which specialists decide whether it is worth risking the mother’s health or whether she can try to give birth herself. The criteria for the possibility of carrying out this operation are as follows:

the fetus must be fully viable;
woman or official representatives must consent to the operation;
the hospital must have a suitable operating theater with all the instruments and a suitably qualified surgeon;
absence inflammatory processes in the body.

Indications and contraindications

There are two types of indications for surgery (instead of allowing the woman to give birth in the usual way):

1. Absolute indications for caesarean section - situations in which a woman cannot give birth in any way, and inaction can lead not only to a difficult birth, but also to the death of the mother and child:

absolutely narrow pelvis, through which the patient will not be able to give birth, even if the doctors do everything possible. This pathology is revealed during another ultrasound examination, during which the expectant mother is informed that she will not be able to give birth in the usual way. Obstetricians clearly differentiate the level of pelvic narrowness (degrees 2-4 are considered unacceptable for normal childbirth);
mechanical obstacles due to which a woman will not be able to give birth on her own. This list includes various kinds tumors, melanomas, fibroids, etc. Deformation of the pelvic bones (for example, if this is the second birth, and the first was very difficult precisely because of this pathology) is also an important indicator;
threat of uterine rupture - if there are scars on the organ that could rupture, the doctor decides on a cesarean section. Of course, this does not happen right away - scars are also clearly visible on ultrasound, so specialists will have a lot of time to get acquainted with the problem and decide what they will do in a specific case;
problems with the location of the placenta (for example, previa - a condition in which it blocks the exit of the baby, or premature detachment) are also considered good reason start a caesarean section without waiting for labor.

2. relative indications for a planned caesarean section - a woman who has them can give birth herself, but usually the process itself is associated with an immediate danger to the health of the baby and the mother:

There are contraindications for vision. The doctor indicates for what vision conditions a cesarean section is recommended - as a rule, it is high myopia;
in stock chronic diseases genital tract, which can be transmitted to the baby during childbirth;
diseases not related to pregnancy, but which can significantly affect the patient’s condition during childbirth;
gestosis is a complication in which the internal organs of a pregnant woman stop working in normal mode, most often problems occur in the blood flow and blood vessels;
deterioration of the fetus due to hypoxia;
age over thirty-five with the obligatory presence of pathology;
too much large fruit, which may not pass through the birth canal, even if the woman’s pelvis is normal.

The indications for cesarean section were given above - but there are situations in which it is still better to refuse the operation, especially if absolute readings No.

a woman may experience purulent complications after the operation, because of which her life will be in danger;
the fetus is completely dead inside and nothing can be done;
after birth, the fetus will not live even a week due to deformities or malformations identified during the examination;
the fetus is too premature and will not be able to live normally after cesarean section (even taking into account the use of modern devices to maintain life);
fetal hypoxia, lasting a period long enough to establish death.

If there is a possibility of fetal death (even a small one), doctors should primarily focus on preserving the life of the mother - which means that surgery, which can lead to multiple complications, is no longer an option. If there are absolute indications, the woman is operated on in any case, and either the uterus is removed completely, or a series of procedures are performed aimed at preserving the possibility of childbearing ( latest technique appeared not so long ago and may not be used in all hospitals).

In any case, before prescribing treatment, the doctor must collect a complete medical history, highlight the pros and cons of the operation, and only then express his opinion.

How many weeks is a planned caesarean section performed?

It all depends on the reason why the woman was offered this option in the first place, and on whether this is the first cesarean. During the primary operation, there is no point in extracting the fetus before forty weeks - it is at this moment that the fetus is sufficiently developed to easily adapt it to environment and learn to breathe on your own. In rare cases, the doctor may lower the threshold, provided that tests and examinations show the viability of the fetus, and the mother’s condition requires emergency measures.

The second planned cesarean section can be performed a little earlier (at about 37-39 weeks), but if it is possible to wait, the baby is left until the last. The doctor’s final decision depends only on the condition of the pregnant woman.

If the patient is interested in how long a planned caesarean section will be performed in her case, she can contact her pregnancy-related doctor directly.

How to prepare for surgery?

For any planned surgery I want to come as prepared as possible, think through all the options and have the necessary things for the postoperative period. These tips should help expectant mothers who already know that they will not give birth themselves - by following them, they will make life much easier for themselves and the medical staff of the institution where they are during childbirth:

You should start preparing at home. They are doing a second cesarean section with anesthesia, so it is worth making the task easier for the anesthesiologist - there should be no polish on the nails, because their color can indicate any deviations from the norm in the reaction to anesthesia. Absolutely all jewelry is removed - there is no one to show off, doctors will be more interested inner world the patient and her health, and she herself is more likely to lose things dear to her after the operation;
It’s better to pack a bag with the necessary things in advance. It is necessary to plan your leisure time in the period after surgery before it. Typically, a woman and her child spend up to a week in the hospital, which means that it is necessary to collect vital items so as not to have to chase friends or relatives after them. The list usually includes:
all documents (personal and medical) that doctors may need;
usual hygiene products (without fanaticism - the simplest things are enough). If the patient is going to leave the maternity hospital herself, you can take cosmetics, but use them only on the day of discharge;
telephone - to keep loved ones informed of events;
comfortable underwear, nightgown, slippers. If it happens in winter, you can bring a warm sweater and pants made from natural materials;
clothes and everything necessary for the child;
clothes in which the woman will go home (you can bring them a little later, closer to discharge);
The intervention is planned, so everything is done on the last day, but some pregnant women are asked to arrive at least a day earlier so that the doctor has time to collect the analysis. This will also allow the patient to better control herself by not consuming foods prohibited before surgery. Some people have a negative attitude towards the idea of arriving a day earlier, not wanting to spend an extra hour in the maternity hospital. This is a fundamentally wrong approach - it’s better to get to know the specialist in advance who will manage everything; the nurses and nurses who perform caesarean sections (at least help during and after them) are also very important, so it’s better to make friends with them, trying not to to be rude;
The last time the patient can eat is eight hours before the operation, and the food should be quite simple: a light dish without spices or salt. Many hospitals provide meals, but if this is not the case, or the woman arrives too late, she can bring some food with her, the list of which is agreed in advance with the obstetrician-gynecologist who is in charge of the operation.

The essence of the method

Previously, caesarean sections were performed only under general anesthesia, but now there are options with epidural anesthesia. When is surgery performed under general anesthesia? If the patient is unable to calmly bear the sight of blood, or there is a risk of complications during the operation, then it is easier to let the woman fall asleep until the end of the operation.

On the plus side local anesthesia I would like to note the closer connection between the mother and the baby; she will hear his first cry and will be able to hold him in her arms in the operating room.

In addition, it turns out that the woman is at least somehow involved in the birth process, which greatly increases the chances of restoring maternal instincts in the future. Epidural anesthesia does not have such a strong effect on the general condition of a person, thanks to which a woman in labor can recover much faster after surgery. There, those who are afraid to look at their own internal organs should not be afraid - nothing is visible, a special barrier is installed in front of the patient’s chest.

The duration of the operation usually does not exceed forty minutes, and the child must be removed in the first five to seven minutes. During this time, doctors:

cut the abdominal wall, uterus and bladder around the fetus;
the child is taken out through the incision and handed over to the midwife, who performs all the necessary manipulations with him;
the doctor should squeeze out the placenta at this time;
the remaining time is spent suturing the uterus with special threads, which will dissolve on their own after some time. A sterile dressing, and on top of it - a cold compress;
further participation of doctors in the patient’s life is limited to periodic rounds, monitoring the condition and timely response to possible complaints. At the same time, the woman may be “guided” by a completely different surgeon than the one who performed the operation on her - this is worth taking into account.

Postoperative period

The operation itself is not complicated, but this does not mean that after a cesarean section the patient will immediately be able to run and exercise everyday affairs. Some time must pass: ideally, the first eight hours after surgery (especially if you used general anesthesia) it is better to lie down and then try to get up with the help of a nurse (provided that the doctor allows it). Some women are not able to care for the baby themselves in the first days after the operation, but there is nothing wrong with that - specially trained nurses will look after the child.

For about a day after surgery, it is better to refuse any food, and for the second day, chew crackers with water, drink porridge or thick soup.

Before eating any food, it is better to clarify whether it is safe to eat now or whether it makes sense to wait a few more hours. You can feed the baby already in the first hours - if possible.

The most important thing is not to be shy about asking for help. Medical staff can solve almost any problem. If you ask the nurse, she will help you get up, the doctor will advise you on any strange sensations(it is recommended to monitor the condition of the wound yourself, without touching the bandage with your bare hands - if there is too much blood or pus on it, you need to inform a specialist) - in general, you should not leave it in trouble.

Common Myths

Unfortunately, many women do not understand under what indications a cesarean section is performed, and look at this operation as a way to get rid of a difficult labor process. All this is because during pregnancy they only read positive reviews about Caesarian, losing sight of obvious things. Myths or truth?

1. Caesarean section is absolutely painless, unlike normal childbirth. This is absolutely not true: yes, during the operation the patient does not feel anything, but then, when the action will take place anesthesia, the pain will return. Some note that the pain does not go away until several months - and this takes into account the fact that the woman will still need to monitor the children during this period;
2. A planned caesarean section is good for the child because he does not go through a tight birth canal and does not receive birth trauma. On the contrary, any baby born not naturally, by default is considered traumatized during childbirth, because after a cesarean it is much more difficult for him to adapt to the world around him. According to statistics, such children master primary skills much worse, such as screaming, swallowing, etc.;
3. thirty years or more is too old to give birth on your own - no, and again no, the doctor is guided not by the patient’s passport data, but by what indications and contraindications are currently available;
4. It doesn’t matter how many weeks a cesarean section is performed - in fact, if there are no indications for urgent surgery, a specialist may suggest waiting until the fortieth week. How better baby will be developed, the easier it will be to care for it in the future;
5. If a woman had a caesarean section before, she should always give birth through surgery, and nothing else. A scar on the uterus can make it difficult birth process, but in some cases a repeat cesarean section is not justified. By using modern means diagnostics can tell you exactly how the patient will behave during natural childbirth and whether surgery can be prescribed.

Conclusion on the topic

A caesarean section is not scary at all. If there are any contraindications to natural childbirth, and doctors indicate that in the case of a planned cesarean section there is a chance of giving birth healthy child a woman has much higher, she should do right choice and abandon normal childbirth. Not a single critic who will be indignant at the fact that the patient refused a normal birth will support her later in difficult times if the result of refusing the operation is the birth of a sick child or serious problems with health.

Specialists can accurately say how many weeks a planned caesarean section is performed, for what indications and how it all ends. If the patient cannot decide, she should once again talk to her gynecologist and ask him professional opinion- this will allow you to make a more informed decision.

Previously, women did not have the opportunity to give birth to a baby on their own after a caesarean section. But now everything has changed. A second cesarean section (if there is no indication for it) is sometimes more dangerous than a normal birth due to the high risk of bleeding and other complications. Because of frequent occurrence adhesive processes are sometimes difficult to perform. But to say that after surgery any woman can subsequently give birth to a child herself is fundamentally wrong. Each case is approached individually and, if there are no contraindications, the woman is prepared for normal childbirth.

Repeated caesarean section, ideal spacing for childbirth

The ideal time interval between two pregnancies is considered to be an interval of 2–3 years. During this period it overgrows postoperative scar on the uterus after a cesarean section, its reproductive functions are restored. During this period, unnecessary pregnancy should be avoided due to the fact that after an abortion, natural childbirth will most likely be impossible. Most best option, if the scar on the uterus is not noticeable, the longitudinal position of the fetus, cephalic presentation, the real pregnancy is full-term, the placenta is located away from the scar on the uterus.

Contraindications for childbirth after cesarean section

There are several reasons for contraindications to childbirth after a cesarean section:

vertical scar after cesarean section (it often ruptures during childbirth);
large (weighing over 3500 kg) child;
abortions or miscarriages; a long interval between pregnancies (after 5–6 years, the scar becomes coarser and can rupture during labor);
complications after a previous operation;
developmental features real pregnancy– placenta accreta in the area of the suture, its presentation,
gestosis,
narrow pelvis

When can you plan a repeat caesarean section, in what week?

From 35 weeks, pregnant woman undergoes ultrasound examination using a vaginal sensor. After this procedure, you can already find out whether the woman will be able to give birth to a baby. naturally. After a thorough examination of the pregnant woman, the doctor obstetric department makes a verdict: natural birth or repeat CS surgery.

It may be better to choose a natural birth rather than a repeat cesarean section, watch the video.

If a woman is allowed to give birth naturally, then childbirth should be carried out without stimulation of labor, so as not to provoke rupture of the scar. During childbirth with special attention They monitor both the condition of the mother and the condition of the baby; for this, CTG and ultrasound are performed.

It is quite possible that during the birth process something will go wrong and there will be a need to resort to surgery again. Repeated caesarean section is performed in at 38 weeks. This sometimes happens and the mother should be prepared for this, it is advisable that the c-section be planned if you decide to do it.

Waiting for a baby is a pleasant and exciting time, especially if you had to give birth for the first time through surgery. Many women who are planning to become mothers again experience the desire to give birth to a second child on their own.

Is the risk worth it?

The doctor will help

Upon admission repeat pregnancy after cesarean to the expectant mother It is worth registering as early as possible antenatal clinic and tell the doctor in detail about your feelings. A suture on the uterus - the result of an operation - sometimes causes complications during pregnancy:

– placenta previa (location of the placenta in lower parts uterus, which often leads to bleeding);
– ingrowth of the placenta into the body of the uterus in the area of the scar;
– spontaneous termination of pregnancy.

Therefore, you need to be especially careful about your health, listen to yourself and, at the slightest suspicious sign, consult a doctor. Remember that the key to a successful pregnancy and safe birth– a trusting relationship with your obstetrician-gynecologist.

It is worth looking for an experienced doctor who approves of natural childbirth and will support you in your desire to have a baby on your own. By the way, there are more and more such doctors. If 20 years ago the postulate was widespread among gynecologists: “Once a cesarean section, always a cesarean section,” now many do not consider a scar on the uterus a contraindication to natural childbirth.

Risk area

Natural birth after surgery is a high-risk birth. The danger lies in the possibility of suture divergence on the uterus, which, if timely qualified assistance can lead to very disastrous results.

For this reason in obstetric practice doctors for women with a scar on the uterus for a long time They were not allowed to give birth on their own. Nowadays natural births are successfully carried out in some maternity hospitals.

Modern equipment and diagnostic methods allow us to count on favorable outcome, giving the mother the opportunity to feel the joy of giving birth to a child in a natural way, laid down by nature itself.

Moreover, today some doctors consider natural childbirth after cesarean even safer than repeated surgery.

Skyline

During a caesarean section, a transverse (horizontal) incision of the uterus is often made. In this case, the scar is less likely to rupture than with a corporal (vertical) incision.

For complete healing of the suture on the uterus, its restoration reproductive function and the possibility of natural childbirth requires at least two years after surgery.

However, repeat pregnancy should not be postponed for long: five to six years after a cesarean section, the scar will “harden” and lose elasticity.

The condition of the suture on the uterus depends on the type of tissue from which it consists: elastic muscle tissue withstands heavy loads, and connective tissue in the area of the scar does not have the ability to stretch, it can simply burst - in late pregnancy, during contractions or attempts during childbirth.

The term "partial seam dehiscence" refers to a condition in which part of the seam has begun to unravel. In this case, continuation of natural childbirth is impossible; emergency delivery is necessary by reoperation.

If a seam divergence does occur, a qualified doctor urgently carries out operative delivery, helping to give birth to a child and not depriving the woman of the opportunity to become pregnant again in the future.

Important decision

To give birth or not to give birth yourself after a cesarean section is a decision that is literally vital. First of all, the mother HERSELF must want to give birth and experience this incomparable feeling. Of course, in addition to desire, there are also medical indications.

So, what are gynecologists guided by when deciding on the possibility of natural childbirth after cesarean section? There are a number of conditions, if simultaneously met, gynecologists recommend giving birth on your own.

1. Weight of the baby (the baby should not be too large and heavy, corresponding to the size of the woman’s inner pelvis).

2. Position of the baby (the baby should be in a cephalic position).

3. The child’s well-being.

4. Condition and location of the suture (a woman is advised to give birth on her own if she has only one transverse scar on the uterus in the lower segment).

5. The location of the placenta, which should be located outside the scar on the uterus.

6. The consistency and “age” of the scar ( painful sensations in his area are unacceptable, at least two years must pass from the time of the first operation).

7. Absence from mom serious pathologies and multiple pregnancy. Repeated surgery is considered more dangerous for the mother than natural childbirth due to increased risk occurrence of bleeding.

Such an operation is technically somewhat more difficult, since the first cesarean could cause severe adhesive process internal organs. After a second cesarean section, the risk of complications and spontaneous termination of a third pregnancy increases.

And, of course, we are no longer talking about natural childbirth after the second cesarean. Children from subsequent successfully full-term pregnancies will also be born operationally: Caesarean section is performed with two or even three scars on the uterus.

Under control

Before “letting” the patient go into labor, she is carefully examined, the scar is diagnosed, all sorts of tests and ultrasounds are done, how the baby feels is monitored using CTG (cardiotocography is an assessment of the condition of the fetus, based on recording the heart rate, which allows identifying hypoxia and some other health problems for the baby).

Independent childbirth after the first cesarean section should be literally natural.

That is, it should proceed almost perfectly, without requiring medical intervention. It is necessary that they begin on their own, without stimulation, so that the opening of the cervix occurs systematically, labor activity was not weak.

Anesthesia is highly undesirable.

You've probably heard about the concept of natural childbirth, whose proponents prefer not to interfere with the natural (and even sacred) process of the birth of a new life... Now you will have the opportunity to feel the fullness of the sensations of this action - from the seemingly unreal pain to the inexpressible happiness of birth.

The inadmissibility of medical intervention has objective grounds. For example, the administration of stimulation, which is often used in normal birth, impossible due to lack one hundred percent certainty in the consistency of the scar. After all, weak labor can also be a consequence of suture divergence. Therefore, if the birth is prolonged and the baby is suffering, then instead of oxytocin, the doctor, as a rule, offers the mother surgery.

The use of painkillers is also undesirable, since it can hide the picture of the beginning of uterine rupture, since one of its main symptoms is pain along the scar during palpation.

During childbirth, continuous CTG is performed - research, monitoring general condition mommies. Ultrasound is used to assess the consistency of the scar. To connect the CTG device, a supine position is required. Mom needs to try to get more comfortable on her side in order to endure contractions.

When preparing to give birth to a second child on your own, you need to be aware of the complexity of the upcoming process and be confident in yourself.

However, one should not forget about the theory of probability and psychologically prepare for the fact that in the event of unforeseen complications, the baby may be born by caesarean section. After all, the most important thing is the life and health of mother and baby. And doctors think about this first of all.

Almost every woman faces the most difficult and at the same time the happiest day of her life. Namely, happy birthday to your baby. Childbirth is considered a natural process that ends the pregnancy period by freeing the uterine cavity from the fetus and placenta, with the help of birth canal. Childbirth that is physiologically considered to be at term is if it occurs during pregnancy at a period from 37 weeks to 41-42 weeks.

The duration of labor is strictly individual. As a rule, for a woman who gives birth for the first time, the duration of labor is slightly longer than for a woman giving birth repeatedly. So, on average it is considered normal:

primiparous women - up to 11 hours;
multiparous - up to 8 hours.

If labor lasted less than 6 hours for a primiparous woman, and less than 4 hours for a multiparous woman, then such labor is considered rapid. Childbirth is divided into several periods:

the first is disclosure;
the second is the birth of the child itself;
the third is the release of the placenta.

The baby can also be born by caesarean section. Caesarean section means surgery artificial delivery. In this case, the uterine cavity is freed from the fetus and placenta through an incision in the anterior abdominal wall and the body of the uterus.

A caesarean section is prescribed when a woman cannot give birth naturally due to medical reasons or in case of emergency. Also, a caesarean section can be prescribed in case of intrauterine death of a child, when heavy bleeding, to save the woman. Indications for caesarean section differ from planned and emergency.

Planned ones include:

narrow pelvis in relation to the size of the fetus;
abnormal placenta previa;
gynecological diseases that can interfere natural process childbirth, these include, for example, uterine fibroids;
scar on the uterus (after surgery, after cesarean section);
existing diseases that are not related to pregnancy; These include: pathology of the organs of vision, diseases of the cardiovascular system, genitourinary system (kidneys);
severe medical history during pregnancy - gestosis;
incorrect presentation of the fetus;
multiple pregnancy;
infection with genital herpes in the 3rd trimester of pregnancy;
varicose veins of the lower extremities;
oncology;
previously received traumatic brain injury.

TO emergency indications include:

sluggish labor;
complete cessation of labor;
premature placental abruption;
threat of uterine cavity rupture;
acute fetal hypoxia;
complications during childbirth that can threaten the life and health of both the woman and the fetus.

Second caesarean section

A second caesarean section is prescribed for both planned and emergency indications. Same as for the first cesarean intervention. These include: first delivery by caesarean section.

Nowadays in medicine more and more more cases When a woman has had her first cesarean section, she is scheduled to give birth naturally in case of a repeat pregnancy.

A second caesarean section is prescribed after a thorough examination of the pregnancy history and after a complete examination of the woman. The woman’s age is also taken into account. Recommendations for reoperation are considered:

age over 35 years;
features of the postoperative suture;
general health of the woman;
abortions between cesarean and real pregnancy;
features of the course of pregnancy.

If there are no indications for surgery, then the woman is allowed to give birth naturally.

Is it possible to give birth on your own after your first caesarean section?

Currently, it is legal to give birth on your own after your first caesarean section. For this it is necessary thorough examination pregnant woman. There are a number of indicators that are favorable conditions for natural childbirth. These include:

the first caesarean section was at least 3 years ago;
the scar is completely wealthy;
thickness in the seam area is more than 2 mm;
there are no complications during pregnancy monitoring;
directly the desire of the woman.

But we should not forget that at present not all births at home are able to carry out delivery naturally, after the first cesarean section. That is why, if you want to give birth on your own. Then you need to prepare in advance, talk in this topic with your doctor, and choose a birth center that specializes in this issue.

Introduction of pregnancy

If you are registered for your second pregnancy, then do not forget that there cannot be two absolutely identical pregnancies. Monitoring the second and subsequent pregnancies after the first cesarean section occurs a little differently.

Additionally, the following examinations are introduced for women:

Ultrasound examination is prescribed more than 3 times during the entire pregnancy;
more frequent diagnosis in the 3rd trimester of pregnancy;
constant control of the uterine scar.

Introduction of pregnancy is the key to successful childbirth

How to prepare

If you already know for sure that you are scheduled for a caesarean section, then you need to approach it correctly. at this moment. Proper preparation will allow you not only to prepare your body for the difficult upcoming operation, but also to prepare yourself psychologically. All these are important facts for successful operation. For proper preparation recommended:

During pregnancy

Regularly attend school for expectant mothers, especially on the topic “Caesarean section”.
Prepare to remain in the hospital for at least 6 days after the operation. That is why plan in advance with whom and where you can leave your older children. If there are animals, who will take care of them.
Think over the question of how you will give birth. You may want your husband to be present at the operation. What kind of anesthesia will you be given?
Visit your doctor regularly.
Don’t be shy and ask your doctor about all your questions.
You need to agree in advance with 2.3 people. In order for them to donate blood at a blood transfusion station. Since every operation carries a risk of bleeding and this requires donor blood.

A few days before surgery

Prepare all the necessary things for the hospital for yourself and your unborn child. For myself, this is all standard: a robe, clothes, hygiene items, postpartum pads, breast pads, replacement shoes. And for the baby, you need to look on the website for the home where you will give birth.
For 2 days you need to give up solid foods and fried foods. From foods that can lead to bloating.
Get a good night's sleep and rest.
Do not take any food or water for 12 hours.
Shave thoroughly.
Prepare non-carbonated water.
Fully charge your phone.

Preparing for a second cesarean section provides an opportunity to get your body in order and prepare it for surgery.

How is the operation performed?

The woman who has already passed this procedure usually asks: “Is there a difference in performing the 1st cesarean section and the 2nd cesarean section?” — No, all stages of the operation remain the same.

Operation stages:

Prenatal period:

cleansing enema;
consultation with an anesthesiologist;
consultation with an obstetrician-gynecologist;
changing into special clothes;
measurement of blood pressure, fetal CTG;
the nurse examines the pubic area and shaves if necessary;
a catheter is installed in a vein, a catheter is installed in the urethra;
administration of anesthesia.

Surgical stage:

an incision is made along the seam from the previous cesarean section;
cauterization of ruptured vessels;
suction of amniotic fluid;
fetal extraction;
suturing the uterus and skin;
applying a bandage;
administration of drugs to contract the uterus;
applying ice to the stomach.

After this, a sedative is usually administered and sleeping pills, which help a woman to rest after surgery.

At this time, the baby is examined by a neonatologist and medical staff.

Timing of cesarean section for singleton and multiple pregnancies

In this situation, the operation is prescribed individually. Since a multiple pregnancy is always big risk. Many factors are taken into account and individual characteristics. Generally, surgery is scheduled between 34 and 37 weeks. Doctors usually don’t wait longer than 37 weeks. So this is a huge risk that rapid emergency labor may begin.

When determining the timing of the second cesarean section, doctors take into account what week the operation was performed during the first pregnancy - 1-2 weeks are “subtracted” from this value. If the first time a cesarean was performed at 39 weeks, now it will happen at 37-38.

How to make a suture during a second caesarean section

With a planned repeat cesarean section, the suture is made exactly along the suture that was previously. This way there will be no visible second seam. But the direct incision of the uterus itself is selected in a new area of the reproductive organ.

Recovery period

After the operation, the woman is observed in the ward for 12 hours intensive care. After 12 hours you can already get up and walk. Breastfeeding is allowed within 24 hours. I recommend that a woman put her baby to her breast more often.

Every day, medications are prescribed to contract the uterus. Painkillers are administered 2-3 days after surgery. Drink plenty of plain, non-carbonated water.
Doctors recommend immediately putting on a postpartum bandage.
Every day the gynecologist examines you and palpates your stomach.
On days 5-6, the bandage is removed, the stitch is examined, an ultrasound is performed, and then it is decided when to prepare you for discharge.

Uterine discharge continues until 1-2 months after birth. After discharge, it is recommended to see a gynecologist 10 days later to examine the suture. And after 1 month, do a control ultrasound of the pelvic organs.

If, after being discharged from the maternity hospital, your temperature has risen and your discharge has begun to increase, then you should immediately consult a doctor.

Possible complications

With each new operation, the risks of complications increase. But this does not mean that they will necessarily exist. Complications can occur both after the first and after the second cesarean section. They are no different from each other.

Complications include:

scar dehiscence;
adhesive process;
poor uterine contraction;
inflection of the uterus;
inflammatory process of the pelvic organs;
large blood loss;
endometritis.