Optimal timing of the second caesarean section and possible difficulties.

Each pregnancy in a woman proceeds in a new way, not like the previous one. Childbirth, respectively, also goes differently. If for the first time the baby was born with the help of gynecological surgeons, this does not mean that now everything will happen according to the same scenario. What if there is a second caesarean section? What is important for a woman to know? Can surgery be avoided? These and some other questions will be answered in today's article. You will learn about how long a planned second caesarean section is, how the body recovers after manipulation, whether it is possible to plan a third pregnancy, and whether it is realistic to give birth on your own.

Natural childbirth and caesarean section

We will find out how it is carried out and what indications the second caesarean section has. What is important to know? The natural appearance of a child is a process conceived by nature. During childbirth, the baby goes through the appropriate paths, experiences stress and prepares for existence in the new world.

Caesarean section involves the artificial appearance of a child. Surgeons make an incision in the woman's abdomen and uterus, through which the baby is taken out. The baby appears abruptly and unexpectedly, he does not have time to adapt. Note that the development of such children is more difficult and more difficult than those that appeared during natural childbirth.

During pregnancy, many expectant mothers are afraid of the caesarean section. After all, the advantage has always been given to natural childbirth. A few centuries ago, a woman after a cesarean had no chance of survival. In earlier times, manipulation was carried out only in already deceased patients. Now medicine has made a big breakthrough. Caesarean section has become not only a safe intervention, but in some cases necessary to save the life of the child and mother. Now the operation lasts only a few minutes, and the possibilities of anesthesia allow the patient to remain conscious.

Second caesarean section: what is important to know about the indications?

What does the doctor pay attention to when choosing this route of delivery? What are the indications for a second intervention in the natural process? Everything is simple here. The indications for the second caesarean section are the same as for the first operation. Manipulation can be planned and emergency. When prescribing a planned caesarean section, doctors rely on the following indications:

poor eyesight in a woman;
varicose disease of the lower extremities;
heart failure;
chronic diseases;
diabetes;
asthma and hypertension;
oncology;
traumatic brain injury;
narrow pelvis and large fetus.

All these situations are the reason for the first intervention. If after the birth of the child (the first) the diseases were not eliminated, then the operation will be performed during the second pregnancy. Some doctors are inclined to this opinion: the first caesarean section does not allow a woman to give birth herself anymore. This statement is erroneous.

Can you give birth on your own?

So, you are recommended a second caesarean section. What is important to know about it? What are the real indications for the operation, if the woman's health is all right? Re-manipulation is recommended in the following cases:

child has;
after the first caesarean section, two more years have not passed;
the suture on the uterus is untenable;
during the first operation, a longitudinal incision was made;
abortions between pregnancies;
the presence of connective tissue in the scar area;
the location of the placenta on the scar;
pathology of pregnancy (polyhydramnios, oligohydramnios).

An emergency operation is performed with an unforeseen divergence of the scar, weak labor activity, a serious condition of the woman, and so on.

You can give birth on your own if a second caesarean section is recommended. What is important to know? Modern medicine not only allows a woman the natural process of childbirth, but also welcomes it. It is important that the expectant mother is carefully examined. Conditions for natural childbirth after caesarean section are the following circumstances:

more than three years have passed since the first operation;
the scar is wealthy (muscle tissue predominates, the area stretches and contracts);
thickness in the seam zone is more than 2 mm;
no complications during pregnancy;
a woman's desire to give birth on her own.

If you want a second child to appear naturally, then you should take care of this in advance. Find a maternity hospital that specializes in this matter. Discuss your condition with your doctor in advance and undergo an examination. Attend scheduled consultations regularly and follow the recommendations of the gynecologist.

Management of pregnancy

If the first birth took place by caesarean section, then the second time everything can be exactly the same or completely different. For future mothers after such a procedure, there should be an individual approach. As soon as you find out about your new position, you need to contact a gynecologist. A feature of the management of such a pregnancy are additional studies. For example, ultrasound in such cases is done not three times for the entire period, but more. Diagnosis before childbirth is becoming more frequent. The doctor needs to monitor your condition. After all, the entire outcome of pregnancy depends on this indicator.

Be sure to visit other specialists before delivery. You need to address to the therapist, the oculist, the cardiologist, the neurologist. Make sure there are no restrictions on natural childbirth.

Multiple and conventional caesarean section

So, you still scheduled a second caesarean section. At what time is such an operation performed, and is it possible to give birth to yourself with a multiple pregnancy?

Suppose that the previous delivery was performed surgically, and after that the woman became pregnant with twins. What are the predictions? In most cases, the outcome will be a second caesarean section. At what time do it - the doctor will tell. In each case, the individual characteristics of the patient are taken into account. Manipulation is prescribed for a period from 34 to 37 weeks. With multiple pregnancies, they do not wait longer, as rapid natural childbirth can begin.

So, you are carrying one child, and a second caesarean section is scheduled. When is the operation done? The first manipulation plays a role in determining the term. Re-intervention is scheduled 1-2 weeks earlier. If for the first time a caesarean was performed at 39 weeks, now it will happen at 37-38.

The seam

You already know at what time a planned second caesarean section is made. The caesarean is re-performed along the same suture as the first time. Many expectant mothers are very concerned about the aesthetic issue. They worry that the whole belly will be covered with scars. Don't worry, it won't happen. If the manipulation is planned, then the doctor will make an incision where he passed for the first time. The number of external scars you will not increase.

Otherwise, the situation is with the incision of the reproductive organ. Here, with each repeated operation, a new area for the scar is selected. Therefore, doctors do not recommend giving birth by this method more than three times. For many patients, doctors offer sterilization if a second caesarean section is scheduled. When they are admitted to the hospital, gynecologists clarify this issue. If the patient wishes, the fallopian tubes are ligated. Do not worry, without your consent, doctors will not carry out such a manipulation.

After surgery: recovery process

You already know about when the second caesarean section is shown, at what time it is done. Reviews of women report that the recovery period is practically no different from that which was after the first operation. A woman can stand up on her own in about a day. A newly-made mother is allowed to breastfeed a baby almost immediately (provided that illegal drugs were not used).

The discharge after the second operation is the same as during natural childbirth. Within one or two months, there is a discharge of lochia. If you have had a caesarean section, then it is important to monitor your well-being. Consult your doctor if you experience unusual discharge, fever, deterioration in general condition. They are discharged from the maternity hospital after the second caesarean section for about 5-10 days, as for the first time.

Possible Complications

With a second operation, the risk of complications certainly increases. But this does not mean that they will definitely arise. If you give birth on your own after a caesarean section, then there is a chance of a scar divergence. Even if the suture is well-founded, doctors cannot completely exclude such a possibility. That is why in such cases, artificial stimulation and painkillers are never used. It's important to know about this.

During the second cesarean, the doctor has difficulties. The first operation always has consequences in the form of an adhesive process. Thin films between organs make it difficult for the surgeon to work. The procedure itself takes longer. This can be dangerous for the child. Indeed, at this moment, potent drugs used for anesthesia penetrate into his body.

A complication of a second caesarean can be the same as the first time: poor contraction of the uterus, its inflection, inflammation, and so on.

Additionally

Some women are interested: if a second caesarean section is performed, when can I give birth for the third time? Experts cannot answer this question unambiguously. It all depends on the condition of the scar (in this case, two). If the seam area is thinned and filled with connective tissue, then pregnancy will be completely contraindicated. With wealthy scars, it is quite possible to give birth again. But, most likely, this will be the third caesarean section. The possibility of natural childbirth decreases with each subsequent operation.

Some women manage to give birth to five children by caesarean section and feel great. Much depends on the individual characteristics and technique of the surgeon. With a longitudinal incision, doctors do not recommend giving birth more than twice.

Finally

A caesarean section performed during the first pregnancy is not a reason for a second procedure. If you want and can give birth on your own, then this is only a plus. Remember that natural childbirth is always a priority. Talk to a gynecologist about this topic and find out all the nuances. Best wishes!

The birth of a child is a function inherent in a woman by nature itself. However, sometimes it is necessary to intervene in this process in the most persistent way, saving the health (and sometimes life!) of the mother and baby. One of these measures is a caesarean section, which, although it is used as an emergency, is still not some kind of tragedy and does not put an end to the woman's reproductive system.

Is a second caesarean section necessary for the next pregnancy?

Any surgical intervention in such a complex system as the human body leaves a certain mark. Caesarean is not only not an exception, but rather an eloquent example. And it's not even a scar on the upper tissues and skin, but mainly in the broken integrity of the uterus. A repeated pregnancy, in which the walls of the uterus naturally stretch, can lead to rupture of the suture and tragic consequences. Therefore, if a second birth is planned after a cesarean section, then it is very desirable to schedule them at least two (or even three) years after this operation. During this period of time, the uterus should recover and strengthen its walls. In the event that a very short period has passed after the operation, the second caesarean section is predetermined.

Subject to the basic rules, contrary to popular belief, a woman has a good chance to give birth to a child in a natural way. That is, the inability to give birth on her own in the last pregnancy does not mean that the mother will certainly have a second caesarean section. The doctor makes the decision on the actual method of childbirth based on the analysis of many factors, and more and more specialists give preference, if possible, to natural childbirth.

Indications for a second caesarean section

In fact, there are not many good reasons for doctors to prescribe a caesarean section for the second time, but none of them tolerate being taken lightly. The most common indications:

Diseases and conditions that carry a threat: diabetes mellitus, asthma, vision problems, hypertension (high blood pressure), recent traumatic brain injury, disorders of the cardiovascular and central nervous system, oncology;
Excessively narrow or deformed pelvis;
The outcome of the first cesarean - first of all, the state of the seam and its location;
Features of the fetus itself - unfavorable position, large size, as well as multiple pregnancy;
Overwearing, weak labor activity;
Abortions after caesarean;
Insignificant break between pregnancies;
Mother's age after 30-35 years.

The right of the final decision remains with the woman, but it should not be abused. Doctors are not interested in any way in the emergence of a threat to the life of the patient, and therefore they try to resort to the safest option for the woman in labor.

Features of the reoperation

A caesarean section for the second time is unlikely to promise a pregnant woman any surprises, but there are still some differences. A second operation usually takes longer, since the incision is not made along the entire skin, but along a rougher area - along the old seam. Plus, a second caesarean section requires more caution due to increased risks. Therefore, anesthesia will also be stronger.

Another feature of the second caesarean section is the period at which it is carried out. Often, difficult pregnancies are sought to end as early as possible to eliminate the risks that threaten the mother or her baby. The longer and stronger the walls of the uterus are stretched, the higher the likelihood of its rupture. However, if there are no obvious causes for concern, then the operation is carried out as planned - at 37-39 weeks or even later. Usually, a pregnant woman is offered to go to the hospital a little in advance - for preservation.

The consequences of the second caesarean section

The recovery of the body will take a little longer than after the first cesarean, the same applies to the seam. A second operation can significantly harm the female reproductive system. Often there are violations of the menstrual cycle and even the impossibility of conception in the future, i.e. infertility. But some women manage to maintain their reproductive function, which, unfortunately, is also dangerous.

Pregnancy after a second caesarean section is associated with a number of serious risks to the health and life of the woman and the fetus. Therefore, doctors not only do not recommend patients with such a history to plan children again, but also suggest sterilization after the second cesarean section. Such fears and the precautions associated with them, although justified, are not mandatory. There are examples when mothers quite safely produced both the third and the fourth "caesar". But in fairness it should be noted that not all women can boast of such truly good health. Risk is, of course, a noble cause, but saving oneself for already born children is perhaps a higher mission.

Before, then during a new pregnancy, you are likely to worry about whether you will have to have the operation again.

Keep in mind that about two-thirds of women who have tried after having a caesarean section have been successful. However, your doctor may recommend another caesarean section for you. Or maybe you yourself prefer this option for some reason. This is called a planned repeat caesarean section.

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

You had complications during pregnancy, such as, or breech presentation of the fetus.
During a previous caesarean section, you had a vertical incision in your uterus. It is done if the child is strong or lies across.
You have already had two or more cesarean sections.
Have you had during a previous birth (RCOG 2008) .

All this makes natural childbirth more risky. However, they are still possible. (RCOG 2007). If you really want to give birth yourself, talk to your doctor and ask them to tell you in detail about your options.

What are the cons of a planned repeat caesarean?

The risks associated with a caesarean section, which include quite serious complications, become higher with each operation performed. These include:

Adhesions are bands of scar tissue that appear during recovery from surgery. They can fasten the organs of the pelvis together or attach them from the inside to the muscles of the 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 each operation. If there is a lot of it, it will be difficult for the obstetrician to make another incision on your uterus, so the operation may take longer. In rare cases, the surgeon may accidentally incise the 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 cesarean is required. The risk of this complication increases with each operation performed.
Placenta accreta is a complication in which the placenta grows too deep and does not detach from the uterine wall to be released after the baby is born. Removal of the placenta in this case causes severe bleeding. Due to the potential threat to the life of the mother and child, this condition requires urgent treatment, possibly surgery. 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 caesarean section. However, placenta accreta is rarely found in women who have had fewer than three surgeries.
Babies born by caesarean section often have breathing problems, especially if the operation was performed before 39 weeks. The baby may need medical attention (RCOG 2008) . And this is more likely with a repeat caesarean than with vaginal delivery after a caesarean.

What are the benefits of a planned repeat caesarean?

Planned repeat caesarean section significantly reduces the risk (Guise et al 2010, RCOG 2008) life-threatening child. With a planned repeat cesarean, this is very rare. However, this is an infrequent occurrence in natural childbirth after a caesarean section.

Complications in late pregnancy in some cases can lead to. The chance of having a stillborn baby is very low, but a timely scheduled repeat caesarean section can reduce it even more.

After a planned caesarean, newborns are less likely to require mechanical ventilation than in the case of vaginal delivery after caesarean. In addition, during a caesarean section, a woman does not have to endure the pain of contractions, as in natural childbirth. However, after the operation, a painful seam remains, and for some time the stomach hurts.

If we talk directly about childbirth and the first time after, then a second cesarean section avoids the following troubles:

Pain in the abdominal muscles and discomfort due to hematomas and stitches in the perineum.
Severe bleeding after childbirth.
Urinary incontinence when you cough or laugh. (NCCWCH 2011)

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

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

If you have a planned second caesarean, then you know in advance the birthday of your child. It will be easier for you to prepare for the arrival of the baby and organize everything, especially if you need someone in your absence. In addition, it will be easier for you and your husband to plan your maternity leave and parental leave.

What if the birth starts before the caesarean?

If the caesarean section is scheduled for a specific date, such as a week before due date, labor may begin before that date. This happens to one woman out of ten. If it is confirmed that it is indeed childbirth, an emergency caesarean section is usually performed.

If labor is already in the active stage or if the pregnancy is short (less than 37 weeks), you may be advised to have a vaginal birth. The doctors will discuss your options with you so that you understand what is happening to you and your baby.

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

Before deciding to sterilization need to be thought through 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 will help you make the right decision. You need to communicate your intention at least a week before the caesarean section.

There are good reasons for not rushing into sterilization, postponing it for a while and thinking 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 carried out after childbirth.

Quite often, due to different reasons, a woman cannot give birth naturally. Then they use a caesarean section. If this is the second pregnancy after a cesarean section, then for the most part, delivery is also carried out. Therefore, often women who have previously had a similar operation ask about how long the second cesarean section is done and what determines the time of its implementation.

What is the time frame for a repeat caesarean?

Before determining how long to carry out a second caesarean section, doctors have to develop tactics for such an operation. For this you need:

Evaluate the scar on the wall of the uterus, which remained after the first caesarean. In cases where pregnancy occurred earlier than 3 years after the birth of the first child, then surgery for repeated delivery is simply necessary.
Clarify with the expectant mother whether there were any abortions or surgical interventions on the uterine cavity in the interval between the first cesarean and the second pregnancy. For example, the scraping of the endometrium sharply worsens the condition of the uterine scar.
Determine the number of fetuses in multiple pregnancy, as well as their location in the uterus and type of presentation. As you know, with multiple pregnancy, the uterine wall is overstretched, which also negatively affects the condition of the scar.
Also, in cases where the placenta is attached to the uterus in the area of the previous incision, surgery is the only way of delivery, because. high risk of uterine rupture.
In cases where a transverse incision was performed during the first birth, the second birth should also be carried out by caesarean section.

Taking into account all these factors, doctors decide on the time of the caesarean section. If we talk about how long the second planned cesarean is done, then, as a rule, this operation is scheduled 1-2 weeks earlier than the first time. In most cases, this is the 38th week of pregnancy. It is by this time that a surfactant begins to be synthesized in the baby's body, which helps to straighten the lungs at the first breath.

What are the dangers associated with a second caesarean section?

When carrying out such a repeated intervention, doctors have to take into account the fact that in most cases, after the first cesarean in the body of a woman, this circumstance somewhat complicates the course of the operation, and increases its duration, because. access to the uterus can be closed by adhesions formed between the organs of the small pelvis.

In addition, sometimes, when a second planned caesarean is done, there is a development of bleeding in the uterus, which is difficult to stop. In cases where blood loss is large, doctors decide to remove the reproductive organ, to save a woman's life.

We must not forget that during a cesarean, the fetus itself is in great danger. The medications used for anesthesia in some way affect the baby, especially if for some reason the operation is delayed (wrong presentation, the head is outside the small pelvis, etc.).

Thus, we can say that the determination of how long a woman will have a second planned cesarean depends on many of the above factors. In this case, as a rule, a woman will know in advance about the date of the operation, because. It also takes time to prepare.

The second pregnancy, which is completed by the second caesarean section, does not always proceed safely. In some women, the scar from the previous operation becomes very thin, as a result of which many are hospitalized in the maternity hospital 2-3 weeks earlier than the expected date of birth. At what time is the second caesarean section done and what difficulties await the woman?

Much depends on how the pregnancy went, and for what reasons the first operation was performed. For example, if a woman has severe myopia or there are violations of the fundus of the eye, then there are indications for a repeated caesarean section. And doctors will not let a woman go into independent childbirth. And if the first operation was performed due to a long anhydrous period, then natural childbirth is quite possible. But only if the condition of the scar on the uterus at the time of delivery is good and there are no other reasons for surgical delivery.

How is the second caesarean section, are there any features? Virtually none. At least for a woman. Although difficulties may arise if, for example, spinal anesthesia was used for the first time, after which women quickly leave. And the second time was general anesthesia for some reason. After general anesthesia, the recovery period is slightly longer.

Problems can also arise if a long period of time has passed between operations. That is, a woman is already over 30-35 years old. In this case, due to age, the risk of complications is higher. For example, there may be uterine fibroids, due to which the contractility of the myometrium decreases and subinvolution of the uterus is likely, followed by an inflammatory process - endometritis. With veins, many women experience problems with age. And this is the threat of thrombosis. For this reason, doctors recommend not removing compression stockings (bandages, stockings or stockings) after the operation, and wearing them for a few more days. And if there is pain in the leg, it turns red, swollen - urgently inform the doctor about this.

The good news is that the second cesarean is done along the same seam, which means that the woman will not have unnecessary cosmetic defects on the abdominal wall. If only high-quality suture material was used, and the surgeon neatly sewed everything up. A lot depends on the doctor and his experience. Then the seam after the second caesarean section heals no longer than after the first one. Wound care is important. In the maternity hospital, this is done by the medical staff. Treats with antiseptics, makes dressings. And at home everything is in the hands of women. How long a caesarean section heals for the second time will depend on the accuracy of following medical recommendations. Often, doctors do not advise at home to process the seam in any way. Just don't lift heavy things. And wash the seam with soap, but do not rub with a washcloth. Within a few months, all discomfort in the suture area should disappear.

When is a woman operated on again? It all depends on the indications for which the operation is performed. If there is nothing urgent, such as, for example, very high blood pressure that cannot be brought down with medication, then the second planned caesarean section is done at a period of 39-40 weeks, that is, as close as possible to the expected date of birth, calculated by the doctor based on the results of ultrasound in the early stages and date of the first day of the last menstrual period.
If a woman's pregnancy after a second cesarean proceeds with the threat of premature termination, and contractions begin, for example, at 35 weeks, then doctors try to help the woman carry the pregnancy to at least 37-38 weeks, at the same time they give injections for the rapid maturation of the lungs of the fetus. But if the amniotic fluid has departed or the condition of the fetus is poor, severe bleeding has begun - the operation is performed as soon as possible.

What is important to know about the second caesarean section to make it easier to survive everything? There are quite a few nuances. But those who have gone through this operation advise the main thing - to try to get up and move faster. This will help you recover faster. And if possible, do not get too carried away with painkillers.

And, of course, remember that this method of delivery does not detract from your feminine qualities, does not speak of your inferiority. You were able to carry a child. And the method of delivery is not so important. The main thing is that doctors act in the interests of you and the interests of the child.

Don't rush to check out. Be sure to do an ultrasound before discharge. If doctors see signs of an inflammatory process and an accumulation of lochia, they may suggest further treatment to avoid further reproductive health problems.