In what year did caesarean sections begin? C-section

HISTORY OF CESAREAN SECTION

Caesarean section has been a part of human culture since ancient times. According to Greek mythology, Apollo took out Asclepius, the founder of the famous cult religious medicine, from his mother's belly. A large number of links to C-section exists in history ancient india, Egypt, Greece, Roman state, China.

To this day, the history of caesarean section remains shrouded in myth and raises doubts about its accuracy. In ancient times, the procedure was only performed when the mother was dead or dying in order to save the child. Roman law under Caesar stated that all women who were doomed to die in childbirth should be “dissected,” i.e. Caesars. It is believed that the origin of the term “Caesarean” is associated with the birth of Julius Caesar this way. However, another origin of the word is also considered. Perhaps this is the verb "caedare," meaning to cut, and the term "caesones" which was applied to newborns born through post-mortem surgery.

Until the 16th and 17th centuries, the procedure was known as Caesarean surgery. It began to develop following the publication in 1598 of Jacques Guillimeau of a book on obstetrics in which he introduced the term “section”. Increasingly after this, the term “section” replaced the term “operation”. For a long time, surgery was the measure resorted to in last resort, and it was not intended to save the life of the mother, and only in the 19th century such an opportunity arose. There are, however, isolated early reports of heroic efforts to save the mother's life as a result of the operation. It is possible that the very first information regarding mother and child surviving a caesarean section came from Switzerland, where in 1500 pig castrator Jacob Nufer performed the operation on his wife. After several days of labor and the assistance of 13 midwives, the woman was unable to give birth to her child. Her desperate husband eventually received permission from the elders to attempt a caesarean section. The mother survived and subsequently gave birth normally to 5 more children, including twins. The Caesarean baby lived to be 77 years old.

Thanks to his work in animal husbandry, Nufer had, albeit minimal, knowledge of anatomy. The development of anatomy subsequently served as a significant stimulus in the development of surgery and cesarean section as well. During the 16th and 17th centuries, a large number of works appeared that illustrated in detail human anatomy, in particular the female pelvis.

Caesarean sections were not only performed in Europe. In the 19th century, travelers to Africa reported cases of local healers successfully operating on their own medical methods. In 1879, for example, an English traveler witnessed a caesarean section performed by a Ugandan. The healer used banana wine to make the woman semi-intoxicated and disinfect his hands and her stomach before surgery. He used a midline incision and cauterized it to stop the bleeding, then massaged the uterus to make it contract, but did not stitch it up. The abdominal wound was fastened with metal needles and closed with a paste made from roots. According to eyewitnesses, the patient recovered.

The development of cesarean section was directly related to the successes of general surgery. In the early 1800s, when surgeons still relied on old methods, they were feared and treated little better than barbers, butchers, or teeth pullers. Although most surgeons had anatomical knowledge, they were limited by patient pain and the problem of infection. Surgery continued to be a barbaric discipline, and the best surgeons determined by the speed with which they could amputate a limb or stitch up a wound. New era surgical practice began in 1846, when dentist William T.G. Morton used ether to remove a tumor on his face. This method of anesthesia quickly spread throughout Europe. In obstetrics, the method also became widespread, especially after chloroform was used in the labor of Queen Victoria at the birth of her two children (Leopold in 1853 and Beatrice in 1857).

Anesthetics allowed surgeons time to perform operations more accurately and gave them the opportunity to learn from their experience. Women, on the other hand, were freed from suffering during surgery and were less susceptible to shock, which was one of the leading causes of postoperative mortality and morbidity. Despite our successes, the mortality rate from the operation remained high, and the reason for this was infection. Before the germ theory was accepted infectious diseases and the advent of modern bacteriology in the second half of the 19th century, surgeons operated in their street clothes. In the mid-1860s, English surgeon Joseph Lister introduced an antiseptic method using carbolic acid. Subsequently, measures were developed to maintain cleanliness during surgical operations. At the end of the century, antisepsis and asepsis made it possible to solve many problems of surgical infection.

Surgical techniques of the time also contributed to the high maternal mortality rate. So in Paris, according to one source, during the period between 1787 and 1876, not a single woman survived a caesarean section. Surgeons were afraid to sew up the incision on the uterus, because they believed that internal seams, which subsequently could not be removed, can become a source of infection and cause uterine rupture in subsequent pregnancies. They believed that the muscles of the uterus, contracting, would lead to the closure of the wound. However, this did not happen. As a result, some women died from blood loss, but most died from infectious complications. After anesthesia, antisepsis and asepsis were finally established in surgery, obstetricians were able to focus on improving the technique of performing cesarean sections. In 1876, the Italian professor Eduard Porro proposed, in parallel with a caesarean section, to remove the uterus, thereby preventing bleeding and the development of a generalized infection. This reduced the incidence of postoperative sepsis and mortality. However, this mutilating technique was soon abandoned, as a technique for suturing the uterus was developed. In 1882, Max Saumlnger from Leipzig put uterine suturing into practice. To do this, he suggested using silver wire stitches. In the 20th century, the cesarean section operation underwent rapid development and today is the leading obstetric surgery, allowing you to solve many emerging problems. ABOUT current state We will cover caesarean section operations in the next article.

Bibliography

A.Sh. Makhmutkhodzhev, E.V. Makhmutkhodzhaeva. History of caesarean section

A caesarean section is a surgical procedure that allows the baby to be delivered through an incision in the abdomen rather than through the vagina. IN Lately about 30% of births occur by caesarean section. In some cases, this is done electively due to pregnancy complications or because the woman has already had a caesarean section. Some women prefer a caesarean section to a regular birth. However, in many cases the need for a cesarean section becomes apparent only during labor.

Knowing what to expect will help you be better prepared if surgery is necessary.

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

Indications for caesarean section

Indications for cesarean section can be absolute and relative. But for the most part, the decision to undergo surgery stems from many reasons, such as a combination of medical assessments on the part of the doctor and midwife, and personal wishes on the part of the woman in labor. Fortunately, pregnant women have plenty of time to think things through and figure out exactly how they would like to give birth. Emergency situations where a caesarean section becomes unavoidable 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, everything should be discussed in detail possible risks so that you really feel well prepared. Therefore, do not hesitate to ask again if something is not clear to you.

Medical indications for cesarean section include:

transverse or pelvic presentation of the child;
placenta previa;
discrepancy in the size of the maternal pelvis
child's size;
severe maternal illness;
threat of child hypoxia;
premature birth;
pathology of child development.

Partial anesthesia for caesarean section

Currently local anesthesia is a universally accepted standard. The operation is performed using spinal anesthesia or, for a planned caesarean section, 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 caesarean section performed?

There are many reasons why a caesarean section is performed. Sometimes this is due to the health of the mother, sometimes due to concerns for the child. Sometimes surgery is done even if both mother and baby are fine. This is an elective caesarean, and there are mixed feelings about it.

Childbirth is not going well. One of the main reasons why a caesarean section is performed is because labor is not progressing normally - too slowly or stopping altogether. The reasons for this are manifold. The uterus may not contract vigorously enough to fully dilate the cervix.

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

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

The decision to have a caesarean section depends on many factors, such as how long labor will continue or how likely there are complications other than heart problems.

Unfortunate position of the child. If the baby enters the birth canal legs or buttocks first, it is called breech presentation. Most of these babies are born by caesarean section, as there is a high risk of complications with normal childbirth. 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 transverse presentation and is also an indication for cesarean section.

The baby's head is positioned poorly. Ideally, the baby's chin should be pressed to the chest so that the part of the head with the smallest diameter is in front. If the chin is lifted 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 have no problems with this, but others may have difficulties.

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

You serious problems with health. A caesarean section may be done if you have diabetes, diseased heart, lungs or high blood pressure. With such diseases, a situation may arise when it is preferable to give birth to a child at a later date. early stage pregnancy. If labor cannot be induced, a caesarean section may be necessary. If you have serious health problems, discuss your prospects with your doctor well before the end of your pregnancy.

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

You multiple pregnancy. About half of twins are born by Caesarean section. Twins can also be born in the usual way, depending on the weight, position and duration of pregnancy. With triplets it's a different story. Most triplets are delivered by caesarean section.

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

There are problems with the placenta. In two cases, a cesarean section 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 both your life and your child's. If electronic monitoring shows that there is no immediate danger to the baby, you will be hospitalized and closely monitored. If the child is in danger, it is necessary urgent birth and a caesarean section will be used.

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

There are problems with the umbilical cord. When your water breaks, the umbilical cord may slip out of your cervix before the baby is born. This is called umbilical cord prolapse and is great danger for a child. As the baby pushes through the cervix, pressure on the umbilical cord can cut off oxygen supply. If the umbilical cord slips out when your cervix is fully dilated and labor has 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 your water breaks, each contraction of the uterus will compress the umbilical cord, slowing blood flow and reducing oxygen supply to the baby. In these cases, caesarean section - best option, especially if the umbilical cord is compressed for a long time or very strongly. This common reason problems with the heart, but it is usually impossible to know for sure how the umbilical cord is positioned until labor begins.

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

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

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

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

How does a caesarean section happen?

Before your planned cesarean section, your gynecologist or anesthesiologist will talk to you about the procedure and anesthesia in advance. If something is unclear to you, clarify and ask again! On the appointed day, you must arrive at the hospital in advance. It is best to avoid eating: You should not eat for six hours before surgery.

First of all, the doctor and midwife will check your baby’s condition using ultrasound and CTG. Take this opportunity to express your wishes and ideas about upcoming birth. Then preparations for the operation will begin: your hair will be shaved off in the incision area, and a compression stockings and will be given spinal anesthesia. Later, 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, except for your abdomen, will be covered with sterile drapes. To prevent you from seeing what is happening and to prevent infection, the nurses will pull a sheet over your upper abdomen. Although you will be able to see the heads of the operating team members, you will not be able to understand what they are doing with their hands. After the anesthesia begins to take full effect, the doctor will make the first incision.

For cosmetic reasons and also for better healing wounds, skin incision is made directly above the symphysis (pubic joint) along a vertical line, the length of the incision is 10 cm. Subcutaneous adipose tissue splits down the middle. Above the abdominal muscles there is a very elastic and strong connective tissue membrane (fascia), which the surgeon opens with a scalpel in the center. Then he pulls the abdominal wall upward with his hand and moves 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 uses a scalpel to make a transverse incision in the lower segment of the uterus. Now all that remains is to get the baby out of the womb and you can say hello to your baby. After the placenta is separated and removed, the operating team sutures the wound. Meanwhile, your partner is already accompanying the child to the first examination. In total, the operation lasts from 20 to 30 minutes.

Misgav Ladakh Method

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

Risks of caesarean section

A caesarean section is a major operation. Although it is considered completely safe, as with any surgery, there are certain risks. It is important to remember that caesarean sections are often done to avoid life-threatening complications. However, certain complications may also arise after surgery.

Risks for you. Having a child is always a risk. With a caesarean section it is higher than with a normal birth.

Increased bleeding. On average, blood loss during a caesarean section is twice as much as during a normal birth. However, blood transfusions are rarely required.
Reactions or anesthesia. Medicines used during surgery, including painkillers, can sometimes cause unintended consequences, including breathing problems. IN in rare cases General anesthesia can cause pneumonia if a woman inhales stomach contents. But general anesthesia is rarely used for caesarean sections, and precautions are taken to avoid such complications.
Bladder or bowel damage. Such surgical injuries are rare, but they do occur during caesarean sections.
Endometritis. This is a complication that causes inflammation and infection of the membrane lining the uterus, most often after cesarean section. This happens when bacteria normally found in the vagina enters the uterus. Urinary tract infection.
Slowing intestinal activity. In some cases, painkillers used during surgery can slow down bowel movements, causing bloating and discomfort.
Blood clots in the legs, lungs and pelvic organs. The risk of developing a blood clot in the veins is 3-5 times higher after a cesarean section than after a normal birth. If left untreated, a blood clot in the leg can travel to the heart or lungs, cutting off 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 cesarean section is higher if you drink alcohol heavily, have type 2 diabetes, or are overweight.
Seam rupture. If the wound becomes infected or does not heal well, there is a risk of rupture of the sutures.
Placenta accreta and hysterectomy. Placenta accreta is attached too deeply and too firmly to the wall of the uterus. If you have already had a caesarean section, next pregnancy the likelihood of placenta accreta increases significantly. Placenta accreta is the most common reason for hysterectomy during caesarean section.
Readmission to hospital. Compared with women who gave birth vaginally, women who had a caesarean section were twice as likely to be hospitalized again within the first two months after birth.
Fatal outcome. Although the likelihood of death after a caesarean section is very low - approximately two cases per 100,000 - it is almost twice as high as after natural birth.

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

Premature birth. If a caesarean section is your choice, the baby's age must be determined correctly. Premature birth can cause breathing problems and low weight at birth.
Breathing problems. Babies born by Caesarean section are more likely to have mild breathing problems - breathing abnormally quickly during the first few days after birth.
Injury. Occasionally, the child may be injured during surgery.

What to expect with a caesarean section

Whether your caesarean section is planned or done as needed, it will go something like this:

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

Methods of pain relief. An anesthetist may come to your room to discuss anesthesia options. For a caesarean section, spinal, epidural and general anesthesia are used. With spinal and epidural anesthesia, the body loses sensation below the chest, but you remain conscious during the operation. In this case, you practically do not feel pain, and practically no medicine reaches the child. There is little difference between spinal and epidural anesthesia. For spinal pain, an anesthetic is injected into the fluid surrounding the spinal nerves. With an epidural, the agent is injected from the outside of the fluid-filled space. Epidural anesthesia lasts 20 minutes and lasts a very long time. Spinal is done faster, but lasts only about two hours.

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

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

Intravenous catheter. An intravenous needle will be placed in your arm. This will ensure that you receive the fluids and medications you need during and after 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 significantly reduces the risk of lung damage if you vomit during anesthesia and the contents will get in the stomach into the lungs.
Monitors. Your blood pressure will be monitored continuously during the operation. You may also be connected to a heart monitor, with sensors placed on your chest to monitor your heart function and rhythm during surgery. A special monitor may be attached to the finger to monitor the level of oxygen in the blood.
Urinary catheter. A thin tube will be inserted into your bladder to drain urine to keep the bladder empty during surgery.

Operating room. Most caesarean sections are performed in operating rooms specifically designed for this purpose. The atmosphere may be different from that of the birthplace. Since operations are group work, there will be a lot more people here. If you or your child have serious medical problems, doctors from various specialties will be present.

Preparation. If you are having an epidural or spinal anesthesia, you will be asked to sit with your back rounded or lie on your side curled up. Anesthesiologist will wipe your back antiseptic solution and will give you a painkiller injection. He will then insert a needle between the vertebrae through thick fabric surrounding the spinal cord.

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

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

The arms are extended and fixed on special pillows. The nurse will shave off any 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 site clean.

Incision 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 abdominal cavity. Bleeding vessels will be cauterized or bandaged.

The location of the incision depends on several factors: whether your C-section is an emergency and whether you have any 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 cuts:

Low horizontal cut. Also called a bikini cut, which runs in the lower abdomen along the line of an imaginary bikini panty, is preferred. It heals well and causes less pain after surgery. Also preferable cosmetic reasons and allows the surgeon to clearly see the lower part of the pregnant uterus. b Low vertical section. Sometimes this type of incision is preferable. It provides quick access to the lower part of the uterus and allows you to remove the baby faster. In some cases, time is of the essence.
Uterine incision. After completing the incision into the abdominal wall, the surgeon pushes back the bladder and cuts through the wall of the uterus. The uterine incision may be the same or a different type as the abdominal wall incision. It is usually smaller in size. Just 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 inside the uterus. A low horizontal incision in the lower part of the uterus is the most common and is used in most caesarean sections. It provides easy access, bleeds less than higher incisions, and is less likely to damage the bladder. A durable scar is formed on it, reducing 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 tissue is thinner - can be made when the baby is positioned feet first, buttocks forward, 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 called a classic incision. A potential advantage of the classic incision is that it allows easier access to the uterus to remove the baby. Sometimes a classic incision is used to avoid injury to the bladder or if the woman has decided that this is her last pregnancy.

Birth. Once the uterus is open, the next step is dissection amniotic sac so that the child can be born. If you are conscious, you may feel some tugging and pressure as the baby is pulled out. This is done in such a way as to keep the incision size to a minimum. You won't feel pain.

Once the baby is born and the umbilical cord has been cut, he will be given to a doctor who will check that his 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. Sutures on internal organs and tissues will dissolve on their own and do not require removal. For the skin incision, the surgeon may place sutures or use special metal clips to hold the edges of the wound together. You may feel some movement during these activities, but no pain. If the incision is closed with clamps, they will be removed with special forceps before discharge.

When you see the baby. The entire cesarean section operation usually takes 45 minutes to an hour. And the baby will be born in the first 5-10 minutes. If you are conscious and willing, you can hold your baby while the surgeon closes the incisions. Or you might see the baby in your partner's arms. Before giving the baby to you or your partner, doctors will clean the baby's nose and mouth and perform an initial 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 monitored until the anesthesia wears off and your condition stabilizes. This usually takes 1-2 hours. During this time, you and your partner can spend a few minutes alone with your child and get to know him.

If you decide to breastfeed, you can do so for the first time in the recovery room if you wish. 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 have pain relief before you start feeding.

After a cesarean section

In a few hours you will be moved from the recovery room to the birthing room. Over the next 24 hours, doctors will monitor your well-being, the condition of the stitches, the amount of urine excreted and postpartum hemorrhage. Your condition will be closely monitored throughout your hospital stay.

Recovery. Typically, you will spend three days in the hospital after a caesarean section. 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 cesarean section without any problems.

Pain. You will receive pain medication at the hospital. You may not like it, especially if you plan to breastfeed. But painkillers are necessary 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 will start working normally again, you will be able to drink more fluids or even eat some easy to digest food. You'll know you're ready to eat when you can pass gas. This is a sign that your digestive system is awakened and ready to get started. You can usually eat solid food the day after surgery.

Walking. You will most likely be asked to walk around a few hours after surgery, if it is not yet overnight. You won't want to, but walking is beneficial and an important part of your recovery. It will help clear your lungs, improve blood circulation, speed up healing, and bring your digestive and urinary systems back to normal. If you are bothered by bloating, walking will bring relief. It also prevents blood clots, a possible post-operative complication.

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

Vaginal discharge. After your baby is born, you will have lochia, a brownish or colorless discharge, for several weeks. Some women after a cesarean 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.

Healing of the incision. The bandage will most likely be removed the day after surgery, when the incision has healed. Your wound will be monitored while you are in the hospital. As the incision heals, itching will occur. But don't scratch it. It's safer to use lotion.

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

The scar will be tender and painful for several weeks. Wear loose clothing that does not chafe. If clothing irritates your scar, cover it with a light bandage. Sometimes you will feel twitching and tingling in the area of the incision - this is normal. While the wound is healing, it will itch.

Restrictions. When returning home after a caesarean section, it is important to limit your activity for the first week and focus primarily on yourself and your newborn.

Don't lift weights or do anything that strains your still-unhealed belly. Hold correct posture while standing or walking. Support your stomach during sudden movements such as coughing, sneezing, or laughing. Use pillows or rolled up towels when feeding.
Accept necessary medications. Your 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. Exercise can be very tiring for you. Give yourself time to recover. You had an operation. Many women, when they begin to feel better, find it difficult to adhere to the necessary restrictions
As long as fast movements cause pain, do not drive. Some women recover faster, but usually the period when you shouldn't drive lasts about two weeks.
No sex. Refrain until your doctor gives permission - usually after a month and a half. However, intimacy should not be avoided. Spend time with your partner, at least a little in the morning or evening, when the baby is already asleep.
When your doctor allows it, start doing it. physical exercise. But don't go too hard. Hiking and swimming - the best choice. Within 3-4 weeks after discharge you will feel able to lead a normal normal life.

Possible complications.

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

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

Emergency caesarean section

An emergency caesarean section is performed only if the life of the mother or child is threatened.

The decision on an emergency operation or a secondary caesarean section is made only when there is really no other choice, 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 a child;
complications that threaten the life of the mother (uterine rupture, premature separation of the placenta).

If one of these complications unexpectedly occurs, you need to act very quickly. If the supply through the umbilical cord is disrupted, the doctor has only a few minutes to prevent significant harm to the baby'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.

Once the doctor decides on an emergency caesarean section, the induction of anesthesia and the operation are performed without delay and without long preparation. The surgical intervention can also be carried out in the maternity ward, if there is enough space and the necessary equipment is available.

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

How to deal with anxiety

It doesn't matter how hard you tried, whether you had normal pregnancy without complications, you may need an emergency caesarean section. You will be disappointed. You might feel like a failure. However, it is very important to remain forward-thinking. Caesarean section does pose a risk, as does normal operations For example, during it internal bleeding may begin, blood clots may appear, infection or damage to internal organs may occur. Some babies experience minor breathing problems after a cesarean section. But because surgical techniques and pain management have improved, there are very few dangers associated with caesarean sections, and of course rhodium. healthy child much more important than trying to give birth naturally.

Reasons for emergency caesarean section

Most often, the indication for an emergency cesarean section is an unexpected abnormal position of the baby (if he is positioned with his legs or buttocks forward) or lateral presentation. Another reason is heavy bleeding that occurred 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 survive the birth; if the child's cardiogram shows possible deviations, caesarean section will be safe and in a 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 surgery. Your stomach will be washed, your hair may be shaved, you will be given antibiotics and other fluids intravenously. The anesthesia will be either epidural (with a dose adjusted for caesarean section), or spinal, and maybe even general. If a woman has an epidural or spinal anesthesia, she will not feel anything from her toes to her chest; at the same time, she will be conscious, but will not feel the doctor making the incision. Most likely, she will not see this, because a special fence will be placed between her and the doctor, or maybe because the baby will be born very quickly.

Caesarean section by woman's choice

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

This caesarean section is not done due to 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 choosing a caesarean section, and this raises a number of questions.

Is there a limit?

Many women successfully undergo up to three operations. However, each subsequent caesarean section 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 before your first cesarean section, a repeat cesarean section will be physically easier, but the healing process will take just as long. For other women - who have large internal scars - each subsequent C-section becomes more and more risky.

Many women have a repeat cesarean section. 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 caesarean section can be a shock to both you and your partner. Your ideas about how you will give birth will suddenly change. To make matters worse, this news 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 baby during surgery, but don't let those concerns overwhelm you completely. Most mothers and children undergo surgery safely with a minimum of complications. Although you may have preferred to have a natural birth, remember that the health of you and your baby is more important than how it is delivered.

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

Caesarean section: partner involvement

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

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

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

Caesarean section by 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. Some of them find it convenient to accurately plan the due date. If you're used to planning everything in your life down to the minute, waiting until the unknown day your baby arrives can seem impossible.

Other women choose a caesarean section due to 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 it's scary. You may have heard horror stories about childbirth and women suffering from urinary incontinence when coughing or laughing after giving birth. If you've already had a vaginal birth and it didn't go smoothly, you may be worried about a repeat.

If you are inclined to choose a caesarean section, discuss this openly with your doctor. If your main motivator is fear, having a frank conversation about what to expect and attending a birthing school can help. If they start telling you about the horrors of childbirth, politely but firmly say that you will listen about it after your baby is born.

If your previous natural birth really was such a horror story, remember that every birth is different and this time it could be completely different. Think about why labor was so difficult and discuss this 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 cesarean section, he may refer you to another specialist. Learn more about the pros and cons of both birth methods and discuss them with experts, but don't let fear be the deciding factor.

What should you consider?

Elective caesarean section is a controversial thing. Those in favor say that a woman has the right to choose how she wants to give birth to her child. Those who are against believe that the dangers of a caesarean section outweigh any positive sides. On this moment There is no convincing evidence in the medical literature that cesarean section is the preferred option. good medical practice generally rejects procedures - especially surgical ones - that do not provide undoubted benefit to the patient. In addition, there is little research on this issue.

Because everything is ambiguous, you may find that doctors' opinions differ greatly. Some are ready to have surgery. Others refuse, believing that a caesarean section could be dangerous and thus contrary to their oath to do no harm.

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

Benefits and risks

Many experts believe that when modern level development surgical technique A caesarean section is no more dangerous than a normal birth if this is your first child. If this is already the third birth, the situation is different. A caesarean section is more likely to cause complications than a normal birth. Here is a list of the benefits and dangers of this operation:

Benefits for the mother. Positive consequences Elective caesarean sections 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 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 birth. However, there is no evidence that this risk is lower 2-5 years after birth. Some women also fear that natural childbirth may cause pelvic organ prolapse, which is when organs such as the bladder or uterus protrude into the vagina. There is currently no clear medical evidence linking cesarean section to a reduced risk of prolapse. pelvic organs. But an elective caesarean section is not a 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 arise even in women who have never had children.
Guarantee against emergency caesarean section. An emergency Caesarean section, which is usually done for difficult labor, is much more dangerous than an elective Caesarean section or a normal birth. With an emergency caesarean section, infections, internal organ damage and bleeding are more likely.
Guarantee against difficult births. Sometimes difficult labor requires the use of forceps or vacuum suction. These methods are usually 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 cesarean section can reduce the baby's risk of some problems. For example, the death of a baby during childbirth, pathology of childbirth due to incorrect position the fetus, birth trauma - which is especially important when the baby is very large - and inhalation of meconium, which occurs if the baby begins to defecate before birth. The risk of paralysis is also reduced. However, it is important to remember that the risk of all these complications is quite low during normal childbirth, and a caesarean section is not a guarantee that these problems will not arise.
Less risk of transmitting infections. With a caesarean section, the risk of transmission from mother to child of infections such as AIDS, hepatitis B and C, herpes and papilloma virus is reduced.
Establishment exact date childbirth If you know exactly when the baby is coming, you can be better prepared. This is also convenient for planning the work of the medical team.

Risk to the mother immediately after surgery

There are certain inconveniences and dangers associated with a caesarean section. You will have to stay in the hospital longer. The average length of stay in the hospital after a cesarean section is three days, and after a normal birth it is two.

Increased chance of infection. Because it is a surgical procedure, the risk of infection after a caesarean section is higher than after a normal birth.

Postoperative complications

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

Reducing the possibility of early connection with the child and the beginning breastfeeding. For the first time after surgery, you will not be able to care for your child or breastfeed him. But this is temporary. You will be able to bond with your baby and breastfeed once you recover from surgery.

Payment for insurance

Your insurance may not cover elective C-sections, and they will cost more than a normal birth. Before making a decision, check whether this surgery is covered by your insurance.

Risks for the mother in the future

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

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

Uterine rupture in the next pregnancy. Having a Caesarean section increases your risk of uterine rupture in your next pregnancy, especially if you decide to have a normal birth this time. The likelihood 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 placenta-related problems, such as breech, in subsequent pregnancies. In case of previa, the placenta closes the opening of the cervix, which can lead to premature birth. Placenta previa and other related problems caused by cesarean section greatly increase the risk of bleeding.

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

Damage to the intestines and bladder. Serious bowel and bladder injuries are rare during a caesarean section, but they are much more likely to occur than during a normal birth. Complications related to the placenta can also lead to bladder damage.

Dangers to the fetus

Dangers to the baby associated with a cesarean section:

Breathing disorders. One of frequent violations in a baby after a cesarean section, there is a slight breathing disorder called tachypnea (rapid shallow breathing). This happens when there is too much fluid in the baby's lungs. When a baby is in the womb, his lungs are normally filled with fluid. During normal childbirth, progress through birth canal squeezes 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 increased breathing and usually requires pressurized oxygen to remove fluid from the lungs.
Immaturity. Even slight immaturity can have a major negative impact on a child. If the due date is inaccurate and the caesarean section is performed too early, the baby may have complications associated with prematurity.
Cuts. During a caesarean section, the baby may get cuts. But this happens rarely.

Decision-making

If your doctor doesn't accept your request for a C-section, ask yourself why. Physicians and surgeons are required to avoid unnecessary medical interventions, especially if they could be dangerous. The lack of scientific evidence to support elective caesarean section makes this procedure unnecessary. Although, from a physician's perspective, scheduling convenience, efficiency, and financial rewards favor a cesarean section, a physician you trust should be at least cautious about the procedure.

All over the world there is a clear trend towards gentle childbirth, which helps preserve the health of both mother and child. The tool that helps achieve this is the cesarean section (CS). A significant achievement was wide application modern methods of pain relief.

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

When is surgical delivery indicated?

A caesarean section is a major surgical procedure that increases the risk of complications compared to a normal vaginal birth. It is carried out only by strict indications. At the request of the patient, CS can be performed in private clinic, but not all obstetricians-gynecologists will undertake such an operation unless necessary.

The operation is performed in the following situations:

1. Full presentation placenta - a condition in which the placenta is located in the lower part of the uterus and closes the internal os, 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 slight damage to it can cause blood loss, lack of oxygen and fetal death.

2. Occurred prematurely from the uterine wall - a condition life-threatening woman and child. The placenta detached from the uterus is a source of blood loss for the mother. The fetus stops receiving oxygen and may die.

3. Previously transferred surgical interventions on the uterus, namely:

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

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

Pregnancy can occur even during the first weeks of the postpartum period. Calendar method contraception in conditions irregular cycle not applicable. The most commonly used condoms, mini-pills (gestagen contraceptives that do not affect the child during feeding) or regular ones (in the absence of lactation). Use must be excluded.

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

If a woman is over 35 years old and has at least two children, at her request, the surgeon can perform surgical sterilization, in other words, dressing fallopian tubes. This is an irreversible method, after which conception almost never occurs.

Subsequent pregnancy

Natural childbirth after a cesarean section is allowed if the formed connective tissue on the uterus is strong, that is, strong, smooth, and able to withstand muscle tension during childbirth. This issue should be discussed with your attending physician during your next pregnancy.

The likelihood of a subsequent birth normally increases in the following cases:

the woman gave birth to at least one child vaginally;
if the CS was performed due to incorrect fetal position.

On the other hand, if the patient is over 35 years old at the time of subsequent births, she has excess weight, concomitant diseases, discrepant sizes of the fetus and pelvis, it is likely that she will undergo surgery again.

How many times can you have a caesarean section?

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

Usually the tactic is repeat pregnancy the following: the woman is regularly observed by an obstetrician-gynecologist, and at the end of the gestation period a choice is made - surgery or natural childbirth. During a normal birth, doctors are ready to perform emergency surgery at any time.

Pregnancy after cesarean section is best planned at intervals of three years or more. In this case, the risk of suture failure on the uterus is reduced, pregnancy and childbirth proceed without complications.

How long after surgery can I give birth?

It depends on the consistency of the scar, the age of the woman, concomitant diseases. Abortion after CS has a negative impact on reproductive health. Therefore, if a woman does become pregnant almost immediately after the CS, then with a normal course of pregnancy and constant medical supervision she can carry a child, but delivery will most likely be surgical.

The main danger early pregnancy after CS there is a failure of the suture. It is manifested by increasing intense pain in the abdomen, the appearance bloody discharge from the vagina, then signs may appear internal bleeding: dizziness, pallor, falling blood pressure, loss of consciousness. In this case, it is necessary to urgently call an ambulance.

What is important to know when having a second caesarean section?

Elective surgery is usually performed at 37-39 weeks. The incision is made along the old scar, which somewhat lengthens the operation time and requires stronger anesthesia. Recovery after a CS may also be slower because scar tissue and adhesions in the abdominal cavity prevent good reduction uterus. However, when positive attitude women and her family, with the help of relatives, these temporary difficulties are completely surmountable.

Eastern legends describe the legend that the future hero of Persia Rustem could not be born, the sacred bird Simurgh gave advice: wine, cutting a dagger and stroking the cut with the feather of the Simurgh bird. In myths Ancient Greece the future patron of medicine, Aesculalapius, was saved from intrauterine death only thanks to Apollo, who tore the child from the womb of an already dead mother.

At the end of the 7th century in Rome there was a law according to which deceased pregnant women could be buried after the child was removed. This operation was practiced only on deceased women.

In Switzerland, there is evidence that the first caesarean section was performed on the wife of Jacob Nyfer in 1500. The woman already had 5 children, but she took too long to give birth to the sixth and her husband, having received the consent of the city council, literally opened up his wife. It was possible to save both mother and child. This was not her last child, the woman gave birth to five more children, one of the births ended in the birth of twins. By the way, her husband, according to the manuscripts, was engaged in castration of boars. This case is not officially recognized, since data in the historical literature appeared only 82 years after the operation.

In the 16th century, the French doctor Ambroise Pare was the first to perform surgery on a living woman. He managed to save many children, but the women died. The fact is that the incision on the uterus was not sutured; the women experienced massive bleeding or an infection. Dr. Trautmann was able to save the woman's life, which is the reason why his name is most often cited as the name of the first doctor to perform a successful caesarean section. The woman died a month after the operation, but not from postoperative complications. In Russia, the first section was performed by Dr. Erasmus in 1756.

First and the only woman The one who performed a caesarean section on herself was Mexican Ines Ramirez. In 2000, already a mother of seven children, Ines gave birth for the ninth time (one of the children, alas, died). Realizing that something was going wrong and realizing that there was no way to get help ─ her husband was celebrating a holiday, there was no midwife in the settlement, and the phone was too far away ─ the woman made a desperate decision. After drinking several servings of alcohol, she cut her stomach with a kitchen knife, without harming either the child or internal organs, extracted her son and cut his umbilical cord. A little later, having come to her senses, she was able to stop the bleeding and ask her son to help her. The six-year-old boy found a veterinarian's assistant who stitched up the wound with ordinary sewing thread. And only 16 hours later Ines was admitted to the hospital. After 10 days she was already home. Doctors call it a miracle, and Iness calls it God’s providence.

Why caesarean section

One version says that this is how one of Caesar’s ancestors was born. Another claims that the Caesarean section is due to the law according to which a child must be removed from the womb of a dead or dying woman (from the Latin Lex Caesarea ─ the law of the king). At the same time, in

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Operation history

According to the information that has reached us today, caesarean section is one of the most ancient operations. The myths of Ancient Greece describe that with the help of this operation, Asclepius and Dionysus were removed from the womb of their dead mothers. In Rome, at the end of the 7th century BC, a law was passed according to which the burial of a deceased pregnant woman was carried out only after the child had been removed through abdominal cutting. Subsequently, this manipulation was performed in other countries, but only for deceased women. In the 16th century, the court physician of the French king, Ambroise Pare, first began performing caesarean sections on living women. But the outcome was always fatal. The mistake of Paré and his followers was that the incision on the uterus was not sutured, counting on her contractility. The operation was performed only to save the child, when the mother’s life could no longer be saved.

Only in the 19th century was it proposed to remove the uterus during surgery; as a result, the mortality rate dropped to 20-25%. Five years after this, the uterus began to be sutured with a special three-layer suture. So it began new stage Caesarean section operations. They began to perform it not only for the dying person, but also in order to save the life of the woman herself. With the advent of the antibiotic era in the mid-20th century, surgical outcomes improved and deaths during surgery became rare. This caused the expansion of indications for caesarean section on both the maternal and fetal sides.

Indications

Planned caesarean section

A planned cesarean section is an operation whose indications are determined before pregnancy is resolved. This category also includes elective caesarean sections. In a planned CS, the incision is made horizontally. The indications are:

Discrepancy between the size of the woman’s pelvis and the size of the child
Placenta previa - the placenta is located above the cervix, closing the exit route for the baby
Mechanical obstacles that interfere with natural childbirth, for example, fibroids in the cervix
Threatening uterine rupture (scar on the uterus from a previous birth)
Diseases not related to pregnancy, in which natural childbirth poses a threat to the health of the mother (diseases of the cardiovascular system, kidneys; history of retinal detachment)
Complications of pregnancy that threaten the life of the mother during childbirth (severe gestosis - eclampsia)
Breech presentation or transverse position of the fetus
Multiple pregnancy
genital herpes at the end of pregnancy (the need to avoid contact of the child with the genital tract)

Emergency caesarean section

An emergency caesarean section is an operation performed when complications arise during natural childbirth that threaten the health of the mother or child. In an emergency caesarean section, the incision is usually made vertically. Possible reasons:

Sluggish labor activity or its complete cessation
Premature abruption of a normally located placenta (the oxygen supply to the fetus is cut off and potentially fatal bleeding)
(Threatened) uterine rupture
Acute hypoxia (lack of oxygen in a child)

Contraindications

Intrauterine fetal death
Fetal malformations incompatible with life.

Anesthesia

Caesarean section is usually (up to 95% of cases) performed under regional anesthesia (epidural or spinal anesthesia, or a combination of both). It only relieves pain Bottom part body, a woman can immediately after removing the child from the uterus take him in her hands and attach him to her breast.

In the case of an emergency caesarean section, it is sometimes necessary to resort to general anesthesia.

Operation

Before surgery, the pubis is first shaved and a catheter is inserted into the bladder to empty it. An empty bladder will not put pressure on the uterus, which will contribute to its better contraction in postpartum period. It will also be less likely to be damaged during the operation. After anesthesia, the woman is placed on operating table and fence off top part torso with a screen.

After operation

The woman's condition is monitored around the clock the day after the operation. An ice pack is placed on the abdomen to contract the uterus and stop bleeding, and painkillers, drugs that promote uterine contraction, and drugs to restore gastrointestinal function are prescribed. Antibiotics are also sometimes prescribed. It is currently believed that if there is no ongoing bleeding, then intravenous fluid infusions are unnecessary and even harmful, as they cause swelling of the intestinal wall. The earliest possible activation (up to 4-6 hours after surgery) with sufficient pain relief, early start intake of fluids and food (Fast Track Recovery concept) has been proven to reduce recovery time after surgery and reduce the number of postoperative complications several times.