Factors under which a second cesarean section is performed. Pros and cons of a cesarean section, basic questions about it and recovery after surgery

There are only two ways for a baby to be born: through the natural birth canal and cesarean section.Caesarean section is the most common obstetric operation: according to statistics , calculated for 1990-2014, in world practice, 18.6 percent of births occur surgically.

There are absolute indications for surgery: transverse position of the fetus, placenta previa, premature abruption of a normally located placenta, and a number of others. During natural childbirth, complications may also arise in which doctors will have to perform emergency surgery, for example, acute fetal hypoxia, clinically narrow pelvis, labor anomalies that are not amenable to drug therapy. And this is only part of the list.

In any case, you need to understand that a caesarean section is performed in order to save the life of the mother and child or to prevent possible complications.

There is enough information in various sources about how the operation and recovery proceed, what the scars look like, what they are like, and how often complications occur. But what we really don’t talk about enough is how a newborn “cesarean” feels after surgery, how and how it differs from a baby who passed through the natural birth canal.

How do newborn “Caesareans” differ from “natural babies”?

According to pediatricians, it is almost impossible to externally distinguish a child after a natural birth and after a cesarean section. Neonatologists say that babies can still be distinguished within the walls of the maternity hospital - caesareans may suck the breast worse and be more lethargic, but after discharge this is no longer the case. In infants after natural childbirth, a birth tumor may appear on the head. By the way, if we talk about the shape of the head, then in children after a cesarean section the head will often be round, not deformed, as happens after passing through the birth canal, but it is also worth taking into account that not all children, even after a cesarean section, have the correct shape of the skull - sometimes The baby's head is so located in the womb that it cannot be round - for example, if one side was pressed against the ribs, this happens when the fetus is in a transverse position. Of course, if something went wrong during the birth process, then there are birth injuries specific to each method - for example, cephalohematoma after natural childbirth or facial nerve paresis after cesarean section. We decided to write an educational program about the differences

How is the emotional connection between “Caesareans” and their mothers formed?

There is an opinion that if the child does not pass through the natural birth canal, his emotional connection with the mother will be lost.

So far, no one has conducted large clinical studies on the power of love between mother and child after natural birth and after cesarean section, but before, for example, children were generally taken away immediately after birth and brought to the mother only for feeding, and so on for five or six days in the maternity hospital. The contact that was created over nine months is not so easy to break.

But still, it is worth noting that during a planned caesarean section, oxytocin does not begin to be produced during the operation, and it is largely responsible for the emotional connection between mother and child, this is the hormone that makes the mother cry with emotion over the sniffling baby. Oxytocin is produced during lactation, so breastfeeding also plays a very important role here.

In 2008, one small study , which compared MRI findings in women three to four weeks after giving birth. During the tomography, they were allowed to listen to the voice of a crying child (their own, someone else’s, and simulated crying). The result showed that women who had a caesarean section had lower activity in the brain regions responsible for empathy and motivation than women who had a vaginal birth. Researchers see the reason precisely in lower levels of oxytocin. Unfortunately, the number of participants, and there were only twelve of them, allows us to consider the study simply as an interesting fact.

Are the Caesar babies lagging behind in physical and mental development?

If a child was born as a result of a planned operation performed according to the mother’s indications (for example, an anatomically narrow pelvis), if no complications arose during the operation, such a child will most likely be no different from his peers. But if we talk about an emergency caesarean section, then it is necessary to take into account the condition of the fetus at the time of birth - for example, if there was acute fetal hypoxia, then undoubtedly there is a possibility of long-term complications.

In April 2017, Sweden published data from a very large research (almost one and a half million participants born from 1982 to 1995). Scientists examined the dependence of school performance in four groups of children born as a result of: natural birth without intervention from doctors, natural birth with intervention from doctors (meaning a vacuum extractor and obstetric forceps), planned cesarean section (before the onset of labor activities) and emergency caesarean section. And the results of the study showed that there are practically no differences in school performance among children. That is, the indicator is so small that it must be interpreted with caution.

However, in Canada, the visuospatial reaction speed of 12 infants aged three and a half to four months after cesarean section and after vaginal birth was studied. Using special devices, we monitored the child's eye movements in response to a visual stimulus. Even with such a small sample, the researchers concluded that the decrease in response in children after cesarean section is significant. And of course, they themselves write that it is necessary to repeat the study with the involvement of more participants.

Is it true that cesarean delivery increases the risk of having a hyperactive baby?

Hyperactivity is a whole complex of neurological and behavioral disorders. Yes, cesarean section can be one of the risk factors (but not the only one), as well as birth trauma during natural childbirth. Therefore, it is not worth giving such a big diagnosis to all children born surgically.

Is it true that “Caesarean babies” are born less healthy than children born naturally?

On the Internet you can find quite a lot of references to the fact that bacteria from the mother are transmitted to the baby during natural birth, but during a cesarean section this does not happen for several reasons: the child does not pass through the natural birth canal, does not end up on the mother’s stomach immediately after birth, and is not immediately applied to the breast, where mother’s important bacteria for the formation of immunity live. It is an indisputable fact that healthy intestinal microflora contributes to the development and maturation of the immune system, while abnormal ones are considered the main cause of severe gastrointestinal infections in infancy.

What research tells us ? Indeed, in the first three months of life, the microflora of the examined infants is different and poorer in caesareans, but by six months the differences disappear. Then everything depends on the individual characteristics of the physical state of health.

They say that “Caesarean babies” suffer barotrauma during birth.

On the Internet you may come across information that if a child is abruptly taken out of the mother’s womb, then this is comparable to the fact that a diver quickly rose to the surface from the depths. This allegedly inevitably causes barotrauma in the child. We honestly reviewed a bunch of materials, studies, articles, talked with pediatricians, neonatologists and pediatric neurologists, but we found mention of barotrauma in a child as a result of cesarean section only on the Russian-language Internet on forums and forum pages for mothers.

What kind of injuries can a baby actually get during a caesarean section?

Traumatic injury to the fetus is minimal during elective caesarean section and is more common during emergency surgery.

What injuries are we talking about? Very rarely, there are cuts on the baby’s skin that occur at the time of the incision of the uterine wall, injuries to the cervical spine with a breech presentation of the fetus, damage to the central nervous system is possible, they occur more often with a transverse presentation of the fetus and weakness of labor; with a cephalic presentation, the baby may develop paresis.

It is worth noting that with the onset of labor, the fetus’s body begins to produce hormones that allow it to quickly adapt to the outside world after birth. During a planned caesarean section, these hormones do not have time to appear in the child’s body.

During caesarean section, especially in premature infants, it is most likely to developrespiratory distress syndrome - a condition in which the child cannot breathe on his own.

There is data that cesarean section significantly increases the risk of developing asthma. Scientists from Norway estimate that asthma develops 52 percent more often in children after cesarean section than in children after vaginal birth.

And yet, caesarean sections save the lives of mothers and babies around the world every day. Of course, it is better not to interfere with the natural process, but there are situations when surgery is vitally necessary. For a baby, both ways are not very simple - both natural birth and caesarean section.

Every year the number of women undergoing cesarean section is growing. How to care for babies born as a result of caesarean section?

Psychologists say that the moment of birth largely determines a person’s future life. At each stage of natural childbirth, certain personal qualities are laid down, in particular such as perseverance in achieving a goal, the ability to wait, endure pain, adapt to the current situation and not lose faith in one’s own strength.

Intervention at any stage of birth can leave a lifelong impact. In the old days, they believed that children who escaped labor pains grew up to be fearless, powerful and strong-willed people, and they called the operation to remove the fetus through an incision on the anterior abdominal wall a cesarean section.

Julius Caesar and many other royals were born this way. The ancient Greeks attributed the operation of Caesarean section to divine origin. According to Greek legend, in this way Apollo helped the birth of his son Asclepius, by the way, the god of healing.

Truths and lies about caesarean sections

However, studies of children born by Caesarean section dispel the myth about their strength of character. Thus, according to Western psychologists, children who have not gone through the stage of contractions have a fear of change, excessive touchiness, hot temper and anxiety, a tendency to exaggerate the complexity of the situation, absent-mindedness, and a decrease in the ability to plan and self-control.

Among caesarean babies, hyperactive children suffering from attention deficit are more common. This is combined with weakness of will: the child wants and can only do what interests him. But he is not able to overcome difficulties, even minor ones.

In addition, the surgical method of delivery is not indifferent to the physical health of the newborn. Indeed, during a normal birth, passing through the birth canal, the child gradually adapts to the action of atmospheric pressure, is freed from fetal fluid, and acquires the mother’s lactobacilli, which at first help him protect himself from pathogenic microbes.

During a caesarean section, the baby immediately faces a new environment, the crisis of separation from the mother and cutting the umbilical cord, and the effects of anesthesia. In addition to the high risk of traumatizing the child, it has long been noted that caesareans have impaired adaptation reactions; neurological and respiratory pathologies and food allergies are more common.

Children who have undergone surgery using endotracheal anesthesia have the lowest concentrations of the hormone cortisol, which is responsible for the body's response to stress, and thyroid hormones.

There is immaturity and shorter life expectancy of neutrophils, “protector” leukocytes. During surgery, due to the rapid transition from intrauterine to extrauterine existence, there is not sufficient production of hormones that normally activate pulmonary lymph flow.

The airways do not always have time to clear the fetal fluid, i.e. fetal fluid. In this situation, the number of complications, primarily infectious, from the respiratory tract increases. In addition, during a cesarean section, anesthesia is used using potent drugs that can have an inhibitory effect on the respiratory center.

Recently, scientists from the Institute of Public Health in Oslo (Norway), having examined 2803 children, found that babies born by Caesarean section were 7 times more likely to have allergic reactions to food. Scientists believe that this is due to the characteristics of the microflora of the gastrointestinal tract. Caesarean section causes a delay in the development of intestinal microflora, and this leads to disruption of food absorption processes.

As for the pain when passing through the birth canal, it has been proven that before the onset of labor the baby falls asleep, all physiological processes in his body slow down, he prepares for a gradual pressure drop, transition to another environment and in this state does not experience pain.

Indications for caesarean section

Disputes over the pros and cons of surgical delivery fade into the background when it comes to caesarean section for medical reasons, when normal childbirth is dangerous to the life and health of the mother or child. However, more and more often you can hear conversations among women that they have no desire to give birth on their own.

Indeed, why these many hours of pain, ruptures, stitches, the risk of postpartum problems with sexual life, exacerbation of hemorrhoids... It’s easier to resort to the services of surgeons: I fell asleep and woke up as a mother. Moreover, with the commercialization of medicine, there is no shortage of medical institutions where cesarean sections are performed at the request of women. Suffice it to say that according to statistics, recently the frequency of these operations in some regions has increased to 24.8%.

Of course, most are carried out for medical reasons, but often, given the woman’s desire, supported by payment for services, these indications are unjustifiably expanded and taken into account formally. For example, not everyone knows that in case of myopia, good fundus condition implies the possibility of normal childbirth. Without sufficient information, women make incompletely informed, unconscious decisions. But initially this operation was performed only on dying mothers in order to save the child!

Even with the modern level of development of medicine, the risk to a woman’s health and life during a cesarean section increases many times over. Complications after surgery can be quite serious: from suppuration and suture dehiscence to problems caused by anesthesia. In addition, the pain after a cesarean operation is much stronger than after childbirth, and lasts much longer.

Finally, not only the physical, but also the psychological state of the woman suffers. The body does not receive a signal that childbirth has passed, which is why there is a feeling of incompleteness and incorrectness of what is happening. So, today it is absolutely clear that for both mother and child the best way of birth is independent childbirth. However, this is true during normal pregnancy.

Unfortunately, there are situations when obstetricians are forced to resort to surgery. Of course, the most important advantage of a cesarean section is the birth of a child in cases where otherwise he or the mother would risk life or health. After all, for a child, a caesarean section is a more gentle method than other obstetric operations, especially the infamous forceps.

Caring for caesareans

Babies born by cesarean section require additional attention and even more careful care. And you can take care of the baby even before he is born. Discuss with your doctor what kind of pain relief you will have during the operation. There is an alternative option that has fewer negative consequences for both mother and child - epidural, or spinal, anesthesia. This is pain relief for the lower part of the body, which is carried out by injecting drugs into the spinal canal.

The advantage is that the woman in labor is conscious all the time and after such anesthesia the woman quickly comes to her senses. In this case, the child receives significantly less medications, and the mother is immediately given the baby to feed, which helps both the contraction of the uterus and the establishment of breastfeeding, in addition, it is useful for the psychological state of the mother and, of course, for the baby.

According to psychologists, children who did not feel maternal warmth and protection immediately after birth, in most cases develop tense relationships with their parents, and develop an attitude toward “winning love.” Subsequently, the attitude turns into lust for power. A man wants to subjugate the world, “which greeted him so poorly.” At the same time, no matter what results a person achieves, he is always not satisfied with his own achievements.

If a caesarean section is performed with epidural anesthesia, the woman in labor can observe the process of labor and attach the baby to the breast immediately after the operation, then this time greatly reduces the negative mood of the newborn.

If you set yourself up for breastfeeding from the very beginning, you will be able to avoid many problems. Experts say that emotional and psychological development, and problems with gastrointestinal disorders and infant neurology in infants proceed much more smoothly than in artificial ones. Even simple observation of the baby and caring for him helps the appearance of milk. Therefore, you need to use the time before discharge home to maximize your recovery. After all, a child needs a full-fledged mother at home.

What are the features of caring for caesareans?

Sometimes babies need swaddling for a long time, you can’t start walking with them longer, and adaptation bathing takes longer.
Little ones have scary dreams more often, so they are more restless at night and require attention.
Under no circumstances should Caesar babies be forced into a separate bed. These babies especially need to sleep together with their mother.
It often happens that such children gain weight more slowly. Therefore, try to maintain breastfeeding for as long as possible.
It has been proven that physical activity is very important to strengthen the immune system. So don't forget about gymnastics and massage. Let at first it be only the nurturing, well-known “Magpie” exercises from time immemorial, exercises, etc. Gradually, you will be able to increase the load and this will help your baby become strong and healthy.

Many psychological difficulties of Caesarea children can be overcome or at least partially corrected.

Help your child develop missing qualities. For example, in order to overcome the fear of change, psychologists recommend changing the child’s environment more often from birth. Moreover, it is not at all necessary to move from place to place. Enough rearrangement in the nursery, walks in different areas, and not in the same yard, as varied a children's menu as possible. The main thing is that changes and innovations evoke positive emotions in the baby. Then gradually the attitude “everything new is bad” will fade into the background for the baby.
From the huge number of educational games, pay attention to construction sets; with their help, you can build many different structures from the same parts.
In the development of qualities that the baby may not receive after passing the birth canal, role-playing games in which you, the parents, help. You play the role of the strong, and the baby plays the role of weak and defenseless heroes. For example, a gray wolf and a hare. Create a seemingly hopeless situation for the “little bunny”, and let him look for a way out of it. The child must learn to mobilize in difficult situations and solve the problem. Or you can play “mother-daughter”, when the parents become small children, and the baby becomes a father (or mother). “Children” will fool around and argue, and “adults” will think about who is right and who is wrong.
When during the game the child learns to concentrate, find the right solutions and win, then in real life he will believe in his own strength.
Praise your child more often, tell him how smart, good he is and how much you love him. The baby should feel that his parents love him just because he is. Even when you scold the baby, do it very carefully so as not to undermine faith in parental love: “I love you very much, but you are behaving badly.”

At the same time, it is very important not to let the child manipulate himself and his love. After all, when commanding adults, the baby ceases to feel support from them. And whoever is not a support is not a defense. This only increases the fears to which the Caesar baby is already very susceptible.

To summarize, I would like to remind you once again that, if necessary, a caesarean section is a salvation for mother and child. If there are no indications, remember that natural childbirth is preferable, do not make the baby pay for your momentary weakness.

30.10.2019 17:53:00

Each pregnancy in a woman proceeds in a new way, different from the previous one. Childbirth, accordingly, also goes differently. If the baby was born for the first time with the help of gynecological surgeons, this does not mean that now everything will happen according to the same scenario. What to do if you have a second caesarean section? What is important for a woman to know? Is it possible to avoid surgery? Today's article will answer these and some other questions. You will learn about the period at which a planned second caesarean section is performed, how the body recovers after manipulation, whether it is possible to plan a third pregnancy and whether it is actually possible to give birth on your own.

Natural birth and caesarean section

Let's find out how a second caesarean section is performed and what indications it has. What is important to know? The natural birth of a child is a process intended 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 birth of a child. Surgeons make an incision in the woman’s abdomen and uterus, through which they remove the baby. The baby appears abruptly and unexpectedly, he does not have time to adapt. Let us note that the development of such children is more difficult and complex than those born during natural childbirth.

During pregnancy, many expectant mothers are afraid of the cesarean section procedure. After all, preference has always been given to natural childbirth. A few centuries ago, a woman had no chance of survival after a Caesarean section. At an earlier time, manipulation was carried out only in patients who had already died. 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 anesthesia capabilities 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 cesarean section are the same as for the first operation. The manipulation can be planned or emergency. When prescribing a planned caesarean section, doctors rely on the following indications:

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

All these situations are a reason for the first intervention. If after the birth of the child (the first) the diseases have not been eliminated, then the operation will be performed during the second pregnancy. Some doctors are inclined to this opinion: the first cesarean section does not allow the woman to give birth again on her own. This statement is wrong.

Is it possible to give birth on your own?

So, you are recommended for a second cesarean section. What is important to know about him? What are the real indications for surgery if the woman’s health is fine? Repeated manipulation is recommended in the following cases:

the child has ;
less than two years have passed since the first caesarean section;
the suture on the uterus is incompetent;
During the first operation, a longitudinal incision was made;
abortions between pregnancies;
the presence of connective tissue in the scar area;
location of the placenta on the scar;
pregnancy pathologies (polyhydramnios, oligohydramnios).

An emergency operation is performed in case of unexpected scar divergence, weak labor, a woman’s serious condition, and so on.

You can give birth yourself 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 thoroughly examined. The conditions for natural childbirth after cesarean 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 area is more than 2 mm;
no complications during pregnancy;
a woman's desire to give birth on her own.

If you want your second child to appear naturally, then you should take care of this in advance. Find a maternity hospital that specializes in this issue. Discuss your condition with your doctor in advance and get examined. Attend your appointments regularly and follow your gynecologist's recommendations.

Pregnancy management

If the first birth took place via cesarean section, then the second time everything can be exactly the same or completely different. Expectant mothers after such a procedure should have an individual approach. As soon as you find out about your new situation, you need to contact a gynecologist. A special feature of managing such a pregnancy is additional research. For example, in such cases, ultrasound is done not three times during 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 the pregnancy depends on this indicator.

Be sure to visit other specialists before delivery. You need to see a therapist, ophthalmologist, cardiologist, neurologist. Make sure there are no restrictions on natural childbirth.

Multiple and regular caesarean section

So, you are still scheduled for a second cesarean section. At what time is such an operation performed, and is it possible to give birth on your own during a multiple pregnancy?

Let's assume that the previous delivery was performed surgically, and after that the woman became pregnant with twins. What are the forecasts? In most cases, the outcome will be a second cesarean section. The doctor will tell you at what time it is done. In each case, the individual characteristics of the patient are taken into account. The manipulation is prescribed for the period from 34 to 37 weeks. In case of multiple pregnancy, do not wait longer, as a rapid natural birth may begin.

So, you are pregnant with one child, and a second cesarean section is scheduled. When is the operation performed? The first manipulation plays a role in determining the deadline. Repeated intervention is scheduled 1-2 weeks earlier. If the first time a cesarean was performed at 39 weeks, now it will happen at 37-38.

Seam

You already know at what time a planned second caesarean section is performed. The cesarean section is repeated using the same suture as the first time. Many expectant mothers are very concerned about aesthetic issues. They worry that their entire stomach will be covered in scars. Don't worry, that won't happen. If the manipulation is planned, then the doctor will make an incision where it was made the first time. Your number of external scars will not increase.

The situation is different with the incision of the reproductive organ. Here, with each repeat operation, a new area for the scar is selected. Therefore, doctors do not recommend giving birth using this method more than three times. For many patients, doctors offer sterilization if a second cesarean section is scheduled. When admitted to the hospital, gynecologists clarify this issue. If the patient wishes, tubal ligation is performed. Don’t worry, doctors will not carry out such a manipulation without your consent.

After surgery: recovery process

You already know when a second caesarean section is indicated and at what time it is done. Reviews from women report that the recovery period is practically no different from what it was after the first operation. A woman can stand up on her own in about a day. A new mother is allowed to breastfeed her baby almost immediately (provided that no illegal drugs were used).

Discharge after the second operation is the same as during natural childbirth. Within one or two months, the discharge of lochia is observed. If you had a caesarean section, it is important to monitor your well-being. Consult a doctor if unusual discharge appears, temperature rises, or general condition worsens. They are discharged from the maternity hospital after the second cesarean section approximately 5-10 days later, the same as the first time.

Possible complications

With repeated surgery, 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 cesarean section, then there is a possibility of scar dehiscence. Even if the suture is strong, doctors cannot completely exclude this possibility. That is why in such cases artificial stimulation and painkillers are never used. This is important to know.

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

A complication of a repeat cesarean 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 they 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 suture area is thinned and filled with connective tissue, then pregnancy will be completely contraindicated. With sufficient 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.

In conclusion

A caesarean section performed during the first pregnancy is not a reason for a repeat 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 your gynecologist about this topic and find out all the nuances. Best wishes!

When childbirth cannot be carried out through the natural birth canal, one has to resort to surgery. In this regard, expectant mothers are concerned about many questions. What are the indications for a caesarean section and when is the operation performed for emergency reasons? What should a woman in labor do after surgical delivery and how is the recovery period going? And most importantly, will a baby born through surgery be healthy?

Caesarean section is a surgical operation in which the fetus and placenta are removed through an incision in the abdominal wall and uterus. Currently, between 12 and 27% of all births are performed by caesarean section.

Indications for caesarean section

The doctor can make the decision to perform surgical delivery at different stages of pregnancy, which depends on the condition of both the mother and the fetus. In this case, absolute and relative indications for caesarean section are distinguished.

TO absolute indications include conditions in which vaginal delivery is impossible or is associated with a very high risk to the health of the mother or fetus.

In these cases, the doctor is obliged to carry out the birth by cesarean section and no other way, regardless of all other conditions and possible contraindications.

In each specific case, when deciding whether to perform a cesarean section, not only the current condition of the pregnant woman and the child is taken into account, but also the course of the pregnancy as a whole, and the state of the mother’s health before pregnancy, especially in the presence of chronic diseases. Also important factors for deciding on a caesarean section are the age of the pregnant woman, the course and outcomes of previous pregnancies. But the desire of the woman herself can be taken into account only in controversial situations and only when there are relative indications for a cesarean section.

Narrow pelvis that is, an anatomical structure in which the child cannot pass through the pelvic ring. The size of the pelvis is determined during the first examination of a pregnant woman; the presence of a narrowing is judged by its size. In most cases, it is possible to determine the discrepancy between the size of the mother’s pelvis and the presenting part of the child even before the onset of labor, but in some cases the diagnosis is made directly during childbirth. There are clear criteria for the normal size of the pelvis and narrow pelvis according to the degree of narrowing, however, before entering labor, only a diagnosis of anatomical narrowing of the pelvis is made, which allows only with some degree of probability to assume a clinically narrow pelvis - a discrepancy between the sizes of the pelvis and the presenting part (usually the head) of the child. If during pregnancy it is discovered that the pelvis is anatomically very narrow (III-IV degrees of narrowing), a planned cesarean section is performed; with II degrees, the decision is most often made directly during childbirth; with I degrees of narrowing, childbirth is most often carried out through the natural birth canal. Also, the cause of the development of a clinically narrow pelvis can be incorrect insertion of the fetal head, when the head is in an extended state and passes through the bony pelvis with its largest dimensions. This happens with frontal, facial presentation, while normally the head passes through the bony pelvis bent - the baby’s chin is pressed to the chest.

Mechanical obstacles preventing vaginal delivery. A mechanical obstacle can be uterine fibroids located in the isthmus region (the area where the body of the uterus meets the cervix), ovarian tumors, tumors and deformities of the pelvic bones.

Threat of uterine rupture. This complication most often occurs if the first ones were performed using a cesarean section, or after other operations on the uterus, after which a scar remained. With normal healing of the uterine wall with muscle tissue, the uterus does not threaten to rupture. But it happens that the scar on the uterus turns out to be insolvent, that is, it threatens to rupture. The failure of the scar is determined by ultrasound data and the “behavior” of the scar during pregnancy and childbirth. A caesarean section is also performed after two or more previous caesarean sections, because this situation also increases the risk of uterine rupture along the scar during childbirth. Numerous births in the past, leading to thinning of the uterine wall, can also create a threat of uterine rupture.

Progress of caesarean section operation

During a planned cesarean section, a pregnant woman enters the maternity hospital several days before the expected date of the operation. In the hospital, additional examination and drug correction of identified deviations in the state of health are carried out. The condition of the fetus is also assessed; Cardiotocography (registration of fetal heartbeats) and ultrasound examination are performed. The expected date of surgery is determined based on the condition of the mother and fetus, and, of course, the gestational age is taken into account. As a rule, elective surgery is performed at 38-40 weeks of pregnancy.

1-2 days before the operation, the pregnant woman must be consulted by a therapist and an anesthesiologist, who discusses the pain management plan with the patient and identifies possible contraindications to various types of anesthesia. On the eve of the birth, the attending physician explains the approximate plan of the operation and possible complications, after which the pregnant woman signs consent to perform the operation.

The night before the operation, the woman is given a cleansing enema and, as a rule, is prescribed sleeping pills. On the morning of surgery, the bowels are cleaned again and a urinary catheter is then inserted. On the day before the operation, a pregnant woman should not have dinner, and on the day of the operation she should neither drink nor eat.

Currently, when performing a cesarean section, regional (epidural or spinal) anesthesia is most often performed. The patient is conscious and can hear and see her baby immediately after birth and attach him to the breast.

In some situations, general anesthesia is used.

The duration of the operation, depending on the technique and complexity, averages 20-40 minutes. At the end of the operation, an ice pack is placed on the lower abdomen for 1.5-2 hours, which helps to contract the uterus and reduce blood loss.

Normal blood loss during spontaneous childbirth is approximately 200-250 ml; this volume of blood is easily restored by a woman’s body prepared for this. During a caesarean section, the blood loss is somewhat greater than physiological: its average volume is from 500 to 1000 ml, therefore during the operation and in the postoperative period, intravenous administration of blood replacement solutions is performed: blood plasma, red blood cells, and sometimes whole blood - this depends on the amount lost during the time of the blood operation and the initial condition of the woman in labor.

Emergency caesarean

An emergency caesarean section is performed in situations where childbirth cannot be quickly carried out through the natural birth canal without compromising the health of the mother and child.

Emergency surgery requires minimal preparation. For pain relief during emergency surgery, general anesthesia is used more often than during planned operations, since with epidural anesthesia the analgesic effect occurs only after 15-30 minutes. Recently, during emergency caesarean section, spinal anesthesia has been widely used, in which, just like with epidural, an injection is given in the back in the lumbar region, but the anesthetic is injected directly into the spinal canal, while with epidural anesthesia - into space above the dura mater. Spinal anesthesia takes effect within the first 5 minutes, allowing the operation to begin quickly.

If during a planned operation a transverse incision is often made in the lower abdomen, then during an emergency operation a longitudinal incision from the navel to the pubis is possible. This incision provides wider access to the abdominal and pelvic organs, which is important in a difficult situation.

Postoperative period

After surgical delivery, the postpartum woman spends the first 24 hours in a special postpartum ward (or intensive care ward). She is constantly monitored by an intensive care unit nurse and an anesthesiologist, as well as an obstetrician-gynecologist. During this time, the necessary treatment is carried out.

In the postoperative period, painkillers are prescribed; the frequency of their administration depends on the intensity of pain. All drugs are administered only intravenously or intramuscularly. Typically, anesthesia is required in the first 2-3 days, then it is gradually abandoned.

It is mandatory to prescribe drugs for better uterine contractions (Oxytocin) for 3-5 days to contract the uterus. 6-8 hours after the operation (of course, taking into account the patient’s condition), the young mother is allowed to get out of bed under the supervision of a doctor and nurse. Transfer to the postpartum department is possible 12-24 hours after surgery. The child is currently in the children's department. In the postpartum department, the woman herself will be able to begin caring for the baby and breastfeeding it. But in the first few days she will need help from medical staff and relatives (if visits are allowed in the maternity hospital).

For 6-7 days after a cesarean section (before the stitches are removed), the procedural nurse daily treats the postoperative suture with antiseptic solutions and changes the bandage.

On the first day after a cesarean section, you are only allowed to drink water with lemon juice. On the second day, the diet expands: you can eat porridge, low-fat broth, boiled meat, sweet tea. You can completely return to a normal diet after the first independent bowel movement (on the 3-5th day); foods that are not recommended for breastfeeding are excluded from the diet. Usually, to normalize intestinal function, a cleansing enema is prescribed about a day after surgery.

When you can be discharged home, the attending physician decides. Typically, an ultrasound examination of the uterus is performed on the 5th day after surgery, and the staples or sutures are removed on the 6th day. If the postoperative period is successful, discharge is possible on the 6-7th day after cesarean section.

Alexander Vorobyov, obstetrician-gynecologist, Ph.D. honey. sciences,
MMA im. Sechenov, Moscow

Discuss your situation with your obstetrician or other qualified health professional. For most women, vaginal birth is the optimal way to give birth. Most doctors recommend against unnecessary cesarean sections because natural birth allows you to carry the baby longer and reduces recovery time for the mother. However, if you are in one of the following situations, you need to decide whether a caesarean section may be the best choice.

Your baby is placed in a difficult birthing position - with your baby's legs or lower torso turned toward the birth canal, your labor may be longer and more difficult, with an increased risk of injury to you and the baby. If this is the case, you should discuss with your doctor how likely it is that you will deliver your baby unharmed. In some cases, a caesarean section is necessary to safely deliver the baby.
The umbilical cord may become tangled or partially pass into your cervix before the baby is born. If the umbilical cord becomes compressed due to contractions or gets wrapped around the baby's neck during labor, a caesarean section may be necessary to give the baby immediate access to oxygen.
If you give birth to twins, triplets, or more - in most cases, even if you give birth to your first child naturally, the risk of a difficult birth increases for the remaining children. At least one of the twins is often positioned in an abnormal position, further increasing the inevitability of surgery. If the first baby was born normally, you can wait and see how the birth of the second baby progresses and decide on a caesarean section, just to ensure the safety of the baby. It is possible to have more than one baby safely naturally.
If there are problems with your placenta or your labor is not going well, in some cases, your placenta may detach before delivery or cover your cervix, in which case a C-section may be a safe option for your baby. Additionally, if you are having a vaginal birth and have experienced several hours of steady, strong contractions with very little dilatation to move the baby forward, a C-section may be the only way to ensure your baby is delivered safely.
You've had a C-section before - in some cases, the previous C-section was done and stitched up in such a way that another vaginal birth is dangerous or undesirable. If you have had a previous C-section, your doctor may recommend another C-section for your safety. However, many women successfully have a second vaginal birth after a cesarean section.
You have high blood pressure, diabetes, heart disease or another serious medical condition - these conditions may pose risks to your health and the health of your baby, and your doctor may recommend a C-section to reduce the risk of dangerous complications during labor. Many doctors believe that it is easier to control and guide the birth process with surgery, and they may try to schedule a caesarean section simply before the due date. If possible, your doctor may advise you to wait until after labor pains begin. But if your situation is serious or life-threatening, he may recommend a caesarean section, despite the partial pregnancy.
Your baby has serious medical complications, such as hydrocephalus (excess fluid in the brain) - if your doctor feels that the baby may be injured during vaginal birth due to a possible worsening medical condition, a C-section is the safest option. Likewise, if your baby's head is too large to fit through the birth canal without problems, your doctor may recommend a C-section.

Know the risks of a cesarean section. Before you decide whether to have a cesarean section, especially if the decision is not urgent, learn about the risks associated with the operation.

In some cases, cesarean section birth causes temporary breathing problems. Giving birth by Caesarean section before 39 weeks' gestation can also cause problems related to prematurity or immature lungs, which may result in breathing difficulties.
It is possible for your baby's skin to be cut by a surgical instrument, although such incidents are usually very rare.
Inflammation or infection may appear in the uterus or its mucous membrane. This is usually treated with antibiotics. You may also lose more blood during a C-section than through a vaginal birth, but you are unlikely to need a blood transfusion.
You may have an adverse reaction to the anesthesia. Some women are allergic to the anesthesia or suffer side effects from the drug. If you have had a negative reaction to anesthesia in the past, try to avoid a C-section if possible.
You may develop a blood clot. The surgical team will take every possible precaution to prevent blood clots, but in some cases, the clot may travel to the legs, internal organs, or the brain. If this happens, it can be life-threatening.
You may become infected or suffer injuries during surgery. In some cases, internal organs may be damaged during a C-section and you may need another surgery to repair it. As with any surgery, there is also some risk of infection at the incision and suture site.
You may need a caesarean section for any future pregnancies. A C-section puts you at risk for future pregnancy-related complications, such as placenta previa, uterine rupture, bleeding, and you will most likely have to give birth via C-section in the future.

If possible, make your final decision before it is time to give birth.

If you will be supported by a partner, friend, family member or nurse during labor, be sure to communicate your decision in advance so that they can speak on your behalf during labor.
Express your preferences to your healthcare team before giving birth and repeat when you arrive at the hospital or birth center. In some cases, a cesarean section is necessary for the health of you and your baby. If you want to try giving birth vaginally, be sure to tell your doctors.
If you have a high-risk pregnancy, scheduling a cesarean section can reduce your anxiety so you can know what to expect from the surgery and relax with your health or your baby's safety in mind.
Have a good discussion about both vaginal and cesarean birth options with your obstetrician before your scheduled date. This will give you time to ask questions and get advice for your specific situation. If your doctor recommends a C-section, it's best to learn as much as possible in advance to prevent misunderstandings or confusion immediately before the procedure. You can also schedule your surgery for a specific time, which will ensure that the right doctor is available for you.