Where is a caesarean section performed? Caesarean section operation progress

Caesarean section is a method of delivery in which the fetus is removed through an incision in the anterior abdominal wall and uterus. Surgery always entails serious recovery period, and in some cases complications. Therefore, caesarean section is performed only when natural childbirth become unsafe for mother and child.

The first caesarean section was performed by the German surgeon I. Trautmann in 1610. In those days it was emergency measure if natural childbirth is not possible. Antiseptics were not used in medicine, and the incision on the uterus was not sutured. In 100% of cases, the woman died after the operation. With the beginning of the use of broad-spectrum antibiotics, the risk of complications has decreased to a minimum.

“According to Rosstat, in 2010, 22% of pregnancies in Russia ended in caesarean section. In the West this figure is 25-28%.

Indications for cesarean section are divided into absolute and relative. One of them is enough absolute readings to carry out the operation. In the presence of relative readings the doctor makes a decision about surgery based on their combination.

Absolute readings

Complete placenta previa.
Premature placental abruption.
Anatomically narrow pelvis of III and IV degrees.
History of 2 caesarean sections or 1 corporal section.
Insolvent scar on the uterus (if it is damaged during an abortion).
Beginning uterine rupture.
Scar on the perineum III degree after a break in childbirth.
Acute fetal hypoxia.
Transverse position of the fetus after the rupture of water.

Relative readings

Severe form of gestosis.
Fracture of the pelvic bones and lumbar region in the anamnesis.
Pelvic position of a fetus weighing more than 3500 g.
Multiple pregnancy with a single fetus in the pelvic position.
Diseases of the brain, kidneys, of cardio-vascular system, retinal detachment.
Umbilical cord prolapse.

Indications for cesarean section are identified during pregnancy. Then the woman is prepared for planned surgery. She needs to go to the hospital in advance to prepare for childbirth. But sometimes it happens that a woman is preparing for natural childbirth, but complications are discovered during labor. In this case, doctors perform an emergency caesarean section. The photo below clearly demonstrates the operation process.

Preparing for surgery

With a planned caesarean section, the woman in labor is given a referral to the hospital 1-2 weeks before the birth. During this time, she takes tests and undergoes examinations. If necessary, doctors correct the woman’s health. They also monitor the child’s condition: they check the blood flow in the mother-placenta-fetus system using Doppler ultrasound, do CTG, and ultrasound.

If desired, a woman can donate plasma to a blood bank. If necessary during the operation, the mother in labor will be infused with her own blood components, not donor ones. Usually about 300 ml of plasma is donated. The blood is restored in 2-3 days.

A planned operation is usually performed at 38-39 weeks of pregnancy, based on the indicators of the child’s condition. Although the best moment for operative delivery is considered to be the beginning of labor. Then the cervix is open and postpartum discharge flows out better. Involution of the uterus passes faster, lactation occurs on time.

Caesarean sections are usually performed in the morning. In the evening they give a cleansing enema, shave the pubis, and give sleeping pills at night. The enema is repeated in the morning.

Schematic photo of childbirth by caesarean section

How does a caesarean section proceed in stages?

At the beginning of the operation, the body is prepared for anesthesia and a catheter is placed in the urinary canal to drain urine. During surgery, the bladder should be empty to make it easier for the doctor to access the uterus.

Anesthesia

The doctor chooses the method of pain relief based on the circumstances and health status of the woman in labor. General anesthesia is used in in case of emergency. This type of anesthesia has a negative effect on the body of the mother and child: it causes respiratory depression in the child, in Airways gastric contents may be ingested into the mother and cause pneumonia. For elective caesarean section is selected regional anesthesia: spinal, epidural or a combination thereof. For pain relief, an injection is given in the lower back. During spinal anesthesia, the drug is injected into the fluid washing the spinal cord and the needle is removed. With an epidural, a tube is inserted under the skin along with a needle through which the medicine is delivered, and the needle is removed. The anesthesia procedure is painless, as the injection site is first numbed.

Spinal anesthesia during surgery

After anesthesia, the woman in labor is fenced off with a screen and the removal of the baby begins immediately. During the operation with regional anesthesia, the woman in labor is conscious. Immediately after birth, the baby is put to the breast.

Progress of the operation

The cesarean operation lasts 30-40 minutes. At 15-20 minutes, the baby is removed from the uterus.

The skin in the lower abdomen is cut into a cross section 15 cm long.
Cut subcutaneously in layers fatty tissue, muscles, peritoneum.
An incision is made in the lower segment of the uterus.
The amniotic sac is opened.
The child is taken out.
The umbilical cord is crossed.
Delete the last one.
The incision on the wall of the uterus is sutured.
Restore layers abdominal cavity.
The seam is sutured on the skin with absorbable or silk threads.

The seam

Currently C-section performed through an incision in the lower segment of the uterus. This is the thinnest place on the uterus, which has a small amount of muscle fibers. Due to this, after the involution of the uterus, this area becomes the smallest, and the scar also decreases in size. With this type of scar location, the incision on the uterus and on the anterior abdominal wall does not coincide, and the risk adhesive process uterus and peritoneum minimal.

Corporal caesarean section is performed with a vertical incision in the anterior abdominal wall, which coincides with the scar on the uterus. This arrangement of incisions provokes inflammatory processes in the abdominal cavity and adhesions. It is performed only in emergency cases, when there is a question of saving the life of the mother and child.

Types of incisions for caesarean section

Possible complications

In the early postpartum period, on the first day after surgery, complications such as peritonitis, endometritis, inflammation of the deep veins may occur. In the late postpartum period: suture dehiscence on the uterus,.

Spinal anesthesia often leaves unpleasant consequences. An error when placing an injection leads to a puncture of the dura mater. Cerebrospinal fluid flows into the epidural area. This causes headaches and back pain that can last for several months or even years.

Often difficulties arise due to the simple inattention of obstetricians. When the postpartum mother is transferred to the couch after surgery, medical staff sometimes he doesn’t straighten his legs and they remain bent. But the woman does not feel the lower part of the body after anesthesia and can spend several hours in this position. This leads to poor circulation. Tissue compression occurs, and severe swelling, amyotrophy. After the operation, it is better to draw the nurse’s attention to this point.

IN modern world Caesarean section is no longer a risky operation. This type of surgical intervention is very common these days. Statistics say that for every 8 women who give birth on their own, one does so by cesarean section. In order not to be afraid to give birth this way and to be positive, every pregnant woman needs to know the basic indications of this manipulation, as well as how to prepare for it.

Indications for elective caesarean section

Despite the routine nature of this surgical intervention For gynecological surgeons, the risks of having a baby via cesarean section are 12 times higher than those with natural birth. Therefore, before we begin to consider how a caesarean section is performed, it is worth understanding what conditions are indications for its implementation.

Only in cases where childbirth naturally pose a danger to mother and child, and risks independent childbirth exceed the likelihood of complications during cesarean section, the obstetrician-gynecologist refers the woman to the surgical birth of the child.

Below is a list of indications for caesarean section:

conditions of severe preeclampsia and eclampsia during pregnancy;
diabetes in the stage of decompensation;
chronic diseases pregnant;
severe myopia, accompanied by changes in the structure of the fundus;
malformations of the birth canal (uterus and vagina);
severe anatomically narrow pelvis;
the presence of infections of the internal and external genital organs, in which there is a high risk of infection of the fetus as it passes through the genital tract;
full presentation placenta (the placenta completely blocks the external opening of the uterus, preventing the exit of the fetus);
incorrect position of the fetus (transverse, oblique);
foot presentation of the fetus;
multiple pregnancy with breech presentation of the first fetus;
plural;
pregnancy after prolonged infertility, if there are any other complications that may threaten natural childbirth.

Indications for emergency caesarean section

As you can see, there are many conditions for which a cesarean section is recommended. It is also possible to have an emergency caesarean section during vaginal delivery. It is worth noting that it can only be carried out in cases where the fetus has not yet descended into the pelvis. Further, an emergency birth is possible only with the help of an operation using obstetric forceps.

Performed urgently after pushing has already begun? The reason for this may be the following pathological conditions:

discrepancy between the size of the mother's pelvis and the size of the fetus (clinically narrow pelvis);
fetal distress (impaired placental circulation);
weakness of labor;
loss of umbilical cord loops;
premature detachment placental tissue;
complete cessation of labor.

Preparing for surgery

Many pregnant women are extremely nervous before undergoing a caesarean section. Therefore, for many it will be useful to familiarize yourself in detail with the features of a cesarean section. Where does it all begin?

A woman enters the maternity hospital a few days before the scheduled date of the operation. In the hospital, the health status of the mother and fetus is examined. For this purpose, a cardiotocogram is used, where the parameters of the fetal heartbeat are recorded, and ultrasound diagnostics are performed. Mothers regularly measure blood pressure, heart rate, and monitor the amount of urine excreted.

When answering the question of which week is the most optimal for a cesarean section, it is worth noting that much depends on the condition of the mother and child. Usually, planned surgery carried out at 38-40 weeks.

Essentially, the procedure begins before the pregnant woman is anesthetized and placed on the operating table. After all, preoperative preparation is extremely important for a successful cesarean section.

The day before, the doctor may prescribe the woman sedatives and sedatives with excessive excitement.

Important! Taking any medications by pregnant women should be strictly under the supervision of the attending physician.

Before the operation, after full explanations from the surgeon and anesthesiologist about the progress of the cesarean section, the pregnant woman signs a written consent. The choice of the type of anesthesia, the method of applying a surgical suture - all stages should be discussed with the expectant mother.

Two hours before the operation, the woman is given a cleansing enema to sanitize the intestines. Immediately before the manipulation of the pregnant woman, urinary catheter, which remains with her for one day.

Progress of the operation

To give birth to a child using this surgical intervention, a number of conditions for cesarean section must be met:

the presence of a doctor with appropriate qualifications: a surgeon, perinatologist, obstetrician-gynecologist with surgical practice;
written consent of the woman in labor;
availability of a doctor’s referral strictly according to indications: the operation should not be performed only at the request of the woman.

The step-by-step progress of a caesarean section can be presented as follows:

incision of the skin, subcutaneous fat, muscle fascia;
separation of muscle fibers from each other;
incision of the uterine cavity;
child extraction;
removal of placenta;
suturing the incision on the uterus;
suturing of the anterior abdominal wall.

Thus, the step-by-step course of a caesarean section does not pose any great difficulties for the obstetrician-gynecologist. The main points are the opening of the uterine cavity and the extraction of the fetus, since it is at these stages that you need to act especially carefully so as not to injure the child.

Below is a photo of a caesarean section. We will talk about the process of this manipulation further.

Opening of the abdominal cavity and uterine cavity

Basically, the incision of the skin and subcutaneous fat is made in the suprapubic area in the transverse direction. This localization of the incision has a number of advantages:

less subcutaneous fat thickness;
minimal risk development of hernias in the postoperative period;
the possibility of greater activity of the mother in labor, which contributes to prevention postoperative complications;
minimum size suture after surgery, which looks more aesthetically pleasing.

It is also possible to make a longitudinal incision in cases where there is already a longitudinal scar from a previous cesarean section, in case of severe bleeding, and also in cases where it may be necessary to increase the incision up or down.

The opening of the uterine cavity is carried out in its lower segment using a transverse incision.

Extraction of the child and the last stages of the operation

The most crucial moment in a caesarean section is the extraction of the fetus. It must be done carefully and in a strict order. With one hand, the surgeon removes the child by the pelvic end, holding him by the leg or inguinal fold. He should support the baby's neck and head with his other hand at this time to prevent damage. cervical spine spine.

Next, two clamps are placed on the umbilical cord and crossed between them. The child is transferred to a neonatologist to assess his vital functions. Since it is not possible to place the baby on the mother’s chest, and according to the latest recommendations this necessary stage Immediately after the baby is born, it is advised to place it on the father’s chest.

But let’s return to the course of the cesarean section operation, a detailed analysis last stages. Afterwards, the placenta is carefully removed manually, and it is necessary to check that no parts of it remain in the uterus. Afterwards, the uterus is sutured, carefully matching the edges of the incision. In the modern world, synthetic surgical threads are used, which dissolve after tissue fusion.

The anterior abdominal wall is sutured using a suture or surgical staples. To minimize the postoperative scar, the surgeon can make an internal suture with absorbable sutures. With this method there are no external threads that then need to be removed. Unfortunately, the aesthetic seam has more high cost Therefore, surgeons should discuss this issue separately with women.

On average, the duration of the operation is 30-40 minutes. And immediately after Caesarean woman An ice pack is placed on the lower abdomen for one and a half to two hours, which helps to contract the uterus and reduce blood loss in the postoperative period.

Types of anesthesia

In obstetrics, a caesarean section can be performed using two types of anesthesia:

regional - epidural;
general - mask, parenteral, endotracheal anesthesia.

Most common in this moment epidural anesthesia. During the entire operation, the woman remains conscious, but does not feel anything. This is a more favorable type of anesthesia for both the mother (less risk of complications) and the child (minimal exposure to medications). In addition, such anesthesia promotes contact between mother and child in the first minutes after birth.

How is a caesarean section performed with epidural anesthesia? The anesthetic is injected directly into the spinal canal through a catheter under the dura mater. The puncture is made between 3-4 lumbar vertebrae. This localization prevents the needle from getting into spinal cord. The injection of an anesthetic blocks pain sensitivity in the lower body and motor function of the lower extremities. Thus, the woman does not feel pain and cannot move her legs during the operation.

If for any reason local anesthesia cannot be performed, general anesthesia is performed, most often through endotracheal administration of the drug. When using it, you must first administer the muscle relaxant intravenously. This medication provides relaxation of all muscles. Next, a tube is inserted into the trachea, through which the pregnant woman is given an anesthetic. This type of anesthesia is most often used for emergency caesarean.

Postoperative period

After a caesarean section, the woman remains in the recovery room for several hours under the supervision of a surgeon and nurses. Then she is left in the hospital for another two to three days. These days, a woman undergoes infusion therapy- infusion saline solutions to replenish blood loss. Per day allowed intravenous administration up to one liter of liquids (isotonic sodium chloride solution, Disol, Trisol).

Medications are also required for a certain period of time to reduce pain in the postoperative scar. For this they use "Analgin", "Baralgin".

To prevent complications in the postoperative period, it is necessary to carry out a number of preventive measures:

getting up as early as possible (in the first 10-12 hours after surgery);
breathing exercises, starting 6 hours after surgery;
self-massage;
diet for three days after cesarean section.

The diet must be strict. On the first day, only consumption is allowed mineral water still, a small amount of tea without sugar. On the second and third days, the diet is expanded by eating low calorie dishes: soups for vegetable broth, boiled or steamed lean meats, jelly. A woman should return to her normal diet gradually, only after normal bowel function has been restored, gases and stool have passed.

Also, after surgery, you need to adhere to a number of rules regarding personal hygiene. Washing is allowed only from the second day, and only gentle washing of individual parts of the body is allowed. Only after the surgeon removes the stitches (usually a week after surgery) can you shower completely.

Possible complications

Despite the fact that the course of a cesarean section operation does not seem difficult for both the operating nurse and the surgeon, it is nevertheless a serious abdominal surgery, which can be accompanied by a number of complications.

The most common undesirable situations that arise are:

high blood loss;
injury to organs surrounding the uterus: intestinal loops, Bladder(usually occurs when repeated operations);
fetal injury;
allergic reaction to anesthetic.

Postoperative suture care

Now women are discharged from the hospital on the third day after a caesarean section. It's connected with fast healing wounds after surgery thanks to the use of modern surgical suture materials. But how the woman looks after it is also important in caring for the suture after surgery. After all proper care prevents the development of infectious infection.

It is not recommended to lubricate or treat the seam area with anything. The main thing for a woman is to maintain hygiene and carefully monitor the condition of the skin in this area. It is necessary to immediately consult a doctor if there are following signs:

redness and swelling of the skin in the suture area;
soreness when pressed;
purulent discharge.

Within 42 days after the operation, a woman has the right to contact the hospital where she had a caesarean section with any question that interests her. The doctor must examine the woman, conduct additional methods examinations and, if necessary, prescribe appropriate treatment.

Yes, the cesarean section procedure and procedure are simple and routine for most surgeons. But we must remember that any surgical intervention is a risk, so a cesarean section should be strictly performed if there are appropriate indications.

Timing, duration and progress of the operation

All pregnant women experience fear before childbirth. And it’s even worse if the birth takes place not naturally, but by caesarean section. But to make it not so scary, let's figure out why a caesarean section is performed, at what time the operation is usually performed, how long it takes and consider the entire course of the operation.

During pregnancy monitoring, the doctor makes a recommendation on how the birth should proceed. If a woman’s pregnancy is progressing normally, then most likely the birth will take place naturally. If there are any abnormalities during pregnancy or during the birth itself, then doctors may decide to perform the birth by cesarean section.

There are emergency and planned caesarean sections:

prescribed during pregnancy. In this case, the woman in labor prepares for the operation in advance, undergoes all the necessary examinations and, at a predetermined stage of pregnancy, is admitted to the pathology department. The most common indications for elective caesarean section are:

premature placental abruption;
hemolytic disease fetus;
multiple pregnancy;
severe form of gestosis;
absolutely narrow pelvis;
transverse position of the fetus, etc.

Emergency caesarean section carried out in case of unforeseen complications directly during childbirth, health threatening mother or child. The health of both the child and the mother may depend on the timeliness of the decision to perform the operation. In such situations, the qualifications of the doctor and the determination of the woman in labor are very important (after all, the operation cannot be performed without her consent).

Optimal timing

A planned caesarean section is usually performed at 40 weeks of pregnancy. This optimal time for the operation - if the fetus is of sufficient weight, it is already considered full-term, and the child’s lungs are developed enough for him to breathe independently.

With a repeat caesarean section, the timing of the operation is shifted downwards - it is done a couple of weeks earlier than the planned date of birth, usually the 38th week of pregnancy.

This approach avoids the onset of contractions, which reduces the risk various complications during the operation. Remember that only a doctor can correctly determine at what time to perform a cesarean section in each specific case.

Preparing for surgery

A woman in labor who is scheduled for a planned cesarean section is usually sent to the hospital about a week before the operation. If a woman wants to stay at home, she can come to the hospital on the day the operation will take place. But this is only permissible if there is no severe complications and at good health mother and child.

Postoperative period

After surgery, painkillers are usually prescribed because the woman experiences severe painful sensations after caesarean section. Also, depending on the woman’s condition, the doctor may prescribe various medications, such as antibiotics, or supplements that improve the functioning of the gastrointestinal tract.

You can get up after surgery no earlier than six hours later. It is also recommended to buy a postoperative bandage, which will greatly improve the condition when walking.

Nutrition after surgery must be special - on the first day after a caesarean section, you can only drink plain water.

On the second day, a woman can try soups, cereals and other liquid foods.

On the third day, at proper recovery, you can eat any food that is allowed during lactation.

If you are still scheduled for a planned caesarean section, then you should not be afraid. Most often, fear of cesarean section occurs due to insufficient awareness of the operation. Knowing exactly what she has to go through, it is much easier for a woman to psychologically prepare herself for the upcoming events.

The Greek word "Caesar" and the Latin "Caesar" have the same meaning. They mean "monarch" or "lord". According to legend, the name of the Caesarean section operation is directly related to Julius Caesar. The fact is that his mother died during childbirth. The only thing the frightened obstetricians could come up with was to cut open the mother’s belly and remove the baby. The caesarean section was surprisingly successful. Since then, this type of operation has been called a “caesarean section.”

What is a caesarean section?

Caesarean section is a surgical procedure in which the baby is removed through an incision in the woman's abdomen. The risk is twelve times higher than with natural childbirth. naturally. The operation of caesarean section can be planned and urgent or emergency, which is carried out in case of urgent need in the process of natural childbirth.

According to statistics, 25% of all children are born by caesarean section. In countries such as Brazil and the Dominican Republic, 57% of all births occur by caesarean section. Next on the list of leaders are Egypt – 52%, Turkey – 48%, Italy – 38%. In China, every fourth birth occurs by caesarean section. But, at the same time, the third part of them is carried out simply at the request of the patient, without serious medical indicators.

There is also another extreme, when the number of such operations is extremely low, which is typical for countries such as Niger, Chad, and Ethiopia. Caesarean section is performed in 2% of all cases. The reason for this low rate is an underdeveloped healthcare system.

Holland has the most optimal percentage of caesarean sections: their number there is 15%. This is due to the fact that home births are the most common practice in the country, accounting for 65%, thus reducing the number of births by caesarean section.

Why is a caesarean section performed?

A caesarean section is performed to avoid dire consequences in the case of:

Pros of caesarean section

With a caesarean section, the possibility of death of the fetus or the woman in labor is practically excluded.
A woman’s genitals remain in the same form as before childbirth, which has a positive effect on her sex life. The possibility of uterine ruptures, hemorrhoids, and bladder prolapse is excluded.
Speed. Everything happens much faster than during natural childbirth. There is no need to suffer for hours in difficult contractions and endure unbearable pain until the birth canal opens.

Cons of caesarean section

Possible risks for the baby and for the expectant mother during cesarean section

Although a caesarean section is considered harmless surgical intervention, it has quite serious risks that you should know about in advance.

Risks for mom after caesarean section:

Severe blood loss.
Damage internal organs.
Wound infection.
Inability to walk for some time.
The occurrence of adhesions between tissues and internal organs.
Chronic pain in the lower abdomen.
Inability to give birth on your own in the future.

Risks for the baby after cesarean section:

cuts and abrasions on the body;
disturbances in the functioning of the pulmonary and cardiovascular systems;
difficult adaptation.

Postoperative recovery period after cesarean section

The first day after a cesarean section, the mother remains in the operating room. An anesthesiologist and obstetrician-gynecologist carefully monitor the woman’s health condition.

A day later the woman is transferred to postpartum ward. To recover after a cesarean section, the mother is recommended to drink still water with the addition of lemon. There is no need to eat on this day, as the woman is given IVs with vitamins and microelements.

On the second day, sweet tea, boiled meat, and broth are allowed. On the third day, you can eat everything except foods that are prohibited during.

During the first two to three days after a cesarean section, the woman takes painkillers. Then the need for these medications disappears. In addition, medications are prescribed that contract the uterus and normalize the functioning of the gastrointestinal tract.

The suture after a cesarean section is tied daily. Over time, it will become completely invisible. It is not recommended to wet the abdomen for 7 days after a cesarean section.

IN postpartum period After a caesarean section, you should not lift weights, allow overwork and psycho-emotional stress.

Everything about caesarean section from preparation to surgery:

Video: Why caesarean section?

Video: Natural birth after caesarean section

C-section - surgical procedure, which allows the baby to be removed 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 his first look at the world through the incision that is made when the uterus is opened. 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. Your doctor may try different methods, such as glans massage, to see if your 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 because normal birth the likelihood of complications is high. Sometimes the doctor is able to transfer the child to correct position, 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, light 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 are having a 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 poses a great danger to the baby. 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 between the head and pelvic bones, if the water has broken, each contraction of the uterus will compress the umbilical cord, slowing down the blood flow and reducing the supply of oxygen 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 they will do 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. The subcutaneous adipose tissue is divided in 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've already had a caesarean section, you're much more likely to have placenta accreta in your next pregnancy. 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 in 100,000 - it is almost twice as high as after a vaginal 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 amount medicine may reach the child, but 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. The anesthesiologist will wipe your back with an antiseptic solution and give you an anesthetic 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 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 your 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.

Abdominal wall incision. When everything is ready, the surgeon makes the first incision. This will be an incision in the abdominal wall, about 15 cm long, cutting through the skin, fat and muscle to reach the lining of the 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. It is also preferred for 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-placed incisions, and there is less risk of damaging 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 that it will have to be extended to high vertical section- sometimes called classic. 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 to open the membranes so that the baby 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 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 for emergency surgery or a secondary caesarean section is made only when there is truly no other option, since this is due to great risk for a pregnant woman (intubation, bleeding, damage to neighboring organs, infection).

Indications for emergency surgery:

acute hypoxia of a child;
complications, life threatening 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 important to stay ahead of the curve. Caesarean sections do carry risks, just like regular operations, such as internal bleeding, blood clots, infection or damage to internal organs. Some babies experience minor breathing problems after a caesarean section. But because surgical techniques and pain management have improved, there are very few dangers associated with a caesarean section, and of course, giving birth to a healthy baby is 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 against it believe that the dangers of caesarean section outweigh any positive benefits. Currently in medical literature there is no convincing evidence that choosing a caesarean section is preferable. 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 widely. 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 pelvic organ prolapse. But an elective caesarean section is not a guarantee that problems with incontinence and prolapse will not arise at all. Baby's weight during pregnancy, pregnancy hormones and genetic factors may 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 fruit, birth injuries- which is especially important when the child is very large, - and inhalation of meconium, which occurs if the child began 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 this surgery, the risk of infection after a cesarean 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, ease of scheduling, efficiency, and financial rewards favor a cesarean section, a physician you trust should be at least cautious about the procedure.