Paid caesarean without absolute indications. Is it possible to do a caesarean section without indications? Cesarean section without indications: if the woman in labor has the right to choose

Around the world, there is a clear trend towards gentle delivery, which allows you to save the health of both mother and child. A tool to help achieve this is the caesarean section (CS). A significant achievement has been the widespread use of modern methods of anesthesia.

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

When is operative delivery indicated?

A caesarean section is a major surgical procedure that increases the risk of complications compared to normal natural childbirth. It is carried out only under strict indications. At the request of the patient, CS can be performed in a private clinic, but not all obstetrician-gynecologists will undertake such an operation without the need.

The operation is performed in the following situations:

1. Complete placenta previa - a condition in which the placenta is located in the lower part of the uterus and closes the internal pharynx, preventing the baby from being born. Incomplete presentation is an indication for surgery when bleeding occurs. The placenta is abundantly supplied with blood vessels, and even a slight damage to it can cause blood loss, lack of oxygen and fetal death.

2. Occurred ahead of time from the uterine wall - a condition that threatens the life of a woman and a child. The placenta detached from the uterus is a source of blood loss for the mother. The fetus ceases to receive oxygen and may die.

3. Previous surgical interventions on the uterus, namely:

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

4. Transverse and oblique positions of the child in the uterine cavity, breech presentation (“booty down”) in combination with the expected weight of the fetus over 3.6 kg or with any relative indication for operative delivery: a situation where the child is located at the internal os with a non-parietal region , and forehead (frontal) or face (facial presentation), and other features of the location that contribute to birth trauma in a child.

Pregnancy can occur even during the first weeks of the postpartum period. The calendar method of contraception in conditions of an irregular cycle is not applicable. The most commonly used condoms are mini-pills (progestin contraceptives that do not affect the baby while breastfeeding) or conventional (in the absence of lactation). Use must be excluded.

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

If a woman is over 35 years old and has at least two children, if she wishes, the surgeon can perform surgical sterilization during the operation, in other words, tubal ligation. This is an irreversible method, after which conception almost never occurs.

Subsequent pregnancy

Natural childbirth after caesarean section is allowed if the formed connective tissue on the uterus is wealthy, that is, strong, even, able to withstand muscle tension during childbirth. This issue should be discussed with the supervising physician during the next pregnancy.

The likelihood of subsequent births in a normal way increases in the following cases:

• a woman has given birth to at least one child through natural means;
• if CS was performed due to malposition of the fetus.

On the other hand, if the patient is over 35 years old at the time of the next birth, she is overweight, comorbidities, mismatched fetal and pelvic sizes, it is likely that she will undergo surgery again.

How many times can a caesarean section be done?

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

Usually, the tactics for re-pregnancy are as follows: a woman is regularly observed by an obstetrician-gynecologist, and at the end of the gestation period, a choice is made - surgery or natural childbirth. In normal childbirth, doctors are ready to perform an emergency operation at any time.

Pregnancy after caesarean section is best planned with an interval of three years or more. In this case, the risk of insolvency of the suture on the uterus decreases, pregnancy and childbirth proceed without complications.

How soon can I give birth after surgery?

It depends on the consistency of the scar, the age of the woman, concomitant diseases. Abortions after CS adversely affect reproductive health. Therefore, if a woman nevertheless became pregnant almost immediately after a CS, then with a normal course of pregnancy and constant medical supervision, she can bear a child, but delivery will most likely be operative.

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

What is important to know about the second caesarean section?

A planned operation is usually performed in the period of 37-39 weeks. The incision is made along the old scar, which somewhat lengthens the operation time and requires stronger anesthesia. Recovery from CS can also be slower because scar tissue and adhesions in the abdomen prevent good uterine contractions. However, with the positive attitude of the woman and her family, the help of relatives, these temporary difficulties are quite surmountable.

Surgical childbirth (caesarean section) is carried out according to indications, when there is a threat to the health and / or life of the mother or baby. Today, however, many women in childbirth, out of fear, think about an assisted delivery option, even in the absence of health problems. Is it possible to have a caesarean at will? Is it worth insisting on surgical delivery if there are no indications? The expectant mother needs to learn as much as possible about this operation.

A newborn baby who was born through surgery

CS is a surgical delivery method that involves removing the baby from the uterus through an incision in the abdominal wall. The operation requires some preparation. The last meal is allowed 18 hours before the operation. Before the COP, an enema is given, hygiene procedures are carried out. A catheter is inserted into the patient's bladder, and the stomach must be treated with a special disinfectant.

The operation is performed under epidural anesthesia or under general anesthesia. If the CS is done according to plan, then the doctors tend to the epidural. This type of anesthesia assumes that the patient will see everything that is happening around, but will temporarily lose tactile and pain sensations below the waist. Anesthesia is done by puncturing the lower back, where the nerve roots are located. General anesthesia for surgical delivery is used urgently when there is no time to wait for the action of regional anesthesia.
The operation itself consists of the following steps:

1. Section of the abdominal wall. It can be longitudinal and transverse. The first is designed for emergencies, because it makes it possible to get the baby as quickly as possible.
2. Muscle extension.
3. Incision of the uterus.
4. Opening of the fetal bladder.
5. Removing the baby, and then the placenta.
6. Stitching of the uterus and abdominal cavity. For the uterus, self-absorbable threads must be used.
7. Applying a sterile dressing. Ice is placed on top of it. This is necessary to increase the intensity of uterine contractions and reduce blood loss.

In the absence of any complications, the operation does not last long - a maximum of forty minutes. The baby is taken out of the mother's womb in the first ten minutes.

There is an opinion that caesarean is a simple operation. If you do not delve into the nuances, it seems that everything is extremely easy. Based on this, many women in labor dream of a surgical method of delivery, especially considering how much effort natural childbirth requires. But you must always remember that a coin cannot have one side.

When is CS required?

The attending gynecologist will decide whether the woman in labor needs surgery

In most cases, COPs are planned. The doctor determines whether there are threats to the mother and the baby if the birth takes place naturally. The obstetrician then discusses delivery options with the woman in labor. Scheduled CS is carried out on a pre-arranged day. A few days before the operation, the expectant mother should go to the hospital for a control examination. While the pregnant woman is planned to be in the hospital, the doctor monitors her condition. This allows you to predict the likelihood of a successful outcome of the operation. Also, the examination before the COP is aimed at determining the full-term pregnancy: using various diagnostic methods, it is revealed that the baby is ready for birth and you can not wait for contractions.

The operation has a number of indications. Some factors leave room for discussion about the method of delivery, others are absolute indications, that is, those in which EP is not possible. Absolute indications include conditions that threaten the life of the mother and baby during natural delivery. CS must be done when:

• absolutely narrow pelvis;
• the presence of obstructions in the birth canal (uterine fibroids);
• insolvency of the uterine scar from past CS;
• thinning of the uterine wall, which threatens to rupture it;
• placenta previa;
• foot presentation of the fetus.

There are also relative indications for CS. With such factors, both natural and surgical childbirth are possible. The delivery option is chosen taking into account the circumstances, the health and age of the mother, the condition of the fetus. The most common relative indication for CS is breech presentation. If the position is incorrect, the type of presentation, the sex of the baby is taken into account. For example, in the gluteal-leg position, EPs are acceptable, but if a boy is expected, the doctor insists on a caesarean section in order to avoid damage to the scrotum. With relative indications for caesarean section, only an obstetrician-gynecologist can tell the right decision regarding the way the baby is born. The task of parents is to listen to his arguments, because they will not be able to assess all the risks on their own.

A cesarean may be performed on an emergency basis. This happens if childbirth began naturally, but something went wrong. Emergency CS is carried out if bleeding has begun in the process of natural release, premature placental detachment has occurred, acute hypoxia has been recorded in the fetus. An emergency operation is performed if labor is difficult due to weak contraction of the uterus, which cannot be corrected with medication.

Elective CS: is it possible?

Happy mother with a long-awaited daughter

Whether it is possible to do a CS at the request of a woman in labor is a moot point. Some believe that the decision on the method of delivery should remain with the woman, others are sure that only a doctor can determine all the risks and choose the best method. At the same time, the popularity of elective cesarean is growing. This trend is especially noticeable in the West, where expectant mothers are actively choosing the way to give birth to their own baby.

Women in labor prefer surgical childbirth, guided by fear of attempts. In paid clinics, doctors listen to the wishes of expectant mothers and leave them the right to choose. Naturally, if there are no factors under which CS is undesirable. The operation has no absolute contraindications, however, there are conditions that increase the risk of infectious and septic complications after surgical delivery. These include:

• infectious diseases in the mother;
• diseases that disrupt blood microcirculation;
• immunodeficiency states.

In the CIS countries, the attitude towards the elective CC differs from the Western one. Without evidence, it is problematic to perform a caesarean section, because the doctor is legally responsible for each surgical intervention. Some women in labor, considering surgical childbirth as a painless way to give birth to a baby, even invent diseases for themselves that could serve as relative indications for CS. But is the game worth the candle? Is it necessary to defend the right to choose the way of having a child? To understand this, the expectant mother must understand the intricacies of the operation, compare the pros and cons, and study the risks that exist with any surgical intervention.

Benefits of CS at will

Why do many expectant mothers want to have a cesarean? “Order” the operation of many pushes the fear of natural childbirth. The birth of a baby is accompanied by severe pain, the process requires a lot of effort from a woman. Some expectant mothers are afraid that they will not cope with their mission and begin to persuade the doctor to procaesare them, even if there are no indications for surgical delivery. Another common fear is that the passage of the baby through the birth canal is difficult to control, and there may be a threat to his health or even life.

Fear of EP is common. But not all expectant mothers can handle it. For patients who see a lot of threats in natural delivery, the advantages of a "custom" CS are obvious:

An additional bonus is the ability to choose the date of birth of the baby. However, only this should not push a woman in labor to insist on a CS, because, in fact, the date does not mean anything, the main thing is the health of the baby.

The reverse side of the "custom" COP

Many expectant mothers do not see anything wrong with a caesarean section if a woman wishes. The operation is presented to them as a simple procedure, where the woman in labor falls asleep, and wakes up with the baby in her arms. But those women who have gone through surgical childbirth are unlikely to agree with this. The easy way also has a downside.

It is believed that CS, unlike EP, is painless, but this is not true. In any case, this is an operation. Even if anesthesia or anesthesia “turns off” pain during surgical delivery, it returns after. Departure from the operation is accompanied by pain at the suture site. Sometimes the postoperative period becomes completely unbearable due to pain. Some women even suffer from pain for the first couple of months after surgery. Difficulties arise in the "service" of herself and the child: it is difficult for the patient to get up, take the baby in her arms, and feed him.

Possible complications for the mother

Why is a caesarean section in many countries done exclusively on the basis of indications? This is due to the possibility of complications after surgery. Complications concerning the female body are divided into three types. The first type includes complications that may appear after surgery on the internal organs:

1. Big blood loss. With CS, the body always loses more blood than with EP, because when tissues are cut, blood vessels are damaged. You never know how your body will react to it. In addition, bleeding opens with the pathology of pregnancy, disruption of the operation.
2. Spikes. This phenomenon is observed during any surgical intervention, it is a kind of protective mechanism. Usually adhesions do not manifest themselves, but if there are a lot of them, then a malfunction in the work of internal organs may occur.
3. Endometritis. The uterine cavity during the operation "contacts" with the air. If pathogens enter the uterus during surgical delivery, then one of the forms of endometritis occurs.

After CS, there are often complications at the sutures. If they appear immediately after the operation, then they will be noticed by the doctor who did the CS during the examination. However, suture complications do not always make themselves felt immediately: sometimes they appear only after a couple of years. Early suture complications include:

Late complications after cesarean include ligature fistulas, hernias, keloid scars. The difficulty in determining such conditions lies in the fact that after some time women stop examining their seam and can simply miss the formation of a pathological phenomenon.

• malfunctions of the heart and blood vessels;
• aspiration;
• throat injuries from the introduction of a tube through the trachea;
• a sharp decrease in blood pressure;
• neuralgic complications (severe headache/back pain);
• spinal block (when using epidural anesthesia, severe spinal pain occurs, and if the puncture is incorrect, even respiratory arrest can occur);
• poisoning with toxins from anesthesia.

In many ways, the appearance of complications depends on the qualifications of the medical team that will perform the operation. However, no one is immune from mistakes and unforeseen situations, so a woman in labor who insists on a caesarean without indications should be aware of the possible threats to her own body.

What complications can a child have?

Caesareas are no different from babies born naturally

Caesarean section at will (in the absence of indications), doctors do not undertake to carry out because of the likelihood of complications in the baby. CS is a well-established operation, which is often resorted to, but no one has canceled its complexity. Surgical intervention can affect not only the female body, but also affect the health of the baby. Complications of a caesarean section affecting a child can be of varying degrees.

With a natural birth method, the baby goes through the birth canal, which is stressful for him, but such stress is necessary for the baby to adapt to the conditions of a new life - extrauterine. With CS, there is no adaptation, especially if the extraction occurs according to plan, before the start of contractions. Violation of the natural process leads to the fact that the baby is born unprepared. This is a huge stress for a fragile organism. CS can provoke the following complications:

• inhibited activity from drugs (increased drowsiness);
• violation of breathing and heartbeat;
• low muscle tone;
• slow healing of the navel.

According to statistics, “caesarites” often refuse to breastfeed, plus the mother may have problems with the amount of milk. You have to turn to artificial feeding, which leaves its mark on the immunity of the crumbs and getting used to the new environment. Children born by caesarean section are more likely to suffer from manifestations of allergic reactions, intestinal diseases. "Kesaryata" may lag behind their peers in development, which is due to their passivity in labor activity. This manifests itself almost immediately: it is more difficult for them to breathe, suck, scream.

weigh everything

The CS really rightfully deserved the title of "easy delivery". But at the same time, many forget that surgical childbirth can have consequences for the health of both "participants in the process." Of course, most complications in a baby can be easily “removed” if you pay maximum attention to this issue. For example, massage can correct muscle tone, and if a mother fights for breastfeeding, then the baby's immunity will be strong. But why complicate your life if there is no reason for this, and the expectant mother is simply driven by fears?

A caesarean section of your own free will is not worth it. Naturally, a woman should have the right to choose, but it is not for nothing that this operation is performed according to indications. Only a doctor can determine when it is appropriate to turn to a caesarean section, and when a natural delivery is possible.

Nature has thought of everything by itself: the process of childbirth prepares the baby for extrauterine life as much as possible, and although the body of the woman in labor has a big load, recovery is much faster than after surgery.

When there is a threat to the fetus or mother and the doctor insists on a cesarean, it is strictly forbidden to refuse the operation. The doctor always determines the risks, taking into account the fact that it is safer for the life of the woman in labor and the baby. There are situations when caesarean is the only option for delivery. If the method is subject to discussion, it is always recommended to grasp the possibility of natural childbirth. The momentary desire to "caesare" in order to avoid pain must be suppressed. To do this, it is enough to talk with the doctor about the possible risks and likelihood of complications after the operation.

It is 100% impossible to predict how the CS will pass in each specific case. There is always the possibility that something will go wrong. Therefore, doctors advocate natural childbirth whenever possible.

If the expectant mother herself cannot overcome her own fears associated with the upcoming moment of the baby's appearance, she can always turn to a psychologist. Pregnancy is not the time for fears. You need to let go of all bad thoughts, not be led by momentary desires, and clearly follow the recommendations of a gynecologist - from regimen correction to the method of delivery.

familyr_health wrote on June 4th, 2012

text: N. Semenova

A month ago I gave birth to my third child. More precisely, it was skillfully extracted from me by an excellent operational team of five people. As a result of the caesarean section, all my children appeared: a son and two daughters. I will never know what childbirth is, but I know about caesarean, if not all, then a lot. I give my experience to everyone who will have this option of the birth of a long-awaited child.

When is a caesarean section done?

Personally, I have very poor eyesight (-12), while there are tears in the retina. Ophthalmologists told me ten years ago that it is contraindicated for me to give birth myself - I will go blind. My sister has -7 vision, but her retina is in good condition, she was allowed to give birth naturally.

In general, there is list of absolute readings for the operation:

1. Narrow pelvis.
2. Cicatricial narrowing of the vagina.
3. Tumors of the bone pelvis, cervical fibroids, ovarian tumors with localization in the small pelvis, preventing the birth or extraction of the fetus even in a reduced size, cervical cancer.
4. Complete placenta previa.
5. Defective scar on the uterus after caesarean section or sewn incision of the uterus.
6. Threatening uterine rupture.
7. Progressive premature detachment of the placenta with unprepared birth canal.
8. Death of the mother with a live viable fetus.
9. Transverse position of the fetus during prenatal rupture of amniotic fluid

Relative indications for caesarean section include bleeding during pregnancy and childbirth, preeclampsia, a scar on the uterus, weakness of labor, extragenital diseases. The decision to terminate the pregnancy in an operative way is also made in cases where the child suffers from hypoxia (lack of oxygen) in utero, the umbilical cord prolapsed, the gestational age is after 40 weeks.

Such an operation is planned if it is already established during pregnancy that otherwise the woman will not be able to resolve. Emergency, when emergency situations occur during normal childbirth. My third caesarean section is unique in this regard.

The date of the operation was set, but the child decided to choose his own birthday. The day before the operation, at dawn, my water broke. This day was exactly 38 weeks of pregnancy. Having survived a planned caesarean section twice, I did not expect such a turn of events. Horror seized me, the voice of my doctor in the telephone receiver, kind and cheerful for 5 in the morning, brought me back to life: “Everything will be fine. I'm leaving, I'll be there soon." God, it's good that I went to the hospital a few weeks before the due date.

When to go to the hospital?

My case is indicative, but cannot serve as an unconditional example. You should always listen to yourself, your intuition and trust the results of tests and examinations of the fetus. Drawing pains in lower abdomen at night. My legs ached, my back, my stomach was a stake. After this, I didn’t go - I ran to the clinic for a referral to the maternity hospital. But my middle daughter was born exactly two weeks before the expected date of birth. I came to the obstetricians strictly on the day of the operation, I felt good, and it was not even in my thoughts to lie with a book for two weeks in pathology.

Mostly primiparas (according to very serious indications), women who already have children go to the hospital in advance (many do not manage to rest before childbirth, they have to interrupt the endless cycle of duties of mother and wife in such a categorical way). Usually put in one to two weeks. If an inner voice at least a little audibly tells you: “Let's lie down” - you need to listen to it, and not a sense of duty to other family members!

Benefits of being in the hospital:

In the event of the onset of childbirth, you will not need to frighten the household with your condition and think about whether to go yourself, whether to call an ambulance and where to put the children at this time.

Additional examinations of the mother and fetus (tests, cardiotocography, ultrasound, etc.)

No worries about cleaning the “entrusted territory”, as well as cooking. The floors will be washed even without you, they will feed you within the limits of state funding. Gastronomic delicacies will be brought by relatives.

Your absence will finally indicate the full power of your role in the family. My husband will never break from his tongue: “What are you tired of - are you sitting at home?” The maturation of the head of the family and the children must sometimes take place in this painful way.

The feeling of "pioneer camp". Be sure to remember the summer shift at school time.

The day before the operation

It is good to dedicate this day to purity: spiritual and physical. You can pray, meditate, or just relax. No matter how energized you are, you still won’t drive away fear. Accept it. What doesn't kill us makes us stronger. Friedrich Nietzsche is absolutely right.

Take a shower, carry out all the necessary hygiene procedures necessary before the operation. Before you have a caesarean section, your doctor will give you a letter of consent for the operation to sign. In particular, it says that in an emergency (threat to the life of the mother and (and) the child), doctors have the right to even remove the uterus. This rarely happens in practice. For example, in the obstetric ward of the Vladimir Regional Clinical Hospital, there are only 2-3 cases of hysterectomy per 2500 deliveries per year.

On the eve of the operation, it is best to eat at 17:00. At night, you can ask the midwife to give you a light sedative to get a good night's sleep.

Operation day

First, a cleansing enema awaits you. You will then be transferred to the operating room. They will give you a sterile shirt, but a headscarf or cap and special long shoe covers for your feet. For the last three years, in order to avoid postoperative complications, doctors recommend wearing special stockings before surgery. Well, if this one is not stockings, but stockings. They cost about a thousand rubles. You may only need them once in your life. Therefore, before you go to the hospital, look for ads for the sale of used stockings. They will cost much less.

Before surgery, a catheter will be placed in your bladder. This is not a very pleasant procedure. But this will also have to be experienced. The anesthesiologist will definitely ask what types of drugs you are allergic to, whether you have had anesthesia before, which one. Usually now doctors suggest doing epidural anesthesia. An injection is made in a certain place in the spine - while only the lower part of the body is anesthetized.

After epidural you can get up after 6-12 hours (anesthesia is slower, the operation after anesthesia can be started in 15-20 minutes - not earlier). With this type of anesthesia, women can also give birth naturally. You can do prolonged anesthesia and anesthetize as early as 1 day after cesarean section.

But spinal(which was done specifically for me) acts quickly, since the medicine enters directly into the spinal canal, and not around it, as with the epidural. This type of local anesthesia is more effective - pain relief during surgery is better. The only negative is that after it is carried out, you need to lie down for a day, you can’t get up and roll over.

Of course, you will not see the progress of the operation. A barrier will be placed in front of you. During the operation, you can talk to the doctors. This is not forbidden. If something is bothering you, be sure to say so.

Now doctors use synthetic suture material, it does not cause inflammation, the threads dissolve after 2 months. An incision is made in the lower segment with a transverse dissection of the uterus. Even in underwear with a low waist, the seam is then not visible. And before, doctors made a corporal (longitudinal) incision - the stomach was cut from the navel to the pubis down. The uterus burst and opened like a rose. The suture material (kegut) was of animal origin, caused inflammation, wounds healed for a long time.

First, doctors will open the abdominal cavity, then the uterus and take out the child. Caesarean section is the only operation in the world that gives such happiness. Thanks to the fact that you are conscious - you will finally see your baby! And while I'm sewing you up, the child will be weighed and measured for height. And as is customary in Russian maternity hospitals, your name, date and time of birth, the baby's gender, height and weight will be written on a brown piece of oilcloth. Many mothers carefully store the metric even after their babies become parents themselves.

After you get stitches, you will be transferred to the ward and immediately put on drips. Medicines are administered intravenously for the first three days after surgery. The child is usually brought only once a day - so that you can look at him. You can’t feed the baby, as you are given antibiotics that are incompatible with breastfeeding. You, in principle, at this time will not be up to feeding - and the milk stays at the end of the third or fourth day after the operation. The main thing is to endure the pain.

And it is also very difficult to hold out for a day, lying on your back. You will be allowed to get up the next day. By the way, I have repeatedly met information on the network that you need to get up after 6 hours. So, in reality, this is not practiced in maternity hospitals, at least with epidural anesthesia. The insertion site of the spinal anesthesia needle should be overgrown. This process takes 24 hours. All the first day you can drink only mineral water without gas or plain water with lemon juice. If the operation was done in the morning, in the evening you will be asked to try to go to the toilet for a duck. Try to do it yourself for as long as possible. If it doesn’t work out, they will insert a catheter, and this, as I already wrote, is not a very pleasant procedure.

After operation

By the end of the second day, the most persistent, on the third day, those who have a weaker will will begin to roll over to the left and right side. It hurts, but it's necessary. The more you toss and turn, the less likely it is that adhesions will form and the intestines will stagnate. Aerobatics - lie on your stomach!

On the second day, you will be offered low-fat broth, porridge on the water, boiled meat. By the third knock, you can already eat almost everything that will not harm your child, that does not form gases. The baby will be brought to you for feeding that day. From now on, you will already learn how to move around the department quite quickly and your outlook on life will again become more optimistic. Congratulations, you have survived the most difficult period! More difficult is coming. I mean the beginning of breastfeeding - many mothers have a strong engorgement of the mammary glands. Doctors say to express, not everyone succeeds. However, this is a topic for a separate discussion.

As soon as the doctor allows you to get up, get up. Ask relatives to bring you a postoperative bandage beforehand. It will make your life much easier in the first two weeks after surgery. Instead of a bandage in the hospital, they will show you how to tie up your stomach with a diaper so as not to injure the seam. But - I repeat - it is better to use a bandage.

To begin with, you just need to sit on the bed. After a day of continuous lying, it will seem to you that it became painful in the lungs, it is difficult to breathe - everything has stagnated so much. Don't worry, it'll all be over soon. It is convenient to put your feet not immediately on the floor, but on a bench. Then slowly stand up. Do not hurry. Your main achievement now is to reach the washbasin and look at yourself, the beauty. And then back to bed. Relax and repeat the feats. The main thing - try to keep your back straight, although at first it is very difficult to do.

In addition to injections, droppers and other procedures, you must put ice on your stomach at least three times a day. Cold contributes to the contraction of the uterus, it decreases to its normal size more slowly during surgical delivery. I will touch on an intimate topic - ordinary underpants are not allowed to be worn in maternity hospitals, but disposable ones are allowed. Very comfortable - scolded-soiled-thrown away!

After discharge from the hospital

The seam at home must be treated with hydrogen peroxide, then dried with alcohol (vodka). The hot liquid can be replaced with brilliant green or potassium permanganate. 2 weeks after the operation of the month, you can begin to smear the seam with preparations for resorption of the scar, for example, contratubex.

Intimate relations with the husband can be resumed 6 weeks after the operation. First you need to visit a doctor and make sure that everything is in order. Be sure to choose an acceptable contraceptive option with your doctor. 8 weeks after the caesarean section, you can start physical activity - including the abdominals. But do not be too zealous, everything is within reason.

In order to regain the former figure, the main thing in the first year of a child’s life is not to eat bakery products made from premium flour (there is no benefit for the baby) and not to abuse dishes from the “carbohydrate + protein” series. Eat more raw vegetables and fruits, drink kefir - this is very good for peristalsis. Women after surgery very often have problems with bowel movements.

How many times can a caesarean section be done?

Olga Sakharova, an obstetrician-gynecologist, worked for six years as the head of the obstetric department, currently heads the postpartum department of the obstetric corps of the Vladimir Regional Clinical Hospital. She believes that the maximum number of caesarean sections that a woman can endure without harm to herself is three:

“In the future, during pregnancy, a lot of serious complications can occur. Each scar disrupts the normal blood supply to the uterus. There is always a threat of uterine rupture, there is a high probability of bleeding. There are cases that the placenta is attached not at the top, but at the bottom, in the area of ​​the scar. This is fraught with consequences for both the mother and the child.

Surely, with 4-5 cesarean sections, adhesions are formed, which means that the woman will suffer from chronic pain in the abdomen in the future. Repeated operations are difficult for obstetrician-gynecologists also because opening the abdominal cavity, you can accidentally injure the intestines or bladder. Therefore, repeated operations are best done in multifunctional medical centers, for example, regional hospitals, where doctors of other specialties are located in neighboring departments or buildings - a five-minute walk, and not at the other end of the city.

If the mother already has two healthy, live children and her age is over 35 - we always advise after the second and third caesarean sections to ligate the fallopian tubes (to do sterilization), - this is certainly a last resort, but sometimes it is necessary. - This is all so that a woman maintains her health, so that she has the strength to raise existing babies. But we do not have the right to decide this issue ourselves, without a woman. Before the procedure, the patient must sign the consent form. In our maternity hospital, of course, there are also fourth cesarean deliveries. But this is a very rare occurrence."

Ideally, if there is a gap of at least two years between pregnancies. During this time, the body is restored and the woman is ready both mentally and physically for a new operation. I am now talking about those women whose indications for caesarean section are lifelong.

Natural childbirth after caesarean - is it possible?

Giving birth without surgery is the dream of many women who had to undergo surgery once due to extraordinary circumstances. And not according to the absolute indications of physicians.

It is indeed possible, says obstetrician-gynecologist Olga Sakharova:

“In order to give birth after a previous caesarean section, at least 4 conditions must be met. First, the child should not be large. Secondly, the baby should occupy a normal position - head down. Thirdly, the maturity of the birth canal is important. Fourthly, a woman should have a mindset for childbirth so that it does not happen that after some time after the onset of childbirth she will scream: “Cut me!”

Childbirth after caesarean section has many nuances. One of the main points is that a woman cannot be anesthetized. She must feel what is happening to her, where exactly it hurts. Doctors can find out the thickness of the scar from the results of ultrasound, but this does not indicate its viability. At any moment, a seemingly quite reliable scar can disperse, that is, the uterus will open. And if at this moment a woman is under the influence of drugs that relieve pain, she simply will not feel it. The consequences can be the most deplorable.

Based on the practice of the obstetric corps of the Vladimir Regional Clinical Hospital, only 1% of women who have previously been operated on are ready and able to give birth without the help of surgeons.

When I got pregnant, from the first days I experienced fear, I thought about childbirth all the time! The gynecologist assured that everything would be fine, everyone gives birth and I give birth! And I had a premonition that I needed to do a caesarean! Maybe my friends' experiences influenced my choice, they all had an emergency caesarean, that's for real, it's better not to allow it. Therefore, I tuned in to the planned one. Before giving birth, I met a doctor at the maternity hospital, she also persuaded me to give birth naturally, even if I give birth under a contract (that is, for a fee). As it turned out later, in maternity hospitals there was some kind of unloading, so that there were more natural births than caesarean ones. I got even more scared. I knew that natural childbirth was higher than the risk of injury to the child and my intuition told me that a caesarean should be sought! A year ago, before giving birth, I had a vision correction and I went to the center, where they wrote me a certificate that delivery by caesarean section was recommended! All! They did not argue with the conclusion of the ophthalmologists in the maternity hospital, they believed the certificate. I sincerely believe that if your heart tells you that the baby needs to be born that way, you need to do everything in your power! Previously, for example, weakened women who had health problems only gave birth in this way! And the absolute indications for a cesarean are: a narrow pelvis, all sorts of mechanical obstacles like uterine fibroids, if before that there were 2 cesareans, placenta previa or placental abruption, relative indications are cardiovascular diseases, kidney diseases, high myopia, chronic diseases of the genital tract , transverse or pelvic presentation of the fetus, large fetus, preeclampsia, fetal hypoxia. And other. If necessary, you can find a lot of information on this issue and go to the doctors for examination and conclusions! The operation itself is not difficult, as the doctors explained to me, it is rather scary psychologically for the patient herself. It was assigned to me for a certain day. Early in the morning I arrived at the maternity hospital, they prepared me, I won’t go into details, put on compression stockings so that everything was fine with the veins, and they did epidural anesthesia. Then I only remember how I was taken to the intensive care unit, where I lay for a couple of hours, as it should be. Then in the ward, in the evening they forced me to get up to disperse and there was no stagnation. Ice was applied to the abdomen to contract the uterus. In the afternoon they brought the child to show. It was for the sake of the ego that it was worth going through everything! The rehabilitation was long and difficult, for another two months I experienced discomfort, it was especially painful to get out of bed! She wore little bondage, all because of her laziness, but her stomach still shrunk well, quickly! The seam is almost invisible, it is cosmetic, it looks like a stretch. In the beginning, you need to process with brilliant green and Contractubex. After half a year, everything is OK, as if there was no operation!

A year has passed, I feel pain, if suddenly the baby hits my stomach, it’s quite strong, I was on an ultrasound, they say everything is fine. I also feel clearly when ovulation comes. In general, I still can’t recover from the operation, I feel very tired from the loads, although it can be like that for all young mothers. Not as optimistic as I wrote in the review earlier ...

• Maternal illnesses that can lead to major health problems during natural childbirth. These are diseases of the cardiovascular system, musculoskeletal system, kidneys, eyes, cancer, diabetes, psychoses and neuroses.
• In addition, a caesarean section is advised to do with severe gestosis, exacerbated genital herpes, a large (more than 4 kg) child in combination with a clinically narrow pelvis or any pathology.
• A planned caesarean section is also prescribed when, for medical reasons, the mother needs to exclude the straining period.
• Also, caesarean section is used for women who have undergone ART (assisted reproductive technologies), especially if they are multiple.

Why is an emergency caesarean section performed?

There may be several indications for this:

• this is a prolapse of the umbilical cord, in which the umbilical cord is clamped and the child cannot receive oxygen,
• placental abruption,
• weakness of labor activity,
• acute fetal hypoxia, etc.

How dangerous is the operation?

It should be understood that risks always exist, as with conventional childbirth, and with caesarean section. Doctors evaluate all the pros and cons. And they appoint a caesarean only when it is really impossible to do without it.

Since this is an abdominal operation, no one is immune from all the standard postoperative complications that may arise. These are infections, problems with the healing of the suture, soreness, unforeseen reactions to anesthesia and blood loss.

Doctors must inform patients and their relatives about these risks. But in the vast majority of cases, everything is fine. Moreover, a cesarean is done in order to protect the mother and child from more terrible consequences.

How is a caesarean section going today?

With a planned caesarean, the woman remains conscious and feels only slight pain during the removal of the baby. Usually during the operation, an epidural anesthesia is used so that the mother can immediately see her baby and attach him to the breast.

The father may also be present at the operation, who is given the baby, while the woman in labor is stitched in layers and prepared for transfer to the ward. The procedure itself lasts from 20 to 40 minutes. Sometimes spinal or general anesthesia is used. With an emergency caesarean, everything happens in exactly the same way, but general anesthesia is used more often.

How long does it take to recover after a caesarean? Is it possible to give birth later naturally?

Recovery after a caesarean may be slightly shorter than after a vaginal delivery. Since there are incisions that need time to heal. But usually on the seventh day mother and child are already being discharged home.

Sometimes after surgery, women feel chills, this is due to the individual tolerance of anesthesia. The first days you need to follow a strict diet, take antibiotics to prevent infection.

Lochia (postpartum discharge) usually lasts several weeks longer than in women who have given birth vaginally. Breastfeeding after a cesarean section is not only possible, but necessary, doctors specifically select antibiotics that are compatible with breastfeeding.

After a caesarean section, you can become pregnant and give birth vaginally, provided that the scar on the uterus has healed well. recommended not earlier than after a few years.

Is it true that cesarean is bad for children and they are “different”?

A caesarean section does not cause any significant harm to the child. There may be breathing problems or expected problems related to the health of the woman in labor and the condition of the fetus at the time of the operation.

Sometimes babies have small scalpel cuts that heal on their own. Each birth is individual, as are children and their parents. Therefore, all children are “different” and special in some way.

If you give birth with your husband, immediately took the baby in your arms, put it on your chest, then the stress associated with the operation will be forgotten by the child very soon. The advantage is that, unlike children born naturally, the “caesarites” do not have cranial bones squeezed, there are no bruises and hematomas.

Is it possible to ask for a caesarean section without medical indications?

This should not be done, because, after all, the natural and best way for a baby to be born is in childbirth, and not with a scalpel. After all, the less intervention in the birth process, the better.

It is not necessary to think that a caesarean section is Healing of sutures, a scar, anesthesia (exit from it), catheters used during the operation - all this is quite unpleasant, and sometimes painful. The female body knows very well how to give birth to a healthy child. Therefore, if there are no medical indications, trust nature.

New fashion for childbirth.

Women who are soon waiting for the birth of a baby, thinking about the process of childbirth, sort out various options for the outcome. The reviews confirm that recently in Moscow more and more pregnant women prefer a caesarean section without indications for natural childbirth and the reason for this is the relief of their own suffering. Fear of pain overshadows the possibility of negative consequences.

But fear is far from the only reason to go under the knife, there are a variety of them, but there are simply absurd ones, such as the desire for a child to be born on a certain date, because it's so great to control the fate of the future little man.

It is generally accepted that the fashion for the operation was introduced by the rich and famous. But after all, this type of procedure cannot be considered as simply safe childbirth without pain. In any case, this is an operation that can have serious consequences in the form of unforeseen situations and complications.

Is it possible to do a caesarean section without indications?

For a caesarean section, you must have strict medical indications. True, if you try, they can be found in almost every pregnant woman.

There are two types of indications for surgery:

1. Absolute indications for caesarean section:
   • clinically narrow pelvis
   • transverse or oblique position of the fetus
   • complete placenta previa
   • various rough scars
   • severe preeclampsia
   • extragenital pathology
2. Relative indications for caesarean section:
   • myopia
   • diabetes
   • arterial hypertension
   • various infections
   • late first birth.

The consequences of "painless childbirth"

Perhaps a caesarean section is not the most difficult intervention, but still it is an abdominal operation that can affect not only the mother, but also the baby himself.

Of course, this type of childbirth is less painful than natural, however, the postoperative period is exactly the opposite, therefore, in the first days, communication between the mother and the child is inferior, because after the operation you need to recover.

Another weighty argument against caesarean without indications is the scheduled date. Future mothers continue to think only about themselves, forgetting about the baby. After all, contractions are the main signal of readiness to be born. A sudden operation can cause irreparable damage to an already frightened baby. Often a peacefully sleeping baby is taken out of the uterus. It is difficult to imagine what a newborn may experience at this moment.

There is an opinion that being born naturally, the child experiences stress, but this is not so. After all, everything is laid down by nature itself. When passing through the birth canal, fluid comes out of the baby's lungs, so that breathing becomes stable rather quickly. This process affects the longer adaptation of the "caesar" to the world around him.

Many mothers note that children born by caesarean section are more passive than their peers, more closed, it is harder for them to make decisions. More often, these are just prejudices that are associated with psychological trauma, when a mother feels inferior because she could not give birth on her own.

Before deciding to take such a step as voluntarily undergoing a caesarean section without indications and going under the knife, you need to carefully consider all the nuances and consequences. Throw away your egoism, start learning to think not only about yourself, but also about your own child. Many women dream of giving birth on their own when they are scheduled for a caesarean section, but, alas, fate decreed otherwise. The final decision must be made by 37-38 weeks, because that is when the date of the operation is set.

It should also be noted that everyone's organisms and health are different and have hidden possibilities. For some pregnant women, a cesarean is not a choice, but a necessity, the only chance to become a mother. At this moment, you should not be afraid of surgical intervention, nature is on the side of the woman in labor, she will help the child take the first breath.

The article lists all absolute and relative indications for caesarean section, as well as the most common reasons for operative delivery.

If, for any reason, vaginal delivery is not recommended, doctors suggest a caesarean section, but the expectant mother in some cases can determine the way her child is born. But when a caesarean section is the only safe option, the woman is left with no choice.

Indications for caesarean section may include:

• absolute- circumstances on the part of the mother or fetus that preclude the possibility of vaginal delivery
• conditional- when, despite the indications, the doctor can perform a vaginal birth at his discretion

IMPORTANT: Caesarean section, like any other operation, can be performed with the consent of the woman in labor and her relatives. In addition, the obligatory conditions are the absence of infections in the mother, a live fetus, the presence of a doctor practicing this type of delivery and a prepared operating room.

Absolute medical indications for caesarean section: list

For absolute readings standard childbirth is not carried out due to physiological characteristics.

These include:

• narrow pelvis (2-4 degree)
• malformations and injuries of the musculoskeletal system
• mechanical obstacles that will prevent the baby from being born (tumors or deformities)
• chance of uterine rupture if there is an incompetent scar less than 3 mm with uneven contours from recent uterine surgery
• two or more previous births by caesarean section
• thinning of the uterus due to repeated births in the past
• placenta previa, dangerous with a high probability of occurrence
• bleeding during childbirth
• placental abruption
• multiple pregnancy (three or more children)
• macrosomia - large fetus
• abnormal fetal development
• Mother's HIV positive status
• the presence of herpes rashes on the labia
• repeated entanglement of the fetus with the umbilical cord, entanglement around the neck can be especially dangerous

Indication for caesarean section - repeated entanglement of the child with the umbilical cord

Medical indications relative to caesarean section: list

Relative readings to caesarean section do not exclude the possibility of vaginal delivery, however, they are a serious reason to think about their necessity.

In this case, vaginal birth may be associated with the likelihood of a serious threat to the health and life of the woman in labor and her baby, but this issue must be resolved individually.

Relative medical indications are:

• diseases and pathologies of the cardiovascular system in the mother
• kidney disease
• myopia
• diabetes
• malignant tumors
• exacerbation of any chronic disease
• nervous system damage
• preeclampsia
• mother's age over 30 years
• malpresentation
• large fruit
• entanglement

IMPORTANT: A combination of several relative readings can be regarded as an absolute reading. In such cases, a caesarean section is performed.

Large fetus - relative indication for caesarean section

Emergency caesarean section: indications for surgery

Decision to conduct emergency caesarean section (ECS) taken during childbirth, when something went wrong and the current situation poses a real threat.

Such a situation could be:

• cervix stopped dilating
• baby stopped moving down
• stimulation of contractions does not bring results
• the child lacks oxygen
• fetal heart rate is significantly higher (lower) than normal
• baby tangled in the umbilical cord
• there was bleeding
• threat of uterine rupture

IMPORTANT: EX must be carried out on time. Untimely operational actions can lead to the loss of the child and the removal of the uterus.

Indications for caesarean section due to vision, due to myopia

Myopia, in other words myopia, one of the most common reasons doctors recommend that pregnant women have a cesarean delivery.

With myopia, the eyeballs change somewhat in size, namely, they increase. This entails stretching and thinning of the retina.

Such pathological changes lead to the formation of holes in the retina, the size of which increases with the deterioration of the situation. Then comes a noticeable deterioration in vision, and in critical situations - blindness.

The risk of breaks in the retina during childbirth is greater, the higher the degree of myopia. Therefore, doctors do not recommend giving birth naturally to pregnant women with an average and high degree of myopia.

The indications for caesarean section are:

• permanent visual impairment
• myopia of 6 or more diopters
• serious pathological changes in the fundus
• retinal tear
• previous surgery for retinal detachment
• diabetes
• retinal dystrophy

IMPORTANT: It is the condition of the fundus that determines. If it is satisfactory or has minor deviations from the norm, it is possible to give birth independently and with a high degree of myopia.

Myopia - indication for caesarean section

Conditions in which a pregnant woman can give birth on her own, regardless of whether she has myopia:

• no abnormalities in the fundus
• improvement of the retina
• rupture healing

IMPORTANT: Women with myopia during natural childbirth are required to undergo episiotomy.

Indications for caesarean section by age

However, if the state of health of the future mother allows you to give birth on your own, this chance should be taken.

IMPORTANT: Age alone is not an indication for caesarean section. A planned operation should be performed if there are concomitant circumstances that can interfere with the normal course of childbirth: a narrow pelvis, an immature cervix after 40 weeks, etc.

If complications occur during vaginal delivery, such as weakening of labor, an emergency caesarean section is performed to eliminate the risk of further complications and deterioration of the fetus.

Indications for caesarean section due to hemorrhoids, varicose veins

natural childbirth with hemorrhoids dangerous due to the risk of rupture of external nodes. This can happen during attempts, when the blood overflows the bumps and tears them under strong pressure. Severe bleeding occurs, internal bumps fall out.

If the obstetrician does not have time to set the internal nodes before the anus is compressed, they will pinch, which is fraught with the transition of the disease to an acute form. The woman is in severe pain.

To prevent this situation, doctors may recommend a caesarean section for hemorrhoids. However, natural childbirth is possible even with chronic hemorrhoids.

IMPORTANT: If a decision is made to give birth vaginally, a woman should prepare for a rather painful and time-consuming process.

Hemorrhoids - one of the indications for a caesarean section

A similar situation with the choice of method of delivery in varicose veins. If during pregnancy a woman took measures to prevent thrombosis, and the doctor did not notice deterioration, it is likely that natural childbirth will be carried out.

Immediately before childbirth, a woman's legs are bandaged with an elastic bandage. This helps to avoid reflux of blood at the moments of greatest pressure - with attempts.

A few hours before the expected birth, the woman in labor is given special drugs that will help avoid the complications of varicose veins.

IMPORTANT: Varicose veins themselves are not an absolute indication for caesarean section. However, in women with varicose veins, there are frequent cases of premature rupture of amniotic fluid, placental abruption, and bleeding during or after childbirth.

Then a caesarean section is the safest for both the mother and the baby. Given these factors and the condition of the woman, the doctor makes a decision and chooses the method of delivery.

Indications for a caesarean section due to a large fetus

"Big fruit"- the concept is individual for each pregnant woman. If the expectant mother is a miniature thin woman of small stature with a narrow pelvis, even a child of 3 kg can be large for her. Then the doctor will recommend that she give birth by caesarean section.

However, for a woman of any complexion, there is a danger of “feeding” a child in the womb, which will deprive her of the opportunity to give birth on her own.

Development macrosomia possible for the following reasons:

• expectant mother moves a little
• a pregnant woman receives improper high-carbohydrate nutrition and quickly gains weight
• second and subsequent pregnancy - often each child is born larger than the previous one
• diabetes in the mother, leading to the child receiving a large amount of glucose
• taking medications to improve placental blood flow
• enhanced fetal nutrition through a thickened placenta
• post-term fetus

IMPORTANT: If the doctor detects signs of the development of macrosomia at any time, first of all he tries to find out the causes of this phenomenon and normalize the situation. If this succeeds and the weight of the fetus returns to normal before delivery, a caesarean section is not prescribed.

To normalize the weight of the fetus of a pregnant woman, it is necessary:

• complete recommended examinations
• consult an endocrinologist
• donate blood for glucose
• exercise every day
• stop eating sweet, starchy, fatty and fried foods

Large fetus - indication for caesarean section

Indications for caesarean section due to narrow pelvis

Each woman, her figure and body is unique, so it is difficult to answer the question of whether a pregnant woman with certain parameters can normally give birth naturally.

When prescribing a cesarean due to a narrow pelvis, doctors are guided not only by standard tabular indicators, but also by such an important factor as the size of the child's head.

If the child has a large skull, he will not be able to pass through the birth canal in a natural way, even if the cervix is ​​​​well prepared for childbirth, and the contractions will intensify. At the same time, if the pelvis of the woman in labor is narrow, but the child corresponds to the size of the pelvis, natural childbirth will be quite successful.

IMPORTANT: A pathologically narrow pelvis, not intended for natural childbirth, occurs only in 5-7% of women. In other cases, the definition of "narrow pelvis" implies a discrepancy between its size and the size of the fetal skull.

In any case, when the pregnant woman is registered, pelvic measurements will be taken. The data obtained will allow predicting the likelihood of complications.

IMPORTANT: Even a slight narrowing of the pelvis often leads to the fact that the child takes the wrong position - oblique or transverse. This position of the child is in itself an indication for a caesarean section.

Also, an absolute indication for surgical intervention is a combination of a narrow pelvis with:

• prematurity of the fetus
• hypoxia
• a scar on the uterus
• over 30 years of age
• pathologies of the pelvic organs

Narrow pelvis - indication for caesarean section

Indications for caesarean section due to preeclampsia

early and late preeclampsia are a complication of pregnancy. But if early gestosis is practically harmless and does not lead to pathological changes in the body of a pregnant woman, then later ones can lead to serious consequences and even death of the mother.

IMPORTANT: Early gestosis are manifested by nausea and vomiting in the early stages, later ones can be recognized by severe edema, increased pressure and the appearance of protein in the urine test.

deceit late gestosis lies in the unpredictability of the development of the disease. They can be successfully stopped, or they can lead to serious complications, such as:

• kidney dysfunction
• blurred vision
• hemorrhage in the brain
• deterioration in blood clotting
• ecplasia

IMPORTANT: Preeclampsia is treated in a hospital, where a woman is under the supervision of medical personnel around the clock.

Preeclampsia of pregnancy - an indication for caesarean section

Indications for caesarean section breech presentation

breech presentation- an unfavorable position for natural delivery, which the child occupied in the womb. On the ultrasound images, you can see that the child seems to be sitting with his legs up or tucked up, instead of lying head down.

Up to 33 weeks all coups of the fetus inside the mother's abdomen are quite natural and do not cause concern. However after 33 weeks the baby should roll over. If this does not happen and the child sits on the priest even before the very birth, the doctor may decide to perform delivery by caesarean section.

Several factors influence the way in which childbirth will be carried out in this situation:

• mother's age
• baby's weight
• gender of the child - if a boy, then only a cesarean, so as not to damage the male genital organs
• type of presentation - the most dangerous - foot, as there is a real danger of loss of limbs during childbirth in a natural way
• pelvis size - if narrow, then cesarean

Breech presentation and multiple pregnancy - indications for caesarean section

Is it possible to ask for a caesarean section without indications?

Caesarean section is performed for medical reasons. But if the expectant mother has no desire to give birth on her own, she is set only for the operation, in the maternity hospital, most likely, they will go to meet her.

Psychological readiness is one of the important factors determining the way of childbirth. Having a negative experience of natural childbirth in the past, a woman may be so afraid of repeating the experience that she will lose control of herself and her actions at the most inopportune moment. In such cases, a caesarean section will be the safest delivery option for both mother and child.

IMPORTANT: If a woman, despite the lack of evidence, intends to give birth only by caesarean section, you need to inform the doctor in advance. Then the woman in labor will have time to prepare for childbirth, and the doctors will have the opportunity to perform a planned rather than an emergency operation.

Expectant mothers who are going to have a caesarean section should not be afraid.

Modern technologies make it possible not to put the woman in labor to sleep, but to apply spinal anesthesia and carry out childbirth in her presence, and good postpartum care and pain medications will help to survive the first few difficult days after the operation.

The operation of caesarean section is a topic that does not leave indifferent any expectant mother. From the time of its inception to the present day, the surgical method of childbirth has been a cause for fear, misconception and heated debate.

Recently, a large number of supporters of caesarean section have appeared. Many pregnant women seriously believe that surgery is just one of the birthing options that they can choose on their own, such as vertical birth or childbirth in water. Some even argue that a caesarean section is a more modern, easy and painless version of the birth of a child, it is supposedly easier and safer for mom and baby than a long and complicated process of natural childbirth. In fact, this is not true; operative delivery is a special type of obstetric care, indispensable in cases where natural childbirth is impossible for a number of reasons or even dangerous to the life of the mother or fetus. However, neither the less painful nor the safer way of giving birth "caesarean" can not be called. Like any other surgical intervention, operative delivery is associated with significant risks to the health of the mother, both during the operation itself and in the postoperative period. That is why a caesarean section is never performed simply "at the request" of the patient, without real medical indications.

Indications for caesarean section

Indications for operative delivery are divided into absolute and relative. Absolute indications include situations in which childbirth through the birth canal is in principle impossible or dangerous to the life of the mother and / or fetus. Here are the most common absolute indications for delivery by caesarean section:

Complete placenta previa- attachment of a child's place in the lower segment of the uterus, in which it completely covers the area of ​​\u200b\u200bthe internal os of the cervix. In this case, childbirth through the natural birth canal is impossible: the placenta simply closes the baby's exit from the uterus. In addition, at the very first contractions, accompanied by the opening of the cervix, the placenta will begin to exfoliate from the area of ​​\u200b\u200bthe internal pharynx; this can lead to the development of massive bleeding, which poses a real threat to the life of the mother and baby.

Transverse position of the fetus- such an arrangement of the baby, in which its progress through the birth canal becomes impossible. In the transverse position, the fetus is located in the uterus horizontally, perpendicular to the mother's spine. In this case, there is no presenting part of the fetus - the head or buttocks - which normally should put pressure on the cervix during contractions, helping it to open. As a result, during childbirth in the transverse position of the fetus, the cervix practically does not open, and the walls of the contracting uterus put pressure on the transverse spine of the baby, which is fraught with severe birth injuries.

narrow pelvis is an absolute indication for operative delivery if a third or fourth degree of a uniformly narrowed pelvis is detected (a decrease in all sizes by more than 3 cm) or an oblique pelvis - a narrowing of the internal dimensions with a mutual displacement of the bones that form the small pelvis due to trauma or rickets. With such a degree of narrowing, childbirth through the birth canal is impossible, regardless of the size and location of the fetus.

large fruit is not always an absolute indication for operative childbirth: with normal pelvic sizes, even a large baby can be born naturally. Newborns with a weight of more than 3600 g are considered large. However, with a fetal weight of more than 4500 g, even a normal pelvis may be too narrow for the fetus, and natural childbirth can be risky for health.

Multiple entanglement of the umbilical cord leads to a significant shortening of its length and deterioration of the blood supply to the fetus. In addition, numerous, more than three, loops of the umbilical cord interfere with the normal location of the fetus in the uterus and prevent the movements necessary for the normal biomechanism of childbirth. Biomechanism is the totality of the baby's own movements during birth, helping him to adapt to the size and shape of the mother's pelvis. If the fetus does not have the ability to make the necessary movements - for example, bend, unbend and turn the head, birth injuries are inevitable even with the normal size of the pelvis and the fetus itself.

Maternal illnesses accompanied by a violation of muscle tone and nervous regulation of the pelvic organs. There are few such diseases, and they are quite rare. Childbirth through the natural birth canal in this case is impossible, since with these pathologies productive labor activity does not develop. An example of such an absolute indication for "caesarean" are paralysis and paresis (partial paralysis) of the pelvic organs, as well as multiple sclerosis - a lesion of the nervous system, characterized by a violation of the transmission of nerve impulses to organs and muscles.

Complications of pregnancy and childbirth, which pose a real threat to the life of the mother and fetus, are the main absolute indications for emergency operative delivery.

Actually, the operation, called "caesarean section", was first carried out precisely for the purpose of saving lives. The "vital" indications include an acute violation of the cardiac activity of the mother and fetus, placental abruption, severe forms of late toxicosis (preeclampsia), impaired placental blood flow of the 3rd degree, the threat of uterine rupture or an old postoperative scar on the uterus.

Relative indications include situations in which operative delivery is preferable to natural childbirth:

• the woman's age is under 16 or, on the contrary, over 40;
• pathology of vision, cardiovascular and neuroendocrine systems;
• slight narrowing of the pelvis or an increase in fetal weight;
• breech presentation - the location of the baby in the uterus, in which the buttocks or legs are located below;
• complicated course of pregnancy - late toxicosis, impaired placental blood flow;
• the presence of general and gynecological chronic diseases.

To decide on the need for surgical intervention, one absolute or a combination of several relative indications is sufficient.

Operation or childbirth?

Why is a caesarean section done only according to indications? After all, the operation is much faster than natural childbirth, it is completely anesthetized and eliminates the risk of birth injuries for mother and baby. To answer this question, you need to learn more about the features of operative delivery.

1. Cesarean section is an abdominal operation; this means that doctors need to open the abdomen to remove the fetus. Of all types of surgical interventions, abdominal operations are associated with the greatest number of risks to the life and health of the patient. This is the risk of developing intra-abdominal bleeding, and the risk of infection of the abdominal organs, and the risk of divergence of postoperative sutures, rejection of the suture material, and many others. In the postoperative period, the puerperal experiences significant abdominal pain, requiring medical anesthesia. The recovery of the mother's body after surgical delivery takes longer than after natural delivery, and is associated with a significant limitation of physical activity. If we compare the traumatism of "natural" and "artificial" childbirth, then, of course, abrasions, a perineal incision and even ruptures of the birth canal are incomparable with the traumatism of abdominal surgery.

2. To extract the fetus, doctors have to dissect the anterior abdominal wall, the aponeurosis is a wide tendon plate connecting the abdominal muscles, the peritoneum is a thin translucent serous membrane that protects the internal organs of the abdominal cavity and the wall of the uterus. After extraction of the fetus, the uterus, peritoneum, aponeurosis, subcutaneous fat and skin are sutured. Modern suture material is hypoallergenic, aseptic, i.e. does not cause suppuration, and eventually completely resolves, however, the consequences of surgery still remain forever. First of all, these are scars - areas of connective tissue formed at the site of the seam; unlike true cells of an organ, connective tissue cells do not perform any specific functions necessary for the normal functioning of an organ. The tissue formed at the site of the suture is less durable than the organ's own tissue, therefore, subsequently, if stretched or injured, a rupture may occur at the site of the scar. The risk of rupture of the scar on the uterus is always preserved in all subsequent pregnancies and childbirth. Throughout pregnancy, in the presence of a postoperative scar on the uterus, a woman is under especially careful medical supervision. In addition, surgery limits the ability to have more than three children: during each subsequent operation, the tissue of the old scar is excised, which reduces the area of ​​\u200b\u200bthe anterior wall of the uterus and creates an even higher risk of rupture in the next pregnancy. Another unpleasant consequence of any surgical intervention in the abdominal cavity is the formation of adhesions; These are connective tissue strands between the organs and walls of the abdominal cavity. Adhesions can disrupt the patency of the fallopian tubes and intestines, causing secondary infertility and serious digestive problems.

3. The main disadvantage of operative delivery for a baby is that during a caesarean section, the fetus does not pass through the birth canal and does not experience a pressure difference to the extent that it needs to “start” autonomous life processes. With various pathologies of the fetus and mother, this fact is the advantage of caesarean section and determines the choice of doctors in favor of the operation: pressure drops for a long time become an additional burden for the crumbs. When it comes to saving the lives of mothers and babies, surgical delivery is also preferable due to the temporary advantage: from the start of the operation to the extraction of the fetus, an average of no more than 7 minutes passes. However, for a healthy fetus, this difficult path through the birth canal, oddly enough, is preferable to a quick extraction from the surgical wound: the baby is genetically “programmed” for just such a birth scenario, and surgical extraction is additional stress for him.

In the process of moving through the birth canal, the fetus experiences increased pressure from the birth canal, which contributes to the removal of fetal - intrauterine - fluid from its lungs; this is necessary for uniform spreading of the lung tissue during the first breath and the beginning of a full pulmonary respiration. Equally important is the difference in pressure that the baby experiences during natural childbirth, and for the start of independent work of his kidneys, digestive and nervous systems. Of great importance is the passage of the crumbs through the tight birth canal and for the full start of the cardiovascular system: in many respects, the launch of the second circle of blood circulation and the closure of the oval window, the opening between the atria, functioning in the fetus during pregnancy, depend on this.

The caesarean section is an additional surgical intervention of the maximum volume for obstetrics and is associated with a significant risk to the health of the mother, it is never performed at the request of the patient. Caesarean section cannot be considered as an alternative delivery option; this is an additional intervention in the natural process, produced strictly for medical reasons. The final decision on the need for surgery can only be made by a doctor who observes the expectant mother during pregnancy and during childbirth.

• Country Russia
• City Moscow region

Since you are a doctor, you probably understand that a professional will not perform an operation without evidence. There is the law, the Standard of Medical Practice and professional ethics. If there is someone who decides to break the rules, the question of what else he decides to break is also worth considering.

• Country Russia

Ooh, morals have begun! In my opinion, it is written in Russian - go past with morals! without absolute indications, according to an acquaintance, there were small problems that pulled "by the ears". Everything went fine, thank God, and I consider my decision the most correct in my life. I had just an animal, a panic fear of EP and strong confidence that in childbirth something terrible will happen either to me or to the baby. No psychotherapy, conversations with doctors and self-adjustment helped. Good luck to you, the Author, and a healthy baby!

• Country: Denmark

I understand the author completely!
I have 2 EX. True according to testimony.
But what I want to say is that a girl was lying in the ward with me when I gave birth to my first (and it was in Ukraine then), she was afraid of gynecologists to convulsions, to go to a chair, etc. She had an unsuccessful abortion, when the inflammation went and she was cleaned alive - after that she got all these fears.
At the hospital, she begged the doctors to give her a CS. But everyone considered it their duty to tell her that every woman MUST go through the pangs of childbirth, that it is better than the COP, because after the COP and the children are sick and there is no maternal feeling ... In general, sheer nonsense.
As a result, when she began giving birth, she was taken to the delivery room, she began to have convulsions, panic, tears from horror ... They tried to give her an epidural anesthesia, but this only caused her to hallucinate ....
How she screamed .... I was just in the next room after the COP ... so I myself went for a walk in the corridor, so as not to hear this ...
After giving birth, I saw her .... She was completely morally crushed. ..
She said - she will never do it again .. They live like that - they have one daughter ...
So the question is - why did she have to be tortured like that?
There are women who give birth like cats, and there are those for whom everything is more complicated.

When my second contractions started, I almost climbed the wall myself. Doctors also persuaded me to EP, despite the fact that I already had a CS. In the end - looking at me, and how "good" I was)))), they made an EX ... What I was immensely glad))
My children are healthy. GV is excellent - the youngest is 2 years old and she is still ha GV. I love children more than life - so all the horror stories about the COP are not true ...

• Country Russia
• City Moscow region

, about sick children and the lack of maternal feelings, I agree, complete nonsense. I would run away from such a maternity hospital and from such doctors - my heels would sparkle, they can’t give birth to either EP or KS, what a violent fantasy and a complete lack of professional ethics. It's not about these horrors. It's good that you're lucky. But any operation is a risk. Risk of nosocomial infection, complications, bleeding and inflammation. Surgery carries more risk than physiological childbirth, all other things being equal. The differences are only in this, and competent doctors are guided precisely by the correlation of risk and benefit for the patient.

, try contacting Lapino. Perhaps it is in your case that the fear of EP is already limited or has turned into a phobia, the hospital psychologist can give you a referral to a CS, according to relative indications.

• Country Russia
• Moscow city

ProstoMama, there are absolute and relative indications. And so, to relative indications it is possible to write though anything. I will not write about chronic diseases and the structure of the pelvis of the woman in labor. For example, just fear. It is different for everyone, and the degree of fear from pain (pain shock and pain threshold) is also different. From fear, a woman may experience discoordination of labor, and with it, epidural anesthesia can no longer be done.
And, if you worked in our "Russian" medicine, you would perfectly understand why I asked such a question. And once again, thank you for not imposing your opinion!)))
The question is due to the fact that I did not study in Moscow, and in my city I have the opportunity to do a CS for less money and without unnecessary stupid questions. But I want it in Moscow, next to the house, so that my husband takes it from the hospital.

• Country Russia
• Moscow city

Yes thank you!)))

The thing is that it is necessary to negotiate with the doctor and with the anesthesiologist. Since, even with a referral (from anyone: a cardiologist, an ophthalmologist, a psychologist), if you enter the maternity hospital without an “agreement” and wave this recommendatory referral, our kind doctors will shove it away and say this: “Darling, give birth yourself! everyone gave birth and you will give birth. I have just witnessed such situations myself more than once.
There is one maternity hospital, I won’t name where everyone was Caesarean, because 30 minutes and everything is ready! But here the line control (usually comes from the Department) suspected something was wrong and requested documents with explanations and testimony. Now in that maternity hospital only herself, though so narrow, even an artificial pacemaker.
The fact is that in our country everything is focused on statistics, on positive results on paper, according to documents. And this makes me sad.
Although, if the COP is carried out correctly, no hospital-acquired infections are taken into account (since people are generally removed from their posts for this), then antibiotics are not even prescribed. In terms of complexity, this operation is no more difficult than the removal of appendicitis.

• Country Russia
• City Moscow region

Unfortunately, nosocomial infections are a harsh reality of the time, you yourself probably know, since you work in medicine. No, no one will dismiss the testimony of their doctor there. She advised me, because a woman who had a CS with a similar relative indication, with a fear of childbirth, was giving birth with me. Her fear of childbirth was recognized as a high risk, a phobia, and even working with a psychologist did not help. Made CS.

Moreover, these are contract births, paid for at 36 weeks. The contract for the COP is more expensive, no one will accept the EP with the concluded contract for the COP) This is a violation of the contract. Do not worry, do not panic, find out, everything will be fine) Health to you!

• Country Russia
• Moscow city

Unfortunately, nosocomial infections are a harsh reality of the time, you yourself probably know, since you work in medicine. No, no one will dismiss the testimony of their doctor there. She advised me, because a woman who had a CS with a similar relative indication, with a fear of childbirth, was giving birth with me. Her fear of childbirth was recognized as a high risk, a phobia, and even working with a psychologist did not help. Made CS. Moreover, these are contract births, paid for at 36 weeks. The contract for the COP is more expensive, no one will accept the EP with the concluded contract for the COP) This is a violation of the contract. Do not worry, do not panic, find out, everything will be fine) Health to you!

Yes, I really hope for a good resolution))) Thank you! Health!

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