Childbirth through cesarean section - indications and types, preparation for surgery, conduct and postoperative care. Facing the unexpected

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

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

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

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

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

Why caesarean section

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

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In some cases, natural delivery is not possible, and doctors have to remove the baby from the mother's womb through surgery.

is a surgical intervention through the abdominal wall that results in the birth of a newborn. This operation was performed back in Ancient Rome and Ancient Greece, but in those days it was only made dead.

Medieval doctors attempted to operate on living women, but this venture was not crowned with success: only the child could be saved.

Only in the 19th century did doctors learn to keep the mother alive, and in the mid-20th century, with the beginning of the era of antibiotics, caesarean section became a standard procedure that carries minimal risks for woman.

Indications for caesarean section (list)

Despite the fact that caesarean section is quite common, it is prescribed only if there are certain indications, see the list.

Absolute readings:

Complete placenta previa - suggests that the baby's place was implanted so close to the entrance to the cervix that, as it enlarged, it began to block the child's exit through the natural birth canal.
Anatomically narrow pelvis – absolute contraindication To normal childbirth. This diagnosis is made if pelvic bones women are fused in such a way that they do not allow the child to come out.
Transverse presentation of the fetus - if before the onset of labor the child was unable to get into a cephalic or at least breech position, then he will not be able to be born on his own.
A history of more than two cesarean sections. It is believed that natural childbirth in this case poses a threat of uterine rupture and intra-abdominal bleeding, which can be fatal to expectant mother.

Relative readings:

Incomplete placenta previa - in some cases, based on ultrasound results, doctors decide that the child will be able to be born on his own, since the entrance to the uterus is not completely blocked.
Breech presentation of the fetus - caesarean section is performed if there is additional factors risk (for example, repeated entanglement with the umbilical cord).
The presence of fibroids - surgery is indicated only when the size of the tumor is large or if the fibroids are located in the cervix and block the natural birth canal.
Multiple pregnancy - the doctor decides on a caesarean section if the condition of the mother and children is alarming.
- surgical intervention is performed in mandatory in cases of preeclampsia and eclampsia. The stages of late toxicosis that precede these two conditions are not always an indication for cesarean section.
Illnesses of the mother that existed before pregnancy - the doctor must assess whether natural childbirth will lead to a worsening of the course chronic diseases the expectant mother, and if the threat to her health is obvious, then she will be prescribed obstetric surgery.

The decision on surgical intervention is made not by the patient at will, but by the doctor, based on medical indications.

Conventionally, the operation can be divided into four phases: anesthesia, dissection of the wall of the abdominal cavity, the wall of the uterus and placenta, extraction of the fetus, suturing the walls of the uterus and abdominal cavity.

Choice of anesthesia

Currently, most caesarean sections are performed under epidural anesthesia. The lower part of the body is anesthetized, and the woman in labor is conscious. If an emergency caesarean section (ECS) is performed, the woman is given general anesthesia.

Throughout the entire period surgical intervention An anesthesiologist is present who monitors the effect of general or epidural anesthesia on the woman’s well-being. The question of how long a caesarean section lasts is difficult to answer definitively. It usually takes no more than 40 minutes, but can be completed earlier. The effect of anesthesia ends after the surgeon sews up the incisions.

Tissue dissection

Surgical procedures are performed in several stages:

1. B bladder a catheter is inserted for timely drainage of urine, the pubic area is shaved - this is an additional guarantee of the hygiene of the upcoming intervention.
2. A screen is placed between the upper and lower parts of the body, thus delimiting the operable area.
3. The incision site is pre-marked, and then the edges of the marked area are manually pulled together to ensure that the skin will stretch sufficiently so that the edges of the wound can later be sutured.
4. If there is an old scar from a previous cesarean section, then first it is excised with a scalpel.
5. The surgeon makes a transverse or longitudinal incision abdominal wall smooth forward movements. He has to run a scalpel along the marked lines several times, slightly deepening the instrument into the thickness of the skin and fat layer.
6. When cutting the muscles, the doctor makes efforts to manually push them apart and get to the uterus.
7. The edges of the wound are fixed by an assistant and spread apart to provide the surgeon with more complete access to the body of the uterus.
8. The same transverse incision is made on the uterus in several steps as on the abdominal cavity.

Until the moment of dissection reproductive organ the operation is almost bloodless and the assistant’s assistance in stopping the bleeding is minimal.

Fetal extraction

From the moment the uterus is incised until it is sutured, as little time as possible should pass. Therefore, the child is removed quickly; if there are umbilical cord loops on his neck, they are removed, and the umbilical cord itself is cut.

Doctors wait several minutes for the placenta to separate from the walls of the uterus on its own. It is then removed and accumulated blood and clots are removed.

Suturing tissues

The edges of the wound of the body of the uterus are fixed and stitched. At the same time, the assistant ensures the elimination of released blood using cotton pads.

In this case, the uterus itself is located outside the abdominal cavity; it is reduced after the suture is applied. Then the skin along with the fat layer is pulled apart and fixed, while the surgeon sutures the abdominal muscles. Unlike the uterus and skin, they are dissected vertically.

The last layer of skin is stitched, after which the operated surface is treated with an antimicrobial solution.

After the caesarean section procedure

If delivery was performed through surgery, this does not mean that the woman will not have bleeding from the uterus.

The reproductive organ, as in the situation with natural childbirth, will shrink, which will provoke the appearance of discharge after a cesarean section, but how many days it will last depends on how successful the operation was. Normally there are lochias abundant first 5 – 6 days, and then, within a month, gradually stop. If there were any postoperative complications, the duration of bleeding may increase.

6 hours after surgery, the woman is allowed to get up.

Many people are concerned about the question: how many days after a cesarean section can you be discharged from the hospital? Typically, such patients remain under observation a little longer than those who had a natural birth. But by 7–10 days, as a rule, most women are ready for discharge.

At first you should pay increased attention condition of the seam. If it is discovered that it has become swollen, inflamed, festered, or its pain does not decrease, but rather intensifies, you must immediately consult a doctor to avoid the development of infection.

To prevent muscle strain after a cesarean section, you should wear a bandage. The fact is that in the first few weeks it is necessary to avoid stress on the abs, so the sagging belly needs to be supported.

Pregnancy and childbirth after caesarean section

The suture on the uterus must be given time to heal. This means that the uterus should not be stretched during the first few months. Excessive stress on a suture that has not yet healed can result in rupture of the reproductive organ, peritonitis and the death of the woman.

The earliest period that will be relatively safe for a woman in labor is a cesarean section performed one year after the first cesarean section. And even in this case, the woman exposes her body to serious risk - over a long period of time, the suture on the uterus may begin to separate, so the doctor must regularly monitor its condition and thickness based on ultrasound results.

In such a situation, the chance of having a second child naturally No. Doctors will not take risks and will not allow a woman in labor to have a natural birth - the risk of rupture of the reproductive organ is too great. Of course, the uterus can be amputated urgently, but the woman will not survive due to extensive internal hemorrhage.

Fine next pregnancy can be planned no earlier than one year after cesarean section. The most ideal thing is in one and a half to two years. During this time, the suture will finally heal, but before planning conception, it is necessary to evaluate its condition using an ultrasound.

There are cases when the suture after surgery has fused extremely unsuccessfully, and it is very dangerous for a woman to carry another pregnancy.

IN Soviet time there was no point in thinking about natural delivery, given a history of cesarean section. Such experiments were not practiced. Now the situation has changed, and last years Many mothers, planning a second child, think about having it not at the operating room, but at the birth table.

In large clinics in Russia they take on such a difficult task; there was even a case of spontaneous birth after two obstetric operations in the anamnesis (which is a reckless risk from the point of view of doctors).

Therefore, natural childbirth after a cesarean section is now possible, however, the doctor will give permission for this only if the suture from the previous operation was in good condition, and at least 3 years passed after it.

When can you have sex after a caesarean section?

As with natural childbirth, you should have sex only 2 months after the birth of the child. Even though the vagina itself was not damaged by ruptures as a result of the baby passing through the birth canal, there is a possibility of infection, which will lead to the suture on the uterus becoming inflamed.

In addition, in the first month after childbirth there will be bloody issues that sex life will only interfere. In the first weeks, the suture after a caesarean section heals: it is very painful and sensitive, so it is worth postponing intimacy until a more appropriate time.

C-section is an operation in which the baby and placenta are removed from the uterine cavity through an incision on the anterior abdominal wall. The caesarean section rate averages 25 – 30%, but these values can vary significantly depending on the region of the country and medical institution. In some European countries there is elective caesarean section, that is, the operation is performed only at the request of the woman.

Information In Russia and Belarus, surgical delivery is performed only for strict medical indications. Currently, a distinction is made between relative and absolute readings to the operation. Let's figure out how they differ.

Indications for caesarean section

Absolute readings mean that with this pathology, natural childbirth is impossible, or poses a threat to the life of the mother or her child:

Anatomically narrow pelvis II - IV degree;
Pelvis, deformed bone tumors and fractures;
Tumors of the genital organs large sizes(uterine fibroids in the lower segment and cervical area, ovarian tumors);
Complete (the placenta completely covers the cervical canal) or partial (the placenta covers part of the uterine os) placenta previa;
– the placenta separates from the wall of the uterus before the birth of the fetus, and the baby experiences acute hypoxia (oxygen deficiency);
Acute fetal hypoxia;
Threatening uterine rupture;
Inconsistency of the postoperative scar on the uterus. Its condition is determined using ultrasound even during pregnancy;
Significant scar changes cervix of the uterus and vagina. In this situation, the cervix will not be able to open sufficiently and the vagina will not be able to fully stretch in order for the birth to proceed normally;
Transverse position of the fetus;
Eclampsia – severe complication gestosis, in which convulsions and loss of consciousness are observed;

Relative readings– technically independent childbirth are possible, but their outcome will be less favorable than after surgery:

Anatomically narrow pelvis of the 1st degree;
Large fetus (estimated fetal weight more than 4000 g for cephalic presentation and more than 3600 g for breech presentation);
(with a foot view and an extension position of the head);
. Since the bones of the fetal head become denser and are more difficult to configure as they pass through the birth canal;
Strongly expressed varicose veins veins of the vulva and vagina;
Persistent weakness of labor;
Malformations of the uterus;
Postoperative scar on the uterus;
Diseases of a woman not related to pregnancy, in which excessive load during natural childbirth can aggravate the condition ( cardiovascular diseases, kidney disease, diabetes, high myopia);
The pregnant woman’s age is over 35 years;
Complicated obstetric history (long-term infertility, in vitro fertilization, miscarriages, stillbirths);
Preeclampsia;
Genital tract infections;
HIV infection of the mother (to reduce the risk of infection of the child);
Symphysitis - excessive enlargement of the cartilage of the pubic symphysis (more than 11 - 12 mm) is detected on;
Chronic hypoxia fetus

dangerous Most often, the operation is performed for combined indications, and the need to preserve the life and health of the child is always taken into account.

Contraindications for surgery:

Intrauterine fetal death;
Congenital defects incompatible with life;
Infectious diseases of the skin of the abdomen.

Some women want to give birth quickly, wanting to avoid painful ones. However, most often they do not think about the fact that, as with any operation, there is a risk of complications. Maternal and child mortality in elective surgery higher by 4 - 5 times, and with an emergency caesarean section by 8 - 10 times compared to natural birth.

Progress of the operation

If the operation is performed as planned, the pregnant woman is hospitalized several days before the expected date for examination. The day before surgery, the anesthesia method is selected together with the anesthesiologist. . Epidural anesthesia gives a woman the opportunity to be conscious and see her baby and even put him to her breast. The anesthetic drug is injected into the epidural space of the spine and has no effect on the child. During emergency operations they are often given general anesthesia, because in such situations every minute counts. But you shouldn’t be afraid of this, because from the moment anesthesia is given until the birth of the child, an average of up to 5 minutes passes, and the baby receives minimum concentration medicines.

There are two types of abdominal skin incision:

Inferomedian laparotomy - the skin is incised down from the navel along the midline. This access allows you to quickly remove the baby from the uterine cavity and is used during emergency operations.
Pfannenstiel incision - an incision is made transversely above the pubis along the hairline. Currently, it is performed during planned operations, if, for example, there is no scar in the midline from a previous operation.

After the skin is cut, the muscles, peritoneum (the thin film covering the intestines), and ligaments are opened layer by layer, and then an incision is made in the lower segment of the uterus and the baby is removed. During the operation, they do not wait for the placenta to separate on its own, but remove it by hand and the doctor additionally examines the entire uterine cavity. Special substances (oxytocin, methylergometrine) are injected into the myometrium (uterine muscles) to promote its contraction. A continuous cut is applied to the incision on the uterus, the peritoneum, ligaments and muscles are sutured. Depending on the situation, either separate sutures or intradermal continuous sutures are applied to the skin. cosmetic stitch(used much more often due to better aesthetic effect).

On average, the operation lasts 30 – 40 minutes. Then the woman in labor is transferred to the intensive care unit, where doctors will monitor her for the first day. The baby is examined by a pediatrician, a midwife treats him and transfers him to the children's department.

Features of the postpartum period

In the intensive care unit, the woman is corrected for disorders that arose during the operation. Blood loss during natural childbirth Normally it does not exceed 250 – 300 ml and the body is able to replenish it itself. During a caesarean section, a woman in labor loses up to 900 ml of blood. And it is necessary to compensate for blood loss with blood replacement solutions, plasma or red blood cells. For prevention infectious complications, especially during emergency surgery, a course of antibiotics is prescribed. And to stimulate uterine contractions, oxytocin is administered for 3 to 5 days. prescribed for the first three days.

Nutrition after caesarean section

Nutrition after surgery:

Eat first nothing can be done for a day and therefore nutrient solutions containing everything are injected intravenously necessary substances. You can only drink mineral water without gases with lemon juice.
On second day add low-fat chicken bouillon, pureed meat, thin porridge, unsweetened fruit drink.
On the third day, the menu expands - you can already eat cottage cheese, yogurt, and drink unsweetened tea.
Starting from the fourth day, you can eat everything that is not prohibited for nursing young mothers.

It is advisable to eat small portions 5-6 times a day.

After the operation, intestinal motility is impaired (due to a violation of the integrity of the peritoneum) and, if there is no independent stool on the third day, then a cleansing enema or laxative is prescribed.

Feeding

Immediately after transfer to postpartum ward You can pick up your baby from the nursery and be with him all the time. From personal experience I will say that early stay together speeds up recovery after surgery, because your baby is the best analgesic.

And breastfeeding on demand improves uterine contractions and stimulates milk production better than hourly feeding. But, if the condition does not allow, then until the third day the child can only be brought in for feeding 5-6 times a day. However, it is worth remembering that on the third day the narcotic painkillers are stopped, but the stitch still hurts and adapting to your baby and caring for him is more difficult than right away.

After surgery, milk may arrive within 4–5 days, which is slightly later than during natural childbirth. But don’t be upset, it’s rich in nutrients and if applied frequently at the baby’s request, it will be enough for him. In the first week, the baby’s weight is allowed to decrease by up to 10% of his birth weight. This is due to adaptation to new living conditions.

additionally The postoperative suture is treated with brilliant green every day, and on the 7th – 8th day the skin scar has already formed and the suture material can be pulled out.

Consequences of the operation

Possible complications of the postoperative period:

Endometritis- inflammation of the uterus, due to open wound With a large wound surface, the risk of inflammation is higher than during normal childbirth.
Subinvolution of the uterus– disruption of the process of contraction of the uterus and reduction in its size. During planned operations, there is no production of internal oxytocin, which causes the uterus to contract, so it is introduced from the outside. Blood clots may become trapped in the uterus and sometimes it is necessary to perform a so-called “uterine cleansing” to prevent further complications from developing.
are formed between intestinal loops due to a violation of the integrity of the peritoneum. Usually there are few of them and they are not felt at all. But it happens that adhesions interfere normal operation intestines and pain occurs, then drug treatment or surgery to cut adhesions is prescribed.

Sex after cesarean

They are usually discharged from the hospital on the 8th – 9th day. At home, you should try not to lift anything heavier than the child for at least the first three months. You should also abstain from sexual activity at this time, since the uterine mucosa has not yet fully recovered. You need to think in advance about how to prevent pregnancy, because the body needs at least 2 years to recover after surgical birth.

Along with traditional vaginal birth in medical practice, caesarean section is used less widely, but still with a certain frequency. It has become a kind of stereotype that this type of childbirth is inferior in almost all respects natural method, but in modern conditions This is far from true.

In certain cases, a caesarean section is, first of all, an operation necessary for the normal functioning of mother and child, and any intervention can lead to certain complications. Sometimes it cannot be said which is 100% safer: natural birth or caesarean section.

When is a planned CS scheduled?

In most cases, when complications occur during pregnancy and traditional childbirth can be extremely dangerous, an elective caesarean section (Csection) is prescribed by the doctor for certain time before . This time is given, among other things, for psychological preparation the expectant mother to such an operation.

Planned surgery is prescribed in the following cases:

Diabetes;
Obstetric pathologies such as incorrect position fetus (transverse or oblique), breech presentation (when the placenta covers the cervix);
Previous births performed with the help of a sectional section, as a result of which a scar formed on the uterus. There is a high probability of uterine wall rupture during normal childbirth;
Myopia and others major changes in the fundus of the eye (for example, retinal detachment);
The pelvis is too narrow for the baby to pass naturally, or the fetus is too large.

Emergency caesarean section (ECS)

However, there are also more severe cases when the move normal birth violated, and the decision to conduct a CS is made in urgently. This is an uncommon situation and may be caused by:

Oxygen starvation of the fetus, which can lead to death;
Sharply weakened condition of the pregnant woman;
When there is a multiple pregnancy, the position of one of the babies may play a dominant role in determining the mode of delivery. For example, if the presentation of the first is characterized as gluteal, or the position is transverse;
Caesarean section is also recommended for prematurity.

Is there a chance to avoid CC?

If a woman has firmly decided that she is only going to give birth traditional way, then she has a full 9 months of pregnancy to maximize her chances of a natural birth. Of course, this does not apply to the cases described above when surgery is necessary.

Watch your health

Don't allow yourself to overeat or get too cold. Any poisoning or cold can lead to a weakening of the immune system during such a delicate period and general condition body;

Do gymnastics for pregnant women. Physical activity designed specifically for women in excellent position has a good effect on cardiovascular system, strengthen muscle tone.

How is a caesarean section performed?

The progress of the CS depends on whether the operation was planned or emergency. In the first case, the date is set in advance, as close as possible to the expected date of birth. That is, mommy will know in advance and exactly when her baby will be born.

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Painkillers are prescribed individually, taking into account possible intolerance certain drugs or allergies.

In the case of PCS, epidural (local, analgesic delivered through the spinal canal) anesthesia is mainly used, in which the woman remains fully conscious.

The operated area is hidden behind a special screen. After a transverse incision has been made, the baby is removed from the amniotic sac and, in most cases, immediately begins to cry.

If the operation went without complications, then on the same day the woman can already apply the baby to the breast for the first time. On the second day she is allowed to get up, using extreme caution.

In general, light physical activity is encouraged, as it helps speedy recovery body.

When the operation is performed on an emergency basis, the option of complete anesthesia is possible, through Airways, after which the mother may regain consciousness within several days, depending on the degree of weakening of the body.

In any situation, after a CS, a strict diet is prescribed. In the first days it is advisable to use only plain water, because there is a risk of significant disruption of intestinal function. The stitches placed on the incision are removed within a week.

Consequences of caesarean section

Unfortunately, like any surgical intervention on the body, CS can lead to a number of unpleasant consequences, such as:

1 Painful sensations. During a caesarean section, a fairly large incision is made. Naturally, it will be extremely difficult to manage without the help of painkillers at first;

2 Difficulties with feeding. Even if the mother is fully conscious, breastfeeding poses a certain risk, again associated with analgesics and antibiotics that can enter the baby’s body through milk. And starting to breastfeed when the moment of first attachment has been greatly delayed is somewhat more difficult than during natural childbirth. But when helping experienced doctor or midwives, the chance of successful feeding increases significantly;

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3 Risk in subsequent pregnancies. Doctors recommend careful protection in the first few years after a CS, since an unhealed scar can cause uterine rupture;

4 Cosmetic aspect. Considering that the operation may have saved the lives of both the baby and the mother, the stitch that remains a reminder of this story is not such a problem. But if its appearance still causes discomfort in a woman, then this can be easily corrected through polishing and smoothing procedures by a cosmetologist.

How to quickly recover after a c-section

The main thing that should not be forgotten after surgery is that our whole life is in movement. It is movement that gives us strength and leads us to our goals. Therefore, try to move away from bed rest ordinary life stands as quickly as possible, of course, without overexerting yourself.

Getting out of bed for the first time will most likely not be easy; a nurse will help you get up. Do not make sudden movements, stand up through sitting position: You can climb further only after you sit down, realize that you are not dizzy and can easily move your legs. These are just the first steps; further movements will become easier and easier.

Be sure to follow the digestive-friendly diet prescribed to you.

Don't worry, lack of food will not contribute to weakness in the first days after surgery nutrients enter the body through an IV. You can expand the menu only on the third day; you are allowed to eat low-fat foods: diet broth, skim cheese, porridge, meat puree. It is also recommended to consume dried fruits, which contribute to the speedy rehabilitation of intestinal function.

Modern doctors are increasingly deciding during natural childbirth about surgical intervention, in which the child is removed from an incision made in the uterus. For a long time, caesarean section has caused controversy about how dangerous this operation is for mother and baby. There is no clear opinion, but in most cases it is this decision that saves lives and allows one to avoid severe birth injuries. The consequences of CS are not so critical and most of them are eliminated. Complications after it do not occur more often than after other abdominal operations.

Depending on where and what kind of incision is made, as well as on the urgency of the operation, there are different types Caesarean section, each of which has its own characteristics.

At the location of the incision

Abdominal view

This option of cesarean section is the most common. It involves a suprapubic or longitudinal (from the navel to the pubis) incision of the peritoneum followed by dissection of the lower segment of the uterus. It is carried out under anesthesia, so it lasts no more than 10-20 minutes so that the drug does not enter the baby’s body. Amniotic sac breaks, the child is taken out, the placenta is removed.

Corporal view

A corporal (trunk) cesarean section involves an infero-median incision across the entire abdominal wall. It should be located exactly in the middle of the uterus so as not to provoke profuse bleeding. After the incision, the abdominal cavity is isolated so that placenta particles do not get into it, amniotic fluid, which can lead to internal inflammatory diseases.

Extraperitoneal view

Extraperitoneal (extraperitoneal) caesarean section is performed without such dangerous interference into the sensitive area of the abdominal cavity. The incision is made longitudinally, offset to the left from the middle of the abdomen, only the muscles are dissected. This type of cesarean section is contraindicated for placental abruption, uterine rupture, scars from previous operations, and tumors.

Vaginal view

Rarely used, it requires high surgical skill and experience. This is an abortion in 3-6 months of pregnancy, with scarring on the cervix, sharp deterioration woman's health, placental abruption. Can be produced according to two different techniques.

A small part of the uterus is dissected along the anterior wall. The cervix remains intact, injuries are excluded, and the young mother is recovering quickly.
It is much worse when an incision during a caesarean section of this type is made along the walls of the vagina and uterus. It severely damages internal organs and requires a longer rehabilitation period.

Minor caesarean section

This is also an abortion, but already later pregnancy (from 13 to 22 weeks) with severe functional impairment in the mother or child. An incision is made along the anterior wall and cervix, through which the embryo and placenta are removed. This caesarean section is very traumatic and is prescribed when no other birth is possible.

By urgency

Depending on whether the upcoming complications were previously known, or whether they arose suddenly during delivery, a caesarean section can be of two types - planned and emergency. The first allows both the woman and the doctor to prepare as much as possible for surgical intervention. It is much more difficult when problems arise already at the moment the baby is born.

Planned surgery

It is carried out if during the pregnancy stage, during examinations, indications for surgical intervention were identified. Since they entail complications for the health and life of the mother and fetus, a decision is made to prepare the woman for surgery.

Indications

Indications for a caesarean section can be absolute when there is no other choice, since the life and health of the mother and child are in the balance. They can also be relative, when the threat is not so great. In the latter case, the spouses’ opinions are asked whether they agree to the CS or not. Depending on which side the pathologies are found on, the reasons for the operation may relate to the conditions of the woman in labor or the fetus.

Testimony from the mother

Narrow pelvis;
risk of uterine rupture;
abnormal placenta previa;
its detachment;
scars on the uterus;
previous corporal (peritoneal) caesarean section;
T or J-shaped uterine incision;
previously held uterine operations of any nature;
two or more CS already performed;
HIV infection;
genital herpes;
any kind of cardiovascular disease;
vision problems;
pathologies of a pulmonary, neurological, gastroenterological nature;
injuries, tumors of any origin of the pelvic organs;
late toxicosis in severe form;
plastic surgeries performed on the perineum;
genitourinary or entero-genital fistulas;
gastroschisis - prolapse of intestinal loops (this can be other internal organs) through a cleft in the abdominal cavity;
teratoma - ovarian tumor;
abdominal infections;
uterine cancer;
gestosis;
preeclampsia is a type of gestosis with clear signs cerebrovascular accidents.

Fetal indications

breech or transverse presentation;
malpresentation multiple pregnancy;
monoamniotic twins;
too long dehydration in the fetus;
twin fusion;
delayed development of one fetus in multiple pregnancies;
premature birth.

Here are the cases in which a cesarean section is performed: medical indications for this operation must be observed very strictly. In their absence, a woman’s mere desire to give birth this way is not enough. For abdominal surgery, which will have a lot of consequences for the health of mother and child, we need good reasons. Fear of pain during childbirth is not one of them. After identifying the indications, a decision is made about a CS and the preparation stage begins.

Attention! If an ultrasound shows that monoamniotic twins are developing in the womb, they can be born exclusively by caesarean section. These twins develop in the same bladder, they share one placenta, and they cannot be born on their own without injury.

Preparation

As soon as the doctor has identified complications and pathologies that prevent natural course childbirth, preparations begin for a caesarean section, regardless of whether it is planned or emergency.

In the first case, everything will go much easier and better, since much more time will be spent on this stage. The woman will have time to prepare herself mentally for the operation and will be better prepared physically. Preparation will include two stages - at home, at last weeks before childbirth, and in the maternity hospital, immediately before the scheduled date of the operation.

At home

Regularly visit a gynecologist, come to the antenatal clinic at his first request, and take all necessary tests.
Enroll in special courses to prepare for a planned cesarean section.
Inform your doctor about any deviations in your health and condition.
Eat properly.
Lead healthy, correct image life, maintain a daily routine.
Be physically active in moderation.
Before sending to the maternity hospital, prepare things, documents, money, clothes, and pack bags in advance.

In the maternity hospital

Do not shave your pubic area yourself, as you may get an infection.
Two days before a cesarean section, you should not eat solid food.
Approximately 12 hours before surgery, you should not eat at all, as anesthesia can cause vomiting.
The day before, all the details are discussed with the doctor again: is everything okay with the baby? this moment time, whether any of the relatives will be with the woman in labor at this crucial moment.
If a caesarean section is performed as an emergency, preparation is reduced to several hours and includes screening for allergies to anesthesia and medications used during the operation. It is also specified when the woman in labor last took food.

Throughout the entire preparatory period for a cesarean section, the woman in labor is monitored and led to the operation by a whole team of doctors: a gynecologist, an anesthesiologist, a surgeon, and a therapist (if indications are identified from the mother’s side). Their joint task is to eliminate as much as possible all complications during the operation. Find out in advance what week you will have the CS in order to agree with the doctors on a date that is convenient for everyone.

Opinion. Some consider the big advantage of a cesarean section to be that you can accurately plan the baby's birth date. Indeed, you can make it coincide with some holiday or birthday of one of the other family members. Natural childbirth does not have such an advantage, since it is never possible to accurately guess its timing.

Deadlines

As part of your preparation, ask your doctor in advance about the timing of a caesarean section so that there are no problems with the appointed date. There are indications for this too.

Normally, the timing of a planned operation is almost the same number of weeks as during a natural birth: 39-40.
In case of multiple pregnancy, the mother is HIV-infected, the operation is performed at 38 weeks.
In the presence of monoamniotic twins, a planned CS is scheduled at 32 weeks.

In any case, even these recommended periods are purely individual and depend on a combination of a large number of factors. These include the health of the mother and the intrauterine condition of the baby. Once the cherished date has been set, all that remains is to wait for it. To be sure, some women learn the progress of the operation in detail, so as not to worry and know what happens at one time or another during a caesarean section.

Keep in mind! The date of the planned CS is set by the doctor, you can only ask him if it can be moved. Usually 1-2 days are not significant.

Progress of the operation

Since during epidural anesthesia the woman remains conscious, even before the operation begins, she is interested in knowing how a caesarean section is performed in order to be internally calm and not be surprised by anything, as well as how long this whole procedure lasts in order to be patient and calculate her strength. This allows you to relax and not distract doctors with unnecessary questions during the operation.

Preparation

They give an enema.
A catheter is inserted.
They put on an IV (most often with antibiotics).
They give pain relief.

Operation

An incision is made.
The child is removed.
The placenta is removed.
The wound is stitched up. Typically, the operating time is calculated from the moment the incision is made until the last suture is placed.

Recovery

The woman in labor is transferred to the intensive care unit (depending on her condition, she will spend 1-2 days there).
Body support medicines through an IV.
If there are no complications, the young mother is transferred to the ward.
You can get out of bed (very carefully and briefly) on the 3rd or 4th day.
Before discharge, an ultrasound is prescribed after a cesarean section, which allows you to check for internal bleeding and the condition of the seams. Ultrasonography uterine examination is performed regularly after this operation during the first six months to identify complications.

A caesarean section is not complicated at all. Most of all, women are usually concerned about how long the entire operation lasts. On average, from 25 minutes (in the absence of complications or surprises) to 2 hours. For multiple pregnancies, the procedure usually takes at least an hour. These indicators are also very individual and not always predictable.

Wow! Oddly enough, the longest stage of a caesarean section is suturing the wound, as this is truly a jeweled job that requires real skill from the surgeon.

Recovery period

One of the most important stages- rehabilitation after cesarean section, because every woman wants to care for her newborn as quickly as possible. However, this does not always work out. If there are complications, recovery may take an indefinite period. To speed it up and eliminate factors that inhibit it, you should follow medical recommendations.

First days

You will have to spend the first day in intensive care under IV drips. On day 2, they are transferred to a regular ward. Then they are allowed to stand up for a short time, walk, eat more or less normal food and care for the baby. In three days they will be allowed to land. So special care After a caesarean section, the woman in labor does not need to take care of herself.

Nutrition

On the first day after surgery, you are allowed to drink only water. Next, during the week you should adhere to a diet that prevents constipation: they should be avoided by any means after a cesarean section.

Figure restoration

This is perhaps the most difficult thing. There are only two ways to remove a sagging tummy, tighten your breasts, and lose excess weight. The first is diet, but it is contraindicated during lactation. Second - physical exercise, which after surgery are possible only six months later. You can get out of this situation by not overeating, eating right, and also leading active image life. You can walk a lot and do simple exercises at home, designed specifically for young mothers after a cesarean section.

Cycle recovery

The menstrual cycle after a cesarean section takes longer to recover than after a natural birth. If for some reason a woman was unable to breastfeed her baby, the previous rhythm returns after 2-3 months. During lactation, menstruation after a cesarean section may be delayed by 3-4, or even 6-7 months.

Restoration of the uterus

The uterus after a cesarean section also takes a little longer to heal than after a natural birth. In this regard, they can be released for 6-8 weeks. Sex life it will be possible to start exactly from the moment they end (we already wrote about this in).

But conceiving the next baby is recommended no earlier than after 2 years. According to research, this is how long it takes for muscles to fully recover after surgery. Otherwise, the stitches may come apart and the uterus itself may rupture. It is because of its contraction that after a cesarean section the stomach hurts for 2-3 weeks. Then these discomfort should quiet down.

Healing of sutures

Home, self-care after cesarean section suggests hygiene procedures: treatment with antiseptics, applying bandages, avoiding contact with water in the first week. In the presence of bleeding and suppuration, self-medication is excluded: you must seek help from a doctor as soon as possible.

We should not forget that, in addition to physical recovery body, the woman requires psychological rehabilitation after a caesarean section. Numerous conversations that such an operation disrupts the close bond between mother and child give rise to a real inferiority complex in young mothers. It requires titanic internal efforts and the help of family and friends. Moreover, if any complications arise after the CS.

Psychological support

To reassure a young mother, you can tell her which of the modern celebrities gave birth to a baby by caesarean section. Among them are Victoria Beckham (three planned cesareans), Christina Aguilera, Britney Spears, Jennifer Lopez, Claudia Schiffer, Kate Winslet (emergency surgery), Angelina Jolie, Pink, Shakira, Gwyneth Paltrow and many other famous women.

Consequences

You need to understand that this operation is intracavitary, it affects the activity internal organs Moreover, anesthesia has a significant effect on the bodies of the mother and child. Therefore, the consequences of a cesarean section are inevitable. Over time, all these difficulties can be overcome.

If a young mother has a great desire to recover faster, if she leads healthy image life and listens to all the instructions and advice of doctors, all troubles will be left behind. If you take this lightly, living one day at a time, the risks of a cesarean section develop into complications that will require further treatment.

Consequences for the mother

Incorrectly performed epidural or spinal anesthesia leads to serious injury spinal cord and long-term pain;
an allergy not detected in time provokes a severe toxic reaction to the drug administered for pain relief;
difficulties with lactation;
very long recovery period with a number of prohibitions;
at large blood loss anemia develops;
the pain of the sutures forces a woman to take medications that are undesirable during lactation;
a ban on sports in the first six months leads to excess weight gain and a vague figure;
the risk of formation of adhesions is very high;
The doctor must immediately warn the woman how long after a caesarean section she can give birth: next conception It is recommended to plan only after a couple of years (pregnancy after cesarean section);
subsequent births in 80% of cases also end in caesarean section.

Consequences for the child

Due to anesthesia, a newborn often experiences a decrease in heart rate, impaired breathing and motor skills, and disorientation in space;
difficulty with the sucking reflex;
disruption of the baby's adaptation to environment;
reduced immunity.

As a rule, complications after a cesarean section appear if something did not go according to plan during the operation: problems arose with anesthesia, the mother’s condition sharply worsened, the child was born with some kind of pathology, etc.

Childbirth is always unpredictable, so there can be no guarantee that everything will go perfectly. However, women should calm down in this regard: at risk undesirable consequences no less than with a cesarean section.

What is the difference between complications? There is a high risk of natural childbirth birth trauma for a child and uterine rupture for a woman. After a caesarean section, most complications are associated with the effects of anesthesia and suture dehiscence.

Advantages

To reassure herself, a woman should appreciate in advance all the advantages of a cesarean section, which are noted by doctors and those who have had a baby born this way:

This the only way out if there is a threat to the lives of mother and child;
anesthesia;
perineal ruptures are excluded;
the operation ends quickly;
the ability to choose the baby’s birthday;
predictable outcome;
minimal risk of hemorrhoids;
absence of birth injuries.

Most women prefer to give birth by caesarean section precisely because they are afraid pain during childbirth. However, here it is worth considering the other side of the coin: the anesthesia used cannot pass without a trace for either the mother or the baby. Therefore, having assessed the advantages of a CS, do not forget to take into account why a cesarean section is dangerous, i.e. all its possible disadvantages.

Flaws

Many people are frightened by the fact that the disadvantages of a cesarean section are a much longer list than its advantages. However, not all of them necessarily appear after surgery. At proper care and lifestyle, many of them bypass women. Among the most common shortcomings are:

the recovery period lasts many weeks;
required bed rest, which prevents the newborn from fully exercising;
pain in the suture, abdomen, back;
taking painkillers that are undesirable during breastfeeding;
: there may be too little milk, and sometimes it does not appear at all;
ban on intense sports;
the presence of an ugly seam on the stomach spoils the appearance;
after a caesarean section it will be difficult to give birth on your own;
a scar on the uterus complicates subsequent pregnancies and childbirths;
ban on conceiving a child in the next 2 years;
negative effects of anesthesia on the fetus;
poor adaptation of the baby to the environment in the future.

First of all, it is worth assessing all the pros and cons for the child during a cesarean section. He will not be injured while passing through the birth canal, as often happens during natural childbirth. But it is worth considering the effect of anesthesia on his small body. So discuss all these points with your doctor in advance.

Amazing fact. Despite the fact that domestic doctors claim that after a caesarean section it will not be possible to give birth many times, there are facts that indicate the opposite. For example, the wife of Robert Kennedy (35th President of the United States) experienced 11 successful caesarean sections.

And other features of the CS

Despite the fact that the problems of cesarean section, its pros and cons are widely discussed in the media today, women can rarely calm down their anxiety before the operation. A large number of questions arise, relating to both small nuances and large-scale problems. You will find answers to some of them below.

How many times can you have a caesarean section?

It is not recommended to do this operation more than three times. After the third operation, doctors warn the young mother that the condition of the uterus and the scars on it is becoming more and more critical each time, which is fraught with ruptures, bleeding and death of the fetus. However, everyone’s body is so individual that reusable CS, especially in the West, is not prohibited today. The question of how long a caesarean section can be performed specifically in your case can only be answered by a doctor after a series of medical studies.

How to protect yourself after a caesarean section?

Of all the methods of protection against unwanted pregnancy you need to choose the most optimal and safe one. An almost 100% guarantee after a caesarean section is provided by a spiral, but it can only be installed six months after the operation. In the meantime, you will have to be content with a condom or vaginal suppositories. Contraceptive drugs not recommended during lactation.

Will treatment be required?

Drug treatment after cesarean section is prescribed only if complications are detected. These are inflammatory processes, infection in abdominal cavity, formation of adhesions, rotting of sutures, divergence of the uterine scar, endometritis, etc. Each disease requires special diagnostics and a mandatory course of therapy.

What to do if your condition worsens after a CS?

The first month after surgery is the most dangerous. Bleeding, pain, stitches and other troubles can cause serious complications. Therefore, at the slightest deviation in her condition, a young mother should seek advice and help from a supervising doctor. In particular, red flags may include:

temperature after cesarean section indicates that something has started in the body inflammatory process which will require treatment;
pain after cesarean section at the suture site indicates their healing or the onset of inflammation; in the stomach - about education adhesive processes or contraction of the uterus; in the back - about the consequences of epidural anesthesia;
hematoma after cesarean section at the suture site - a common hemorrhage in soft fabrics, which you should not be afraid of, in most cases it passes very quickly;
blood after a cesarean section can be released either from the uterus ( postpartum lochia), or from a healing suture; if the first phenomenon is quite natural and lasts from 4 to 8 weeks, then in the second case you need to be more careful: if the suture bleeds for a long time and profusely, something is preventing it from healing, so you need to inform the doctor about this.

These are the main features of a cesarean section that you should not be afraid of. At the slightest deviation, you just need to take appropriate measures in time, according to medical recommendations.

The most important thing is to understand that doctors resort to this operation only in the most extreme and in rare cases. It is she who saves the lives of the mother and child in case of complications and pathologies. If you tune in to a positive mood, this method of delivery will not affect the mother-child relationship in any way. It doesn’t matter how the baby was born: the main thing is that he is healthy and is next to his loving mother.