Natural childbirth after cesarean: is it possible? Is it possible to give birth naturally after a caesarean section: all the pros and cons.

Childbirth after a caesarean section raises many questions for women planning a second pregnancy. Doctors at the same time indicate possible complications of the process. Let's consider the situation in detail, find out when you can give birth after a cesarean section and how the process is carried out.

Is it possible to give birth after a cesarean?

According to obstetric practice, the second birth after a caesarean section should be carried out in the same way. The reason for this is availability. This area of tissue has low elasticity, which increases the likelihood of rupture of the reproductive organ. As a result, a complication develops - uterine bleeding occurs. The situation requires urgent, surgical intervention, it is dangerous with the possible death of a woman in labor.

At the same time, modern studies of Western neonatal centers prove that childbirth after caesarean section is possible by the classical method - through the birth canal. So British doctors calculated: 75% of women who gave birth naturally had no complications in labor. As for the consequences for the fetus (hypoxia, neurological complications), they are recorded in 1% of cases. Given this information, obstetricians, when asked by a woman as to whether it is possible to give birth herself after a cesarean section, give a positive answer.

How soon can you give birth after a caesarean?

Women who have undergone surgery are often worried about the question of how long it takes to give birth after a cesarean section. At the same time, doctors do not name an unambiguous time period that must pass before planning the next pregnancy. It all depends on the rate of regeneration of the tissues of the uterus and the formation of a scar on it. A preliminary examination helps to determine this fact.

Obstetricians themselves try to adhere to the rule that says that childbirth after a cesarean section that has taken place should occur no earlier than 2 years later. This fact is due to the failure of the scar - the likelihood of development increases. In addition, the curettage during the onset of pregnancy also thins the uterine tissue, which negatively affects the restoration of the reproductive organ. Is it possible to give birth after a caesarean section to a particular woman - the doctor determines.

Is it possible to give birth after a cesarean in a year?

In each case, when it is possible to give birth after a caesarean section, the doctor determines. For this, a comprehensive examination of the uterus is prescribed, which includes ultrasound, examination in the gynecological chair. Particular attention is paid to the condition of the postoperative scar. This area of tissue has low extensibility, which increases the risk of uterine rupture in this place. After the examination, the woman receives recommendations for planning the next pregnancy.

Is natural childbirth possible after a caesarean section?

Women planning a second pregnancy are often interested in the question of whether it is possible to give birth after a cesarean. Doctors do not deny this possibility. At the same time, they point to the factors determining the variant of this delivery. Among them:

scar condition;
the number of cesareans in history;
absence of concomitant diseases of the reproductive system.

Contraindications for natural childbirth after cesarean

It is worth noting that in such situations, not all women are allowed natural delivery. This is due to the possibility of developing complications - after a cesarean section, the uterus acquires some features. Contraindications for vaginal delivery in this case are:

longitudinal scar on the uterus;
placenta previa in the area of the scar;
peppered location of the fetus;
large fruit;
anatomically narrow pelvis;
oncological process.

Preparing for childbirth after cesarean

Independent childbirth after caesarean section requires a preparatory stage. It begins with an assessment of the condition of the reproductive organ. To do this, the woman provides the doctors with an extract from the maternity hospital, which contains the following information:

reasons for the previous caesarean;
the duration of the anhydrous period, childbirth;
method of suturing, material used;
the amount of blood lost;
list of drugs used.

Based on the information received, doctors draw conclusions and conduct the necessary examination. It includes:

Ultrasound of the small pelvis;
laboratory tests: blood, urine, hormone levels;
exclusion of chronic foci of inflammation.

How is natural childbirth after caesarean?

Natural childbirth after caesarean section is always planned. They are carried out for a period of 39-40 weeks. The process begins with an amniotomy - opening the amniotic sac, which starts the process of childbirth. The delivery itself is carried out in the same order as always. Special attention is paid to the condition of the scar. With its initial divergence, the appearance of blood, proceed to an emergency cesarean.

How many times can you give birth after a cesarean?

When asked how many times you can give birth after a caesarean section, obstetricians previously answered that a woman can only have 2 caesareans in her entire life. The modern development of medicine and obstetrics allows for several deliveries after such an operation. Decisions of this kind are made by a team of doctors who evaluate the available results of the study, the condition of the genital organ, and the scar that has formed on it.

Western obstetricians have long used vaginal delivery after caesarean section. At the same time, a low percentage of complications is recorded. This is achieved through a thorough study of the process of such delivery, continuous monitoring of the state of the woman in labor in the process of the birth of the baby. Cases are recorded when a woman after such an operation gives birth to 2 children by natural childbirth. At the same time, the babies themselves do not have any pathologies.

Natural childbirth after two caesarean sections

As mentioned above, the decision on whether it is possible to give birth after a caesarean section in a natural way is made by the doctor. Domestic obstetricians adhere to the principle that 2 previous caesareans are an indication for a third. Previously, a woman was completely forbidden to give birth in this case, after the second operation, sterilization (ligation of the fallopian tubes) was performed.

Many women who have a caesarean section during their first birth are wondering: is it possible to give birth naturally after this operation? It will not be possible to answer this question unambiguously, because. many features of the female body, labor activity are taken into account, and most importantly, the reason why the caesarean section was done for the first time.

When can I plan a pregnancy after a caesarean?

The caesarean section involves an incision in the peritoneum and a direct incision in the uterus to extract the fetus. Then the integrity of the organ is restored, and a scar remains on it. Naturally, in the area of impact, the tissue becomes thinner. In order for the uterus to get stronger, the scar to heal and the organ to be ready for pregnancy again, time must pass. Doctors recommend planning a pregnancy no earlier than 2-3 years after a caesarean section. It is during this period that the scar grows stronger.

Within 2-3 years, you need to protect yourself to avoid pregnancy.

However, this term is not categorical. For some women, healing is much faster, while for others, on the contrary, it is delayed. If a woman wants to give birth to a second child in 10-12 months, it is imperative to consult a doctor to allow or prohibit conception.

Delaying pregnancy is also dangerous. 10 years after cesarean, the strength of the scar decreases, and it can be problematic to endure and give birth to a child.

The question immediately arises: what can happen if we neglect the recommendations of a gynecologist? A fragile and inelastic uterus will not withstand such a load, and the likelihood of rupture of the organ increases greatly.

Is it possible to give birth naturally after a caesarean section?

Natural childbirth after caesarean section is possible in the absence of absolute contraindications.

In most cases, they are successful, and the probability of uterine rupture is only 0.5%. But here it is very important that there are no interventions on the part of the medical staff and the woman in labor, from punctures of the water bladder to the intake of stimulant drugs. The use of prostaglandins to induce labor increases the risk of organ rupture to 15.5%.

What conditions must be met for a woman to be allowed to give birth herself?

First, she herself must want and be mentally prepared for this.

Second, the risk of complications in vaginal delivery should be less than the risk in caesarean section.

The following items are also evaluated:

Child size. A large fetus weighing more than 4 kg is an indication for repeated caesarean section.
Multiple pregnancy. If a woman in labor is expecting two or more babies, natural childbirth is prohibited - too much stress on the uterus.
Location of the placenta. The farther from the scar is the placenta, the better.
The age of the woman. After 35 years, natural childbirth is dangerous.
The course of pregnancy. If pregnancy is difficult for a woman, symptoms of histosis are observed, natural childbirth is contraindicated.
Cause of previous caesarean section. Natural childbirth is allowed if caesarean was done due to weak labor activity.
Scar condition. A strong, healed scar from 3 mm in size is an indication for natural childbirth.

Possible complications and risks

Re-pregnancy after a caesarean section is always a little more difficult, regardless of the chosen method for the birth of the baby.

The first and biggest risk that occurs with natural childbirth after cesarean is the spreading or rupture of the scar. During pregnancy, the uterus greatly increases in size, and during childbirth it is subjected to a large load. With contractions and attempts, the organ may not withstand the pressure and burst. Fortunately, at present, the condition of the scar is carefully checked at the stage of pregnancy planning, so the probability of such an outcome is less than 1%.

Other risks:

Complicated course of childbirth. The area of the uterus in which the scar is located is always partially weakened, so more effort and time are required for normal labor activity.
Postpartum bleeding. After the fetus is released, the uterus should contract due to its elasticity and take on a smaller size. If there is a scar on the organ, the recovery process is more difficult, the fetal membranes cannot come out, due to which hypotonic bleeding occurs.
endometritis- inflammation of the inner lining of the uterus, which is often the result of postpartum hemorrhage.
Peritonitis.

If a woman was observed by a doctor for all 9 months, took tests on time and followed all the recommendations, the birth will be successful and without any complications. Even if an unforeseen situation happens, specialists will quickly find their bearings and take measures that will save the life and health of both the mother and the baby.

Is there an advantage to natural childbirth?

There can be no dispute about what is better - natural childbirth or surgical intervention, because it is obvious that independent childbirth has a number of advantages.

Minimal risks for the child;
Short and easy recovery period;
The use of anesthesia is allowed;
Repeated births are possible after a shorter period;
The child is better adapted to life.

In women who have survived a caesarean section, immunity is weakened. The likelihood of acute respiratory infections increases, and problems with the digestive system may also appear. The microflora of the mother, which is transmitted to the child during his movement through the birth canal, strengthens his immune system.

Doctors strongly advise against performing a caesarean section without absolute indications for this. In addition, many girls themselves ask for an operation because of the fear of childbirth, especially first-time mothers. This is also not worth doing, because there is a risk to the health of the baby, the health and even the life of the mother, and the frequency of complications in subsequent births also increases.

Expectant mothers need to learn one thing: not to listen to the advice of relatives and girlfriends, and even more so not to read Internet forums, but to learn everything first hand - from a gynecologist. Pregnancy planning and its course after a caesarean section is always under the supervision of a doctor who knows exactly what is good for everyone. Only the emotional mood depends on the woman: the stronger the woman believes in the success of natural childbirth, the easier it will be!

Specially for- Elena Kichak

From Guest

The first time she gave birth herself from the first contraction to childbirth, it took 3.5 hours, everything went fine! And the second time there was a CS at 23 weeks, it all ended in a trogically complete placental presentation and here is the result. There are no babies. After the CS, everything seems to go without complications. So I want to get pregnant again and give birth to myself. Just not CS!

Childbirth is an unpredictable process and sometimes they do not go at all the way a woman planned, according to some indications, doctors offer delivery through a caesarean section. Usually, such births require special indications and conditions, about which the woman is informed and her permission is asked. Sometimes situations are emergency and the operation is performed according to vital indications. The baby is born not through the vagina (natural birth canal), but through an incision in the lower abdomen, with further suturing of the uterus and tissues.

But as time passes, the baby grows up and you are increasingly thinking about the child you still want to give birth to. And then the question immediately arises - how will your next birth after a cesarean operation take place, is an operation again necessary or can you give birth to a baby naturally with one (or even more than one) scar on the uterus? Let's talk about the issue of natural childbirth after a caesarean section. Many women really want to give birth on their own after a caesarean section, in order to “know all the pains of motherhood”, so to speak, and the birth of a baby through the natural birth canal is still considered the most optimal way to be born.

By yourself or not?

Previously, obstetrician-gynecologists with repeated births after a cesarean section had a rather categorical position - only a second cesarean and no more than two scars on the uterus in total, that is, no more than two children if the first were by caesarean section. Today, the position and opinion of doctors is gradually changing towards expanding the indications for natural childbirth after a cesarean section, and rightly so. In any situation, an individual approach and forecasting of risks and opportunities are needed. Therefore, today doctors believe that a repeated caesarean section is not the best option for childbirth for a woman with a previous scar on the uterus, it is not at all a safe alternative to the usual natural childbirth. More and more experts are inclined to believe that only natural childbirth with a wealthy scar on the uterus is the safest delivery for both the mother herself and her baby.

One of the undoubted advantages of subsequent births through the natural birth canal (vaginal birth) is that there are no risks of postoperative complications. But with a caesarean section, as with any abdominal operation, they are always present. Here are the sutures, and their healing, and the quality of the suture materials, and even the skills of the surgeon - the outcome of the operation and the healing process depend on all this. Another undoubted plus of natural childbirth is that with them, recovery occurs faster and a woman with a baby spends much less time in the hospital, rather going home to a familiar and calm environment.

But there are, of course, reservations regarding the presence of absolute indications for a second caesarean section in this, new, pregnancy and childbirth. The possibility of carrying out childbirth after the intervention in a natural way depends on the previous operation, its type and indications for its implementation. If the operation was performed on a woman by the classical method of caesarean section with the formation of a longitudinal scar, with this method, further childbirth in a natural way is not allowed, the risk of complications and an unfavorable outcome of childbirth is high. If this is a transverse incision, there are no indications for a caesarean section in this pregnancy, then it is possible to plan childbirth through the birth canal with all precautions and readiness for emergency completion by a second caesarean section.

What is needed for planning?

To make sure and fully appreciate the possibility of a normal birth after surgery, certain rules and conditions must be observed. First of all, when discharged from the maternity hospital, a woman needs to draw up a detailed extract from the doctor who delivered the baby. It should indicate the main indications for performing the operation, carrying out planned or emergency intervention, the total duration of labor, the duration of the anhydrous period before the start of the operation, the method of the operation. It is imperative to indicate the method of suturing the uterus using what kind of suture material it was made, whether it was a catgut suture or synthetic threads, whether there were complications during the operation and after its completion, what was the volume of blood loss during childbirth and the postpartum period, how blood loss was replenished. Next, you need a detailed description of the postpartum period, what measures were taken to prevent postpartum and postoperative complications.

Before the very discharge of the puerperal with the baby from the maternity hospital, the doctor should explain in detail to the woman on the basis of what indications the intervention was carried out - a caesarean section, and in a form accessible to her. If a caesarean section was performed due to the peculiarities of the course of the first pregnancy with placental abruption or placenta previa, due to the development of preeclampsia in the pregnant woman, the mismatch in the size of the fetus to the woman's pelvis, since the baby was large, then during the second pregnancy, childbirth can end in natural childbirth and is necessary by all means strive for this fact.

What do you need from a woman?

If a woman after a caesarean section wants to give birth naturally, preparation for this event must begin in advance, from the very beginning - discharge from the maternity hospital with her first child. It is very important to clearly and fully comply with all recommendations regarding the care of the suture and the prevention of complications. Do not overload yourself physically, strictly monitor your well-being, secretions and the recovery process of the body. In addition, you should not rush with the second baby, allowing the body to recover and form an absolutely normal scar - this is most important for the uterus itself. According to doctors, it takes an average of two to three years to restore the body. During this period, it is necessary to use contraceptives to prevent unwanted pregnancy and its termination. Abortion after a caesarean section is one of the negative factors that will be against natural childbirth in the future. It can significantly worsen the condition of the scar on the uterus and then this will become an indication for another caesarean section.

After the first operation, the fact of subsequent pregnancy will be especially important: planned and physiologically flowing. Before the onset of pregnancy after surgery, it is highly recommended to consult a doctor in order to examine and objectively assess the condition of the scar. Particularly important for an objective assessment will be invasive methods - hysteroscopy and hyterography. These methods are more objective than ultrasound, since not all nuances can be assessed with ultrasound.

Hysterography is an x-ray examination of the uterus filled with a special inert contrast agent, performed in two projections at least six months to a year after birth. Hysteroscorpia is the introduction of a special device with optics at the end through the cervix into its cavity, which allows you to examine the uterine cavity from the inside and especially examine the suture area. The most favorable variant of this examination is a subtle muscle suture. This will speak in favor of the most physiological healing of the uterus and the possibility of preserving all its functions during childbirth.

When examining the uterus, doctors carefully evaluate the tissue from which the scar is formed, especially favorable for further natural childbirth is the formation of a muscle scar. Worse - if it is a mixed scar, the most unfavorable condition is a scar from inelastic and inextensible connective tissue. After a year of motherhood, it is necessary to conduct either both studies, or at least one of them, since it is believed that the scar takes its final form at the end of the first year after childbirth and no longer changes.

Is it possible without examinations?

If you want to get pregnant and give birth in principle, and it doesn’t matter for you which method of delivery it will be, you can limit yourself to the standard set of examinations as part of pregnancy planning. But, if the question arises about the possibility of natural childbirth after a cesarean section, then hysteroscopy is one of the main methods of examination. Only after it will it become known for sure whether it is possible to get pregnant and bear a child at all, whether it is possible to give birth on your own or it is better not to risk your health and the life of the baby. Pregnancy with complicated scars on the uterus or with their failure is generally dangerous in itself, and with natural childbirth - doubly so.

But, if everything is in order with the scar, pregnancy after caesarean section will practically not differ in any way from the pregnancy that occurs in women after natural childbirth. But with the choice of a doctor who will support the idea of natural childbirth after a cesarean, it will be more difficult - many doctors do not like such women in labor, since such childbirth is always a high risk. An agreement is needed with a doctor from the antenatal clinic, and then the maternity hospital, as a thorough preparation of the woman for this type of childbirth is necessary.

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In the whirlpool of surging feelings of love and tenderness for the little creature and fatigue from everything that happened for almost 20 hours, one thought pulsated in my head like a bright spot: “I gave birth. HERSELF!!!"

My first birth was in January 2009, for medical reasons, due to the lack of labor, an emergency was performed. Subsequently, I asked the gynecologist who observed me in the postpartum department about the possibility, to which I was told that it was quite possible. To be honest, I did not believe it and was mentally prepared for the fact that our second child would be born with the help of an operation. The second we planned in five years.

Somewhere in the middle of March 2010, my husband and I found out that we would soon become parents for the second time - the test showed the coveted two strips. I still remember the state of shock and depression that took possession of me at the moment when I saw the result of the pregnancy test: after all, so little time had passed after the first birth, I was afraid that I might simply not be able to bear the child because of the “fresh” scar on uterus. The husband, on the contrary, was very happy and began to wait for his daughter.

I went to counseling the next day. Our local doctor looked at me with great surprise when I asked: “So what, will you keep it?” I answered in the affirmative.

"I had to listen to a lot about the irresponsible attitude towards my own health, that there is a great risk of leaving the first child without a mother, but neither the doctor's "reprimands" nor the offers of relatives to have an abortion changed my decision to give birth.

To learn more about what difficulties you may encounter during pregnancy after a caesarean section, as well as to get the most information about natural childbirth after surgical delivery, I advanced to the vastness of the worldwide network. Of course, there was a lot of information, including quite contradictory ones: from information that subsequent births after cesarean section are possible only through surgery, to statements that natural childbirth after cesarean section is possible regardless of how previous operation was indicated.
Of course, as always, the truth is somewhere in between. After summarizing all the information I learned, I realized the following:

“The ability for a woman to give birth on her own after a caesarean section is primarily due to the technique of performing a caesarean section.

In the case when a woman was made corporal caesarean section (vertical suture) Unfortunately, natural childbirth is not possible. Fortunately, this was not my case, since I have a horizontal suture in the lower segment of the uterus, which in itself already gave me a chance to give birth on my own.

What are doctors afraid of?

What are doctors afraid of, why is the problem of choosing the method of subsequent delivery for women who have undergone caesarean section so relevant? Of course, everything is due to the high probability of such a complication as uterine rupture along the scar.

According to statistics I gleaned from the worldwide web, the risk of uterine rupture along the scar is from 1% to 5% of the total number of women who give birth spontaneously after a caesarean section. It was the rupture of the uterus that I feared. The fact is that, due to such an unexpected pregnancy, I did not have time to conduct a study of the scar, which could give the most reliable and complete information about its viability, and hysteroscopy during pregnancy is impossible.

"Rupture of the uterus is likely with the insolvency of the scar, which is determined not only by its thickness (less than 3.5 mm), but also by the fuzziness of the contours, the discontinuity of the scar.

Pregnancy management of women with a scar on the uterus, as it seemed to me, requires closer attention from the gynecologist. However, comparing with the management of the previous pregnancy, I did not find any striking differences. The only thing is that during the first ultrasound at 12 weeks, the doctor carefully, as far as the ultrasound diagnostic method allows, examined the scar. As it turned out, it was thin (5 mm), but at the same time it was even, with a clear contour.

Doctor's Choice

The more the term of childbirth approached, the more seriously I began to think about the possibility of giving birth on my own, about choosing a maternity hospital and a doctor. In the end, I came to the decision that I would give birth in the same maternity hospital as the first child, and without any prior arrangements with the doctors. However, my husband did not support my decision and took my word that I would go for a consultation with a familiar gynecologist in order to subsequently conclude an agreement for a service delivery.
We went to the doctor. At the very beginning of the conversation, the doctor unequivocally told me that he considered it necessary to have a second delivery by caesarean section: “There is no need to perform feats!” I can’t say that I was driven by a thirst for achievement, but I refused the services of this doctor. At that time, I did not have any indications for surgery, there were all the conditions under which natural delivery is possible:

The pregnant woman has only one wealthy scar on the uterus.
The first operation was carried out according to "transient" indications - the so-called indications for surgery that first arose during the previous birth and may not necessarily appear in the next.

These include:

chronic intrauterine fetal hypoxia - insufficient oxygen supply to the fetus during pregnancy. This condition can occur for various reasons, but does not recur in the next pregnancy;

weakness of labor activity - insufficiently effective contractions that do not lead to the opening of the cervix;

breech presentation - the fetus is located with the pelvic end to the exit from the uterus. This position of the fetus in itself is not an indication for surgery, but serves as a reason for caesarean section only in conjunction with other indications and is not necessarily repeated during the next pregnancy. Other incorrect positions of the fetus, such as the transverse position (in this case, the child cannot be born spontaneously) may also not recur during the next pregnancy;

large fruit (more than 4000 g);

premature birth (premature births are considered to occur before 36-37 weeks of pregnancy);

infectious diseases detected in a previous pregnancy, in particular an exacerbation of a herpes infection of the genitals, shortly before childbirth, which was the reason for a caesarean section, does not necessarily occur before the next birth.

The first operation must be performed in the lower uterine segment with a transverse incision.
The postoperative period should proceed without complications.
The first child must be healthy.
This pregnancy should proceed without complications.
An ultrasound examination performed at full-term pregnancy showed no signs of scar failure.
There must be a healthy fetus.
The estimated weight of the fetus should not exceed 3800 grams.

Antenatal hospitalization

On the term, I took a referral to the hospital, because in my case, mandatory prenatal hospitalization was assumed. True, I went directly to the hospital at 39 weeks. On November 1, 2010, I went to the department of pathology of pregnant women for antenatal hospitalization, my PDR was on November 7. The doctor leading our ward turned out to be a pleasant young woman. After the examination and tests, she supported me in the desire to give birth on my own. The date of birth was determined on November 5 with the help of a stimulating gel.

On the night of November 2-3, I woke up from light contractions that did not stop until the morning, but were not very strong and did not increase. On November 3, my husband came for me and took me home for the day, which made everyone incredibly happy, especially my son. In the evening, my husband took me to the hospital, and we decided that the next day he would come for me - he would take me for a walk. In the hospital, time goes by slowly, so I went to bed early, at 10 o'clock in the evening. However, around 11 I got contractions again, as on the previous night. I could not sleep and walked along the corridor.

At about three o'clock in the morning, the midwife on duty, seeing my staggering, made me count the contractions, it turned out that they were quite regular and long.

They called a doctor, the examination showed a dilatation of 1.5 fingers (in fact, it was about the same during the examination on November 1). They decided to wait and not take me to the maternity ward. However, at six in the morning, after being examined by another doctor, it turned out that the disclosure of 3 fingers, and I was still sent to give birth (my child did not wait for any stimulation and determined when he was born).

Maternity ward

In the maternity ward, I got a nickname: I was called " Scar". The very process of childbirth, I think, was no different from other women in labor. The contractions, which for some reason turned out to be no less long than in the first birth, I endured stoically: I breathed, listened to music and walked along the corridor all the time. In the process of childbirth, the doctors performed the same manipulations with me as with other women in labor: CTG, examination; inspection, CTG. The only thing, the department at the first examination asked: “Are you sure you want to give birth yourself?” and, having heard an affirmative answer, she said: “Well, give birth!”

"When the attempts began, I was faint-hearted and asked to be put under the knife, to which they told me: "Let's go give birth!" I went, and somewhere in the corridor I could hear: “Go quickly, the Scar is giving birth.”

I will not describe the process itself, although I must say that in the process of expelling the fetus, several funny moments and dialogues with doctors took place. Outcome: I gave birth, myself! Contrary to all ultrasound data, the fetus turned out to be quite large (4000 g), so an episiotomy was required, otherwise I had no tears or injuries.

While my lovely baby girl was being washed-measured-weighed, I was put under intravenous anesthesia and had a manual examination of the uterus, which is a must for all women with a uterine scar who have given birth vaginally. No seam defects were found.
The postpartum period was no different.
So to speak, a postscript: today, almost four months after giving birth, I am a completely happy mother of two children.

"Comparing the feelings after childbirth through caesarean section and natural childbirth, I can definitely say that after the second birth I have a feeling of naturalness and completeness of the process.

Recovery after childbirth in the second case was faster and easier. In my example, it can be seen that the possibility of natural childbirth after a caesarean section is quite real. I hope that my story will help women who find themselves in the same situation to go through the whole pregnancy with less anxiety and initially positively tune in to childbirth.

Everything will work out for you!! Health to you and your children!

The first caesarean sections were performed back in the distant 7th century BC. e., but the result was always sad. For thousands of years, doctors have struggled with this issue. Only in the 20th century did doctors learn how to sew up the uterus, and anesthesia greatly facilitated this procedure. Thanks to such progress in obstetric practice, it is possible to save many lives by avoiding pathological births. But, with a large number of surgical operations, the need for repeated births with an already existing scar on the uterus increases. Particular interest in this topic has been observed for the past 15 years, and this branch of obstetrics is actively developing.

Childbirth in a natural way after caesarean section in obstetrics is a rather relevant topic. If 30 years ago for every 1000 births there were only 1-3 caesarean sections, now there are only 22-25 operations for every 100 births. It turns out that almost every fifth woman completes her pregnancy with surgery. Now new methods are being actively developed that contribute to natural delivery with a scar on the uterus. It is impossible to answer unequivocally that a woman is able to give birth in such a situation. A set of indicators with which a woman completed her previous pregnancy is assessed. To begin with, the condition of the scar is determined by hysteroscopy, even before the onset of pregnancy. Then, in each trimester, an ultrasound is done with an elastogram (thickness, localization, scar blood flow). Sometimes an X-ray examination is done in different projections of the uterine cavity (hysterography). With favorable indicators, a woman is allowed to have a natural birth.

Interesting fact! The first successful caesarean section took place in 1610 under the direction of Dr. Trautmann from Wittenberg.

But the opinion of doctors about whether natural childbirth is possible after a caesarean section, which was performed twice, is very ambiguous. Most obstetricians are categorically against this, but, as European practice shows, this is real.

The most dangerous complications, which are rare, but are:

uterine rupture;
fetal hypoxia;
violation of labor activity due to adhesions;
hernia of the stomach or prolapse of the uterus.

Preparatory stage on the way to a future pregnancy

Soon after the birth of their first child, many parents wonder about the next child. But what if a woman had a caesarean section? Having received biased information from girlfriends or from the Internet, frightened parents run to the doctor. About 10 years ago, they would have been told that the second birth should end with the same operation, and getting pregnant for 5 years, in general, is not worth it. Fortunately, these stereotypes are now a thing of the past. Modern obstetrics says that the optimal time for the next pregnancy is from 2 to 10 years after cesarean.

It is worth taking care of good contraception and giving the female body the necessary time to restore its reserves. If pregnancy occurs sooner, then the scar can simply burst with all the ensuing consequences. During the rehabilitation period (2 years), a young mother should exclude the possibility of an abortion or other gynecological manipulations in the uterine cavity. This significantly worsens the condition of the scar.

Before conceiving a new life, both partners will do well to:

visit a gynecologist and andrologist and undergo a complete examination;
varied and balanced diet: proteins, fruits, vegetables, fats.
fitness and yoga, outdoor walks and healthy sleep will help strengthen the scar.

There are two nuances, in the presence of which, you will have to forget about pregnancy:

More than three operative deliveries. But childbirth after two cesareans is considered acceptable.
Longitudinal (corporal) suture after surgery.
The scar was formed from connective, not muscle tissue.

Proven!

A caesarean section is not taboo for having a baby through a woman's genital tract.

Algorithm for managing pregnancy with a scar on the uterus

If the time has come, and you are determined to become a mother, then there are certain rules of the game that must be followed. Some of them come into force even at the time of discharge from the hospital.

If a woman had a caesarean section, then her statement should contain the following data:

cause of caesarean section;
cesarean method and suture suturing method;
complications (if any) and the process of postpartum recovery;
list of prescribed drugs.

Registration and management of pregnancy in women after caesarean section is not much different from women with conventional births. You may have to undergo examinations more often, take tests and do a control ultrasound more than expected. If a woman is carrying twins, then in the third trimester she may be prematurely sent to the hospital of the maternity hospital so that natural childbirth after cesarean goes well.

In half of the cases, a woman is sent to a hospital before the onset of labor. This is caused by frequent premature discharge of amniotic fluid. There can be no talk of giving birth at home or in the water. Often, in women with a scar on the uterus, the placenta does not pass on its own and requires medical attention.

On a note!

The longitudinal incision is called the Joel-Kochen approach, and the transverse incision is called the Pfannenstiel approach.

The main aspects of natural childbirth after CS that you should know

If a woman decides to have a natural birth after a caesarean section, then she must understand that there should be absolutely no intervention in the birth process. This also applies to punctures of the water bladder and preparations that soften the cervix.

Some statistics.

According to statistics, natural childbirth after caesarean section in most cases ends with a favorable outcome. The probability of rupture of the uterus along the scar during natural childbirth without stimulation is 0.5%. If labor activity is stimulated by prostaglandins, then the risk of uterine rupture increases by 15.5%, and when using oxytocin, by 4.5%.

A statistical result of natural childbirth is accepted only at 36 weeks, when the fetus has finally formed and gained its final weight. Permission is granted if all conditions are met:

the weight of the child is not more than 4 kg;
the placenta is not located near the scar;
woman's age up to 40 years;
no symptoms of preeclampsia in a pregnant woman;
the previous caesarean was provoked by weak labor activity;
the scar is in good condition and is at least 3 mm.

Advice! If the body is not ready and your doctor doubts the safety of natural childbirth, you should not risk your health and the life of your baby.

Possible complications and risks

There is always a risk during any childbirth. But deciding on such a feat, it is worth calculating all the little things and weighing all the pros and cons. What to expect or fear, see below:

Spreading or rupture of the scar. The condition is quite rare and occurs in only 1% of women.
Abnormal labor activity. The scar leads a certain segment of the uterus to a non-working state. This partially reduces its ability to contract and push the fetus.
Postpartum bleeding. After pregnancy and childbirth, the body of the uterus is greatly stretched, it contracts poorly and cannot get rid of the membranes. This can cause hypotonic bleeding.

When natural childbirth is forbidden ...

The main reasons for repeat caesarean section:

Vertical or defective scar on the uterus.
Large fruit mass.
Endocrinological diseases (diabetes mellitus, hypothyroidism).
Deformed or narrow pelvis.
Serious eye diseases (myopia, retinal detachment).
Adhesions after surgical operations.
incorrect position of the child.
Infectious, sexually transmitted diseases of the genital tract, HIV.
Fetal pathologies.
Neuro-psychological diseases of women.
Preeclampsia.
Arterial hypertension.
Detachment of the placenta.
Early pregnancy (before 12 months after CS).

About 40% of women give birth to a second child vaginally, and the rest go for a caesarean. In any case, the risk is minimal, since the woman is under close supervision and suddenly goes, what is wrong - she will immediately undergo an operation.

What is better: caesarean section or childbirth?

It is already known how many problems in the future the operative method of birth delivers. What are the benefits of natural childbirth?

Positive points:

minimal risk to the child;
there is no postoperative period;
anesthetic anesthesia is allowed;
childbearing function resumes sooner;
the best adaptation of the child to life.

Often, women who become pregnant with the help of in vitro fertilization cannot decide: to choose childbirth after IVF by the caesarean method, or natural. If there are no direct indications, then it is better to refuse the operation. And there are good reasons for this.

There is evidence that cesarean children are much more likely to be diagnosed with respiratory diseases in the future, and there are also problems with the gastrointestinal tract. Today, scientists do not have a clear picture of the importance of the baby's passage through the birth canal. But, there are speculations that this process allows the child to get rid of lung fluid, and the mother's microflora is transferred to the newborn and strengthens the immune system.

The main question is: will I be able to give birth?

If you are wondering if natural childbirth after caesarean is possible. And you do not have the above contraindications, then the answer is definitely yes!

And for everything to go to “5”, you need only 4 things:

Excellent mood.
Professional obstetrician with similar experience.
Maternity hospital with first-class equipment.
Support for a loved one during childbirth.

If you become pregnant earlier than 6-8 months after the operation, then constant monitoring by a doctor is simply necessary.
It is forbidden to gain excess weight above the norm.
No weights, including lifting a child or weighing more than 5 kg.
After 20 weeks, you need to wear a special bandage.
Avoid flights and long trips.
From the 35th week, it is necessary to constantly monitor the condition of the uterus.

There are very different reviews about natural childbirth after cesarean: someone is happy, but someone had a hard time. Each case is individual. The main thing is to believe that everything will go well.