Whether to perform a caesarean section at the request of the woman in labor. Indications for caesarean section - list

All over the world there is a clear trend towards gentle childbirth, which helps preserve the health of both mother and child. The tool that helps achieve this is the cesarean section (CS). A significant achievement has been the widespread use modern techniques pain relief.

The main disadvantage of this intervention is considered to be an increase in the frequency of postpartum infectious complications by 5-20 times. However, adequate antibacterial therapy significantly reduces the likelihood of their occurrence. However, there is still debate about in what cases they do C-section, and when physiological delivery is permissible.

When is surgical delivery indicated?

A caesarean section is a major surgical procedure that increases the risk of complications compared to a normal vaginal birth. It is carried out only according to strict indications. At the request of the patient, a CS can be performed in a private clinic, but not all obstetricians-gynecologists will undertake such an operation unless necessary.

The operation is performed in the following situations:

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

2. Occurred prematurely from the uterine wall - a condition that threatens the life of the woman and child. The placenta detached from the uterus is a source of blood loss for the mother. The fetus stops receiving oxygen and may die.

3. Previous surgical interventions on the uterus, namely:

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

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

Pregnancy can occur even during the first weeks of the postpartum period. The calendar method of contraception is not applicable in conditions of an irregular cycle. The most commonly used condoms, mini-pills (gestagen contraceptives that do not affect the child during feeding) or regular ones (in the absence of lactation). Use must be excluded.

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

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

Subsequent pregnancy

Natural birth after cesarean section is allowed if the formed connective tissue on the uterus it is strong, that is, strong, smooth, able to withstand muscle tension during childbirth. This issue should be discussed with your attending physician during your next pregnancy.

The likelihood of a subsequent birth normally increases in the following cases:

• the woman gave birth to at least one child vaginally;
• if the CS was performed due to incorrect fetal position.

On the other hand, if the patient is over 35 years old at the time of subsequent births, she has excess weight, concomitant diseases, discrepant sizes of the fetus and pelvis, it is likely that she will undergo surgery again.

How many times can you have a caesarean section?

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

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

Pregnancy after cesarean section is best planned at intervals of three years or more. In this case, the risk of suture failure on the uterus is reduced, pregnancy and childbirth proceed without complications.

How long after surgery can I give birth?

This depends on the condition of the scar, the woman’s age, and concomitant diseases. Abortion after CS has a negative impact on reproductive health. Therefore, if a woman does become pregnant almost immediately after a CS, then with a normal course of pregnancy and constant medical supervision, she can carry a child, but delivery will most likely be operative.

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

What is important to know when having a second caesarean section?

Elective surgery is usually performed at 37-39 weeks. The incision is made along the old scar, which somewhat lengthens the operation time and requires stronger anesthesia. Recovery after a CS may also be slower as scar tissue and abdominal adhesions prevent the uterus from contracting well. However, with a positive attitude of the woman and her family, and the help of relatives, these temporary difficulties are completely surmountable.

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

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

Indications for caesarean section

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

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

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

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

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

. This is the name given to its incorrect location, in which the placenta is attached to the lower third of the uterus, above the cervix, thereby blocking the exit of the fetus. This threatens severe bleeding, dangerous for both the life of the mother and the child, since in the process of opening the cervix, the placenta separates from the wall of the uterus. Because placenta previa can be diagnosed by ultrasound before labor begins, elective cesarean section is performed, most often at 33 weeks of gestation or earlier if symptoms occur. bleeding, indicating placental abruption.

Premature. This is the name for a condition when the placenta separates from the wall of the uterus not after, but before or during childbirth. Placental abruption is life-threatening for both the mother (due to the development of massive bleeding) and the fetus (due to the development of acute hypoxia). In this case, a caesarean section is always performed for emergency reasons.

Presentation and prolapse of umbilical cord loops. There are cases when the umbilical cord loops are in front of the head or pelvic end of the fetus, that is, they will be born first, or the umbilical cord loops fall out even before the birth of the head. This can occur with polyhydramnios. This leads to the fact that the umbilical cord loops are pressed against the walls of the pelvis by the fetal head and blood circulation between the placenta and the fetus is stopped.

TO relative indications include situations in which delivery through the natural birth canal is possible, but the risk of complications during childbirth is quite high. These indications include:

Chronic diseases of the mother. These include cardiovascular diseases, kidney diseases, eye diseases, nervous system, diabetes, oncological diseases. In addition, indications for cesarean section are exacerbations in the mother of chronic diseases of the genital tract (for example, genital herpes), when the disease can be transmitted to the child.

Pregnancy occurring after infertility treatment in the presence of other complications from the mother and fetus.

Some pregnancy complications which may pose a threat to the life of the child or the mother herself during natural childbirth. First of all, this is gestosis, in which the function of vital organs, especially the vascular system and blood flow, is disrupted.

Persistent weakness of labor, when labor, which began normally, subsides for some reason or goes on for a long time without noticeable progress, and drug intervention does not bring success.

Breech presentation of the fetus. Most often, a cesarean section is performed if it is combined with any other pathology. The same can be said about a large fruit.

Progress of caesarean section operation

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

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

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

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

In some situations, general anesthesia is used.

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

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

Emergency caesarean

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

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

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

Postoperative period

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

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

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

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

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

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

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

A caesarean section is an operation in which a newborn baby is removed from a pregnant woman's uterus through an incision in the abdomen. Caesarean section is an alternative to natural childbirth.

Why is caesarean section called that?

It is believed that the name of the operation is associated with Gaius Julius Caesar. According to legend, the mother of the future emperor died during childbirth and doctors had no choice but to cut her stomach and remove the baby in order to save him. Since then, such operations have been called “caesarean sections.” There is another version. Allegedly, during the reign of Caesar, a law was passed obliging obstetricians, upon the death of a laboring mother, to dissect her womb and remove the fetus.

The first caesarean section in which both mother and child survived was performed in Prague in 1337. In any case, scientists managed to find documents confirming this fact. During this operation, Wenzel I, Duke of Luxembourg was born. The birth of his mother, seventeen-year-old Beatrice, was difficult and the doctors even thought that she had died. They decided to get the child to baptize him.

Beatrice woke up in pain. It is believed that the shock she experienced protected her from blood loss - which is why she survived. She lived another 46 years and even outlived her son, though only by 16 days.

When is a caesarean section necessary?

Caesarean section is an alternative to vaginal birth. In some cases, a planned cesarean section is performed, while in others, the operation is performed on an emergency basis.

Before prescribing an operation, doctors carefully study the patient’s medical history and also become familiar with the course of her pregnancy. Indications for cesarean section are multiple pregnancies, too large fruit, placenta accreta, as well as pelvic or transverse presentation of the child. The operation may be scheduled in advance if the mother is severely nearsighted or has severe diabetes, and sometimes if she has already had several Caesarean sections during previous births.

A decision on emergency surgery is made if labor is prolonged, as well as if signs of oxygen starvation of the fetus are detected or an irregular heartbeat is recorded.

What happens during the operation?

The operation is carried out as quickly as possible and is necessary to save the lives of both mother and baby. During the operation, local anesthesia is used, the most common is spinal, but the doctor decides on the type of anesthesia.

Doctors carefully, layer by layer, cut first the skin, then the muscles, and then the abdominal wall. Next stage- opening of the uterine cavity. As with natural childbirth, the baby should be born head first. The newborn's mouth and nose are cleared of mucus and other fluids, and the umbilical cord is not wrapped around his neck. After this, the whole baby is removed, the umbilical cord is cut, the newborn is washed, weighed and measured. Following the baby, doctors remove the placenta, after which they sew up all the previously cut layers in the reverse order. Typically, from the first incision to the extraction of the baby, no more than 15 minutes pass, and the entire operation lasts about 45 minutes.

How do women recover after surgery?

Women who have a caesarean section spend slightly more time in hospital than those who give birth vaginally. Despite the fact that surgical techniques are becoming more and more advanced, women need more time to recover from it. Patients are often prescribed painkillers and antibiotics, and their mobility is limited during the first 24 hours.

However, if the operation went without complications, the recovery period also passes without any problems. After discharge, women should monitor the healing process of the suture and if there are symptoms of inflammation (redness, swelling, fever) they should consult a doctor as soon as possible.

If a woman has already had a caesarean section before, it is not at all necessary that she cannot have her next child naturally. Caesarean section does not always impose a limit on the number of subsequent operations - there are cases when women gave birth to five or more children in this way.

Is it possible to have a caesarean section without appropriate indications?

Caesarean section is one of the most common operations in the world. Its emergence and improvement had a strong impact on reducing maternal and child mortality. The World Health Organization emphasizes that surgery should only be performed in cases where natural childbirth threatens the life of the mother or child.

In some countries, it is common practice for a woman to choose the type of delivery she has. When choosing a cesarean section, they want to avoid incisions and tears of the perineum, as well as labor pains. Experts believe that, despite the fact that a cesarean section really helps to avoid these problems, it can provoke others, often no less serious. These include disability and even death. That is why WHO experts advise against performing surgery at the request of a woman.

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

A newborn baby who was born through surgery

A CS is a surgical method of delivery that involves removing the baby from the uterus through an incision in the abdominal wall. The operation requires certain preparation. The last meal is allowed 18 hours before surgery. Before the CS, an enema is given and hygiene procedures are carried out. IN bladder the patient is given a catheter, and the abdomen is necessarily treated with a special disinfectant.

The operation is performed under epidural anesthesia or general anesthesia. If the CS is done according to plan, then doctors are inclined to use an epidural. This type of anesthesia assumes that the patient will see everything that is happening around, but will temporarily lose tactile and pain sensations below the waist. Anesthesia is given through a puncture in the lower back where the nerve roots are located. General anesthesia during surgical childbirth is used urgently, when there is no time to wait for regional anesthesia to take effect.
The operation itself consists of the following steps:

1. Abdominal wall incision. It can be longitudinal and transverse. The first is intended for emergency cases, because it makes it possible to get the baby as quickly as possible.
2. Muscle extension.
3. Uterine incision.
4. Opening of the amniotic sac.
5. Extraction of the baby, and then the placenta.
6. Suturing the uterus and abdominal cavity. For the uterus, self-absorbable threads must be used.
7. Applying a sterile dressing. Ice is placed on top of it. This is necessary to increase the intensity of uterine contractions and reduce blood loss.

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

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

When is a CS necessary?

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

In most cases, a CS is planned. The doctor determines whether there are any threats to the mother and baby if the birth takes place naturally. The obstetrician then discusses delivery options with the mother. A planned CS is performed on a predetermined day. A few days before the operation, the expectant mother should go to the hospital for a follow-up examination. While the pregnant woman is scheduled to be in the hospital, the doctor monitors her condition. This allows us to predict the likelihood of a successful outcome of the operation. Also, the examination before the CS is aimed at determining the full-term pregnancy: using various diagnostic methods, it is revealed that the baby is ready for birth and there is no need to wait for contractions.

The operation has a number of indications. Some factors leave room for discussion about the method of delivery, others are absolute indications, that is, those in which ER is impossible. Absolute indications include conditions that threaten the life of the mother and baby during natural delivery. CS must be done when:

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

There are also relative indications for CS. Given these factors, both natural and surgical childbirth are possible. The delivery option is selected taking into account the circumstances, the health and age of the mother, and the condition of the fetus. The most common relative indication for CS is breech presentation. If the position is incorrect, the type of presentation and the gender of the baby are taken into account. For example, in the breech-foot position, ER is acceptable, but if they are expecting a boy, the doctor insists on a cesarean section to avoid damage to the scrotum. With relative indications for cesarean section correct solution Regarding the method of birth of a baby, only an obstetrician-gynecologist can advise. The parents’ task is to listen to his arguments, because they will not be able to assess all the risks on their own.

Caesarean section can be performed on an emergency basis. This happens if labor began naturally, but something went wrong. An emergency CS is performed if bleeding begins during natural delivery, premature placental abruption occurs, or acute hypoxia is detected in the fetus. An emergency operation is performed if labor is difficult due to weak contractions of the uterus, which cannot be corrected with medication.

Elective CS: is it possible?

Happy mother with long-awaited daughter

Whether it is possible to perform a CS at the request of a woman in labor is a controversial issue. Some believe that the decision on the method of delivery should remain with the woman, others are confident that all risks should be identified and chosen optimal method Only a doctor can. At the same time, the popularity of elective caesarean section is growing. This trend is especially noticeable in the West, where expectant mothers actively choose the method of giving birth to their own baby.

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

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

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

Advantages of CS at will

Why do many expectant mothers want to have a cesarean section? Many people are motivated to “order” surgery by fear of natural childbirth. The birth of a baby is accompanied by severe pain; the process requires a lot of effort from the woman. Some expectant mothers fear that they will not be able to complete their mission and begin to persuade the doctor to perform a cesarean procedure on them, even if there are no indications for surgical birth. Another common fear is that the baby’s passage through the birth canal is difficult to control and may pose a threat to his health or even life.

Fear of EP is common. But not all expectant mothers can cope with it. For patients who see a lot of threats in natural childbirth, the advantages of a “custom” CS are obvious:

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

The reverse side of a “custom” CS

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

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

Possible complications for the mother

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

1. Major blood loss. During CS, the body always loses more blood than during EP, because when tissues are cut, they are damaged blood vessels. You can never predict how the body will react to this. In addition, bleeding occurs due to pregnancy pathology or disruption of the operation.
2. Spikes. This phenomenon is observed during any surgical intervention; it is a kind of protective mechanism. Usually adhesions do not manifest themselves, but if there are a lot of them, then a malfunction of the internal organs may occur.
3. Endometritis. During the operation, the uterine cavity “comes into contact” with air. If pathogenic microorganisms enter the uterus during surgical childbirth, a form of endometritis occurs.

After a CS, complications often appear on the sutures. If they appear immediately after the operation, the doctor who performed the CS will notice them during the examination. However, suture complications do not always make themselves felt immediately: sometimes they appear only after a couple of years. Early suture complications include:

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

• disruptions in the functioning of the heart and blood vessels;
• aspiration;
• throat injuries from insertion of a tube through the trachea;
• a sharp decrease in blood pressure;
• neuralgic complications (severe headache/back pain);
• spinal block (when using epidural anesthesia, severe spinal pain occurs, and if the puncture is incorrect, breathing may even stop);
• poisoning by toxins from anesthesia.

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

What complications can a child have?

Caesar babies are no different from babies born naturally

Doctors do not undertake to perform a caesarean section at will (in the absence of indications) due to the likelihood of complications in the baby. CS is a proven operation that is often resorted to, but no one has canceled its complexity. Surgery can affect not only female body, but also affect the baby’s health. Complications of cesarean section concerning the child can be of varying degrees.

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

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

According to statistics, “caesareans” often refuse to breastfeed, plus the mother may have problems with the amount of milk. We have to resort to artificial feeding, which leaves its mark on the baby’s immunity and its adaptation to the new environment. Children born by cesarean section are more likely to suffer from allergic reactions and intestinal diseases. “Caesareans” may lag behind their peers in development, which is due to their passivity during labor. This manifests itself almost immediately: it is more difficult for them to breathe, suck, or scream.

Weigh everything

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

Caesarean by at will It's not worth doing. Naturally, a woman should have the right to choose, but it is not without reason that this operation is performed according to indications. Only a doctor can determine when it is advisable to resort to cesarean section and when natural delivery is possible.

Nature has thought of everything itself: the process of childbirth prepares the baby as much as possible for extrauterine life, and although the mother in labor bears a heavy load, recovery occurs much faster than after surgery.

When there is a threat to the fetus or mother and the doctor insists on a cesarean section, refusing the operation is strictly prohibited. The doctor always determines the risks taking into account what is safer for the life of the mother and baby. There are situations when cesarean section is the only option for delivery. If the method is negotiable, it is always recommended to seize the possibility of a natural birth. The momentary desire to “cut” in order to avoid pain must be suppressed. To do this, just talk to your doctor about possible risks and the likelihood of complications after surgery.

It is one hundred percent impossible to predict how the CS will go in each specific case. There is always a possibility that something will go wrong. Therefore, doctors advocate for natural childbirth whenever possible.

If the expectant mother herself cannot overcome her own fears associated with the upcoming moment of the baby’s birth, she can always turn to a psychologist. Pregnancy is not a time for fear. We need to let everything go bad thoughts, do not be led by momentary desires, and strictly follow the recommendations of the gynecologist - from correcting the regimen to the method of delivery.

Childbirth is a process for which a woman’s body is fully adapted. But sometimes, for one reason or another, natural childbirth can pose a danger to the health or even the life of both the child and the mother. In such cases, surgical delivery is performed - a caesarean section.

Caesarean section may be planned And urgent. A planned caesarean section is prescribed during pregnancy: according to indications or at the request of the expectant mother. The decision on an urgent cesarean section is made if complications arise already during childbirth, or dangerous situations requiring urgent intervention (acute fetal hypoxia, placental abruption, etc.).

Indications for caesarean section are divided into absolute And relative. Absolute births are those on the basis of which the doctor unconditionally prescribes an operation, and natural childbirth is out of the question. Such indications include the following.

Absolute indications for caesarean section

Narrow pelvis of a woman in labor. Because of this anatomical feature, a woman simply will not be able to give birth on her own, as there will be problems with the passage of the child through the birth canal. This feature is revealed immediately upon registration, and the woman is prepared and prepared for operative delivery from the very beginning.

Mechanical obstruction, preventing the fetus from passing naturally. It could be:

• defragmentation of the pelvic bones;
• ovarian tumors;
• placenta previa (the placenta is not located where it should be, blocking the fetus’s path to the cervix);
• isolated cases of uterine fibroids.

Probability of uterine rupture. This indication for childbirth through a cesarean section occurs if there are any sutures or scars on the uterus, for example, after previous cesarean sections and abdominal surgeries.

Premature placental abruption. The pathology is expressed in the fact that the placenta is separated from the uterus even before the onset of labor, depriving the baby of nutrition and access to oxygen.

Relative indications for caesarean section

Relative indications for cesarean section suggest the possibility of natural childbirth, but with a risk for the baby or mother. In such a situation, all individual factors are carefully weighed and considered. Relative indications include:

• visual impairment in the mother (this is due to the high load on the eyes when a woman giving birth pushes);
• kidney failure;
• cardiovascular diseases;
• pathologies of the nervous system;
• oncological diseases, etc.

As you can see, these diseases are not related to pregnancy, but the intense stress on the mother’s body during childbirth can cause various complications.

In addition, the indication for caesarean section is gestosis– disturbance in the blood flow and vascular system.

To the testimony threatening the child's health include various sexually transmitted infections in the mother, since the child can become infected while passing through the birth canal.

As for an emergency caesarean section, it is prescribed if labor is very weak or has stopped altogether.

Kinds

According to urgency, caesarean section can be of the following types:

• planned;
• emergency.

According to the technique of execution, they are distinguished:

• abdominal caesarean section - the incision is made through the anterior abdominal wall;
• vaginal cesarean section - an incision through the anterior vaginal fornix.

How is a caesarean section performed and what happens before and after it?

How is a caesarean section performed?

How long does it take to have a planned caesarean section? The date of the operation is determined individually and depends on the condition of the woman and child. If there are no special indications, then a caesarean section is scheduled for the day closest to the expected date of birth. It also happens that the operation is performed with the onset of contractions.

How to prepare for a caesarean section

Usually expectant mother awaiting a planned cesarean section, is placed in the maternity hospital in advance in order to conduct an examination to determine that the baby is full-term and ready for birth, and to monitor the woman’s condition. As a rule, a caesarean section is scheduled for the morning, and the last meal and drink is possible no later than 18 hours the night before. The stomach of the patient must be empty to prevent its contents from entering the Airways. In the morning, on the day of the operation, hygiene procedures are carried out to prepare for a caesarean section: they do an enema, shave the pubis. Next, the woman changes into a shirt and is taken or taken on a gurney to the operating room.

Immediately before the operation, anesthesia is administered, a catheter is inserted into the bladder (it will be removed a couple of hours after the operation), and the abdomen is treated with a disinfectant. Next, a small screen is installed in the woman’s chest area so that she cannot see the progress of the operation.

Anesthesia

There are two types of anesthesia available today: epidural and general anesthesia. Epidural anesthesia involves inserting a thin tube through a needle into the exit site of the spinal cord nerve roots. This sounds quite scary, but in fact, the woman experiences discomfort for only a few seconds when the puncture is performed. Then she stops feeling pain and tactile sensations in the lower part of the body.

General anesthesia. This type of anesthesia is used for emergency caesarean section, when there is no time to wait for the effects of epidural anesthesia. First, a so-called pre-anesthesia drug is injected intravenously, then a mixture of anesthetic gas and oxygen is supplied through a tube in the trachea, and lastly a drug that relaxes the muscles is injected.

Progress of caesarean section operation

After the anesthesia has taken effect, the operation begins. How is a caesarean section performed? First, an incision is made in the abdominal wall. During the operation, 2 types of incisions are possible: longitudinal (vertical from the womb to the navel; done during an emergency caesarean section, because it is faster to get the baby out through it) and transverse (above the womb).

Next, the surgeon spreads the muscles, makes an incision in the uterus and opens the amniotic sac. Once the baby is delivered, the placenta is removed. Then the doctor first sews up the uterus with threads, which dissolve after a few months - after the tissues have grown together, and then the abdominal wall. A sterile bandage is applied and ice is placed on the abdomen so that the uterus contracts intensively, as well as to reduce blood loss.

The duration of a cesarean section usually takes from 20 to 40 minutes, while the baby is delivered into the world within 10 minutes, or even earlier.

Postoperative period

For another day after a cesarean section, the woman remains in the intensive care unit or intensive care unit so that doctors can monitor her condition. Then the new mother is transferred to a regular ward. To reduce pain she is prescribed painkillers, drugs for contraction of the uterus and normalization of the gastrointestinal tract. Sometimes antibiotics are prescribed, but this is decided on an individual basis. Gradually, the doses of medications are reduced and they are abandoned altogether.

If the operation went without complications, stand up for the first time a woman is allowed after at least 6 hours. First you need to sit on the couch, and then stand for a while. Under no circumstances should you strain yourself or experience even minimal physical exercise, as this threatens seam divergence.

It is highly advisable to purchase in advance postoperative bandage, wearing it will greatly ease movement and discomfort in the first days after a cesarean section, especially when you need to lie down or get out of bed.

Care, diet and stool

On the first day after surgery, it is recommended to drink only still water, and you will need to drink a lot to replenish fluid loss. You will also need to empty your bladder on time. It is believed that a full bladder prevents the uterus from contracting.

On the second day, liquid food (porridge, broth, etc.) is allowed. If everything is in order, then from the third day after surgery you can return to the normal diet recommended for nursing women, however, after giving birth, many mothers complain of constipation, and in order to alleviate the situation, it is advisable not to eat solid food for several days.

This problem can also be solved with enemas, suppositories (usually suppositories with glycerin are used; when you put such a suppository, try to lie down for a while) and eating foods that have a laxative effect (kefir, dried fruits, etc.).

After discharge from the hospital

For the first month and a half after a caesarean section, you will not be allowed to take a bath, swim in the pool or reservoirs, you will only be able to wash in the shower.

Active physical exercise must be postponed for at least two months. At this time, you will need the help of relatives and husband. Although completely abandon physical activity it is forbidden. Ideally, after surgery, the doctor should tell you about exercises that will speed up the recovery of the body, at least you can ask about it yourself.

Resume sex life It is recommended no earlier than one and a half months after surgery. Be sure to take care of contraception. Experts advise planning your next pregnancy only after 2 years, during which time the body will fully recover and be able to ensure the full development of the unborn baby.

Is natural childbirth possible after cesarean?

Contrary to popular belief, a woman can give birth to a child herself if her previous pregnancy ended with a caesarean section. If the sutures have healed, no complications have arisen, the reproductive system has successfully recovered and there are no indications for another cesarean section.

Pros and cons of caesarean section

Surgical delivery is possible both for medical reasons and at the woman’s own request. However, doctors usually oppose such a decision, dissuading the expectant mother from surgery. If you are also considering the possibility of undergoing surgery, provided that normal childbirth is not contraindicated for you, carefully weigh all the positive and negative aspects of the issue.

Pros of caesarean section:

• During the operation, injuries to the genital organs, such as ruptures and incisions, are impossible;
• Delivery by caesarean section takes a maximum of 40 minutes, while with natural childbirth a woman is often forced to endure contractions for several hours.

Cons of a caesarean section:

• psychological aspect: mothers complain that at first they do not feel a connection with the child, they do not have the feeling that they gave birth to him themselves;
• limitation of physical activity and pain at the suture site;
• scar. Read more about this in the article

Consequences of a caesarean section

The consequences can be divided into 2 types: for mother, in connection with surgery, and for a child, due to unnatural birth.

Consequences for mom:

• pain in the stitches, resulting in a scar on the abdomen;
• restrictions on physical activity, inability to take a bath and resume intimate relationships for several months;
• psychological condition.

Consequences for the child:

• psychological; There is an opinion that children born through surgery adapt less well to the world around them. It is worth noting that the opinions of scientists on this matter differ, and the experience of mothers shows that in most cases, fears about children falling behind in mental development are far-fetched, and there is no need to worry about this. However, one cannot deny the fact that the child does not follow the path prepared for him by nature, which helps him prepare for a new environment of existence;
• the possibility of residual amniotic fluid in the lungs of the newborn;
• penetration of anesthetic drugs into the child’s blood. Read more about the consequences of a caesarean section and watch the video in

Complications after caesarean section

Complications after anesthesia. If you are having a Caesarean section with an epidural, here's what you need to remember. After the operation, the catheter with an anesthetic is left in the back for some time, and drugs are injected through it to numb the sutures. Therefore, after the operation is completed, the woman may not feel both or one leg, and may not be able to move.

There are cases when, when a woman is transferred to the couch, her legs get tucked in, and since the operated woman does not feel anything, this fact may for a long time remain unnoticed.

What does this mean? Due to the limb being in an unnatural position, it develops long-term positional compression syndrome. In other words, soft fabrics are without blood supply for a long time. After neutralization of the compression, shock, severe swelling, impaired motor activity of the limb and, not always, but quite often, renal failure develop, all this is accompanied by severe pain that lasts for several months.

Be sure to ask the maternity hospital staff to check that you were placed on the couch correctly. Remember that compartment syndrome can sometimes be fatal.

In addition, anesthesia is often accompanied by headaches and back pain.

One of the most common complications is adhesions. Loops of intestines or other abdominal organs grow together. Treatment depends on individual characteristics women: the matter may be limited to ordinary physical procedures or may lead to the need for surgical intervention.

Endometritis- inflammatory process in the uterus. To prevent it, a course of antibiotics is prescribed immediately after surgery.

Bleeding also refer to complications after cesarean section and, in rare cases, lead to the need to remove the uterus.

Complications can also arise during the process. healing of sutures, up to their divergence.

So, a caesarean section is a guarantee of life for mother and child in cases where natural childbirth is impossible or dangerous. Every year this operation is improved, and the number of complications decreases. However human factor cannot be ruled out, therefore, if you know about the main features of the operation and post-operative care, this will help you avoid complications and enjoy the joys of motherhood without unnecessary grief.

Video of a caesarean section

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