Planned caesarean section or emergency caesarean section? How and when it is carried out

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Childbirth is a joyful and at the same time anxious moment. After all, the birth of a child and the health of the mother depend on them. Throughout pregnancy, doctors monitor the woman and the development of the fetus. A medical examination of the pregnant woman is carried out periodically as planned, which shows the positive and negative aspects (how the pregnancy is proceeding, the position of the fetus, the condition of the placenta, the functioning of the internal organs of the expectant mother, etc.), a clear picture emerges that helps the doctor decide on the issue of childbirth. After all, sometimes situations arise when a woman cannot give birth naturally and a special operation is prescribed - “caesarean section”. That is why a woman in labor has questions to which she wants to know the exact answers. For example: what indications lead to the appointment of a cesarean section, how the operation is performed, what are the consequences for the mother and child, how does the postoperative period proceed and how to behave when giving birth, etc. Today, the statistics for resolving childbirth using surgical intervention, that is, cesarean section, is about 12-27%.

Planned caesarean section or emergency caesarean section? How and when it is carried out

A caesarean section is the birth of a baby through an incision in the mother's abdomen.
Currently, this operation is one of the most common in the world, and its frequency continues to increase every year. For example, in Russia the frequency of cesarean sections is 20% and on average increases by 1% per year. In the USA this frequency has reached 30%. There are countries (Mexico, UAE) where the operation is performed in 40-50% of births. The cesarean section operation is one of the oldest. However, over the centuries, it continues to raise questions not only among women, but also among doctors. Answers these questions

expert Oleg Radomirovich Baev :

• obstetrician-gynecologist, doctor of medical sciences, professor at the National Medical Research Center for Obstetrics, Gynecology and Perinatology named after V.I. Kulakova
• work experience - 34 years
• doctor of the highest category
• Member of the Association of Obstetricians and Gynecologists.

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 the operation, 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 of anesthesia. On the eve of the birth, the attending physician explains the approximate plan of the operation and possible complications, after which the pregnant woman signs consent to perform 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 slightly 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.

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Why is there such an increase in caesarean sections?

• Most operations are carried out in the interests of the child, because once upon a time this operation was created specifically for the purpose of saving the life of a newborn.
• A large percentage of women think about having a baby late, and this leads to a number of complications during pregnancy.
• Extragenital diseases in women: cardiovascular (heart defects, arterial hypertension), diseases of the kidneys, adrenal glands, thyroid gland, obesity, disturbance of vaginal biocenosis, etc.
• Induced (using drugs and ART methods) multiple pregnancies.

What is better - physiological birth or caesarean section?

Vaginal birth has a number of advantages:

• no significant blood loss;
• no risk of damage or infection;
• there are no complications associated with surgery, so the patient spends less time in the hospital and recovers faster.

However, in some cases it is preferable to be referred for a planned caesarean section.

Indications for elective caesarean section:

• if during multiple pregnancy the children are lying incorrectly. For example, during a planned caesarean section with twins, one of the children may lie transversely. Or a planned caesarean section may be prescribed for a breech presentation of one baby.
• if labor stops or progresses very slowly;
• the child’s condition worsens (compression of the umbilical cord or prolonged heart rhythm disturbance);
• threat to the mother’s health due to complications (preeclampsia) or diseases (cardiovascular, threat of retinal detachment, etc.);
• some maternal infections (HIV, herpes, etc.);
• placenta previa, when the placenta covers the exit of the uterus;
• premature detachment of a normally expanded placenta;
• discrepancy between the sizes of the pelvis and the fetal head;
• threatening uterine rupture (along the scar from a cesarean section or myomectomy);
• mechanical obstacles to the birth of a child (for example, fibroids in the cervix).

Rumyantseva, md.

I think all readers know that a caesarean section is an operation by which a child is born (the most common alternative to natural childbirth). About 30% of children are born via caesarean section.

Caesarean section is a life-saving service for the child and woman in some situations (for example, placenta previa, uterine rupture during childbirth). And yet there is still talk about the need to reduce the proportion of births by caesarean section. Why? Let's try to figure it out!

Quick links:

• Indications for caesarean section
• How is a caesarean section performed?
• After a cesarean section
• Suture care after cesarean section
• Possible complications
• Natural birth after cesarean section
• Pros and cons of childbirth by cesarean section compared to natural childbirth
• What you should know if you really want a natural birth, but there are suspicions that the birth will take place by caesarean section
• What you should know if you really want a caesarean section, but there are no indications for it
• Can I influence my chances of having an emergency C-section if labor has already started (or what can I do to increase my chances of having a vaginal birth)?
• Labor has already started, the chance of a caesarean section is never zero, which means you can't eat or drink during the entire process?

Indications for caesarean section:

A caesarean section is mandatory and urgent if:

1. there is a danger to the life of the fetus: slowing of the fetal heartbeat or changing heart rate during childbirth, the release of meconium during childbirth with ruptured membranes, prolapse of the umbilical cord;
2. there is a danger to the mother’s life: massive bleeding, a sharp increase in blood pressure readings;
3. there are mechanical obstacles to the birth of a child: the narrowness of the mother’s birth canal and/or the fetus is too large. The dimensions of the mother's pelvis are measured upon registration at the antenatal clinic; if a woman has one or another type of pelvic narrowing, careful monitoring is carried out over the expected size of the fetus, and labor management tactics are based on the correspondence between the sizes of the mother’s birth canal and the fetus’s head;
4. weakness of labor: lack of increase in the strength of contractions and the corresponding movement of the child along the birth canal, not amenable to drug correction.

A caesarean section is most often performed if:

1. previous deliveries were performed by caesarean section. But this is far from necessary; Now in many maternity hospitals you can give birth on your own after a caesarean section;
2. there is placenta previa: a situation in which it is not the head or pelvic end of the fetus that is present to the internal os (“the exit from the uterus”), but the placenta;
3. the fetus is not in a cephalic presentation (breech, transverse position of the fetus). I note that a couple of decades ago, breech presentation was not an indication for a cesarean section; Currently, in Russian regulatory documents, the indication for surgery is fetal weight less than 2500 g and more than 3600 g for breech presentation;
4. there are large tumors/cysts in the mother’s pelvic cavity;
5. By the time of birth, the mother had worsened genital herpes and/or anogenial warts (condylomas): i.e. there are herpetic rashes or massive papillomas on the genitals;
6. the mother has non-gynecological serious health problems: arterial hypertension, diabetes, retinal problems, etc.;
7. , triplets and more fetuses will be born
8. the mother has HIV infection: then childbirth by caesarean section reduces the likelihood of infection of the child (under certain conditions, natural birth is possible, see below).

How is a caesarean section performed:

Currently, caesarean sections are most often performed under epidural or spinal anesthesia. The woman is conscious, and she hears and sees her baby within a few minutes after the start of the operation (tissues are cut and separated quite quickly, but layer-by-layer suturing will take longer).

The incision is often made horizontally in the lower abdomen. The scar after surgery is usually very thin and invisible; there is no need to be afraid that it will ruin your appearance. After healing, it usually hides well under underwear

Sometimes the incision is made vertically, then the scar will be more noticeable (the incision will be quite large). Fortunately, this situation is quite rare. The following incision is made:

• if the previous caesarean section was performed in this way,
• if it is technically impossible to make a horizontal incision,
• if a completely unforeseen and emergency situation occurs (sometimes it’s faster to end the birth this way).

If everything goes well, mother and baby can cuddle and perform their first breastfeeding right after the operation is completed!

After a cesarean section

After the operation you will have to spend some time in intensive care. Your vital signs will be monitored at all times in the intensive care unit. However, this does not mean that you will have to delay starting breastfeeding (discuss this point with your doctor in advance, please).

And yes, the seam will hurt. But there is no need to be a hero! You can use painkillers, discuss and complain if it hurts!

You will have to spend some time in bed, but very soon (often within the first day) you will be able to get up, although it will not be easy. Be sure to call someone (nurse, doctor) before you try to get out of bed for the first time after surgery. Soon after the operation (or rather, when you can already walk to the toilet on your own), the urinary catheter will be removed (don’t be afraid of it, it will be with you at first).

You can eat and drink whenever you want (with your doctor's permission, of course).

Often, blood clotting therapy will be prescribed after surgery. They should tell you and show you which drugs should be used, how and for how many days.

Discharge can be early (2-4 days after birth) or a little later (usually no more than 7 days, if there are no complications). Check with your doctor when you are scheduled to be discharged so that everyone at home has time to prepare for your return!

At home, you should take care of yourself, not allowing yourself unnecessary stress in the first time after surgery.

You should abstain from sex and sports for 6 weeks (if there is an urgent need for one or the other earlier, you should discuss this issue with your doctor!).

Don't forget about contraception when you resume sexual activity. The absence of menstruation (if the child is breastfed) does not mean the inability to become pregnant. After a caesarean section, it is especially important to prevent the next pregnancy from occurring too early, so that you can carry your next child without fear for his or her condition.

Suture care after cesarean section

Pain in the suture area may bother you for several weeks, be sure to discuss with your doctor what you can use for pain relief before discharge!

Keep an eye on the seam area. Increased pain, redness, the appearance of copious discharge in the suture area, as well as a local or general increase in temperature - this is definitely a reason to see a doctor!

At home, try not to wear tight clothes. Friction and excessive sweating in the area of ​​the suture will not speed up its healing. It is because of this that it makes sense to avoid driving the car for a while (so that the seat belt does not come into contact with the seam area).

Many women find it more comfortable to move around in a bandage after a cesarean section. Try wearing a bandage, but if it makes you uncomfortable/hot/painful, don't strive to use it all the time.

The suture needs care; the maternity hospital will show you how and what to do! Nothing terrible or complicated, but the ostrich position (not peeling off the patch and not looking at the seam) is not the best tactic.

By the way, the stitches most often do not need to be removed (they will dissolve on their own). If threads have been used that will have to be removed, you will definitely be informed about this!

Possible complications (fortunately, quite rare in the modern world):

• Infectious complications (from suppuration in the scar to sepsis)
• Blood loss (and possible subsequent coagulation disorders)
• Thrombosis, thromboembolism
• Injuries to the bladder and intestines
• Allergic reactions to the drugs used.

Monitor your condition carefully and be sure to tell your doctor if you have any unpleasant symptoms (fever, weakness, cough, pain in any area other than the suture (or increased pain in the suture area), problems with urination/defecation)!

What's next? C-section only for subsequent children?

After a caesarean section, natural childbirth is possible if the woman wants it!

Previously, it was believed that after a caesarean section you should not become pregnant for three years, but now it is recommended to wait a year after the operation, then the chances of a calm pregnancy and natural childbirth are higher (if the woman wants this).

Pros and cons of childbirth by cesarean section compared to natural childbirth:

Minuses:

- the likelihood of severe complications in the mother (bleeding requiring removal of the uterus or blood transfusion; uterine rupture; cardiac arrest; thromboembolism, etc.) is 3 times higher with a cesarean section;

- the likelihood of death for the mother is 3 times higher during a caesarean section;

- amniotic fluid embolism is 2-5 times more likely during cesarean section;

- placental abnormalities are more common after cesarean section (the risk increases with each subsequent delivery by cesarean section);

— it is possible (admittedly, very unlikely) that the child may be injured by a scalpel;

- according to some data, the risk of respiratory disorders in a child after a cesarean section is higher;

— after a caesarean section there is a higher risk that the child will end up in intensive care for various reasons.

Pros:

+ perineal rupture with serious consequences does not occur during caesarean section;

+ shoulder dystocia is possible only during natural childbirth;

+ For some women, caesarean section is the preferred method due to fear of pain during natural childbirth.

Occurs with equal probability after natural childbirth and after cesarean section:

= urinary incontinence;

= postpartum depression.

It’s worth making a reservation right away: when we talk about risks after a cesarean section, we must keep in mind that a cesarean section is often (not always, of course) carried out according to indications, that is, initially there are “aggravating” circumstances that contribute to the frequency of adverse consequences.

So, what you should know if you really want a natural birth, but there is a suspicion that the birth will take place by caesarean section:

1. Indications during labor (weak labor, fetal heart rhythm disturbances, uterine rupture, bleeding, etc.)

- no amateur performances! During childbirth, the doctor makes decisions, and the doctor also takes responsibility for you! If the doctor suddenly, after the onset of labor, says that it is now necessary to perform a caesarean section, you must obey (for the sake of the child’s health, first of all).

1. Breech presentation of the fetus

- an attempt at external obstetric rotation (turning the fetus at 37 weeks of pregnancy) is possible (and indicated). This is a particularly important topic for me, as some know. Read more about external obstetric rotation here. Important! This manipulation should only be performed by experienced doctors who know how to rotate! As far as I know, there are not very many of these in Russia! Don't demand a turn from a doctor who has never done one before. The success rate is far from 100%, but with a successful rotation, a natural birth in the cephalic presentation is possible.

1. Large fruit

- yes, natural childbirth with a large fetus (especially if it is the first birth) is difficult. But if a woman wants to try, it is worth considering that a cesarean section is strictly indicated for an estimated fetal weight of 5 kg or more (which happens extremely rarely). If the fetal weight is below 5 kg, natural childbirth can be discussed (if the woman wishes and the experience and attitude of the doctors).

1. "Little Fruit"

- if, according to ultrasound data, you are told that the child is too small (in the absence of developmental anomalies), then this fact in itself should not serve as an indication for a cesarean section (outcomes for such babies do not improve after cesarean section).

1. Twins

— first, let’s clarify that three or more fetuses are an indication for a cesarean section. No reasoning. But twins with a cephalic presentation of the first fetus and any presentation of the second is the basis for attempting a natural birth. Delivery by cesarean section with this fetal arrangement does not improve outcomes for mother and children. Again, for natural birth of twins you need a great desire of the woman and the experience of obstetricians!

1. Genital herpes

- herpetic eruptions on the genitals at the time of childbirth - this is a fairly compelling argument in favor of a cesarean section. However, there are prophylactic regimens of antiviral drugs that help avoid rashes at the time of delivery. Be sure to discuss the possibility/need of taking antiviral medications if you have ever had genital herpes (during or before pregnancy). Important! Genital herpes, which bothered you during pregnancy (1-2 trimester), but does not bother you at the time of birth, is not a reason for a cesarean section

1. Premature birth

— Premature birth is always stressful for a woman. If the child’s condition does not suffer, then a natural birth is possible (a caesarean section will not provide a better outcome for the child). But! Doctors should tell you that the baby is not suffering and there are no other indications for a cesarean section other than preterm labor.

1. Mom's weight

— weight control during pregnancy is important for many reasons (in particular, the more a woman gains during pregnancy, the higher her risk of cesarean section), but there is no BMI cutoff above which only cesarean section is indicated. Therefore, it is worth monitoring your weight (both during pregnancy and outside) in order to prevent obesity, but weight (without other aggravating circumstances) should not influence the choice of birth option.

1. HIV positive mother

— undoubtedly, every woman wants to minimize the risks of infection for her child. If a woman receives adequate therapy and the viral load is low (below 50-400 copies/ml), then cesarean section does not provide an advantage in terms of the risk of infection of the child, and therefore the choice between vaginal birth and cesarean section should not be made solely on the basis of HIV-positive mother's status. At the same time, for women who are not receiving therapy and/or have a load above 400 copies/ml, a cesarean section is recommended.

1. Hepatitis B in mother

- if a woman gives birth in a maternity hospital, which can provide proper manipulations for the child after birth (immunoglobulin administration, vaccination), then the risk of infection does not depend on the method of delivery, and therefore natural childbirth is possible.

1. Hepatitis C in mother

- Caesarean section does not reduce the risk of infection of the child if the mother has hepatitis C (natural birth is possible). BUT! If you are infected with both HIV and hepatitis C, the risk of infection for the baby is reduced with a cesarean section, so these women should have a cesarean section.

And what you should know if you really want a caesarean section, but there are no indications for it:

1. Review the section on the pros and cons of a cesarean section.
2. Discuss your fears with your doctor: what exactly and why you are afraid. Perhaps the doctor can clarify some points for you. Be sure to talk about this topic with a doctor you trust.
3. If you feel the need for this, talk to a perinatal psychologist.
4. Despite the fact that in the orders of the Ministry of Health there is no indication for a caesarean section “a woman’s desire”, many international recommendations agree that if a woman is categorically determined to have a caesarean section, she has the right to it. If you are terrified of natural childbirth, do not overstep yourself.

Can I influence my chances of having an emergency C-section if labor has already started (or what can I do to increase my chances of having a vaginal birth)?

The main rule is to listen to doctors and yourself during childbirth. On the part of the woman, no special actions have yet been invented that will increase the chance of natural childbirth and reduce the risk of cesarean section.

But here’s what doesn’t affect whether the birth ends with a cesarean section:

• A woman’s activity during childbirth (if you want, go, if you don’t want, don’t!);
• Position of the woman during childbirth (on her back, sitting, upright, whatever);
• Finding a woman in the water
• Use of epidural anesthesia
• Acupuncture (before or during childbirth)
• Aromatherapy
• Hypnosis
• Herbs in any form
• dietary supplements
• Homeopathy

And one more question: labor has already begun, the probability of a caesarean section is never zero, which means that you cannot eat or drink during the entire process?

Where are all these conversations coming from? Not eating or drinking during labor is associated with the potential risk of gastric aspiration during anesthesia (a situation in which stomach contents enter the airway, blocking it partially or leading to pneumonia later in life).

But it turns out that the data regarding this risk is ambiguous, and therefore there is no strict ban on food during childbirth (it is better to choose something small and filling: cookies, cheese, etc.). And water and other liquids do not carry additional risks (on the contrary, drinking during childbirth is good), because do not lead to a significant increase in gastric volume and do not increase the risk of aspiration.

No matter how your birth goes, the most important thing for both you and the baby is the health and peace of mind of both mother and baby! Take care of yourself, enjoy your children and do not be afraid of childbirth in any form.

Sources:

1. https://www.acog.org/Patients/FAQs/Cesarean-Birth#type
2. https://www.acog.org/Clinical-Guidance-and-Publications/Obstetric-Care-Consensus-Series/Safe-Prevention-of-the-Primary-Cesarean-Delivery?IsMobileSet=false
3. https://www.nice.org.uk/guidance/cg132
4. https://www.ncbi.nlm.nih.gov/pubmed/19812591

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Planned caesarean section: at what time is it done?

A planned caesarean section is usually scheduled after 39 weeks of pregnancy, unless the condition of the mother and baby requires the operation to be performed earlier. At this time, the child is already quite mature and can adapt well to extrauterine conditions of existence.

Is there any special preparation required for a planned caesarean section?

This is a major operation, so a nurse or midwife prepares for a caesarean section. A planned operation requires 1-2 hours of preparation. Preparation for an emergency caesarean section is much faster.

In standard situations:

• a cleansing enema is performed;
• a catheter is inserted into a vein in the woman's arm so that the woman in labor can receive fluids and medications during surgery;
• Antibiotic prophylaxis may be administered according to indications;
• A catheter is placed in the bladder to keep it empty throughout the operation (this reduces the risk of damage to it).

Preparation

• 7 - 10 days before the expected date of birth, you will be hospitalized in the antenatal department of the maternity hospital and a date for surgery will be set. Typically, PCS is performed at 38–39 weeks.

! In many modern maternity hospitals, the expectant mother is allowed to come to the ACL on the day of the operation.

• For ACL, you will need to buy special compression stockings or bandages to protect the vessels of the legs from the formation of blood clots;
• On the day of the operation you should not drink or eat - the doctor will remind you of this;
• Two hours before the PCS, you will have a cleansing enema.

Anesthesia during surgery

Today there are 2 main options for pain relief:

1. Regional anesthesia (elected caesarean section with epidural or spinal anesthesia) is preferred;
2. Sometimes general anesthesia is performed - in this case, the woman sleeps until the end of the operation.

With epidural anesthesia, a drug is injected into the space surrounding the spinal cord, in the lumbar region. A catheter is installed there, through which the medicinal substance is added during and after the operation. During spinal anesthesia, the drug is injected directly into the spinal canal - and then the injection is given once.

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. Recently, during emergency caesarean section, spinal anesthesia has been widely used, in which, just like with epidural, an injection is made in the back in the lumbar region, but the anesthetic is injected directly into the spinal canal, while with epidural anesthesia - into space above the dura mater. 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.

How is a planned caesarean section performed and an emergency one?

At first glance, the operation sequence is simple.

Planned caesarean section, how it all happens:

• An incision is made in the skin and abdominal wall. It can be horizontal, that is, in the lower abdomen (a fairly cosmetic incision, after a while it becomes invisible) or vertical (in case of an emergency caesarean section). If this is the second planned caesarean section for a woman, then the incision is usually made in the same place, with preliminary excision of the old scar.
• The abdominal muscles (which are under the skin) are usually separated without an incision.
• An incision is then made into the wall of the uterus (horizontal or vertical), and the baby is delivered through this incision. With a cephalic presentation, the baby is pulled out by the head, with a pelvic presentation - by the leg or inguinal fold.
• The placenta is removed, and the incision on the uterus is sutured with threads, which later dissolve on their own.
• The skin is closed with sutures or staples, and the urinary catheter is removed.
• If the woman is under regional anesthesia, she may be able to hold the baby and put it to her breast.

How long does it take to do a caesarean section?

If a woman only has a caesarean section, the operation lasts about 1 hour. During repeated surgery, as well as when it is necessary to remove fibroids, tubal ligation (sterilization for medical reasons and the patient’s consent), and separation of adhesions, it lasts 2-3 hours.

Preparing for caesarean

Direct preparation of the expectant mother for a caesarean section includes a psychological attitude, special nutritional rules the day before, and advance collection of the necessary items for the maternity hospital according to the list.

How to prepare for a mother if tomorrow is a caesarean

When a caesarean section is scheduled for tomorrow, the woman must first of all be mentally prepared for it. This operation only seems complicated; its prevalence is close to the removal of the appendix, and the number of successful cases is constantly growing.

Extremely important:

• choose a clinic and specialist in whom you have complete psychological trust;
• create a positive outcome in your imagination by the power of your own conviction, imagine a healthy and strong baby in your arms;
• communicate with family or friends;
• take into account that millions of women have undergone the operation, it is even chosen voluntarily to avoid pain during childbirth;
• With modern anesthesia there will be no unpleasant sensations, and consciousness is completely preserved.

Why you shouldn't drink before surgery

In the evening after 7 pm and in the morning before surgery, you should not drink, especially if general anesthesia is necessary. If there is content in the stomach, then there is a risk of it being thrown into the respiratory tract during cramps and vomiting. In the future, this threatens pneumonia.

When a woman in labor is prescribed spinal or epidural anesthesia (the drug anesthetizes the pelvis and lower extremities), then this danger is lower. However, doctors always prepare to switch to general anesthesia if complications develop. If you are very thirsty, you can suck on a slice of lemon.

What not to eat

The night before you need a light dinner; you cannot eat the following dishes:

• fried,
• fatty,
• spicy,
• salty,
• sweet.

The best options are stewed vegetables with herbs and lemon juice instead of salt, a fermented milk drink, low-fat cottage cheese, pureed vegetable soup with croutons, and a baked apple. Meal time is up to 19 hours, its total volume should not be more than a glass.

List to the maternity hospital

It is better to prepare a package for the maternity hospital in advance, the most important things on the list:

• exchange card, passport, insurance certificate;
• necessary medications;
• elastic bandages or stockings;
• cotton clothing (robe, shirt, change of underwear), slippers;
• sanitary pads, wet, dry, baby wipes;
• diapers, disposable diapers, baby powder.

Planned caesarean section: order after surgery

• The woman is transferred to the observation room for several hours (in an uncomplicated situation - for 4-8 hours).
• Staff will constantly monitor blood pressure, pulse, respiratory rate, amount of bleeding from the genital tract, and abdominal condition.
• If the mother feels well, breastfeeding can be started fairly quickly after the operation.
• If a woman feels weak, she is advised to lie down for a while, and it is better for her to get up with the help of the duty nurse or midwife.
• The suture may hurt for several days: anesthetics are prescribed to relieve pain.
• If a caesarean section is planned, hospitalization in the maternity hospital after the operation takes 4-6 days, but may vary depending on the condition of the mother and child.

What will happen after the operation?

After the operation, the mother and the baby, if his condition allows and he does not need the constant help of neonatologists and intensive care, are transferred to the ward. At first it will be the intensive care ward. Options are possible here: while the mother recovers from anesthesia, the child is kept separately, and if the condition of both is not alarming and the mother is conscious, they will be together right away. 6 hours after spinal anesthesia or 8–12 hours after anesthesia, mother and baby are already moving to the postpartum ward. There are, of course, exceptions - these are those cases when the mother will need intensive treatment - for example, if there was heavy bleeding.

You are allowed to move about 6 hours after the operation - first, carefully lower your legs from the bed, and then walk. Walking after a cesarean section is important, as this is the best prevention of adhesions in the abdominal cavity, congestion in the lungs and complications associated with the formation of blood clots in the veins.

It is also important to drink after surgery - you can drink almost immediately after spinal anesthesia and 2 hours after anesthesia. You can eat food an hour or two after doctors have given you permission to drink, but bread, vegetables and fruits are not something that would be appropriate at this time. The best choice is broth, followed by lean meat, cheese, cereals, and thermally processed cottage cheese dishes.

Please note that a slight increase in body temperature - up to 38C and an increase in the number of leukocytes in the blood after surgery are possible, and their cause is most often the insufficient volume of fluid the woman drinks. Therefore, drink and drink again, and prepare to feed the baby.

Discharge after an uncomplicated cesarean section, if the condition of the mother and newborn allows, today occurs starting from the 3rd day after the operation. And given that, according to modern requirements for the prevention of infectious complications, the expectant mother with a planned cesarean section will be invited to come to the maternity hospital no earlier than a day before the operation, she will stay in the hospital for only 4-5 days. Moreover, her family and close people will be allowed to enter the maternity hospital and even the operating room at this time: for example, a caesarean section in Yekaterinburg, like a natural birth, can be partnered, and the future father, future grandmother or mother’s friend can be with her at the moment the baby is born. Also, in the postoperative period, not only maternity hospital staff, but also members of her family can help the mother in caring for the newborn. This practice is accepted today, for example, in the maternity hospitals of the Yekaterinburg Clinical Perinatal Center.

How long will it take for full recovery?

The same amount as required after a normal birth: that is, about 2 months.

During the first days of recovery, mom may experience:

• painful contractions of the uterus (especially while feeding the baby);
• bloody discharge will gradually decrease, turning into bloody and then serous;
• pain in the suture area, sensitive in the first days, will decrease within 3-5 days.

As after childbirth, in the first 2 months a woman is not recommended to take a bath or be sexually active.

Postoperative period

Any operation is a difficult process and in the postoperative period for 2-3 days, after a cesarean section, the woman is prescribed painkillers.
Also, drugs are used to normalize the functioning of the gastrointestinal tract and to contract the uterus. Since during the operation the woman lost a sufficient amount of fluid, saline solution is injected intravenously to restore the water balance. If necessary, antibiotics are sometimes prescribed at the discretion of the doctor. {rokbox text=|interactive form|}index2.php?option=com_contact&view=contact&id=2{/rokbox}

Can there be complications with a caesarean section?

Despite the fact that this operation is performed quite often, it also has risks of complications.

Planned or emergency caesarean section, consequences for the child:

If the baby is born prematurely, he may develop breathing problems (for example, rapid breathing for several days after birth). Injuries during cesarean sections are very rare.

Planned or emergency caesarean section, maternal consequences:

• infection at the incision site;
• infection and inflammation of the endometrium (inner layer of the uterus);
• the risk of thrombosis of the veins of the lower extremities, as well as pulmonary embolism (3-5 times higher than during natural childbirth);
• increased blood loss (2 times higher than during natural childbirth);
• urinary tract infection;
• intestinal dysfunction;
• reaction to anesthetics.

In addition, the first planned cesarean section increases the chances of surgical intervention at the second planned cesarean section, at the third planned cesarean section and at subsequent deliveries.

Legal aspects

Who should decide how the child is born? This issue is previously resolved in the antenatal clinic, where the patient is observed during pregnancy. If a woman has any diseases, her opinion on the management of pregnancy and the method of delivery is given not only by the obstetrician-gynecologist, but also by other specialists whose consultation is necessary for a particular patient. The final decision is made by the maternity hospital doctors.

The question often arises: can a woman independently choose the method of delivery, that is, decide whether to give birth through the vaginal canal or by caesarean section. Officially, in our country, a caesarean section cannot be performed only at the woman’s request; there must be indications. It is believed that the patient, not having professional knowledge about the dangers of surgery and the impact of the operation on her body and the health of the unborn child, cannot make such decisions. Although in some countries, for example in Holland, a woman’s desire is enough to carry out the operation.

However, in practice it turns out that most caesarean sections are performed according to relative indications, that is, when vaginal delivery is possible. In these cases, the patient’s attitude towards a certain method of delivery is very important, and her desire can be decisive. In addition, if a woman insists on surgery, reasons for it can always be found. But the doctor’s task in this case is not to immediately resolve the issue in favor of a cesarean section. He must find out the reasons why a woman does not want to give birth through the birth canal and tell her about the possible risks for her and for the child. Often, after a conversation with a doctor, a woman agrees to give birth through the birth canal.

It is important that the woman really tunes in to natural childbirth, because a negative attitude towards it can have a negative impact on labor and the condition of the child, and as a result, the birth will end in surgery, as the patient demanded from the very beginning. Therefore, in many maternity hospitals there is a psychologist who helps women get rid of the fear of childbirth and instills confidence in a favorable outcome of childbirth for her and for the child.

Many women, in turn, on the contrary, want to refuse surgery when the doctor insists on this particular method of delivery. In this case, the doctor is also obliged to tell the patient about all the possible risks that exist for her during vaginal birth and during surgery. If doctors determine that surgery is necessary, but the woman does not agree to it, she must put her refusal of surgery in writing, indicating that she was warned about the need for surgery, but refuses it. The final decision in this case remains with the patient. However, remember that if you refuse surgery, you yourself are responsible for the consequences of this refusal for you and the unborn child. You should definitely weigh the pros and cons, compare the possible health hazards of a caesarean section and natural childbirth, and if possible, consult with another doctor.

If a woman agrees to an operation, she signs a consent form, regardless of whether she is undergoing a planned or emergency operation. The “Consent for Operation” form also states that the woman is explained the indications for which the operation is being performed and that she is warned about possible risks. If the woman is unconscious, then the decision on the operation is made by a council of doctors. The conclusion on the need for surgery must have the signatures of at least three doctors.

Before the operation, an anesthesiologist also talks with the woman, who is obliged to explain to the patient the advantages of the method of pain relief that will be used during the operation, and if the woman agrees, she signs a consent form for anesthesia or spinal anesthesia.

In addition, all women undergoing surgery may bleed. In case of massive blood loss, a transfusion of blood products may be required, which also cannot be performed without the woman’s consent. Since the woman may be unconscious during the operation, in most maternity hospitals she is asked to sign a consent form in advance (before the operation) for a blood transfusion, if necessary.

Before signing consent for surgery and other medical procedures or refusing them, a woman has the right to receive answers to all her questions regarding the method of operation, the method of pain relief, and possible risks for her and for the child. The doctor is obliged to explain everything to the woman in a language she can understand, without putting pressure on her.

You should not sign anything without reading, carefully read all the points of the form that you are given to sign, clarify everything that you do not understand. Remember that you are not just observing certain formalities, but are making an important decision.

Breastfeeding after caesarean section

Many mothers are afraid that after the operation the milk will disappear or will not come at all. And here, early attachment is very important in the first hour after the baby is born. And although this is not always possible in the case of surgery, mothers should not panic, because babies maintain high sucking activity for 6-12 hours after birth. Therefore, it is enough for the first application to occur during these hours.

Additionally, babies born by cesarean section sometimes have a weakened sucking reflex for an hour after birth. Therefore, later application is even recommended for them.

If the weakened sucking reflex continues, the mother should put the baby to the breast as often as possible until he begins to show sufficient activity. Also, the mother needs to find a comfortable position for feeding, as some positions can put pressure on the seam, causing pain.

If mother and baby are forced to be separated after surgery, the woman should pump regularly every three hours (except at night) to maintain lactation.

Sometimes after surgery a woman’s milk comes late (9-10 days). In this case, the child will need supplementary feeding with a special formula. And once the milk comes in, you can and should switch to breastfeeding. It is better to supplement feeding not from a bottle with a nipple, but from a small spoon, pipette or syringe without a needle - then it will be easier for the child to learn to suckle when the milk comes. If a child has difficulty sucking the breast, this is not a reason to switch to artificial feeding. We need to teach the child to latch onto the breast, be persistent, and ask for help from a breastfeeding specialist.

What to do when you've had a Caesarean

After the “caesarean” procedure, the state of blood circulation and restoration of sensitivity are monitored, recommendations are given on nutrition and physical activity, and treatment of the suture. Upon discharge, treatment is prescribed according to indications; after resumption of sexual intercourse, contraception is required.

Surveys

During the first hours after surgery, the woman in labor is examined:

• blood pressure is measured, since it often drops or changes;
• monitor the condition of the suture, the presence of vaginal discharge, the height of the uterine fundus and its tone;
• determine pulse, respiratory rate, volume of urine excreted.

An example of a suture on the uterus after an ultrasound
If the woman’s condition is satisfactory, after 8 hours she can sit on the bed, and by the end of 12 hours she should try to get to her feet.

The doctor observes how sensitivity of the lower extremities is gradually restored after spinal anesthesia. If pain occurs in the lower back or lower abdomen, painkillers are used. If necessary, drugs to prevent thrombosis and antibiotics that stimulate intestinal contractions are recommended.

On days 4-6, an examination by a gynecologist, ultrasound, and blood and urine tests are scheduled. If there are no complications, the woman is discharged for observation at her place of residence. After 7-10 days, you must undergo a doctor’s examination and the necessary examination (ultrasound, smears, blood tests).

Suture after caesarean section

Restrictions in the first days

During the first day, you are initially allowed to drink only water, and then non-acidic kefir and diluted juice.

The next day, the list of dishes expands to include:

• low-fat chicken broth with white croutons;
• curdled milk, yogurt without sugar and fruit;
• steam omelette.

From 3-4 days, a gentle diet is prescribed with pureed porridge, fish, meat, and puree soup. By the end of the week, you can switch to a regular table, but with the exception of fried, fatty and spicy foods. It is important for a woman to prevent constipation.

For this we recommend:

• sufficient intake of drinking water;
• vegetable juices;
• boiled pumpkin;
• plum puree.

Seam processing

Until healing, I lubricate the postoperative suture with solutions of iodine, brilliant green, and colorless Fukortsin. At home, antiseptics are recommended for care: Chlorhexidine, Miramistin, Decasan. To speed up healing, ointments (Solcoseryl, Traumeel) and silicone patches (Mepiform, Dermatix) are prescribed.

Behavior at home

In order not to disrupt the healing process of the scar on the uterus and skin, you must refrain from:

• lifting weights over 3 kg (3 months);
• intense physical activity, sports (8 weeks), abdominal exercises (4 months);
• sexual intercourse (2 months);
• hot shower (1 month, warm allowed), bath (2 months);
• visits to the bathhouse, swimming pool (3 months).

When restoring at home, you need to know which symptoms you need to see a doctor urgently (ambulance), routinely (gynecologist in consultation), and which are acceptable (see table).

Contraception

After the gynecologist allows you to resume sexual intercourse, you should take care of the method of contraception. When a woman fully breastfeeds her baby after a natural birth, but does not have periods, then in 98% of cases this gives a fairly reliable contraceptive effect.

During cesarean section, due to the lack of a mechanism for physiological stimulation of lactation, 75% of patients have little milk. By the end of 3 months, many women already have their cycle restored, so it is important to use contraceptives from the first days of sexual relations, regardless of breastfeeding or the presence of menstruation.

It is preferable to use condoms, as they help further protect against infection and there is no risk of side effects, as with hormonal pills. A woman may also be prescribed medications in cases where it is necessary to treat endometriosis, functional ovarian cysts, or prevent active growth of the endometrium. Exluton, Charozetta, Lactinet are used.

2-4 months after cesarean section, an intrauterine device can be inserted. Repeated births are allowed no earlier than after 3 years, since the scar on the uterus must be fully formed.

Antibiotic prophylaxis during cesarean section: is it really necessary?

If a woman is at high risk of developing an infection, the prescription of antibiotics is not in doubt.

Regarding the prescription of antibiotics in other cases:

• There are studies that show that antibiotic prophylaxis in all women reduces the incidence of endometritis, wound infection and fever after CS;
• other experts argue that antibiotics can only be used in women at risk of infectious complications (and only those antibiotics are prescribed for which breastfeeding is allowed);
• Most studies show that there are more benefits than risks to using antibiotics before surgery or immediately after cutting the umbilical cord.

Preparing for a caesarean section

Preparation for the operation necessarily includes: familiarization with the mother’s diseases, assessment of the position and presentation of the baby, its size and heartbeat, examination by an anesthesiologist and, if necessary, related specialists (if the mother has a serious illness, due to which during cesarean delivery they may complications may arise). The area where the incision is planned must be shaved, and compression stockings are put on the expectant mother’s legs. A separate protocol is used to prevent infectious complications with antibiotics - usually a broad-spectrum antibiotic is administered once before surgery. There is no enema on this mandatory list, but there is a urinary catheter, the installation of which is mandatory.

When to plan a new pregnancy after a CS?

You need to wait about a year (any woman who has given birth needs this interval).

Usually, the suture after a cesarean section heals within three months after the birth of the child. However, if more time passes, it will heal better. A poorly healed scar can cause problems in the future, because in this case there may be a risk of uterine rupture along the existing scar. And although the risk is low, it increases if the interval between pregnancies is short (less than 1-1.5 years). Also, the rapid occurrence of a new pregnancy after a CS is accompanied by an increased risk of low placental attachment or placental abruption.

Many women experience postpartum depression, emotional stress or simply fatigue after pregnancy and surgery - in such situations the body also needs rest. Of course, a woman may have reasons to plan a new pregnancy soon after the CS (age or the desired small difference in the ages of the children). In such cases, it is necessary to consult a doctor and make sure that the suture on the uterus has healed and the body is ready to bear a new pregnancy.

When is a transsection necessary?

Indications for a caesarean section can be absolute, when independent childbirth is impossible or involves an extremely high risk for the health of mother and baby, and relative, and the list of both is constantly changing. Some relative reasons have already been transferred to the category of absolute ones.

Reasons for planning a cesarean section arise during pregnancy or when labor has already begun. Women are eligible for elective surgery for the following indications:

• 
  indications for caesarean section

  Complete placenta previa, which is in the path of the fetus;

• Scars from previous operations of childbirth, removal of myomatous nodes, perforation of the uterus during abortion.;
• Anatomically narrow pelvis, starting from the second degree, deformation, neoplasm of the appendages and pelvic walls;
• Inflammatory processes of the pubic joint;
• The probable weight of the fetus is more than 4.5 kg;
• Cicatricial stenosis of the cervical canal, vagina;
• Previous reconstructive and plastic interventions on the perineum, cervix;
• Pelvic, breech presentation, transverse position of the fetus;
• Multiple pregnancy;
• Oncopathology;
• Multiple myomatous nodes;
• Severe gestosis;
• Severe intrauterine growth retardation;
• Pathology of the retina and fundus of the eye with severe myopia;
• Acute herpetic genital infection;
• Kidney transplantation before pregnancy;
• Perinatal death of the fetus, the presence of a disabled child in the family due to previous births;
• In vitro fertilization procedure.

Emergency transection is performed in case of obstetric hemorrhage, placenta previa or abruption, probable or incipient rupture of the fetal sac, acute fetal hypoxia, agony or sudden death of a pregnant woman with a living child, severe pathology of other organs with deterioration of the patient’s condition.

When labor begins, circumstances may arise that force the obstetrician to decide on emergency surgery:

1. Pathology of uterine contractility that does not respond to conservative treatment - weakness of labor forces, discoordinated contractility;
2. Clinically narrow pelvis - its anatomical dimensions allow the fetus to pass through the birth canal, but other reasons make this impossible;
3. Loss of the umbilical cord or parts of the baby's body;
4. Threatened or progressive uterine rupture;
5. Leg presentation.

In some cases, surgery is performed due to a combination of several reasons, each of which in itself is not an argument in favor of surgery, but in the case of their combination there is a very real threat to the health and life of the baby and the expectant mother during normal childbirth - prolonged infertility, earlier miscarriages , IVF procedure, age over 35 years.

Relative indications include severe myopia, kidney pathology, diabetes mellitus, sexually transmitted infections in the acute stage, a pregnant woman’s age over 35 years if there are abnormalities during pregnancy or fetal development, etc.

If there is the slightest doubt about the successful outcome of the birth, and, even more so, if there are reasons for surgery, the obstetrician will prefer a safer route - transection. If the decision is in favor of independent childbirth, and the result is serious consequences for the mother and baby, the specialist will bear not only moral, but also legal responsibility for neglecting the condition of the pregnant woman.

There are contraindications to surgical delivery, although their list is much smaller than the indications. The operation is considered unjustified in case of death of the fetus in the womb, fatal malformations, as well as hypoxia, when there is confidence that the child can be born alive, but there are no absolute indications on the part of the pregnant woman. If the mother's condition is life-threatening, the operation will be performed one way or another, and contraindications will not be taken into account.

Many expectant mothers who are about to undergo surgery worry about the consequences for the newborn. It is believed that children born by cesarean section are no different in their development from babies born naturally. However, observations show that the intervention contributes to more frequent inflammatory processes in the genital tract in girls, as well as type 2 diabetes and asthma in children of both sexes.

Natural birth after caesarean section: possible or not?

Many women who have had a caesarean section can give birth naturally. The decision is made depending on:

• whether there was a birth after an emergency caesarean section, how the operation went, were there any complications;
• type of incision on the uterus;
• number of previous CS;
• the number of pregnancies planned in the future;
• pregnancy complications or health conditions that preclude natural childbirth;
• a history of uterine rupture (with such a complication, an attempt at natural childbirth is not recommended);
• How is this pregnancy progressing?
• from the maternity hospital - is he ready to deal with emergency situations during natural childbirth?

When is natural childbirth after a CS not recommended?

If there is a danger that the uterine scar will weaken or rupture. And stimulation of labor during natural childbirth increases the threat of such a rupture. In the event of such a rupture, an emergency caesarean section will be performed.

Some types of cutting are less dangerous, others are more dangerous. For example, a low transverse incision is less likely to rupture, so women with such an incision can attempt a natural birth. The greatest danger of uterine rupture comes from a high vertical incision: a woman with such an incision should not attempt a natural birth.

What can be unplanned situations during repeated births after a CS?

If labor has not started after 40 weeks, the doctor and woman discuss three options:

• wait for labor to begin;
• stimulate labor - and then the risk of suture divergence on the uterus increases;
• repeat caesarean section.

You should always be prepared to change your birth plan. After all, events may occur that increase the risks and require an emergency cesarean section according to indications - for example, a large fetus or the occurrence of preeclampsia, or stimulation of labor will be required.

If a woman has contractions as scheduled after a previous planned caesarean section, she should come to the hospital so that an emergency caesarean section can be performed if necessary. If labor progresses quickly and without complications, and provided the baby is healthy, a natural birth may be an appropriate choice.

Anesthesia

Today, the first choice method here is spinal anesthesia, when the woman remains conscious, and her sensitivity disappears from the level of the upper abdominal cavity. She can talk to doctors during surgery. But he doesn’t feel pain, he can understand the moment of removing the baby only when he appears in the doctor’s hands, and then he can kiss his child, see how he is being treated and put him to the chest. A not entirely pleasant moment with such anesthesia is the chills that begin after the operation. It is associated with the action of drugs that were used during anesthesia and caused a strong dilation of local vessels through which heat loss occurs. This can be easily overcome with the help of a blanket, so it is important to cover the woman well after a cesarean section (albeit with ice in the lower abdomen for better contraction of the uterus and to prevent bleeding, but under a blanket).

If spinal anesthesia is not possible, then general anesthesia is used, or, as patients uninitiated in anesthesiology say, general anesthesia (although anesthesia is anesthesia with the patient's consciousness turned off, and by definition it can only be general). The patient’s refusal of spinal anesthesia is taken into account by doctors here, and other indications are emergency conditions, for example, uterine rupture during childbirth.

If the birth, during which doctors had to switch to a cesarean section, was performed under epidural anesthesia and there are no indications for anesthesia, a cesarean section can be performed under it - only the amount of the drug, of course, will be increased.

Caesarean section at the patient's request

In some countries this is allowed - in the UK, the UAE, the USA and a number of others: here some women choose a caesarean section even if a natural birth is possible. But such a decision must be balanced, because this operation is always associated with the risk of complications. This practice is not common in Russia.

As for the price, you need to find out how much a planned caesarean section costs in the clinic you have chosen. For example, in a Moscow clinic, a birth with a cesarean section will cost 90-120 thousand rubles. (depending on the level of the maternity hospital). In foreign clinics, prices are several times higher: for example, in Germany a caesarean section will cost 10-14 thousand euros, in Finland - about 5-7 thousand dollars, in France - 10-30 thousand dollars. According to the compulsory medical insurance policy in a Russian maternity hospital, you can give birth by caesarean section absolutely free of charge.

Where to do a caesarean section

A cesarean section is a surgical delivery, so it must be done in a maternity hospital. This can be either a public or private medical institution, but in the latter case it is important to check their permitting documentation in advance. When choosing, they usually focus on the reputation of the hospital and reviews of women in labor. The cost of a paid caesarean section ranges from 25 thousand rubles to 100,000 or more, which depends on the additional services provided.

A caesarean section is performed in the maternity hospital

A planned caesarean section is carried out when there are contraindications to natural childbirth in the mother or child, as well as at the request of the woman. Prescribed at 38-39 weeks of pregnancy. After discharge, it is important to temporarily exclude heavy lifting, hot water treatments, and sexual intercourse.