By cesarean section. Childbirth by caesarean section. How is the operation of a cesarean section, what happens before and after it

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Caesarean section operation is considered one of the most frequent in the practice of obstetricians around the world, and the frequency of its performance is steadily increasing. At the same time, it is important to correctly assess the indications, possible obstacles and risks to operative delivery, its benefits for the mother and potential adverse consequences for the fetus.

Recently, the number of unjustified childbirth operations has increased, among the leaders in their implementation is Brazil, where almost half of women do not want to give birth on their own, preferring to have celiac disease.

The undoubted advantages of operative delivery are the ability to save the life of both the child and the mother in cases where natural childbirth is a real threat or is impossible for a number of obstetric reasons, the absence of perineal ruptures, a lower incidence of hemorrhoids and prolapse of the uterus subsequently.

However, many disadvantages should not be ignored, among which are serious complications, postoperative stress, prolonged rehabilitation, therefore, a cesarean section, like any other abdominal operation, should be performed only for those pregnant women who really need it.

When is celiac disease necessary?

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

The reasons for planning a cesarean section arise in the process of bearing a fetus or during labor that has already begun. Women are supposed to have a planned operation for indications:

Emergency gastrointestinal bleeding is performed with obstetric bleeding, previa or placental abruption, probable or incipient rupture of the fetus, acute fetal hypoxia, agony or sudden death of a pregnant woman with a living child, severe pathology of other organs with a worsening 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, and other reasons make this impossible;
3. Prolapse of the baby's umbilical cord or body parts;
4. Threat or progressive rupture of the uterus;
5. Foot presentation.

In some cases, the operation is carried out 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, miscarriages earlier , IVF procedure, age over 35 years.

Relative indications are considered severe myopia, kidney pathology, diabetes mellitus, genital infections in the acute stage, the age of a pregnant woman over 35 years in the presence of abnormalities during pregnancy or fetal development, etc.

In the case of the slightest doubt about the successful outcome of childbirth, and even more so if there are reasons for the operation, the obstetrician will prefer the safer way - gluttony. If the decision is in favor of independent childbirth, and the result will be 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.

For surgical delivery there are contraindications, however, their list is much smaller than the testimony. The operation is considered unjustified in case of fetal death 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 from the pregnant woman. If the mother is in a life-threatening condition, the operation will be performed one way or another, and contraindications will not be taken into account.

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

Varieties of gluttony surgery

Depending on the features of the surgical technique, there are different types of cesarean section. So, access can be by laparotomy or through the vagina. In the first case, the incision goes along the abdominal wall, in the second - through the genital tract.

Vaginal access is fraught with complications, is technically difficult and is not suitable for delivery after 22 weeks of gestation in the case of a living fetus, therefore it is now practically not used. Viable babies are removed from the uterus only by a laparotomic incision. If the gestational age has not exceeded 22 weeks, then the operation will be called small cesarean section. It is necessary for medical reasons - serious defects, genetic mutations, a threat to the life of the expectant mother.

incision options for CS

The location of the incision on the uterus determines the types of intervention:

• Corporeal caesarean section - midline incision of the uterine wall;
• Istmicocorporeal - the incision goes below, starting from the lower segment of the organ;
• In the lower segment - across the uterus, with / without detachment of the bladder wall.

An indispensable condition for surgical delivery is a living and viable fetus. In case of intrauterine death or defects incompatible with life, a cesarean will be done in case of a high risk of death of a pregnant woman.

Preparation and methods of pain relief

The peculiarities of preparation for operative delivery depend on whether it will be carried out as planned or on an emergency basis.

If a planned intervention is prescribed, then the preparation resembles that for other operations:

1. Light diet the day before;
2. Intestinal cleansing with an enema in the evening before the operation and in the morning two hours before it;
3. Exclusion of any food and water 12 hours before the scheduled intervention;
4. Hygienic procedures (shower, shaving hair from the pubis and abdomen) in the evening.

The list of examinations includes standard general clinical blood and urine tests, blood clotting tests, ultrasound and CTG of the fetus, HIV tests, hepatitis, genital infections, consultations of a therapist and narrow specialists.

In case of emergency intervention, a gastric tube is inserted, an enema is prescribed, analyzes are limited to the study of urine, blood composition and coagulability. The surgeon in the operating room places a catheter in the bladder, installs an intravenous catheter to infuse the necessary drugs.

The method of anesthesia depends on the specific situation, the preparedness of the anesthesiologist and the patient's wishes, if it does not go against common sense. Regional anesthesia is one of the best ways to relieve cesarean delivery.

Unlike most other operations, with a cesarean section, the doctor takes into account not only the need for anesthesia as such, but also the possible adverse consequences of the administration of drugs for the fetus, therefore, spinal anesthesia is considered optimal, which excludes the toxic effect of anesthesia on the baby.

spinal anesthesia

However, it is not always possible to perform spinal anesthesia, and in these cases, obstetricians undergo surgery under general anesthesia. It is mandatory to prevent the reflux of gastric contents into the trachea (ranitidine, sodium citrate, cerucal). The need to cut the abdominal tissue requires the use of muscle relaxants and a ventilator.

Since the operation of gluttony is accompanied by a rather large blood loss, then at the preparatory stage it is advisable to take blood from the pregnant woman herself in advance and prepare plasma from it, and return the erythrocytes back. If necessary, the woman will be given her own frozen plasma.

To replace lost blood, blood substitutes, as well as donor plasma, shaped elements can be prescribed. In some cases, if it is known beforehand about a possible massive blood loss due to obstetric pathology, washed erythrocytes are returned to the woman during the operation through the reinfusion apparatus.

If fetal pathology is diagnosed during pregnancy, in case of premature birth, a neonatologist should be present in the operating room who can immediately examine the newborn and perform resuscitation if necessary.

Anesthesia with a cesarean section carries certain risks. In obstetrics, as before, the bulk of deaths during surgical interventions occur during this operation, and in more than 70% of cases, the fault is the ingress of stomach contents into the trachea and bronchi, difficulties with the introduction of an endotracheal tube, and the development of inflammation in the lungs.

When choosing a method of anesthesia, the obstetrician and anesthesiologist must evaluate all available risk factors (pregnancy course, concomitant pathology, unfavorable previous births, age, etc.), the condition of the fetus, the type of proposed intervention, as well as the desire of the woman herself.

Caesarean section technique

The general principle of celiac surgery may seem quite simple, and the operation itself has been worked out for decades. However, it is still classified as an intervention of increased complexity. The most appropriate is a horizontal incision in the lower uterine segment and in terms of risk, and from the standpoint of aesthetic effect.

Depending on the characteristics of the incision, for a caesarean section, a lower midline laparotomy, a section according to Pfannenstiel and Joel-Cohen are used. The choice of a specific type of operation occurs individually, taking into account changes in the myometrium and abdominal wall, the urgency of the operation, the skills of the surgeon. During the intervention, self-absorbable suture material is used - vicryl, dexon, etc.

It should be noted that the direction of the incision of the abdominal tissues does not always and does not necessarily coincide with the incision of the uterine wall. So, with a lower midline laparotomy, the uterus can be opened as desired, and the Pfannenstiel incision assumes isthmicocorporeal or corporal gluttony. The simplest method is considered to be the lower midline laparotomy, which is preferable for corporal section; it is more convenient to perform a transverse incision in the lower segment through the Pfannenstiel or Joel-Cohen access.

Corporeal Caesarean Section (CCS)

A corporal caesarean section is rarely performed when there are:

• Severe adhesive disease, in which the path to the lower segment is impossible;
• Varicose veins in the lower segment;
• The need to extirpate the uterus after removing the child;
• An insolvent scar after a previously performed corporal gluttony;
• Prematurity;
• Fused twins;
• Living fetus in a dying woman;
• The transverse position of the child, which cannot be changed.

Access for CCS is usually a lower midline laparotomy, in which the skin and underlying tissues are dissected to the aponeurosis at the level from the umbilical ring to the pubic joint, strictly in the middle. Aponeurosis is opened longitudinally over a short length with a scalpel, and then enlarged with scissors up and down.

suture of the uterus with corporal CS

The second caesarean section must be performed very carefully because of the risk of damage to the bowel, bladder... In addition, an existing scar may not be dense enough to maintain the integrity of the organ, which is dangerous for a ruptured uterus. The second and subsequent gluttony is more often carried out on the finished scar with its subsequent removal, and the rest of the operation is standard.

With CCS, the uterus is opened exactly in the middle, for this it is turned so that an incision of at least 12 cm in length is located at an equal distance from the round ligaments. This stage of the intervention should be carried out as quickly as possible due to the profuse blood loss. The fetal bladder is opened with a scalpel or fingers, the fetus is removed by hand, the umbilical cord is pinched and crossed.

To speed up the contraction of the uterus and evacuation of the placenta, the appointment of oxytocin into a vein or muscle is indicated, and antibiotics of a wide spectrum are used intravenously to prevent infectious complications.

For the formation of a lasting scar, prevention of infections, safety in subsequent pregnancies and childbirth, it is extremely important to adequately match the edges of the incision. The first suture is applied at a distance of 1 cm from the corners of the incision, the uterus is sutured in layers.

After removing the fetus and suturing the uterus, an examination of the appendages, appendix and adjacent abdominal organs is mandatory. When the abdominal cavity is flushed, the uterus has contracted and became dense, the surgeon sutures the incisions in layers.

Istmicocorporeal cesarean section

Isthmicorporeal gastrointestinal surgery is performed according to the same principles as CCS, with the only difference that before opening the uterus, the surgeon cuts the peritoneal fold between the bladder and the uterus transversely, and pushes the bladder itself downward. The uterus is dissected 12 cm in length, the incision goes longitudinally in the middle of the organ above the bladder.

Incision in the lower uterine segment

In a caesarean section in the lower segment, the abdominal wall is cut along the suprapubic line - according to Pfannenstiel. This access has several advantages: it is cosmetic, less often it subsequently gives hernias and other complications, the rehabilitation period is shorter and easier than after a median laparotomy.

incision technique in the lower uterine segment

The incision of the skin and soft tissues runs in an arcuate way across the pubic joint. Somewhat above the skin incision, the aponeurosis is opened, after which it exfoliates from the muscle bundles downward to the pubic symphysis and upward to the navel. The rectus abdominal muscles are pulled apart with the fingers.

The serous cover is opened with a scalpel at a distance of up to 2 cm, and then enlarged with scissors. The uterus is exposed, the folds of the peritoneum between it and the bladder are cut horizontally, the bladder is diverted to the womb by a mirror. It should be remembered that during childbirth the bladder is located above the pubis, so there is a risk of injury with careless actions with a scalpel.

The lower uterine segment is opened horizontally, carefully, so as not to damage the baby's head with a sharp instrument, the incision is enlarged with the fingers to the right and left to 10-12 cm, so that there is enough for the newborn's head to pass.

If the baby's head is low or large, the wound can be enlarged, but there is an extremely high risk of damage to the uterine arteries with heavy bleeding, so it is more advisable to make the incision in an arched slightly upward direction.

The fetal bladder is opened together with the uterus or with a scalpel separately with dilution to the sides of the edges. With his left hand, the surgeon penetrates into the fetus, gently tilts the baby's head and turns it to the wound with the occipital region.

To facilitate the extraction of the fetus, the assistant gently presses on the bottom of the uterus, while the surgeon at this time gently pulls the head, helping the baby's shoulders out, and then pulls it out by the armpits. With a breech presentation, the baby is removed by the groin or leg. The umbilical cord is cut, the newborn is handed over to the midwife, and the afterbirth is removed by traction by the umbilical cord.

At the final stage, the surgeon makes sure that there are no fragments of the membranes and afterbirth left in the uterus, there are no myomatous nodes and other pathological processes. After the umbilical cord is cut off, the woman is injected with antibiotics to prevent infectious complications, as well as oxytocin, which accelerates the contraction of the myometrium. The fabrics are sutured tightly in layers, matching their edges as accurately as possible.

In recent years, the technique of lower bladder dissection without exfoliation of the bladder through the Joel-Cohen incision has gained popularity. It has many advantages:

1. The kid is removed quickly;
2. The duration of the intervention is significantly reduced;
3. Less blood loss than with detachment of the bladder and CCS;
4. Less soreness;
5. Lower risk of complications after the intervention.

With this type of cesarean section, the incision goes across 2 cm below the line conventionally drawn between the anterior superior spines of the iliac bones. The aponeurotic leaf is dissected with a scalpel, its edges are removed with scissors, the rectus muscles are pulled back, the peritoneum is opened with the fingers. This sequence of actions minimizes the risk of bladder injury. The wall of the uterus is cut for 12 cm simultaneously with the vesicouterine fold. Further actions are the same as for all other methods of gluttony.

When the operation is completed, the obstetrician examines the vagina, removes blood clots from it and the lower part of the uterus, and rinses with sterile saline, which facilitates the recovery period.

Recovery after gluttony and possible consequences of the operation

If the delivery took place under spinal anesthesia, the mother is conscious and feeling well, the newborn is applied to her breast for 7-10 minutes. This moment is extremely important for the formation of the subsequent close emotional bond between mom and baby. The exception is severely premature babies and those born in asphyxiation.

After all wounds have been closed and the genital tract cleaned, an ice pack is placed on the lower abdomen for two hours to reduce the risk of bleeding. The introduction of oxytocin or dinoprost is indicated, especially for those mothers who have a very high risk of bleeding. In many maternity hospitals, after the operation, a woman spends up to a day in the intensive care unit under close supervision.

During the first days after the intervention, the administration of solutions is shown that improve the properties of the blood and replenish the lost volume. According to indications, analgesics and means to increase uterine contractility, antibiotics, anticoagulants are prescribed.

To prevent intestinal paresis, cerucal, neostigmine sulfate, enemas are prescribed for 2-3 days after the intervention. You can breastfeed your baby already on the first day, if there are no obstacles to this from the mother or newborn.

The stitches from the abdominal wall are removed at the end of the first week, after which the young mother can be discharged home. Every day before discharge, the wound is treated with antiseptics and examined for inflammation or healing problems.

The suture after a caesarean section can be quite noticeable, going longitudinally along the abdomen from the navel to the pubic region, if the operation was carried out by means of a midline laparotomy. The scar is much less visible after the suprapubic transverse approach, which is considered one of the advantages of the Pfannenstiel incision.

Patients who have undergone a cesarean section will need the help of loved ones when caring for the baby at home, especially for the first few weeks, while the internal seams heal and soreness is possible. After discharge, it is not recommended to take a bath or visit the sauna, but a daily shower is not only possible, but also necessary.

suture after cesarean section

The caesarean section technique, even if there are absolute indications for it, is not without its drawbacks. First of all, the disadvantages of this method of delivery include the risk of complications such as bleeding, trauma to neighboring organs, purulent processes with possible sepsis, peritonitis, phlebitis. The risk of consequences is several times greater during emergency operations.

In addition to complications, among the disadvantages of a cesarean section is a scar, which can cause psychological discomfort to a woman if it runs along the abdomen, contributes to hernial protrusions, deformities of the abdominal wall and is noticeable to others.

In some cases, after surgical delivery, mothers experience difficulties with breastfeeding, and it is also believed that the operation increases the likelihood of deep stress up to postpartum psychosis due to the lack of a sense of completeness of the natural birth.

According to the reviews of women who have undergone operative delivery, the greatest discomfort is associated with severe pain in the wound area in the first week, which requires the appointment of analgesics, as well as with the formation of a noticeable skin scar later. The operation, which did not entail complications and was carried out correctly, does not harm the child, but the woman may have difficulties with subsequent pregnancies and childbirth.

Caesarean section is carried out everywhere, in any obstetric hospital with an operating room... This procedure is free and available to any woman who needs it. However, in some cases, pregnant women wish to carry out childbirth and surgery for a fee, which makes it possible to choose a specific attending physician, clinic and conditions of stay before and after the intervention.

The cost of an operative delivery varies widely. The price depends on the specific clinic, the comfort, the medicines used, the qualifications of the doctor, and the same service in different regions of Russia may differ significantly in price. State clinics offer a paid cesarean section in the range of 40-50 thousand rubles, private - 100-150 thousand and more. Abroad, operative delivery will cost 10-12 thousand dollars or more.

A caesarean section is performed in every maternity hospital, and, according to indications, it is free of charge, and the quality of treatment and follow-up does not always depend on financial costs. So, a free operation can go quite well, but a pre-planned and paid one - with complications. It is not for nothing that they say that childbirth is a lottery, so it is impossible to guess their course in advance, and expectant mothers can only hope for the best and prepare for a happy meeting with a little man.

Video: Dr. Komarovsky about caesarean section

When natural childbirth is not possible for medical reasons, an alternative delivery option is used - a cesarean section. It should be borne in mind that this is a difficult path that allows you to bypass the pain of natural childbirth, and a serious procedure that has a number of negative consequences.

In contact with

CS is a surgical procedure to remove a fetus from the uterus through an abdominal incision. Depending on the development of the pregnancy, the procedure may be scheduled as planned. If during the development of pregnancy no complications were observed, but complications arose during the birth process, then an emergency operation is performed.

According to statistics, every ninth baby in Russia is born with help. Despite the fact that the operation is considered simple and often practiced, the likelihood of complications increases more than 12 times.

Indications for elective caesarean section

Planned COP is shown in the following cases:

• diabetes mellitus and Rh-conflict;
• detachment of the retina and myopia;
• physiological characteristics of the mother: a narrow pelvis, malformations of the uterus or vagina;
• the presence of scars on the uterus, remaining;
• breech presentation of the fetus or other abnormal position - frequent indications for a cesarean section;
• with post-term pregnancy, in which the size of the fetus is above normal;
• at ;
• the presence or exacerbation of genital herpes;
• with placenta previa.

Anyway, the operation is performed with the consent of the woman in labor... This consent must be recorded in writing.

In the practice of doctors, there are cases when a woman in labor without medical indications for surgery decides to give birth by caesarean section. The reasons are psychological: fear of pain or physiological changes in the genitals. However, the World Health Organization recommends giving preference to natural childbirth, since the operation lays certain imprints on the health of the baby and mother.

An emergency caesarean section is indicated in the following cases:

• A long labor process leading to oxygen starvation of the fetus. In this case, there is a real threat to the baby's life;
• The loss of the strength of the woman in labor. For the normal development of the birth process, physical strength and psychological determination are required.;
• Wrong position of babies with multiple pregnancies;
• Childbirth that came before the natural time;
• Premature rupture of amniotic fluid. In this case, there is a high risk of contracting infections.;
• Placental abruption in a woman in labor. This is fraught with bleeding;
• Presentation or prolapse of the fetal loop. Threatens with hypoxia and death for the baby;
• At ;
• Rarely, but still there are cases of uterine rupture.

Each generic process is individual. Therefore, this list does not reflect all the complications that may require urgent action. A woman in labor should always be under the close supervision of an obstetrician to prevent certain deviations from the birth process.

Algorithm for preparation in the hospital

When carrying out a planned operation, a woman in labor should prepare in advance for the procedure. What week is the planned cesarean section done? In practice, the operation is prescribed at the end - 38–39 weeks of pregnancy. 8-10 days before the appointed date, the gynecologist writes out a referral to the clinic where the operation is planned. A woman should be hospitalized in advance with everyone, since she:

• General analysis of blood and urine;
• Rh factor analysis;
• Cytological smear;
• Doppler vessels.

These tests help assess the degree of preparation of the body for delivery.

What is the best anesthesia for CS?

general and regional. General anesthesia has a number of negative consequences., among which, respiratory failure of the mother and child or the ingress of fluid from the gastrointestinal tract into the respiratory tract can be noted. The very substances contained in the composition of anesthesia can have a depressing effect on the neurological system of the baby. In this case, the "gold standard" for caesarean section is the spinal and epidural type of pain relief.

The spinal method is carried out by a single injection injected into the cerebrospinal fluid. Epidural anesthesia is administered through a catheter into the spinal cord area. Both types of injections are given in a horizontal or seated position. The procedures are painless, sometimes accompanied by discomfort in the lower part of the peritoneum.

Each of these types has its own characteristics. The analgesic effect in the first case occurs within 10-15 minutes, for an epidural it will take 20-30 minutes.

Sometimes, regional anesthesia may not provide the appropriate level of pain relief. In such cases, if spinal anesthesia is initially administered, then general anesthesia is administered. If epidural anesthesia was initially present, the operation will be continued by increasing the dose of the drug through the inserted catheter.

According to the consequences, the advantages of spinal anesthesia can be noted. With her, mild headaches are possible in the postoperative period. are extremely rare, but can be more tangible.

On the eve of the operation

The COP is usually done in the morning. The night before, a woman in labor should prepare for her. In particular, the anesthesiologist conducts an explanatory conversation. As a result, he must find out the previous facts of taking anesthetics, past illnesses, the woman's weight and other factors. The data obtained will help you choose an individual dose of painkillers.

Hygiene preparation is also carried out: taking a shower and epilation of the genitals. Lunch on this day should be limited to the first course, and dinner should consist of kefir or tea, drunk before 18:00.

On the day of surgery, be sure to refrain from eating and drinking fluids. A couple of hours before the caesarean section, the intestines are cleansed with an enema.

How is the operation going?

The woman in labor lays down on the operating table in shoe covers and a hygienic cap. The legs of the woman in labor are tied with an elastic bandage. This measure is necessary as prevention of thrombosis.... The operating area and the woman's face are separated by a screen. It should be borne in mind that in the absence of other indications, local anesthesia is practiced. After the procedure for pain relief, a dropper is inserted to compensate for the loss of blood. Cuffs are put on the arms to control pressure and pulse. A catheter is placed in the urinary tract. The peritoneum is sterilized and covered with a sterile sheet. The doctor proceeds to the procedure.

How long does a caesarean section take? Itself the operation takes about an hour on average, if there are no additional difficulties during its implementation. And here the process of removing the fetus with a cesarean section takes no more than 10 minutes... The umbilical cord is cut and the baby is handed over for postpartum procedures. The process ends with the extraction of the placenta and suturing of the incision.

After the operation, the woman in labor spends about a day in the intensive care unit, then transferred to the postpartum department. During the day, a number of measures are taken to restore the woman in labor:

• measures to reduce the muscles of the uterus;
• stopping bleeding;
• compensation of fluid in the body;
• anesthesia.

Despite its apparent simplicity, a cesarean section has a number of risks for both the mother and the baby.

The consequences for a woman in labor are divided into two types according to the duration of manifestation:

• Late;
• Postoperative.

Late consequences are expressed:

• The formation of ligature fistulas is an inflammatory process around the seams;
• Hernia of the vertebra;
• Keloid scar is a scar after surgery. Rather, it plays an aesthetic role. The scar is absolutely safe for health.

Postoperative complications include the following factors:

• Pain syndrome after surgery. The process of discharge may be accompanied by headaches, dizziness, severe thirst and general weakness;
• During the operation, the woman in labor loses 4 times more blood than during natural childbirth;
• Adhesions may form in internal organs;
• Upon contact with air, there is a risk of developing endometritis - inflammation of the uterine cavity;
• Hematomas may form on the seams or purulent processes may develop;
• Rarely, but there may be cases of seam divergence;
• Impossibility of caring for a child for several days.

The consequences for the child are also significant.

In the process of natural childbirth, the baby's body must be rebuilt to a new form of life. In this regard, at the beginning of the birth process in his body, the concentration of the hormone catecholamine increases sharply. It is necessary in order to throw fluid out of the lungs and start the baby's respiratory system as soon as he “comes out”. During the operation, the baby's body will not have time to collect the required amount of hormones. The lungs are not ready to breathe, and the heart is under considerable strain. This can cause degenerative phenomena in the heart.

In addition, before the baby enters a period of hibernation, in which all physiological processes slow down. This phenomenon is a preparation for the transition to a new environment. Surgical intervention involves a sharp change in the pressure drop. This grossly disrupts the natural process of preparing the baby for life and is fraught with minor hemorrhages in the brain. These children often have evidence of minimal brain dysfunction.

It has been noticed that children born by caesarean section also have psychological characteristics. This can be expressed in apathy of character, increased dependence on the mother and a pronounced desire to manipulate adults.

Let's summarize:

With an adequate assessment of the risks of surgery, even women in labor with indications may decide to give birth naturally. In this case, the doctor can only warn about the possible development of events. However, the task of medicine is to save the life of the baby and the mother. If natural childbirth is impossible for objective reasons, then one should not persist, thereby endangering two lives.

Pregnancy planning, a healthy lifestyle, and adequate physical activity and a positive attitude towards childbirth help to minimize the risks of complications and possibly help avoid surgery and give new life in a natural way.
Read some feedback from women who have had CS:

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For many decades, this operation - a cesarean section - has been helping to preserve the life and health of a mother and her baby. In the old days, such a surgical intervention was carried out extremely rarely and only if something threatened the life of the mother in order to save the child. However, nowadays, cesarean section is being used more and more often. Therefore, many specialists have already set themselves the task of reducing the percentage of deliveries carried out by surgical intervention.

Who should perform the surgery?

First of all, you need to figure out how a cesarean section is done and what consequences await a young mother. Surgical childbirth itself is fairly safe. However, in some cases, operations are simply impractical. After all, no one is protected from risk. Many expectant mothers ask for a cesarean section only because of fear of severe pain. In this case, modern medicine offers epidural anesthesia, which allows a woman to give birth without pain.

Such childbirth is performed - cesarean section - by a whole team of medical workers, which includes narrow-profile specialists:

• Obstetrician-gynecologist - directly extracts the baby from the uterus.
• Surgeon - makes an incision in the soft tissues and muscles of the abdominal cavity to reach the uterus.
• A pediatric neonatologist is a doctor who accepts and examines a newborn baby. If necessary, a specialist in this profile can provide the child with first aid, as well as prescribe treatment.
• Anesthesiologist - performs pain relief.
• Nurse Anesthetist - Helps administer anesthesia.
• The operating nurse - if necessary, assists the doctors.

The anesthesiologist should talk to the pregnant woman before surgery to clarify which type of pain relief is preferable for her.

Types of cesarean section

Indications for a cesarean section can be completely different, and the operation is performed in different ways in certain cases. Today, there are two types of surgical delivery:

Emergency surgery is performed if any complication occurs during childbirth that requires urgent removal of the baby from the uterus. A planned caesarean section is performed in situations where the doctor is concerned about the progress of labor due to complications during pregnancy. Let's take a closer look at the differences between the two types of operations.

Planned cesarean section

Elective surgery (caesarean section) is performed with epidural anesthesia. Thanks to this method, a young mother has the opportunity to see her newborn baby immediately after the end of the operation. When performing such a surgical intervention, the doctor makes a transverse incision. The child usually does not experience hypoxia.

Emergency caesarean section

As for an emergency caesarean section, general anesthesia is usually used during the operation, since the woman may still have contractions, and they will not allow a puncture to be made for epidural anesthesia. The incision with such an operation is mainly longitudinal. This allows the baby to be removed from the uterus much faster.

It should be noted that during an emergency operation, the child may already experience severe hypoxia. At the end of the cesarean section, the mother cannot immediately see her baby, since the cesarean section is done in this case, as already mentioned, most often under general anesthesia.

Types of incisions for caesarean section

In 90% of cases, a transverse incision is made during the operation. As for the longitudinal, they are currently trying to do it less often, since the walls of the uterus are greatly weakened. In subsequent pregnancies, they may simply overstrain. A transverse incision made in the lower part of the uterus heals much faster, and the stitches do not break.

A longitudinal incision is made along the midline of the abdominal cavity from bottom to top. More precisely, to a level just below the navel from the pubic bone. Making such an incision is much easier and faster. Therefore, it is he who is usually used for emergency caesarean section in order to remove the newborn baby as quickly as possible. The scar from such an incision is much more noticeable. If doctors have the time and opportunity, then during the operation, a transverse incision can be made slightly above the pubic bone. It is practically invisible and heals perfectly.

As for the repeated operation, the suture from the previous one is simply excised.
As a result, only one seam remains visible on the woman's body.

How is the operation going?

If the anesthesiologist performs an epidural, then the site of the operation (incision) is hidden from the woman by a septum. But let's see how a cesarean section is done. The surgeon makes an incision in the wall of the uterus, and then opens the fetal bladder. Then the child is removed. Almost immediately, the newborn begins to cry violently. The pediatrician cuts the umbilical cord, and then carries out all the necessary procedures with the child.

If the young mother is conscious, then the doctor shows her the baby right away and can even give her to hold it. After that, the child is taken to a separate room for further observation. The shortest operation period is incision and extraction of the child. It only takes 10 minutes. These are the main advantages of a cesarean section.

After that, doctors must remove the afterbirth, while processing all the necessary vessels with high quality so that bleeding does not start. The surgeon then sutures the cut tissue. A woman is given a dropper, giving a solution of oxytocin, which speeds up the process of uterine contraction. This phase of the operation is the longest. From the moment the baby is born and until the end of the operation, it takes about 30 minutes. By the time this operation, a cesarean section, takes about 40 minutes.

What happens after childbirth?

After the operation, the newly-made mother is transferred from the operating unit to the intensive care unit or the intensive care unit, since the cesarean section is performed quickly and with anesthesia. The mother should be under the watchful eye of doctors. At the same time, her blood pressure, respiratory rate, and pulse are constantly measured. The doctor must also monitor the rate at which the uterus contracts, how much discharge and what character they have. It is imperative that the urinary system be monitored.

After a caesarean section, mothers are given antibiotics to avoid inflammation, and pain relievers to relieve discomfort.

Of course, the disadvantages of a cesarean section may seem significant to some. However, in some situations, it is precisely such childbirth that allows a healthy and strong baby to be born. It is worth noting that a young mother will be able to get up only after six hours, and walk on the second day.

Consequences of surgery

After the operation, stitches remain on the uterus and abdomen. In some situations, diastasis and suture failure may occur. If such consequences arise, then you should immediately consult a doctor. Comprehensive treatment of the divergence of the edges of the suture located between the rectus muscles includes a set of exercises specially developed by many specialists, which can be performed after a cesarean section.

The consequences of this surgical intervention, of course, are available. The very first thing worth highlighting is an ugly seam. You can fix it by visiting a beautician or surgeon. Usually, procedures such as smoothing, grinding and excision are performed to give the suture an aesthetic appearance. Keloid scars are considered a rather rare phenomenon - reddish growths form above the seam. It is worth noting that the treatment of this kind of scars takes a very long time and has its own characteristics. It should be carried out by a professional in his field.

For a woman, the condition of the suture that is made on the uterus is much more important. After all, it depends on him how the next pregnancy will go and by what method the woman will give birth. The suture on the abdomen can be corrected, but the suture on the uterus cannot be corrected.

Menstruation and sex life

If during the operation there were no complications, then the menstrual cycle begins and passes in the same way as after giving birth in a natural way. If a complication does arise, then the inflammatory one can proceed for several months. In some cases, menstruation may be painful and heavy.

You can start having sex after childbirth with a scalpel after 8 weeks. Of course, if the surgery went without complications. If there were complications, then you can start having sex only after a thorough examination and consultation with a doctor.

It should be borne in mind that after a cesarean section, a woman should use the most reliable contraceptives, since she cannot become pregnant for about two years. It is undesirable to carry out operations on the uterus for two years, as well as abortions, including vacuum ones, since such an intervention makes the walls of the organ weaker. As a result, there is a risk of rupture during subsequent pregnancy.

Lactation after surgery

Many young mothers who have undergone surgery are worried that after a cesarean it is difficult to establish breastfeeding. But this is absolutely not the case.

Milk from a young mother appears at the same time as women after natural childbirth. Of course, breastfeeding after surgery is a little more difficult. This is primarily due to the characteristics of such genera.

Many doctors fear that the baby may receive some of the antibiotic in the mother's milk. Therefore, in the first week, the baby is fed with a mixture from a bottle. As a result, the baby gets used to it and it becomes much more difficult to accustom him to the breast. Although today babies are often applied to the breast immediately after surgery (on the same day).

If you do not have an indication for a caesarean section, then you should not insist on surgery. After all, any surgical intervention has its consequences, and it is not for nothing that nature came up with a different way for the birth of a child.

Around the world, there is a clear trend towards gentle delivery, which preserves the health of both mother and baby. The tool to help achieve this is the caesarean section (CS). A significant achievement was the widespread use of modern methods of 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 antibiotic therapy significantly reduces the likelihood of their occurrence. Nevertheless, there is still debate about when a cesarean section is performed, and when a physiological delivery is permissible.

When operative delivery is indicated

Caesarean section is a major surgery that increases the risk of complications compared to a normal natural birth. It is carried out only on strict indications. At the request of the patient, CS can be performed in a private clinic, but not all obstetricians-gynecologists will undertake such an operation unnecessarily.

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 pharynx, preventing the baby from being born. Incomplete presentation is an indication for surgery when bleeding occurs. The placenta is abundantly vascularized, and even a slight damage to it can cause blood loss, lack of oxygen and fetal death.

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

3. Previously postponed surgical interventions on the uterus, namely:

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

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

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

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

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

Subsequent pregnancy

Natural childbirth after a cesarean section is allowed if the formed connective tissue on the uterus is wealthy, that is, strong, even, capable of withstanding muscle tension during childbirth. This issue should be discussed with the supervising doctor during the next pregnancy.

The likelihood of subsequent births is normally increased in the following cases:

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

On the other hand, if the patient is more than 35 years old at the time of the subsequent birth, she is overweight, concomitant diseases, inappropriate sizes of the fetus and pelvis, it is likely that she will undergo surgery again.

How many times can you have a cesarean section?

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

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

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

How long does it take to give birth after surgery?

It depends on the consistency of the scar, the woman's age, concomitant diseases. Abortion after CS has a negative impact on reproductive health. Therefore, if a woman nevertheless became pregnant almost immediately after the CS, then with the normal course of pregnancy and constant medical supervision, she can carry the child, but the delivery will most likely be prompt.

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

What is important to know about a second cesarean 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 from CS may also be slower because scar tissue and adhesions in the abdomen prevent the uterus from contracting well. However, with a positive attitude of the woman and her family, the help of relatives, these temporary difficulties are quite surmountable.

Caesarean section is a common method of delivery these days. Modern doctors have an impressive experience in carrying out this operation, and maternity hospitals and clinics are equipped with high-quality equipment. Childbirth by caesarean section is easier and faster than 10-20 years ago. But this does not mean that operative childbirth is preferable to natural childbirth. In addition, the caesarean section has its pros and cons.

Up to 25% of babies are born by caesarean section. However, according to the World Health Organization, the optimal proportion is 10-15%. Surgical childbirth should only be performed as a last resort if the mother is unable to deliver the baby naturally for health reasons.

A cesarean section is a surgical procedure in which a baby is delivered through an incision in the mother's abdomen. In recent years, there has been an increasing number of women who are unable to give birth naturally for health reasons, age or because of an incorrect fetus. In such situations, traditional childbirth is considered risky, as it can cause irreparable harm to the health of the mother and child. Therefore, doctors insist on performing a caesarean section.

At first glance, operative childbirth looks like a safe and easy way to give birth to a child, since a woman does not have to go through painful contractions and attempts, and a baby does not have to go through the birth canal.

Compared to other abdominal surgeries, caesarean section is a completely safe procedure. The operation is fast and predictable if planned. In addition, during the surgical intervention, the woman is under the influence of anesthesia, so she does not feel pain.

All this makes a caesarean section quite an attractive way out for many women in labor who are afraid of pain, a hard period and other unpleasant moments of natural childbirth.

But with a more detailed study, it is possible to consider many serious shortcomings in operative childbirth, due to which it is desirable to limit the number of operations performed to a minimum, leaving only situations when childbirth in a natural way is unsafe or impossible.

Caesarean section increases the likelihood of problems with anesthesia, bleeding, and infections. In addition, the woman is hospitalized for a longer period. Due to the long rehabilitation after surgery, the appointment of antibiotics and analgesics, lactation and subsequent breastfeeding of the child often suffer. In addition, a young mother will not be able to immediately start caring for a baby who needs it so badly.

Thus, there are many pros and cons to caesarean section, which must be carefully weighed before the operation.

How is a cesarean section performed?

During the operation, the doctor makes two surgical incisions - the abdominal wall and the uterus. The incisions can be either vertical or horizontal, at the discretion of the physician. After that, the fetal bladder is opened and the child is removed. The doctor manipulates the umbilical cord and afterbirth, removing it from the uterine cavity.

The uterus is then sutured with a special absorbable suture material. Sutures or staples are also applied to the skin, which will be removed on the 7th day. The surgical wound is closed with a sterile dressing. In general, the operation lasts about 40 minutes, it can be planned and emergency.

A planned cesarean section is assigned to a woman during pregnancy, while the patient will know the date of hospitalization for childbirth. Indications for elective caesarean section can be women, and much more.

With a planned operation, a woman is hospitalized before the expected date of birth, less often when contractions occur. If there are indications, hospitalization is carried out from the 37th week of pregnancy, when there is a need to additionally examine the woman in labor and check the child's condition again.

During a planned cesarean section, epidural anesthesia is usually performed, that is, the woman is fully conscious during the operation and sees her baby immediately after removing it from the uterine cavity. In this case, the doctor makes a transverse incision, the so-called cosmetic method.

The decision about emergency surgery is usually made by the doctor already at the beginning of labor, if there is a real threat to the life of the mother and child. An emergency caesarean section is performed if the woman in labor is noted, the fetus suffers from, cannot pass through the birth canal, bleeding and premature discharge of the placenta have begun, or the umbilical cord loops have fallen out of the uterus along with the outflow of amniotic fluid.

That is, a cesarean section is performed urgently against the background of unexpected complications during natural childbirth. In this case, the woman in labor is usually given general anesthesia, and the incision is made vertically, due to which the newborn is removed faster and suffers less from hypoxia.

Arguments for"

1. Minimizing the likelihood of complications. If a woman in the past had a bad experience of natural childbirth, if her pregnancy was due to, if she or her spouse has been treated for infertility for a long time, then the risk of complications during childbirth is considered to be increased. Surgical delivery makes it possible to minimize the likelihood of complications for the mother and child. In this case, the date of the operation is set in advance, the woman goes to the hospital, and undergoes an additional prenatal examination. Complications can also occur in primiparous women over 30 years old, if the weight of the fetus is more than 4 kg or it is located incorrectly.
2. Adequate oxygen supply at birth. If the pregnancy proceeds with serious complications, then the fetus may suffer from hypoxia for some time. In order not to aggravate this condition and prevent the development of asphyxia during natural childbirth, doctors recommend a cesarean section.
3. The pelvic floor muscles will remain in the same condition as before pregnancy. Stretching the vaginal muscles is a serious minus of natural childbirth, which in the future will somehow affect women's health. Muscles stretch and weaken in all women who have given birth naturally. Some of them, with the help of special training, return their former elasticity, but in most, stretched pelvic floor muscles lead to urinary incontinence and dissatisfaction in intimate life.
4. The date of birth of the child is known in advance. This information is relevant for women who have not given birth for the first time. In this case, it becomes possible to discuss in advance the care of older children with grandmothers or a nanny, to solve other problems. Natural childbirth always begins suddenly.
5. Painlessness. Birth pain is something that all women, without exception, are afraid of. Natural childbirth is painless. During a cesarean section, a woman is given pain relief, which will save the woman from pain during the operation.

Arguments against"

1. Caesarean section is an abdominal operation. Surgical childbirth is actually a real surgical intervention, which is dangerous for every person with its risks. As a result of a cesarean section, a woman's body is exposed to real stress, especially if the operation is performed against the background of general anesthesia. Like any other operation, a cesarean section can result in such surgical complications as thrombosis, tissue inflammation, fistulas, adhesions, an unattractive postoperative scar, and much more.
2. Long postoperative period. After the operation, a woman needs a lot of strength to recover. As long as there is pain in the suture area, it is difficult for a woman to pay due attention to the newborn, she needs help. If a woman is given antibiotic therapy, then she cannot breastfeed, which can negatively affect the development of lactation.
3. Too quick birth. The child's transition from one environment to another is too abrupt. This causes a drop in pressure or the so-called atmospheric shock, which has a negative effect on the breathing of the newborn, and can cause microbleeding in the brain.

Caesarean section has its pluses and minuses, but at the same time, the preponderance towards minuses is greater. If a woman wants to have more children in the future, take care of them from the first days of birth and practice breastfeeding - you need to inform the doctor about this. In such a situation, in the absence of absolute medical indications, natural childbirth can be tried.