Almost every family is looking forward to the birth of their own baby. A little more, and there will be an exciting meeting with a new person. Many women want to have a baby in a natural way, but this is not always possible according to indications. Caesarean section is another option for an early meeting with the baby. Surgery has its pros and cons, but usually it all ends well.
What is cesarean section?
Patrimonial activity in women takes place individually. Some give birth naturally, while others need surgery. Caesarean section is a surgical procedure in which a child is removed from the abdominal cavity. This operation is very common in the modern world, about 40% of babies are born thanks to it.
Doctors and obstetricians while studying in medical institutions study in detail photos of Caesarean section. This allows them to better prepare for future operations. Practical skills are very important in the work of a doctor. Photos of Caesarean sections in medical schools are necessarily discussed at lectures. Since the beginning of the use of this procedure during childbirth, the mortality of mothers and infants has decreased markedly.
Sometimes a cesarean section is the only way to save both a woman and her child. But, like any surgical intervention, this procedure has both advantages and disadvantages. Before the Caesarean section begins, the anesthetist selects the optimal method of pain relief. Each type of anesthesia has both pros and cons, so it is important for a doctor to assess all the risks for a woman in labor. After the introduction of anesthesia, the expectant mother falls asleep.
Caesarean section is abdominal surgery. The surgeon first cuts the skin, body fat and associated tissues. After the doctor dissects the uterus. The cut can be either vertical or horizontal, sometimes they can alternate. From a cosmetic point of view, a small transverse seam is considered optimal. The doctor sucks the fetal water with special equipment and takes out a child, which he then passes to a nurse.
If anesthesia is used, in which the woman is conscious, then the baby is applied to her breast. After the child is wiped and weighed. Medical staff must evaluate the newborn on the Apgar scale. The woman in labor at this moment is sutured. The whole operation, if it goes without complications, takes from 30 to 45 minutes.
Who should not have a cesarean section?
Any operation can be dangerous for the life and health of the patient. Caesarean section is a procedure that cannot have absolute contraindications. Very often, there is a rather serious reason for the operation, for example, saving the life of a mother or child. If the health of the woman in labor is at risk, then doctors most often perform surgical intervention.
Can a cesarean section be done with deep prematurity of the fetus? No, since it is a relative contraindication. In this case, doctors do their best to avoid premature birth and maintain pregnancy. If the fetus is not sufficiently developed for life outside the uterus, then it is very rarely possible to save it.
Is it possible to have a cesarean section if the woman in labor has infectious inflammatory diseases of the gynecological profile? Undesirable, it threatens purulent-septic complications. But if a woman has absolute indications for cesarean section, then it is carried out. About 20-30 years ago, during such an operation, the uterus was immediately excised from the woman in labor, which made it impossible for her to subsequently become pregnant again. Currently, all the efforts of doctors are aimed at preserving the organ. This is done with the help of an operation called extra-peritoneal caesarean section, with which temporary isolation of the abdominal cavity occurs.
Another relative contraindication is fetal death. To maintain the health of the mother in this case, it is better to have a natural birth. Prolonged severe hypoxia is also a contraindication for caesarean section. Do not carry it out and with very complicated natural childbirth. For example, if obstetric forceps were placed and a cervical notch was performed, after which a balloon was inserted into it to enhance contractions.
Indications for surgery
Sometimes a woman has no choice, in this case she has to give birth only with Caesarean section. In some situations, surgery can be avoided. Indications for cesarean section in the hospital can be both absolute and relative. In the second case, doctors will reflect on the need for surgery.
Can a caesarean section be replaced by natural childbirth? In some cases this is allowed. But the decision can only be made by doctors, they will take into account the risk to the health of both the mother and the child. Relative indications for caesarean section are non-gynecological diseases of women. For example, with heart ailments, natural birth can be dangerous. In the process, the body of the expectant mother experiences tremendous overloads, which can cause various attacks, raising or falling pressure.
Doctors often recommend a cesarean section for women with diseases of the vessels, kidneys, and nervous system. Natural births are undesirable for expectant mothers with myopia, as they can cause even more visual impairment. For women with diabetes, doctors recommend a cesarean section. Cancer of any kind is a relative contraindication to both natural birth and pregnancy in general.
Very often, caesarean section is recommended for primiparous women over the age of 30 years, as they often have complications. Undesirable natural births in the presence of such a dangerous disease as gestosis of pregnant women. The surgical procedure is most often performed by ladies who already have a scar on the uterus from previous operations. Relative indications for caesarean section include the clinically narrow pelvis and the weakness of labor, which is not corrected by drugs.
Absolute indications for surgery
Sometimes, even before the start of the process, it is clear that a woman will not be able to give birth naturally. In this case, the indications for caesarean section are absolute. In some situations, a woman cannot give birth on her own, as this threatens the life of the future mother and fetus. Then the doctor decides on the optimal way out of the situation, which is the cesarean section and is in this situation.
An absolutely narrow pelvis is one of the indications for surgery. In this case, the child cannot physically pass through the birth canal. There are several degrees of narrowing of the pelvic bones, for example, with the 3-4th type, relief from the burden is possible only by caesarean section through the abdominal cavity. Also, much here depends on the size and weight of the child. With narrowing of the pelvic bones of the 1st-2nd degree, natural childbirth is possible, but sometimes in their process the doctor may decide to have an emergency cesarean section.
Women who have ever undergone any surgery on the uterus should understand that there is a chance of a rupture in childbirth. If the seams are inconsistent or not much time has passed since the intervention, then the doctors direct the expectant mother to a cesarean section. The scar is examined both before childbirth and during them, as the situation may change. If a woman has already undergone 2-3 caesarean sections, then this indication is considered absolute.
Surgery is recommended in the presence of mechanical obstruction to natural childbirth. Absolute indications include ovarian tumors, some types of uterine fibroids, and deformation of the pelvic bones. Sometimes the access to the birth canal may be blocked by an incorrectly attached placenta. Caesarean section is performed with the transverse position of the fetus or with the loss of the umbilical cord due to polyhydramnios. If before the onset or during the birth process, placental abruption occurs, then the woman is operated on. If this is not done, the expectant mother may bleed.
What are the indications of an emergency operation?
Caesarean section is most often performed as planned. If a woman has absolute indications, then on the appointed day she comes to the hospital, where she undergoes surgery. If the contractions begin prematurely, then the procedure is carried out in an emergency. If the pregnancy is successful, then the doctor prescribes a caesarean section and is done on time.
One of the indications for emergency intervention is a weak labor activity or its absence. If the drugs that the doctors gave the patient did not have the necessary effect, then there is only one way out. A woman in this situation is shown an emergency cesarean section. The patient’s uterus is cut and a baby is taken out, this saves his life. With a long anhydrous period in childbirth, the baby often experiences hypoxia, the count in this case is minutes.
Another indication for emergency caesarean section is the sudden onset of heavy bleeding. Every minute is also important here, and the birth process can prevent doctors from providing the patient with all the help needed in this case. Doctors remove the baby from the uterus and transport the woman to the intensive care unit after cesarean section. How long will she stay there? This is a very individual parameter.
If the woman in labor is the second cesarean section, then in the process of childbirth, a scar may begin to diverge. Of course, before the start of contractions, doctors repeatedly check the consistency of the seam, but sometimes everything happens unexpectedly. During childbirth, all the organs of a woman experience overload, but especially the uterus. If the scar dissolves, then the expectant mother may die. In this case, doctors perform an emergency cesarean section.
The number of operations that can be done to a woman in her whole life
Many girls dream of a large family where children's laughter will constantly sound. But some of them think that this is not possible after cesarean section. How many operations can a woman do without much harm to her health? Doctors differ here.
A woman should understand that the second cesarean section and subsequent ones are most often more dangerous than the first because of a scar on the uterus. After the operation, its walls are damaged. Scar tissue has low elasticity, so it cannot fully stretch during subsequent pregnancies. It is especially dangerous if the break between them was short. The scar should completely heal after cesarean section through the abdominal cavity. How long should I wait before planning a new pregnancy? Doctors say at least 3 years.
Anesthesia also does not go without consequences, this also limits the number of operations. Russian doctors talk about 3, maximum 5 caesarean sections, depending on the health status of the woman. It should be borne in mind that with age, the uterus muscles weaken, it scarring worse and longer recovery. With each subsequent operation, the risk of fistula and immune malfunction increases.
Some doctors believe that caesarean sections can be done as much as a woman needs. Some of their foreign colleagues are of the same opinion. But here a lot depends on how past surgical interventions were performed. Modern experience allows us to make more Caesarean sections for a woman with less harm to her health than 10-20 years ago.
What anesthesia is better to use?
Any abdominal surgery is performed under general anesthesia. If it is not done, then the patient will simply die from pain shock. With caesarean section, either general anesthesia or one of two types of anesthesia is used: spinal or epidural. The anesthesiologist chooses the method of anesthesia, it depends on the state of health of the woman. Sometimes doctors combine anesthesia with each other, that is, they do spinal-epidural analgesia.
General anesthesia is now used less frequently than several years ago. This is due to the fact that after it there are more complications than, for example, from spinal anesthesia. It is more difficult for doctors to intubate during anesthesia. The risks from its use during pregnancy increase many times. During general anesthesia, gastric contents may end up in the airways, sometimes leading to severe pneumonia. At the time of the operation, the harmful effect extends to both the expectant mother and the child. After cesarean section, the infant may experience breathing problems. That is why obstetrician-gynecologists are now trying not to use general anesthesia.
But sometimes its use is necessary according to indications. General anesthesia is always used if there is a prolapse of the umbilical cord or the fetus lies across. In some patients, the use of spinal or epidural anesthesia is not possible due to the presence of contraindications to them. An emergency cesarean section is also often performed under general anesthesia, since in this situation the count may go on for minutes. Epidural or spinal anesthesia is not indicated if there is heavy bleeding in the woman in labor.
Pros for Mom
The most important advantage of Caesarean section is that it saves the life of a woman in labor and her baby. Not always a child can be born naturally, in this case, doctors come to the rescue. No cesarean section pain will overshadow the joy of meeting the mother and baby.
Also, the operation is much faster than natural childbirth. How much cesarean section takes time? A little over half an hour. The operation helps not to experience prolonged pain. This is another plus caesarean section. The procedure does not affect the genitals, and they remain in the same state. This has a positive effect on the intimate life of a woman, because she will have no seams or tears there.
Natural birth in some cases leads to hemorrhoids and prolapse of the pelvic organs. With a caesarean section, the patient may not worry about these troubles. Cervical ruptures are also excluded, which are occasionally, but still occur in natural childbirth. Some women may develop incontinence due to prolapse of the pelvic organs, and the bladder in particular.
Another of the positive aspects of Caesarean section is the absence of painful fights and attempts. Yes, after the operation, the woman experiences pain, but it is incomparable with many hours of exhausting muscle contractions, which are necessary for the natural expulsion of the fetus. Some women in labor agree with a doctor for a cesarean section for money, as they are very afraid of discomfort.
Cons for mom
In addition to the indisputable advantages, caesarean section has its drawbacks. If, after a natural birth, which went well, the woman soon forgets about the pain she has experienced, then after the operation, the scar will remain forever. The scar will be less noticeable over time, but it will not disappear completely. If the doctor made a cosmetic suture, then it is usually thin and light. Sometimes, due to a scar after a cesarean section, a woman begins to feel ugly and inferior. Some mothers even stop visiting beaches and going on vacation.
After a natural birth, a woman who has gone through pain and torment for the sake of her baby immediately falls in love with him. After a cesarean section, mommy may feel strange psychologically. The story of the birth of the baby seems to her unsaid. Sometimes women do not perceive a newborn at all as their own child. Or the mother is seized with a sense of guilt before the baby, it may seem to her that she did not try hard enough for him to be born.
After cesarean section, the discharge in duration is the same as after natural birth. For a long time, any load will be forbidden to a woman, it will be more difficult for her to take care of the baby. After a cesarean section, the stomach takes a very long time to form, it will be difficult to return it to the antenatal view. Hard training is needed, but they are contraindicated during this period. A young mother is better to listen to the recommendations of doctors. At least a month after a cesarean section, a woman will not be allowed to lift anything heavier than her child.
Pros for a child
The main advantage of the operation for the baby is his birth. Sometimes a cesarean section is the only way for a woman to give birth. Therefore, without surgical intervention, the baby would simply die. Even if a baby is born prematurely, then a month after a cesarean section, he almost catches up with his peers.
Children born by Caesarean section may experience fear. Mom needs to help her baby.It is often necessary to lay the baby on his stomach, letting him know that he is safe. Another plus is the exclusion of birth injuries after cesarean section. What other benefits does it give? The baby has a reduced risk of infection. This is especially important if the mother suffers from any contagious disease, such as human immunodeficiency virus.
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With a cesarean section, the baby is born too quickly. During natural childbirth, the child walking along the paths gradually adapts to new conditions for him. There are changes in his circulatory and respiratory systems. If in the womb the child accidentally swallowed fetal water, which is quite common, then during the passage of the birth canal they are eliminated. With a caesarean section, this does not happen, which is fraught with the development of inflammation. Due to wet lungs, babies may even have difficulty with the first breath.
With caesarean section, anesthesia affects not only the mother’s body, the child also gets part of the medicine. This can negatively affect it later, since anesthesia can hardly be called useful. Children after cesarean section almost always gain fewer points on the Apgar scale than children born naturally.
In the first months of life, these newborns are more susceptible to disease. They may be less active than babies born naturally. Babies born by Caesarean section, at the beginning of their lives, usually have lower immunity, but here everything is in the hands of the mother. If a woman organizes perfect care for her child, then he will soon catch up with her peers.
Possible complications
Caesarean section is an abdominal operation, which in some cases can be dangerous. One of the most common complications is large blood loss. This can threaten both the life of the woman in labor and her child. With a caesarean section, a woman loses an average of 3-4 times more blood than with a natural process. Sometimes a woman in labor needs a transfusion, which also carries risks.
After cesarean section, many women have another complication - adhesions. So called films that are formed inside the pelvis. A large number of them interfere with the normal functioning of internal organs. In addition, adhesive processes in the pelvis can cause infertility. If the bowel function is disrupted, then the woman is waiting for constant constipation and even obstruction. In severe cases, doctors perform laparoscopy to get rid of adhesions. But this is an operation that carries health risks. In addition, laparoscopy is not a panacea for adhesions, after it they most often reappear.
Endometritis often occurs after cesarean section, since pathogenic microorganisms enter the uterine cavity. Ailment for some time can be asymptomatic. Then the woman periodically begins to experience pain in the lower abdomen. She may be in a fever; she experiences weakness and chills. The woman's heart rate quickens, tachycardia occurs. Uncharacteristic discharge from the genital tract may appear, sometimes they contain impurities of pus. Doctors recommend visiting their gynecologist no later than a week after discharge from the hospital.
Complications after cesarean section may be associated with scar. If the blood vessels are not sufficiently sutured, hematomas often form. They also occur with inaccurate scar treatment. Sutures can become inflamed, it is easy to understand on the swollen and reddened skin. If the process managed to go far, then purulent outflows appear. In difficult cases, a woman may experience fever due to inflammation. In some cases, there is a fever and even delirium. For treatment, the doctor prescribes a course of antibiotics to the patient. If a woman does not pay attention to the seam, then this can lead to reoperation.
The scar sometimes diverges, and this does not always happen in the first couple of days after the operation. The patient must comply with all the doctor's instructions and not lift weights. In some cases, over time, ligature fistulas form near the suture. They arise due to allergies to the threads inside the abdominal cavity. Also, ligature fistulas are formed when an infection enters the wound. This complication does not occur immediately, it can appear several years after cesarean section.
If a longitudinal suture was used during surgery, a hernia may form. This complication is quite rare and mainly in those who do not comply with the recommended periods between caesarean sections. For example, in a woman who becomes pregnant and gives birth every year for several years, the chance of getting a postpartum hernia increases markedly.
The cause of complications with cesarean section is often anesthesia. During insertion of the tracheal tube, the throat is sometimes scratched. A woman may experience complications from the heart, sometimes there is a violation of the functions of blood vessels. Severe consequences are caused by the penetration of the contents of the stomach into the respiratory system. A woman for a long time may be chased by sore throat and back. Complications are possible in the form of ruptured veins, puncture of the spinal cord during epidural anesthesia.
After delivery, the woman’s uterus contracts naturally. With gross intervention in the natural process, complications can begin. Sometimes uterine atony occurs, that is, it becomes incapable of contracting. This can cause prolonged and heavy bleeding. Fortunately, such a complication is quite rare today.
Expert opinion
Doctors use a cesarean section at a time when there is simply no other way out to resolve the burden. After the operation, the main task of the woman is to recover as quickly as possible. This is necessary for herself and her child.
After arriving from the hospital, a woman should explain to her family that in a few weeks she will need their help. At first, when doing household chores, a young mother should not bend over. It will be good if the father takes over the bulk of the bathing and dressing of the baby.
Mom needs to try to arrange breastfeeding, unless the doctor has recommended otherwise. Because of the prescribed drugs in the hospital, they are often forced to give babies a mixture. You can use the services of specialists in breastfeeding, which are at most women's clinics, they will help restore lactation.