How many weeks of pregnancy is a caesarean section performed? Planned caesarean section: indications and preparation

I knew from childhood that I would have a caesarean section. No ophthalmologist would allow me to give birth myself.

When they ask me how it all went, I answer that I’m ready to go through it every day. And it is true!

No, I'm not a masochist at all. It’s just that the very fact of the birth of a long-awaited son overshadowed all the difficulties that I had to go through. And this operation is not as scary as they say it is.

I hope my positive experience of going through a cesarean section will dispel your fears and help you know what you are going through and what to be prepared for.

The most important

The main thing is your adequate attitude towards a caesarean section: if it is not possible to give birth yourself, a caesarean section is an excellent alternative.

I am not tormented by a feeling of guilt or shame that I could not give birth myself. Don't scare possible consequences– I have a separate one about this. Thanks to the right attitude, I avoided postpartum depression, lactation problems and other horror stories that are written about on the Internet.

Positive attitude towards caesarean section will help you avoid many of the problems that young mothers often face when undergoing this operation, especially an emergency one.

When to have a planned caesarean section

Ideally, as close to the expected due date as possible.. In practice, doctors often rush to admit a pregnant woman to the hospital - just in case.

The doctor also sent me to the maternity hospital 2 weeks before giving birth. Fortunately, in the emergency department they returned home to carry the pregnancy to term. As a result, I went to bed 5 days before the operation. And it's still early!

The operation was performed 1–3 days before the expected date of birth. But according to my feelings, it should have been done a week later (at 41 weeks). It’s not without reason that birth usually occurs at 38–42 weeks, when the baby is ready to be born.

Preparing for a caesarean section

Blood and urine tests are taken in advance. There is a conversation with the anesthesiologist. In my case, it’s also a trip to the ophthalmologist. For elective surgery, epidural or spinal anesthesia is used. General anesthesia is used less and less - in special cases or during an emergency caesarean section.

The night before, the nurse gave instructions on how to prepare for the operation and what to bring.

From 18:00 you cannot eat or drink anything. At night - a valerian tablet. At 5 am – cleansing enema, shower, hair removal. Then she bandaged her legs with elastic bandages.

Packed my bag for surgery:

• rubber slippers,
• mug,
• a bottle of water,
• telephone (it was later taken away because it was not allowed).

Personal belongings and things for the newborn, clothes, watches, rings and even earrings - all this is given to the nurse for safekeeping (they are then brought to the postpartum ward).

And finally, they came for me. In the treatment room I undress and lie down on the gurney. IN urethra a catheter is inserted. I was afraid of this moment, but it didn’t really hurt, just unpleasant.

They take you on a gurney to the elevator. Let's get up. Winding empty corridors and here it is - the operating room, the place where my son will be born.

How is a caesarean section performed?

I had spinal anesthesia. It worked quickly. A screen was placed in front of the stomach. When the doctor made the incision, it felt like they were making a pencil, no pain.

After 5 minutes they began to take out the child. I expected it to happen quickly and easily, like in the videos I once watched. But no. The doctor and nurse (or midwife) made great efforts, I saw how difficult it was for them.

And then I started to feel pain. She told me about it, but the doctors reacted calmly. I realized that since they had such a reaction, then everything was fine. All that remained was to wait until they finally got their son. The main thing is that everything is fine with him! I don’t know how long it lasted, it seemed too long to me.

And then my baby screamed. The neonatologist took it to her table. I turned my head, trying to see what she was doing to him. She lay there looking at her son. The pain has disappeared. Instead, a feeling of euphoria came. I became a mother!

It seems to me that the maternal instinct woke up in me at the moment when I saw two stripes on the test. Every day and every month he gets stronger. And here, in the operating room, it reached its climax.

For doctors, this is ordinary everyday life. For mom - one of the most important events in life. Thanks to the neonatologist who, even without asking, brought my son to me for a kiss. For her it’s a small thing, for me it’s a moment that will forever remain in my memory. The son looks like a little gnome with a wrinkled nose. Our first kiss. And so they take him away. All I have to do is wait—there’s still a whole day until our next meeting.

For the remaining time, the anesthesiologist entertained the doctors by reading bad reviews from the Internet about our maternity hospital. The whole operation lasted about 40 minutes.

What happens after the operation?

After the operation you need to stay in the ward for another day intensive care. I have the most unpleasant memories of this place.

There are five of us in the ward. Everyone has just been cut through. The nurse may not bad person, but no one felt any special kindness from her. When the anesthesia began to wear off, drips with oxytocin to contract the uterus only increased the pain.

But the pain is nothing compared to the feeling of helplessness when you are forced to ask permission even to go to the toilet. In addition, you were not allowed to talk to your bedmates. Just sleep, drink and turn from side to side. It was not even allowed to walk around the ward, although it is known that the sooner a woman gets up and starts moving, the better. True, no one wanted to go.

All this time my thoughts were only about my son. I dreamed that the next day would come soon and we would see each other again. Fortunately, At night they put a drip with a strong soporific painkiller. And there is morning and a long-awaited meeting.

As you can see, the operation itself, despite some pain, left only pleasant memories. Subsequent rehabilitation is a small matter. The most important thing awaited me ahead - in

C-section is an operation in which a child is born not through the natural birth canal, but through an incision in the anterior abdominal wall.

Almost every 3 women have to face it. Knowing the indications for surgery will not be superfluous, but even useful. This will allow you to thoroughly prepare and tune in mentally.

As your baby's cherished birthday approaches, expectant mothers start thinking about childbirth. It will not be superfluous to know in what cases a caesarean section is performed.

Reasons for surgery may be:

• relative, when refusal of surgery borders on a high risk of harm to the health of the mother and child.
• absolute. There aren't that many of them. These are cases where vaginal delivery is not possible or can lead to the death of mother and child.

Recently, more and more often, the operation is performed due to a combination of several factors. When each of them in itself is not a reason to undergo surgery.

But a combination of 2 or more causes an operation. For example: a primigravida woman over 30 years old and a large fetus weighing more than 4 kg. Neither a large fetus nor age alone is the reason for the operation. But together this is already an argument.

There are planned and unplanned cesarean or emergency. With a planned operation, indications for it arise in advance, even during pregnancy. For example, myopia high degree. The woman and the doctor have time to prepare. Complications in such cases are rare.

Emergency surgery can be performed at any time and even during natural birth. For example, with fetal hypoxia, placental abruption.

In what cases is caesarean section performed?

• Placental abruption. At this point bleeding begins. Blood does not always come out. It can accumulate between the uterus and placenta. The placenta peels off even more. The child suffers due to hypoxia - oxygen starvation. Woman due to blood loss. It is necessary to urgently remove the child and stop the bleeding.
• Placenta previa. The placenta blocks the entrance to the uterus. Therefore, natural childbirth is not possible. When contractions begin, the cervix opens, the placenta in this place peels off and bleeding begins. Therefore, they try to operate on such women on the appointed day before the onset of labor.
• Loss of umbilical cord loops. Sometimes the umbilical cord loops fall out of the uterus during childbirth before it is completely open. They find themselves sandwiched between the pelvic bones and the head or buttocks of the fetus. Oxygen stops flowing to the child, he may die. It is necessary to complete the birth within a few minutes.
• Discrepancy between the pelvic sizes of mother and child. If the baby is too large, then he will not be able to be born on his own. As they say, it won’t get through. There will be a caesarean section here the best way help the woman without harming the child. Sometimes this circumstance can only be clarified during childbirth. Women begin to give birth on their own, but when signs of size discrepancy appear, they undergo a caesarean section.
• Transverse position of the fetus. child in normal birth must lie upside down. If it lies across the uterus. Such births are not possible. After the outpouring amniotic fluid there is a risk of prolapse of the fetal arm, leg or umbilical cord. This is dangerous for his life. In such situations, they try to plan the operation before the onset of labor.
• Eclampsia and preeclampsia. This condition is severe complication pregnancy. IN difficult cases the functioning of internal organs is disrupted, arterial pressure to critical numbers. The risk of hemorrhage in internal organs increases: the retina, brain, liver, adrenal glands, etc. To help the woman, it is necessary to perform an emergency cesarean delivery.
• After operations on the cervix. Why? Because natural childbirth will damage the cervix.
• Obstacles that prevent childbirth through the natural birth canal. Tumors of the uterus, bladder, pelvic bones. Significant narrowing of the pelvis, as well as its deformation.
• Fistulas between the vagina and rectum or bladder. As well as rectal ruptures in previous births.
• Chronic diseases of women. These are diseases of the eyes, heart, nervous system, endocrine system, joints and bones, as well as chronic infectious diseases hepatitis C and B, HIV infection. The decision in this case is made by doctors of other specialties: ophthalmologists, surgeons, infectious disease specialists. The approach here is planned. The woman knows in advance about the upcoming operation and prepares for it.
• Breech presentation of the fetus. Natural childbirth is possible. But since there is a risk of injury to the child and mother, they often resort to caesarean section.
• Extension insertions of the head. During childbirth, the head should bend as much as possible. To get through narrow pelvis mother. But there are times when something prevents her from doing this. The head extends. In such cases, its size turns out to be too large.
• Scar on the uterus. It can remain both after a cesarean section and after operations on the uterus to remove myomatous nodes and others. Natural childbirth is possible with one scar on the uterus. 2 or more scars are an indication for cesarean section. Natural birth after cesarean is possible only if the scar is strong according to ultrasound. But the woman doesn't have nagging pain lower abdomen and bloody discharge.
• Fetal hypoxia or oxygen starvation. The child receives insufficient nutrition and oxygen. This condition can occur acutely, for example with placental abruption or umbilical cord prolapse. Or develop gradually. Umbilical cord entanglement around the neck, cysts and placental infarctions. Membranous attachment of the placenta. Sometimes a child, due to chronic hypoxia, is stunted and is born low birth weight.
• If indications for childbirth occur between 28 and 34 weeks, a cesarean section should be performed. Since childbirth for a premature baby can be fatal.
• Identical twins, as well as triplets.
• fraternal twins, if the first child is in a breech position or lies transversely in the uterus.
• Weakness of generic forces. When the cervix refuses to open during labor, despite treatment.
• Pregnancy after IVF, and long-term treatment infertility in combination with other factors.
• The woman's age is over 30 years old in combination with other factors.
• Post-term pregnancy in combination with other reasons.

Important! Caesarean section is not performed at the request of the woman. Since this is a very serious intervention with many complications.

However, there are no contraindications to this operation if refusing it would have negative consequences for the woman. But it is undesirable to perform it if there is an infection of any localization in the body, or if the child has died.

When a cesarean section is prescribed, the doctor decides. The task of the expectant mother is to trust the doctor and tune in to a successful outcome of the birth.

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Recently, many expectant mothers often prefer a cesarean section, as it is less painful than natural childbirth. Caesarean section should be planned in advance to avoid possible problems.

What it is

A caesarean section is a full-fledged surgical operation. Doctors make an incision in the abdomen and remove the baby from the woman's uterus. Now this operation is quite common. Of approximately 8 pregnant women, one has a caesarean section. Caesarean section can be planned or emergency.

How many weeks is a planned caesarean section performed?

A planned caesarean section is usually performed at 40 weeks of pregnancy, with second and third caesarean sections performed at 38 weeks earlier. This is the optimal time. The fetus is considered full-term and ready for independent respiration.

Caesarean section pros and cons

Pros of the section:

• The birth of a baby even in cases where the birth process could have ended in the death of both mother and baby.
• The woman's genitals remain unchanged. There are no ruptures, which means no stitches were required. What is the result? Elimination of a number of difficulties with intimate life, cervical rupture, complications of hemorrhoids and bladder prolapse. All organs genitourinary system will remain unharmed.
• Speed. The operation takes less time. Compared to normal birth process. They try to schedule planned surgical intervention at a time that is maximally oriented towards possible date childbirth The spontaneous onset of labor is not taken into account.

Let's discuss the disadvantages of such births. This:

• The most important critical factor is the spiritual mood of the expectant mother. After the baby is born, it often occurs postpartum depression. It disappears with frequent communication between the mother and her baby. After a caesarean section, some patients are haunted by a feeling of incompleteness of what happened. Many people don’t even feel a close connection with their baby at first.
• Narrow frames physical activity. In some cases, women have a very difficult time. Since it is necessary to care for the baby and pay attention to treatment postoperative wound. Recovering from a cesarean section is very difficult. Moreover, in order for everything to go smoothly, many restrictions are imposed on the woman.
• You cannot lift a baby, especially a large one, for a certain amount of time. Therefore, help is needed in the first weeks. Lifting heavy objects and making sudden movements is prohibited. You need to forget about close relationships for now. For some time, you will suffer from postoperative pain and a feeling of tense sutures.
• After surgery, you will have an unsightly scar on your abdomen. However, over time it will become less and less noticeable.

When the anesthesia wears off completely, the pain in the surgical wound will begin to be felt very clearly.

Let us point out another serious disadvantage - general state body after surgery. After all, this process, like any other surgical intervention, cannot be carried out without anesthesia. After the procedure, the woman still needs to recover from anesthesia. Sometimes this is accompanied by dizziness, weakness and nausea. Then, when the effect of anesthesia is completely over and not a trace remains of it, the pain in the surgical wound will begin to be felt very clearly. And this pain will more than cover the sensations caused by natural labor, even if there have been tears or cuts in the vaginal tissue.

Obviously, it is far from the optimal solution to voluntarily, in the absence of indications, agree to a cesarean section only due to fear of natural childbirth. Let us also add that there are disadvantages for both the young mother and her child.

Second and third caesarean section, what is important to know

It is imperative to know that recovery after the second surgical intervention is much longer and more difficult. The skin was cut in the same place twice. Consequently, the wound will take longer to heal than the first time. The seam may be sore and remain wet for several weeks. The uterus will also contract for a long time. This is usually accompanied unpleasant sensations and discomfort. The doctor will allow you to start removing your stomach after the 2nd operation only after 1.5-2 months. And it will be minor physical exercise. However, you should follow the recommendations of a specialist. Then everything will happen faster.

The woman in labor needs this information so that she feels calm and confident. As they say, forewarned is forearmed. The mental state of a woman before childbirth, especially important point. This will affect not only the result of the operation, but also the duration of the adaptation period. Plus another important point - the risks associated with repeated surgery.
Not all doctors tell you at the appointment what the dangers of a second cesarean section are. And this needs to be done in order to mentally prepare a woman for possible negative consequences. Therefore, it is best to find out about everything yourself in advance. There are risks and they are different. Everything will depend on the health of the mother, the characteristics of the child’s intrauterine development, the course of pregnancy and the characteristics that accompanied the first operation.

So, what might await a woman:

• menstrual irregularities;
• adhesions and inflammation in the suture area;
• injuries of the bladder, ureters;
• the hardest result is infertility;
• thrombophlebitis, anemia, endometritis;
• risk of removal of the uterus due to bleeding;
• complications in the next pregnancy.

Consequences for the baby

• violation cerebral circulation;
• hypoxia caused by prolonged exposure to anesthesia (note that the second cesarean section takes longer than the first).

Any specialist when asked whether it is possible to give birth after the second caesarean section, will answer that it is extremely undesirable. Too much a large number of complications and negative consequences. In many institutions before women they even offered to undergo a sterilization procedure to prevent another pregnancy. But! There are happy exceptions to the rules. Sometimes “Caesareans” are born a third or even a fourth time. However, it should be understood that these are rare, special cases. Therefore, you should not focus on them.
If you have a second caesarean section, don't panic! In close contact with the supervising doctor, following all his recommendations and proper preparation the procedure will take place without complications. The most important thing is that you managed to give and save the life of a little man.

Anesthesia for caesarean section

At the stage of preparation for a planned operation, most often, the mother is asked to choose a method of pain relief. This may be general anesthesia or epidural anesthesia.
Let’s say right away that both of these methods can have an adverse effect on the baby. But with general anesthesia the risk of complications is higher. Because a woman’s body receives not one, but several different medications at once.

Note that this method of pain relief is used mainly in in case of emergency. When doctors are limited in time and urgent intervention is required. In such cases, the woman sleeps throughout the operation and feels absolutely nothing.

Epidural anesthesia

"Epidural" is that the place where the nerves exit spinal cord The anesthesiologist injects an anesthetic into the spine. Thanks to this, the sensitivity of the lower body disappears. The woman does not feel pain or touch. Moreover, it does not feel lower limbs and cannot move them.
With this type of anesthesia, mommy maintains a clear consciousness. She sees and hears everything that happens. She is allowed to communicate with the obstetrician or her spouse if he is allowed to be present. By the way, using the same method, if the mother wishes, it is possible to relieve pain during natural childbirth.
Epidural anesthesia is used for elective caesarean sections. In such cases, doctors have time to carefully prepare for the operation. The calmer the situation, the easier it is for the doctor to make a puncture and the pain relief is more effective. In emergency cases, this is not always possible, especially when a woman is having contractions.

Childbirth after cesarean

Very for a long time In gynecology, the rule reigned: “If you have a cesarean once, then you have a cesarean again.” It confused the minds of pregnant women and their gynecologists. But! Today this is no longer an axiom. Don’t worry: the natural birth of a child after a cesarean section is difficult, but possible. Some experts urge you to believe in yourself and not succumb to intimidation by doctors. You just need to set yourself up for success!

In many countries, a first cesarean section is not considered at all a contraindication to natural childbirth. In addition, there are Scientific research, confirming that the risk of uterine rupture, and this is what obstetricians-gynecologists are always afraid of when they perform a natural birth after a cesarean section, with the latest technologies very small. Doctors also now have ultrasound machines at their disposal that allow them to monitor the condition of the uterine scar. Therefore, Russian specialists are gradually changing their attitude towards natural childbirth after cesarean.

Adhesions after cesarean section, symptoms

Adhesions, as doctors assure, are such defensive reaction every organism. So, after surgery Almost any organ begins to recover. This happens separately, as if by itself. It is known that any wounds heal through the formation of scars. Because there is a forced tightening of human skin. It should be noted that sometimes such adhesions occur not only in the wounded organ itself, but also between nearby organs located at the site of the operation. And with a caesarean section, the entire abdominal cavity was exposed. As a result, after surgical delivery, intestinal loops or other pelvic organs can connect with each other in a unique way. It is precisely these scars, formed between different internal organs involved in one way or another in the operation, that began to be called adhesions.

Recovery after cesarean

If the operation was performed after long or very painful childbirth and the woman has never given birth naturally, then she will perceive this procedure as a real liberation from all suffering. And if the operation went without deviations, then the mother has nothing to compare her feelings with. Therefore, next time she can, without the slightest doubt, agree to repeat the cesarean section. Often, when agreeing to surgery, a woman in labor does not even know how much easier it is to recover after a natural birth. After all, it was thought out by Nature itself, which means it is flawless.
It happens that a cesarean section is not entirely successful. Cases have been described where a woman in labor received an insufficient dose of anesthesia. In such a situation, psychological healing proceeds with difficult steps.
How to find a way out of this situation? Perhaps the solution lies in re-living the traumatic experience with an experienced psychologist. Often, a woman is freed from difficult memories only after experiencing a more successful birth. Exactly the first bad experience suppresses a woman’s desire to become pregnant and give birth for a very long time. It must be remembered that the next easy birth can become the very effective remedy that heals, like a balm, the resulting mental shock.

How to remove belly fat after caesarean section at home

Doctors say that it will be possible to think about how a woman can get rid of a sagging belly after surgery, other than wearing a bandage, no sooner than after two, and in most cases after three months. Moreover, after a six-month recovery period, the main physical exercise Regular daily walks with the baby and standard care should remain. Experienced mothers already know that the simplest gymnastics with a child, walks, household chores, proper nutrition and milk feeding can be sufficient load for a woman who has recently given birth.

How long after a caesarean section can you sleep with your husband?

After the section has been performed, it is recommended to begin sex life no earlier than six weeks. But you should know that each organism has its own characteristics. IN in rare cases the period of abstinence is 8 or 12 weeks. Although there are also opposite cases when the restoration of sexual activity occurred after 4 weeks. In this case, the cervix should close completely against the background of the cessation of postpartum hemorrhage.

How long after a cesarean section can you pump up your abs?

You can pump up your abs so that your tummy is elastic again no earlier than six months after the intervention. During this period, all internal and external seams will heal. Attention! It is absolutely forbidden to visit the gym! Exercises at home are also prohibited unless approved by the attending doctor. He must carry out gynecological examination.
In addition, the woman must undergo an ultrasound examination. Only after this can the doctor be sure that everything inner fabrics and the organs were completely restored. This type of examination allows you to find out how long it will take to afford such exercises and sports.

Natural childbirth is the usual way of birth provided by nature. But sometimes, for a number of reasons, giving birth naturally can be dangerous for the life and health of a woman and her child. In this case, doctors solve the problem surgically and resort to a method such as a planned caesarean section. This is the name for a delivery operation, common in obstetric practice. Its meaning is that the child is removed through an incision in the uterus. Despite the fact that it is performed frequently and saves the lives of thousands of children, complications after it also occur.

Sometimes the operation is performed urgently. Emergency surgical delivery is resorted to if complications arise during natural childbirth, life threatening and the health of the child or mother.

A planned caesarean section is an operation that is prescribed during pregnancy. It is carried out only for serious indications. When is a planned caesarean section prescribed, at what time is the operation performed and how to avoid complications?

Indications are divided into absolute, that is, those in which the possibility independent childbirth excluded, and relative.

List of absolute indications:

• fruit whose weight exceeds 4,500 g;
• previous cervical surgery;
• the presence of two or more scars on the uterus or failure of one of them;
• deformation pelvic bones due to previous injuries;
• breech presentation of the fetus, if its weight exceeds 3600 g;
• twins, if one of the fetuses is in a breech position;
• the fetus is in a transverse position.

List of relative indications:

• uterine fibroids;
• high myopia;
• diabetes;
• the presence of malignant or benign tumors;
• weak labor activity.

As a rule, the decision on a planned caesarean section is made if there is at least one absolute reading or a collection of relative ones. If the indications are only relative, it is necessary to weigh the risk of surgery and the risk of complications that may occur during natural childbirth.

When is the operation performed?

At what time a planned caesarean section is performed is decided by the doctor in each specific case, but there are still certain recommended limits. Need to match the date last menstrual period, how many weeks the fetus is developed, what condition the placenta is in.

Based on this information, they decide when exactly to start delivery.

Sometimes doctors in the maternity hospital, when asked by a patient when a planned caesarean section is performed, answer that it is advisable to wait until the first light contractions begin. In this case, the woman is hospitalized in the maternity hospital in advance so as not to miss the onset of labor.

A pregnancy is considered full term when it reaches 37 weeks. Therefore, it is too early to perform surgery before this time. On the other hand, after 37 weeks, contractions can start at any time.

They try to bring the date of a planned caesarean section as close as possible to the expected date of birth. But, since by the end of the term the placenta ages and begins to perform its functions worse, in order to prevent it from occurring in the fetus, the operation is prescribed for a period of 38-39 weeks.

It is at this time that the woman is hospitalized in antenatal department maternity hospital to undergo all necessary tests before surgery.

The surgical method of childbirth is not a contraindication to repeat pregnancies. But if a woman already has a scar on the uterus, it means that the second child will be born in the same way. Monitoring the pregnant woman in this case is especially careful.

A second planned cesarean section is also performed at 38-39 weeks, but if the doctor has doubts about the consistency of the first scar, he may decide to operate on the patient earlier.

Preparing for a caesarean section

Not quite like this when the baby arrives in the usual way need to prepare. Usually, when a planned caesarean section is performed, the pregnant woman is hospitalized a couple of weeks before the expected date of birth.

They will take urine and blood tests from her, determine her blood type and Rh factor, and check the vaginal smear for purity. It is also necessary to monitor the condition of the fetus. For this purpose, ultrasonography and cardiotocography (CTG). Based on these studies, conclusions are drawn about the well-being of the child in the womb.

The specific date and time of the operation is determined by the doctor, having in hand the results of all tests and studies. Usually all planned operations are carried out in the first half of the day. The day before the appointed date, the anesthesiologist meets with the patient to discuss what type of anesthesia will be used and find out if the woman is allergic to any medications.

On the eve of a caesarean section, the diet should be light, and after 18-19 hours it is forbidden not only to eat, but also to drink.

In the morning, a cleansing enema is performed and the pubic hair is shaved. Care must be taken to prevent deep vein thrombosis. For this purpose, the legs are bandaged elastic bandage or they ask the woman in labor to put on special ones.

The patient is wheeled into the operating room on a gurney. A catheter is inserted into the urethra on the operating table and removed in the recovery room. Bottom part abdomen is processed antiseptic solution, at the level chest a special screen is installed to block the woman’s view of the surgical field.

Progress of the operation

To reduce anxiety before surgery, it is helpful to know how a planned caesarean section is performed. After administering anesthesia, the surgeon makes two incisions. The first incision is to cut through the abdominal wall, fat, and connective tissue. The second incision is the uterus.

The incision can be of two types:

• Transverse (horizontal). Produced slightly above the pubis. With this type of incision, there is a low probability that the intestines or bladder will be hit by a scalpel. The recovery period is easier, the formation of hernias is minimized, and the healed suture looks quite aesthetically pleasing.
• Longitudinal (vertical). This cut runs from pubic bone to the navel, while providing good access to internal organs. Abdomen cut longitudinally if the operation needs to be performed urgently.

A planned caesarean section, no matter how long it is performed, provided there is no threat to the life of the fetus, is performed more often using a horizontal incision.

The surgeon removes the placenta from the uterus, and the incision is sutured using synthetic materials. In the same way, integrity is restored abdominal wall. Remains in the lower abdomen cosmetic stitch. Afterwards it is disinfected and a protective bandage is applied.

If no complications arise during the surgeons’ work, the operation lasts from 20 to 40 minutes, after which the patient is transferred to the recovery room.

Possible complications and their prevention

Complications may occur during surgical childbirth and in the postoperative period. They do not depend on the period at which a planned caesarean section is performed.

Common complications are the following:

• Major blood loss. If a woman gives birth on her own, 250 ml of blood is considered acceptable blood loss, and during surgical delivery a woman can lose up to one liter of it. If the blood loss is too great, a transfusion will be required. The most dangerous consequence of heavy bleeding, which cannot be stopped - the need to remove the uterus.
• Formation of adhesions. This is the name given to seals made of connective tissue, which “fuse” one organ with another, for example, the uterus with the intestines or intestinal loops with each other. After abdominal intervention, adhesions almost always form, but if there are too many of them, chronic pain in the abdominal area. If adhesions form in fallopian tubes, the risk of developing an ectopic pregnancy increases.
• Endometritis is an inflammation of the uterine cavity caused by getting into it pathogenic bacteria. Symptoms of endometritis can manifest themselves both on the first day after surgery and on the 10th day after childbirth.
• Inflammatory processes in the suture area due to infection entering the suture. If you don't start on time antibacterial therapy, surgery may be required.
• Seam divergence. It can be triggered by a woman lifting heavy weights (over 4 kilograms), and the dehiscence of the seam is a consequence of the development of infection in it.

To prevent complications, doctors take measures even before operations begin. To prevent the development of endometritis, the woman is given an antibiotic injection before the operation.

Antibacterial therapy continues for several days after. You can prevent the formation of adhesions by attending physiotherapy and doing special gymnastics.

Recovery period

After childbirth, the uterus returns to its previous state after 6-8 weeks. But recovery period after surgical birth lasts longer than after natural ones. After all, the uterus is injured, and the suture does not always heal safely.

In many ways, the recovery period depends on how the planned caesarean section went and how successfully it was done.

At the end of the operation, the patient is moved to the recovery room or intensive care unit. To prevent the occurrence of infectious complications, antibacterial therapy is carried out.

To relieve pain, anesthetic injections are given. Both general and spinal anesthesia slow down bowel function, so in the first 24 hours after the intervention you are only allowed to drink water.

But already on the second day you can use it chicken bouillon with crackers, kefir, yogurt without additives. For 6-7 days you should follow the diet as after any abdominal surgery: no fatty, fried, spicy food. After this period, you can return to your usual diet.

Constipation is highly undesirable. The use of laxative products is recommended, but if this does not help, you will have to resort to the use of laxatives. If a woman is breastfeeding, the annotation should indicate that use during breastfeeding allowed.

While a woman is in the maternity hospital, her postoperative suture is treated daily.

After discharge, you need to continue to do this yourself with the help of hydrogen peroxide and brilliant green. If the suture festers, ichor comes out of it, or shooting pains appear, you need to tell the doctor about it.

Before deciding whether it is necessary to have a planned cesarean section and at what time it is best to perform it, the doctor must analyze all the indications from the mother and child, and also take into account the likely adverse consequences for women’s health.

This operation seems simple to many women, but in order for it to go well, the doctor must be highly qualified, and the woman in labor must follow all recommendations regarding the recovery period.

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A child is not always born naturally. Sometimes, in order to avoid additional risks, the gynecologist is forced to decide to perform a caesarean section. The operation can be planned or emergency, with the first type being preferable because it is performed in a calmer environment. The choice of a specific date for elective surgery depends on many factors.

Indications and contraindications for repeat cesarean section

The second caesarean section is prescribed for the same indications as the first. These include:

• retinal diseases;
• varicose veins in the legs;
• cardiac disorders;
• diabetes;
• high blood pressure;
• chronic respiratory diseases;
• large fruit;
• narrow pelvis of a woman in labor;
• recent traumatic brain injury;
• first birth in a woman over 30 years of age;
• abnormal placenta previa;
• transverse or pelvic presentation of the fetus
• multiple births;
• uterine fibroids.

The decision to perform an operation may also be influenced by some features of the suture left after a previous delivery. A second caesarean section may be prescribed for:

• the threat of its divergence;
• longitudinal arrangement;
• the appearance of connective tissue on the scar.

A woman who had an abortion before pregnancy is not allowed to give birth on her own after surgical resolution of a previous pregnancy, since additional injuries to the uterus increase the risk of suture dehiscence. Very often, doctors prescribe a repeat operation after the first cesarean section, even in the absence of the above risk factors, since this helps protect the life and health of the mother and child.

In some cases, it is very difficult to predict how childbirth will go, so doctors try to protect the mother from unnecessary suffering. Knowing in advance when she will have surgery, a woman will be able to tune in to it, prepare mentally and physically.

How to prepare for a planned cesarean section?

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An expectant mother who knows for sure that she will not give birth herself should prepare for surgery throughout her pregnancy. The most significant activities for this are:

1. A visit to the school for expectant mothers, where they will talk in detail about how the doctor performs the operation.
2. Searching for options for placing an older child while the mother is in the hospital with the newborn.
3. Discussion with my husband about the possibility of his presence in the operating room.
4. Choice of anesthesia. Some women are afraid to remain conscious during surgery. Others, on the contrary, are afraid of general anesthesia. In order to get rid of negative emotions, better get acquainted with all the features various types anesthesia and choose the option that scares you the least.
5. Purchasing all the things necessary for a hospital stay: toiletries, clothes, slippers.
6. Determination for a successful outcome.

Immediately before the operation, a set of measures should also be performed. The day before going to the hospital you need:

1. Take a bath. You can remove pubic hair with a razor. Before doing this, it is recommended to remove nail polish.
2. Get a good night's sleep. Since recovery after 2 operations is more difficult than after 1, to the expectant mother you need to get a good rest.
3. Charge the phone.
4. Avoid eating foods that increase gas formation.

Timing of the operation during the second and third pregnancy

At what stage is a planned cesarean section performed during a second pregnancy? It is important to understand that the date of the operation will depend on how the pregnancy went, how the pregnant woman feels, and how long ago the previous operation was performed. The date of the previous cesarean section is also taken into account.

As a rule, doctors prescribe surgery for the period from 34 to 37 weeks. Doctors rarely wait until 39 weeks, it’s too dangerous. The following circumstances influence the date of 2 cesarean section:

1. If the first cesarean was performed at 39 weeks, the next one will be performed much earlier, approximately 7-14 days.
2. Breech presentation of the fetus is an indication for surgery at 38-39 weeks.
3. Transverse presentation poses a great danger to the health and life of the child. In this case, a cesarean section is scheduled for a date 7-14 days prior to the expected due date.
4. Complete placenta previa. If the expectant mother starts bleeding, she needs to be operated on urgently, but then the operation will be very risky. For these reasons, women with complete placenta previa are tried to undergo surgery before 38 weeks.
5. Condition of a scar on the uterus. Repeated and third cesarean sections are always a new risk. It is difficult to make an incision at the site of the old suture, therefore, the worse its condition, the sooner the operation is performed.
6. Multiple pregnancy. If a woman is carrying two babies, she may have difficulties during the second birth, so she is usually given planned surgery at 36-37 weeks. For monoamniotic twins, surgery can be performed at 32 weeks.
7. HIV infection. Women who are carriers of this dangerous infection, “Caesarean” 14 days before the expected date of birth.

Sometimes women are not informed for a very long time about how many weeks the operation will be performed. This happens because doctors, observing the expectant mother, decide to act according to the situation. If there are no complications during pregnancy, surgery may be postponed until labor begins.

How is the operation performed?

The operation consists of two stages: preparing the patient for surgical intervention and the operation itself. Today, a caesarean section, regardless of whether it is the first, second or third, is treated as quite simple way delivery.

30-40 minutes after entering the operating room, a pregnant woman can already hear her baby crying. If no difficulties arise during the surgical intervention, very soon after birth the mother and baby are discharged home (we recommend reading:).

Preoperative stage

Before surgical intervention the woman is asked to go to the hospital in advance to undergo examination. At the maternity hospital they will take it from her necessary tests designed to determine the condition of the mother and fetus. The day before the operation, an anesthesiologist comes to the expectant mother, who will warn her about what sensations await her after the administration of anesthesia, how it is done, and how it works.

On the day of delivery, the patient is warned about the need to refuse food and food, her intestines are cleansed, and she is offered to wear a special gown. She will also need to remove her makeup, which will make it easier to monitor her condition in the operating room. Just before entering the operating room, the woman is given an IV and a Foley catheter is inserted into the urethra.

Operating period

In the operating room, the patient is given anesthesia. Then an incision is made, which can be either longitudinal or transverse. Most often, doctors choose the latter option, since a horizontal incision is safer for a woman, and the recovery period after a caesarean section performed with such an incision is easier and faster.

Through the incision, the doctor removes the fetus, cuts the umbilical cord and transfers the baby to the neonatologist. After this, the surgeon who operates on the woman removes the placenta from the uterus, connects the cut tissues and applies sutures. Final stage- disinfection of sutures and application of a bandage. The duration of all manipulations is about 40 minutes.

The new mother is taken to the recovery room. If she feels well, she will be asked to put the baby to the breast.

What is important to know?

For an expectant mother who has been scheduled for a cesarean section again, it is important to remember that the operation may be different from the previous one. There are several features of re-excision of the uterus:

1. The second time the operation takes a little longer.
2. More powerful anesthesia is used.
3. They are admitted to the hospital about a week earlier than the scheduled date.
4. It will be more difficult to recover the second time than the first. The period itself will be more difficult.
5. The stitch is made in the same place as the first time, so there will be no new scars.

At the same time, these differences should not cause any panic in the mother. She needs to take into account that she will have to be a little patient before the operation, and then she will need the help and support of loved ones.

Mothers who have undergone such operations are already well aware that until the suture heals completely, they will need to take special care of their health. For a full return to normal life they will likely need at least 2 months. In some especially severe cases duration postoperative period can reach 3-4 months.

What could be the consequences?

As a rule, a planned caesarean section does not have any serious consequences. Sometimes complications arise during or after surgery:

• anemia, which results from excessive blood loss;
• lack of milk;
• prohibition of subsequent natural births;
• development adhesive disease in the abdominal cavity;
• infertility, prohibition on subsequent natural childbirth;
• cerebrovascular accident in a newborn;
• menstrual irregularities.

All of the above complications usually occur only in those women who did not follow doctors’ recommendations during pregnancy. In the vast majority of cases, births by cesarean are absolutely normal, without any particular difficulties, and the baby is born healthy and no different from his peers who were born naturally.