How to find out that the uterus has contracted after a cesarean section. List of folk remedies. How to speed up uterine contractions and body recovery

Long-awaited pregnancy, collecting a dowry for a baby is always a crucial moment in a woman’s life. In order for everything to proceed smoothly, it is necessary to obtain answers to many questions in advance. One of them is how quickly does uterine involution occur and why does the uterus in some cases not contract after childbirth?

During pregnancy, a woman's entire body undergoes changes. First of all, they concern the reproductive organs: the mammary glands and the uterus, the volume of which increases approximately 50 times. In the postpartum period, it returns to its original state. But it happens that the uterus does not contract after childbirth. What causes the development of the pathological condition? What to do? Let's try to figure it out.

IN birth process There are 3 periods:

1. period;
2. period of expulsion of the fetus;
3. succession period.

Normal first period labor activity takes from 12 to 14 hours for primiparous women and 6-8 hours for multiparous women. The second period lasts from 15 to 45 minutes. The third period takes up to 30 minutes if there is no bleeding. If the succession period is accompanied by bleeding, then measures to stop it are taken immediately, without waiting for a half-hour interval.

IN succession period separation of the placenta, or baby's place, occurs, the size of which is on average 20-25 cm in diameter. A wound surface forms at the site of the separated placenta.

The postpartum period is characterized by the release of clots of mucus and blood from the uterine cavity. Typically, cleansing occurs within 72 hours after the baby is born. The main role in cleansing the uterine cavity is played by phagocytes and proteolytic enzymes that break down postpartum residues.

Lochia is bloody in the first 3 days, then becomes serous-sanguineous. By the end of the 3rd week they lighten, and after 6 weeks they disappear.

Restoration of the endometrium occurs in 21 days, and at the site of attachment of the placenta - in 6 weeks.

How many days does the uterus contract after childbirth?

Complete (return to the original size) of the organ occurs in 6-8 weeks. The uterus most actively decreases in size in the first postpartum days.

The cervix after birth has a dilatation of 10-12 cm. After 24 hours, this size is 3-4 cm, after 72 hours - 1-2 cm. Complete closure of the pharynx occurs 21 days after birth.

The uterus undergoes the greatest changes in postpartum period. The weight of the uterus immediately after birth is about 1000 grams. After a week, the organ will shrink by half, and after 8 weeks it will return to its original value (50 g), shrinking another 20 times.

With the development of a pathological condition, the uterus does not contract after childbirth or its contraction occurs very slowly. This is dangerous due to postpartum complications, which if not provided in a timely manner medical care may lead to fatal outcome due to large blood loss.

The uterus does not contract: what is the reason?

There are a number of reasons that can lead to the development of a pathological condition:

• low attachment or ;
• pregnancy complicated by concomitant pathology;
• weakness of labor;
• immobilization of a woman in the early postpartum period;
• anatomical features, such as its bending or underdevelopment;
• injuries of the birth canal;
• history of inflammatory diseases of the uterus or ovaries;
• blood diseases, including decreased clotting ability.

Dynamics of uterine contraction in the normal postpartum period

During the examination, the fundus of the uterus is detected at the level of the navel. Every day it drops within 1.5-2 cm. By the 6th day, the bottom is 4-5 cm above the womb.

If uterine contractions lag behind normal by 24 hours or more, this is a pathology and requires medical intervention.

If the uterus contracts slowly

In this case, a manual examination of the organ cavity is performed to remove remnants of membranes and blood clots. Additionally, uterotonic drugs are prescribed, such as oxytocin, methylergobrevin.

On the 3rd day after childbirth, the woman undergoes an ultrasound of the pelvic organs, which may show expansion of the cavity due to:

• accumulation of blood clots in it;
• remnants of membranes or placenta;
• early closure of the uterine os.

As treatment, it is necessary to perform curettage of the uterine cavity. In cases where contraction of the organ cannot be achieved, surgical intervention is resorted to.

If the uterus contracts slowly, you can follow simple recommendations:

• breastfeed (during lactation, oxytocin is produced, which promotes uterine contractions);
• physical activity;
• timely emptying Bladder;
• maintaining hygiene, which reduces the risk of infection;
• lie down and sleep on your stomach.

Causes of uterine subinvolution

Subinvolution of the uterus is a decrease in the ability of the muscular lining of the organ to contract.

Among the reasons that can lead to pathological condition, highlight:

1. Hormonal disorders.
2. Anatomical reasons.
3. Infectious agents.

Hormonal disorders

Among hormonal reasons leading to subinvolution, the main one is prolactin deficiency.

Prolactin is a hormone that determines the production of milk by a woman’s mammary glands. Normal level hormone leads to the production of oxytocin, which is responsible for uterine contractility. It has been proven that prolactin production is higher in women for whom pregnancy and a child are desired.

If there is not enough prolactin produced, then the level of oxytocin decreases, and the uterus contracts worse after childbirth.

Anatomical reasons

By anatomical reasons subinvolution may occur due to:

• the presence of remnants of membranes or placental lobules;
• inflection of the uterus;
• blockage of the external pharynx with clots;
• premature closure of the cervix.

If there are remnants of the placenta or fetal membranes in the uterine cavity, they prevent normal contraction of the organ due to the lack of possibility of blood vessel thrombosis.

The bend of the uterus helps to delay the release of blood clots and mucus to the outside due to their accumulation at the site of the bend.

If the closure of the external pharynx occurs prematurely, the discharge of the uterine cavity, unable to empty itself, accumulates and stretches the walls of the organ.

Infection

First option infectious lesion– infection during childbirth or infection in the early postpartum period in the absence of sterility. But most often infectious causes uterine subinvolutions are associated with the presence of the disease during pregnancy.

Postpartum endometritis is a continuation of chorionitis, or inflammatory process in the fetal membranes. The uterus, affected by infection, is a flabby organ that does not respond to the administration of uterotonic drugs.

The rehabilitation period after abdominal surgery lasts several months. Successful uterine contraction after caesarean section- one of the important indicators. This physiological process, which normally takes up to 6 weeks, can be significantly delayed due to surgical intervention. The reason for this is a suture on the wall of the uterus.

Condition of the uterus after caesarean section

The female uterus is a unique organ. During pregnancy, its size and weight increase several times, the placenta forms in the cavity, and after childbirth, the condition and structure gradually return to prenatal. Physiological childbirth, with the exception of difficult cases, does not lead to disruption of the integrity of the muscular layer of the walls, so the uterus contracts unhindered. On average, this process takes about 6 weeks. In the first 14 days, involution occurs most intensively.

Caesarean section is a serious physical injury that can affect natural process and complicate it. An incision 12–15 cm long in the anterior area uterine wall sutured with a special ligature, which does not require removal, dissolving on its own after a few weeks. A transverse suture running along the muscle fibers is relatively safe. Its presence rarely leads to disruption of involution, provided the outcome of the operation is favorable. Vertical dissection of the wall is more traumatic: it is cut large quantity vessels and nerve endings, muscle healing takes longer, because of this there is a high risk of infection. The massive blood loss that accompanies the intervention also slows down subsequent recovery.

How many months have passed since the CS?

1 monthfrom 2 months

After all the manipulations performed during the operation, the uterine cavity is a continuous wound filled with bloody exudate and mucous debris. The swollen organ weighs about 900–1000 years. Its bottom can be clearly felt through the abdominal wall at the level of the navel or below. An ice pack is placed on the abdomen to prevent bleeding. Periodically, the obstetrician massages the organ, encouraging it to begin contracting.

The presence of a seam does not add pleasant sensations to the mother in labor. In the first few days, taking analgesic drugs is indicated. To maintain muscles and reduce pain After getting out of bed, it is recommended to wear thick underwear or a special bandage.

Everything that happens to the uterus after natural birth, is also typical for the operated organ. Closing the walls helps to compress the blood vessels and prevents the development of massive bleeding. At the same time, muscle contraction begins.

How the uterus contracts after cesarean section

Within 24 hours after the baby and the placenta are removed, the walls of the organ decrease by approximately 2–3 cm. After 2 days, you can feel its edge below the navel by 3–4 cm. Every day, the bottom drops towards the womb, and the weight of the organ decreases - the tissues get rid of excess liquid and blood clots. Every week the organ decreases by almost 2 times. Normally, 9–12 days after surgery, palpating it through the abdominal wall becomes impossible - it returns to its previous “rightful” place. In this case, the recovery continues until they heal. damaged tissue, and a full-fledged dense scar will not form at the suture site.

A woman can clearly feel how the uterus contracts after a caesarean section. convulsive spasms inside abdominal cavity. Particularly intense the process is underway when oxytocin, the hormone responsible for the secretion of breast milk, is released into the blood. It also stimulates an increase in the tone of muscle fibers.

The involution process can also be monitored by the intensity of postpartum discharge. Caesarean section normally does not affect their character. In the first week, abundant bright red with brown clots of caked blood, require changing several thick pads per day. As the walls of the uterus contract, the fluid brightens, becoming scanty, light pink, then yellowish-whitish. The discharge ends after 6–7 weeks.

How long does the uterus contract after cesarean section?

The period during which the operated uterus returns to its previous size varies from 45 to 70 days. Scar formation takes from 10 months to 2 years.

It should be noted that the speed of recovery is influenced by factors such as:

• age and physical state women;
• Availability systemic violations in organism;
• seam location;
• what kind of caesarean section it was.

After the first planned operation, performed without complications, the time of uterine contraction does not exceed 50 days. With each new intervention, the muscle walls become thinner, and the presence of scars reduces their elasticity - recovery occurs more slowly.

How many days the uterus contracts after a cesarean section also depends on the formation of lactation. Breastfeeding naturally promotes increased tone - every time a baby is applied to the breast causes an oxytocin surge, which is immediately responded to muscle fibers. Lack of milk for any reason, forced or voluntary refusal mother from breastfeeding provokes delay involution.

The uterus is completely restored 1–1.5 years after surgery. Its weight and size remain 1.5 times greater than before the operation. Due to the presence of a scar, the shape may change slightly. Despite the virtual absence of any physical limitations after the lapse of rehabilitation period, repeated pregnancy before 2 years after surgery should be excluded. Connective tissue in the area of ​​the formed scar it acquires the necessary density and resistance to stretching only by this time.

If the reduction is delayed

Situations in which the uterus contracts poorly are possible for several reasons.

The most common:

• development of hypoxia: muscles, due to lack of oxygen, receive insufficient nutrition and are unable to quickly regain their tone;
• lack of physical activity: moderate exercise helps restore the body; if a woman spends a lot of time in bed, uterine contractions slow down;
• severe tissue damage: in the presence of a vertical suture, the regeneration of fibers and blood vessels takes up a lot of resources, involution is especially painful;
• intestinal atony: if the contents of the digestive tract are difficult to move through and are excreted, the blood circulation of the pelvic organs is disrupted, and the tone of the walls of the reproductive organ decreases;
• uterine inclination: this condition is often accompanied by a sudden cessation of lochia in the early postpartum period, in which case a significant amount of blood and placenta remains accumulate inside the cavity.

How to speed up the process

In order for the uterus to shrink faster after a cesarean section to its previous size, the basic principles of recovery should not be neglected.

1. After the anesthesia wears off, you need to start moving: get up in bed, raise your arms, bend your knees. You shouldn't lie down all the time. From the second day it is necessary to gradually increase physical activity. How quickly the body recovers directly depends on how much time the patient spends in motion.
2. If there are no contraindications, it is recommended to perform Kegel exercises daily: forcefully squeeze and relax the vaginal and gluteal muscles.
3. It is advisable to feed a newborn every 3 hours. With each application, a new portion of oxytocin is released into the blood, and the tone of the uterus increases.
4. It is important to monitor your digestion. Emptying the intestines is required daily, and the process itself should not cause difficulties. If necessary, it is recommended to take mild laxatives.

The nature and amount of discharge also needs to be monitored, especially if a woman is worried about how to speed up uterine contractions. A feeling of heaviness, swelling and increased pain in the abdominal cavity simultaneously with the cessation of lochia is a sign developing pathology. Blood clots blocking the cervical canal can cause further suppuration. In this case, you must seek help immediately.

What do doctors think?

Medical statistics do not record a large number of cases of violation of the timing of uterine involution after cesarean section. The presence of a seam on the anterior wall often causes the development of infectious processes. However, it is necessary to carefully monitor the reduction in organ volume in the first weeks.

If the uterus does not contract sufficiently in the first weeks, it is advisable to make sure that there is no hematometers, bends, other possible complications and consequences of the operation that prevent involution. IN severe cases The woman is given doses of oxytocin intravenously.

Help stimulate an increase in tone: a measured lifestyle, regular breastfeeding or expressing milk, light massage abdominal wall. In the first weeks, you should wear it for at least three hours a day.

Each case of recovery after surgical delivery is individual. Usually, by the end of the second month from the day of surgery, the volume of the uterus is reduced to its previous size. Reasons slow recovery are: multiple pregnancy, thinning of the walls after several cesareans.

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A caesarean section is an incision into the uterus to remove a baby, which is often performed in emergency situations to save lives. But often to surgical intervention resort as planned, due to certain factors and the course of pregnancy. Question, How long does the uterus contract after a caesarean section?, occurs primarily in young mothers, since it is generally accepted that natural childbirth promotes more rapid recovery. However, this statement is inaccurate and lacks validity.

Uterine contraction is one of the main indicators when a woman in labor is discharged from the hospital. The parameter signals recovery, as well as the condition of the uterus - the presence of blood clots and fetal membranes in it. A woman’s uterine deposits come out within almost two months, but they don’t stay in the maternity hospital for that long. In the first days after birth, doctors at a medical institution only monitor the rate of contraction, which determines the state of the body and its readiness for independent recovery. If the uterus contracts slowly, the woman may be prescribed additional medications, promoting faster recovery. In particular difficult cases the woman in labor is subjected to the intervention of doctors - specialists begin to “clean” the reproductive organ using instruments. To avoid such problems, you should use the recommendations of specialists and in effective ways to restore the uterus after the birth of the baby.

Few women know that during pregnancy the uterus increases 500 times, so its complete restoration to its previous size requires quite a lot. long time– more than 2 months. In the first days after childbirth, lochia emerge from the cavity of the genital organ - bleeding. They can be stimulated a little so that emptying occurs faster, because clots separated from the walls cause pain and discomfort.

After even a natural birth, the uterus is one bleeding wound, the healing of which requires careful treatment and certain procedures. What can we say about the organ after cesarean section? Here, in addition, there is also an incision, accompanied by damage to cells and tissues. During natural delivery, the weight of the organ is about 1 kg, after two weeks - no more than 0.5 kg, and only after 2 months - 350 g. normal sizes the organ arrives only after 3-4 months. The created suture after a cesarean section interferes with the normal contraction of the uterus, so it is necessary additional stimulation. Doctors advise resorting to simple recommendations in the absence of complications and use medications in case of extremely slow recovery.

This is important: Why is it necessary to stimulate contractions of a woman’s uterus after a cesarean section? The increased size and the presence of clots in the organ significantly slow down the healing of the suture, and this provokes pain.

Reasons for slow recovery

It is impossible to give an exact answer to the question of how long the uterus contracts after a cesarean section. The uterus is restored in strength individual factors- It is impossible to determine exact dates. For deadlines full recovery The size of the organ before pregnancy is influenced by the following factors:

• multiple pregnancy;
• complications during pregnancy or after the birth of a child;
• large size of the fruit;
• exhaustion of a woman’s body before and after childbirth;
• weak labor activity;
• passive behavior of a woman after the birth of a child - lack of body movements.

There are factors that provoke and complete absence contractions of the uterus both after natural childbirth and after caesarean section. An organ may not contract at all if there is:

• inflection of the uterus;
• injuries to the birth canal resulting from difficult childbirth;
• inflammation in the organ and the entire reproductive system;
• benign tumor in the organ cavity;
• polyhydramnios during pregnancy;
• problems with blood clotting and other prerequisites.

This is important: In the first days after the birth of the child, the woman in labor is observed by doctors, who set the rate at which the uterus contracts. If there are problems, the woman is given recommendations for stimulation, and a course of treatment is prescribed to eliminate developed diseases.

Symptoms of normal recovery

Understand that the uterus is shrinking completely acceptable standards possible based on the following criteria:

• The woman has cramping pain lower abdomen, which are tolerable but unpleasant.
• Periodically after childbirth, characteristic discomfort is felt in the chest - the so-called sudden rush of breast milk, which has a well-founded name. Yes, with a sharp contraction of the uterus, stimulation of milk occurs rapidly - the concentration of hormones responsible for lactation in the body increases sharply.
• There is a constant release of lochia - at first with the presence of bloody streaks, later they acquire transparent view with a yellow tint.

The period of uterine contraction reaches 6-8 weeks. At this time, the woman must have discharge and other symptoms. If the manifestation of symptoms that the uterus is contracting suddenly stops, it is necessary to use methods for stimulation.

Stimulation methods

If you notice slow uterine contractions, you should consult a doctor. The specialist, after conducting an examination using ultrasound, will assure the woman that there are no problems or tell her how to contract the uterus after a cesarean section.

Required Methods

You should start stimulating the uterus so that it begins to contract within normal limits from the very first days after delivery. Here the young mother must independently use the following methods:

• First, you should start breastfeeding. As mentioned above, the flow of breast milk is directly related to uterine contractions. Therefore, you should put your baby to the breast as often as possible - this will stimulate milk production in the quantities required for the baby, which will make him eat up and become calmer. Moreover, after each feeding, the mammary glands begin to rapidly begin producing milk, and this contributes to a rapid and equally rapid contraction.
• After a caesarean section, the woman in labor is allowed to lie down only for the first few hours until the anesthesia wears off. Subsequently, women are lifted out of bed and forced to move. Elementary actions for personal care after childbirth must be performed independently - movements also stimulate the reduction of the organ. The uterus begins to contract faster when the young mother herself monitors her child from the first days of his life. After discharge, the woman should not be lazy to walk with the baby.
• Even if there is a scar, a woman in labor is recommended to sleep on her stomach. If this is not possible due to pain in the abdomen or chest, you should at least lie down on it periodically. It is recommended to carry out the presented actions at least 3 times a day for 20 minutes.

After a cesarean section in women, the risk of developing adhesions increases not only fallopian tubes, but also the intestines. Therefore, it is extremely important to monitor the frequency of bowel movements and even the bladder. Surprisingly, these factors also directly affect how quickly the uterus will contract.

Gymnastics

A woman in labor, even after a cesarean section, should not avoid activities that will help the uterus contract. One of the most effective exercises is cycling - it is recommended to do it without fanaticism and, if possible, in a medical facility immediately after the birth of the child.

• In a standing position, it is recommended to sit down “half-crouched”, bending your knees together.
• When sitting or lying down, it is recommended to raise your legs a little so as not to provoke strong abdominal tension, and tense your feet, and then immediately relax them.
• While standing, you should perform breathing exercises - breathe deeply using the abdominal wall. During breathing exercises a woman should run her palms over her abdomen to increase blood circulation.

Young mothers should take advantage effective exercises Kegels to strengthen the pelvic muscles - this will ensure normal emptying of the bladder and intestines.

Massage

In the absence of diseases of the uterus and other complications after a cesarean section, the woman in labor is prescribed a massage performed only by a specialist. The massage is carried out through the abdominal wall, without causing discomfort to the young mother. At home, a young mother can only gently stroke her belly clockwise, stimulating blood circulation and corresponding contraction of the organ.

Medications

Immediately after a caesarean section, a young mother is prescribed medications to stimulate uterine contractions. Oxytocin is used here, which is administered intramuscularly or intravenously. It is used only for 3 days after birth. In the future, if the uterus does not recover, the woman is prescribed the following drugs:

• Hyfotocin - recommended for those giving birth due to its natural origin. The drug stimulates muscles and preserves blood vessels internal organs intact.
• Demoxytocin – protects a woman from the development of mastitis and other diseases of the internal organs. Promotes uterine contraction.
• Pituitrin - in addition to stimulating recovery, has a vascular strengthening effect.

It is important: Independent use medicines after childbirth is strictly prohibited. A woman should definitely consult a doctor.

In addition to medications, a woman in labor can use folk remedies to stimulate contraction of the organ - their use is also discussed with the gynecologist. Using folk remedies It is important to monitor the baby’s condition, since this increases the risk of developing allergic manifestations, colic and others unpleasant diseases The child has. You can buy a special one at the pharmacy royal collection, where the composition includes grass shepherd's purse. Its effect is aimed at muscle contraction, which has a positive effect on the reduction of the reproductive organ. The uterus should contract after natural birth and cesarean section - this happens over several months. During this time, the young mother should experience unpleasant, but quite tolerable symptoms. If they are absent, it is important to immediately consult a doctor, since this may signal the development of inflammation and other pathologies that doctors did not detect immediately after birth.

The uterus is a hollow, unpaired, pear-shaped organ located in the pelvic area and consisting of smooth muscle tissue. The main purpose of the uterus is to carry a fertilized egg.

During pregnancy, all organs and systems of a woman undergo changes, but only the uterus is so significant: by the end of the ninth month, its weight increases from 50 grams to 1000-1200 (excluding the child and placenta), and the internal cavity increases 500 times! And if all these changes occur gradually, over many weeks, then the reverse process (involution) takes a record short term– one and a half to two months.

Postpartum period - features of the course

It takes 6 to 8 weeks, during which time the uterus returns to its previous size. Immediately after childbirth, the inside of the uterus is a continuous wound surface, covered blood clots and remnants of the fetal membrane. When muscles contract, part of the lymphatic and blood vessels compresses and dries out (obliterates). Some of the muscle cells that have grown during pregnancy die, while the rest decrease in size.

Within a day after natural birth, the fundus of the uterus drops 2 cm lower, and on days 9-10 it takes its usual place below the pubic line. The external uterine os, through which the remains of the placenta are sometimes removed manually, also contracts gradually. The next day it allows only one finger to pass through, and after three weeks it closes completely. A slit-like uterine pharynx is a sure sign of a woman who has given birth.

Causes of poor uterine contractions

Ways to accelerate uterine involution

After removing the placenta, a cold heating pad is placed on the mother’s stomach in the area of ​​the uterus to speed up the onset of contractions. The woman feels the contractions as unpleasant, but tolerable. aching pain lower abdomen. In some, very in rare cases pain when the uterus contracts so noticeable that it is necessary to administer intramuscular painkillers and antispasmodics.

In many maternity hospitals, women in labor are given injections of a hormone that accelerates the process of involution. Breastfeeding also has the same effect; when sucking, the concentration of oxytocin in a woman’s blood increases greatly and distinct twitching is felt in the muscles of the uterus.

It is also of great importance postpartum hygiene women: washing, treating wounds, timely changing pads - all this will protect against infections and prevent possible complications. Doctors also recommend wearing a special postpartum bandage and rehabilitation exercises.

A set of exercises to contract the uterus can be started the day after birth and continued for 10-12 weeks. It is important not to overdo it and exercise in a gentle manner.

Contraction of the uterus after caesarean section

The uterus of a woman who has undergone surgery, contracts much more slowly than after natural delivery.

First of all, this is due to a violation of the integrity of muscles, blood vessels and nerve endings. Also, the restoration of the uterus to its previous size is affected by time restrictions motor activity women in labor - for the first day they lie under IVs, and then when walking they experience pain and discomfort from a fresh stitch.

Wearing a postoperative bandage afterwards is a must!

When to sound the alarm

IN maternity hospital patients are under close attention of medical personnel. They are tested daily, examined and asked about their well-being.

It's a different matter after discharge. A new mother does not have time to listen to her body - it is completely absorbed in caring for the newborn. Therefore, you should know what is considered normal and when you should see a doctor.

The secreted uterine wound secretion (lochia) is bloody only for the first 3-5 days after birth, then it becomes serous and bloody, and by the end of the third week it becomes light and liquid. Normally, lochia stops after 40 days. If the discharge continues further, you need to visit a gynecologist.

Other extreme dangerous condition- started suddenly uterine bleeding- reason to call immediately ambulance! Reasons for similar phenomenon two:

• Pieces of the placenta remain in the uterine cavity, which is unlikely, since before discharge the woman in labor is examined again in a chair and/or a control ultrasound is performed;
• Hypotension – mild contractile activity uterine muscles (in the most severe cases - atony (muscle paralysis).

No need to self-medicate! Water pepper tincture for uterine contraction, nettle decoction is only an auxiliary remedy; our grandmothers used it to treat them when the level of medicine was extremely low.

In the hospital, hemostatic and contracting drugs will be prescribed; based on the results taken, antibiotics may also be prescribed; ultrasound diagnostics, and if necessary, scraping was done.

It is important to understand that a healthy uterus is a guarantee women's health and happy motherhood in the future!

Caesarean section is performed in cases where vaginal delivery is impossible or life-threatening for the mother or fetus. This is the most frequent operation in obstetrics. What should a woman who has undergone this intervention pay attention to so that the postoperative period goes well?

When is surgery required?

During a caesarean section, the wall of the uterus is cut. Indications for surgery can be on the part of the mother, when, due to a particular disease, childbirth poses a threat to her health, and on the part of the fetus, when the birth act is an unreasonable burden for him. More often, indications occur simultaneously on the part of the mother and on the part of the fetus.

Indications for surgery may occur during pregnancy (complete placenta previa, premature detachment a normally located placenta, failure of the uterine scar after a previous cesarean section or other operations on the uterus, narrow pelvis, severe forms toxicosis of the second half of pregnancy, serious illnesses mothers (heart defects, diabetes, high myopia), IVF, etc.). In such cases, a planned caesarean section is performed. It happens that indications for surgery arise during childbirth (weak labor that is not amenable to special treatment, acute fetal hypoxia, etc.), when it is performed.

What is the postpartum period?

The postpartum period is the period during which the reverse development of those organs and systems that have undergone changes due to pregnancy and childbirth ends. Usually this period, taking into account individual characteristics The course of pregnancy and childbirth lasts 6-8 weeks. An exception is the mammary glands, the function of which reaches its maximum development during the first days of the postpartum period and continues during lactation.

The main task of the postpartum period is the prevention of infectious complications in the woman and newborn. In this regard, especially important has the woman's observance of personal hygiene rules. Penetration of infection into the genital tract and mammary glands poses a great danger to the health of mother and baby.

Necessary measures after cesarean section

Immediately after the completion of the operation, the woman lower section place an ice pack on the abdomen for 2 hours better reduction uterus and prevention of bleeding from the uterus. She is transferred to the ward intensive care, where in the first 12-24 hours after surgery they monitor general condition, size and condition of the uterus, discharge from the genital tract, bladder function, pulse is measured, arterial pressure. Solutions that improve the condition of the blood are administered intravenously, depending on the amount of blood loss (for an uncomplicated operation it is 500-800 ml). If necessary, the woman in labor is transfused with blood components - red blood cells, fresh frozen plasma. The need for this is determined by the woman’s condition - the level of hemoglobin before and after surgery, the amount of blood loss, etc.

Painkillers are required. The frequency of their administration depends on the intensity of pain. Pain relief is usually needed for the first 1-3 days after surgery.

To prevent infectious complications, the woman is given antibiotics: during surgery, 12 and 24 hours after surgery. In cases of high risk of infectious complications (in the presence of chronic infectious diseases, tonsillitis, sinusitis, etc., poor results of vaginal smears) antibiotics are administered for 5-7 days.

After modern operations After a few hours, it is recommended to turn over in bed, move your arms and legs. You can sit down and walk around the ward after 5-6 hours. First time raising a woman in labor nurse intensive care wards.

12-24 hours after the operation, the woman is transferred to the postpartum ward.

The postoperative suture is examined by a doctor once a day. Every day, the nurse treats it with brilliant green or a manganese solution to remove possible bacteria that can cause inflammation, and seals it with a special sterile bandage. On the 5-7th day, the sutures are removed from the abdominal wall and an ultrasound is performed, which allows one to judge the size of the uterus, its cavity, its contents, and the condition of the sutures. After removing the sutures on the 5-7th day, they can continue to be treated with the same solutions and apply a sterile bandage at home until complete healing. Applying a bandage prevents friction between the seam and the laundry and ensures better healing. Solutions and sterile dressings are sold in pharmacies. When the scab (crust) on the postoperative suture has completely come off, you no longer need to wear the bandage. If pain or any discharge from the postoperative suture appears after being discharged home, especially if there is an increase in temperature, the woman should urgently consult a doctor.

The skin scar forms approximately on the 7th day after surgery; therefore, already a week after a caesarean section you can shower completely calmly. Just don’t rub the seam with a washcloth - this can be done in another week. For 7 days, until a skin scar has formed, you can use wet wipes or wash from the waist up, leaning over a bathtub or shower tray.

On the 7-10th day, the woman can be discharged home under the supervision of a doctor at the antenatal clinic.

The maternity hospital doctor pays special attention to the nature of discharge from the genital tract and changes in the size of the uterus. ( postpartum discharge) in the first 3 days they are bloody in nature, on the 4th-9th days they become serous-bloody (yellowish-brown), and from about the 10th day they take on the appearance of liquid light discharge. By the end of the 2nd week, the lochia becomes very scarce, and by the 6-8th week, discharge from the genital tract stops. During breastfeeding for the first time bloody issues may intensify.

It is necessary to wash the genitals warm water after each urination, move from front to back - from urethra and vagina to the rectum - to prevent intestinal bacteria from entering the urinary and birth canals. If not allergic reactions, can be used special means For intimate hygiene with antibacterial additives.

Problems of the postoperative period

Contraction of the uterus. The size of the uterus in the maternity hospital is measured every day, and by the 10th day after cesarean section its size is negligible more sizes uterus before pregnancy. In breastfeeding women, the size of the uterus normalizes faster.

Within a few days after birth, the uterus should normally decrease significantly in size. Such uterine contractions cause minor nagging pain lower abdomen, as during menstruation. Pain may intensify during breastfeeding, because... During feeding, the hormone oxytocin is produced, which promotes uterine contractions. But after surgical delivery, due to the presence of a suture, sometimes the uterus does not contract well enough. As a result, blood may accumulate in it and inflammation may begin and body temperature may rise. Contractions of the uterus can be painful and, just like with, intensify with feeding. In such cases, the woman receives painkillers and drugs that improve uterine contractions in the form of tablets or injections. The duration of such treatment is usually several days, and it depends on the condition of the individual woman. Treatment begins in conditions maternity hospital under the control of ultrasound of the uterus, it can be completed on an outpatient basis under the supervision of a doctor at the antenatal clinic. For better contraction of the uterus, it is advisable to periodically lie on your stomach, a light abdominal massage is useful, it is necessary to wear a bandage, regular bowel movements, it is also recommended to apply ice to the lower abdomen 3-5 times a day for 7-10 minutes.

Constipation. After a caesarean section there may be a decrease in normal function intestines - constipation.

On the 2nd day after the operation, a cleansing enema is given to stimulate intestinal activity and better contraction of the uterus, since after the operation the intestines are in a relaxed state, which contributes to the accumulation of gas and prevents the normal movement of food through the intestines.

A woman after a cesarean section is suitable for a diet that includes a large amount of fermented milk products with increased content bifidobacteria and lactobacilli (kefir, yogurt). Flour products(bread, pasta) in the diet should be reduced to a minimum. Raw vegetables and fruits are excluded, because... their use through breast milk can lead to severe gas formation and diarrhea in the child, as well as increased gas formation in the mother. Reasonable physical activity stimulates the intestines well. If bowel function does not return to normal, you should consult your doctor. Now you can buy it in pharmacies domestic drug Lactusan. It is approved for use in pregnant and lactating women. The principle of operation of Lactusan is to attract fluid into the intestinal lumen, due to which the stool softens and the process of defecation is facilitated. It also has the ability to normalize intestinal microflora and fight dysbiosis, which is especially important for women after cesarean section and the use of antibiotics.

Nutrition for women after a cesarean section, as well as after a normal birth, it should be high-calorie and varied and contain 2500-2800 kcal per day. Preference should be given to protein foods (meat, milk, kefir, etc.) as the main source for synthesizing the required amount of milk and restoring the body after pregnancy and childbirth.

You can drink on the first day after surgery mineral water without gas. On the second day you can eat broths, porridges, boiled meat, cookies, jam, cottage cheese, sour cream, and drink tea. From the third day, normal nutrition is possible with the exception of foods that are not recommended for breastfeeding (milk porridges, fruit jelly, vegetable broths and side dishes, steamed cutlets, boiled meat and fish, vegetables are recommended). It is necessary to exclude fatty, fried, smoked, salty, flour and sweet foods, soda, chips, hamburgers, etc. from your diet.

Abdominal muscle recovery. In the postpartum period, it is recommended to wear a special postoperative bandage, which helps better recovery stretched and weakened abdominal muscles.

After childbirth, for several weeks, even without special load, the muscles of the abdominal wall contract on their own. Immediately after a caesarean section, you can’t pump up your abs, because... The seams may come apart - you should wait 2 months. During this time, you can support the muscles by wearing a postpartum bandage for several hours a day. The bandage is worn as indicated for 1 month of the postoperative period or more. Start wearing postoperative bandage possible from the first days after surgery. Modern ones are made of elastic fabric that allows air to pass through. It can be worn over sterile dressing on the seam. The postpartum postoperative bandage provides support for the abdominal muscles, their fixation, exerting moderate pressure on them. adjustable pressure for faster reduction and restoration of their tone in the postoperative period, thereby ensuring normalization intra-abdominal pressure. The bandage protects against the development of hernias and their increase in size, stabilizes the position of the internal organs and the uterus, and provides the postpartum woman with more comfortable movements and walking. The bandage also secures sutures after a cesarean section and in postoperative period helps reduce pain in the postoperative suture area.

Lactation. Milk production after a cesarean section generally does not differ from that after a natural birth, except for the timing of the onset and establishment of lactation. After the operation, when pressure is applied to the nipple, colostrum begins to be released, then milk. There is little colostrum, but it is 10 times more nutritious than milk, so even a small amount of colostrum is enough to feed the baby in the very first days after birth.

Milk comes in the same way as after spontaneous birth, on the 3-10th day (usually after emergency operations carried out against the background of the onset of labor - a little earlier - on the 3-4th day, after planned operations- on the 5th-10th). After transfer to the postpartum department, the woman should wear a special bra to prevent excessive engorgement of the mammary glands. To prevent excessive engorgement caused by milk production, limit drinking to 800 ml per day. The first breastfeeding is possible already in the intensive care ward on the first day after surgery, if this is provided for by the conditions of the maternity hospital, or in the postpartum ward. The nipples should be carefully inspected to ensure there are no cracks on the surface.

The main condition for successful lactation, especially after surgical birth, is the woman’s presence in an atmosphere of complete psychological and physical peace and her correct attitude.

A woman after a caesarean section is given a large number of different medications. Despite the use of painkillers, antibiotics and other drugs that pass into milk, after a cesarean section, a woman can fully breastfeed her baby. In the postpartum period, drugs compatible with breastfeeding are used. The feeding schedule (on demand or by the hour) is determined by the conditions of the maternity hospital and the woman’s desire. But in each specific case, a woman should additionally check with her doctor about the possibility of such a combination.

The most comfortable position when feeding a child for a woman after a cesarean section in the first days after the operation is the position lying on her side, because. in this situation there is no impact on postoperative suture. In the future, during recovery after surgery, other postures are possible - standing, sitting.

If breastfeeding is impossible (if in serious condition mother or child) it is necessary to express milk according to the number of expected feedings.

After recovery

All women after a caesarean section with a scar on the uterus should be registered at the antenatal clinic immediately after discharge from the maternity hospital. Dispensary registration is regular preventive monitoring of a woman and identification of diseases or complications after surgery early stage, which allows for more timely and therefore effective treatment. Women should remain on it for at least 2 years after surgery, since it has been established that restoration of the full structure of the muscular layer of the uterus after a cesarean section occurs within 1-2 years. This is also done in order to diagnose earlier and begin treatment if disorders occur. menstrual cycle, inflammatory diseases genital area, adhesive process in the abdominal cavity, possible after a cesarean section, and for speedy recovery normal reproductive function.

Menstrual function after a cesarean section is not much different from that after a natural birth. In the case of full breastfeeding on demand more than 11-12 times a day (including night feedings), menstruation is absent for 6-12 months after birth. If for one reason or another there is no breastfeeding, then the first menstruation after surgery occurs approximately 8 weeks after birth.

For 1-2 years after caesarean section it is necessary reliable contraception. An abortion performed after surgery seriously worsens the prognosis for a planned second pregnancy.

Self-administration after a cesarean section is possible, but only in a certain group of women. This possibility depends primarily on the condition of the scar after a previous cesarean section, on the readiness of the birth canal for the passage of a child through it, on the experience of the maternity hospital doctors, the indications that led to the cesarean section, etc.

Ekaterina Venediktova
Obstetrician-gynecologist, City Clinical Hospital No. 67, Moscow

Discussion

Hi, I had spinal anesthesia CS + tube ligation, 4th child, CS for the first time/age 45 years, fetus 4500 kg. She endured the Caesarean with a bang, after that the stitch didn’t hurt at all, the ligated tubes inside hurt, it hurt, it burned, it was impossible to bend over. Dad helped with the child in the ward, she lay in bed for 2 days, on the third day they were discharged home, I live abroad, here, if there are no threats to the mother and child, you can even leave on the 2nd day and hire a nurse at home. Today we are 5 days old, we are already running!

06.26.2018 17:36:16, Mikael's Mom

I had a planned caesarean section, everything is exactly as in the article. The only thing I would add is possible problems after operation. This summer is very hot, a week after the CS I had bleeding, well, the doctor advised me by phone to put ice on my stomach at home and continue to inject oxytocin, because the uterus was not contracting well. Before this, I could not even imagine that hot weather would have such an impact on the body’s ability to recover.

07/28/2010 18:53:14, Irina, Ukraine

The article is good. I gave birth in 2004 and everything was the same as in the article: intensive care and antibiotics and careful sewing under the panties. But the article could also include a description of the difficulties in bearing the next child. Now I’m at 24 weeks, it looks like they’re going to have a cesarean section again, and I’m afraid whether my stitch will last until 40 weeks.

06.11.2008 19:10:49, Maria

for Maria 11.4.2008. I had a caesarean section in October 2007 at Maternity Hospital No. 29 in Moscow. He was recommended to us by many friends of friends. I entered there “by gravity”, when my water broke prematurely, they called an ambulance, paid and I was taken from the River Station to Aviamotornaya (maternity hospital at the Burdenko Institute) by ambulance. Everything went great!!! Just like in the article. And it’s also mandatory to stay together and breastfeed. Consider it as an option. By the way, I had spinal anesthesia - so the most an important event I never missed it in my life!!!

05/26/2008 19:27:11, Ekaterina

My vision is -4.5/-5 - I’m now 16 weeks - the ophthalmologist scheduled a second appointment at 7 months - he said we’ll see - most likely I’ll have a planned cesarean section
By the way, in light of the recent births of some of my friends, whose babies were almost killed during a normal birth, I’m even more inclined to undergo surgery.
Tell me who did a caesarean section not so long ago - where it was high quality and tell me a specific doctor based on personal experience
I would be very grateful and grateful. We ourselves live not far from Odintsovo, but I don’t even know about the local maternity hospital yet

04/11/2008 15:14:45, Maria

My little one is 7.5 months old. She only crawled to the floor above the baby on the third day. Everything is as in the article. I was discharged on the 9th day due to low hemoglobin (by the way, the transfused plasma did not help); a day later, the hemoglobin dropped to 74 (only meat in incredible quantities helps). Fed on special nursing pillow.

03/24/2008 11:19:38, Galina

I had two caesarean sections, in 2004 and in 2008 (that is, 1 month ago) and everything was exactly as written in this article, and ice on the stomach, and an intensive care ward - 12 hours, and antibiotics - 5 days, and reducing drugs ( oxytocin) - 7 days, and a cleansing enema, and daily treatment of the suture, and the diet in the maternity hospital is the same, and instructions from doctors at home for full recovery- absolutely the same!!!

03/13/2008 08:19:57, Inna

I had, in principle, everything the same as described in the article. But I’m interested in one question: Did the girls look at anyone in the chair after the CS?

She gave birth via cesarean section in 2007. Everything was as in the article. The baby was with me in the room. A huge plus was dad’s 24-hour stay with us in the ward))), I was able to lift and carry the baby on the 3rd day, before that I fed her reclining on the first day, then sat down, but with pain.... I advise everyone to involve dad.

12/13/2007 11:51:29, Natalia

The article is good, there are a lot of explanations on questions of interest, but at the same time I agree with Olga, it is impossible to feed while lying down due to pain, it was comfortable to lie only on your back and stomach (if you are comfortable). I also nurse mostly while sitting

12/10/2007 16:14:58, Nadyusha

Excellent article! I received answers to the questions I was interested in. I had everything like that, but I was interested in the question about the restoration of menstruation, thanks for the explanation.

20.11.2007 22:36:39, Oksana

It is impossible to feed after a caesarean section while lying down, because... the seam hurts. I could only lie down for 5 days on my back. She nursed while sitting on a high bed, placing a pillow on her knees and the baby on it.

09.19.2007 23:20:27, Olga

no ice, no care. Orenburg immediately allowed me to call my mother, or rather they advised me since there was no one to take care of me. Thanks to the anesthesiologist, he helped me get to the room and onto the bed. Can you imagine they asked me, after spinal anesthesia, to get down onto the bed myself. And then, thank God, my mother, mother-in-law and husband took turns for 12 hours and so on for ten days. On the last day, the stitches were removed and an ultrasound scan was performed on the stitch. and my SON AND I WENT HOME. that was 1 year ago, but since then I almost hate doctors

08/17/2007 20:57:19, Galina