Childbirth through caesarean section - indications and types, preparation for surgery, conduct and postoperative care. Planned caesarean section terms, duration and course of the operation

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All recommendations are indicative and are not applicable without consulting the attending physician.

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

AT recent times the number of unjustified childbirth operations has increased, among the leaders in their implementation is Brazil, where almost half of the women do not want to give birth on their own, preferring abdominoplasty.

The undoubted advantages of operative delivery are considered to be the ability to save the life of both the child and the mother in cases where natural childbirth poses a real threat or is impossible for a number of obstetric reasons, the absence of perineal tears, more low frequency hemorrhoids and uterine prolapse afterwards.

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

When is a transsection necessary?

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

The reasons for planning a caesarean section arise in the process of bearing a fetus or when childbirth has already begun. Women are scheduled for elective surgery indications:

Emergency abdominal surgery is performed with obstetric bleeding, placenta previa or abruption, probable or incipient rupture of the fetus, acute fetal hypoxia, agony or sudden death of a pregnant woman with a living child, severe pathology of other organs with a deterioration in the patient's condition.

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

1. Pathology of uterine contractility, not responding to conservative treatment- weakness of tribal forces, discoordinated contractility;
2. Clinically narrow pelvis - its anatomical dimensions allow the fetus to pass the birth canal, and other reasons make this impossible;
3. Prolapse of the umbilical cord or parts of the child's body;
4. Threat or progressive uterine rupture;
5. Foot presentation.

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

Relative readings severe myopia, kidney pathology, diabetes mellitus, sexually transmitted infections in the acute stage, the age of the pregnant woman over 35 years in the presence of abnormalities during pregnancy or fetal development, etc.

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

For surgical delivery there are contraindications, however, their list is much less than the testimony. The operation is considered unjustified in case of fetal death in the womb, fatal malformations, as well as hypoxia, when there is confidence that the child can be born alive, but there are no absolute indications from the pregnant woman. If the mother is in a life-threatening condition, the operation will be carried out one way or another, and contraindications will not be taken into account.

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

Varieties of abdominal surgery

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

Vaginal access is fraught with complications, is technically difficult and is not suitable for delivery after 22 weeks of pregnancy in the case of a live fetus, so it is now practically not used. Viable babies are removed from the uterus only by laparotomy. If the gestational age did not exceed 22 weeks, then the operation will be called small caesarean section. It is necessary for medical reasons- severe defects, genetic mutations, threat to the life of the expectant mother.

incision options for CS

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

• Corporal caesarean section - median incision of the uterine wall;
• Isthmicocorporal - the incision goes lower, starting from the lower segment of the organ;
• In the lower segment - across the uterus, with / without detachment of the wall Bladder.

An indispensable condition for surgical delivery is a live and viable fetus. In case of intrauterine death or defects that are not compatible with life, a caesarean section will be done in case of a high risk of death for a pregnant woman.

Preparation and methods of anesthesia

Features of preparation for operative delivery depend on whether it will be planned or according to emergency indications.

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

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

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

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

The method of anesthesia depends on the specific situation, the preparedness of the anesthesiologist and the desire of the patient, if it does not run counter to common sense. One of the best ways to anesthetize a caesarean section can be considered regional anesthesia.

Unlike most other operations, during caesarean section, the doctor takes into account not only the need for pain relief as such, but also the possible adverse effects of the introduction of drugs for the fetus, so spinal anesthesia is considered optimal, excluding toxic effect drugs for anesthesia for the baby.

spinal anesthesia

However, it is not always possible to perform spinal anesthesia, and in these cases, obstetricians go to the operation under general anesthesia. AT without fail prevention of reflux of gastric contents into the trachea (ranitidine, sodium citrate, cerucal) is carried out. The need to cut the tissues of the abdomen requires the use of muscle relaxants and a ventilator.

Since the operation of abdominal surgery is accompanied by a rather large blood loss, then preparatory stage it is advisable to take blood from the pregnant woman in advance and prepare plasma from it, and return the red blood cells back. If necessary, the woman will receive a transfusion of her own frozen plasma.

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

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

Anesthesia for caesarean section carries certain risks. In obstetrics, as before, the bulk of deaths during surgical interventions occur precisely during this operation, and in more than 70% of cases, the ingestion of the contents of the stomach into the trachea and bronchi, difficulties with the introduction of an endotracheal tube, and the development of inflammation in the lungs are to blame.

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

caesarean section technique

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

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

It should be noted that the direction of the abdominal tissue incision does not always and does not necessarily coincide with the dissection of the uterine wall. So, with a lower median laparotomy, the uterus can be opened in any way, and the Pfannenstiel incision suggests an isthmic-corporal or corporal ventricular surgery. by the most in a simple way Inferior median laparotomy is considered to be preferable for corporal section, transverse incision in the lower segment is more conveniently performed through the Pfannenstiel or Joel-Cohen approach.

Corporal caesarean section (CCS)

Corporal caesarean section is rarely performed when there are:

• Severe adhesive disease, in which the path to the lower segment is impossible;
• Varicose veins in the lower segment;
• The need for extirpation of the uterus after removing the child;
• An inconsistent scar after a previous corporal ventricular surgery;
• prematurity;
• conjoined twins;
• A living fetus in a dying woman;
• The transverse position of the child, which cannot be changed.

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

uterine suture for corporal CS

The second caesarean section must be carried out very carefully because of the risk of damage to the intestines, bladder. In addition, the already existing scar may not be dense enough to hold the integrity of the organ, which is dangerous for uterine rupture. The second and subsequent abdominal surgeries are often performed on the finished scar with its subsequent removal, and the rest of the operation is standard.

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

To accelerate the contraction of the uterus and the evacuation of the afterbirth, the appointment of oxytocin in a vein or muscle is indicated, and to prevent infectious complications, broad-spectrum antibiotics are used intravenously.

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

After extraction of the fetus and suturing of the uterus, an examination of the appendages, appendix and adjacent organs of the abdomen is mandatory. When the abdominal cavity is washed out, the uterus has contracted and become dense, the surgeon sutures the incisions in layers.

Isthmicocorporal caesarean section

Isthmicorporal ventricular surgery is carried out according to the same principles as KKS, with the only difference being that before opening the uterus, the surgeon cuts transversely the peritoneal fold between the bladder and uterus, and pushes the bladder down. The uterus is dissected 12 cm in length, the incision goes longitudinally in the middle of the organ above the bladder.

Incision in the lower uterine segment

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

incision technique in the lower uterine segment

The incision of the skin and soft tissues is arched across over the pubic articulation. Slightly above the skin incision, the aponeurosis is opened, after which it exfoliates from the muscle bundles down to the pubic symphysis and up to the navel. The rectus abdominis muscles are spread apart with the fingers.

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

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

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

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

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

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

In recent years, the method of abdominal dissection in the lower segment without peeling the bladder through the Joel-Cohen incision has gained popularity. It has many advantages:

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

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

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

Recovery after abdominal surgery and possible consequences of the operation

If the delivery took place under conditions of spinal anesthesia, the mother is conscious and feels well, the newborn is applied to her breast for 7-10 minutes. This moment is extremely important for the formation of a subsequent close emotional connection between mother and baby. The exceptions are severely premature infants and those born in asphyxia.

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

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

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

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

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

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

seam after caesarean section

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

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

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

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

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

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

A caesarean section is performed in every maternity hospital, and, according to indications, free of charge, and the quality of treatment and observation does not always depend on financial costs. So, a free operation can go quite well, and a pre-planned and paid one can lead to complications. No wonder they say that childbirth is a lottery, so it is impossible to guess their course in advance, and expectant mothers can only hope for the best and prepare for a successful meeting with a little person.

Video: Dr. Komarovsky about caesarean section

K-section suggests surgical intervention- an incision in the mother's abdomen and uterus, allowing the newborn to be taken directly from the uterus without passing through the birth canal.
Most often, a caesarean section is done in the case of a previous birth by caesarean section or when, in the opinion of the obstetrician, a vaginal delivery is dangerous for the baby's health. Usually, the obstetrician performs an emergency caesarean section when the fetal heart rate is severely reduced or irregular, and the fetus is not in danger of continuing a normal birth.
If the fetus is in breech position (buttocks or legs forward), a caesarean section is also recommended as the best way childbirth. With the breech presentation of the fetus, vaginal delivery is difficult and the likelihood of complications increases. In most cases, the fetus is head down, but in three out of a hundred newborns, the buttocks or legs come out first at birth, and sometimes both together (breech presentation). The doctor determines the position of the fetus by palpation of certain areas of the lower abdomen of the mother; to confirm the breech presentation can be assigned ultrasound procedure or other tests.
The process of childbirth by caesarean section is significantly different from vaginal delivery. Firstly, the whole operation takes no more than an hour, and depending on the circumstances, you may not feel labor pains at all. Important difference is the need to use drugs that affect both the mother and the child. When choosing anesthesia, most women in labor prefer regional (local) anesthesia. Here, an injection of an anesthetic into the back causes an epidural, or spinal, blockade of the nerve pathways, resulting in no pain being felt. With regional anesthesia, the lower part of the body becomes numb. She has relatively few side effects and allows you to monitor the process of childbirth. But sometimes, especially when
emergency K-section, general anesthesia is required, in which the woman in labor is unconscious. With the current level of development of medicine and as a result of the examination, the obstetrician and anesthetist will tell you the best choice.
Because of the effects of anesthesia, infants born by caesarean section sometimes have difficulty breathing and require extra help. A caesarean section is usually attended by a pediatrician or other doctor familiar with newborns. Immediately after birth, they examine the baby and, if necessary, provide assistance to him.
If you were conscious during the operation, you will be able to see your child immediately after they are examined and declared healthy. Then he will be taken to the children's ward, where he will spend several hours in an airtight bed with controlled air temperature. This allows doctors to watch him while the anesthesia wears off and he adapts to his new environment.
When using general anesthesia, you may sleep for several hours and wake up with a heavy head and confusion. In addition, you may feel pain at the incision site. But pretty soon you'll be able to pick up your baby and quickly make up for lost time.

Even if you have seen photos of newborns, the first look at your own child will undoubtedly amaze you.

K-section babies may look more "pretty" than those born by vaginal delivery because they don't have to squeeze through the birth canal. As a result, their head does not become elongated, but retains its rounded shape.
Don't be surprised if, for six to twelve hours after birth, the baby is still affected by anesthesia and looks a little sleepy. If you are going to breastfeed him, try to do it as soon as he comes to his senses. Even if the baby is sleepy, the first feeding will push him to wake up and face the new world - and you.
As already mentioned, many obstetricians believe that in women who have given birth using a K-section, all subsequent births should proceed in a similar way. If you are a future father, discuss your role and presence in the delivery room and how best to support your partner during labour.

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

Up to 25% of children are born by caesarean section. However, according to the World Health Organization, a share of 10-15% is considered optimal. Surgical births should only be performed as a last resort if the mother is unable to give birth naturally for health reasons.

A caesarean section is surgery during which the baby is born through an incision in the abdominal cavity mother. In recent years, there has been an increasing number of women who are unable to give birth naturally due to health reasons, age, or an abnormal fetus. In such situations, traditional births are considered risky, as they can cause irreparable harm to the health of the mother and child. Therefore, doctors insist on a caesarean section.

At first glance, operative delivery appears to be safe and easy way the birth of a child, since the woman does not have to go through painful contractions and attempts, and the baby through the birth canal.

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

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

But with more detailed study many serious shortcomings can be considered in operational childbirth, because of which it is desirable to limit the number of operations performed to a minimum, leaving only situations where natural childbirth is unsafe or impossible.

A caesarean section increases the chance of problems with anesthesia, bleeding, and infections. In addition, the woman is hospitalized for a longer period. Due to the long rehabilitation after surgery, the appointment of antibiotics and analgesics, lactation and subsequent breast-feeding child. In addition, a young mother will not be able to immediately start caring for a baby who needs it so much.

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

How is a cesarean section performed?

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

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

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

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

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

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

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

Arguments for"

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

Arguments against"

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

A caesarean section has its pros and cons, but at the same time, the advantage in the direction of the minuses is greater. If a woman wants to have more children in the future, take care of them from the first days of birth and practice breastfeeding, you need to inform the doctor about this. In such a situation, in the absence of absolute medical indications, you can try natural childbirth.

It is believed that the name of the operation is associated with the name of the Roman emperor Gaius Julius Caesar, whose mother died during childbirth, and he was removed from her womb by means of surgical intervention. There is evidence that under Caesar a law was passed indicating that in the event of the death of a woman in childbirth, an attempt must be made to save the child by dissecting the abdominal wall and uterus with the extraction of the fetus. Long time caesarean section was performed only when the mother died during childbirth. And only in the XVI century there were reports of the first cases when the operation allowed not only the child, but also the mother to survive.

When is the operation performed?

In many cases, a caesarean section is performed in absolute terms. These are conditions or diseases that are mortal danger for the life of mother and child, for example placenta previa- a situation where the placenta closes the exit from the uterus. Most often, this condition occurs in multi-pregnant women, especially after previous abortions or postpartum diseases. In these cases, during childbirth or in the last stages of pregnancy, bright bloody discharge appears from the genital tract, which is not accompanied by pain and is most often observed at night. The location of the placenta in the uterus is clarified by ultrasound. Pregnant women with placenta previa are observed and treated only in an obstetric hospital.

Absolute indications also include:

Premature detachment of a normally located placenta. Normally, the placenta separates from the uterine wall only after the baby is born. If the placenta or a significant part of it is separated before the birth of the child, then there are sharp pains in the abdomen, which can be accompanied by severe bleeding and even the development of a state of shock. At the same time, the supply of oxygen to the fetus is sharply disrupted, it is necessary to urgently take measures to save the life of the mother and baby.

Transverse position of the fetus. A child can be born through the natural birth canal if it is in a longitudinal (parallel to the axis of the uterus) position with the head or pelvic end down to the entrance to the pelvis. The transverse position of the fetus is more common in multiparous women due to a decrease in the tone of the uterus and the anterior abdominal wall, with polyhydramnios, placenta previa. Usually, with the onset of labor, the fetus spontaneously rotates into the correct longitudinal position. If this does not happen and external methods fail to turn the fetus into a longitudinal position, and if the waters break, then childbirth through the natural birth canal is impossible.

Cord prolapse. This situation occurs during the outflow of amniotic fluid with polyhydramnios in cases where the head is not inserted into the pelvic inlet for a long time (narrow pelvis, large fetus). With the flow of water, the loop of the umbilical cord slips into the vagina and may even be outside the genital gap, especially if the umbilical cord is long. There is a compression of the umbilical cord between the walls of the pelvis and the head of the fetus, which leads to impaired blood circulation between the mother and fetus. In order to timely diagnose such a complication, after the outflow of amniotic fluid, a vaginal examination is performed.

Preeclampsia. This is a serious complication of the second half of pregnancy, manifested by high blood pressure, the appearance of protein in the urine, edema, there may be a headache, blurred vision in the form of flashing "flies" before the eyes, pain in the upper abdomen and even convulsions, which requires immediate delivery, since both the mother's condition and the condition suffer from this complication fetus.

However, most operations are according to relative indications- such clinical situations in which the birth of the fetus through the natural birth canal is associated with a significantly greater risk to the mother and fetus than with a caesarean section, as well as by combination of indications- a combination of several complications of pregnancy or childbirth, which individually may not be significant, but in general pose a threat to the condition of the fetus during vaginal delivery. An example is breech presentation fetus. Births in the breech presentation are pathological, because. there is a high risk of injury and oxygen starvation of the fetus during childbirth through the natural birth canal. The likelihood of these complications increases especially when the breech presentation of the fetus is combined with its large size (more than 3600 g), overwearing, excessive extension of the head of the fetus, with anatomical narrowing of the pelvis.

Age of nulliparous over 30 years. Age alone is not an indication for caesarean section, but is common in this age group. gynecological pathology - chronic diseases genital organs, leading to long-term infertility, miscarriage. Non-gynecological diseases are accumulating - hypertension, diabetes mellitus, obesity, heart disease. Pregnancy and childbirth in such patients occur with a large number of complications, with a high risk for the child and mother. The indications for caesarean section in women of late reproductive age with breech presentation of the fetus, chronic fetal hypoxia are expanding.

Scar on the uterus. It remains after the removal of fibroids or suturing the uterine wall after perforation during an artificial abortion, after a previous caesarean section. Previously, this indication had an absolute character, but now it is taken into account only in cases of an inferior scar on the uterus, in the presence of two or more scars on the uterus after cesarean section, reconstructive operations for uterine defects, and in some other cases. Clarify the condition of the scar on the uterus allows ultrasound diagnostics, the study must be carried out from 36-37 weeks of pregnancy. At the present stage, the technique of performing the operation using high-quality suture material contributes to the formation of a wealthy scar on the uterus and gives a chance for subsequent births through the natural birth canal.

Allocate also indications for caesarean section during pregnancy and childbirth.

According to the urgency of performing a caesarean section, it can be planned and emergency. Caesarean section during pregnancy is usually carried out in a planned manner, less often in emergency cases (bleeding with placenta previa or premature detachment of a normally located placenta and other situations).

A planned operation allows you to prepare, decide on the technique of its implementation, anesthesia, as well as carefully assess the state of a woman’s health, and, if necessary, conduct corrective therapy. In childbirth, a caesarean section is performed according to emergency indications.

Clinically narrow pelvis. This complication occurs during childbirth when the size of the fetal head exceeds the internal size of the mother's pelvis. The complication is manifested by the lack of progressive advancement of the fetal head through the birth canal with full disclosure of the cervix, despite vigorous labor activity. In this case, there may be a threat of uterine rupture, acute fetal hypoxia (oxygen starvation), and even his death. Such a complication can occur both with an anatomically narrow pelvis, and with normal pelvic sizes, if the fetus is large, especially when overextended, with incorrect insertion of the fetal head. In advance, correctly assess the size of the mother's pelvis and the size of the fetal head allow additional research methods: ultrasound diagnostics and X-ray pelvimetry (the study of the radiograph of the pelvic bones), which allow predicting the outcome of childbirth. With significant degrees of narrowing of the pelvis, it is considered absolutely narrow and is an absolute indication for caesarean section, as well as in the presence of bone tumors, gross deformities in the small pelvis, which are an obstacle to the passage of the fetus. Diagnosed during childbirth during vaginal examination, incorrect insertion of the head (frontal, facial) is also an absolute indication for caesarean section. In these cases, the fetal head is inserted into the pelvis with its largest size, significantly exceeding the size of the pelvis, and childbirth cannot occur.

Acute fetal hypoxia(oxygen starvation). This condition occurs due to insufficient oxygen supply to the fetus through the placenta and umbilical cord vessels. The reasons can be very diverse: placental abruption, prolapse of the umbilical cord, prolonged labor, excessive labor activity, etc. Diagnose threatening state fetus along with auscultation (listening) with an obstetric stethoscope help modern methods diagnostics: cardiotocography (registration of fetal heartbeats using a special apparatus), ultrasound with dopplerometry (study of blood flow through the vessels of the placenta, fetus, uterus), amnioscopy (examination of amniotic fluid, carried out using a special optical device inserted into the cervical canal with a whole fetal bladder). If signs of threatening fetal hypoxia are detected and there is no effect from the treatment, an urgent surgical intervention is performed.

Weak labor activity. The complication is characterized by the fact that the frequency, intensity and duration of contractions is insufficient to complete the birth naturally, despite the use of corrective drug therapy. As a result, there is no progress in dilating the cervix and moving the presenting part of the fetus along birth canal. Childbirth can take a protracted nature, there is a risk of infection with an increase in the anhydrous gap and fetal hypoxia.

Operation progress

The incision of the anterior abdominal wall is carried out, as a rule, in the transverse direction above the pubis. In this place, the layer of subcutaneous adipose tissue is less pronounced, wound healing is better with a minimal risk of postoperative hernia formation, patients are more active after surgery, get up earlier. The aesthetic side is also taken into account, when a small, almost imperceptible scar remains in the pubic area. A longitudinal incision between the pubis and the navel is performed if there was already a longitudinal scar on the anterior abdominal wall after a previous operation, or with massive blood loss, when examination is required upper division abdomen, with an unclear volume of the operation with a possible extension of the incision upwards.

The opening of the uterus is performed in its lower segment in the transverse direction, On later dates During pregnancy, the isthmus (the part of the uterus between the cervix and the body) increases significantly in size, forming the lower segment of the uterus. The muscle layers and blood vessels here are located in a horizontal direction, the wall thickness of the lower segment is much less compared to the body of the uterus. Therefore, the opening of the uterus in the transverse direction in this place along the vessels and muscle bundles occurs almost bloodlessly. It is extremely rare to resort to the longitudinal method of opening the uterus in its body in cases where access to the lower segment of the uterus is difficult, for example, due to scars after previous operations, or it becomes necessary to remove it after a caesarean section. This access was practiced earlier, it is accompanied by increased bleeding due to the intersection of a large number of blood vessels and the formation of a less complete scar, as well as a large number of postoperative complications.

The fetus is removed by the head or by the pelvic end (by the inguinal fold or by the leg) with the fetus in the pelvic position, the umbilical cord is crossed between the clamps, and the child is transferred to the midwife and neonatologist. After removing the child, the afterbirth is removed.

The incision on the uterus is sutured, while ensuring the correct matching of the edges of the wound with minimal use of suture material. For suturing, modern synthetic absorbable threads are used, which are sterile, durable, and do not cause allergic reactions. All this contributes to the optimal healing process and the formation of a rich scar on the uterus, which is extremely important for subsequent pregnancies and childbirth.

When suturing the anterior abdominal wall, separate sutures or surgical brackets are usually applied to the skin. Sometimes an intradermal “cosmetic” suture is used with absorbable sutures, in this case there are no external removable sutures.

Complications of caesarean section and their prevention

A caesarean section is a serious abdominal operation and, like any surgical intervention, should be performed only if there is evidence, but not at the request of the woman. Before the operation, the volume of the planned operation and possible complications are discussed with the pregnant woman (parturient woman). The written consent of the patient is required for the operation. In vital conditions - for example, if a woman is unconscious - the operation is performed according to health reasons or with the consent of relatives, if they accompany her.

And although caesarean section at the present stage is considered a reliable and safe operation, surgical complications are possible: injury to blood vessels due to an extended incision in the uterus and associated bleeding; injury to the bladder and intestines (more common with repeated entries due to adhesions), injury to the fetus. There are complications associated with anesthetic management. In the postoperative period, there is a risk of uterine bleeding due to impaired uterine contractility caused by surgical trauma and action drugs. In connection with a change in the physicochemical properties of blood, an increase in its viscosity, the formation of blood clots and blockage of various vessels by them is possible.

Purulent-septic complications during caesarean section are more common than after vaginal delivery. Prevention of these complications begins even during the operation with the introduction of highly effective broad-spectrum antibiotics immediately after cutting the umbilical cord in order to reduce their negative impact on the child. In the future, if necessary, antibiotic therapy continues in the postoperative period with a short course. The most common are wound infection (suppuration and divergence of the sutures of the anterior abdominal wall), endometritis (inflammation of the inner lining of the uterus), adnexitis (inflammation of the appendages), parametritis (inflammation of the periuterine tissue).

Before and after surgery

The very procedure of preparation for surgery, as well as the postoperative period, promises some discomfort, some restrictions, will require effort, work on oneself.

During a planned operation the night before and 2 hours before the operation, a cleansing enema is done, which will be repeated again on the 2nd day after the operation in order to activate intestinal motility (motor activity). Taking tranquilizers at night, which the doctor will prescribe, helps to cope with excitement and fear. Immediately before the operation, a urinary catheter is placed, which will remain in the bladder for a day.

After abdominal delivery, a woman is both a puerperal and a postoperative patient. During the first day, she will be in the intensive care unit under the close supervision of an anesthesiologist and an obstetrician-gynecologist. Possible discomfort during exit from general anesthesia: sore throat, nausea, vomiting, - after epidural anesthesia, there may be dizziness, headache, back pain. Within 2-3 days after the operation, infusion therapy is carried out by intravenous infusion of solutions in order to compensate for blood loss, which during the operation is 600-800 ml, i.e. 2-3 times more than with vaginal delivery. The surgical wound will be a source of pain in the area of ​​​​the sutures and in the lower abdomen, which will require the introduction of painkillers.

In order to prevent postoperative complications, early rising is practiced after 10-12 hours, breathing exercises and self-massage 6 hours after the operation. Compliance with the diet is mandatory for the first 3 days. In the first day it is recommended to starve, you can drink mineral water without gases, tea without sugar with lemon in small portions. On the second day, a low-calorie diet is observed: meat broth, liquid cereals, jelly. To normal diet you can return after the activation of intestinal motility and independent stool. You will have to come to terms with some restrictions on the hygiene plan: washing the body in parts is carried out from the 2nd day, it will be possible to take a full shower after removing the stitches on the 5th-7th day and discharge from the maternity hospital (usually on the 7th-8th day after operation). gradual recovery muscle tissue in the area of ​​the scar on the uterus occurs within 1-2 years after the operation.

A woman may have to face some of the difficulties in breastfeeding, which are more common after a planned caesarean section. Surgical stress, blood loss, late attachment of the child to the breast due to impaired adaptation or drowsiness of the newborn are the cause of late lactation; in addition, it is difficult for a young mother to find a position for feeding.

If she is sitting, then the baby presses on the seam, but this problem can be dealt with by using the prone position for feeding.

During delivery by caesarean section, the process of launching adaptive mechanisms that ensure the transition of the newborn to extrauterine existence is disrupted. Respiratory disorders in the newborn occur much more often with a planned caesarean section performed before the onset of labor than with vaginal delivery and caesarean section in childbirth. Therefore, a planned caesarean section should be performed as close as possible to the date of the expected birth.

After a caesarean section, the child's heart functions differently, the level of glucose and the level of hormones that regulate the activity of the thyroid gland are lower, in the first 1.5 hours the body temperature is usually lower. Lethargy increases, muscle tone and physiological reflexes decrease, healing of the umbilical wound is sluggish, the immune system works worse, But at present, medicine has all the necessary resources in order to minimize the difficulties experienced by the baby. Usually, by the time of discharge, the indicators of the physical development of the newborn return to normal, and after a month the baby is no different from children born through the natural birth canal.

Cesarean section: choice of anesthesia

In modern obstetrics, the following types of anesthesia are used for caesarean section: regional (epidural, slenic) and general (intravenous, mask and endotracheal anesthesia). The most popular is regional anesthesia, because. with it, the woman remains conscious during the operation, which ensures early contact with the child in the first minutes of life. There is a good condition of the newborn, because. he is less susceptible to the influence of drugs that depress his vital functions. With spinal anesthesia, an anesthetic drug is injected through a thin tube-catheter directly into the spinal canal, and with epidural anesthesia it is injected more superficially under the hard meninges thus blocking pain sensitivity and motor nerves that control the muscles of the lower body (during the action of anesthesia, a woman cannot move her legs). With general anesthesia, as a rule, endotracheal anesthesia is used. An anesthetic drug is administered intravenously, and as soon as the muscles relax, a tube is inserted into the trachea, and artificial ventilation is performed. This type of anesthesia is more often used in emergency operations.

A caesarean section is a surgical procedure that removes the baby through an incision in the abdomen rather than through the vagina. Recently, about 30% of births occur by caesarean section. In some cases, this is done as planned due to pregnancy complications or because the woman has already had a caesarean section. Some women prefer a caesarean section to a conventional birth. However, in many cases, the need for a caesarean section becomes apparent only during childbirth.

Knowing what to expect will help you better prepare if surgery is needed.

A caesarean section is a surgical procedure to remove a baby from the mother's womb. In this case, he is not born naturally, but takes his first look at the world through the incision that is made when the uterus is opened. In Germany, every year, 20 to 30 percent of children are born by caesarean section.

Indications for caesarean section

Indications for caesarean section can be absolute and relative. But for the most part, the decision to have surgery stems from many factors at once, such as a combination of medical assessments by the doctor and midwife, and personal wishes on the part of the woman in labor. Fortunately, pregnant women have enough time to think things over and understand exactly how they would like to give birth. Emergencies when a caesarean section becomes inevitable is rare.

If you decide to have a caesarean section, you must confirm your consent to the operation in writing. But first, the doctor will give you the most detailed explanations. During this conversation, you should discuss in detail all possible risks to make you really feel well prepared. So don't hesitate to ask if you don't understand something.

Medical indications for a caesarean section include:

• transverse or pelvic presentation of the child;
• placenta previa;
• maternal pelvis size mismatch
• the size of the child;
• severe illness of the mother;
• the threat of hypoxia of the child;
• premature birth;
• developmental pathology of the child.

Partial anesthesia for caesarean section

Currently local anesthesia is the universally accepted standard. The operation is performed under spinal anesthesia or in a planned caesarean section with epidural-spinal anesthesia (see page 300). General anesthesia is recommended only in cases where other anesthesia is not possible for medical reasons.

When is a cesarean section done?

There are many reasons why a caesarean section is done. Sometimes this is due to the health of the mother, sometimes with fears for the child. Sometimes surgery is done even if both mother and child are fine. This is a cesarean by choice, and the attitude towards it is ambiguous.

The birth is not going well. One of the main reasons why a caesarean section is done is that labor does not go well - it stops too slowly or stops altogether. The reasons for this are manifold. The uterus may not contract forcefully enough to fully dilate the cervix.

The child's heart is broken. In most cases, the baby's heart rate allows you to expect a successful outcome of childbirth. But sometimes it becomes obvious that the child does not have enough oxygen. If there are such problems, the doctor may recommend a caesarean section.

Heart problems can occur if the baby is not getting enough oxygen, the umbilical cord is clamped, or the placenta is not functioning well. Occasionally, heart rhythm disturbances occur, but nothing indicates real danger for a child. In other cases, a serious danger is obvious. One of the most difficult decisions for doctors is deciding how big this danger is. The doctor can try different methods, for example, massage the head, and see if the work of the heart improves.

The decision to have a caesarean depends on many factors, such as how long the birth will continue or how likely there are other complications besides heart failure.

The unfortunate position of the child. If the baby enters the birth canal with the legs or buttocks forward, this is called a breech presentation. Most of these babies are born by caesarean section, because conventional births are more likely to have complications. Sometimes the doctor is able to move the baby into the correct position by pushing it through the abdomen before labor begins, thereby avoiding surgery. If the baby lies horizontally, this is called a transverse presentation and is also an indication for a caesarean section.

The baby's head is in the wrong position. Ideally, the baby's chin should be pressed against the chest so that the part of the head that has the smallest diameter is in front. If the chin is raised or the head is turned so that the smallest diameter is not in front, the larger diameter of the head should pass through your pelvis. Some women do not have any problems in this case, but others may have difficulties.

Before having a caesarean, your doctor may ask you to get on all fours - in this position, the uterus drops forward and the baby may turn. Sometimes the doctor may be able to turn the glans during a vaginal examination or with forceps.

You have serious health problems. A caesarean section can be done if you have diabetes, diseased heart, lungs or high blood pressure. With such diseases, a situation may arise when it is preferable to give birth to a child for more early stage pregnancy. If induction of labor fails, a caesarean section may be necessary. If you have serious health problems, discuss your outlook with your doctor well in advance of your pregnancy.

Rarely, a caesarean section is done to prevent the baby from contracting a herpes infection. If a mother has herpes in her genitals, it can be passed on to a newborn baby and cause serious illness. Caesarean section avoids this complication.

You have a multiple pregnancy. Approximately half of twins are born by caesarean section. Twins can also be born in the usual way, depending on the weight, position and gestational age. Triplets and more are a different story. Most triplets are delivered by caesarean section.

Every multiple pregnancy is unique. If this is your case, discuss the prospects for childbirth with your doctor and decide together what is best for you. Remember that everything is changeable. Even if both babies are head first, the situation may change after the first is born.

There are problems with the placenta. In two cases, a caesarean is necessary: ​​placental abruption and placenta previa.

Placental abruption occurs when the placenta separates from the wall of the uterus before labor begins. This can pose a threat to the life of both you and the child. If the electronic monitoring shows that there is no immediate danger to the baby, you will be admitted to the hospital and will be closely monitored. If the baby is in danger, an urgent delivery is necessary and a caesarean section will be used.

The placenta cannot be born first, because then the child will lose access to oxygen. Therefore, almost always a caesarean is done.

There are problems with the umbilical cord. When the water has broken, the cord can slip out of the cervix before the baby is born. This is called cord prolapse and is very dangerous for the baby. As the baby squeezes through the cervix, pressure on the umbilical cord can cut off oxygen. If the umbilical cord slips out when the cervix is ​​fully dilated and labor has already begun, you can give birth normally. Otherwise, only a caesarean section can save the situation.

Also, if the umbilical cord is wrapped around the baby's neck or is between the head and pelvic bones if water is out, each contraction of the uterus will compress the umbilical cord, slowing down blood flow and reducing oxygen supply to the baby. In these cases, a caesarean section is the best option, especially if the umbilical cord is compressed for a long time or very hard. This is common cause heart problems, but it is usually impossible to know for sure where the umbilical cord is located before labor begins.

The child is very big. Sometimes the baby is too big to be successfully born in the usual way. The size of the baby can be a problem if you have an abnormally narrow pelvis that the head cannot pass through. Occasionally, this may be a consequence of a pelvic fracture or other deformities.

If you develop diabetes during pregnancy, your baby may gain a lot of weight. If the baby is too large, a caesarean section is preferable.

Child health problems. If a defect such as spina bifida is diagnosed in a child in the mother's womb, the doctor may recommend a caesarean section. Discuss the situation in detail with your doctor.

You've already had a cesarean. If you've had a caesarean before, you may need to do it again. But this is optional. Sometimes, after a caesarean section, a normal birth is possible.

How is a caesarean section

Before a planned caesarean section, the gynecologist or anesthesiologist will tell you in advance about the operation and methods of anesthesia. If you don't understand something, please clarify and ask again! On the appointed day, you must arrive at the hospital in advance. It is best to refrain from eating: you cannot eat for six hours before the operation.

First of all, the doctor and midwife will check your baby's condition with the help of ultrasound and CTG. Take this opportunity to express your wishes and ideas about the upcoming birth. Then the preparation for the operation will begin: you will shave off the hair in the incision area, put on compression stockings and make spinal anesthesia. Later, already in the operating room, the surface of the abdomen will be disinfected and a catheter will be inserted into the bladder. Before the operation begins, your entire body, with the exception of the abdomen, will be covered with sterile wipes. To prevent you from seeing what is happening and to prevent infection, the nurses will pull the sheet up to the level of your upper abdomen. Although you will be able to see the heads of the members of the operating team, you will not be able to understand what they are doing with their hands. After the anesthesia begins to operate in full force, the doctor will make the first incision.

For cosmetic reasons, as well as for better wound healing, the skin is incised directly above the symphysis (pubic articulation) along a vertical line, the length of the incision is 10 cm. The subcutaneous adipose tissue is divided in the middle. Above the abdominal muscles is a very elastic and strong connective tissue sheath (fascia), which the surgeon opens with a scalpel in the center. Then he pulls the abdominal wall up with his hand and takes the abdominal muscles to the side. To open the peritoneum, the doctor uses only his fingers. At the same time, he must make sure that he does not injure either the intestines or the bladder. Finally, the doctor makes a transverse incision in the lower segment of the uterus with a scalpel. Now it remains only to get the baby out of the uterus, and you can say hello to your baby. After separation and removal of the placenta, the operating team sews up the wound. Meanwhile, your partner is already accompanying the child for the first examination. In total, the operation lasts from 20 to 30 minutes.

Misgav Ladakh method

The so-called “soft” surgical technique described on the previous pages, developed in the Israeli hospital Misgav Ladakh, is used today, with minor deviations, in all maternity clinics.

Risks of a caesarean section

A caesarean section is major operation. Although it is considered quite safe, as with any operation, there are certain risks. It is important to remember that a caesarean section is often done to avoid life-threatening complications. However, after the operation, certain complications can also occur.

Risks for you. Having a baby is always a risk. With caesarean section, it is higher than with conventional childbirth.

• Increased bleeding. On average, blood loss during a caesarean section is twice as much as during a conventional birth. However, a blood transfusion is rarely required.
• Reactions or anesthesia. Medicines used during surgery, including painkillers, can sometimes cause unintended effects, including breathing problems. In rare cases, general anesthesia can cause pneumonia if a woman inhales stomach contents. But general anesthesia is rarely used for caesarean sections, and care is taken to avoid such complications.
• Injury to the bladder or intestines. Such surgical injuries are rare, but they do occur during caesarean section.
• Endometritis. This is a complication that causes inflammation and infection of the membrane lining the uterus, most commonly after a caesarean section. This happens when bacteria normally found in the vagina enters the uterus. Urinary tract infection.
• Slow down bowel activity. In some cases, the pain medications used during surgery can slow down the bowels, causing bloating and discomfort.
• Blood clots in the legs, lungs and pelvic organs. The risk of a blood clot in the veins is 3-5 times higher after a caesarean section than after a conventional birth. If left untreated, a blood clot in the leg can travel to the heart or lungs, disrupt circulation, causing chest pain, shortness of breath, and even death. Blood clots can also form in the veins of the pelvis.
• Wound infection. The possibility of such an infection after a caesarean section is higher if you drink alcohol, have type 2 diabetes, or are overweight.
• Rupture of seams. If the wound is infected or does not heal well, there is a risk of rupture of the stitches.
• Placenta accreta and hysterectomy. Placenta accreta is attached too deeply and too firmly to the wall of the uterus. If you've already had a caesarean section, your next pregnancy is much more likely to have a placenta accreta. Placenta accreta is the most common cause of hysterectomy for caesarean section.
• Rehospitalization. Compared with women who gave birth vaginally, women who had a caesarean section were twice as likely to be admitted to the hospital a second time within the first two months after giving birth.
• Fatal outcome. Although the chance of dying after a caesarean section is very low - about two per 100,000 - it is almost twice as high as after a natural birth.

risk for the child. A caesarean section is potentially dangerous for the baby as well.

• premature birth. If the caesarean is of your choice, the child's age must be determined correctly. Premature birth can lead to respiratory failure and low birth weight.
• Breathing problems. Babies born by caesarean section are more likely to have a slight breathing problem - they breathe abnormally frequently during the first days after birth.
• Injury. Rarely, the child may be injured during surgery.

What to Expect During a Cesarean Section

Whether you have a caesarean section planned or done out of necessity, it will go something like this:

Training. To prepare you for the operation, some procedures will be done. In urgent cases, some steps are reduced or skipped altogether.

Anesthesia methods. An anesthesiologist may come to your room to discuss anesthesia options. Spinal, epidural and general anesthesia are used for caesarean section. With spinal and epidural anesthesia, the body loses sensation below the chest, but you remain conscious during the operation. At the same time, you practically do not feel pain, and the drug practically does not get to the child. There is little difference between spinal and epidural anesthesia. In spinal cord surgery, an anesthetic is injected into the fluid surrounding the spinal nerves. With an epidural, the agent is injected outside the fluid-filled space. Epidural anesthesia is carried out within 20 minutes and lasts a very long time. Spinal is done faster, but only lasts about two hours.

General anesthesia, in which you are unconscious, can be used for an emergency caesarean section. Some amount medicinal product can get to the child, but usually this does not cause problems. Most children are not affected by general anesthesia, because the mother's brain absorbs the drug quickly and in large quantities. If necessary, the child will be given medication to relieve the effects of general anesthesia.

Other preparations. Once you, your doctor, and anesthesiologist have decided which type of pain relief to use, preparations will begin. They usually include:

• intravenous catheter. An intravenous needle will be placed in your arm. This will allow you to get the fluids and medicines you need during and after your surgery.
• Blood test. Your blood will be drawn and sent to a laboratory for analysis. This will allow the doctor to assess your condition before surgery.
• Antacid. You will be given an antacid to neutralize stomach acids. This simple measure significantly reduces the risk of lung damage if you vomit during anesthesia and the contents of the stomach enter the lungs.
• Monitors. During surgery, your blood pressure will be continuously monitored. You may also be connected to a heart monitor with sensors on your chest to monitor your heart and rhythm during surgery. A special monitor can be attached to the finger to monitor the level of oxygen in the blood.
• urinary catheter. A thin tube will be inserted into the bladder to drain urine to keep the bladder empty during surgery.

Operating room. Most caesarean sections are done in operating rooms specifically designed for this purpose. The atmosphere may differ from the one that was in the family. Since operations are a group work, there will be many more people here. If you or your child has a serious medical problem, a variety of medical specialties will be present.

Training. If you are going to have an epidural or spinal anesthetic, you will be asked to sit with your back rounded, or lie on your side, curled up. The anesthetist will wipe your back with an antiseptic solution and give you an injection of pain medication. Then he will insert a needle between the vertebrae through the dense tissue surrounding the spinal cord.

You may be given one dose of pain medication through a needle and then removed. Or a thin catheter is inserted through the needle, the needle is removed, and the catheter is glued with a plaster. This will allow you to receive new doses of pain medication as needed.

If you require general anesthesia, all preparations for the operation will be made before you receive pain medication. The anesthesiologist will administer pain medication through an intravenous catheter. You will then be placed on your back with your legs fixed. A special pad may be placed under your back on the right so that your body leans to the left. This shifts the weight of the uterus to the left, which ensures its good blood supply.

Hands are pulled out and fixed on special pillows. The nurse will shave off the pubic hair if it might interfere with the operation.

The nurse will wipe the stomach with an antiseptic solution and cover it with sterile wipes. A tissue will be placed under the chin to keep the surgical field clean.

Section of the abdominal wall. When everything is ready, the surgeon makes the first incision. This will be an incision in the abdominal wall, about 15 cm long, cutting through the skin, fat, and muscle to reach the lining of the abdomen. Bleeding vessels will be cauterized or ligated.

The location of the incision depends on several factors: whether your caesarean section is an emergency and whether you have other scarring on your abdomen. The size of the baby and the location of the placenta are also taken into account.

The most common types of incisions:

• Low horizontal cut. Also called a bikini slit and runs in the lower abdomen along the line of an imaginary bikini panty, is preferred. Heals well and causes less pain after surgery. Also preferred for cosmetic reasons and allows the surgeon to clearly see the lower part of the pregnant uterus. b Low vertical cut. Sometimes this type of incision is preferred. It provides quick access to the lower part of the uterus and allows you to remove the baby faster. In some cases, time is the most important thing.
• Incision of the uterus. After completing the incision in the abdominal wall, the surgeon pushes back the bladder and cuts the wall of the uterus. The uterine incision may be the same or different type as the abdominal wall incision. It is usually smaller in size. As with an abdominal incision, the location of the uterine incision depends on several factors, such as the urgency of the operation, the size of the baby, and the location of the baby and placenta within the uterus. A low horizontal incision at the bottom of the uterus is the most common, used in most caesarean sections. It provides easy access, bleeds less than higher incisions, and is less likely to damage the bladder. A strong scar is formed on it, which reduces the risk of rupture during subsequent births.
• In some cases, a vertical incision is preferable. A low vertical incision - in the lower part of the uterus, where the tissues are thinner - can be done with the baby in the legs, buttocks, or across the uterus (breech or transverse presentation). It is also used if the surgeon believes it will have to be extended to a high vertical incision - sometimes referred to as the classic. The potential advantage of the classic incision is that it allows easier access to the uterus to remove the baby. Sometimes a classic incision is made to avoid trauma to the bladder or if the woman thinks this is her last pregnancy.

Birth. Once the uterus is open, the next step is to open amniotic sac so that the child can be born. If you are conscious, you may feel some twitching and pressure as the baby is pulled out. This is done in such a way as to keep the cut size as small as possible. You won't feel pain.

When the baby is born and the umbilical cord has been cut, the baby will be given to a doctor who will check that the nose and mouth are free of fluid and that he is breathing well. In a few minutes, you will see your baby for the first time.

After birth. Once the baby is born, the next step is to separate and remove the placenta from the uterus, and then close the incisions, layer by layer. The stitches on the internal organs and tissues will dissolve themselves and do not require removal. For a skin incision, the surgeon may suture or use special metal clips to hold the edges of the wound together. During these activities, you may feel some movement, but no pain. If the incision is closed with clamps, they will be removed with special tweezers before discharge.

When you see the child. The entire caesarean section usually takes 45 minutes to an hour. And the baby will be born in the first 5-10 minutes. If you are awake and willing, you can hold the baby while the surgeon closes the incisions. Or you may be able to see the baby in your partner's arms. Before giving the baby to you or your partner, doctors will clean his nose and mouth and perform the first Apgar score - a quick assessment of the baby's appearance, pulse, reflexes, activity and breathing one minute after birth.

Postoperative ward. There, you will be monitored until the anesthesia wears off and your condition stabilizes. This usually takes 1-2 hours. During this time, you and your partner will be able to spend a few minutes alone with the child and get to know him.

If you choose to breastfeed your baby, you can do so for the first time in the recovery room if you feel like it. The sooner you start feeding, the better. However, after general anesthesia, you may not feel well for several hours. You may want to wait until you are completely awake and receive pain medication before feeding.

After caesarean section

In a few hours, you will be transferred from the recovery room to the delivery room. Over the next 24 hours, doctors will monitor your condition, stitches, urine output, and postpartum bleeding. Throughout your stay in the hospital, your condition will be closely monitored.

Recovery. Usually, after a caesarean section, they stay in the hospital for three days. Some women are discharged after two. It is important that you take good care of yourself both in the hospital and at home to speed up your recovery. Most women usually recover from a caesarean section without any problems.

Pain. In the hospital, you will receive pain medication. You may not like it, especially if you are going to breastfeed. But painkillers are needed after the anesthesia wears off to make you feel comfortable. This is especially important in the first few days, when the incision begins to heal. If you are still in pain when you are discharged, your doctor may prescribe pain medication for you to take at home.

Food and drink. In the first hours after surgery, you may only be given ice cubes or a sip of water. When your digestive system will start to work normally again, you will be able to drink more fluids or even eat some easily digestible food. You will know that you are ready to start eating when you can pass gases. This is a sign that your digestive system is awake and ready to get to work. You can usually eat solid food the day after surgery.

Walking. You will most likely be asked to walk around a few hours after the operation, if it is not yet night. You won't want to, but walking is healthy and an important part of your recovery. It will help clear your lungs, improve circulation, speed up healing, and get your digestive and urinary systems back on track. If you are bothered by bloating, walking will bring relief. It also prevents blood clots, a possible postoperative complication.

After the first time, you should take short walks at least twice a day until discharge.

Vaginal discharge. After your baby is born, you will have lochia, a brownish or colorless discharge, for several weeks. Some women after a caesarean section are surprised by the amount of discharge. Even if the placenta is removed during surgery, the uterus must heal, and discharge is part of the process.

Incision healing. The bandage will most likely be removed the day after the operation, when the incision has already healed. While you are in the hospital, the condition of the wound will be monitored. As the incision heals, it will itch. But don't scratch it. It is safer to use lotion.

If the incision was connected with clamps, they will be removed before discharge. At home, take a shower or bath as usual. Then dry the incision with a towel or hair dryer on low heat.

Within a few weeks, the scar will be sensitive and painful. Wear loose clothing that doesn't chafe. If clothing irritates the scar, cover it with a light bandage. Sometimes you will feel twitching and tingling around the incision area - this is normal. While the wound heals, it will itch.

Restrictions. After returning home after a caesarean section, it is important to limit your activities in the first week and take care of yourself and your newborn first of all.

• Don't lift heavy things or do anything that puts strain on an unhealed belly. Maintain correct posture when standing or walking. Support your belly when you cough, sneeze, or laugh. Use pillows or rolled towels when feeding.
• Take necessary medications. The doctor may recommend pain medication. If you have constipation or bowel pain, your doctor may recommend an over-the-counter stool softener or mild laxative.
• Check with your doctor about what you can and cannot do. Physical exercise can be very tiring for you. Give yourself time to recover. You also had an operation. Many women, when they start to feel better, find it difficult to adhere to the necessary restrictions.
• While fast movements hurt, don't drive. Some women recover faster, but usually the period when you should not drive a car lasts about two weeks.
• No sex. Abstain until the doctor allows - usually after a month and a half. However, closeness should not be avoided. Spend time with your partner, at least a little in the morning or in the evening when the baby is already asleep.
• When the doctor allows, start doing physical exercises. But don't be too zealous. Hiking and swimming - the best choice. 3-4 weeks after discharge, you will feel that you are able to lead a normal normal life.

Possible complications.

Tell your doctor right away about these symptoms if they appear while you are at home:

• The temperature is above 38 °C.
• Painful urination.
• Too much vaginal discharge.
• The edges of the wound diverge.
• The incision site is red or wet.
• Severe pain in the abdomen.

emergency caesarean section

An emergency caesarean section is performed only in case of a threat to the life of the mother or child.

The decision to have an emergency operation or a secondary caesarean section is made only when there really is no other way out, since this is associated with a high risk for the pregnant woman (intubation, bleeding, damage to neighboring organs, infection).

Indications for emergency surgery:

• acute hypoxia of the child;
• complications, life threatening mother (rupture of the uterus, premature separation of the placenta).

If one of these complications occurs unexpectedly, you need to act very quickly. In the event of a disruption in the supply through the umbilical cord, the doctor has only a few minutes to prevent significant damage to the child's health. The obstetric team must take all measures to ensure that the birth takes place in the next 20 minutes. An interruption in oxygen supply that lasts longer than 10 minutes can damage the baby's brain.

As soon as the doctor decides on an emergency caesarean section, the introduction of anesthesia and the operation are carried out without delay and without long preparation. Surgical intervention can also be done in the delivery room if there is enough space and the necessary equipment.

Women always hope that they will give birth with dignity, that they will be able to endure pain, sometimes even smile when they push for the last time, giving the child life. Many people try very hard to give birth naturally by choosing doctors who have few caesarean sections in their practice, go to pregnancy courses, play sports during pregnancy, trying to gain only the right weight, sometimes even hiring a doula to be nearby in the delivery room. However, there are a lot of caesarean sections, more than ever before.

How to deal with anxiety

No matter how hard you tried, whether you had a normal pregnancy without complications, it may happen that you need an emergency caesarean section. You will be disappointed. Maybe you will feel like a failure. However, it is very important to remain far-sighted. Cesarean section is indeed a risk, like conventional operations, for example, during it, internal bleeding, blood clots occur, infection or damage occurs internal organs. Some babies have minor breathing problems after a caesarean section. But because surgical techniques and pain management have improved, there are very few hazards associated with caesarean sections, and of course, rhodium, healthy child much more important than trying to give birth naturally.

Reasons for an emergency caesarean section

The most common indication for an emergency caesarean section is an unexpected incorrect position of the child (if it is located legs or buttocks forward) or lateral presentation. Another reason is heavy bleeding before childbirth and suspicion of premature detachment or placenta previa. The most common reason for caesarean sections is the risk that the baby may not be able to deliver; if the baby's cardiogram shows possible abnormalities, a caesarean section will be a safe and quick way to have a baby.

Emergency caesarean section procedure

It may happen that everything will happen quickly and chaotically. The lower abdomen will be prepared for the operation. They will wash your belly, maybe shave your hair, and you will be given antibiotics and other intravenous fluids. Anesthesia will be either epidural (with a dose adjusted for caesarean section) or spinal, or maybe even general. If a woman is given an epidural or spinal anesthetic, she will feel nothing from her toes to her chest; while she will be conscious, but will not feel how the doctor makes an incision. Most likely, she will not see this, because a special fence will be put between her and the doctor, or maybe because the baby will be born very quickly.

Caesarean section of the woman's choice

Some healthy women prefer caesarean section at first birth - usually to avoid pain and possible complications during childbirth. Sometimes the doctor will suggest a caesarean section so that the baby will be born at a time that is more convenient for the woman, the doctor, or both.

This caesarean section is not done because of health problems. The reason is fear or a desire to avoid difficulties. And these are not the best reasons for a caesarean section.

However, women are increasingly opting for a caesarean section, and this raises a number of questions.

Is there a limit?

Many women successfully undergo up to three surgeries. However, each next cesarean is more difficult than the previous one. For some women, the risk of complications - such as infection or heavy bleeding- with each caesarean section increases only slightly. If you had a long and difficult labor prior to your first C-section, a second C-section will be physically easier, but the healing process will take just as long. For other women - who have developed large internal scarring - each subsequent caesarean becomes more and more risky.

Repeated cesarean is done by many women. But after the third, you need to weigh the possible risks and your desire to have more children.

Facing the Unexpected

The unexpected news that you need a C-section can be a shock to both you and your partner. Your ideas about how you will give birth will suddenly change. Even worse, this news may come when you are already exhausted from long hours of contractions. And the doctor no longer has time to explain everything and answer your questions.

Of course, you will have concerns about what it will be like for you and your child during the operation, but do not let these fears completely control you. Most mothers and children successfully undergo surgery with a minimum of complications. While you might prefer to have a natural birth, remember that the health of you and your baby is more important than how it was born.

If you have concerns about a planned repeat caesarean section, discuss this with your doctor and partner. This will help you worry less. Tell yourself that you have been through this once before and you can do it again. This time it will be easier for you to recover from the operation because you already know what to expect.

Caesarean section: partner involvement

If the caesarean section is not urgent, requiring general anesthesia, your partner may come into the operating room with you. Some hospitals allow this. Some like the idea, others may be afraid or disgusted. It is generally difficult to be present during the operation, especially when it is done to a loved one.

If the partner decides to attend, he will be given surgical clothes. He can watch the procedure or sit at the head of the bed and hold your hand. Perhaps his presence will make you feel calmer. But there are also difficulties: men sometimes faint, and doctors have a second patient who needs immediate help.

In most maternity hospitals, the baby is photographed and the doctors can even take pictures for you. But in many it is not allowed. Therefore, you should ask permission to take photos or videos.

Cesarean section of choice

Some women who have a normal pregnancy choose to give birth by caesarean section even though they have no complications or problems with the baby. For some of them, it is convenient to precisely plan the date of birth. If you're used to planning everything in your life down to the minute, waiting for an unknown day for your baby's arrival may seem impossible.

Other women choose to have a caesarean section out of fear:

• Fear of the birth process and the pain that accompanies it.
• Fear of damaging the pelvic floor.
• Fear of sexual problems after childbirth.

If this is your first child, childbirth is something unknown and scary. You may have heard horror stories about childbirth and about women who, after childbirth, suffer from urinary incontinence when coughing or laughing. If you've had a vaginal birth before and it didn't go very smoothly, you may be wary of a repeat.

If you are inclined to choose a caesarean section, discuss this frankly with your doctor. If fear is your main motive, talking frankly about what to expect and going to prenatal school can help. If you are told about the horrors of childbirth, politely but firmly say that you will hear about it after your baby is born.

If your previous natural births have been such a terrible story, remember that all births are different and this time may be very different. Think about why the birth was so difficult and discuss it with your doctor or partner. Perhaps something needs to be done to make the experience more positive this time.

If your doctor agrees with your choice, the final decision is yours. If the doctor does not agree and will not perform a caesarean section, he may refer you to another specialist. Learn more about the advantages and disadvantages of both birth methods and discuss them with experts, but don't let fear be the deciding factor.

What should be taken into account?

Elective caesarean section is a tricky thing. Those who are in favor say that a woman has the right to choose how she wants to give birth to her child. Those who oppose believe that the dangers of a caesarean section outweigh any positives. At this point in the medical literature, there is no convincing evidence that the choice of caesarean section is preferable. Good medical practice generally rejects procedures - especially surgical ones - that do not provide undoubted benefit to the patient. Moreover, there is little research on this subject.

Since everything is ambiguous, you may find that the opinions of doctors differ greatly. Some are ready for surgery. Others refuse, believing that a caesarean section could be dangerous and thus goes against their vow to do no harm.

The best way to make a decision is to collect as much information as possible. Ask yourself why this option appeals to you. Study the issue, consult with experts and carefully weigh the pros and cons.

Benefit and risk

Many experts believe that with the current level of development of surgical technology, a caesarean section is no more dangerous than a conventional birth if this is your first child. If this is the third birth, the situation is different. Caesarean section is more fraught with complications than conventional childbirth. Here is a list of the benefits and dangers of this operation:

Benefits for the mother. Benefits of an elective caesarean section may include:

• Protection against urinary incontinence. Some women fear that the effort required to push the baby through the birth canal can lead to urinary or fecal incontinence and damage to the muscles and nerves of the pelvic floor.
• Medical evidence has shown that women who have had a caesarean section have a lower risk of urinary incontinence in the first months after childbirth. However, there is no evidence that this risk is lower 2–5 years after birth. Some women also fear that natural childbirth can cause pelvic organ prolapse, when organs such as the bladder or uterus protrude into the vagina. At the moment there is no clear medical evidence linking caesarean section and reducing the risk of prolapse pelvic organs. But a caesarean section of choice is no guarantee that problems with incontinence and prolapse will not arise at all. The baby's weight during pregnancy, pregnancy hormones, and genetic factors can weaken the pelvic muscles. Such problems can occur even in women who have never had children.
• Emergency caesarean section guarantee. An emergency caesarean section, which is usually done during a difficult birth, is much more dangerous than an elective caesarean section or conventional birth. An emergency caesarean is more likely to cause infections, damage to internal organs, and bleeding.
• Warranty against difficult childbirth. Sometimes difficult labors require the use of forceps or vacuum suction. Usually these methods are not dangerous. Just as with caesarean section, the success of their use depends on the individual skill of the doctor performing the procedure.
• Less problems with the child. In theory, a planned caesarean section could reduce the risk of some problems in the baby. For example, the death of an infant during childbirth, pathology of labor due to the incorrect position of the fetus, birth trauma - which is especially important when the child is very large - and inhalation of meconium, which occurs if the child began to defecate before birth. It also reduces the risk of paralysis. However, it is important to remember that the risk of all these complications is quite low with conventional births, and a caesarean section is no guarantee that these problems will not occur.
• Less risk of transmission of infections. A caesarean section reduces the risk of mother-to-child transmission of infections such as AIDS, hepatitis B and C, herpes, and papillomavirus.
• Establishing the exact date of birth. If you know exactly when the baby is due, you can better prepare. It is also convenient for planning the work of the medical team.

Risk to the mother immediately after surgery

Certain inconveniences and dangers are associated with caesarean section. It will take longer to stay in the hospital. The average length of stay in the hospital after a caesarean is three days, after a normal birth - two.

Increased chance of infection. Because it is a surgical operation, the risk of infection after a caesarean is higher than after a conventional birth.

Postoperative complications

Since a caesarean section is an abdominal operation, certain risks are associated with it, such as infection, poor healing of stitches, bleeding, damage to internal organs, and blood clots. The risk of complications after anesthesia is also higher.

Reducing the possibility of early connection with the child and the beginning breastfeeding. For the first time after the operation, you will not be able to take care of the child and breastfeed him. But this is temporary. You will be able to bond with your baby and breastfeed as soon as you recover from the surgery.

Insurance payment

Your insurance may not cover a caesarean section of choice, and it will cost more than a conventional birth. Before making a decision, check if this operation is covered by your insurance.

Risks for the mother in the future

After a caesarean section, the following troubles are possible in the future:

future complications. With multiple pregnancies, the likelihood of complications increases with each subsequent pregnancy. Repeated cesarean sections further increase this likelihood. Most women can safely have up to three surgeries. However, each subsequent one will be more difficult than the previous one. For some women, the risk of complications such as infection or bleeding increases only slightly. For others, especially those who have large internal scarring, the risk of complications with each subsequent caesarean section increases very significantly.

Rupture of the uterus in the next pregnancy. A caesarean section increases the risk of uterine rupture in the next pregnancy, especially if you choose to have a normal birth this time. The probability is not very high, but you should discuss this with your doctor.

Problems with the placenta. Women who have had a caesarean section have a higher risk of placental disorders, such as presentation, in subsequent pregnancies. In previa, the placenta closes the opening of the cervix, which can lead to preterm labor. Placenta previa and other related disorders caused by caesarean section greatly increase the risk of bleeding.

Increased risk of hysterectomy. Some placental problems, such as placenta accreta, where the placenta is attached too deeply and firmly to the wall of the uterus, may require removal of the uterus (hysterectomy) at birth or soon after.

Damage to the intestines and bladder. Serious damage to the intestines and bladder during caesarean section is rare, but they are much more likely than during conventional births. Complications associated with the placenta can also lead to bladder damage.

Dangers for the fetus

Dangers for the child associated with a caesarean section:

• Respiratory disorders. One of frequent violations in a child after a caesarean section, this is a small breathing disorder called tachypnea (rapid shallow breathing). This happens when there is too much fluid in a child's lungs. When the baby is in the uterus, her lungs are normally filled with fluid. In normal childbirth, progression through the birth canal compresses chest and naturally pushes fluid out of the baby's lungs. With a caesarean section, this compression does not occur, and fluid may remain in the baby's lungs after birth. This results in rapid breathing and usually requires a pressurized supply of oxygen to remove fluid from the lungs.
• Immaturity. Even a little immaturity can have a very negative impact on the child. If the due date is inaccurate and the caesarean section is too early, the baby may have complications associated with prematurity.
• Cuts. During a caesarean section, the baby may get cut. But this rarely happens.

Decision-making

If your doctor does not accept your request for a caesarean section, ask yourself why. Physicians and surgeons have a duty to avoid unnecessary medical interventions, especially if they may be dangerous. The lack of scientific evidence to support elective caesarean section makes this operation unnecessary. Although, from the doctor's point of view, ease of planning, efficiency, and financial rewards favor a caesarean section, a doctor you trust should be at least reticent about this operation.