Is it possible to ask for a caesarean section? Medical indications for caesarean section: list. Indications for cesarean section by age

The final decision regarding how a woman should give birth is made by the doctor at 37-38 weeks of pregnancy, after all examinations. Among those who passed through natural childbirth not only women with a uterine scar, but also those who were over forty when they decided to have their first child, as well as those who dared to carry and independently give birth to twins.

Dear Irina!

Caesarean section is difficult surgery, which is primarily carried out strictly for medical reasons. However, more and more often women prefer this method of delivery, guided only by their own desire. Often, women simply want to avoid the pain that accompanies natural childbirth, forgetting that postoperative pain no less intense than generic ones. In addition, as after any other operation, there is a risk of complications.

Another reason that prompts women in labor to have a caesarean section is the desire to independently choose the date of birth of the child, so that the doctor is not on vacation and the child’s father is not on a business trip. Thus, a situation of forced childbirth arises when neither the woman’s body nor the child are ready for this. This may also have a number of negative consequences for the health of mother and baby.

Some mothers believe that a child born with the help caesarean section, relieved of the stress of going through birth canal. However, it is not for nothing that nature came up with this particular method of birth. Thanks to movement through the narrow birth canal, the baby is removed from the lungs. excess liquid, which is artificially sucked out in case of surgery.

Indications for caesarean section

There are absolute indications for surgery, when it cannot be avoided, as well as relative indications, when the decision is made by a council of doctors after analyzing the condition of the mother and child. Absolute indications are an anatomically narrow pelvis (degree of narrowing 3 - 4 s true conjugate less than 9 cm), complete placenta previa, incomplete placenta previa but with risk of serious bleeding, premature detachment placenta, beginning or threatening uterine rupture, defective scar on the uterus, the presence of two or more scars on the uterus, severe gestosis in the absence of readiness of the birth canal for delivery, heart disease in the stage of decompensation, pathology nervous system, serious illnesses thyroid gland, diabetes , hypertonic disease, myopia 3 degrees, retinal detachment, tumors of the cervix, vagina or ovaries, abnormal fetal position, acute intrauterine hypoxia, umbilical cord prolapse.

Relative indications include large fetuses with a narrow pelvis, divergence of the symphysis pubis during pregnancy, weakness ancestral forces, post-term pregnancy, IVF or artificial insemination, chronic fetal hypoxia, hemolytic disease of the fetus, the presence of three or more fetuses, severe varicose veins of the vulva and vagina.

Sometimes, if the age of the first-time mother has exceeded 30 years, due to the risk of perineal ruptures and abnormalities in labor, birth by cesarean section may be indicated, especially in the presence of extragenital diseases or obstetric pathology.

Caesarean section at will

In many countries around the world, a woman has the legal right to choose her own method of childbirth. First caesarean section at will began to practice in Japan, South Korea and China. In Venezuela, 60% of births end in surgery. In Russia, there is no legal framework prohibiting a doctor from performing a caesarean section at the request of a woman in labor, even if there are no indications for the operation. Moreover, a number of experts believe that a woman should choose how her child will be born. Nevertheless, officially the desire of a woman in labor is not an indication for a cesarean section. Everything will depend on the doctor and on the prerequisites for surgical intervention, because the obstetrician-gynecologist is obliged to report for each case in which a caesarean section was performed. In many maternity hospitals, the request of the woman in labor is taken into account if there are any relative indications.

Best regards, Ksenia.

I have medical education. Of course there was practice in maternity ward. Having seen enough natural childbirth with and without perineal incisions, I decided for myself that my pregnancy would only end through a caesarean section. With this review, I would like to help those girls who are also considering only this option. Having successfully become pregnant, I began to visit various paid clinics so that I could manage my pregnancy with competent doctors and know exactly when, who and where would perform the cherished operation on me. But it was not there! Every doctor was ready to manage the pregnancy. But regarding the cesarean...first I had to sign a contract for pregnancy management (the cost of which is around 60 - 90 thousand) and only at the end of the third trimester the doctor calls a mythical doctor he knows in a mythical maternity hospital and makes an agreement. I initially needed guarantees. And so, we found Lapino Hospital on the Internet. Of course, for average earnings, this is a fairly expensive establishment. But for the sake of having a child (an event that happens once or several times in life, if you like it) you can spend money. At that time, an action was taking place in the hospital: free consultation on pregnancy management. They called. The operator answered the phone immediately, without a five-minute wait, as in other medical institutions. Signed up. We've arrived. Gorgeous clinic. Entrance with passes. There are no queues, although there are plenty of patients. Everywhere there is beauty and purity. They came to the reception and explained the situation. The doctor said that she perfectly understands our desire and everything will be as we want. The only thing is that they will hold a consultation on this matter (apparently they wanted to check my mental health). They set a day and time. After the consultation, I was given a paper that said that I would undergo the desired operation! Then we calmly went to be observed. The doctor left her contact number. And then one night, I realized it was time! I called the doctor and told them to prepare the operating room as we were leaving. The contract includes an ambulance, but we decided to get there slowly ourselves. In the end, we could call her along the way. Security was already aware that we were coming. They opened the door for us right away and told us that everyone was waiting for us. The operation went perfectly! After the operation, my child and I stayed in this wonderful place for 5 days. The chamber can hardly be called a chamber. Rather, this is a room in a five-star Turkish hotel. The room has a TV, internet, air conditioning, toilet, shower with all sorts of personal hygiene products. You don’t need to take anything with you at all, everything is there. The height of the bed can be adjusted by lightly pressing. Emergency call buttons are installed everywhere. I accidentally pressed one at night, and the nurse was in the room in 20 seconds! The staff knocks before entering the room. You can also put a "do not disturb" sign on the door. Great food. They are delivered in beautiful plates with lids. First, second, compote, dessert. Even if you don’t want to eat, you will. Before discharge, the baby and I underwent various ultrasounds. The children's clinic was surprised. Why did you have an ultrasound? Have you had any health problems? Our health is excellent. It turns out that they don’t do ultrasounds in state institutions. The patients are breathing well and can be sent home. The scar after a cesarean section is very neat, about the thickness of a hair. Sometimes I even miss this wonderful place. Of course, it’s a little expensive for me, but you have to pay for comfort. And according to my calculations (I monitored prices paid services in the state genus. houses) is not much cheaper, but the conditions, care, and equipment are not so good. For your second child only in Lapino!

Is it possible to have a caesarean section at will?

Sex before childbirth is quite natural and understandable, but is it worth voluntarily going “under the knife” because of this? Let's look at the pros and cons of an elective caesarean section.

Right to choose

Whether the expectant mother has the right to choose the method of delivery is a controversial issue. Many people believe that only the mother should decide how her child will be born. Most doctors reserve the prerogative to prescribe a cesarean section, although the number of obstetricians listening to the opinions of patients is growing.

In the West, paid cesarean sections at will have become fashionable. Moreover, when signing a contract with the clinic, patients take lawyers with them, not their husbands. Signed list of all possible consequences has full legal force and “frees up” the hands of doctors who are happy to undertake to operate on everyone for a tidy sum.

In Russia, the situation is different: it is quite problematic for our women to have an official Caesarean without evidence for it. The refusal of natural obstetrics, which a woman signs on the threshold of the operating room, is just a formal piece of paper, so doctors do not risk following the lead of their patients, even for decent money. Some even invent diseases for themselves that can serve as at least relative indications for surgery.

Advantages of a “custom” caesarean section

Insurmountable fear of labor pains, fear of injuries to the perineum and vagina, fear for the health of the child due to unpredictability birth process. What guides a woman who is capable of giving birth on her own when she persuades the attending physician to give her planned surgery? For many women in labor, the advantages of cesarean section are obvious:

• quick and painless extraction of the child;
• confidence in the life and health of the baby;
• hope for a favorable outcome thanks to modern advances in medicine;
• no damage to the genital organs;
• ability to choose the date of birth of the child.

The downside of the easy way

Caesarean section has become so commonplace that it is perceived as absolutely safe procedure. In the eyes of many women, it looks like this: “I fell asleep, woke up, got a baby.” However, a woman who has undergone such an operation is unlikely to agree with this.

1. According to the woman, the operating table is an “easy” method of childbirth, but intense pain after it for several days will be akin to natural contractions.
2. Caesarean is an abdominal operation, which means that none of the surgical risks can be excluded. Unpredictable consequences during manipulations, complications and even mortality during cesarean section are not a myth, but a harsh reality.
3. The sudden removal of a newborn, unprepared for contractions, sometimes sleeping, is too strong a shock for the child, in contrast to the natural process of birth, which for the baby is stressful situation with a plus sign.
4. “Caesarean babies” that have not passed through the birth canal and are separated from their mother during the most important hours of life are more susceptible to intestinal and allergic diseases, and mom may have problems with breastfeeding.
5. It is difficult to care for a baby without outside help: every movement is difficult and causes concern for the integrity of the seam.
6. Recovery after surgery takes many months, but after giving birth, a woman comes to her senses within a few days.
7. Difficulties may arise with subsequent pregnancies and childbirths.

The risk is great, so the decision to have an elective caesarean section should be made carefully by the woman and her doctor, and not under the influence of immediate desires.

Home " Food " Caesarean section without indications: does the woman in labor have the right to choose? Childbirth and caesarean section.

text: N. Semenova

A month ago I gave birth to my third child. More precisely, it was skillfully removed from me by an excellent operating team of five people. As a result of a caesarean section, all my children were born: a son and two daughters. I will never know what childbirth is, but I know, if not everything, then a lot about cesarean. I give my experience to everyone who is facing this option of the birth of a long-awaited child.

When is a caesarean section performed?

Personally, I have very poor vision (-12), and there are tears in the retina. Ophthalmologists said ten years ago that it was contraindicated for me to give birth on my own - I would go blind. My sister has -7 vision, but her retina is in good condition, she was allowed to give birth naturally.

Does it exist at all? list of absolute indications for the operation:

1. Narrow pelvis.
2. Cicatricial narrowing of the vagina.
3. Tumors bony pelvis, cervical fibroids, ovarian tumors localized in the pelvis, preventing the birth or extraction of a fetus even in reduced sizes, cervical cancer.
4. Complete placenta previa.
5. Defective scar on the uterus after a cesarean section or a sutured uterine incision.
6. Threatening uterine rupture.
7. Progressive premature placental abruption with unprepared birth canal.
8. Death of the mother while the fetus is still alive.
9. Transverse position of the fetus during prenatal rupture of amniotic fluid

Relative indications for a cesarean section include bleeding during pregnancy and childbirth, gestosis, uterine scar, weakness of labor, extragenital diseases. The decision to end the pregnancy surgically is also made in cases where the child suffers from hypoxia (lack of oxygen) in utero, the umbilical cord prolapses, and the gestation period is after 40 weeks.

Such an operation is planned if it is established already during pregnancy that the woman will not be able to conceive otherwise. Emergency when emergency situations occur during normal childbirth. My third caesarean section is unique in this regard.

The date for the operation was set, but the child decided to choose his own birthday. The day before the operation, at dawn, my water broke. On this day I was exactly 38 weeks pregnant. Having undergone planned cesarean sections twice, I did not expect such a turn of events. Horror gripped me, and the voice of my doctor, kind and cheerful for 5 a.m., brought me back to life. handset: "Everything will be fine. I’m leaving, I’ll be there soon.” God, it’s so good that I went to the maternity hospital a few weeks before my due date.

When to go to the maternity hospital?

My case is illustrative, but cannot serve as an unconditional example. You should always listen to yourself, your intuition and trust the results of tests and examinations of the fetus. Nagging pain lower abdomen at night. My legs, back, and stomach were aching. After this, I didn’t go - I ran to the clinic to get a referral to the maternity hospital. But my middle daughter was born exactly two weeks before the expected due date. I came to the obstetricians strictly on the day of the operation, I felt good, and I didn’t even think about lying with a book for two weeks in pathology.

Mostly first-time mothers (for very serious reasons) and women who already have children are admitted to the hospital in advance (many never manage to rest before giving birth; they have to so categorically interrupt the endless cycle of responsibilities of mother and wife). Usually they are placed in one to two weeks. If inner voice even just barely audibly says to you: “Let’s go to bed” - you need to listen to him, and not to a sense of duty to other family members!

Pros of being in a hospital:

If labor begins, you will not have to frighten your household with your condition and think about whether to go yourself, whether to call an ambulance, and where to put the children during this time.

Additional examinations of the mother and fetus (tests, cardiotocography, ultrasound, etc.)

No worries about cleaning the “entrusted territory”, as well as preparing food. They will wash the floors without you, and feed you within the limits of government funding. Gastronomic delicacies will be brought by relatives.

Your absence will finally mark the full power of your role in the family. My husband will never leave his mouth again: “Why are you tired? Are you sitting at home?” The growing up of the head of the family and children must sometimes happen in such a painful way.

Feeling like a “pioneer camp”. I will definitely remember the summer shift during school time.

The day before surgery

It’s a good day to dedicate to cleanliness: mental and physical. You can pray, meditate, or just relax. No matter how cheerful you are, you still won’t drive away fear. Accept it. Everything that doesn't kill us makes us stronger. Friedrich Nietzsche is absolutely right.

Take a shower and carry out all the necessary hygiene procedures required before the operation. Before performing a cesarean section, your doctor will definitely give you a document to sign. information mail about consent to the operation. In particular, it states that in emergency(threat to the life of the mother and/or child), doctors have the right to even remove the uterus. It rarely comes to this in practice. For example, in the obstetric building of the Vladimir regional clinical hospital For every 2,500 births per year, there are only 2-3 cases of hysterectomy.

The day before surgery, it is best to eat at 17:00. At night, you can ask your midwife to give you a light sedative to help you get a good night's sleep.

Day of surgery

First, you will receive a cleansing enema. You will then be transferred to the operating room. There you will be given a sterile shirt, but a headscarf or cap and special long shoe covers for your feet. The last three years to avoid postoperative complications Doctors recommend wearing special stockings before surgery. It would be good if these were not knee socks, but stockings. They cost about a thousand rubles. You may only need them once in your life. Therefore, before going to the hospital, look for advertisements for the sale of used stockings. They will cost much less.

Before the operation you bladder a catheter will be inserted. It's not very pleasant procedure. But this too will have to be overcome. The anesthesiologist will definitely ask what types of medications you are allergic to, whether you have had anesthesia before, and what kind of anesthesia. Doctors usually now suggest epidural anesthesia. An injection is given to a certain place in the spine - this only numbs the Bottom part torso.

After epidural you can get up after 6-12 hours (anesthesia acts more slowly, the operation after anesthesia can begin in 15-20 minutes - not earlier). With this type of pain relief, women can give birth naturally. You can do prolonged anesthesia and pain relief for another 1 day after cesarean section.

And here spinal(which was done specifically to me) acts quickly, since the medicine goes directly into spinal canal, and not around it, as with an epidural. This kind local anesthesia more effective - better pain relief during surgery. The only negative is that after it you need to lie down for a day; you cannot get up or roll over.

Of course, you will not see the progress of the operation. They will put a barrier in front of you. You can talk to the doctors during the operation. This is not forbidden. If something bothers you, you should definitely say so.

Now doctors use synthetic suture material, it does not cause inflammation, the threads dissolve after 2 months. An incision is made in the lower segment with a transverse dissection of the uterus. Even in low-waisted underwear, the seam is not visible later. A doctors before They made a corporal (longitudinal) incision - the stomach was cut from the navel to the pubis down. The uterus burst and opened like a rose. The suture material (kegut) was of animal origin, caused inflammation, and the wounds took a long time to heal.

First, doctors will open the abdominal cavity, then the uterus and remove the baby. Caesarean section is the only operation in the world that gives such happiness. Thanks to the fact that you are conscious, you will finally see your baby! And while I’m stitching you up, the child will be weighed and his height measured. And as is customary in Russian maternity hospitals, your name, date and time of birth, gender of the child, his height and weight will be written on a brown piece of oilcloth. Many mothers carefully keep the metric even after their babies become parents themselves.

After you get stitches, you will be transferred to a ward and immediately put on IVs. Medicines are administered intravenously for the first three days after surgery. The baby is usually brought only once a day - so that you can look at him. You cannot feed your baby, as you are being given antibiotics that are incompatible with breastfeeding. In principle, you will not have time to feed at this time - and the milk remains at the end of the third or fourth day after the operation. The main thing is to endure the pain.

It’s also very difficult to survive a day while lying on your back. You will be allowed to get up the next day. By the way, I have repeatedly come across information on the Internet that you need to get up after 6 hours. So, in reality this is not practiced in maternity hospitals, at least with epidural anesthesia. The site where the spinal anesthesia needle was inserted should be healed. This process takes 24 hours. The entire first day you can only drink mineral water without gas or regular water with lemon juice. If the operation was done in the morning, in the evening you will be asked to try to go to the toilet on a duck. Try to do it yourself as much as possible. If it doesn’t work out, they will insert a catheter, and this, as I already wrote, is not a very pleasant procedure.

After operation

By the end of the second day, the most persistent ones; on the third day, those with a weaker will will begin to roll over to their left and right sides. It hurts, but it's necessary. The more you toss and turn, the more less likely that adhesions will form and the intestines will stagnate. Aerobatics - lie on your stomach!

On the second day you will be offered low-fat broth, porridge with water, and boiled meat. By the third knock, you can already eat almost everything that will not harm your baby and that does not form gases. The baby will be brought to you for feeding on this day. From now on, you will learn to move around the department quite quickly and your outlook on life will again become more optimistic. Congratulations, you have survived the most difficult period! An even more difficult one is coming. I mean the beginning of breastfeeding - many mothers experience severe engorgement of the mammary glands. Doctors say to express, but not everyone can do it. However, this is a topic for another discussion.

As soon as the doctor allows you to get up, get up. First ask your relatives to bring you postoperative bandage. It will make your life much easier in the first two weeks after surgery. Instead of a bandage, in the maternity hospital they will show you how to tie up your stomach with a diaper so as not to injure the seam. But - I repeat once again - it is better to use a bandage.

To begin with, you just need to sit on the bed. After a day of continuous lying down, it will seem to you that your lungs begin to hurt, it’s difficult to breathe - everything is so stagnant. It's okay, soon everything will be over. It is convenient to place your feet not immediately on the floor, but on a bench. Then slowly stand up completely. Do not hurry. Your main achievement now is to get to the washbasin and look at yourself, beauty. And then return to the bed. Rest and repeat your feats. The main thing is to try to keep your back straight, although at first it is very difficult to do.

In addition to injections, IVs and other procedures, you must put ice on your stomach at least three times a day. Cold promotes contraction of the uterus; during surgical delivery, it decreases to its normal size more slowly. Let me touch on an intimate topic - ordinary panties are not allowed in maternity hospitals, but disposable ones are allowed. Very convenient - wear it, get it dirty, throw it away!

After discharge from the hospital

The seam at home must be treated with hydrogen peroxide, then dried with alcohol (vodka). The hot liquid can be replaced with brilliant green or potassium permanganate. 2 weeks after the operation, you can start smearing the seam with preparations for scar resorption, contratubex, for example.

Intimate relationships with your husband can be resumed 6 weeks after the operation. You must first visit a doctor and make sure everything is in order. Be sure to discuss with your doctor the contraceptive option that is acceptable to you. 8 weeks after caesarean section you can start physical activity- including the abdominals. But don’t be too zealous, everything is within reason.

To regain your previous figure, the main thing in the first year of a child’s life is not to eat baked goods made from premium flour (there is no benefit for the baby) and not to overuse dishes from the “carbohydrate + protein” series. Eat more raw vegetables and fruits, drink kefir - it’s very good for peristalsis. Women often have problems with bowel movements after surgery.

How many times can you have a caesarean section?

Olga Sakharova, obstetrician-gynecologist, worked as head of the obstetrics department for six years, in this moment Heads the postpartum department of the obstetric ward of the Vladimir Regional Clinical Hospital. She thinks that maximum amount Caesarean sections that a woman can endure without harm to herself are three:

“Later on during pregnancy, a lot of problems can arise. serious complications. Each scar disrupts the normal blood supply to the uterus. There is always a threat of uterine rupture, and there is a high probability of bleeding. There are cases when the placenta is attached not at the top, but at the bottom, in the area of ​​the scar. This is fraught with consequences for both mother and child.

Surely, with 4-5 caesarean sections, adhesions form, which means that the woman will suffer in the future chronic pain in the abdominal area. Repeated operations are also difficult for obstetricians and gynecologists because by opening the abdominal cavity, one can accidentally injure the intestines or bladder. Therefore, it is best to perform repeated operations in multifunctional medical centers, for example, regional hospitals, where doctors of other specialties are located in neighboring departments or buildings - a five-minute walk, and not at the other end of the city.

If the mother already has two healthy, living children and is over 35 years old, we always recommend ligating the fallopian tubes (sterilization) after the second and third caesarean sections - this is, of course, last resort, but sometimes it is necessary. - This is all so that the woman maintains her health, so that she has the strength to raise the children she already has. But we do not have the right to decide this issue ourselves, without a woman. Before the procedure, the patient must sign a consent form. In our maternity hospital, of course, there are fourth caesarean sections. But this is a very rare occurrence."

Ideally, there will be a gap of at least two years between pregnancies. During this time, the body is restored and the woman is ready both mentally and physically for a new operation. I am now talking about those women whose indications for caesarean section are lifelong.

Natural birth after cesarean - is it possible?

Giving birth without surgery is the dream of many women who had to undergo surgery once due to emergency circumstances. And not according to absolute medical testimony.

This is really possible, says obstetrician-gynecologist Olga Sakharova:

“In order to give birth after a previous caesarean section, at least 4 conditions must be met. Firstly, the child should not be large. Secondly, the baby must occupy normal position- head down. Thirdly, the maturity of the birth canal is important. Fourthly, a woman must be in the mood for childbirth, so that some time after the start of labor she will not scream: “Cut me!”

Childbirth after cesarean section has many nuances. One of the main points is that a woman should not be given pain relief. She must feel what is happening to her, where exactly it hurts. Doctors can determine the thickness of the scar from the ultrasound results, but this does not indicate its consistency. At any moment, a seemingly completely reliable scar can separate, that is, the uterus will open. And if at this moment a woman is under the influence of drugs that relieve pain, she simply will not feel it. The consequences can be the most dire.

Based on the practice of the obstetric corps of the Vladimir Regional Clinical Hospital, only 1% of women who were previously operated on are ready and able to give birth without the help of surgeons.”

Caesarean section is a topic that leaves no one indifferent. expectant mother. From its inception to the present day surgical method childbirth is a cause for fear, confusion and heated debate.

IN Lately appeared a large number of supporters of cesarean section. Many pregnant women seriously believe that surgery is just one of the options for obstetric care that can be chosen at their own request, such as vertical birth or water birth. Some even argue that a caesarean section is a more modern, less burdensome and painless option for giving birth to a child; it is supposedly easier and safer for mother and baby than the long and complex process of natural childbirth. Actually this is not true; operative delivery is a special type of obstetric care, indispensable in cases where natural childbirth for a number of reasons is impossible or even dangerous to the life of the mother or fetus. However, neither less painful nor more in a safe way The birth cannot be called “caesarean”. Like any other surgical intervention, operative delivery is associated with significant risks to the mother’s health both during the operation itself and during postoperative period. That is why a caesarean section is never performed simply “at the request” of the patient, without real medical indications.

Indications for cesarean section, list

Indications for operative delivery are divided into absolute and relative. Absolute indications include situations in which vaginal delivery is fundamentally impossible or dangerous to the life of the mother and/or fetus. Here are the most common absolute indications for delivery by cesarean section:

Complete placenta previa– attachment children's place in the lower segment of the uterus, in which it completely covers the area internal pharynx cervix. In this case, childbirth through the natural birth canal is impossible: the placenta simply blocks the baby’s exit from the uterus. In addition, at the very first contractions, accompanied by dilatation of the cervix, the placenta will begin to peel off from the area of ​​the internal os; this can lead to the development of massive bleeding, which poses a real threat to the life of mother and baby.

Transverse position of the fetus- such a position of the baby in which its movement along the birth canal becomes impossible. In the transverse position, the fetus is located horizontally in the uterus, perpendicular to the mother’s spine. In this case, there is no presenting part of the fetus - the head or buttocks - which normally should put pressure on the cervix during contractions, helping it open. As a result, during childbirth in the transverse position of the fetus, the cervix practically does not open, and the walls of the contracting uterus put pressure on the transversely located spine of the baby, which is fraught with severe birth injuries.

Narrow pelvis is an absolute indication for surgical delivery if the third or fourth degree of a uniformly narrowed pelvis is detected (a decrease in all sizes by more than 3 cm) or an obliquely displaced pelvis - narrowing internal dimensions with mutual displacement of the bones forming the pelvis due to injury or rickets. With such a degree of narrowing, childbirth through the natural birth canal is impossible, regardless of the size and location of the fetus.

Large fruit is not always an absolute indication for surgical delivery: when normal sizes pelvis, even a large baby can be born naturally. Newborns weighing more than 3600 g are considered large. However, with a fetal weight of more than 4500 g, even normal pelvis may be too narrow for the fetus, and natural birth may be risky for health.

Repeated entanglement of the umbilical cord leads to a significant shortening of its length and a deterioration in the blood supply to the fetus. In addition, numerous, more than three, loops of the umbilical cord interfere with the normal position of the fetus in the uterus and prevent the movements necessary for the normal biomechanism of childbirth. Biomechanism is the totality of the baby’s own movements during birth, which help him adapt to the size and shape of the mother’s pelvis. If the fetus is not able to perform the necessary movements - for example, bending, unbending and turning the head, birth injuries are inevitable even with normal sizes of the pelvis and the fetus itself.

Maternal diseases accompanied by impaired muscle tone and nervous regulation work pelvic organs. Such diseases are few and far between. Childbirth through the natural birth canal is impossible in this case, since with these pathologies productive birth does not develop. labor activity. An example of such an absolute indication for a “cesarean section” is paralysis and paresis (partial paralysis) of the pelvic organs, as well as multiple sclerosis– damage to the nervous system, characterized by disruption of transmission nerve impulse to organs and muscles.

Complications of pregnancy and childbirth, which pose a real threat to the life of the mother and fetus, are the main absolute indications for emergency surgical delivery.

In fact, the operation, called a “caesarean section,” was first performed specifically for the purpose of saving lives. Vital indications include acute disorder cardiac activity of mother and fetus, placental abruption, severe forms late toxicosis (gestosis), disturbance of placental blood flow of the 3rd degree, threat of uterine rupture or old postoperative scar on the uterus.

Relative indications include situations in which surgical delivery is preferable to natural childbirth:

• the woman’s age is under 16 or, on the contrary, over 40 years old;
• pathologies of vision, cardiovascular and neuroendocrine systems;
• slight narrowing of the pelvis or increase in fetal weight;
• breech presentation - the position of the baby in the uterus, in which the buttocks or legs are located below;
• complicated course of pregnancy - late toxicosis, disturbance of placental blood flow;
• the presence of general and gynecological chronic diseases.

To decide on the need for surgical intervention, one absolute or a combination of several relative indications is sufficient.

Surgery or childbirth?

Why is a caesarean section performed only when indicated? After all, the operation is much faster than a natural birth, completely anesthetizes and eliminates the risk of birth injuries for mother and baby. To answer this question, you need to learn more about the features of operative delivery.

1. Caesarean section is an abdominal operation; this means doctors must open the abdomen to extract the fetus. Of all types of surgical interventions abdominal operations connected with the largest number risks to the life and health of the patient. This is also a risk of developing intra-abdominal bleeding, and the risk of organ infection abdominal cavity, and the risk of divergence postoperative sutures, rejection of suture material, and many others. In the postoperative period, the postoperative mother experiences significant abdominal pain, requiring drug pain relief. Recovery of the mother’s body after surgical birth takes longer than after natural delivery and is associated with significant limitations. physical activity. If we compare the traumatism of “natural” and “artificial” childbirth, then, of course, abrasions, perineal incisions and even ruptures of the birth canal are incomparable with the traumatism of abdominal surgery.

2. To extract the fetus, doctors have to cut the anterior abdominal wall, the aponeurosis - a wide tendon plate connecting the muscles abdominals, peritoneum – thin translucent serosa, protecting internal organs abdominal cavity and uterine wall. After removing the fetus onto the uterus, peritoneum, aponeurosis, subcutaneous fat and the skin is sutured. Modern suture material is hypoallergenic, aseptic, i.e. does not cause suppuration, and completely resolves over time, however, the consequences of surgical intervention still remain forever. First of all, these are scars - areas of connective tissue formed at the site of the suture; Unlike real organ cells, connective tissue cells do not perform any specific functions necessary for normal operation organ. The tissue formed at the seam site is less durable than own fabric organ, so subsequently, if there is a sprain or injury, a rupture may occur at the site of the scar. The risk of uterine scar rupture always remains during all subsequent pregnancies and births. Throughout pregnancy, if there is a postoperative scar on the uterus, the woman is under especially careful medical supervision. In addition, surgical intervention limits the possibility of having more than three children: during each subsequent operation, the old scar tissue is excised, which reduces the area of ​​the anterior wall of the uterus and creates even more high risk gap in next pregnancy. Other unpleasant consequence any surgical intervention in the abdominal cavity - the formation of adhesions; these are connective tissue cords between the organs and the walls of the abdominal cavity. Adhesions can impair patency fallopian tubes and intestines, causing secondary infertility and serious problems digestion.

3. The main disadvantage of operative delivery for a baby is that during a caesarean section, the fetus does not pass through the birth canal and does not experience the pressure difference to the extent that it needs to “launch” autonomous life processes. At various pathologies For the fetus and mother, this very fact is an advantage of cesarean section and determines the choice of doctors in favor of the operation: pressure drops over a long period of time become an additional burden for the baby. If we're talking about about saving the life of mother and baby, surgical delivery is also preferable due to the temporary advantage: from the start of the operation to the extraction of the fetus, an average of no more than 7 minutes passes. However for healthy fetus this difficult path through the birth canal, oddly enough, is preferable to quick extraction from a surgical wound: the baby is genetically “programmed” for just such a birth scenario, and surgical extraction is additional stress for him.

As the fetus moves through the birth canal, it experiences high blood pressure from the birth canal, which promotes the removal of fetal - intrauterine - fluid from his lungs; this is necessary for uniform spreading lung tissue during the first breath and the beginning of full pulmonary respiration. No less important is the difference in pressure that the baby experiences during natural childbirth, and to begin with independent work its kidneys, digestive and nervous systems. Great importance has the passage of the baby through the narrow birth canal and for a full start to work of cardio-vascular system: in many ways, the launch of the second circle of blood circulation and closure depends on this oval window- openings between the atria that function in the fetus during pregnancy.

Caesarean section is optional surgical intervention the maximum volume for obstetrics and is associated with a significant risk to the health of the mother, it is never performed at the request of the patient. Caesarean section should not be considered as Alternative option childbirth; This is an additional intervention in the natural process, performed strictly for medical reasons. The final decision on the need for surgery can only be made by a doctor who observes the expectant mother during pregnancy and during childbirth.

All over the world there is a clear trend towards gentle childbirth, which helps preserve the health of both mother and child. The tool that helps achieve this is the cesarean section (CS). A significant achievement was wide application modern techniques pain relief.

The main disadvantage of this intervention is considered to be an increase in the frequency of postpartum infectious complications 5-20 times. However, adequate antibacterial therapy significantly reduces the likelihood of their occurrence. However, there is still debate about in what cases a cesarean section is performed and when physiological delivery is acceptable.

When is surgical delivery indicated?

A caesarean section is a major surgical procedure that increases the risk of complications compared to a normal vaginal birth. It is carried out only by strict indications. At the request of the patient, CS can be performed in private clinic, but not all obstetricians-gynecologists will undertake such an operation unless necessary.

The operation is performed in the following situations:

1. Complete placenta previa is a condition in which the placenta is located in the lower part of the uterus and closes the internal os, preventing the baby from being born. Incomplete presentation is an indication for surgery when bleeding occurs. The placenta is abundantly supplied with blood vessels, and even slight damage to it can cause blood loss, lack of oxygen and fetal death.

2. Occurred prematurely from the uterine wall - a condition that threatens the life of the woman and child. The placenta detached from the uterus is a source of blood loss for the mother. The fetus stops receiving oxygen and may die.

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

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

4. Transverse and oblique position baby in the uterine cavity, breech presentation (“butt down”) in combination with an expected fetal weight of over 3.6 kg or with any relative indication for surgical delivery: a situation where the baby is located at the internal os not by the parietal region, but by the forehead (frontal) or face (facial presentation), and other location features that contribute to birth trauma The child has.

Pregnancy can occur even during the first weeks postpartum period. Calendar method of contraception in conditions irregular cycle not applicable. The most commonly used condoms, mini-pills (gestagen contraceptives that do not affect the child during feeding) or regular ones (in the absence of lactation). Use must be excluded.

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

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

Subsequent pregnancy

Natural childbirth after a cesarean section is allowed if the formed connective tissue on the uterus is strong, that is, strong, smooth, and able to withstand muscle tension during childbirth. This issue should be discussed with your attending physician during your next pregnancy.

Probability of subsequent births in a normal way increases in the following cases:

• the woman gave birth to at least one child vaginally;
• if the CS was performed due to incorrect position fetus

On the other hand, if the patient is over 35 years old at the time of subsequent births, she has excess weight, concomitant diseases, discrepant sizes of the fetus and pelvis, it is likely that she will undergo surgery again.

How many times can you have a caesarean section?

The number of such interventions is theoretically unlimited, but to maintain health it is recommended to do them no more than twice.

Usually the tactic is repeat pregnancy the following: the woman is regularly observed by an obstetrician-gynecologist, and at the end of the gestation period a choice is made - surgery or natural childbirth. During a normal birth, doctors are ready to perform emergency surgery at any time.

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

How long after surgery can I give birth?

It depends on the consistency of the scar, the age of the woman, concomitant diseases. Abortions after CS have a negative impact on reproductive health. Therefore, if a woman nevertheless becomes pregnant almost immediately after the CS, then with normal course pregnancy and permanent medical supervision she can carry a child, but delivery will most likely be surgical.

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

What is important to know when having a second caesarean section?

Elective surgery is usually performed at 37-39 weeks. The incision is made along the old scar, which somewhat lengthens the operation time and requires stronger anesthesia. Recovery after a CS may also be slower as scar tissue and adhesions in the abdomen prevent good reduction uterus. However, when positive attitude women and her family, with the help of relatives, these temporary difficulties are completely surmountable.