At what stage of pregnancy is a caesarean section performed and what does it depend on?

As you know, a caesarean section is nothing more than a surgical intervention during which the fetus is removed from the mother’s womb through an incision in the anterior abdominal wall and uterus. The decision to carry out such a planned operation is made depending on the presence of indications that do not allow childbirth to occur naturally.

At what stage of pregnancy is a planned caesarean section performed and what are its advantages?

With this type of surgical intervention, the likelihood of uterine rupture is sharply reduced. Besides? Various types of complications observed during natural childbirth occur less frequently during cesarean. The operation also reduces the risk of uterine prolapse, which prevents heavy, uterine bleeding during childbirth.

If we talk about the period at which a planned cesarean section is performed, it is most often the 39th week. The thing is that it is by this time that the fetus’s body begins to produce a substance called surfactant, which helps to open the lungs with the baby’s first breath. If the operation is performed earlier than the specified period, the baby needs artificial ventilation.

Who is scheduled for elective caesarean section?

This kind of surgical intervention is not always prescribed. The main principles for its implementation are:

• features of the anatomical structure (narrow pelvis);
• the presence of mechanical obstacles to natural birth (fibroids, bone deformities, tumor);
• previous cesarean section.

Regarding the last point, previously, if a woman had already given birth by cesarean section, then the subsequent ones were carried out as well. Today, if there is a dense scar on the uterus, childbirth can be carried out through natural means. However, a repeat cesarean section is mandatory in the presence of complications such as a vertical incision of the uterus, uterine rupture, or abnormal placenta or fetal previa.

If we talk about the period at which a planned cesarean section is performed, then it is usually the same as for the first one - 39 weeks. However, if there is a risk of complications, it can be done earlier.

Why is a caesarean section dangerous?

Like any surgical procedure, cesarean section is associated with certain risks of complications. These primarily include:

• the development of adhesions and scars, which subsequently fasten together the organs located in the pelvis and the muscles of the abdominal wall. This is accompanied by unpleasant sensations and discomfort;
• violation of placenta previa during subsequent births.
• placenta accreta. This complication occurs when the placenta cannot detach itself from the wall of the uterus. Therefore, manual separation is required, which is accompanied by severe bleeding. This kind of violation is observed in cases where a woman has already had 3 or more cesarean sections in the past.

What is the recovery period like after a caesarean section?
The first day after the operation, the woman is under the supervision of doctors in the postpartum ward. She is prescribed painkillers for several days after the operation. In this case, special attention is paid to the condition of the uterus, observing its contractility.

Sutures placed on the anterior abdominal wall are treated daily with antiseptic solutions and then removed on days 7-10. If the mother has no complications, and if the baby does not have any disorders and was born absolutely healthy, discharge home occurs a week after the cesarean section.

Thus, doctors determine the choice of the best time to do a planned cesarean section based on the condition of the fetus and the pregnant woman. In the absence of any risks, such an operation can be performed with the onset of the first contractions in a pregnant woman.

You should also adhere to the regimen recommended for expectant mothers and perform special sets of exercises, do gymnastics and swimming - well-trained muscles will help you get back into shape faster after surgery, regular exercise and walks in the fresh air will be useful not only for you, but also for your a baby who is also facing a serious test.

If you have a planned operation, especially if it is due to your condition, you will most likely be sent to a maternity hospital. You will undergo all examinations and, if necessary, receive the necessary drug treatment that will prepare your body for the upcoming surgical intervention.

Particular attention will be paid to the baby’s readiness for birth. Doctors will evaluate it using tests such as cardiotocography, echography and Doppler. However, if your pregnancy is proceeding without complications and the reason for the need for surgery, for example, is the incorrect position of the fetus, you can undergo all the examinations in advance and come to the maternity hospital directly on the day of the operation.

Perhaps, when preparing for a planned operation, doctors will suggest that you resort to so-called autologous plasma donation. This procedure involves taking 300 ml of plasma (the liquid part of blood) from a woman in the second half of pregnancy, which will be placed for storage in a special freezer. This is absolutely safe for you and your baby: your body will cope with restoring this amount of plasma in a few days. But, if during the operation there is a need for a blood transfusion, you will receive your own plasma, not someone else’s, which completely eliminates the possibility of infection and a number of other problems.

The date of the operation is calculated in the same way as the date of the expected birth, taking into account the day of the start of the last menstruation, the expected day of conception, and the results of an ultrasound examination.

The night before your surgery, your dinner should be light. Take a shower before going to bed and remember to get a good night's sleep. If anxiety is preventing you from falling asleep, consult your doctor - he will recommend a sedative that is safe for your baby.

In the morning you will have to do without breakfast, and you cannot drink water either. In the maternity hospital, two hours before the operation, you will have a cleansing enema, and your pubis and perineum will be shaved.

Previously, such surgery could only be performed under general anesthesia.

However, only the operation site and the lower part of your torso will be numbed, you will remain conscious, you will be able to see your baby immediately after he is born, and immediately attach him to your breast.

After the administration of painkillers, the woman’s abdomen is treated with special antiseptic agents and covered with sterile sheets. The doctor makes an incision in the abdominal wall. Most often, the incision is made horizontally above the woman's pubic hairline, which makes the postoperative scar almost invisible. A longitudinal incision in the direction from the pubis to the navel is made extremely rarely, as a rule, only in cases where it is necessary to immediately remove the child. If you have already had a similar operation, the incision will be made along the old suture.

By cutting the subcutaneous tissue and muscles of the abdominal wall and moving the bladder to the side, the surgeon gains access to the lower part of the uterus. Usually in this place - the thinnest and most durable - a transverse incision is made. Longitudinal dissection of the uterus is performed extremely rarely.

Having opened the amniotic sac, the surgeon removes the baby from the uterus by hand. The umbilical cord is cut and the baby is delivered by a midwife.

After removing the placenta and membranes from the uterus, the doctor places a suture on the wall of the uterus. The special threads used for this will dissolve in a few months.

Having connected all the tissues, the surgeon places sutures or staples on the abdominal wall, covering them on top with a sterile bandage. An ice pack is placed on the lower abdomen, which will be removed after 1.5 - 2 hours - this helps reduce bleeding and more active contractions of the uterus. The entire operation usually takes from 20 to 40 minutes.

If the child’s condition does not require assistance, then the mother can take him in her arms before the end of the operation.

Currently, it is allowed for the father to be present at the operation or to meet the baby immediately after the baby is removed from the mother’s womb. This is significant if a caesarean section is performed under general anesthesia and the mother does not have the opportunity to immediately touch the newborn - the baby can wait for her to wake up in dad’s reliable hands.

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

Caesarean section pros and cons

Pros of the section:

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

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

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

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

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

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

When is an emergency caesarean section performed?

Indications for emergency caesarean section can occur at any stage, even with premature pregnancy, i.e. before 37 weeks. If labor begins between 28 and 34 weeks, or indications arise for the birth of a child ahead of schedule, then a caesarean section is performed. The child is not mature and childbirth through the birth canal is too difficult for him.

An emergency caesarean section is performed before 37 weeks if:

1. Bleeding begins due to premature placental abruption.
2. Bleeding with placenta previa.
3. When signs of uterine rupture along the scar appear. Especially if there is more than one scar on the uterus.
4. Another reason is fetal hypoxia. The child does not receive enough nutrition and oxygen from the mother. If this condition continues for a long time, the baby may die. To save a child, you have to give birth and nurse him in an incubator, even if the pregnancy is still short.
5. If you have been suffering from swelling, high blood pressure, and poor urine tests since 22 weeks of pregnancy, this is gestosis. As the pregnancy progresses, it becomes more and more difficult to treat; the child also suffers from the mother’s edema and is stunted in growth. If the condition of the woman and fetus deteriorates sharply, then a cesarean section is performed at any time.

A caesarean section can also be performed during labor that begins on its own.

• Clinically narrow pelvis
  – when the dimensions of the mother’s pelvis and the dimensions of the presenting part of the child do not correspond to each other and childbirth is impossible. This becomes clear only during childbirth.
• Frontal presentation
  - when the head enters the small pelvis at its largest size. Her birth through the natural birth canal becomes impossible.
• Prolapse of umbilical cord loops
  after rupture of amniotic fluid.
• hypoxia
  can develop during childbirth. In this case, the birth must be completed immediately so that the baby does not suffer.

There is also a minor caesarean section. It is performed at 13-22 weeks of pregnancy in order to terminate it. It is performed if the placenta completely blocks the entrance to the uterus. Or there is placental abruption and bleeding, which requires emergency assistance to the woman.

As you can see, indications for caesarean section can be very different and occur at any stage and at any time. Therefore, as soon as you go on maternity leave, pack an “emergency suitcase” that will contain everything you need for you and your baby.

Fetal passport and your passport, shirt, robe, disposable diapers, spoon, mug, personal hygiene products: comb, pads, toothpaste and brush, toilet paper, intimate hygiene gel or soap. For the baby, diapers, powder, diapers, suits.

No matter how long a cesarean section is performed, the main thing is that it is done according to indications and preserves the health of the expectant mother and child.

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In recent decades, more and more babies are born via cesarean section (CS). In some maternity hospitals in the CIS countries, CS rates reach 50% of all births. In 2005, WHO conducted studies showing that with an increase in the frequency of CS, the frequency of antibiotic prescriptions in the postpartum period increases, and the level of maternal morbidity and mortality increases. On average, cesarean section occurs in 15 births out of 100, while a further increase in the frequency of CS does not lead to a decrease in perinatal morbidity and mortality in children.

Given the relatively high incidence of CS, any opportunity to reduce the risks associated with operative delivery will have significant benefits both for individual women in labor and in terms of economic costs.

Compared with vaginal births, maternal mortality rates for CS (40 per 10,000 cases) are 4 times higher than for all types of vaginal births and 8 times higher than for normal vaginal births (5 out of 10,000 cases).

Second and third caesarean section, what is important to know

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

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

So, what might await a woman:

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

How long will it take for full recovery?

The same amount as required after a normal birth: that is, about 2 months.

During the first days of recovery, mom may experience:

• painful contractions of the uterus (especially while feeding the baby);
• bloody discharge will gradually decrease, turning into bloody and then serous;
• pain in the suture area, sensitive in the first days, will decrease within 3-5 days.

As after childbirth, in the first 2 months a woman is not recommended to take a bath or be sexually active.

Consequences for the baby

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

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

Timing of planned caesarean section

Performed after complete obstetric 39 weeks of pregnancy. This is due to the minimization of respiratory distress syndrome (RDS) in the newborn.

In case of multiple pregnancy, a planned CS is performed after 38 weeks.

In order to prevent vertical transmission of the disease in case of HIV infection of the mother - at 38 weeks of pregnancy, before the rupture of amniotic fluid or before the onset of labor.

In case of monoamniotic twins, the CS operation should be performed at 32 weeks after the prevention of fetal RDS (special injections are given to promote the opening of the lungs).

Our lives change every day. Both medicine and science are developing rapidly, saving and making lives easier with the help of new technologies. We are freed from many previously existing problems. But the main thing does not change - we continue to love, hope, give birth and raise children. The most amazing and significant event in our lives is always the birth of a child.

Pregnancy

- a physiological process, not a disease, many doctors say. However, during this period of life, a woman’s health is tested for strength; she needs to go through increased stress, which makes her more sensitive and vulnerable. Childbirth is also not a pathological condition, but a necessary difficult process that ends with the birth of a baby. But it is a huge stress for both and sometimes requires special medical intervention.

There is no general opinion among doctors about the only correct, safe and most painless method of childbirth, especially for healthy women with a normal pregnancy.

Every woman has the right, and now the opportunity, to choose the optimal and safest delivery option for herself and the child, chosen together with her supervising physician and approved by him in accordance with all indications that arose during pregnancy.

But there are situations when an obstetrician-gynecologist, unequivocally or weighing the risks, insists on performing a cesarean section - a surgical operation that allows a child to be born by removing it from the belly of a mother who cannot or cannot give birth to him in the usual way.

Anesthesia for caesarean section

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

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

Epidural anesthesia

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

Why is there such an increase in caesarean sections?

• Most operations are carried out in the interests of the child, because once upon a time this operation was created specifically for the purpose of saving the life of a newborn.
• A large percentage of women think about having a baby late, and this leads to a number of complications during pregnancy.
• Extragenital diseases in women: cardiovascular (heart defects, arterial hypertension), diseases of the kidneys, adrenal glands, thyroid gland, obesity, disturbance of vaginal biocenosis, etc.
• Induced (using drugs and ART methods) multiple pregnancies.

Childbirth after cesarean

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

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

When to plan a new pregnancy after a CS?

You need to wait about a year (any woman who has given birth needs this interval).

Usually, the suture after a cesarean section heals within three months after the birth of the child. However, if more time passes, it will heal better. A poorly healed scar can cause problems in the future, because in this case there may be a risk of uterine rupture along the existing scar. And although the risk is low, it increases if the interval between pregnancies is short (less than 1-1.5 years). Also, the rapid occurrence of a new pregnancy after a CS is accompanied by an increased risk of low placental attachment or placental abruption.

Many women experience postpartum depression, emotional stress or simply fatigue after pregnancy and surgery - in such situations the body also needs rest. Of course, a woman may have reasons to plan a new pregnancy soon after the CS (age or the desired small difference in the ages of the children). In such cases, it is necessary to consult a doctor and make sure that the suture on the uterus has healed and the body is ready to bear a new pregnancy.

Adhesions after cesarean section, symptoms

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

Progress of the operation

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

The incision can be of two types:

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

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

Next, the doctor inserts his hand into the uterine cavity and carefully removes the fetus. The umbilical cord is cut and the baby is transferred to a neonatologist, who will assess his condition using the Apgar score.

Recovery after cesarean

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

Reasons for increasing caesarean section rates

An increase in the number of women who decide to give birth only after 30 years of age in combination with possible gynecological pathologies (adnexitis, endomyometritis, neuroendocrine disorders, infertility, operations on the uterus and appendages, uterine fibroids, endometriosis, etc.).

Frequent course of pregnancy against the background of various other non-gynecological diseases, when pregnancy occurs with complications. Often there is a complicated course of labor.

Improving the diagnosis of pathology during pregnancy through new research methods that make it possible to establish a more accurate diagnosis.

Expanding the indications for cesarean section in cases of severe gestosis, premature pregnancy, and breech presentation of the fetus.

Expanding the indications for caesarean section performed in the interests of the fetus.

Possibility to avoid the use of obstetric forceps.

Most pregnant women who have previously had a cesarean section are not recommended to give birth on their own.

Despite all these reasons and indications, experts unanimously recommend that if it is possible to give birth on your own, then there should be no talk of any caesarean section, since the risks for both the mother and the child with a caesarean section are not at all lower, but often higher than during natural childbirth.

How to remove belly fat after caesarean section at home

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

Recovery period

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

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

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

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

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

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

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

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

In the first weeks, it is not recommended to lift anything heavier than the baby's weight. You can return to fitness activities no earlier than after 8 weeks and only after examination by a doctor. This also applies to resuming sexual activity.

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

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

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

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

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

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

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

Useful video about planned caesarean section

It is not always recommended for a woman to give birth on her own. If there are a number of complications or characteristics of the body, childbirth is carried out using a planned caesarean section. This method involves bringing the baby into the world through an incision in the peritoneum and uterus. This surgical intervention is used in almost a third of births carried out in the country. Some of them are carried out not because of the doctor’s testimony, but because of the reluctance of mothers to endure pain during labor.

Indications

Indications for surgical intervention are divided into primary and secondary. The first are associated with physiological reasons. In this case, the need for a cesarean section is not even discussed. If there are secondary reasons, the doctor decides whether surgery should be performed or whether the birth can take place naturally. However, when giving birth to a baby on your own, there is a high risk of complications.

The most important

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

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

Positive attitude towards caesarean section

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

Question

Good afternoon

I am 33 years old. I'm 36-37 weeks pregnant with my third pregnancy. Pregnancy proceeds without complications, tests are normal. There will be an ACL.

Previous births were also CS:

• 1 — weakness of labor, ECS.
• 2 — ACL 1 year 8 months after the first CS.

7 years have passed since the second CS.

I have a question:

At what obstetric stage is a referral for hospitalization to the maternity department of the RD issued?

At what obstetric stage is an ACL performed, given that there have already been two CS, will this be the third?

Thank you very much in advance…

When to have a planned caesarean section

Ideally, as close to the expected due date as possible.

. In practice, doctors often rush to admit a pregnant woman to the hospital - just in case.

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

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

Caesarean section at the patient's request

In some countries this is allowed - in the UK, the UAE, the USA and a number of others: here some women choose a caesarean section even if a natural birth is possible. But such a decision must be balanced, because this operation is always associated with the risk of complications. This practice is not common in Russia.

As for the price, you need to find out how much a planned caesarean section costs in the clinic you have chosen. For example, in a Moscow clinic, a birth with a cesarean section will cost 90-120 thousand rubles. (depending on the level of the maternity hospital). In foreign clinics, prices are several times higher: for example, in Germany a caesarean section will cost 10-14 thousand euros, in Finland - about 5-7 thousand dollars, in France - 10-30 thousand dollars. According to the compulsory medical insurance policy in a Russian maternity hospital, you can give birth by caesarean section absolutely free of charge.

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Preparing for a caesarean section

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

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

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

Packed my bag for surgery:

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

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

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

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

Operation

Anesthesia used during cesarean section:

During the operation, the tissues of the peritoneum and uterus are horizontally cut, the baby is removed and the umbilical cord is cut. Then the baby is washed, mucus and remaining amniotic fluid are removed from the nose and mouth. In the meantime, the placenta is removed, several stitches are applied and the operation is completed. The duration of the operation is on average about half an hour. Because viable babies are removed during elective surgeries, there is usually no need to place them in an incubator.

Then the woman remains in the recovery room under observation for 24 hours. She is prescribed painkillers and uterine contraction medications, as well as the administration of blood replacement solutions to replenish the blood loss that occurred during the operation.

In the normal course of the postoperative period, the patient is transferred to the postpartum department, where she is already with the baby. She is given painkillers and contraction injections for a few more days, the condition of the suture is monitored, and it is treated with antiseptics daily.

How is a caesarean section performed?

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

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

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

And then my baby screamed

.
The neonatologist took it to her table. I turned my head, trying to see what she was doing to him. She lay there looking at her son. The pain has disappeared. Instead, a feeling of euphoria came. I became a mother!
It seems to me that the maternal instinct woke up in me at the moment when I saw two stripes on the test. Every day and every month he gets stronger. And here, in the operating room, it reached its climax.

For doctors, this is ordinary everyday life. For a mother, this is one of the most important events in life.

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

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

Indications for elective surgery

For these reasons, even during pregnancy, the doctor may schedule a cesarean section:

• Anatomically narrow pelvis - a child’s normal-sized head cannot pass through it. This is determined by measuring the pelvis during consultation;
• Severe gestosis in the second half of pregnancy: increased blood pressure, preeclampsia and eclampsia. In this case, independent childbirth is dangerous due to complications for the mother’s brain and blood vessels;
• Complete placenta previa. The placenta blocks the baby's exit from the uterus. During childbirth, severe bleeding and fetal hypoxia may develop;
• Incomplete placenta previa if there is severe bleeding.
• Tumors of the pelvic organs that prevent the birth of a child. These may be tumors of the cervix or other organs;
• Active stage of genital herpes. In this case, during natural childbirth, the infection can be transmitted to the baby and cause him serious illness;
• Defective scar on the uterus after operations on it. In this case, uterine rupture during childbirth is likely;
• A full-fledged scar on the uterus after operations on it in the presence of any obstetric complications. This is decided individually for each woman.
• Severe cicatricial narrowing of the cervix and vagina. May prevent the baby from leaving the uterus;
• Severe varicose veins in the area of ​​the external genitalia and vagina. Threatens venous bleeding during childbirth;
• Breech presentation of the fetus in combination with other obstetric pathology. In some cases, spontaneous birth in a breech presentation is possible;
• Transverse and stable oblique position of the fetus. Independent childbirth is impossible. Caesarean section only;
• Large fruit. Relative indication, the possibility of childbirth depends on the size of the mother's pelvis;
• Some serious diseases in the mother: high myopia, retinal detachment, diseases of the nervous and cardiovascular systems, etc. The decision in this case is made individually;
• Mother's age over 30 years in combination with other unfavorable obstetric factors;
• Previous infertility in combination with other factors;
• Pregnancy after IVF

Separate indications exist for pregnant women with twins (multiple pregnancy):

• premature pregnancy (children weigh less than 1800 grams)
• transverse position of twins
• breech presentation of the first fetus
• combination of multiple pregnancy with any other obstetric pathology.

What happens after the operation?

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

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

But the pain is nothing compared to the feeling of helplessness

when you are forced to ask permission even to go to the toilet. In addition, you were not allowed to talk to your bedmates. Just sleep, drink and turn from side to side. It was not even allowed to walk around the ward, although it is known that the sooner a woman gets up and starts moving, the better. True, no one wanted to go.

All this time my thoughts were only about my son. I dreamed that the next day would come soon and we would see each other again. Fortunately, they put on a drip with a strong soporific painkiller for the night.

. And there is morning and a long-awaited meeting.

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

From the very beginning of pregnancy, literally every mother worries about how the birth itself will take place and at what period it is necessary to wait for a joyful event. In the case of such a complex operation as a caesarean section, the timing of the procedure is critical. The more accurately the doctor determines the date of the upcoming birth, the higher the likelihood that the outcome of the operation will be favorable.

It is worth noting that a good obstetrician-gynecologist, even during pregnancy monitoring, should find out how the woman will give birth. If the expectant mother feels normal and there is no danger to her and the baby, most likely the birth will take place naturally. If during pregnancy or after the onset of labor serious abnormalities are observed, the doctor prescribes a cesarean section.

Possible complications and their prevention

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

Common complications are the following:

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

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

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

Planned caesarean section: timing and prerequisites for the operation

The specialist informs the woman about a planned caesarean section during pregnancy. This also has its advantages, since the expectant mother has the opportunity to find out the exact date of birth of the baby. The doctor may prescribe a cesarean section, timing of the operation, and other additional procedures. In order to determine the date of the upcoming cesarean as accurately as possible, a number of various studies and analyzes are carried out during pregnancy. This is the only way to calculate the optimal date for future births.

The main indications for a planned caesarean section are:

• Placental abruption ahead of schedule;
• Multiple pregnancy;
• Excessively narrow pelvis;
• Incorrect presentation of the fetus, its damage;
• Rh conflict between mother and child.

Some complications during childbirth are difficult to predict, so if something goes wrong during labor, your doctor may order an emergency caesarean section. The main thing is that in such a situation he can quickly determine the extent of the problem and choose the optimal method for solving it. In such cases, courage and awareness are required from the woman in labor, because the gynecologist has no right to carry out such an operation without her consent.

Contraindications to surgery

Surgical birth, named after the Roman Emperor Gaius Julius Caesar, does not involve the baby passing through the mother's birth canal. The child is born as a result of laparotomy and hysterotomy - incisions in the abdominal wall and uterine wall.

This method of delivery is sometimes life-saving. It is carried out urgently to save the lives of a woman and her baby if something goes wrong during the process of physiological childbirth or as a result of injury. Emergency caesarean section accounts for no more than 7-9% of all surgical births. The remaining share is allocated for planned operations.

Indications for elective surgery may appear from the very beginning of pregnancy, or may become obvious only at the end of the gestation period. Therefore, the decision on the timing of the operation is made at different times.

For an emergency caesarean section, the issue of timing is irrelevant. It is carried out when there is an urgent vital need for it. The planned operation is carried out according to the indications provided for in the list of clinical recommendations of the Russian Ministry of Health. This list is regularly reviewed and adjustments are made to it.

Today it provides for the following situations:

• The pathological location of the placenta is low placentation with incomplete overlap of the internal os or complete placenta previa.
• Postoperative scars on the reproductive organ from cesarean section or other surgical manipulations on the uterus. Caesarean section is also recommended as the only delivery option if there is a history of two or more cesarean sections.
• Clinical narrowness of the pelvis, pathologies of the bones and joints of the pelvis, trauma and deformation, tumors of the pelvic organs, polyps.
• Pathological discrepancy of the bones of the pubic symphysis - symphysitis.
• Pathological position of the fetus. By the 36th week of pregnancy - pelvic, oblique, transverse. Also pathological include some types of presentation, for example, breech presentation.
• The estimated weight of the child is more than 3.6 kg and its position in the uterus is incorrect.
• Multiple pregnancy, in which the fetus closest to the exit is located in the breech position.
• Monozygotic twins (twins are inside the same fetal sac).
• IVF pregnancy with twins, triplets, and often singletons.
• Incompetent cervix, with scars, deformation, scars in the vagina left after a difficult previous birth, which took place with tears above the third degree of severity.
• Significant developmental delay in the baby.
• Lack of effect from conservative stimulation of labor during post-term pregnancy – after 41-42 weeks.
• Severe form and degree of gestosis, preeclampsia.
• The inability to push due to a ban on such an action in case of myopia, retinal detachment of a woman’s eyes, certain heart diseases, as well as in the presence of a kidney transplant.
• Long-term compensated fetal hypoxia.
• A bleeding disorder in the mother or baby.
• Genital herpes, maternal HIV infection.
• Fetal developmental anomalies (hydrocephalus, gastroschisis, etc.).

On an individual basis, a decision may be made about elective surgery for some other reasons.

Caesarean section: at what time is it better to perform the operation?

If a caesarean section has been pre-arranged, the operation often takes place around the 40th week of pregnancy. This is the most convenient and optimal time to carry out such a procedure. By this time, the child is already quite developed and is able to breathe on his own, which means he is quite ready to be born.

In cases where a caesarean section is not performed for the first time, the date of the operation is slightly shifted towards an earlier date. Often, surgical delivery is scheduled for the 38th week, approximately 10-14 days before natural labor begins. This option is used to avoid waiting for contractions, which could pose a danger to the mother and child. However, in each specific case, everything happens differently, so the doctor always determines the timing of a cesarean section based on the individual characteristics of the woman and the nature of the pregnancy.

In order for the woman in labor to recover as soon as possible after the operation and be able to return to her previous lifestyle, she is prescribed constant bed rest and painkillers. If the young mother's condition worsens or requires medication, the doctor may prescribe additional medications.

It is worth remembering that caesarean sections are performed quite often today, and there is no need to be afraid of this operation. As a rule, women have a fear of medical procedures because they do not fully understand what will await them. If the expectant mother is well informed about this issue, and the treatment is carried out by a qualified specialist who will prescribe a planned cesarean section, the timing of the procedure and the course of recovery after it, there is a high probability that the birth will go well.

Optimal time

If circumstances that are an indication for surgery arise already during the process of bearing a baby, for example, breech presentation is detected with a large fetus or placenta previa, then doctors wait until 34-36 weeks of pregnancy. This period is considered the “control” period. If by 35 weeks the baby does not turn over into the correct position, if the placenta does not rise, then the indication for surgery becomes absolute. An appropriate decision is made and a date for surgical delivery is set.

When circumstances implying surgical delivery as the only possible or the only rational one occur from the very beginning after the onset of pregnancy, then the issue of caesarean section is not considered separately. Operative delivery is assumed a priori.

Contrary to the widespread belief among women that a caesarean section is best performed when contractions have begun, since it is “closer to nature,” doctors prefer to operate on relaxed and calm muscles of the uterus rather than those tense during labor contractions.

The Russian Ministry of Health, in its protocol and clinical recommendations for caesarean section, names very specific periods at which the operation is considered the most desirable. It is recommended to have a planned cesarean section after the 39th week of pregnancy.

How long before a caesarean section is performed? Yes, on any one, if necessary. But the 39th week is considered the most favorable, because by this time, in the vast majority of children, the lung tissue has matured sufficiently for independent breathing to be possible, the child is ready, he will not need intensive care, the risks of distress syndrome and the development of acute respiratory failure are minimal.

Children are considered viable from the 36th week of pregnancy; children born earlier also survive, but the risks of respiratory failure increase in proportion to the period of prematurity.

When pregnant with twins or triplets, the likelihood of the onset of physiological labor a couple of weeks before the expected date of birth is higher, and therefore, in case of multiple pregnancies, they try to schedule a planned cesarean section at 37-38 weeks, and sometimes before 37 weeks. Children may require intensive care in the first hours of life, and therefore not only surgeons, but also a team consisting of a neonatologist and a pediatric resuscitator always prepare for such operations in advance.

Does this mean that a woman is not given the right to participate in the discussion of the birth date of her own child? Not at all. The doctor can indicate a time frame - several days, in which he considers it appropriate to perform the operation. A woman can choose one of these days at her own discretion. They try not to perform elective surgeries on weekends and holidays.

Possible complications

Negative consequences of a planned cesarean section are still possible in rare cases. And they can affect the health and life of both mother and child. The most common and dangerous include:

• excessive blood loss often leads to anemia;
• difficulties with lactation, in some cases - its absence;
• impossibility;
• anesthesia has a harmful effect on the baby;
• there is an assumption that during any cesarean (planned or emergency) a child does not produce proteins and hormones, which subsequently have a huge impact on his mental activity and adaptation to the environment;
• menstruation disorders;
• abdominal injury;
• infertility;
• thrombophlebitis of the pelvic veins, endometritis;
• uterus removal;
• disturbance of the baby's cerebral circulation.

Complications arise only in cases where a young mother ignored doctors’ orders or led an incorrect lifestyle during pregnancy. If you think first of all about your baby, he will definitely be born healthy, without pathologies, despite surgical intervention. High-quality, complete preparation for this event will shorten your recovery period after surgery. This will allow you to quickly return to your normal rhythm of life.

Postoperative period

How long a woman in labor will stay in the maternity hospital after surgery is decided by the attending physician who monitors her condition. As a rule, on the 5-7th day the woman is discharged home. She is prescribed a special diet to restore normal bowel functions, two months of sexual rest and abstinence from physical activity for up to six months.

Complications associated with the operation:

After the operation, the doctor orders several ultrasound examinations, the first of which is two months after the operation.

An ultrasound will show how the suture is healing and the restoration of the operated areas. It is believed that in 2-3 years the female body undergoes complete recovery after surgery, and it is better to plan a subsequent pregnancy at least 3 years after cesarean section.

By following the doctor's instructions, as well as regularly visiting the gynecologist to examine the suture, a woman will minimize all possible risks and complications associated with a cesarean section.

A caesarean section can be emergency or planned, that is, carried out at a previously established date or earlier than this time, or even for a woman for whom this operation was not planned. What to expect from surgical delivery? How do they prepare a woman for it? What are the difficulties of restoring the body after surgery? And what are the reasons for a planned caesarean section?

Usually, a woman learns about a possible operation, if there are any grounds for it, in advance, several weeks before the expected start of labor, from the antenatal clinic doctor managing her pregnancy. However, it is not he who decides whether there will be an operation or not. And it is not the doctor who writes out a referral to the hospital so that his patient can undergo planned surgery. The doctor leading the pregnancy only requires a referral to the maternity hospital, namely to the pregnancy pathology department. The question of the operation, its necessity, timing, anesthesia is decided directly by the doctors of the maternity hospital.

Typically, a planned caesarean section is performed as close as possible to the expected date of birth. But without special indications, not on weekends or holidays. This is especially true in small maternity hospitals in small towns, where there are no anesthesiologists constantly on duty in the maternity hospital.

Upon admission to the pregnancy pathology department, the woman is thoroughly examined. Even if she had already taken urine and blood tests before hospitalization, she will definitely retake everything. In addition to general tests, blood is taken from a vein for HIV, RW (syphilis), hepatitis, biochemical analysis, sugar, blood type and Rh factor. Over a long period of time, especially with low blood pressure, in the morning, on an empty stomach, when donating blood from a vein, a woman may become ill. If you were already unwell during the blood donation, ask the nurse to collect the blood while you are lying down on the couch. And immediately after, eat a piece of chocolate. It will quickly restore your vigor.

Preparing for a planned cesarean also includes visiting different doctors. Definitely an ophthalmologist, therapist, otolaryngologist. An ECG is performed the day before surgery. A conversation is held with an anesthesiologist. If hospitalization is carried out several days before surgery, the woman may be given IVs with saline solution. This is necessary to saturate the body with fluid, because large blood loss is expected during surgery. This liquid will be used to replenish it. In addition, as a standard, women are given intravenous injections of Piracetam, a drug that improves cerebral blood flow.

The evening before the operation, the woman is given an enema. Colon cleansing is carried out again in the morning. A catheter is placed in the bladder. Well, then, the work of doctors and honey. sisters. How the planned cesarean operation proceeds—how successful it is—depends on them, as well as on the individual characteristics of the mother’s health and the course of her pregnancy. The woman is given spinal (epidural) anesthesia or endotracheal (general) anesthesia. The peritoneal incision is usually made in the lower segment of the abdomen, transverse, less often vertical. The second heals worse and gives more complications. Therefore, it is performed only when it is carried out, especially during a premature pregnancy, or planned, but with a life-threatening condition of the mother or child. This type of incision is bad because it is unaesthetic and takes a long time to heal. This not only reduces a woman’s quality of life in the first months after surgery, but also negatively affects the onset and course of the next pregnancy. Thus, complications after a planned cesarean section in the form of an incompetent scar on the uterus, in the case of a horizontal incision, are rare. True, not only the type of incision plays a role here, but also the operation and postoperative period.

Thus, the following pros and cons of planned cesarean

.

Pros:

• no labor pain;
• there is no fear that the child will have a birth injury;
• there are no ruptures of the perineum or cervix.

Minuses:

• prolonged healing of sutures and problems in the form of hernias and other surgical complications;
• problems with establishing breastfeeding (due to untimely attachment of the baby to the breast and infrequent sucking);
• frequently developing endometritis (inflammation of the uterus), requiring treatment with antibiotics - a common consequence of a cesarean section;
• possible scar divergence during the next pregnancy;
• postoperative pain;
• the need to use contraception and plan pregnancy no earlier than two years after surgery.

Indications for planned caesarean section and timing of its implementation

There are many reasons why doctors may decide to operate on a woman. These are just some of them, the most common.

1. Clinically narrow pelvis.

This is the case when there is a very strong narrowing of it. The doctor clearly understands that the child cannot be born on his own. But more often, some narrowing of the pelvis is diagnosed, in which it is still possible to give birth to a small child on your own.

2. High degree of myopia (myopia).

The issue of surgery is decided after consultation with an ophthalmologist. It often happens that a woman is still allowed to give birth naturally, but with the use of epidural anesthesia and they try to reduce the period of pushing as much as possible.

3. Threat of divergence of the uterine scar.

At what time a planned cesarean section is performed and how it proceeds depends on the consistency of the uterine scar, that is, its thickness along its entire length. If there is a suspicion of its failure, the operation may be postponed to an earlier date, 37-38 weeks.

4. Breech presentation of the fetus or other, not cephalic.

Planned fetuses are done if a woman is carrying a boy. Fortunately, modern ultrasound machines make it possible to almost accurately determine the sex of a child. Or if the baby weighs more than 3.5 kg and the woman is primigravida. Multiparous women can give birth to girls on their own if the baby weighs less than 4 kg, and the maternity hospital has the ability to perform emergency surgery. Transverse position of the fetus is an absolute indication for surgery.

5. Symphysitis.

A planned caesarean section at 39 weeks or even earlier is performed for this pathology. The duration depends on the degree of divergence of the pelvic bones of the pregnant woman and her well-being. In case of pronounced symphysitis, independent childbirth is contraindicated. An accurate diagnosis is made based on ultrasound data.

6. Non-occurrence of labor despite ongoing “stimulating” therapy.

Sometimes it happens that the fetus has already shown signs of “overripeness”, there is reason to believe that it has hypoxia, there is little amniotic fluid, but labor does not begin. Then, especially if a woman is over 28 years old and is giving birth for the first time, doctors may recommend that the expectant mother be delivered surgically. In what week is a planned caesarean section performed in this case? Typically, unfavorable signs of post-term pregnancy appear at 41-42 weeks. That is, the timing for the operation is individual.

7. Some cardiovascular diseases, heart defects.

If a woman is generally having a good pregnancy, the maternity hospital may offer her hospitalization immediately at the beginning of labor, or when, as a result of examination of the cervix, it becomes clear that spontaneous labor is about to begin. How long does it take to do the planning, you ask? As close as possible to the beginning of natural childbirth. Otherwise, there remains a high probability of difficulties with adaptation to the external environment in the fetus. Sometimes even full-term babies born by Caesarean section, but prematurely, have problems with independent breathing. That is, a planned second cesarean section is often done at about 40 weeks, when the amniotic fluid breaks or the woman begins to feel cramping pain.

Less commonly, the reasons for surgery are varicose veins in the vaginal area, severe hemorrhoids (there is a possibility of node thrombosis).

What happens on the day of a planned caesarean section?

As a rule, such operations are carried out in the morning. Less often during the day. Therefore, in the evening, a woman should take a shower and, if necessary, shave her pubic hair. The food a woman takes for dinner should be light. You can't eat at all in the morning. In the hospital, a nurse will help you do an enema to cleanse your intestines, as before any abdominal surgery.

After this, an anesthesiologist will have a conversation with the woman, who will talk about what and how will happen to her during the operation in terms of pain relief. Most likely, this will be spinal anesthesia, that is, when the operation is performed while the woman is conscious. But, if there are any contraindications, the patient will be offered general anesthesia. Consent to the operation and a certain type of anesthesia is recorded in writing.

Deadlines

Most women are interested in what week a planned caesarean section is performed, because very often doctors are silent until the last minute and delay setting the date for the operation. The fact is that the timing in this case is very individual and depends on a combination of many factors: the characteristics of pregnancy, the state of the mother’s health, the intrauterine development of the fetus, and even the operating hours of the hospital in which you will be operated on. You can only take the following dates into account.

1. The norm for a planned cesarean section: 39-40 weeks, i.e. the timing is as close as possible to natural childbirth. This is to minimize respiratory distress in the newborn. The first contractions are considered the ideal time for surgery.
2. Multiple pregnancy and maternal HIV infection: 38 weeks.
3. Monoamniotic twins: planned caesarean section at 32 weeks.

In certain cases, the timing of a planned cesarean section is not dictated by the child. If the placenta previa is incorrect, the operation is performed before the first contractions begin. There are other reasons when there is no time to wait for a natural birth - it is too dangerous.

Knowing for sure how many weeks you will have surgery will help you prepare for a specific date. This will reduce the threshold of anxiety, allow you to maximize time distribution and effectively prepare for a planned caesarean section, which in this case takes place with minimal risks.

Preoperative preparation a few days before the CS

Be sure to check whether you need to shave your pubic area yourself. It is better to entrust this manipulation to medical workers (to avoid cuts, infection and inflammation), but some institutions recommend preparing this area in advance.

After admission to the antenatal department (usually 2 weeks before the intervention), a series of tests will be required so that doctors can objectively assess the condition of their patient at the present time.

List of required tests:

• blood group and Rh factor;
• vaginal smear.

Additionally, a hardware examination is carried out - and CTG - cardiotocography.

You need to give up solid food for 48 hours. On the eve of the CS, you cannot eat after 18-00, and on the day of the operation it is extremely undesirable to even consume liquid. In the morning before the intervention, you need to cleanse the intestines, using an enema if necessary.

The method of anesthesia is discussed in advance.

Local anesthesia (spinal or) is recommended for those who want to see their child in the first moments of his life.
In addition, you need to take into account that anesthesia can negatively affect the baby's condition
. In any case, the procedure will not be associated with pain.

note

In most specialized maternity hospitals, mothers are allowed to hold their newborn for a short time immediately after the CS.

The patient is taken from the ward to the operating room on a gurney.

Already on the table, a catheter is inserted into the bladder. A dropper with a solution must be placed or a drug injection must be given.

The surgical field (lower abdomen) is carefully treated with an antiseptic solution. If it is expected that the patient will remain conscious, then a screen is installed in front of her at chest level, blocking the view (to avoid mental trauma).

After anesthesia, two incisions are made (most often transverse) in the lower abdomen

.
During the first, the skin, the layer of fiber and the abdominal wall are dissected, and during the second, the uterus.
The baby is removed and, after cutting the umbilical cord, transferred to a neonatologist. The newborn's mouth and nasal passages are cleaned. His condition is assessed using the generally accepted ten-point APGAR scale.

note

If a caesarean section is not being performed for the first time, the incision is usually made along the line of the old suture.

The longest stage is suturing. It requires jeweler precision from the obstetrician, since not only the severity of the cosmetic defect, but also the healing process of soft tissues will depend on the quality of sutures. Neat transverse seams are practically invisible in the future, because they are hidden under the hair.

The advantage of a horizontal incision above the pubis is that it practically reduces to zero the likelihood that the bladder or intestinal wall will be accidentally hit. In addition, the risk of hernia formation is minimized, and healing proceeds faster. An incision in the vertical direction from the navel to the pubic bone is often made during an emergency caesarean section, when the need to save the mother and child comes to the fore, rather than aesthetic considerations.

At the final stage of a planned cesarean section, which in the absence of complications lasts only 20-40 minutes, the suture is treated with an antiseptic and covered with a sterile bandage.