Each pregnancy in a woman proceeds in a new way, not like the previous one. Childbirth, respectively, also goes differently. If for the first time the baby was born with the help of gynecological surgeons, this does not mean that now everything will happen according to the same scenario. What if there is a second caesarean section? What is important for a woman to know? Can surgery be avoided? These and some other questions will be answered in today's article. You will learn about how long a planned second cesarean section is, how the body recovers after manipulation, whether it is possible to plan a third pregnancy, and whether it is realistic to give birth on your own.

Natural childbirth and caesarean section

We will find out how it is carried out and what indications the second caesarean section has. What is important to know? The natural appearance of a child is a process conceived by nature. During childbirth, the baby goes through the appropriate paths, experiences stress and prepares for existence in the new world.

Cesarean section suggests the artificial birth of a child. Surgeons make an incision in the woman's abdomen and uterus, through which the baby is taken out. The baby appears abruptly and unexpectedly, he does not have time to adapt. Note that the development of such children is more difficult and more difficult than those that appeared during natural childbirth.

During pregnancy, many expectant mothers are afraid of the caesarean section. After all, the advantage has always been given to natural childbirth. A few centuries ago, a woman after a cesarean had no chance of survival. In earlier times, manipulation was carried out only in already deceased patients. Now medicine has made a big breakthrough. Caesarean section has become not only a safe intervention, but in some cases necessary to save the life of the child and mother. Now the operation lasts only a few minutes, and the possibilities of anesthesia allow the patient to remain conscious.

Second caesarean section: what is important to know about the indications?

What does the doctor pay attention to when choosing this route of delivery? What are the indications for a second intervention in the natural process? Everything is simple here. The indications for the second caesarean section are the same as for the first operation. Manipulation can be planned and emergency. When prescribing a planned caesarean section, doctors rely on the following indications:

• poor eyesight in a woman;
• varicose disease of the lower extremities;
• heart failure;
• chronic diseases;
• diabetes;
• asthma and hypertension;
• oncology;
• traumatic brain injury;
• narrow pelvis and large fetus.

All these situations are the reason for the first intervention. If after the birth of the child (the first) the diseases were not eliminated, then the operation will be performed during the second pregnancy. Some doctors are inclined to this opinion: the first caesarean section does not allow a woman to give birth herself anymore. This statement is erroneous.

Can you give birth on your own?

So, you are recommended a second caesarean section. What is important to know about it? What are the real indications for the operation, if the woman's health is all right? Re-manipulation is recommended in the following cases:

• child has;
• after the first caesarean section, two more years have not passed;
• the suture on the uterus is untenable;
• during the first operation, a longitudinal incision was made;
• abortions between pregnancies;
• the presence of connective tissue in the scar area;
• the location of the placenta on the scar;
• pathology of pregnancy (polyhydramnios, oligohydramnios).

An emergency operation is performed with an unforeseen divergence of the scar, weak labor activity, the serious condition of the woman and so on.

You can give birth on your own if a second caesarean section is recommended. What is important to know? modern medicine not only allows a woman the natural process of childbirth, but also welcomes it. It is important to future mom was carefully examined. Conditions for natural childbirth after caesarean section are the following circumstances:

• more than three years have passed since the first operation;
• the scar is wealthy (muscle tissue predominates, the area stretches and contracts);
• thickness in the seam zone is more than 2 mm;
• no complications during pregnancy;
• a woman's desire to give birth on her own.

If you want a second child to appear naturally, then you should take care of this in advance. Find a maternity hospital that specializes in this matter. Discuss your condition with your doctor in advance and undergo an examination. Attend scheduled consultations regularly and follow the recommendations of the gynecologist.

Management of pregnancy

If the first birth took place by caesarean section, then the second time everything can be exactly the same or completely different. For future mothers after such a procedure, there should be an individual approach. As soon as you find out about your new position, you need to contact a gynecologist. A feature of the management of such a pregnancy are additional studies. For example, ultrasound in such cases is done not three times for the entire period, but more. Diagnosis before childbirth is becoming more frequent. The doctor needs to monitor your condition. After all, the entire outcome of pregnancy depends on this indicator.

Be sure to visit other specialists before delivery. You need to address to the therapist, the oculist, the cardiologist, the neurologist. Make sure there are no restrictions on natural childbirth.

Multiple and conventional caesarean section

So, you still scheduled a second caesarean section. At what time is such an operation performed, and is it possible to give birth to yourself with a multiple pregnancy?

Suppose that the previous delivery was performed surgically, and after that the woman became pregnant with twins. What are the predictions? In most cases, the outcome will be a second caesarean section. At what time do it - the doctor will tell. In each case, the individual characteristics of the patient are taken into account. Manipulation is prescribed for a period from 34 to 37 weeks. With multiple pregnancies, they do not wait longer, as rapid natural childbirth can begin.

So, you are carrying one child, and a second caesarean section is scheduled. When is the operation done? The first manipulation plays a role in determining the term. Re-intervention is scheduled 1-2 weeks earlier. If for the first time a caesarean was performed at 39 weeks, now it will happen at 37-38.

The seam

You already know at what time a planned second caesarean section is made. The caesarean is re-performed along the same suture as the first time. Many expectant mothers are very concerned about the aesthetic issue. They worry that the whole belly will be covered with scars. Don't worry, it won't happen. If the manipulation is planned, then the doctor will make an incision where he passed for the first time. The number of external scars you will not increase.

Otherwise, the situation is with the incision of the reproductive organ. Here, with each repeated operation, a new area for the scar is selected. Therefore, doctors do not recommend giving birth by this method more than three times. For many patients, doctors offer sterilization if a second caesarean section is scheduled. When they are admitted to the hospital, gynecologists clarify this issue. If the patient wishes, the fallopian tubes are ligated. Do not worry, without your consent, doctors will not carry out such a manipulation.

After surgery: recovery process

You already know about when the second caesarean section is shown, at what time it is done. Reviews of women report that the recovery period is practically no different from that which was after the first operation. A woman can stand up on her own in about a day. A newly-made mother is allowed to breastfeed a baby almost immediately (provided that illegal drugs were not used).

The discharge after the second operation is the same as during natural childbirth. Within one or two months, there is a discharge of lochia. If you have had a caesarean section, then it is important to monitor your well-being. Consult your doctor if you experience unusual discharge, fever, deterioration in general condition. They are discharged from the maternity hospital after the second caesarean section for about 5-10 days, as well as for the first time.

Possible Complications

With a second operation, the risk of complications certainly increases. But this does not mean that they will definitely arise. If you give birth on your own after a caesarean section, then there is a chance of a scar divergence. Even if the suture is well-founded, doctors cannot completely exclude such a possibility. That is why in such cases, artificial stimulation and painkillers are never used. It's important to know about this.

During the second cesarean, the doctor has difficulties. The first operation always has consequences in the form of an adhesive process. Thin films between organs make it difficult for the surgeon to work. The procedure itself takes longer. This can be dangerous for the child. Indeed, at this moment, potent drugs used for anesthesia penetrate into his body.

A complication of a second caesarean can be the same as the first time: poor contraction of the uterus, its inflection, inflammation, and so on.

Additionally

Some women are interested: if a second caesarean section is performed, when can I give birth for the third time? Experts cannot answer this question unambiguously. It all depends on the condition of the scar (in this case, two). If the seam area is thinned and filled with connective tissue, then pregnancy will be completely contraindicated. With wealthy scars, it is quite possible to give birth again. But, most likely, this will be the third caesarean section. The possibility of natural childbirth decreases with each subsequent operation.

Some women manage to give birth to five children by caesarean section and feel great. Much depends on the individual characteristics and technique of the surgeon. At longitudinal section doctors do not recommend giving birth more than twice.

Finally

A caesarean section performed during the first pregnancy is not a reason for a second procedure. If you want and can give birth on your own, then this is only a plus. Remember that natural childbirth is always a priority. Talk to a gynecologist about this topic and find out all the nuances. Good luck!

Surgical childbirth (caesarean section) is carried out according to indications, when there is a threat to the health and / or life of the mother or baby. Today, however, many women in childbirth, out of fear, think about an assisted delivery option, even in the absence of health problems. Is it possible to have a caesarean at will? Is it worth insisting on surgical delivery if there are no indications? The expectant mother needs to learn as much as possible about this operation.

A newborn baby who was born through surgery

CS is a surgical delivery method that involves removing the baby from the uterus through an incision in the abdominal wall. The operation requires some preparation. The last meal is allowed 18 hours before the operation. Before the COP, an enema is given, hygiene procedures are carried out. AT bladder patients insert a catheter, and the stomach must be treated with a special disinfectant.

The operation is performed under epidural anesthesia or under general anesthesia. If the CS is done according to plan, then the doctors tend to the epidural. This type of anesthesia assumes that the patient will see everything that is happening around, but will temporarily lose tactile and pain sensations below the waist. Anesthesia is done by puncturing the lower back, where the nerve roots are located. General anesthesia for surgical delivery is used urgently when there is no time to wait for the action of regional anesthesia.
The operation itself consists of the following steps:

1. Section of the abdominal wall. It can be longitudinal and transverse. The first is designed for emergencies, because it makes it possible to get the baby as quickly as possible.
2. Muscle extension.
3. Incision of the uterus.
4. Opening of the fetal bladder.
5. Removing the baby, and then the placenta.
6. Stitching of the uterus and abdominal cavity. For the uterus, self-absorbable threads must be used.
7. Applying a sterile dressing. Ice is placed on top of it. This is necessary to increase the intensity of uterine contractions and reduce blood loss.

In the absence of any complications, the operation does not last long - a maximum of forty minutes. The baby is taken out of the mother's womb in the first ten minutes.

There is an opinion that caesarean is a simple operation. If you do not delve into the nuances, it seems that everything is extremely easy. Based on this, many women in labor dream of surgical method delivery, especially given the effort required for natural childbirth. But you must always remember that a coin cannot have one side.

When is CS required?

The attending gynecologist will decide whether the woman in labor needs surgery

In most cases, COPs are planned. The doctor determines whether there are threats to the mother and the baby if the birth takes place naturally. The obstetrician then discusses delivery options with the woman in labor. Scheduled CS is carried out on a pre-arranged day. A few days before the operation, the expectant mother should go to the hospital for a control examination. While the pregnant woman is planned to be in the hospital, the doctor monitors her condition. This allows you to predict the likelihood of a successful outcome of the operation. Also, the examination before the COP is aimed at determining the full-term pregnancy: using various diagnostic methods, it is revealed that the baby is ready for birth and you can not wait for contractions.

The operation has a number of indications. Some factors leave room for discussion about the method of delivery, others are absolute indications, that is, those in which EP is not possible. Absolute indications include conditions that threaten the life of the mother and baby during natural delivery. CS must be done when:

• absolutely narrow pelvis;
• the presence of obstructions in the birth canal (uterine fibroids);
• insolvency of the uterine scar from past CS;
• thinning of the uterine wall, which threatens to rupture it;
• placenta previa;
• foot presentation of the fetus.

There are also relative indications for CS. With such factors, both natural and surgical childbirth are possible. The delivery option is chosen taking into account the circumstances, the health and age of the mother, the condition of the fetus. The most common relative indication for CS is breech presentation. If the position is incorrect, the type of presentation, the sex of the baby is taken into account. For example, in the gluteal-leg position, EPs are acceptable, but if a boy is expected, the doctor insists on a caesarean section in order to avoid damage to the scrotum. With relative indications for caesarean section, only an obstetrician-gynecologist can tell the right decision regarding the way the baby is born. The task of parents is to listen to his arguments, because they will not be able to assess all the risks on their own.

A cesarean may be performed on an emergency basis. This happens if childbirth began naturally, but something went wrong. Emergency CS is carried out if bleeding has begun in the process of natural release, premature placental detachment has occurred, acute hypoxia has been recorded in the fetus. An emergency operation is performed if labor is difficult due to weak contraction of the uterus, which cannot be corrected with medication.

Elective CS: is it possible?

Happy mother with a long-awaited daughter

Whether it is possible to do a CS at the request of a woman in labor is a moot point. Some believe that the decision on the method of delivery should remain with the woman, others are sure that only a doctor can determine all the risks and choose the best method. At the same time, the popularity of elective cesarean is growing. This trend is especially noticeable in the West, where expectant mothers are actively choosing the way to give birth to their own baby.

Women in labor prefer surgical childbirth, guided by fear of attempts. In paid clinics, doctors listen to the wishes of expectant mothers and leave them the right to choose. Naturally, if there are no factors under which CS is undesirable. The operation has no absolute contraindications, however, there are conditions that increase the risk of infectious and septic complications after surgical delivery. These include:

• infectious diseases in the mother;
• diseases that disrupt blood microcirculation;
• immunodeficiency states.

In the CIS countries, the attitude towards the elective CC differs from the Western one. Without evidence, it is problematic to perform a caesarean section, because the doctor is legally responsible for each surgical intervention. Some women in labor, considering surgical childbirth as a painless way to give birth to a baby, even invent diseases for themselves that could serve as relative indications for CS. But is the game worth the candle? Is it necessary to defend the right to choose the way of having a child? To understand this, the expectant mother must understand the intricacies of the operation, compare the pros and cons, and study the risks that exist with any surgical intervention.

Benefits of CS at will

Why do many expectant mothers want to have a cesarean? “Order” the operation of many pushes the fear of natural childbirth. The birth of a baby is accompanied by severe pain, the process requires a lot of effort from a woman. Some expectant mothers are afraid that they will not cope with their mission and begin to persuade the doctor to procaesare them, even if there are no indications for surgical delivery. Another common fear is that the passage of the baby through the birth canal is difficult to control, and there may be a threat to his health or even life.

Fear of EP is common. But not all expectant mothers can handle it. For patients who see a lot of threats in natural delivery, the advantages of a "custom" CS are obvious:

An additional bonus is the ability to choose the date of birth of the baby. However, only this should not push a woman in labor to insist on a CS, because, in fact, the date does not mean anything, the main thing is the health of the baby.

The reverse side of the "custom" COP

Many expectant mothers do not see anything wrong with a caesarean section if a woman wishes. The operation appears to them as simple procedure where a woman in labor falls asleep and wakes up with a baby in her arms. But those women who have gone through surgical childbirth are unlikely to agree with this. The easy way also has a downside.

It is believed that CS, unlike EP, is painless, but this is not true. In any case, this is an operation. Even if anesthesia or anesthesia “turns off” pain during surgical delivery, it returns after. Departure from the operation is accompanied by pain at the suture site. Sometimes postoperative period becomes completely unbearable because of the pain. Some women even suffer from pain for the first couple of months after surgery. Difficulties arise in the "service" of herself and the child: it is difficult for the patient to get up, take the baby in her arms, and feed him.

Possible complications for the mother

Why is a caesarean section in many countries done exclusively on the basis of indications? This is due to the possibility of complications after surgery. Complications concerning the female body are divided into three types. The first type includes complications that may appear after surgery on the internal organs:

1. Big blood loss. With CS, the body always loses more blood than with EP, because when tissues are cut, blood vessels are damaged. You never know how your body will react to it. In addition, bleeding opens with the pathology of pregnancy, disruption of the operation.
2. Spikes. This phenomenon is observed during any surgical intervention, it is a kind of protective mechanism. Usually adhesions do not manifest themselves, but if there are a lot of them, then a malfunction in the work of internal organs may occur.
3. Endometritis. The uterine cavity during the operation "contacts" with the air. If pathogens enter the uterus during surgical delivery, then one of the forms of endometritis occurs.

After CS, there are often complications at the sutures. If they appear immediately after the operation, then they will be noticed by the doctor who did the CS during the examination. However, suture complications do not always make themselves felt immediately: sometimes they appear only after a couple of years. Early suture complications include:

Late complications after cesarean include ligature fistulas, hernias, keloid scars. The difficulty in determining such conditions lies in the fact that after some time women stop examining their seam and can simply miss the formation of a pathological phenomenon.

• malfunctions of the heart and blood vessels;
• aspiration;
• throat injuries from the introduction of a tube through the trachea;
• a sharp decrease in blood pressure;
• neuralgic complications (severe headache/back pain);
• spinal block (when using epidural anesthesia, severe spinal pain occurs, and if the puncture is incorrect, even respiratory arrest can occur);
• poisoning with toxins from anesthesia.

In many ways, the appearance of complications depends on the qualifications of the medical team that will perform the operation. However, no one is immune from mistakes and unforeseen situations, so a woman in labor who insists on a caesarean without indications should be aware of the possible threats to her own body.

What complications can a child have?

Caesareas are no different from babies born naturally

Caesarean section at will (in the absence of indications), doctors do not undertake to carry out because of the likelihood of complications in the baby. CS is a well-established operation, which is often resorted to, but no one has canceled its complexity. Surgical intervention may affect not only female body but also affect the health of the baby. Complications of a caesarean section affecting a child can be of varying degrees.

With a natural birth method, the baby goes through the birth canal, which is stressful for him, but such stress is necessary for the baby to adapt to the conditions of a new life - extrauterine. With CS, there is no adaptation, especially if the extraction occurs according to plan, before the start of contractions. Violation of the natural process leads to the fact that the baby is born unprepared. This is a huge stress for a fragile organism. CS can provoke the following complications:

• inhibited activity from drugs (increased drowsiness);
• violation of breathing and heartbeat;
• low muscle tone;
• slow healing of the navel.

According to statistics, “caesarites” often refuse to breastfeed, plus the mother may have problems with the amount of milk. You have to turn to artificial feeding, which leaves its mark on the immunity of the crumbs and getting used to the new environment. Children born by caesarean section are more likely to suffer from manifestations of allergic reactions, intestinal diseases. "Kesaryata" may lag behind their peers in development, which is due to their passivity in labor activity. This manifests itself almost immediately: it is more difficult for them to breathe, suck, scream.

weigh everything

The CS really rightfully deserved the title of "easy delivery". But at the same time, many forget that surgical childbirth can have consequences for the health of both "participants in the process." Of course, most complications in a baby can be easily “removed” if you pay maximum attention to this issue. For example, massage can correct muscle tone, and if a mother fights for breastfeeding, then the baby's immunity will be strong. But why complicate your life if there is no reason for this, and the expectant mother is simply driven by fears?

A caesarean section of your own free will is not worth it. Naturally, a woman should have the right to choose, but it is not for nothing that this operation is performed according to indications. Only a doctor can determine when it is appropriate to turn to a caesarean section, and when a natural delivery is possible.

Nature has thought of everything by itself: the process of childbirth prepares the baby for extrauterine life as much as possible, and although the body of the woman in labor has a big load, recovery is much faster than after surgery.

When there is a threat to the fetus or mother and the doctor insists on a cesarean, it is strictly forbidden to refuse the operation. The doctor always determines the risks, taking into account the fact that it is safer for the life of the woman in labor and the baby. There are situations when caesarean is the only option for delivery. If the method is subject to discussion, it is always recommended to grasp the possibility of natural childbirth. The momentary desire to "caesare" in order to avoid pain must be suppressed. All you need to do is talk to your doctor about possible risks and the likelihood of complications after surgery.

It is 100% impossible to predict how the COP will go in each specific case. There is always the possibility that something will go wrong. Therefore, doctors advocate natural childbirth whenever possible.

If the expectant mother herself cannot overcome her own fears associated with the upcoming moment of the baby's appearance, she can always turn to a psychologist. Pregnancy is not the time for fears. You need to let go of all bad thoughts, not be led by momentary desires, and clearly follow the recommendations of a gynecologist - from regimen correction to the method of delivery.

The final decision on how to give birth to a woman is made by the doctor at the 37-38th week of pregnancy, after all examinations. Among those who went through natural childbirth are not only women with a scar on the uterus, but also those who were over forty when they decided on their first child, as well as those who dared to endure and give birth to twins on their own.

Dear Irina!

Caesarean section is a complex surgical operation, which is primarily carried out strictly for medical reasons. However, more and more 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 is no less intense than childbirth. In addition, as with any other operation, there is a risk of complications.

Another reason that encourages women in labor to have a cesarean 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 arises of forced delivery, when neither the woman's body nor the child is ready for this. It can also have a number of negative consequences for the health of mother and baby.

Some mothers believe that a baby born by caesarean section is spared the stress of going through the birth canal. However, nature knowingly came up with just such a way of birth. Thanks to the advancement through the narrow birth canal, excess fluid, which is artificially aspirated in case of surgery.

Indications for caesarean section

There are absolute indications for surgery, when it is indispensable, as well as relative indications, when the decision is made by a council of doctors, after analyzing the condition of the woman in labor and the child. Absolute indications are anatomically narrow pelvis (constriction degree 3-4 with a true conjugate less than 9 cm), complete placenta previa, incomplete placenta previa, but with a risk of serious bleeding, premature detachment of the placenta, onset or threatening uterine rupture, defective uterine scar, 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 of the nervous system, severe thyroid disease, diabetes mellitus, hypertension, grade 3 myopia, retinal detachment, tumors of the cervix, vagina or ovaries, abnormal position of the fetus, acute intrauterine hypoxia, prolapse of the umbilical cord.

Relative indications include large fetus with a narrow pelvis, divergence of the pubic symphysis during childbearing, weakness of birth 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 primipara has exceeded 30 years, due to the risk of perineal ruptures and anomalies of the birth forces, childbirth by caesarean section may be indicated, especially in the presence of extragenital diseases or obstetric pathology.

Cesarean section on your own

In many parts of the world, a woman has the legal right to choose her own way of giving birth. The first caesarean sections of their own free will began to be practiced 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 caesarean 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 when 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.

Sincerely, Xenia.

I have a medical background. Of course there was practice in the maternity ward. Having seen enough of natural childbirth with and without perineal incisions, I decided for myself that my pregnancy would end only 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 conduct a pregnancy. But about the caesarean section ... first I had to sign a contract for the management of pregnancy (the cost of which is in the region of 60 - 90 thousand) and only at the end of the third trimester the doctor calls the familiar mythical doctor at the mythical maternity hospital and agrees. I originally needed guarantees. And so, we found Lapino Hospital on the Internet. Of course, for an average income, this is a rather expensive institution. But for the sake of the birth of a child (an event that happens once or several times in a lifetime, if you like it), you can and will spend it. At that time, an action was taking place in the hospital: a free consultation on pregnancy management. They called. The operator picked up the phone immediately, without a five-minute wait, as in other medical institutions. Signed up. We've arrived. Gorgeous clinic. Pass entry. There are no queues, although there are plenty of patients. Everywhere beauty and cleanliness. Came in 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 gather a council on this matter (apparently they wanted to check my mental health). They appointed a day and time. After the consultation, they gave me a paper that said that I would have the coveted operation! Then we quietly went to observe. The doctor left her contact number. And then one night, I realized that it was time! I called the doctor and told them to prepare the operating room, as we were leaving. The contract includes the departure of an ambulance, but we decided to drive on the sly. In the end, we could call her along the way. Security was already aware that we were going. We were immediately opened and told that everyone was waiting for us. The operation went perfect! After the operation, my child and I stayed in this wonderful place for 5 days. It is difficult to call a chamber a chamber. Rather, it is the number of a five-star Turkish hotel. The room has a TV, internet, air conditioning, toilet, shower with all kinds of personal hygiene products. You don't need to take anything with you, everything is there. The rise of the bed is regulated by light pressure. There are emergency call buttons everywhere. I accidentally clicked on one at night, so the nurse was in the ward in 20 seconds! The staff knocks before entering the room. You can also put a "do not disturb" sign on the door. Great food. Brought in beautiful plates with lids. First, second, compote, dessert. Even if you don't want to eat, you will. Before discharge, my child and I underwent various ultrasounds. The children's clinic was surprised. Why did you have an ultrasound? Have you had health problems? Our health is excellent. It turns out that ultrasound is not done in state institutions. Patients breathe well, they can go home. The scar after cesarean is very neat, as thick as a hair. Sometimes I even miss this wonderful place. Of course for me a little expensive, but you have to pay for the comfort. And according to my calculations (I monitored prices in state-owned family houses), it turns out not much cheaper, and the conditions, care, and equipment are not so good. For the second child only in Lapino!

Is it possible to do a caesarean at will?

C fucking before childbirth is quite natural and understandable, but is it worth it to voluntarily go under the knife because of this? Let's take a look at the pros and cons of an elective caesarean section.

The right to choose

Whether the expectant mother has the right to choose the method of delivery is a moot point. Many believe that only the mother should decide how her child will be born. Most doctors reserve the prerogative to prescribe caesarean, although the number of obstetricians who listen to the opinion of patients is growing.

In the West, paid caesarean sections of their own accord have become fashionable. Moreover, to draw up a contract with the clinic, the patients do not take their husbands with them, but lawyers. The signed list of all possible consequences has full legal force and “unties” the hands of doctors who are happy to undertake to operate on everyone for a round sum.

In Russia, the situation is different: it is rather problematic for our women to officially procure without evidence. Refusal of natural childbirth, which a woman signs on the threshold of the operating room, is just a formal piece of paper, so doctors do not risk being led by 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

Irresistible fear of childbirth in agony, fear of injuries to the perineum and vagina, fear for the health of the child due to the unpredictability of the birth process. What is guided by a woman who is able to give birth herself when she persuades the attending physician to perform a planned operation on her? For many women in labor, the advantages of caesarean are obvious:

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

The other side of the easy way

Cesarean delivery has become so commonplace that it is perceived as an absolutely safe procedure. In the eyes of many women, it looks like this: “fell asleep, woke up, got a baby.” However, a woman who has gone through 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 section is an abdominal operation, which means that none of the surgical risks can be ruled out. Unpredictable consequences during manipulations, complications and even mortality during caesarean section are not a myth, but a harsh reality.
3. The abrupt extraction of a newborn unprepared by contractions, sometimes sleeping, is too much shock for the child, in contrast to the natural birth process, which for the baby is a stressful situation with a “plus” sign.
4. “Caesarites”, who have not passed through the birth canal and are separated from their mother during the most important hours of life, are more prone to intestinal and allergic diseases, and the mother 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, after childbirth, the woman comes to her senses in a few days.
7. There may be difficulties with subsequent pregnancies and childbirth.

The risk is high, so the decision to have an elective caesarean section should be made by the woman and her doctor in a balanced way, and not under the influence of momentary desires.

Home " Food " Cesarean section without indications: if the woman in labor has the right to choose. Childbirth and caesarean section.

30/09/2011

Even those who have never read the Bible know that a woman's destiny is "to give birth to her children in pain." And it's scary. From fear, a fashionable trend appeared - a caesarean section "of one's own free will." On the other hand, on the contrary, some refuse the necessary caesarean section, believing that childbirth should be natural. Who is right?

H and this question Online812 is answered by the head physician of the maternity hospital No. 9, Ph.D., Vladimir ATLASOV.

Why is there a growing number of women who, without medical indications, want a child to be born by caesarean section? And they are even willing to pay for it. Is it correct?
- I believe that the doctor should listen to this “own desire”, because the woman knows, and maybe feels what is best for her and for the child if the birth ends with an operation. This is the position of not only Russian obstetricians and gynecologists. In many countries, even some European ones, a woman has the right to choose. But Japan was the first to follow this path, South Korea, China. In Venezuela, in general, the caesarean section rate is as high as 60%.

Now we, among specialists, are increasingly saying that a woman should be given the opportunity to choose the way her child is born: through the birth canal or a surgical incision. If there is any deviation in the state of health of the child, more precisely, even the fetus, or the woman herself, we go to meet her. Because of this, the frequency of caesarean section is really increasing. And it is right.

A caesarean section is a surgery, and therefore a risk. Is it possible to give a woman the right to make such a choice herself? Wouldn't it be easier to save her from fears and from those very torments in childbirth that were promised to her forever in the Old Testament? Modern medicine has the ability to argue with him ...
- Of course, the doctor makes a decision based on the information received from the patient and on the basis of the recommendations of the antenatal clinic doctor. Moreover, as a rule, already during the outpatient observation of pregnancy, a woman knows whether she will have a caesarean section or she will give birth on her own. Of course, women will be less likely to have surgery if childbirth becomes painless. I am here for them to decide for themselves whether to give birth in pain or with an anesthetic injection: childbirth is a very difficult test for the body.

There is another opinion: it is necessary to give birth naturally. And the birth itself is called the first session of osteopathy, because, passing through the birth canal, the child's skeleton acquires a shape programmed by nature. In addition, the difficult movement "out" is an important stage of adaptation to the outside world ...
- It's all fantasy. And if they are not stopped in time, they end in tragedy. Our women are "wound up" by near-medical specialists - osteopaths, "fashionable" perinatal psychologists. But one should not confuse official medicine and semi-official, one should not go to extremes.

- For example, in Sweden, cesarean without very serious indications is not done.
- They do, but in case of any deviation from the recommendations of the doctor, they take informed consent. For medical or non-medical reasons in England, 26% of women in labor have a caesarean section, in Italy - 21%, in Finland - 18%. And the relatively small "Finnish percentage" is explained by the fact that the Finns actively use vacuum extraction - a modern substitute for forceps, which we used when the child was difficult to come out. This is also an operative delivery, fraught with complications for the child and for the woman.

- Other than "own desire", what are the main indications for a caesarean section?
- Indications for caesarean section are mainly from the side of the unborn child. This is explained by the fact that many problems have appeared with the intrauterine development of children: chronic placental insufficiency, fetal malnutrition, genetic lesions ... These children are already weak and may not withstand natural childbirth. And sometimes a woman doesn’t even understand why she is offered a caesarean, because she feels good, while the child’s blood supply has already been disrupted, he has begun to lag behind in development ...

In our maternity hospital, another common indication for surgery is a scar on the uterus after a previous cesarean. This is the situation described in classical obstetrics: "One caesarean section - always caesarean section." That is, if the first birth took place with a cesarean, then all subsequent pregnancies will end with the same operation.

- No matter how many years have passed since the previous one?
- There are no set deadlines. We believe that after 2 - 3 months the scar heals completely and a woman can conceive a child and, accordingly, give birth after 9 months.

- And yet, in some maternity hospitals, after a cesarean, women give birth a second time on their own ...
- Yes, modern obstetrics allows a woman with a scar on the uterus to give birth through the natural birth canal. But in our hospital I forbid experiments. For such births, an individual doctor and an individual midwife are needed. One thing - the Institute of Obstetrics and Gynecology. Ott, where 5-6 births are taken per day, and another is the city maternity hospital, where at the same time in the birthing room for one doctor and one midwife 10 women in labor. And per day, the medical team takes 30 - 40 births. We work according to the staffing table approved by the Ministry of Health in 1983, despite the fact that medicine is now different, women in labor and newborns are also different.

- How often do cesareans in your hospital?
- The frequency of caesarean section in our country is 26 - 27%. For comparison: in Russia - 21%, in St. Petersburg - 22%. But we do not have a typical maternity hospital, pregnant women with problems come to us to give birth. In case of premature birth, we almost always recommend operative delivery in the interests of the child - we are afraid of birth injuries.

The rate of caesarean section is on the rise, new medical technologies are emerging, and maternal mortality remains. Why, at the present level of medicine, do women continue to die either in childbirth or immediately after them?
- Maternal mortality exists all over the world. There are 4 reasons why women die during childbirth or within 1.5 months after them. In the first place - obstetric bleeding, in the second - preeclampsia - the so-called late toxicosis of pregnant women with hypertension, swelling, convulsions, in the third - sepsis, inflammation of the uterus after cesarean or ordinary childbirth, which progresses at lightning speed and a woman can die in 5 - 7 days.

The last, fourth place - in diseases not associated with pregnancy, but aggravating both her and childbirth, the so-called extragenital. Most often these are diseases of the heart, lungs, kidneys, liver. In 2009, swine flu was the leading cause of maternal death in Russia. In Russia, 116 pregnant women died from it, in St. Petersburg - two. We were not ready for the peculiarities of swine flu to affect pregnant women, as, indeed, the whole world.

- Previously, it was forbidden to give birth to women with severe diseases of the liver, kidneys, of cardio-vascular system…
- Modern medicine allows women with these diseases to bear a child. Another thing is that they, as a rule, need to do a caesarean section and they are safely resolved and sent home with the newborn. But, unfortunately, unlike civilized countries, we do not study catamnesis - a study of the state of health after childbirth.

A woman with a congenital heart disease, with the help of doctors, endured and gave birth to a child, and what happens to her later when she left the maternity hospital? We don’t know how she feels, whether her heart withstood without loss not only the birth itself (whether natural or through a caesarean section), but also feeding, nursing, crazy physical and psychological stress, which is why many now suffer from postpartum depression. We don't even know if she's alive. After all, they give birth now and with very serious diseases - for example, with kidney failure.

Abroad, in connection with this, such an indicator as late maternal mortality has been introduced - the level of mortality among women within a year after childbirth, which is part of the maternal mortality statistics. And in our country, not only is it not included in the statistics, we don’t even have such information.

Rosstat gives some figures for maternal mortality, the Ministry of Health and Social Development - others. And as a result, when it is necessary to scare someone, one data is used, and when it is necessary to demonstrate success, another.
- It is necessary to believe the information of the Ministry of Health and Social Development, because they come from hospitals. If a woman died in childbirth there, you can't hide her. And Rosstat receives information from the registry office, which classifies the causes of death on the basis of medical certificates of death. And they often do not indicate childbirth as its cause.

Big lie - data from some regions of the country, in particular, from the South and Central federal districts. In 2009, in the Chechen Republic, according to the Ministry of Health and Social Development, 22 women died, and the statistical office of the republic transmitted the figure - 1. In Astrakhan, 6 female deaths out of 8 were not taken into account by Rosstat. And the Ministry of Health knows this, but they are silent there, although in such a situation it is necessary to send a thousand checks there and ring the bells.

As a result, according to Rosstat data for 2009 (official data for 2010 has not yet been made public), 388 women died, according to the Ministry of Health - 459: 71 deaths were not taken into account. Hence the different indicators: the real one is 26 deaths per 100 thousand women who gave birth, and for reports on improving the quality of medical care and for comparison with maternal mortality rates in developed countries, Rosstat data are calculated, according to which we have this indicator on the same level with them - 22 per 100 thousand births.

- What is being done in the city to reduce maternal mortality?
- As part of the modernization program, we will receive new equipment for a total of 10 million rubles. Including the Selsaver device for reinfusion of blood in obstetric bleeding, which is in the first place among the causes of maternal death all over the world. In addition, we purchase a three-dimensional (3D) ultrasound machine, monitors for monitoring the condition of newborns, a ventilator, a laparoscope and a hysteroscope, and other equipment. This equipment will be provided to all maternity hospitals in the city.

- Is there something that you lack to save the life and health of a woman?
- We have everything, we just need to work smartly. Over the past eight years, not a single woman in childbirth has died in the 9th maternity hospital .

In this article, we will consider what types of caesarean section exist, how the date of the operation is determined, when to go to the hospital if you are planning a caesarean section.

In addition, we will analyze in detail the question of whether it is possible to perform a caesarean section at the request of a woman (without medical indications), and whether it is worth doing so.

Planned and emergency caesarean section

I will briefly list the difference between a planned and an emergency caesarean section.

• Elective and emergency caesarean sections are performed for various medical reasons. Read more about the indications for a planned cesarean in the article. About indications for an emergency - in the article.
• As a rule, both the woman in labor and the doctor know about the indications for a planned caesarean section long before the birth, sometimes even before the onset of pregnancy. And vice versa, indications for emergency surgery arise, as a rule, right in the process of childbirth or shortly before it.
• It happens less and less now, but sometimes it does happen. With planned and emergency cesarean, the type of incision (subsequently, the surgical suture) may differ. More about this in the article.

The type of anesthesia (anesthesia) may vary, more about this in the article.

How the caesarean section operation itself goes can be read in the article .

When to go to the hospital for a caesarean section

Only your doctor, who fully knows your situation, indications for surgery, and so on, will answer this question for sure. If we consider the general case, then they are placed in the hospital 1-2 weeks before the expected date of birth (PDR), so that they will try to set the date of the operation closer to this date. But this is a general option. And in each case it can be different. In any case, a woman should be examined at least 2 weeks before the PDR (and even earlier for certain indications). The following areas are being investigated (this is a minimum, there may be more examinations depending on the indications):

• The general condition of the pregnant woman (pressure, blood tests, urine);
• If there is already a scar on the uterus, then the condition of the scar;
• Condition of the cervix, assessment of readiness for childbirth;

If the condition of the woman and the course of pregnancy is good, then these studies can be done on an outpatient basis. After that, the date of the operation will be set. Then the woman can stay in the maternity hospital until the operation, or maybe at home (if everything is fine according to tests, studies, etc.).

For example, in my first birth, the doctor recommended that I go to bed two days before the date of the operation. And in the second birth, I myself asked to lie down 2 weeks before the birth, even the doctor resisted, which was early, and there was no evidence. And it seemed to me that so I was under supervision, and it was calmer. She went through all the tests and studies, even the date of the operation had not yet been set, they said “go for another week, we'll see.” And it’s good that I went to bed earlier, because the waters suddenly broke, and I had to quickly do the operation.

In general, you can say so. 2 weeks before the DA, you need to go through all the necessary examinations (the main ones are listed above) in the maternity hospital. Further - according to the results and your condition. Either go home and come to the hospital before the operation, or stay in the hospital until the operation.

How is the date of operation determined for a planned caesarean section

There is a concept of EDD (estimated date of birth). This date is determined by the following parameters:

• by the date of the last menstruation,
• by the expected date of conception;
• according to the results of the first ultrasound;
• according to the first recorded intrauterine movements of the fetus.

You can read more about how the estimated date of birth is determined in the article.

Given this date, and under normal conditions, doctors will try to carry out the operation as close as possible to the intended one. Most sources assure that doctors "will definitely take into account the wishes of the woman in labor regarding the date." Here it is necessary to bring clarity. Doctors, of course, will take into account your wishes, but only after they take into account all the really important factors. The final date of the planned operation is set on the basis of preliminary studies in the maternity hospital. As a rule, these studies are carried out 1-2 weeks before the due date. We study (in the general case) the parameters listed below.

• The state of health of the mother, according to what indications a caesarean section was planned. It depends on how "close" to the PDR it will be possible to "approach". In some cases, doctors may wait until the onset of labor (but not until the water breaks), and only after that do the operation. In the case of multiple pregnancy, for example, their indications, they can, under certain indications, perform an operation for a period of 36-37 weeks and even 32 weeks with monoamniotic twins. In HIV-infected women, a caesarean section is performed at 38 weeks before the onset of labor and delivery.
• If there is already a scar on the uterus, then look at the condition of the scar.
• Condition of the cervix, assessment of readiness for childbirth.
• The state of the fetus (ultrasound, CTG, Doppler in the vessels of the mother, placenta and fetus).

According to these parameters, the doctor can appoint a date. From experience it can be said that a one or two day difference is given as a choice for a woman. That is: Do you want Monday or Tuesday? There is no particularly wide choice in this situation.

Is it possible to do a caesarean at will?

AT last years cases when women apply for a caesarean section without medical indications for surgery have become more frequent. The most common reasons for such requests are as follows:

• Fear before. This is the fear of the process itself, pain, and the fear of consequences (for example).
• Fear that there will be changes in the genitals (in the size of the vagina, labia, for example), and this will adversely affect sexual life.
• The belief that natural childbirth is bad for the baby.

What can be said about this. A few moments.

If you decide that you only need a caesarean section, and you categorically do not want to give birth naturally, then you are guaranteed to find a doctor who will do it. Despite the fact that it is written everywhere that the decision on the need for surgery is made by doctors. There are many doctors, and there will definitely be a doctor who will perform the operation without indications for it, for the agreed amount. To urgently perform a caesarean section, if all the indications for natural childbirth, most likely will not work. But finding a doctor and agreeing on a planned operation is most likely to succeed. I am writing all this to the fact that no matter how much they write that “only doctors decide on a planned operation”, you will still achieve your goal if you really want to.

Another question is whether to insist on a caesarean section if there is no need for it. Our opinion is not worth it. Let me explain what we are based on (specifically, the authors of these materials have experience in both natural childbirth and childbirth by caesarean section).

1. Yes, natural childbirth is a painful thing, no one argues here. But, women who have survived both caesarean and natural childbirth say that this is quite comparable in terms of pain. Only in natural childbirth it hurts during childbirth, and in cesarean birth it hurts after childbirth.

Mom's Store has for healing and tissue repair after caesarean section.

Note. Return of food and cosmetics possible only with undamaged packaging.

In general, in our opinion, such a comparison is correct here. If we compare natural childbirth without complications, of medium duration, without "surprises" and an average caesarean section, then according to most opinions (women who have experienced both), natural childbirth is better and easier. The arguments in most cases are as follows:

• After a normal natural birth, it is much easier to recover.
• In the first days after childbirth, you need strength. You are accustomed to new role(especially when the child is the first). It's not easy for you either. So, these first days can generally be remembered as a continuous pain (in comparison with the first days after a normal natural birth).
• After natural childbirth, milk comes faster, and this greatly facilitates the first days. After a caesarean section, milk comes later, and for the first three or four days there may be very little of it, and the child may behave very restlessly. A hungry child cries, the mother is nervous, and it also hurts. What can be done in this situation, we will consider in detail in the article.

Prepare thoroughly for breastfeeding and spending time from a few days to a week in the hospital. Buy at Mom's Store:

• (according to the doctor's indications);
• and for comfortable feeding.

About whether your genitals will be "the same" after natural childbirth. Now we will dwell on this briefly, and we will analyze this issue in more detail in a separate article. We can say that with a normal natural birth, your genitals have every chance to recover by 80-95% (in relation to the previous size).

In general, we can say the following. If you have all the indications for natural childbirth, then doing a caesarean "just like that" is not worth it.

In this connection another question arises. It often happens that a woman gets so used to the idea that she will give birth naturally that she simply cannot accept the need for a caesarean (if it suddenly arises).

For example, one of my friends even naturally ran away from the hospital when she was told that she would have to operate. Of course, she didn’t run far, she became ill on the street, and in an ambulance she was returned to the same maternity hospital, and caesarean. Everything went well, and mother and child are healthy. But, is the question of how exactly to give birth worth the risk? In my opinion, it's not worth it.

In addition, after giving birth by caesarean section, a woman (apart from postoperative discomfort) is faced with the fact that they begin to evaluate her by her birth, no matter how ridiculous it may sound. It turns out something like this: she gave birth herself, - well done, a real woman and mother, and so on. And they procesarized, - well, well .. and it happens .. well, the second time, let's do it myself .., well, it's not your fault, and so on. So, dear girls. I want to tell you that it is categorically impossible to let all this nonsense come to you. You go in with the intention of having a baby. And how exactly you give birth to him - does not matter.

Your goal is to give birth without harm to your health and your child. You are not going to give birth in order to get a "good mark for the birth process." Therefore, whether you gave birth naturally or by caesarean, in any case, you are a real woman and mother. And believe me, your child's life is just beginning with childbirth. This is just a starting point. And the child himself, and you and the child, still have so much to come that the features of his birth really do not have the same importance that they can be given immediately after birth. In general, we would advise not to tune in precisely categorically to the fact that "I give birth anyway." Anything can happen. Much correct installation: I will give birth to a healthy child and everything will be fine with us.

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