Indications for caesarean section, rehabilitation

Planned caesarean section or emergency caesarean section? How and when it is carried out

A caesarean section is the birth of a baby through an incision in the mother's abdomen.
Currently, this operation is one of the most common in the world, and its frequency continues to increase every year. For example, in Russia the frequency of cesarean sections is 20% and on average increases by 1% per year. In the USA this frequency has reached 30%. There are countries (Mexico, UAE) where the operation is performed in 40-50% of births. The cesarean section operation is one of the oldest. However, over the centuries, it continues to raise questions not only among women, but also among doctors. Answers these questions

expert Oleg Radomirovich Baev :

• obstetrician-gynecologist, doctor of medical sciences, professor at the National Medical Research Center for Obstetrics, Gynecology and Perinatology named after V.I. Kulakova
• work experience - 34 years
• doctor of the highest category
• Member of the Association of Obstetricians and Gynecologists.

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.

What is better - physiological birth or caesarean section?

Vaginal birth has a number of advantages:

• no significant blood loss;
• no risk of damage or infection;
• there are no complications associated with surgery, so the patient spends less time in the hospital and recovers faster.

However, in some cases it is preferable to be referred for a planned caesarean section.

Indications for elective caesarean section:

• if during multiple pregnancy the children are lying incorrectly. For example, during a planned caesarean section with twins, one of the children may lie transversely. Or a planned caesarean section may be prescribed for a breech presentation of one baby.
• if labor stops or progresses very slowly;
• the child’s condition worsens (compression of the umbilical cord or prolonged heart rhythm disturbance);
• threat to the mother’s health due to complications (preeclampsia) or diseases (cardiovascular, threat of retinal detachment, etc.);
• some maternal infections (HIV, herpes, etc.);
• placenta previa, when the placenta covers the exit of the uterus;
• premature detachment of a normally expanded placenta;
• discrepancy between the sizes of the pelvis and the fetal head;
• threatening uterine rupture (along the scar from a cesarean section or myomectomy);
• mechanical obstacles to the birth of a child (for example, fibroids in the cervix).

Caesarean section today

Once upon a time in the distant past, this operation was equivalent to a death sentence for a woman, and was resorted to only in critical cases. It was carried out without anesthesia, suture material, and there were no antibiotics... Nowadays, from an “operation of despair,” a cesarean section has turned into an operation, the choice of which is often known long before the due date, for which one prepares and the outcomes of which are much more favorable for both the mother and and for the child. We talked about when a caesarean section is necessary, about anesthesia and the possibility of spontaneous childbirth after such an operation with an obstetrician-gynecologist at the “9 months” clinic, Ph.D. Golovanov Leonid Arkadevich.

— Leonid Arkadyevich, these days, cesarean section (CS) has become so common that there are women who, afraid to give birth on their own, insist on surgical delivery. How justified is their choice?

— An ideal birth is always better than an ideal operation. Although in our country a pregnant woman has the right to write a statement and insist on a CS, the percentage of such operations is still extremely low. An Indian who completed his residency with us said that in their homeland, approximately 80% of patients who have the opportunity to give birth in a clinical institution go for a CS of their own free will, without medical indications.

— What are considered indications for CS?

— Indications for surgery can be absolute, when childbirth poses a danger to the mother’s life (for example, placenta previa, discrepancy between the size of the woman’s pelvis and the fetal head, etc.), and relative, in which the birth of a living and healthy child through the natural birth canal is doubtful (anomalies labor, oxygen starvation of the fetus that cannot be treated, breech presentation or transverse position of the fetus, multiple pregnancy, etc.). Of course, about two hundred years ago, taking into account the possibilities of medicine of those times, only complete placenta previa was an indication for CS, and, for example, the application of obstetric forceps to pull the child by the head and fetal-destroying operations were commonplace. And they gave birth in the field... But then there was natural selection: according to some data, up to 30% of those born in the field remained in the field! Of course, in our days, in our country, this is unacceptable.

— If the operation is indicated in advance, what is better - to carry it out as planned, scheduling it for a certain day, or to do an emergency CS, when contractions have already begun or the waters have broken?

“It is believed that during contractions the “ripening” of the fetus occurs: lung tissue, enzymes in the intestines, the thermoregulation center, the liver - organs and systems are activated, and the fetus, having been in labor, is removed as mature as possible. Such a child is more active, he absorbs milk better, he has a lower risk of developing jaundice, etc. There are also advantages for the mother: the uterus empties better, contracts faster, and much less postoperative medical manipulations have to be performed. Thus, if labor has begun, but you cannot push, then expectant management is justified. Everything is decided individually. There are cases when contractions are completely contraindicated, for example, with complete placenta previa - then the CS is done as planned, and without waiting for the full term.

— Today, epidural anesthesia (EDA) is increasingly used in obstetrics. However, many women are afraid of this type of pain relief, considering it unsafe both for the child and for their own health. Are such fears justified?

— Most fears associated with EDA are based on rumors and ignorance. To date, the advantage of EDA over other types of anesthesia during abdominal surgery, including CS, has been clinically proven and scientifically substantiated. For example, with EDA, drug-induced depression does not occur in the mother and fetus, bowel and bladder function is restored faster, and the patient can get up earlier and move independently. The mother is conscious when the baby is born, hears his first cry, and can have the baby placed on her breast, which, by the way, is very useful for the newborn. Of course, a lot depends on the anesthesiologist, obstetrician-gynecologist and, of course, the patient herself. And this applies not only to the CS. EDA is also successfully used during spontaneous childbirth. Here, the so-called mobile EDA is used - the dosage is selected individually in such a way that the feeling of labor is maintained: the woman in labor feels contractions, pushing and behaves adequately. Absolute pain relief (as during a CS) during childbirth is unacceptable. Contractions pass a little faster, nutrition, oxygen supply and blood circulation to the fetus improve. The risk of birth injuries in the mother (internal ruptures, perineal injuries) and fetus (injuries of the shoulder girdle, cervical spine) is reduced.

— So, we can say that it is better to give birth with anesthesia than without it?

— Constitutionally, any manipulation that is painful and can be anesthetized must be anesthetized. I am not saying that if childbirth is carried out with an epidural, then everything is very good, but if without it, then there will definitely be injuries. But the likelihood of injury, purely generic, mechanical, is reduced. But I think it’s wrong to rely on the principle “grandmothers gave birth this way and I’ll tolerate it.” This is not just a matter of the ability to “not shout.” For example, even yogis cannot relax the perineum during pushing. Anyone who has given birth will understand.

— Are there any contraindications to EDA?

— Contraindications, for example, may include injuries and abnormalities of the spine, pustular rashes on the back, continued heavy bleeding, the use of certain drugs that affect blood clotting, and allergies to drugs used for anesthesia. All this is necessarily assessed by the anesthesiologist, and together with the obstetrician a decision is made on the possibility and method of pain relief.

— Many women, having undergone a CS, have a desire to give birth again naturally. How dangerous is childbirth with a uterine scar?

— Scar tissue is less elastic, and there is always a risk of uterine rupture along the scar. Therefore, a good diagnostic base, highly professional doctors and careful monitoring are needed here. During pregnancy, it is advisable to dynamically monitor the condition of the scar area on the uterus. With an ultrasound, it is better to look not just at the thickness of the scar, but to observe it layer by layer, monitoring the blood circulation in this area. Taken together, this makes it possible to assess whether the scar will be strong and will withstand contractions and pushing. Ultrasound monitoring directly during labor provides even more guarantees and opportunities for making adequate and timely obstetric decisions. Childbirth with a scar on the uterus is a rather risky, tedious and labor-intensive manipulation, but it is worthwhile. Those women who gave birth on their own after a CS were almost all satisfied - they have something to compare with. The postpartum period is smoother, the babies are more active, the mother can carry the baby in her arms and calmly breastfeed - there is no such drug burden as after a cesarean section.

— How long after a CS is it best to plan a new birth?

— The strongest and most elastic scar occurs after about 1.5-2 years. If a woman becomes pregnant soon after surgery, the scar is immature and may become insolvent. If pregnancy occurs after 10-15 years, the risk of uterine rupture also increases. But here everything is very individual. Nowadays, taking into account good suture material, possibilities of care and observation, the chances of a safe birth even 15 years after the CS are great. In our practice, there were cases of spontaneous childbirth after two CS operations, and even with a large fetus. The main thing, I repeat, is careful monitoring from the beginning of pregnancy until the birth of the child. The tactics of managing pregnancy with a uterine scar differs from normal pregnancy, requires more attention, and additional examinations are more often necessary. It is rare to survive up to 40 weeks with a scar on the uterus - it is better to give birth a little earlier, but so that the fetus is mature and the birth canal is ready.

And finally, on my own behalf. Dear future happy mothers, when you choose a doctor, trust him, ask more, complain promptly and don’t be afraid of anything! Doctors will do everything possible to ensure that you are discharged healthy with a healthy baby. A perfect birth is always better than a perfect operation. Most fears related to EDA are based on rumors and ignorance. Relying on the principle “grandmothers gave birth this way - and I will tolerate it” is wrong. Childbirth with a scar on the uterus is a rather risky manipulation, but it pays off. Those women who gave birth on their own after a CS were almost all satisfied.

Author:

Golovanov Leonid Arkadevich

Obstetrician-gynecologist, Ph.D.

Planned caesarean section: at what time is it done?

A planned caesarean section is usually scheduled after 39 weeks of pregnancy, unless the condition of the mother and baby requires the operation to be performed earlier. At this time, the child is already quite mature and can adapt well to extrauterine conditions of existence.

Is there any special preparation required for a planned caesarean section?

This is a major operation, so a nurse or midwife prepares for a caesarean section. A planned operation requires 1-2 hours of preparation. Preparation for an emergency caesarean section is much faster.

In standard situations:

• a cleansing enema is performed;
• a catheter is inserted into a vein in the woman's arm so that the woman in labor can receive fluids and medications during surgery;
• Antibiotic prophylaxis may be administered according to indications;
• A catheter is placed in the bladder to keep it empty throughout the operation (this reduces the risk of damage to it).

Anesthesia during surgery

Today there are 2 main options for pain relief:

1. Regional anesthesia (elected caesarean section with epidural or spinal anesthesia) is preferred;
2. Sometimes general anesthesia is performed - in this case, the woman sleeps until the end of the operation.

With epidural anesthesia, a drug is injected into the space surrounding the spinal cord, in the lumbar region. A catheter is installed there, through which the medicinal substance is added during and after the operation. During spinal anesthesia, the drug is injected directly into the spinal canal - and then the injection is given once.

Carrying out a cesarean operation

Performing a caesarean section falls on the shoulders of a medical team, which includes an obstetrician-gynecologist, a physician assistant, an anesthesiologist, a pediatric neonatologist, and operating nurses. Planned and emergency operations have fundamentally different approaches. A planned operation is performed according to a pre-planned algorithm, and an emergency caesarean section is performed if, due to complications during childbirth, it is necessary to urgently deliver a woman in labor. The main differences between elective and emergency caesarean section are:

• Most often, during a planned operation, epidural anesthesia is used so that the mother can immediately see the newborn;
• in emergency situations, as a rule, doctors use general anesthesia, since the woman may continue to have contractions that will prevent an accurate injection into the spinal canal;
• During planned operations, the surgeon always makes a transverse incision, while in emergency cases, sometimes it is necessary to make a longitudinal one in order to get the child out as quickly as possible.

After the baby is removed from the uterus, doctors remove the placenta and then apply stitches. The woman in labor is given an IV with a medicine that helps the uterus contract. Typically, a caesarean section lasts about forty minutes from the moment of the incision to the application of the last stitches.

The first day after the operation, the woman remains under the supervision of doctors in the intensive care unit. She is prescribed painkillers, constantly monitors her general condition, blood pressure and pulse, discharge from the genital tract, and monitors uterine contractions. After just six hours you are allowed to get up, and on the second day you can walk and start breastfeeding. An ultrasound and a number of tests are required. If everything is normal, you will be discharged within a week.

How is a planned caesarean section performed and an emergency one?

At first glance, the operation sequence is simple.

Planned caesarean section, how it all happens:

• An incision is made in the skin and abdominal wall. It can be horizontal, that is, in the lower abdomen (a fairly cosmetic incision, after a while it becomes invisible) or vertical (in case of an emergency caesarean section). If this is the second planned caesarean section for a woman, then the incision is usually made in the same place, with preliminary excision of the old scar.
• The abdominal muscles (which are under the skin) are usually separated without an incision.
• An incision is then made into the wall of the uterus (horizontal or vertical), and the baby is delivered through this incision. With a cephalic presentation, the baby is pulled out by the head, with a pelvic presentation - by the leg or inguinal fold.
• The placenta is removed, and the incision on the uterus is sutured with threads, which later dissolve on their own.
• The skin is closed with sutures or staples, and the urinary catheter is removed.
• If the woman is under regional anesthesia, she may be able to hold the baby and put it to her breast.

Indications for caesarean section, rehabilitation

A caesarean section is a birth that is performed surgically. The fetus and placenta are removed by caesarean section through incisions in the wall of the peritoneum and uterus. A caesarean section is rarely prescribed. On average, the maternity hospital carries out such operations in the amount of 12-30% of the total number of births.

Indications for cesarean section may appear both during pregnancy and directly during natural delivery. The need for a cesarean section may be related to the health of the mother or fetus, problems encountered during pregnancy and childbirth.

Indications for caesarean section

During pregnancy, the following indications for caesarean section may arise:

• abruption and placenta previa;
• the presence of scars on the uterus - this often happens if a second caesarean section is planned. Scars can also be a consequence of operations on the uterus;
• the presence of deformations and tumors on the pelvic bones;
• narrow pelvis;
• pathologies of vaginal and pelvic development;
• fetal weight exceeds 4 kg;
• pronounced discrepancy of the pubic bones, which is accompanied by pain when walking (symphysitis);
• presence of uterine fibroids;
• severe gestosis;
• presence of severe cardiovascular diseases;
• presence of diseases of the nervous system;
• high myopia;
• severe dilatation of veins in the vaginal area;
• perineal rupture, accompanied by damage to the anal sphincter or rectum and which occurred during a previous birth;
• transverse position of the fetus;
• chronic fetal hypoxia;
• cancer;
• exacerbation of genital herpes;
• fetal malnutrition.

During childbirth, the following indications for caesarean section may arise:

• lack of response to labor stimulation;
• premature release of amniotic fluid;
• incoordination and weakness of labor that cannot be treated;
• acute fetal hypoxia;
• prolapse of umbilical cord loops.

Thus, there can be an emergency and planned caesarean section. In an emergency, a caesarean section is prescribed during childbirth, and a planned caesarean section is prescribed to a woman in advance, and the date when the birth will take place is determined. They try to schedule a caesarean section several days before the expected natural delivery. In order to better determine the date when the birth (caesarean section) will take place, the woman is recommended to go to the maternity hospital a week or two before the cesarean section is expected to be performed. An examination is required in the hospital, regardless of whether the pregnancy is going well or poorly.

Caesarean section is a serious operation and poor preparation for it can affect the health of both mother and child. If necessary, drug therapy is prescribed to correct the pregnant woman’s condition. Be sure to take written consent from the woman who will have a cesarean section. The maternity hospital thus protects itself from possible accusations from the woman in labor. In the event that the need for a cesarean section is identified already during childbirth, the permission is signed by close relatives of the mother in labor.

How to do a caesarean section

First, a little about preparing for a cesarean section. The woman can have a light dinner the night before, but on the morning of the day when the caesarean section will be performed, she cannot eat or drink. Before the operation, you need to take a hygienic shower, and two hours before the cesarean section, do an enema.

Immediately before the operation, a catheter is inserted into the woman’s bladder, and it is removed a couple of hours after the caesarean section.

Next, the woman in labor is injected with an anesthetic. Spinal or epidural anesthesia is used for caesarean section - this is the safest for the child and mother. The use of such anesthesia for caesarean section makes it possible to numb only the lower part of the body and the place on the abdomen where the incision will be made. Thus, thanks to local anesthesia during a caesarean section, the woman is conscious, can hear the cry of her child after childbirth, and attach him to her chest.

After administering an anesthetic, the surgeon makes an incision in the peritoneum. In most cases, a transverse incision is made above the pubic bone when a caesarean section is performed. Photos of women with such characteristic transverse scars can be seen on the Internet.

In some cases, when performing a caesarean section, the doctor cuts the abdominal cavity longitudinally - from the pubic bone to the navel. After the abdominal wall is cut, the doctor spreads the muscles, cuts the uterus (the incision is also often made transversely) and then the amniotic sac. The doctor then removes the baby from the uterus, cuts the umbilical cord and hands him over to the midwife. After this, the placenta is removed from the uterus and the incision on the uterus is sutured. Special staples or sutures and a sterile bandage are applied to the incision on the abdominal wall. Despite the fact that special threads are used, a scar remains forever after a caesarean section.

This is what women who are preparing for a cesarean section often ask the doctor about - how long does the operation last? In fact, it doesn’t last long - 20-40 minutes, depending on the complexity of the operation, which, of course, is incomparable with ordinary childbirth, which lasts several hours or days.

Caesarean section - recovery

For 24 hours after a caesarean section, a woman must be under constant observation in a special post-operative ward. Here they should monitor the pressure, general well-being, pulse, breathing of the woman in labor, the tone of the uterus and its size, the amount of discharge and how the bladder works.

After the caesarean section is completed, the woman’s abdomen is covered with cold - an ice pack is placed on top for one and a half to two hours. This is done to reduce bleeding and increase uterine contractions.

After a caesarean section, the woman’s recovery begins with pain relief. Usually painkillers are administered during the first two or three days. The frequency of injections depends on the severity of pain. In addition, a woman who has undergone a cesarean section is prescribed medications that help restore the gastrointestinal tract, contract the uterus, replenish fluid loss (saline), and prevent complications such as infections (antibacterial therapy is administered).

A woman can get up only 6 hours after a caesarean section. Reviews confirm that it is not advisable for a woman to get up earlier. Failure to comply with this rule may cause bleeding. At the same time, a woman who has undergone a caesarean section is not recommended to immediately get to her feet and walk - she must first sit for a while and only then get up. A woman can begin to move more actively after moving to a regular ward.

It is also necessary to purchase a postoperative bandage in advance. For a woman who has had a caesarean section, the bandage is useful because it facilitates her movements in the first days after the operation. The bandage used after a cesarean section makes it possible to even perform light physical exercises, which contribute to a good course of the postoperative recovery period.

A woman is transferred to the postpartum department 12-24 hours after a caesarean section. All this time, after the caesarean section was performed, the children are under the supervision of maternity hospital staff in the children's department.

The postoperative period can last about a week after a caesarean section is performed. The observing doctor decides exactly how many days, it all depends on the woman’s condition. Usually, 5 days after the caesarean section, an ultrasound of the uterus is performed, and on the 6th day, the stitches or staples are removed from the abdomen. After another day, if the woman feels well, she is discharged home. For some time after a caesarean section, the abdomen in the area of ​​the incision may hurt, and you may also experience increased fatigue and weakness.

At home, a woman after a caesarean section must follow a special regime - take only a shower (you can take a bath and resume swimming lessons only after a month and a half). A woman can engage in sports only two months after a caesarean section, and have sex after a month and a half.

The next pregnancy after a cesarean section is possible only after two years. And it is not at all necessary that a woman will have a second caesarean section - if she approaches the recovery process correctly and does not have other contraindications, she will be able to give birth on her own.

Caesarean section - how to remove belly fat

In most cases, the abdominal muscles recover on their own - 9 months after the cesarean section was performed. The following measures can help recovery:

• use of creams and body scrubs - products quickly improve skin tone and saturate it with moisture;
• You should sleep on your stomach after a caesarean section - this way the muscles will quickly return to their original position and the uterus will begin to shrink;
• a postpartum bandage, which was used immediately after a caesarean section, can help here too - it well supports the skin on the abdomen, which has been stretched;
• When walking, the child should be carried on his back with the help of special devices, and not in front of him in his arms. This way you can avoid stress on the abdominal muscles weakened after a cesarean section.

What to do if there are no results even 9 months after the caesarean section. How to remove belly fat? Swimming and a special bodyflex system - a combination of aerobics and breathing exercises - can help here.

A radical method of correcting a distended abdomen is abdominoplasty after a cesarean section. Reviews indicate that women resort to it as a last resort, when gymnastics and swimming have not yielded results. In the process of plastic surgery, fat deposits on the abdomen, excess skin are removed, and the discrepancy of the rectus muscles, which often occurs due to an incision along the navel, is hidden. After plastic surgery, the distended abdomen after a caesarean section actually returns to normal. Photos of women serve as clear confirmation of this.

Childbirth performed with the help of an operation is not as scary as you might think; the main thing is to prepare for it correctly and take the rehabilitation period seriously.

Rehabilitation, caesarean section

Planned caesarean section: order after surgery

• The woman is transferred to the observation room for several hours (in an uncomplicated situation - for 4-8 hours).
• Staff will constantly monitor blood pressure, pulse, respiratory rate, amount of bleeding from the genital tract, and abdominal condition.
• If the mother feels well, breastfeeding can be started fairly quickly after the operation.
• If a woman feels weak, she is advised to lie down for a while, and it is better for her to get up with the help of the duty nurse or midwife.
• The suture may hurt for several days: anesthetics are prescribed to relieve pain.
• If a caesarean section is planned, hospitalization in the maternity hospital after the operation takes 4-6 days, but may vary depending on the condition of the mother and child.

Progress of the operation

The patient is admitted to the maternity ward a few days before the planned operation. At what time a cesarean section should be performed is determined by analyzing the condition of the mother and fetus. On the day of surgery, a cleansing enema is prescribed. The operation is performed under epidural or spinal anesthesia. In some cases, general anesthesia is used. The operation lasts less than an hour. In the postoperative period, blood replacement solutions are administered, since up to 1000 ml of blood is lost during surgery.

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.

Can there be complications with a caesarean section?

Despite the fact that this operation is performed quite often, it also has risks of complications.

Planned or emergency caesarean section, consequences for the child:

If the baby is born prematurely, he may develop breathing problems (for example, rapid breathing for several days after birth). Injuries during cesarean sections are very rare.

Planned or emergency caesarean section, maternal consequences:

• infection at the incision site;
• infection and inflammation of the endometrium (inner layer of the uterus);
• the risk of thrombosis of the veins of the lower extremities, as well as pulmonary embolism (3-5 times higher than during natural childbirth);
• increased blood loss (2 times higher than during natural childbirth);
• urinary tract infection;
• intestinal dysfunction;
• reaction to anesthetics.

In addition, the first planned cesarean section increases the chances of surgical intervention at the second planned cesarean section, at the third planned cesarean section and at subsequent deliveries.

Enema before caesarean section

The birth of a child through surgical intervention is being practiced more and more often. The reasons for this decision are varied. The main factors leading to the inevitability of a CS:

• The risk of a threat to the health and life of the baby during natural childbirth.
• There is a high risk of loss of health or death of the mother if the child is allowed to be born independently.

As a rule, this operation is planned. The exception is natural childbirth with complications, when only a CS can save the mother and baby.

Any surgical intervention involves performing enema procedures and cleansing the intestines of contents. An enema before a cesarean section will avoid unplanned penetration of feces into the wound and the development of secondary infection. Additionally, an enema before childbirth greatly facilitates the postpartum period and speeds up recovery.

CS is a violation of the integrity of the skin of the abdomen, the inner layer of the epidermis and the uterus. In the first postoperative days, attempts to tense the abdominal muscles will be painful, even when taking painkillers. Therefore, a clean intestinal tract will eliminate the need to visit the toilet on these days and will reduce pain until the stitches are completely healed.

Also, performing forced cleansing of the intestinal tract during cesarean section has a preventive effect. After childbirth or surgery, it is often observed that women cannot go big. Fecal masses release toxins and gases, bloating and pain occur, inflammatory processes develop, and the risk of complications increases.

Is this necessary?

When there is no content in the intestines, there is no pressure on the uterus. This is considered the main reason why the doctor sends a woman in labor for enema procedures. First of all, this makes the surgeon’s work easier and guarantees high-quality surgery. The risks of developing infection at the incision site are minimized. A free bowel is important in the postoperative period, when any tension or contraction of the uterus causes discomfort. It hurts to laugh, cough, sneeze.

Giving an enema before surgery will ensure that the next three days are free from the urge to go to the toilet. The stitches will heal faster and the risk of their rupture will be reduced. But additional actions are required from the woman. First of all, you will have to switch to a strict diet that prevents excessive stress on the intestines. The absence of unnecessary discomfort speeds up healing. In the period after surgery, if feces are retained, doctors' recommendations speak in favor of microenemas or suppositories. The drugs will have a mild laxative effect, which will allow you to empty your intestines without effort and tension in the abdominal muscles.

Proper execution

As a rule, during planned surgery, an enema is given in the morning. A pregnant woman will have to wake up early for the procedure.

Everything happens in a separate room, where there is a toilet and a bathroom for washing. The patient lies on her side, the tip of a rubber hose, lubricated with fat, is inserted into the anus. The clamp opens and fluid flows into the colon. The nurse should supervise the insertion process. An important point: water is introduced warm to relax the intestines as much as possible and gently remove fecal matter. Using cold water will have the opposite effect. Phenomena of spasms occur in the intestines and are transmitted to the vessels. This will provide negative consequences for both organisms.

Two liters of water are prepared for administration. But in the process of manipulation they are guided by the situation. Often the amount of liquid used for enema procedures is taken less. This is connected with the woman's feelings. Often the procedure is stopped due to a feeling of fullness, causing pain.

After adding water, you should wait ten minutes. Next, the pregnant woman goes to the toilet and emptys the intestines of the contents. Taking a bath and shaving your pubic area is preparation for surgery. It is worth noting that you cannot eat after cleaning the organ, since anesthesia is planned.

Do all maternity hospitals give enemas to pregnant women?

Today, many maternity hospitals have refused to perform mandatory enema procedures. First of all, this applies to private clinics. But more and more often, state medical institutions are performing this manipulation at the request of a pregnant woman.

The reasons for refusing enemas were refutations of facts that have long been considered the basis for cleansing the intestines before childbirth:

• Based on numerous studies conducted in America, evidence was obtained that the procedure of forced cleansing of the colon and rectum does not affect the birth process. It doesn't speed up or slow down. Previously, official medicine had a different opinion.
• Often the final evacuation does not take place, and already at the beginning of efforts to push the child out of the anus, the remains of feces, liquefied with water, come out. Therefore, gradually obstetricians began to come to the conclusion that a single bowel movement during childbirth is better than constantly flying pieces that pollute more space.
• Official medicine, when doing an enema, stated: if the intestinal tract is full and emptying begins during childbirth, then the child’s body can come into contact with feces and become infected with the microbes present there. However, the above studies suggest the opposite. During childbirth, bowel movements occur before the baby's head appears. Thus, contact between feces and the child is excluded.

• Natural childbirth is becoming popular. In this case, enema procedures are not provided.

You need to find out in advance whether the maternity hospital where the woman is going to give birth conducts enemas.

Breastfeeding after caesarean section

Many mothers are afraid that after the operation the milk will disappear or will not come at all. And here, early attachment is very important in the first hour after the baby is born. And although this is not always possible in the case of surgery, mothers should not panic, because babies maintain high sucking activity for 6-12 hours after birth. Therefore, it is enough for the first application to occur during these hours.

Additionally, babies born by cesarean section sometimes have a weakened sucking reflex for an hour after birth. Therefore, later application is even recommended for them.

If the weakened sucking reflex continues, the mother should put the baby to the breast as often as possible until he begins to show sufficient activity. Also, the mother needs to find a comfortable position for feeding, as some positions can put pressure on the seam, causing pain.

If mother and baby are forced to be separated after surgery, the woman should pump regularly every three hours (except at night) to maintain lactation.

Sometimes after surgery a woman’s milk comes late (9-10 days). In this case, the child will need supplementary feeding with a special formula. And once the milk comes in, you can and should switch to breastfeeding. It is better to supplement feeding not from a bottle with a nipple, but from a small spoon, pipette or syringe without a needle - then it will be easier for the child to learn to suckle when the milk comes. If a child has difficulty sucking the breast, this is not a reason to switch to artificial feeding. We need to teach the child to latch onto the breast, be persistent, and ask for help from a breastfeeding specialist.

Antibiotic prophylaxis during cesarean section: is it really necessary?

If a woman is at high risk of developing an infection, the prescription of antibiotics is not in doubt.

Regarding the prescription of antibiotics in other cases:

• There are studies that show that antibiotic prophylaxis in all women reduces the incidence of endometritis, wound infection and fever after CS;
• other experts argue that antibiotics can only be used in women at risk of infectious complications (and only those antibiotics are prescribed for which breastfeeding is allowed);
• Most studies show that there are more benefits than risks to using antibiotics before surgery or immediately after cutting the umbilical cord.

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.

Natural birth after caesarean section: possible or not?

Many women who have had a caesarean section can give birth naturally. The decision is made depending on:

• whether there was a birth after an emergency caesarean section, how the operation went, were there any complications;
• type of incision on the uterus;
• number of previous CS;
• the number of pregnancies planned in the future;
• pregnancy complications or health conditions that preclude natural childbirth;
• a history of uterine rupture (with such a complication, an attempt at natural childbirth is not recommended);
• How is this pregnancy progressing?
• from the maternity hospital - is he ready to deal with emergency situations during natural childbirth?

Recovery period after cesarean section

After a caesarean section, it will take about eight weeks for your body to fully recover. However, during the first four months you will have to refrain from physical activity and sexual contact. Also, in the first weeks after surgery, it is necessary to treat the sutures on the skin of the abdomen. If the postoperative period progresses well, you and your baby may be discharged home.

As a rule, after discharge from the maternity hospital, you will have an appointment with a doctor so that he can evaluate the healing process of the stitches and the restoration of your body. You will also be advised a special diet if you are breastfeeding.

When is natural childbirth after a CS not recommended?

If there is a danger that the uterine scar will weaken or rupture. And stimulation of labor during natural childbirth increases the threat of such a rupture. In the event of such a rupture, an emergency caesarean section will be performed.

Some types of cutting are less dangerous, others are more dangerous. For example, a low transverse incision is less likely to rupture, so women with such an incision can attempt a natural birth. The greatest danger of uterine rupture comes from a high vertical incision: a woman with such an incision should not attempt a natural birth.

What can be unplanned situations during repeated births after a CS?

If labor has not started after 40 weeks, the doctor and woman discuss three options:

• wait for labor to begin;
• stimulate labor - and then the risk of suture divergence on the uterus increases;
• repeat caesarean section.

You should always be prepared to change your birth plan. After all, events may occur that increase the risks and require an emergency cesarean section according to indications - for example, a large fetus or the occurrence of preeclampsia, or stimulation of labor will be required.

If a woman has contractions as scheduled after a previous planned caesarean section, she should come to the hospital so that an emergency caesarean section can be performed if necessary. If labor progresses quickly and without complications, and provided the baby is healthy, a natural birth may be an appropriate choice.

Does everyone get an enema?

Cleaning schedule for maternity hospitals in Moscow in 2021

Childbirth is one of the most important events in a woman’s life. Not only the life of the child, but also the health of the mother and the future of the family depend on how easily they pass.

Not all women undergo an enema before childbirth. There may be several reasons for this:

• the method of obstetric care in a particular maternity hospital may not include a mandatory enema before childbirth;
• late arrival of a woman in labor at the maternity hospital, when the baby is ready to be born and there is no time for an enema;
• rapid labor, in which the birth process develops very quickly and there is no time left for hygiene procedures;
• if there are complications during childbirth or contraindications to performing an enema.

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.

Content

1. Indications for caesarean section
2. Progress of the operation
3. When is a planned caesarean section performed?
4. Postoperative period

Due to the impossibility of natural childbirth as a result of some pathologies, it is necessary to resort to surgical intervention.
In such cases, mothers in labor have many questions: at what time is a planned caesarean section performed, what are the indications for the operation, how is the recovery period going, and whether this will harm the baby’s health.

A caesarean section is a surgical procedure in which the fetus is removed through an incision in the peritoneum and uterus. The decision to perform a planned operation is made depending on the presence of indications that make natural childbirth impossible. Various complications put the life of the mother and baby at risk, as a result of which a caesarean section is preferable to a natural birth.

With surgery, the likelihood of uterine rupture is reduced. The likelihood of complications in the later stages of a second pregnancy can be reduced by having a planned caesarean section. In case of elective surgery, newborns do not often require mechanical ventilation. The operation also reduces the risk of uterine prolapse, helps to avoid excessive bleeding after childbirth, stitches and hematomas in the perineal area.