Cesarean section - a surgical procedure used to extract the baby through an incision in the abdominal wall and uterus, if the birth through natural ways considered too difficult or dangerous for the mother and / or child.
For the first time on the caesarean section mentioned by Pliny the Elder; there is evidence that a caesarean section was known in ancient Egypt and in ancient India, but it is rarely done, since the possibilities of medicine were very limited, and the risk with this surgery is great. In ancient times, this operation made primarily in the case of death of the mother - to save the fetus. In Russia, a caesarean section was first produced in the middle of the XVIII century. When cesarean section (under general anesthesia or epidural anesthesia) cut in the abdominal wall, and then made a longitudinal section of the uterine wall, after which the fetus and afterbirth are removed from the uterus.
Your doctor may warn you that you may need a cesarean section. First of all, try to calm down and thoroughly discuss this problem with your doctor, to collect and examine as much information on the subject.
Today, a cesarean section is almost as safe for the mother, as well as birth naturally, and with the threat of a fetus - sometimes even more safe for the fetus. Although caesarean section is considered major surgery, but the risk associated with it, compared with the risk in removing the tonsils or gall bladder.
Every year thousands of children who could die or be crippled during natural childbirth, born healthy at caesarean section. Compared with other surgical operations, it is extremely safe. Births a convenient, fast and predictable than the natural way. The operation itself is usually painless, is performed under general anesthesia since. The doctor also receives a higher fee for a caesarean section. All this makes it attractive as a caesarean section for women in childbirth, and for doctors.
A closer look, however, reveals major shortcomings, because of which should limit the use of cesarean cases where childbirth through natural way unsafe or impossible. Caesarean section increases the risk of serious problems with anesthesia, infection and bleeding. It will take a long hospitalization. You will have pain weeks after childbirth and difficulties in caring for newborns and other children. You need more pain medication, antibiotics and blood transfusions are more likely than after vaginal delivery. Not so soon you will be able to return to domestic duties or work. Furthermore, the financial cost far more than natural childbirth.
According to some experts, babies born by Caesarean section have more breathing problems and maintaining the temperature, especially if labor did not exist. Even compared with long or difficult childbirth through natural ways this extra risk exists.
Such errors and adverse events should be prevented from the outset. Firstly, it should make sense that the way in which the child was born, does not affect either the mother or the child; neither woman gets to a lesser extent the mother nor the child is not a lesser extent, the product of her womb when he was born by Caesarean section. Secondly, it is important that the mother and child to spend as much time together since birth.
At the same time should not panic if you feel too weak to care for their child, or if your child requires intensive monitoring of newborns. There is no reason to believe that the relationship of mother and child is fastened only after the birth.
In some cases, for certain indications the decision on caesarean section may be made in advance:
- Disproportion the pelvis and head (utero-fruit); (fetal head is too big to pass through the mother's pelvis); This is evidenced by the value of the child, certain ultrasonographic study or difficult previous generations;
- Disease or other abnormality of the fetus, causing a risk of injury or during self-delivery;
- End of previous pregnancy by cesarean section because the cause of cesarean section continues to pose a threat (such as illness of the mother or the wrong structure of the pelvis), or if the uterus was dissected vertically;
- High blood pressure, or kidney disease mother, the mother may not be able to transfer the stress of labor;
- Malposition, such as breech (buttocks or foot forward) or transverse presentation, which can make separate deliveries difficult or impossible.
There are also reasons for the caesarean section, long before the birth:
- Diabetes in the mother in the case where you must end the pregnancy to term and confirmed by the lack of maturity of the cervix;
- Infection viral type is available at the onset of labor; Cesarean section is also done with a view to prevent infection of the fetus during its passage through the birth canal;
- Placenta previa (when the child seat is partially or completely blocks the opening of the cervix), which can cause bleeding if the baby will begin to place ahead of time to separate;
- Early separation of child seats - clearly manifested Department placenta from the uterine wall, creating a greater risk to the fetus.
Cesarean section is also shown in the case where an urgent need to end delivery, no time to activate labor, or if it is assumed that the mother and / or fetus will not be able to transfer the stress of childbirth.
There may be other reasons:
- Status predekslampsii ekslampsiya or do not respond to treatment;
- Prolonged pregnancy (in excess of the due date for 2 weeks or more) leads to a deterioration in the living conditions of the fetus in the uterus;
- The emergence of the threat to life of the fetus or the mother.
Often, however, on the need of caesarean section was adopted already in the process of childbirth. The reason for this phenomenon are the following:
- Lack of labor (cervix dilates too slowly) after 16-18 hours from the beginning (some doctors are waiting even longer). Sometimes used as oxytocin to stimulate uterine spasmodic activity, before making a decision about Caesarean section;
- The phenomena of the threat to the fetus, noted during the observation by means of special equipment or other tests;
- Prolapse of the umbilical cord: its compression can cut off the flow of oxygen to the fetus, causing a threat to his life;
- Unrecognized previous cases of placenta previa or premature separation of child seats - especially if there is a risk of bleeding.
Sections of skin and uterus
During the operation, the doctor makes two incisions: the first cut - the abdominal wall (skin, fat and connective tissue), the second - the uterus. The abdominal muscles are not cut; They parted to the side, allowing them to more easily heal. Both incision can be vertical or horizontal (transverse) or one can be vertical, the other - horizontally. For example, the skin incision can be horizontal, and the uterus - vertical. It is important for subsequent births to know what uterine incision you had. It must be indicated in the history of the disease.
There are two types of skin incisions for caesarean section:
- The cross section is used more often; it is horizontally just above the pubic bone.
- The incision in the midline runs vertically between the navel and pubic bone. This incision allows you to quickly remove the fetus in extraordinary circumstances and may be preferred in some other cases (eg, obesity mother).
There are three types of uterine incision:
- Classic vertical incision is made in the upper part of the uterus. Currently, he is rarely done except in cases of threat to life of the fetus, placenta previa and transverse position of the fetus. After the birth of the classic cut through the natural way is usually not recommended.
- The most common practice is now lower transverse uterine incision. It is associated with less blood loss, lower risk of postpartum infection, but requires more time than the classic cut. Subsequent generations may occur vaginally because this incision heals well and leaves a lasting scar.
- The vertical section of the lower segment of the uterus is performed only when the lower part of the uterus undeveloped or too thin for the cross-section (as in the case of some premature births).
Taking a decision on caesarean section, you and your doctor must weigh the risks and benefits. The risk of cesarean delivery pays off only in cases where childbirth through natural paths may create an even greater risk to the mother or child.
Sure, you have to trust your doctor, believing that the decision on caesarean section is not made unnecessarily. Previously a number of issues to be discussed.
- Whether there are other methods of birth, before a decision on Caesarean section (except for unexpected situations)? For example, the use of oxytocin to stimulate the spasmodic activity or use standing attempts to increase the activity? However, it should be noted that the local clinics alternative childbirth very rarely used.
- Is it possible to decide on the operational labor (because of breech) to try to turn the head of the outer way (to change the position of the fetus)?
- What type of anesthesia can be used? When general anesthesia is used? You can also use extradural anesthesia (to stay awake) when a caesarean section is not done suddenly?
- During the passage of birth incision a doctor womb low in the lower portion, so as to be able to end next pregnancy by natural means? You must also specify (for cosmetic reasons) would look like incision of the abdominal tissue (which is not normally associated with a notch of the uterus).
- During cross-section (with preservation of consciousness or not) may be present your spouse or a close relative?
- Can you or your partner hold the baby immediately after birth and
- Can you feed your baby in the operating room? Will your partner to keep the child, if the operation will take place under general anesthesia? Can you be a child in the same room if the child does not require special care? Will your family to stay the night in order to help you?
After cesarean section
Within days, the cuts will hurt badly enough, and you need pain medication. You must decide for yourself how much pain medication is acceptable to you. You can take it as little as possible, but if the pain prevents you care for a child, it is wiser to take a sufficient dose to feel comfortable. Solution you can discuss with your doctor, and it is better to listen to his advice.
The first few days after a cesarean section particularly difficult: to turn over on his side, breathing, cough - everything is given with difficulty.
Here are some simple tips that will help you feel more comfortable:
- Turning his back on his side
Bend your knees so your feet are rested in the plane on which you are lying. Uprites feet and raise your hips so that the body is straight from the shoulders to the knees. Rotate hips to the side and lower them. Then turn the upper body in the same direction. You lie on your side. This method of rotation save your joints from damage and eliminates the elbows from painful friction of the sheets.
Cough given pain, but after general anesthesia has to cough to get rid of the slime in the lungs and sometimes cause infection. Use the following method: strengthen your joints hands, small pillow or tie a towel. Take a deep breath, completely filling your lungs. Fully exhale - strong and sharply, but accurately - plunging the stomach and not inflating it. Made a sound "wow." Repeat several times an hour, especially if you feel gurgling or sobs in the chest. If the chest is clean and you regularly get up out of bed, there is no need to do it often.
It is useful to try these techniques prior to surgery, to understand how it is done.
- The rise to his feet and walking
The first time you dare to climb out of bed a few hours after surgery. A nurse or your loved ones will help you to sit down, then stand up. First raised, you may feel weak and dizzy. You can reduce the dizziness, making exercises in bed with hands and feet to improve krovoob-rashchenija. Do not rush, give yourself to get used to each new state, when the transition from the lying position to standing.
Here's how to get out of bed: turning on its side, let the legs lean over the edge of the bed and turn yourself into a sitting position. Sit for a while and help it move the legs. When you are ready, you lower the legs to the floor and stand up (with someone's help). Stand as straight as possible. It will not hurt your joints, even if it seems that they are tightened. As soon get used to stand, make a small step. Each time, getting out of bed, you will notice that to do this it gets easier and easier. Try to gradually increase the length of your walks.
Intestinal gases sometimes become a real problem after cesarean section, as well as after any abdominal surgery. You will become swollen, there may be severe pain, until you release the gases. Accumulation of gases caused by slowing intestinal activity in the operation. Movement back and forth in bed, deep breathing, swinging chair will help to prevent or alleviate the accumulation of gases. Try to avoid foods and beverages, which are allocated by the gases. The nurse can supply you with the vapor tube or enema to help get rid of gas, if you can not do.
There may be difficulty with urination after ureteral catheter, anesthesia and surgery of the abdominal cavity. The nurse will offer you ways to help deal with this problem. If you are unable to urinate within a reasonable period of time, you may need to re-insertion of the catheter.
Perhaps, it is desirable to breastfeed after a caesarean section, but to find a comfortable position can be a problem. To protect your joints and body movements of the weight baby, put it next to her on a cushion or a pillow over the seams, before taking the child in his arms for feeding.
You may find it difficult to regain strength as compared to women, gave birth at the natural way. But give yourself time, the pain will soon pass. At first you have to someone to help in child care and household chores. But as soon as the start to your physical condition postnatal exercise. Pre consult your doctor.
Natural birth after cesarean
Most women who have had a caesarean section, can and should, for safety reasons to give birth naturally in the next pregnancy
. Ongoing cesarean surgery almost always leave the womb strong and healthy, with a good seam overgrown
. In fact, now that the doctors and midwives have gained great experience of childbirth through natural ways after a previous Caesarean section, they almost do not see it as an additional risk for most women
. Their experience is consistent with numerous reports in the medical literature supporting the safety and benefits of vaginal delivery after cesarean section before repeating the operation
. Among the advantages - lower maternal and infant mortality, lack of post-operative complications, reducing the time spent in the hospital, the economic benefits, the ability to get back to normal life, finally, the psychological benefits
There are some situations where generations through natural ways after cesarean impossible or unreasonable, such as cases where the indications for surgery are preserved. If you suffer from a chronic illness or your physical condition makes natural childbirth unsafe or impossible, probably should again settle for a caesarean section. In most cases, however, the reasons for the first Caesarean section does not appear again. The most frequent indications for the first Caesarean section - the lack of progress, fetal distress, failure, or presentation chlenoraspolozhenie fetus - rarely repeated during the next pregnancy.
In the case of high vertical (classical) cut the risk that the seam will disperse during childbirth, slightly higher than in the case of a low cross.