She stayed after the caesarean section. How long can you not sit after a caesarean section. Length of stay in the hospital after caesarean section. Departure after surgery

The birth of a child is an amazing event in the life of every family. If problems appeared during pregnancy, or it was not possible to get pregnant for a long time for a number of reasons, as a rule, doctors decide to deliver the woman using a caesarean section (CS). This gives both the doctors and the woman the confidence that the birth will go well for both the mother and the baby. After all, a caesarean section is performed according to a well-known scheme, and variations in the course of childbirth are hardly possible. What can not be said about natural childbirth.

Condition in the first 3 days after caesarean section

All 9 months the woman has been patiently waiting for a meeting with her long-awaited miracle. The day of childbirth comes, the baby is born and, it would seem, what else to think about, except for maternal worries. But, unfortunately, in the first few days after childbirth, it will not be possible to devote yourself completely emotionally and physically to the child, since the consequences of the abdominal operation cannot pass without leaving a trace.

Cesarean section is now a common delivery option, previously it was done extremely rarely and in special cases.

When to get up after surgery

Firstly, you will not be able to get out of bed in the next few hours after a cesarean even with all your desire - spinal anesthesia will immobilize your legs for quite a long time. Emotionally, you can feel an upsurge, a surge of strength, because adrenaline was thrown into your blood at the time of childbirth. But physically after childbirth the body is weakened, and after the operation it is wounded and damaged.

Set yourself up for the fact that everything is behind you, the baby is healthy, everything is in order. Try to sleep, rest and relax. Restoring strength is your main task in the first day after childbirth.

After 8-10 hours, the legs will gradually “move away” from anesthesia, the sensitivity will return. But this also does not mean that you are ready to assume an upright position. All decisions in the postoperative period and the period of the mother in intensive care are taken by the attending physician. Immediately after entering the intensive care unit with a certain frequency, your blood pressure and pulse will be measured, the abundance of secretions, and the contractility of the uterus will be assessed. These indicators will allow doctors to get a picture of your condition after childbirth, it will depend on how quickly you are allowed to get up, sit down and stand up.

You should sit down for the first time after a caesarean only with the help of a nurse. You will most likely feel dizzy, and this is normal. If the dizziness passes quickly, then you can try to stand up. All movements must be done slowly and carefully. You won't be able to unfold completely right away. The first days you will walk slightly bent over, the pain in the suture area will not allow you to straighten up.

After the mother and child are transferred to the postpartum ward for a joint stay, it is advised not to stay too long and try to move more. Walk for short distances - along the ward, along the corridor. So the uterus will begin to contract faster, and this will also prevent the formation of postoperative adhesions.

In the future, during the recovery period, learn to gently get out of bed with your hand.

How much can not push after cesarean

Often after a caesarean section, women experience problems with bowel movements. Constipation and hemorrhoids may occur. Hemorrhoids can form both during pregnancy and after childbirth. This happens due to the pressure of the fetus on the rectum. Especially often this happens in the last period, when the mass of the fetus is maximum.

If you have hemorrhoids, you can not push at all. Otherwise, you risk aggravating the matter - cracks, bleeding, prolapse of the rectum at the time of emptying may appear. Use glycerin suppositories, they are safe for the child and will help to cope with the problem of constipation.

You can not push also in order to keep the seams intact. During straining, the muscles of the peritoneum become very tense, and the uterus also tenses. Despite the fact that after a cesarean the scar is well sewn (it cannot easily disperse), you should not overexert yourself until the stitches are removed.

To make it easier to go to the toilet in the first months after a caesarean section, eat vegetables, while not forgetting about the diet. breastfeeding.

When faced with constipation after a caesarean section, remember that this is a temporary phenomenon, and after a while your stool will return to normal

In the second pregnancy, I was able to "enjoy" the presence of hemorrhoids. It was small and not causing any problems. But after giving birth, I was faced with the problem of bowel movement. The stool was painful and infrequent. Tried to normalize the situation proper nutrition and an increase in fluid. Everything improved about 3 months after the CS.

How long does it take to remove the catheter

A urinary catheter is one of the annoyances of any operation. During anesthesia, the passage of urine cannot be controlled, so a catheter is inserted, while the urine is drained into a bag.

The color and volume of urine allow you to control the patient's condition during cesarean. The absence of blood in the urine is an indication that the bladder is not affected during the operation.

The first day the catheter will be in your bladder even after childbirth. During the period of anesthesia, its presence is not felt. Later, this causes a little discomfort.

The catheter is removed before you are transferred from intensive care to the postpartum ward. They will already make sure that you can urinate on your own after childbirth. It is also an indicator of the normal functioning of the body after delivery.

The catheter is taken out quickly, on a deep breath, as well as inserted.

Duration of the postpartum period after caesarean section

After a caesarean section, a woman recovers a little longer than after a natural birth (EP). As after any operation, injury to the integrity of tissues and organs slows down the recovery process. In the case of childbirth, this is the uterus and abdominal wall.

Due to trauma, the contractile function of the uterus slows down, and the process of excretion of lochia (postpartum discharge) also slows down. As a rule, cesarean women have fewer of them, so it takes more time to fully restore the uterus to its previous size.

After natural childbirth, the recovery period lasts up to 40 days, after CS about 60 days. Even if a woman has sutures in her perineum during EP, such sutures heal faster than the scar and sutures after CS.

Now, during childbirth, doctors use self-absorbable threads, which allows the woman not to remove the stitches, with the time of wound healing, the threads dissolve.

After 2 CS, my scar was also sewn with self-absorbable threads. But since I am a full woman, and even after the first CS, my stomach was stretched with stretch marks (stretch marks) and a large fetus hanging in a bag, the healing of the sutures was difficult and long. On the 14th day, the gynecologist said that in my case it is still better to remove the stitches, otherwise they will dissolve for six months with such a sagging belly with excess subcutaneous fat. The stitches were removed by the surgeon, after which the pain became much less.

Take care of yourself during the recovery period after CS - do not lift heavy things, relax with your baby, spend more time on fresh air

The recovery period of each woman lasts a different amount of time. It depends on many factors:

• individual characteristics. You can not equal all women under each other. Each birth is individual, the condition of the child is individual, the situation in the family, relations with her husband and many other factors affect the period of complete recovery of a woman after CS;
• psychological condition. It completely depends on the environment - relationships with a spouse, relatives, the mother's willingness to give herself completely to the baby, etc.;
• physical state. Every woman's pain threshold is different. Someone after a few days forgets about the pain, and someone else for a long time cannot sleep peacefully, fully care for the child;
• presence/absence of complications. This factor can be attributed to physical condition. After all, if after surgery a woman has complications in the form of suppuration of the sutures or the discovery of placental remains in the uterine cavity, there is no question of the completion of the recovery period. Additional difficulties will only increase this period, as well as leave unpleasant sensations in the memory, which will add emotions to the general psychological state of the woman after childbirth.

Recovery plan after caesarean section

Since CS is a surgical intervention, the number one task will be to prevent complications. To do this, without fail in the maternity hospital, the newly-made mother receives injections of oxytocin for timely contraction of the uterus. The delay in the excretion of lochia, which are released at the time of uterine contraction, can cause the most common complication - the presence of the placenta and its parts in the uterus. In this case, the woman inevitably goes to the hospital, where they clean the uterine cavity.

Depending on the condition of the scar and sutures, antibiotics may also be prescribed for 5-7 days. You should not refuse this measure either. Antibiotics will not allow the inflammatory process to progress, and will greatly alleviate the patient's condition.

Don't forget to take painkillers as well. After the CS, they are placed from the very moment of childbirth until discharge from the hospital. Even if it seems to you that the condition has improved, do not refuse an anesthetic injection, perhaps the previous administration of the drug is still valid. And this means that after the termination of its action, you will fully feel all the pain. This is useless, because the mother should be calm and adequate.

With a favorable course of the postpartum period after CS, antibiotics are not prescribed.

For a speedy recovery, start physical activity on the first day after childbirth. Try to sit and lie down more often, but carefully. Do a light warm-up with your feet right on the bed. The main thing is not to strain the stomach, so as not to compromise the integrity of the seams.

Seam healing

In order for the suture to heal faster, even in the maternity hospital it is regularly treated with antiseptic solutions. Often this is a solution of manganese, which disinfects the skin and dries the injection sites on the seam.

Self-absorbable threads should dissolve already 7–8 days after CS. After that, still continue to process the seam at home until complete healing.

You can also use sterile dressings so that the seam does not come into contact with the linen, and clothes do not press on it.

If there is hyperemia (redness) on the seam, additional treatment may be prescribed - for example, Xeroform powder.

Xeroform is a powder that has yellow, weak specific smell, prepared in the prescription department of pharmacies

Alternating with a solution of manganese, Xeroform is applied to the seam. It has a disinfecting, astringent and drying effect.

Even in the hospital, you can be assigned procedures in the physical room - UHF and electrophoresis. These procedures help tissues recover and regenerate faster. After discharge, the gynecologist may additionally prescribe a number of procedures.

Xeroform helped me a lot. The healing of the suture was slow and painful. Relatives brought this wonderful powder to the maternity hospital. And even after discharge, my husband applied it to my healing suture.

Restoration of the menstrual cycle

The resumption of menstruation after CS will depend on the presence or absence of breastfeeding (BF). With GV, the first menstruation after childbirth will come in 6-12 months. If this does not happen, do not delay the visit to the doctor. With artificial feeding, menstruation can begin 2–3 months after CS. Regularity is also built up over several months.

Postpartum lochia is not related to postpartum menstruation, so comparing these two processes is not worth it.

Important! Do not forget that the presence of HB does not protect a woman from pregnancy.

Although during this period the work of the reproductive system of a young mother is controlled by the hormone prolactin, which inhibits the work of the ovaries and suppresses ovulation, pregnancy is still possible, this should not be forgotten. In a situation where a woman becomes pregnant during HB, weather is born. In the case of CS, it is recommended to avoid pregnancy for two years in order to restore and completely heal the scar on the uterus. Having a baby a year after CS is a big risk for mom and baby.

Pay attention to the regularity and abundance of menstruation after CS. If the discharge is too abundant or, on the contrary, scanty, make an appointment with your doctor for a consultation.

Figure restoration

Of course, after a caesarean section, every woman dreams of getting rid of the belly stretched during pregnancy. This is the most problematic part of the body after childbirth. Also, a young mother may be disturbed by stretch marks and cellulite. During pregnancy, the activity of the body decreases, the lifestyle becomes less mobile, corresponding defects in the skin and the figure as a whole appear.

There is no need to hurry with the introduction of sports into postpartum life. It is recommended to include in the recovery plan no earlier than 6 months after the CS. The best exercise in the fight against a sagging stomach is the swing of the press. The first short exercises for the press should be done no earlier than 4-6 weeks after the operation.

In the first months, it is better not to use dumbbells at all. After the restoration and healing of the sutures, start introducing weighting agents from the smallest weight, but not more than 3-4 kg.

The recovery plan after the COP should not start with sports such as:

• Athletics;
• volleyball, basketball and any other active ball sports
• tennis;
• Weightlifting;
• active cycling.

I had an emergency CS. I gained +25 kg during pregnancy. And I look great now. The child is 1.5 years old. 170 height, weight 51 kg. Everything is as before childbirth. And the seam is almost invisible. Thin thread. But I didn't sit idle. 1.5 months after the CS, I was already running at the stadium. At home, while the child was sleeping, she shook the press, did sit-ups, shook her hands daily. I have always been involved in sports, so this is a joy for me. A contrast shower is required every evening. Olive oil rubbed into the skin daily. I began to drink water - 2-3 liters of water daily, before I could not drink so much water. The child has diathesis, it bled out, so she ate very little food. And she lost a lot of weight. I will not paint, but from 4 months I was on IV, and my hormones returned to normal, the weight returned to my former native.

4. Guest

Without the inclusion of sports in life, it will be extremely difficult to get rid of a sagging belly and return to its previous shape.

Create your own workout program to do at home. We recommend that you include basic and simple exercises in it:

1. In the position on the side, alternately do leg raises without bending them at the knees. The toe of the foot should be facing you.
2. Do lunges on all fours. Simultaneously raise the arm and leg of opposite limbs (left leg/right arm, right leg/left arm). In this case, the head is a continuation of the neck and should be in line with it. Hold your arm and leg up for a few seconds.
3. In the supine position, inflate and retract the stomach. At the same time, the hands lie under the head, the legs are bent at the knees and slightly apart. Inflate your belly as you inhale, retract as you exhale.
4. Lie on your side, one arm is bent at the elbow and holds your head, the other lies in front of you. The leg on which you are lying must be lifted up as far as possible, the second leg is in front of you. Then the sides need to be changed.
5. Wall squats. Stand close to the wall. Feel the contact with the wall of the shoulder blades and buttocks. Do slow squats, trying not to tear off the shoulder blades and buttocks.

In addition to sports, nutrition plays an important role. By including sports loads, but without changing the diet, you will not be able to achieve the desired results. Calories lost in training will come back with the wrong food.

It is advisable to exclude sweets, bakery products from the diet, add more vegetables, water, greenery.

I have two children, the youngest is 5 years old. I can only tell you about stretch marks, excess weight(was +15) and cellulite. So, I got rid of all this after giving birth for about 6-8 months. What I did: I drank 2 liters of water a day (I didn’t feel like drinking, but I forced myself), I stopped eating sweets, pasta and potatoes, I did wraps with red pepper twice a week, I used a hot scrub in the shower (I don’t remember the name, in orange jar) + smeared with creams of the same company. I did not remove stretch marks with a laser, I only used these products. I can say that now the skin is very beautiful, the whole body is tightened.

Lilka

http://www.woman.ru/beauty/body/thread/4486229/

Walking is a great start. They will allow you to expend energy, but at the same time not overstrain the damaged muscles.

Video. Leslie Sansone Walking with Leslie Sansone 1 Mile

I myself tried classes with Leslie Sanson. Great workouts - not a driving pace, but at the same time I was sweating and losing grams of excess weight with each session.

Breast reconstruction

In addition to figure flaws, any woman after childbirth is faced with the problem of breast changes - the skin becomes flabby, weak, the breasts are no longer elastic and tightened. All this happens along with a change in processes in the breast - during pregnancy, adipose tissue is replaced by glandular tissue, thus, the mammary glands are preparing to feed the child. After childbirth, with the cessation of lactation, the glandular tissue should again be replaced by adipose tissue, but, firstly, this process cannot happen instantly, and secondly, the stretched skin in any case cannot become the same.

But do not panic, over time, and also thanks to your efforts, breasts can be given a beautiful and seductive look.

To do this, it is necessary to act from different sides, namely:

1. Make your diet right. Include more amino acids and vitamins in your diet. Such nutrition will be beneficial to the body as a whole.
2. Physical exercises. There are special exercises for the chest. Change your daily routine to include chest exercises.
3. Help restore breast skin with masks and other cosmetics.
4. Do contrast baths while taking a shower.
5. Additionally, make a course of massage, if possible.

This set of exercises is not difficult and will not take much time to complete.

Here are some exercises to help you get in shape:

1. Clenching hands. Stand up, feet shoulder width apart. Connect your palms and resist one another. Hold your hands in tension for 1-2 minutes. Then relax your arms and lower them. Repeat the exercise 5 times.
2. Squeezing the ball. Take the ball, spread your elbows to the sides, put your palms on the ball. Try to squeeze the ball with your palms, holding the pose for 1-2 minutes.
3. Lifting dumbbells. To perform the exercise, use small dumbbells (2-3 kg). Stretch your arms with dumbbells in front of you, slightly apart. Alternately bend and unbend your arms. Watch for even breathing. Do the exercise for 2-3 minutes.
4. Scissors. Perform cross movements with your hands, changing the position of your hands from above / below. Keep an even pace. Watch your breath. Do this exercise for 2-3 minutes.
5. Tilts with dumbbells. Take dumbbells, bend your elbows and spread them apart so that your elbows are directed away from you. Without straightening your elbows, raise and lower your arms to the sides. The body should be tilted slightly forward.
6. Hands up. Get into the starting position. Press your hands to the side of the thigh, clench your fingers into fists. At the same time, raise your arms to the sides until your shoulders drop, then lower them. Repeat the exercise for 1-2 minutes.
7. Push-ups 1. Go to a free wall and lean against it with your palms. Start pushing up from the wall without leaning your body against it. Do the exercise for 1-2 minutes.
8. Push-ups 2. Place your palms against the wall and bend your elbows, pressing them to your body. In this position, do push-ups for 1-2 minutes.

Alternative exercise- swimming in the pool. If you can afford this luxury while having a baby, it will have a wonderful effect on all muscle groups in your body. During swimming, the chest is perfectly tightened.

Restoration of hair, teeth and nails after CS

Hair, teeth and nails begin to suffer catastrophically even during pregnancy. You don’t have to think about it for a long time, everything is understandable - the child grows, the skeleton is formed, the rudiments of teeth, hair grows. The fetus, like any other living being, needs calcium for life. The baby in the stomach extracts calcium at the expense of the mother. That is why teeth and nails are simply a disaster. To maintain the level of calcium in the body, pregnant women are prescribed vitamin-mineral complexes.

After childbirth, it is worth continuing to take them. In pharmacies, such complexes are sold in a great variety, for every wallet.

Don't forget to add calcium-rich foods to your diet as well. These include hard cheese, black bread, milk, shrimp, cabbage, cottage cheese, sour cream, leek, dried fruits.

Calcium deficiency is manifested in fatigue, irritability, anxiety

Important! Calcium is fully absorbed only with sufficient levels of vitamin D. We get it from sunlight, or in the form of fish oil or an aqueous solution of vitamin D.

Can also be used for hair restoration vitamin complexes for the whole body, or specifically for the hair.

Photo gallery: vitamin complexes for restoring hair and nails

Contains biotin - a vitamin for hair, the cost is about 400 rubles
Contains a large number of vitamin E, the approximate cost of 750 rubles
This complex has collected a lot of positive feedback on improving the condition of nails, hair and skin, 650 rubles
As part of the yeast, which have a positive effect on the condition of the hair, about 400 rubles

Also use masks. A large assortment of masks is now available in stores, or at home, you can use products to strengthen and restore hair. For example, burdock oil. It is very effective for growth, because the problem of hair loss is very relevant for women after childbirth.

After the first and second births, my hair climbed very strongly. Once I even thought that I need to see a doctor, because so much hair cannot be left on a comb just like that. Over time, everything returned to normal. I used burdock oil and restoring purchased masks.

Recovery of digestion and metabolism

To restore metabolism after childbirth, and, accordingly, digestion, you should adjust your lifestyle to a healthy one, which includes healthy eating, sports, and walking.

Starving to achieve such a goal is wrong, because after childbirth a woman breastfeeds a child and must eat well so that milk is nutritious and healthy for the baby.

Eating should be in small portions, so the body will not be able to store strategic reserves in the form of fat. Include fresh vegetables, more fruits, fresh fish, cottage cheese, liver, eggs in your diet. Be sure to periodically breakfast cereals. If possible, give up sweets, foods containing a large amount of sugar - this is false food for the body.

By the way, when fasting, the metabolism decreases, so provide yourself with food for the whole day. It is better to think over meals in the evening, it would be right to prepare food in advance for each meal and arrange it in containers. So you definitely won't eat anything wrong.

Restoring metabolism will also help compliance with sleep and activity. It is very important. In order for the body to function properly, it must have a sufficient amount of time to rest and stay awake.

Spend more time outdoors. Let it be just walking with a stroller. The main thing is not to sit too long on the bench, but to walk and move.

Moderate exercise will also help improve digestion and metabolism after CS. There will be no stagnation of peristalsis during movement and light load.

Posture restoration

The spoiled posture lies all in the same 9 months of pregnancy. A woman gets used to walking with a duck gait, waddling from side to side. The abdomen protrudes, since it did not need to be kept taut throughout the pregnancy, the muscles have lost the habit of being in a constant tone. The fetus in the abdomen, plus amniotic fluid and the weight of the uterus - all this makes a woman break correct posture, a heavy load pulls forward. And so the whole pregnancy, with increasing weighting in front.

Incorrect posture is just a habit that can and should be fought, because the habit, as you know, is developed within 21 days.

It turns out that disturbed posture and gait is a habit that involuntarily became the norm for a woman after childbirth. And with any habit it is necessary and possible to fight.

• try to control yourself. It is clear that after childbirth with baby it is difficult, but nothing is impossible for a woman. It is so? Pull yourself up with your inner self. Do not be lazy to be beautiful, even with a lot of worries in your head;
• use a corset. On sale there are corsets that will control your posture. They can be worn both at home and worn under clothing even outside the home;
• Don't give up wearing heels completely. When you put on a heel or a hairpin, you will involuntarily straighten up, because this is the only way to keep your balance. Do not torment yourself if you do not like such shoes after childbirth. Wear heels occasionally, on occasion;
• get a massage. The specialist will help to relax the muscles of the back and neck, relieve tension.

Video: beautiful posture after childbirth - stoop exercises

Recovery of the pelvic floor muscles

After a caesarean section, not only the muscles of the abdominal wall suffer, the muscles of the pelvic floor also weaken during pregnancy. To feel desired and enjoy intimacy with your husband, learn to train your muscles.

If you have never come across this information and do not know what condition your pelvic floor muscles are in, note the following symptoms in yourself:

• reduced sensitivity;
• vaginal dryness is felt;
• pain during intercourse;
• you hear the sound of air escaping during intercourse;
• feeling of distension of the vagina.

If you have noted two or more signs in yourself, then we can say that your intimate muscles are stretched. Don't despair, the pelvic floor muscles can be perfectly trained.

With the help of special Kegel exercises, you can make your sex life brighter and more varied:

• after training, the vagina narrows, becomes more elastic, ribbed;
• you will be able to solve problems with achieving orgasm;
• such exercises serve as the prevention of urinary incontinence;
• you will save yourself from prolapse of the pelvic organs with age;
• trained muscles will prolong the woman's youth and the moment of the onset of menopause will be postponed.

It is best to start training intimate muscles even before childbirth, then the process of delivery will be easier (we are talking about natural childbirth):

Kegel exercises are simple at first glance, but in fact they can turn out far from the first time.

1. Tighten your pelvic floor muscles upwards and inward, standing shoulder-width apart, palms resting on your buttocks.
2. Tighten your pelvic floor muscles up and inward while kneeling (on all fours) with your head resting on your hands.
3. Lying on your stomach and bending one leg at the knee, relax and tighten the muscles of the pelvic floor in turn.
4. Lie on your back, bend your knees and spread your legs apart. One hand lies under the buttocks, the other on the stomach. Relax and tighten your pelvic floor muscles with your palms.
5. Sitting cross-legged and straightening your back, tighten your muscles in an upward and inward direction, as if breaking away from the floor.
6. Legs to the sides, hands rest on the knees, the body is tilted forward, the muscles of the pelvic floor are tense. Pull your muscles up and in.

In addition to exercises to restore the muscles of the pelvic floor, you can use special intimate simulators. As a rule, these simulators look like balls connected by a thread. To use such balls at home, knowledge and skills in their use are required. Otherwise, you can only harm the mucous membrane of the internal genital organs. Before use, consult a specialist.

Select trainers from quality materials so as not to harm the internal organs and not to infect

Navel restoration

A change in the muscles of the umbilical ring is called an umbilical hernia. It occurs in women after childbirth, when a huge belly grows during pregnancy and often after CS. We can fix this ailment, it is possible to restore the muscles of the navel.

During pregnancy, a fetus, especially a large one, presses hard on the abdominal wall, which causes weakening of the muscles of the umbilical ring. It also happens if a woman is concerned about constipation, this phenomenon occurs already in the last stages of pregnancy. Excess weight also plays a big role in weakening these muscles.

You can fight an umbilical hernia with the help of antispasmodics, it is also recommended to strengthen the muscles of the abdominal wall with abdominal exercises and wear a special bandage.

Important! Press exercises should be postponed until the postpartum discharge stops.

To prevent the appearance of an umbilical hernia, women are recommended before pregnancy:

• keep your weight under control and fight with its excess;
• play sports and keep muscles, including the muscles of the abdominal wall, in good shape;
• during pregnancy, it is mandatory to use a prenatal bandage. It will help the muscles to be in the correct position.

An umbilical hernia is a fusion of a scar after a CS

Psychological recovery

From a psychological point of view, a woman often experiences difficulties after childbirth. They manifest as depression and fatigue. Often, it is after a caesarean section that a young mother blames herself for not being able to “give birth normally”, “failing to cope”, that the birth of a baby seemed to pass her by. More often, such thoughts are visited by women who have a CS happened urgently. It is believed that when the CS is planned and scheduled in advance, the expectant mother has time to prepare for this thought, to think over and think everything over.

The operation is especially difficult psychologically for opponents of the CS, who are sure that only natural childbirth can go smoothly and positively for the child. It is difficult for such women in the postpartum period. They were definitely not prepared for this turn of events.

Be sure to attend courses for pregnant women, where there is a topic of caesarean section. Ask the facilitator to elaborate on certain issues. Get maximum information, ask questions, discuss and get rid of fears.

All the fault in the postpartum period is the restructuring of hormones. It is she who makes the mood change, return to the day of childbirth, think over the details. In a way, this is even the norm, indeed hormonal background women change after childbirth, just as it changes during pregnancy.

If you feel that there are more and more negative thoughts, your mood is getting worse, do not hesitate - seek help from a psychologist, because the baby needs a cheerful and healthy mother who loves, cares and enjoys every day of motherhood.

If in a moment of postpartum depression it seems that it doesn’t matter to you what will happen next, then remember your baby - he depends on you not only physically in terms of feeding, walking and bathing, but also emotionally. Charge your child only with positive emotions.

Remember that you are the conductor of mood and general condition from mother to baby.

Honestly, after two births I did not experience psychological problems, both pregnancies were desired. But in the environment I met women with the manifestation of postpartum depression to one degree or another. Consultation with a psychologist, or at least the support of loved ones, is essential for a woman during this period. Do not withdraw into yourself, do not ignore the help, and everything will gradually improve.

How to recover from a caesarean section if the mother is over 35 years old

Now more and more women give birth after 35-40 years, there are cases when the first-born appears in the family at this age.

Children are always a great happiness for a married couple. It is said that pregnancy makes a woman younger. All this is fine, if not for some BUT:

• As women age, more and more chronic diseases worsen. Bearing a child is not an easy task at any age, the older the mother, the greater the load she experiences during pregnancy;
• pregnancy after 35 is considered difficult, as there is a high risk of chromosomal abnormalities, such as Down syndrome, etc .;
• while maintaining a pregnancy at a late age, a woman should think about what the future of this child will be. After all, every year the age of the mother does not become less, no one guarantees a long life and not burdened by age-related diseases.

The postpartum recovery period after age 35 may be slightly longer. It depends on the health of the new mother.

Be sure to carefully examine before pregnancy, if it is planned. If not, then after the birth of a child, visit specialists in precisely those areas in which your health is “lame”, since pregnancy hits weak points organism. The load during the bearing of the baby can affect the organs and organ systems that bothered before pregnancy.

It also happens that despite life experience and the possible repeated experience of motherhood, it is difficult for a woman after 35–40 years to endure sleepless nights, lack of free time, and a heavy load of household chores. In order not to regret the birth of a late child, seek the help of a specialist in time. It will help you understand yourself and see the world of a happy mother in a new way.

Being a mother is happiness for a woman, but any issue must be approached wisely

What can help in recovery after a caesarean section

Every woman after a CS wants to return to her previous shape as soon as possible. This applies to both physical and emotional abilities. I want to be like before pregnancy.

For a quick recovery, use a few tips:

• Start walking as soon as possible after surgery. This will prevent the formation of adhesions and help to quickly move away from anesthesia and its consequences;
• wear a bandage. Put it on in the first few days after the CS, of course, with the permission of the doctor. The bandage will help to keep weakened abdominal muscles, the scar will be at rest, the seams will be covered and protected from damage, pressed. This will ease coughing and sneezing;
• Don't forget compression underwear. The CS operation must be performed strictly in compression stockings. They are also recommended to be worn after childbirth for some time. They will prevent the development of thrombosis;
• observe the hygiene of the seams. Treat the seam even after discharge from the hospital, until complete healing. Cover it with a sterile dressing to prevent contamination and mechanical damage;
• observe the sleep and rest regimen. Sleep with your baby if possible;
• walk more and be outdoors. Oxygen is useful for tissue regeneration and the general condition of the body;
• eat well. Your body needs strength to recover. Include iron-rich foods in your diet. Women who have given birth often have anemia;
• drink vitamins. The child during the period of being in the stomach grew thanks to your vitamins and microelements. It is necessary to replenish their supply;
• drink more water. This will be useful both for lactation and for the timely emptying of the intestines and bladder.

Video: fast recovery after caesarean section

Video: how to survive a caesarean section

If a caesarean section is due according to indications, then take it for granted, communicate more with the doctor, consult, gain information. If you are considering whether to choose natural childbirth or CS, and think that CS is an alternative to painful and painful childbirth, then read the information about the recovery period and be prepared for them.

C-section- a type of surgical intervention, during which the fetus is removed from the uterus of a pregnant woman. Extraction of the child occurs through an incision in the uterus and anterior abdominal wall.

Statistics on caesarean section vary from country to country. So, according to unofficial statistics in Russia, with the help of this delivery operation, about a quarter are born ( 25 percent) of all babies. This figure is increasing every year due to the increase in caesarean section at will. In the United States of America and most of Europe, every third child is born by caesarean section. Most high percent this operation is registered in Germany. In some cities of this country, every second child is born by caesarean section ( 50 percent). The lowest percentage is registered in Japan. In Latin America, this percentage is 35, in Australia - 30, in France - 20, in China - 45.

This statistic goes against the recommendations of the World Health Organization ( WHO). According to the WHO, the "recommended" proportion of caesarean sections should not exceed 15 percent. This means that a caesarean section should be carried out exclusively for medical reasons, when natural childbirth is impossible or involves a risk to the life of the mother and child. C-section ( from the Latin "caesarea" - royal, and "sectio" - cut) is one of the most ancient operations. According to legend, Julius Caesar himself ( 100 - 44 BC) was born thanks to this operation. There is also evidence that during his reign, a law was passed mandating that, in the event of the death of a woman in labor, it is mandatory to remove a child from her by dissecting the uterus and anterior abdominal wall. Many myths and legends are associated with this delivery operation. There are also many ancient Chinese engravings depicting this operation, and on a living woman. However, for the most part, these operations ended fatally for the woman in labor. The main mistake that doctors made was that after removing the fetus, they did not sew up the bleeding uterus. As a result, the woman died from blood loss.

The first official data on a successful caesarean section date back to 1500, when Jacob Nufer, who lives in Switzerland, performed this operation on his wife. His wife for a long time was tormented by prolonged childbirth and still could not give birth. Then Jacob, who was engaged in the castration of pigs, received permission from the city authorities to extract the fetus using an incision in the uterus. The child born into the world as a result of this lived 70 years, and the mother gave birth to several more children. The very term "caesarean section" was introduced less than 100 years later by Jacques Guillimo. In his writings, Jacques described this type of delivery operation and called it "caesarean section."

Further, with the development of surgery as a branch of medicine, this type of surgical intervention was practiced more and more often. After Morton used ether as an anesthetic in 1846, obstetrics entered a new stage of development. With the development of antiseptics, mortality from postoperative sepsis has decreased by 25 percent. However, there remained a high percentage of deaths due to postoperative bleeding. Various methods have been used to eliminate it. So, the Italian professor Porro proposed to remove the uterus after the extraction of the fetus and thereby prevent bleeding. This method of carrying out the operation reduced the mortality of women in labor by 4 times. Saumlnger put the final point on this issue when, for the first time in 1882, he carried out the technique of applying silver wire sutures to the uterus. After that, obstetric surgeons only continued to improve this technique.

The development of surgery and the discovery of antibiotics led to the fact that already in the 50s of the 20th century, 4 percent of children were born by caesarean section, and 20 years later - already 5 percent.

Despite the fact that caesarean section is an operation, with all the possible postoperative complications, an increasing number of women prefer this procedure due to fear of natural childbirth. The absence of strict regulations in the legislation on when a caesarean section should be performed gives the doctor the opportunity to act at his own discretion and at the request of the woman herself.

The fashion for caesarean section was provoked not only by the ability to "quickly" solve the problem, but also financial side question. More and more clinics offer women in labor operative delivery in order to avoid pain and give birth quickly. The Berlin Charité clinic has gone even further in this matter. She offers the service of the so-called "imperial birth". According to the doctors of this clinic, an imperial birth makes it possible to experience the beauty of natural childbirth without painful contractions. The difference between this operation is that local anesthesia allows parents to see the moment the baby is born. At the moment the child is taken out of the mother's womb, the cloth protecting the mother and surgeons is lowered and thus given to the mother and father ( if he's around) the opportunity to observe the birth of a baby. The father is allowed to cut the umbilical cord, after which the baby is placed on the mother's chest. After this touching procedure, the canvas is lifted, and the doctors complete the operation.

When is a caesarean section necessary?

There are two options for caesarean section - planned and emergency. Planned is the one when initially, even during pregnancy, indications for it are determined.

It should be noted that these indications may change during pregnancy. So, a low-lying placenta can migrate to the upper sections of the uterus and then the need for surgery disappears. A similar situation occurs with the fetus. It is known that the fetus changes its position during pregnancy. So, from a transverse position, it can move into a longitudinal one. Sometimes such changes can occur just a couple of days before delivery. Therefore, it is necessary to constantly monitor carry out continuous monitoring) the condition of the fetus and mother, and before the scheduled operation, once again undergo an ultrasound examination.

Caesarean section is necessary if the following pathologies are present:

• caesarean section in history and failure of the scar after it;
• anomalies of placental attachment total or partial placenta previa);
• deformity of the pelvic bones or an anatomically narrow pelvis;
• fetal position anomalies breech presentation, transverse position);
• large fruit (over 4 kg) or giant fruit ( over 5 kg), or multiple pregnancy;
• severe pathologies on the part of the mother, associated and not associated with pregnancy.

Previous caesarean section and inconsistency of the scar after it

As a rule, a single caesarean section excludes repeated physiological births. This is due to the presence of a scar on the uterus after the first operative delivery. It is nothing more than a connective tissue that is not able to contract and stretch ( in contrast to the muscle tissue of the uterus). The danger lies in the fact that in the next birth, the place of the scar may become a place of uterine rupture.

How the scar is formed is determined by the postoperative period. If after the first caesarean section the woman had some inflammatory complications ( which are not uncommon), then the scar may not heal well. The consistency of the scar before the next birth is determined using ultrasound ( ultrasound). If on ultrasound the thickness of the scar is determined to be less than 3 centimeters, its edges are uneven, and in its structure it is visible connective tissue, then the scar is considered insolvent and the doctor decides in favor of a repeated caesarean section. This decision is also influenced by many other factors. For example, a large fetus, the presence of multiple pregnancy ( twins or triplets) or pathologies in the mother will also be in favor of caesarean section. Sometimes a doctor, even without contraindications, but in order to exclude possible complications, resorts to a caesarean section.

Sometimes, already in the birth itself, signs of inferiority of the scar may appear, and there is a threat of uterine rupture. Then an emergency caesarean section is performed.

Anomalies of attachment of the placenta

The unconditional indication for caesarean section is total placenta previa. In this case, the placenta, which is normally attached to the upper uterus ( fundus or body of the uterus), located in its lower segments. With total or complete presentation, the placenta completely covers the internal pharynx, with partial - by more than one third. The internal os is the lower opening in the cervix, which connects the uterine cavity and the vagina. Through this opening, the head of the fetus passes from the uterus into the internal genital tract, and from there out.

The prevalence of complete placenta previa is less than 1 percent of total births. Natural childbirth becomes impossible, since the internal os, through which the fetus must pass, is blocked by the placenta. Also, with uterine contractions ( which occur most intensively in the lower sections) the placenta will exfoliate, which will lead to bleeding. Therefore, with complete placenta previa, delivery by caesarean section is mandatory.

With partial placenta previa, the choice of delivery is determined by the presence of complications. So, if pregnancy is accompanied by an incorrect position of the fetus or there is a scar on the uterus, then childbirth is resolved by surgery.

With incomplete presentation, a caesarean section is carried out in the presence of the following complications:

• transverse position of the fetus;
• an inconsistent scar on the uterus;
• polyhydramnios and oligohydramnios ( polyhydramnios or oligohydramnios);
• discrepancy between the size of the pelvis and the size of the fetus;
• multiple pregnancy;
• the woman is over 30 years of age.

Anomalies of attachment can serve as an indication not only for a planned caesarean section, but also for an emergency one. So, the main symptom of placenta previa is periodic bleeding. This bleeding occurs without pain, but is distinguished by its abundance. It becomes the main reason oxygen starvation fetus and maternal ill health. Therefore, frequent, heavy bleeding is an indication for emergency delivery by caesarean section.

Pelvic deformity or narrow pelvis

Anomalies in the development of the pelvic bones are one of the causes of prolonged labor. The pelvis can be deformed for a variety of reasons that arose both in childhood and in adulthood.

The most common causes of pelvic deformity are:

• rickets or poliomyelitis suffered in childhood;
• poor nutrition in childhood;
• spinal deformity, including the coccyx;
• damage to the pelvic bones and their joints as a result of injuries;
• damage to the pelvic bones and their joints due to neoplasms or diseases such as tuberculosis;
• congenital malformations of the pelvic bones.

The deformed pelvis serves as a barrier to the passage of the child through the birth canal. At the same time, initially the fetus can enter the small pelvis, but then, due to any local narrowing, its progress is difficult.

In the presence of a narrow pelvis, the child's head initially cannot enter the small pelvis. There are two variants of this pathology - anatomically and clinically narrow pelvis.

An anatomically narrow pelvis is a pelvis that is more than 1.5 to 2 centimeters smaller than a normal pelvis. Moreover, even a deviation from the norm of at least one of the dimensions of the pelvis leads to complications.

The dimensions of a normal pelvis are:

• external conjugate- the distance between the supra-sacral fossa and the upper border of the pubic joint is at least 20 - 21 centimeters;
• true conjugate- 9 centimeters are subtracted from the outer length, which, respectively, will be equal to 11 - 12 centimeters.
• interosseous size- the distance between the upper iliac spines should be 25 - 26 centimeters;
• length between the furthest points of the iliac crests should be at least 28 - 29 centimeters.

Based on how much smaller the size of the pelvis, there are several degrees of narrowness of the pelvis. The third and fourth degree of the pelvis is an unconditional indication for caesarean section. At the first and second, the size of the fetus is estimated, and if the fetus is not large, and there are no complications, then natural childbirth is performed. As a rule, the degree of narrowness of the pelvis is determined by the size of the true conjugate.

Degrees of a narrow pelvis

True conjugate size	Degrees of narrowness of the pelvis	Childbirth option
9 - 11 centimeters	I degree of narrow pelvis	Natural childbirth is possible.
7.5 - 9 centimeters	II degree narrow pelvis	If the fetus is less than 3.5 kg, then natural childbirth is possible. If more than 3.5 kg, then the decision will be made in favor of a caesarean section. The likelihood of complications is high.
6.5 - 7.5 centimeters	III degree of narrow pelvis	Natural childbirth is not possible.
Less than 6.5 centimeters	IV degree narrow pelvis	Exclusive caesarean section.

A narrow pelvis complicates the course of not only the birth itself, but also pregnancy. In the later stages, when the baby's head does not descend into the small pelvis ( because she more sizes pelvis), the uterus is forced to rise up. The growing and rising uterus puts pressure on the chest and, accordingly, on the lungs. Because of this, a pregnant woman develops severe shortness of breath.

Anomalies in the position of the fetus

When the fetus is located in the uterus of a pregnant woman, two criteria are evaluated - the presentation of the fetus and its position. The position of the fetus is the ratio of the vertical axis of the child to the axis of the uterus. With the longitudinal position of the fetus, the axis of the child coincides with the axis of the mother. In this case, if there are no other contraindications, then childbirth is resolved naturally. In the transverse position, the axis of the child forms a right angle with the axis of the mother. In this case, the fetus cannot enter the small pelvis to pass further through the woman's birth canal. Therefore, this position, if it does not change by the end of the third semester, is an absolute indication for caesarean section.

The presentation of the fetus characterizes which end, head or pelvic, is located at the entrance to the small pelvis. In 95 - 97 percent of cases, there is a head presentation of the fetus, in which the head of the fetus is located at the entrance to the woman's small pelvis. With such a presentation, at the birth of a child, his head initially appears, and then the rest of the body. In breech presentation, birth occurs in reverse ( legs first, then head), since the pelvic end of the child is located at the entrance to the small pelvis. Breech presentation is not an unconditional indication for caesarean section. If the pregnant woman has no other pathologies, her age is less than 30 years, and the size of the pelvis corresponds to the expected size of the fetus, then natural childbirth is possible. Most often, with a breech presentation, the decision in favor of a caesarean section is made by the doctor on an individual basis.

Large fetus or multiple pregnancy

A large fruit is one that weighs more than 4 kilograms. By itself, a large fetus does not mean that natural childbirth is impossible. However, in combination with other circumstances ( narrow pelvis of the first degree, the first birth after 30) it becomes an indication for a caesarean section.

Approaches to childbirth in the presence of a fetus of more than 4 kilograms in different countries are not the same. In European countries, such a fetus, even in the absence of other complications and successfully resolved previous births, is an indication for caesarean section.

Similarly, experts approach the management of childbirth in multiple pregnancies. By itself, such a pregnancy often occurs with various anomalies in the presentation and position of the fetus. Very often, twins end up in a breech presentation. Sometimes one fetus is located in the cranial presentation, and the other in the pelvic. The absolute indication for caesarean section is the transverse position of the entire twin.

At the same time, it is worth noting that both in the case of a large fetus and in the case of multiple pregnancy, natural delivery is often complicated by vaginal ruptures and premature discharge of water. One of the most serious complications in such childbirth is the weakness of labor. It can occur both at the beginning of childbirth, and in the process. If the weakness of labor activity is detected before childbirth, then the doctor may proceed to an emergency caesarean section. Also, the birth of a large fetus is more often complicated than in other cases by traumatism of the mother and child. Therefore, as is often the case, the question of the method of childbirth is determined by the doctor on an individual basis.

An unscheduled caesarean section in the case of a large fetus is resorted to if:

• weakness of labor activity is revealed;
• fetal oxygen starvation is diagnosed;
• the size of the pelvis does not correspond to the size of the fetus.

Severe pathologies on the part of the mother, associated and not associated with pregnancy

Indications for surgery are also maternal pathologies associated with pregnancy or not. The former include preeclampsia of varying severity and eclampsia. Preeclampsia is the condition of a pregnant woman, which is manifested by edema, high blood pressure and protein in the urine. Eclampsia is a critical condition that is manifested by a sharp increase in blood pressure, loss of consciousness and convulsions. These two conditions pose a threat to the life of the mother and child. Natural childbirth with these pathologies is difficult, because suddenly rising pressure can cause pulmonary edema, acute heart failure. With a sharply developed eclampsia, which is accompanied by seizures and a serious condition of a woman, they proceed to an emergency caesarean section.

The health of a woman can be threatened not only by pathologies caused by pregnancy, but also by diseases not associated with it.

The following diseases require a caesarean section:

• severe heart failure;
• exacerbation of renal failure;
• retinal detachment in this or a previous pregnancy;
• exacerbation of urinary infections;
• cervical fibroids and other tumors.

These diseases during natural childbirth can threaten the health of the mother or interfere with the progress of the child through the birth canal. For example, cervical fibroids will create a mechanical obstacle to the passage of the fetus. With an active sexual infection, there is also an increased risk of infection of the child at the moment when he passes through the birth canal.

Dystrophic changes in the retina are also a frequent indication for caesarean section. The reason for this is the fluctuations in blood pressure that occur in natural childbirth. Because of this, there is a risk of retinal detachment in women with myopia. It should be noted that the risk of detachment is observed in cases of severe myopia ( myopia from minus 3 diopters).

An emergency caesarean section is performed unscheduled due to complications that arose during the birth itself.

Pathologies, upon detection of which an unscheduled caesarean section is performed, are:

• weak generic activity;
• premature detachment of the placenta;
• the threat of uterine rupture;
• clinically narrow pelvis.

Weak labor activity

This pathology, which occurs during childbirth and is characterized by weak, short contractions or their complete absence. It can be primary and secondary. In the primary, the dynamics of labor is initially absent, in the secondary, the contractions are initially good, but then weaken. As a result, childbirth is delayed. Sluggish labor activity is the cause of oxygen starvation ( hypoxia) of the fetus and its traumatization. If this pathology is detected, an operative delivery is performed on an emergency basis.

Premature placental abruption

Premature abruption of the placenta is complicated by the occurrence of deadly bleeding. This bleeding is very painful, and most importantly - profuse. Massive blood loss can cause death of the mother and fetus. There are several degrees of severity of this pathology. Sometimes, if the detachment is insignificant, then it is advisable to use expectant tactics. This requires constant monitoring of the condition of the fetus. If placental abruption progresses, it is urgent to carry out delivery by caesarean section.

Threat of uterine rupture

Uterine rupture is the most dangerous complication in childbirth. Fortunately, its frequency does not exceed 0.5 percent. In the event of a threat of rupture, the uterus changes its shape, becomes sharply painful, and the fetus stops moving. At the same time, the woman in labor becomes excited, her blood pressure drops sharply. The main symptom is a sharp pain in the abdomen. Rupture of the uterus ends in death for the fetus. At the first signs of a rupture, a woman in labor is prescribed medications that relax the uterus and eliminate its contractions. In parallel, the woman in labor is urgently transferred to the operating room and the operation is deployed.

Clinically narrow pelvis

A clinically narrow pelvis is one that is detected in the birth itself in the presence of a large fetus. The dimensions of the clinically narrow pelvis correspond to normal, but do not correspond to the size of the fetus. Such a pelvis causes prolonged labor and therefore may serve as an indication for an emergency caesarean section. The cause of the clinical pelvis is an incorrect calculation of the size of the fetus. So, the size and weight of the fetus can be approximately calculated from the circumference of the abdomen of a pregnant woman or according to ultrasound. If this procedure has not been done in advance, then the risk of detecting a clinically narrow pelvis increases. A complication of this is rupture of the perineum, and in rare cases, the uterus.

"For" and "against" caesarean section

Despite the high percentage of childbirth by caesarean section, this operation cannot be equated with physiological childbirth. This opinion is shared by a number of experts who believe that such a "demand" for cesarean section is not quite normal. The problem of the growing number of women who prefer childbirth under anesthesia is not so harmless. After all, by relieving themselves from suffering, they complicate the future life not only for themselves, but also for their child.

In order to evaluate all the pros and cons of a caesarean section, it must be remembered that in 15-20 percent of cases this type of surgical intervention is still performed for health reasons. According to WHO, 15 percent are those pathologies that prevent natural childbirth.

Advantages of a caesarean section

Elective or emergency caesarean section helps to safely remove the fetus when this is not possible naturally. The main advantage of caesarean section is saving the life of the mother and child in cases where they are in danger of death. After all, many pathologies and conditions during pregnancy can end fatally during natural childbirth.

Natural childbirth is not possible in the following cases:

• total placenta previa;
• transverse position of the fetus;
• narrow pelvis 3 and 4 degrees;
• severe, life-threatening pathologies of the mother ( tumors in the small pelvis, severe preeclampsia).

In these cases, the operation saves the life of both the mother and the child. Another advantage of cesarean is the possibility of its emergency in cases where the need suddenly arose. For example, with weak labor activity, when the uterus is unable to contract normally and the child is threatened with death.

The advantage of caesarean section is also the ability to prevent such complications of natural childbirth as perineal and uterine ruptures.

A significant plus for a woman's sexual life is the preservation of the genital tract. After all, pushing the fetus through itself, the woman's vagina is stretched. The situation is worse if an episiotomy is performed during childbirth. With this surgical manipulation, a dissection of the posterior wall of the vagina is performed in order to avoid ruptures and make it easier to push the fetus out. After an episiotomy, further sexual life is significantly complicated. This is due to both the stretching of the vagina and the long non-healing sutures on it. Caesarean section will minimize the risk of prolapse and prolapse of the internal genital organs ( uterus and vagina), pelvic muscle strains, and involuntary urination associated with sprains.

An important plus for many women is that the birth itself is quick and painless, and you can program them for any time. The absence of pain is one of the most stimulating factors, because almost all women have a fear of painful natural childbirth. A caesarean section also protects the child being born from possible injuries that he can easily get during complicated and protracted births. The baby is most at risk when various third-party methods are used in natural childbirth to remove the baby. It can be forceps or vacuum extraction of the fetus. In these cases, the child often receives craniocerebral injuries, which subsequently affect his health.

Cons of a caesarean section for a woman in labor

Despite all the seeming ease and speed of the operation ( lasts 40 minutes) caesarean section remains a complex abdominal operation. The disadvantages of this surgical intervention affect both the child and the mother.

The disadvantages of the operation for a woman are reduced to all sorts of postoperative complications, as well as to complications that may arise during the operation itself.

The disadvantages of a caesarean section for the mother are:

• postoperative complications;
• long recovery period;
• postpartum depression;
• difficulty initiating breastfeeding after surgery.

A high percentage of postoperative complications
Since caesarean section is an operation, it bears all the disadvantages that are associated with postoperative complications. These are primarily infections, the risk of which is much higher with caesarean section than with natural childbirth.

The risk of development is especially high in emergency, unscheduled operations. Due to direct contact of the uterus with non-sterile environment pathogens enter it. These microorganisms are subsequently the source of infection, most often endometritis.

In 100 percent of cases, a cesarean section, like other operations, loses a fairly large amount of blood. The amount of blood that a woman loses in this case is two or even three times the volume that a woman loses in natural childbirth. This causes weakness and malaise in the postoperative period. If a woman was anemic before childbirth ( low hemoglobin content), which worsens her condition even more. In order to return this blood, transfusion is most often resorted to ( transfusion of donated blood into the body), which is also associated with the risk of side effects.
The most severe complications are associated with anesthesia and the effect of anesthetic on mother and baby.

Long recovery period
After surgery on the uterus, its contractility decreases. This, as well as impaired blood supply ( due to damage to blood vessels during surgery) causes prolonged healing. The long recovery period is also aggravated by the postoperative suture, which can very often diverge. Muscle recovery cannot be started immediately after the operation, because within a month or two after it, any physical activity is prohibited.

All this limits the necessary contact between mother and child. A woman does not immediately start breastfeeding, and caring for a baby can be difficult.
The recovery period is delayed if a woman develops complications. Most often, intestinal motility is disturbed, which is the cause of prolonged constipation.

Women after caesarean section have a 3 times higher risk of rehospitalization in the first 30 days than women who gave birth vaginally. It is also associated with the development of frequent complications.

The prolonged recovery period is also due to the action of anesthesia. So, in the first days after anesthesia, a woman is worried about severe headaches, nausea, and sometimes vomiting. Pain at the injection site of epidural anesthesia restricts the mother's movements and negatively affects her general well-being.

postpartum depression
In addition to the consequences that can harm the mother's bodily health, there is psychological discomfort and a high risk of developing postpartum depression. Many women may suffer from the fact that they did not give birth to a child on their own. Experts believe that the interrupted contact with the child and the lack of close proximity during childbirth are to blame.

It is known that postpartum depression ( the frequency of which has been increasing in recent years) no one is safe. However, the risk of its development is higher, according to many experts, in women who have undergone surgery. Depression is associated both with a long recovery period and with the feeling that the connection with the baby has been lost. Both psychoemotional and endocrine factors are involved in its development.
With caesarean section, a high percentage of early postpartum depression was recorded, which manifests itself in the first weeks after childbirth.

Difficulties in starting breastfeeding after surgery
After surgery, there are difficulties with feeding. This is due to two reasons. The first is that the first milk ( colostrum) becomes unsuitable for feeding the child due to the penetration of drugs for anesthesia into it. Therefore, on the first day after the operation, the child should not be breastfed. If a woman has undergone general anesthesia, then the feeding of the child is postponed for several weeks, since the anesthetics used for general anesthesia are stronger and, therefore, take longer to be removed. The second reason is the development of postoperative complications that prevent the full care and feeding of the child.

Cons of a caesarean section for a baby

The main disadvantage for the child during the operation itself is the negative impact of the anesthetic. General anesthesia has recently become less common, but, nevertheless, the medicines used in it adversely affect the respiratory and nervous system child. Local anesthesia is not so harmful for the baby, but there is still a risk of oppression of vital organs and systems. Very often, children after cesarean section are very lethargic in the first days, which is associated with the action of anesthetics and muscle relaxants on them ( medicines that relax the muscles).

Another significant disadvantage is the poor adaptation of the baby to the external environment after the operation. During natural childbirth, the fetus, passing through the birth canal of the mother, gradually adapts to changes in the external environment. It adapts to the new pressure, light, temperature. After all, for 9 months he is in the same climate. With a caesarean section, when the baby is abruptly removed from the mother's uterus, there is no such adaptation. In this case, the child experiences a sharp drop in atmospheric pressure, which, of course, negatively affects his nervous system. Some believe that such a drop is a further cause of problems with vascular tone in children ( for example, the cause of banal vascular dystonia).

Another complication for the baby is fetal fluid retention syndrome. It is known that the child, while in the womb, receives the necessary oxygen through the umbilical cord. His lungs are not filled with air, but with amniotic fluid. When passing through the birth canal, this fluid is pushed out and only a small amount of it is removed using an aspirator. In a baby born by caesarean section, this fluid often remains in the lungs. Sometimes it is absorbed by the lung tissue, but in debilitated children, this fluid can cause the development of pneumonia.

As with natural childbirth, with a caesarean section there is a risk of injuring the child if it is difficult to extract it. However, the risk of injury in this case is much lower.

There are many scientific publications on the topic that children born as a result of caesarean section are more likely to suffer from autism, attention deficit hyperactivity disorder, and are less stress resistant. Much of this is disputed by experts, because although childbirth is important, many believe, it is still only an episode in the life of a child. After childbirth, a whole complex of care and upbringing follows, which determines both the mental and physical health of the child.

Despite the abundance of minuses, sometimes a caesarean section is the only possible way to extract the fetus. It helps reduce the risk of maternal and perinatal mortality ( fetal death during pregnancy and within the first week after delivery). Also, the operation avoids many herbs, which are not uncommon in protracted natural childbirth. At the same time, it should be carried out according to strict indications, only when all the pros and cons are weighed. After all, any childbirth - both natural and by caesarean section - carry possible risks.

Preparing a pregnant woman for a caesarean section

Preparation of a pregnant woman for a caesarean section begins after the indications for its implementation have been determined. The doctor must explain to the expectant mother all the risks and possible complications of the operation. Next, select the date when the operation will be performed. Before the operation, the woman undergoes periodic ultrasound examination, passes the necessary tests ( blood and urine), attends preparatory courses for expectant mothers.

It is necessary to go to the hospital a day or two before the operation. If a woman has a repeated caesarean section, then it is necessary to be hospitalized 2 weeks before the proposed operation. During this time, the woman is examined by a doctor, takes tests. Blood of the required group is also prepared, which will compensate for blood losses during the operation.

Before carrying out the operation, it is necessary to carry out:
General analysis blood
A blood test is done primarily in order to assess the level of hemoglobin and red blood cells in the blood of a woman in labor. Normally, the hemoglobin level should not be less than 120 grams per liter of blood, while the content of red blood cells should be in the range of 3.7 - 4.7 million per milliliter of blood. If at least one of the indicators is lower, then this means that the pregnant woman is suffering from anemia. Women with anemia tolerate surgery worse and, as a result, lose a lot of blood. The doctor, knowing about anemia, must ensure that there is a sufficient volume of blood of the required type in the operating room for emergency cases.

Attention is also paid to leukocytes, the number of which should not exceed 9x10 9

An increase in leukocytes ( leukocytosis) indicates an inflammatory process in the body of a pregnant woman, which is a relative contraindication to caesarean section. If there is an inflammatory process in a woman's body, then this increases the risk of developing septic complications tenfold.

Blood chemistry
The main indicator that the doctor is most interested in before surgery is blood glucose. Elevated glucose levels ( popularly sugar) in the blood indicates that the woman may have diabetes. This disease is the second cause of complications in the postoperative period after anemia. Women with diabetes mellitus are more likely to develop infectious complications ( endometritis, wound suppuration), complications during the operation. So if the doctor discovers high level glucose, he will prescribe treatment to stabilize its level.

Risk of major ( over 4 kg) and giant ( over 5 kg) of the fetus in such women is ten times higher than in women who do not suffer from this pathology. As you know, a large fetus is more prone to injury.

General urine analysis
A general urine test is also carried out in order to exclude infectious processes in the woman's body. So, inflammation of the appendages, cervicitis and vaginitis are often accompanied by an increased content of leukocytes in the urine, a change in its composition. Diseases of the genital area are the main contraindication to caesarean section. Therefore, if signs of these diseases are detected in the urine or in the blood, the doctor may postpone the operation due to an increased risk of purulent complications.

ultrasound
An ultrasound examination is also a mandatory examination before a caesarean section. Its purpose is to determine the position of the fetus. It is very important to exclude anomalies incompatible with life in the fetus, which are an absolute contraindication to caesarean section. In women with a history of caesarean section, ultrasound is performed to assess the consistency of the scar on the uterus.

Coagulogram
Coagulogram is a method laboratory research which studies blood clotting. Coagulation pathologies are also a contraindication to caesarean section, because bleeding develops due to the fact that the blood does not clot well. The coagulogram includes such indicators as thrombin and prothrombin time, fibrinogen concentration.
The blood group and its Rh factor are also re-determined.

On the eve of the operation

On the eve of the operation, lunch and dinner for a pregnant woman should be as light as possible. Lunch may include broth or porridge, for dinner it will be enough to drink sweet tea and eat a sandwich with butter. During the day, the anesthesiologist examines the woman in labor and asks her questions, mainly related to her allergic history. He will find out if the woman in labor has allergies and to what. He also asks her about chronic diseases, pathologies of the heart and lungs.
In the evening, the woman in labor takes a shower, toilets the external genital organs. At night she is given a mild sedative and some kind of antihistamine ( e.g. suprastin tablet). It is important that all indications for surgery are re-evaluated and all risks are weighed. Also before surgery future mom signs a written agreement for the operation, which indicates that she is aware of all possible risks.

On the day of the operation

On the day of the operation, the woman excludes any food and drink. Before the operation, the pregnant woman must get rid of makeup, remove nail polish. By the color of the skin and nails, the anesthesiologist will determine the condition of the pregnant woman under anesthesia. You must also remove all jewelry. A cleansing enema is given two hours before the operation. Immediately before the operation, the doctor listens to the fetal heartbeat, determines its position. A catheter is inserted into the woman's bladder.

Description of the caesarean section

A caesarean section is a complex surgical intervention during childbirth with the extraction of the fetus from the uterine cavity through the incision made. In terms of duration, the usual caesarean section takes no more than 30-40 minutes.

The operation can be performed according to various methods, depending on the necessary access to the uterus and to the fetus. There are three main options for surgical access ( abdominal wall incision) to the pregnant uterus.

Surgical access to the uterus are:

• access along the midline of the abdomen ( classic cut);
• low transverse Pfannenstiel approach;
• suprapubic transverse approach according to Joel-Cohen.

Classic Access

Access along the midline of the abdomen is a classic surgical approach for caesarean section. It is performed along the midline of the abdomen from the level of the pubis to a point about 4 to 5 centimeters above the navel. Such an incision is quite large and often leads to postoperative complications. In modern surgery, a low classical incision is used. It is made along the midline of the abdomen from the pubis to the navel.

Pfannenstiel access

In such operations, the Pfannenstiel incision is most often the surgical access. The anterior abdominal wall is cut across the midline of the abdomen along the suprapubic fold. The incision is an arc 15 - 16 centimeters in length. Such a surgical approach is the most beneficial in cosmetic terms. Also, with this access, the development of postoperative hernias is rare, in contrast to the classical approach.

Access by Joel-Kohen

The Joel-Kochen approach is also a transverse incision, as is the Pfannenstiel approach. However, the dissection of the tissues of the abdominal wall is made slightly above the pubic fold. The incision is straight and has a length of about 10 - 12 centimeters. This access is used when the bladder is lowered into the pelvic cavity and there is no need to open the vesicouterine fold.

During caesarean section, there are several options for accessing the fetus through the wall of the uterus.

Options for incision of the uterine wall are:

• transverse incision in the lower part of the uterus;
• median incision of the body of the uterus;
• median section of the body and lower part of the uterus.

Techniques for caesarean section

In accordance with the options for uterine incisions, several methods of operation are distinguished:

• transverse incision technique in the lower part of the uterus;
• corporal technique;
• isthmicocorporal technique.

Transverse incision technique in the lower part of the uterus

The technique of transverse incision in the lower part of the uterus for caesarean section is the technique of choice.
Surgical access is performed according to the Pfannenstiel or Joel-Kohen technique, less often - a small classic access along the midline of the abdomen. Depending on the surgical approach, the transverse incision technique in the lower part of the uterus has two options.

Variants of the transverse incision technique in the lower part of the uterus are:

• with dissection of the vesicouterine fold ( Pfannenstiel access or small classical incision);
• without incision of the vesicouterine fold ( access by Joel-Kohen).

In the first variant, the vesicouterine fold is opened and the bladder is moved away from the uterus. In the second option, the incision on the uterus is made without opening the fold and manipulation of the bladder.
In both cases, the uterus is dissected in its lower segment, where the fetal head is exposed. A transverse incision is made along the muscle fibers of the uterine wall. On average, its length is 10 - 12 centimeters, which is enough for the passage of the fetal head.
With the method of transverse incision of the uterus, the least damage is done to the myometrium ( muscular layer of the uterus), which favors the rapid healing and scarring of the postoperative wound.

Corporal methodology

The corporal caesarean section method consists in extracting the fetus through a longitudinal incision on the body of the uterus. Hence the name of the method - from the Latin "corporis" - the body. Surgical access with this method of operation is usually classical - along the midline of the abdomen. Also, the body of the uterus is cut along the midline from the vesicouterine fold towards the bottom. The length of the incision is 12 - 14 centimeters. Initially, 3-4 centimeters are cut with a scalpel, then the incision is enlarged with scissors. These manipulations cause profuse bleeding, which forces you to work very quickly. Incised with a scalpel or fingers amniotic sac. The fetus is removed and the afterbirth is removed. If necessary, the uterus is also removed.
A corporal caesarean section often results in the formation of many adhesions, the wound heals for a long time, and there is a high risk of scar dehiscence during subsequent pregnancy. This method is used extremely rarely in modern obstetrics and only for special indications.

The main indications for corporal caesarean section are:

• the need for a hysterectomy removal of the uterus) after delivery - with benign and malignant formations in the wall of the uterus;
• profuse bleeding;
• the fetus is in a transverse position;
• live fetus in a dead woman in labor;
• lack of experience with the surgeon in performing caesarean section by other methods.

The main advantage of the corporal technique is the rapid opening of the uterus and removal of the fetus. Therefore, this method is mainly used for emergency caesarean section.

Isthmicocorporal technique

In the isthmicocorporal caesarean section, a longitudinal incision is made not only in the body of the uterus, but also in its lower segment. Surgical access is performed according to Pfannenstiel, which allows opening the vesicouterine fold and moving the bladder downwards. The incision of the uterus begins in its lower segment one centimeter above the bladder and ends on the body of the uterus. The longitudinal section averages 11 - 12 centimeters. This technique is rarely used in modern surgery.

Stages of a caesarean section

The caesarean section operation consists of four stages. Each surgical technique has similarities and differences at different stages of the surgical intervention.

Similarities and differences in the stages of caesarean section with different methods

Stages	Method of transverse incision of the uterus	Corporal methodology	Isthmicocorporal technique
First stage: surgical access.	according to Pfannenstiel; according to Joel-Kohen; low classic cut.	classic access; according to Pfannenstiel.	classic access; according to Pfannenstiel.
Second phase: opening of the uterus; opening of the fetal bladder.	Cross section of the lower part of the uterus.	Median section of the body of the uterus.	Median section of the body and lower part of the uterus.
Third stage: extraction of the fetus; removal of the placenta.		The fetus and afterbirth are removed by hand. If necessary, the uterus is removed.	The fetus and afterbirth are removed by hand.
Fourth stage: suturing of the uterus; suturing of the abdominal wall.	The uterus is sutured with a suture in one row.	The abdominal wall is sutured in layers.	The uterus is sutured with two rows of sutures. The abdominal wall is sutured in layers.

First stage

At the first stage of the operation, a transverse incision is made with a scalpel in the skin and subcutaneous tissue of the anterior abdominal wall. Usually resort to transverse incisions of the abdominal wall ( Pfannenstiel and Joel-Kohen access), less often to median incisions ( classic and low classic).

Then the aponeurosis is cut transversely with a scalpel ( tendon) rectus and oblique abdominal muscles. Using scissors, the aponeurosis is separated from the muscles and white ( middle) lines of the abdomen. Its upper and lower edges are captured with special clamps and stratified to the navel and pubic bones, respectively. The exposed muscles of the abdominal wall are pushed apart with the fingers along the course of the muscle fibers. Next, a longitudinal incision is made in the peritoneum ( membrane covering internal organs) from the level of the navel to the top of the bladder and the uterus is visualized.

Second phase

At the second stage, access to the fetus is created through the uterus and fetal membrane. With the help of sterile napkins, the abdominal cavity is delimited. If the bladder is located quite high and interferes with the course of the operation, then the vesicouterine fold is opened. To do this, a small incision is made with a scalpel on the fold, through which the most of folds lengthwise. This exposes the bladder, which can be easily separated from the uterus.

This is followed by dissection of the uterus itself. Using the transverse incision technique, the surgeon determines the location of the fetal head and makes a small transverse incision with a scalpel in this area. Using the index fingers, the incision is expanded into longitudinal direction up to 10 - 12 centimeters, which corresponds to the diameter of the fetal head.

Then the fetal bladder is opened with a scalpel and the fetal membranes are separated with fingers.

Third stage

The third stage is the extraction of the fetus. The surgeon inserts a hand into the uterine cavity and grasps the fetal head. With a slow movement, the head is bent and turned with the back of the head to the incision. The shoulders are gradually extended one by one. The surgeon then inserts fingers into the armpits of the fetus and pulls it completely out of the uterus. With unusual diligence ( locations) the fetus can be removed by the legs. If the head does not pass, then the incision on the uterus expands by a couple of centimeters. After removing the baby, two clamps are applied to the umbilical cord and cut between them.

To reduce blood loss and make it easier to remove the placenta, medications are injected into the uterus with a syringe, which lead to a contraction of the muscle layer.

Drugs that promote uterine contraction include:

• oxytocin;
• ergotamine;
• methylergometrine.

Then the surgeon gently pulls on the umbilical cord, removing the placenta with the afterbirth. If the placenta itself does not separate, then it is removed with a hand inserted into the uterine cavity.

Fourth stage

At the fourth stage of the operation, a revision of the uterus is performed. The surgeon inserts his hands into the uterine cavity and checks it for the presence of remnants of the placenta and placenta. The uterus is then sutured in one row. The seam can be continuous or discontinuous with a distance of no more than one centimeter. Currently, threads made of synthetic materials are used, which dissolve over time - vicryl, polysorb, dexon.

Wipes are removed from the abdominal cavity and the peritoneum is sutured with a continuous suture from top to bottom. Next, the muscles, aponeurosis and subcutaneous tissue are sutured in layers with continuous sutures. A cosmetic suture is applied to the skin with thin threads ( silk, nylon, catgut) or medical brackets.

Methods of anesthesia for caesarean section

A caesarean section, like any other surgical procedure, requires appropriate anesthesia ( anesthesia).

The choice of method of anesthesia depends on a number of factors:

• pregnancy history ( information about previous births, obstetric and gynecological pathologies);
• general condition of the body of a pregnant woman ( age, comorbidities, especially of the cardiovascular system);
• state of the fetal body abnormal position of the fetus, acute placental insufficiency or fetal hypoxia);
• type of transaction ( emergency or planned);
• the presence in the obstetric department of appropriate devices and equipment for anesthesia;
• experience of an anesthesiologist;
• wish of the mother be conscious and see a newborn baby or sleep peacefully during surgical procedures).

Currently, there are two options for anesthesia for surgical delivery - general anesthesia and regional ( local) anesthesia.

General anesthesia

General anesthesia is also called general anesthesia or endotracheal anesthesia. This type of anesthesia consists of several stages.

The stages of anesthesia are:

• induction anesthesia;
• muscle relaxation;
• aeration of the lungs with the help of a ventilator;
• main ( supporting) anesthesia.

Induction anesthesia acts as a preparation for general anesthesia. With its help, the patient calms down and is put to sleep. Induction anesthesia is carried out using intravenous administration of general anesthetics ( ketamine) and inhalation of gaseous anesthetics ( nitrous oxide, desflurane, sevoflurane).

Complete muscle relaxation is achieved by intravenous administration of muscle relaxants ( drugs that relax muscles). The main muscle relaxant used in obstetric practice is succinylcholine. Muscle relaxants relax all the muscles of the body, including the uterine.
Due to the complete relaxation of the respiratory muscles, the patient needs artificial aeration of the lungs ( breathing is supported artificially). To do this, a tracheal tube connected to a ventilator is inserted into the trachea. The machine delivers a mixture of oxygen and anesthetic to the lungs.

Basic anesthesia is maintained by the administration of gaseous anesthetics ( nitrous oxide, desflurane, sevoflurane) and intravenous antipsychotics ( fentanyl, droperidol).
General anesthesia has a number of negative effects on the mother and fetus.

Negative effects of general anesthesia

General anesthesia is used under the following conditions:

• regional anesthesia is contraindicated for pregnant women ( especially in pathologies of the heart and nervous system);
• the life of the pregnant woman and/or the fetus is at risk, and the caesarean section is urgent ( emergency);
• the pregnant woman categorically refuses other types of anesthesia.

Regional anesthesia

During cesarean section operations, the regional method of anesthesia is most often used, since it is the safest for the woman in labor and the fetus. However, this method requires high professionalism and accuracy from the anesthesiologist.

Two types of regional anesthesia are used:

• spinal anesthesia.

Epidural anesthesia method
The epidural method of anesthesia consists in "paralyzing" the spinal nerves responsible for sensation in the lower body. At the same time, the woman in labor remains fully conscious, but does not feel pain.

Before the start of the operation, the pregnant woman is punctured ( puncture) at the level of the lower back with a special needle. The needle is deepened to the epidural space, where all the nerves exit the spinal canal. A catheter is inserted through the needle thin flexible tube) and remove the needle itself. Pain medications are injected through the catheter lidocaine, marcaine), which suppress pain and tactile sensitivity from the lower back to the tips of the toes. Thanks to the indwelling catheter, anesthetic can be added during the operation as needed. After the surgery is completed, the catheter remains for a couple of days for the administration of pain medications in the postoperative period.

Spinal anesthesia method
The spinal method of anesthesia, like the epidural, leads to a loss of sensation in the lower body. Unlike epidural anesthesia, with spinal anesthesia, the needle is inserted directly into the spinal canal, where the anesthetic enters. In more than 97 - 98 percent of cases, a complete loss of all sensitivity and relaxation of the muscles of the lower body, including the uterus, is achieved. The main advantage of this type of anesthesia is the need for small doses of anesthetics to achieve the result, which provides less impact on the body of the mother and fetus.

There are a number of conditions under which regional anesthesia is contraindicated.

The main contraindications include:

• inflammatory and infectious processes in the area of ​​lumbar puncture;
• blood diseases with impaired coagulation;
• acute infectious process in the body;
• allergic reactions to painkillers;
• the absence of an anesthesiologist who has the technique of regional anesthesia, or the lack of equipment for it;
• severe pathology of the spine with its deformation;
• categorical refusal of a pregnant woman.

Complications of caesarean section

The greatest danger is the complications that arose during the operation itself. Most often they are associated with anesthesia, but can also be the result of a large loss of blood.

Complications during the operation

The main complications during the operation itself are associated with blood loss. Blood loss, both in natural childbirth and in caesarean section, is inevitable. In the first case, the woman in labor loses from 200 to 400 milliliters of blood ( Of course, if there are no complications). During an operative delivery, a woman in labor loses about a liter of blood. This massive loss is due to damage to the blood vessels that occurs when incisions are made at the time of surgery. The loss of more than a liter of blood during caesarean section creates the need for a transfusion. Massive blood loss that occurred at the time of the operation, in 8 cases out of 1000 ends with the removal of the uterus. In 9 cases out of 1000 it is necessary to carry out resuscitation measures.

The following complications may also occur during the operation:

• circulatory disorders;
• violations of ventilation of the lungs;
• violations of thermoregulation;
• damage to large vessels and nearby organs.

These complications are the most dangerous. Most often, there are violations of blood circulation and ventilation of the lungs. With hemodynamic disorders, both arterial hypotension and hypertension can occur. In the first case, the pressure drops, the organs cease to receive sufficient blood supply. Hypotension can be caused by both blood loss and an overdose of the anesthetic. Hypertension during surgery is not as dangerous as hypotension. However, it negatively affects the work of the heart. The most severe and dangerous complication associated with the cardiovascular system is cardiac arrest.
Respiratory disorders can be caused by both the action of anesthesia and pathologies on the part of the mother.

Disorders of thermoregulation are manifested by hyperthermia and hypothermia. Malignant hyperthermia is characterized by an increase in body temperature by 2 degrees Celsius within two hours. In hypothermia, body temperature drops below 36 degrees Celsius. Hypothermia is more common than hyperthermia. Thermoregulation disorders can be provoked by anesthetics ( e.g. isoflurane) and muscle relaxants.
During caesarean section, organs close to the uterus can also be accidentally damaged. The most common injury is the bladder.

Complications in the postoperative period are:

• complications of an infectious nature;
• the formation of adhesions;
• severe pain syndrome;
• postoperative scar.

Complications of an infectious nature

These complications are the most common, ranging from 20 to 30 percent depending on the type of surgery ( emergency or planned). Most often they occur in women who are overweight or have diabetes, as well as during an emergency caesarean section. This is due to the fact that during a planned operation, a woman in labor is pre-prescribed antibiotics, while during an emergency, no. The infection can affect both the postoperative wound ( incision in the abdomen), and the internal organs of a woman.

Infection of the postoperative wound, despite all attempts to reduce the risk of infections after surgery, occurs in one to two out of ten cases. At the same time, the woman has an increase in temperature, there is a sharp pain and redness in the wound area. Further, discharges appear from the incision site, and the edges of the incision themselves diverge. Discharges very quickly acquire an unpleasant purulent odor.

Inflammation of the internal organs extends to the uterus and organs of the urinary system. A common complication after caesarean section is inflammation of the tissues of the uterus or endometritis. The risk of developing endometritis during this operation is 10 times higher compared to natural childbirth. With endometritis, such common symptoms of infection as fever, chills, severe malaise also appear. A characteristic symptom of endometritis is bloody or purulent discharge from the vagina, as well as sharp pains in the lower abdomen. The cause of endometritis is infection in the uterine cavity.

The infection may also involve urinary tract. Usually after caesarean as after other operations) infection of the urethra occurs. This is related to the catheter thin tube) into the urethra during surgery. This is done to empty the bladder. The main symptom in this case is painful, difficult urination.

Blood clots

An increased risk of blood clots occurs with any operation. A thrombus is a blood clot in a blood vessel. There are many reasons for the formation of blood clots. During surgery, this reason is the entry into the bloodstream of a large amount of a substance that stimulates blood clotting ( thromboplastin). The longer the operation, the more thromboplastin is released from the tissues into the blood. Accordingly, in complicated and protracted operations, the risk of thrombosis is maximum.

The danger of a blood clot lies in the fact that it can clog a blood vessel and stop blood from reaching the organ that is supplied with blood by this vessel. The symptoms of thrombosis are determined by the organ where it occurred. So pulmonary thrombosis ( pulmonary thromboembolism) is manifested by cough, shortness of breath; thrombosis of the vessels of the lower extremities - sharp pain, pallor of the skin, numbness.

Prevention of thrombus formation during cesarean section consists in the appointment of special drugs that thin the blood and prevent the formation of blood clots.

Adhesion formation

Spikes are called fibrous strands of connective tissue that can connect various organs or tissues and block the gaps of the viscera. The adhesive process is characteristic of all abdominal operations, including caesarean section.

The mechanism of adhesion formation is associated with the process of scarring after surgery. This process releases a substance called fibrin. This substance glues soft tissues together, thus restoring damaged integrity. However, gluing occurs not only where necessary, but also in those places where the integrity of the tissues was not violated. So fibrin affects the loops of the intestines, the organs of the small pelvis, soldering them together.

After a caesarean section, the adhesive process most often affects the intestines and the uterus itself. The danger lies in the fact that adhesions affecting the fallopian tubes and ovaries, in the future, can cause tubal obstruction and, as a result, infertility. The adhesions that form between the intestinal loops limit its mobility. The loops become, as it were, “soldered” together. This phenomenon can cause intestinal obstruction. Even if obstruction does not form, adhesions still disrupt the normal functioning of the intestine. The result is long, painful constipation.

Severe pain syndrome

Pain after caesarean section, as a rule, is much more intense than during natural childbirth. Pain in the area of ​​the incision and in the lower abdomen persists for several weeks after surgery. This is the time the body needs to recover. There may also be various adverse reactions to the anesthetic.
After local anesthesia, pain is present in the lumbar region ( at the injection site of the anesthetic). This pain can make it difficult for a woman to move for several days.

Postoperative scar

A postoperative scar on the front wall of the abdomen, although it does not pose a threat to a woman's health, is a serious cosmetic defect for many. Caring for him involves the release from lifting and carrying weights and proper hygiene in the postoperative period. At the same time, the scar on the uterus largely determines subsequent births. It is a risk for the development of complications in childbirth ( uterine rupture) and is often the cause of repeat caesarean section.

Complications associated with anesthesia

Despite the fact that local anesthesia has recently been performed for caesarean section, there are still risks of complications. The most frequent side effect after anesthesia is strong headache. Much less often, nerves can be damaged during anesthesia.

The greatest danger is general anesthesia. It is known that more than 80 percent of all postoperative complications are associated with anesthesia. With this type of anesthesia, the risk of developing respiratory and cardiovascular complications is maximum. Most often, respiratory depression due to the action of an anesthetic is recorded. With prolonged operations, there is a risk of developing pneumonia associated with lung intubation.
With both general and local anesthesia, there is a risk of a drop in blood pressure.

How does a caesarean section affect the baby?

The consequences of a caesarean section are inevitable for both the mother and the child. The main effect that a caesarean section has on a child is associated with the effect of anesthesia on him and a sharp pressure drop.

The effect of anesthesia

The greatest danger to the newborn is general anesthesia. Some anesthetics depress the baby's central nervous system, causing them to initially appear calmer. The greatest danger is the development of encephalopathy ( brain damage), which, fortunately, is quite rare.
Substances for anesthesia affect not only the nervous system, but also the respiratory system. According to various studies, respiratory disorders in children born by caesarean section are very common. Despite the fact that the effect of the anesthetic on the fetus is very short ( from the moment of anesthesia to the extraction of the fetus takes 15-20 minutes), he manages to exert his inhibitory effect. This is confirmed by the fact that children removed from the womb by caesarean section do not react so intensely to birth. The reaction in this case is determined by the cry of the newborn, his breath or excitability ( grimace, movements). Often it is necessary to stimulate breathing or reflex excitability. It is believed that children born by caesarean section have Apgar scores ( newborn assessment scale), lower than those born naturally.

Influence on the emotional sphere

The effect of a caesarean section on a child is due to the fact that the child does not pass through the mother's birth canal. It is known that during natural childbirth, the fetus, before being born, gradually adapting, passes through the mother's birth canal. On average, the passage takes from 20 to 30 minutes. During this time, the baby gradually gets rid of amniotic fluid from the lungs and adapts to changes in the external environment. This makes his birth softer, unlike a caesarean section, where the baby is abruptly pulled out. There is an opinion that passing through the birth canal, the child experiences a kind of stress. As a result, he produces stress hormones - adrenaline and cortisol. This, some experts believe, subsequently regulates the child's resistance to stress and the ability to concentrate. The lowest concentration of these hormones, as well as thyroid hormones, is observed in children born under general anesthesia.

Effect on the gastrointestinal tract

Also, according to recent studies, children born by caesarean section are more likely than others to suffer from dysbacteriosis. This is due to the fact that at the time of the passage of the child through the birth canal, he acquires the mother's lactobacilli. These bacteria form the basis of the intestinal microflora. The gastrointestinal tract of a newborn is one of its most vulnerable places. The baby's intestines are practically sterile, as it lacks the necessary flora. It is also believed that caesarean section itself has an effect on the delay in the development of microflora. As a result of this, babies have disorders of the gastrointestinal tract, and because of its immaturity, it is most susceptible to infection.

Recovery of a woman rehabilitation) after caesarean section

Diet

After a caesarean section, a woman must follow a number of rules when eating food for a month. The diet of a patient who has undergone a caesarean section should help restore the body and increase its resistance to infections. The nutrition of the woman in labor should ensure the elimination of the protein deficiency that develops after the operation. A large amount of protein is found in meat broths, lean meats, and eggs.

The daily norms of the chemical composition and energy value of nutrition after cesarean section are:

• squirrels ( 60 percent animal origin) - 1.5 grams per 1 kilogram of weight;
• fats ( 30 percent vegetable) - 80 - 90 grams;
• carbohydrates ( 30 percent easily digestible) - 200 - 250 grams;
• energy value - 2000 - 2000 kilocalories.

The rules for the use of products after cesarean section in the postpartum period (first 6 weeks) are:

• the first three days the consistency of the dishes should be liquid or mushy;
• the menu should include foods that are easily digestible;
• recommended heat treatment - boiling in water or steam;
• the daily norm of products must be divided into 5 - 6 servings;
• the temperature of the food consumed should not be too high or too low.

Patients after caesarean section should include in the diet foods rich in fiber, because it has a beneficial effect on the functioning of the gastrointestinal tract. Vegetables and fruits should be eaten steamed or boiled, because fresh, these foods can cause bloating. The first day after the caesarean section, the patient is advised to refuse to eat. A woman in labor should drink still mineral water with a small amount of lemon or other juice.
On the second day, the menu can include chicken or beef broth, boiled in third water. Such food is rich in protein, from which the body receives amino acids, with the help of which cells recover faster.

The stages of preparation and the rules for using the broth are:

• Place meat in water and bring to a boil. Then it is necessary to drain the broth, add clean cold water and drain again after boiling.
• Pour the third water over the meat, bring to a boil. Next, add vegetables and bring the broth to readiness.
• Divide the finished broth into portions of 100 milliliters.
• The recommended daily allowance is 200 to 300 milliliters of broth.

If the patient's well-being allows, the diet on the second day after cesarean section can be varied with low-fat cottage cheese, natural yogurt, mashed potatoes or lean boiled meat.
On the third day, you can enter in the menu steam cutlets, vegetable puree, light soups, low-fat cottage cheese, baked apples. It is necessary to use new products gradually, in small portions.

Drinking regimen after caesarean section
The diet of a nursing woman involves a reduction in the amount of fluid consumed. Immediately after the operation, doctors recommend that you stop drinking water and start drinking after 6 to 8 hours. The rate of liquid per day during the first week, starting from the second day after the operation, should not exceed 1 liter, not counting the broth. After day 7, the amount of water or drinks can be increased to 1.5 liters.

During the postpartum period, you can drink the following drinks:

• weakly brewed tea;
• rosehip decoction;
• dried fruits compote;
• fruit drink;
• apple juice diluted with water.

On the fourth day after the operation, you should gradually begin to introduce meals that are acceptable during breastfeeding.

Products that are allowed to be included in the menu when recovering from a caesarean section are:

• yogurt ( without fruit additives);
• cottage cheese of low fat content;
• kefir 1 percent fat;
• potato ( puree);
• beet;
• apples ( baked);
• bananas;
• eggs ( boiled or steamed omelettes);
• lean meat ( boiled);
• lean fish ( boiled);
• cereals ( except rice).

The following foods should be excluded from the diet during the recovery period:

• coffee;
• chocolate;
• spicy seasonings and spices;
• raw eggs;
• caviar ( red and black);
• citrus and exotic fruits;
• fresh cabbage, radishes, raw onions and garlic, cucumbers, tomatoes;
• plums, cherries, pears, strawberries.

Do not eat fried, smoked and salty foods. It is also necessary to reduce the amount of sugar and sweets consumed.

How to relieve pain after caesarean section?

Pain after caesarean section disturbs patients during the first month after surgery. In some cases, pain may not disappear for a longer period, sometimes for about a year. Measures that should be taken to reduce the feeling of discomfort depend on what caused it.

Factors that provoke pain after a caesarean section are:

• seam after surgery;
• bowel dysfunction;
• uterine contractions.

Reducing the pain caused by the stitch

To reduce the discomfort that the postoperative suture causes, a number of rules for caring for it should be followed. The patient should get up from the bed, turn from side to side and make other movements in such a way as not to put a load on the suture.

• During the first day, a special cool pillow can be applied to the seam area, which can be purchased at a pharmacy.
• It is worth reducing the frequency of touching the seam, as well as keeping it clean to prevent infection.
• Every day, the seam should be washed, and then dried dry with a clean towel.
• You should refrain from lifting weights and making sudden movements.
• So that the child does not put pressure on the seam during feeding, you should find a special position. A chair with low armrests for feeding, in a sitting position, pillows ( under the back) and roller ( between belly and bed) while feeding lying down.

The patient can relieve pain by learning how to move correctly. To turn from side to side while lying in bed, you need to fix your feet on the surface of the bed. Next, you should carefully raise your hips, turn them in the desired direction and lower them onto the bed. Following the hips, you can turn the torso. Special rules must also be observed when getting out of bed. Before taking a horizontal position, you should turn on your side and hang your legs on the floor. After that, the patient should raise the body and assume a sitting position. Then you need to move your legs for a while and get out of bed, trying to keep your back straight.

Another factor that makes the suture hurt is a cough that occurs due to the accumulation of mucus in the lungs after anesthesia. In order to get rid of mucus faster and at the same time reduce pain, it is recommended that a woman after a cesarean section take a deep breath, and then, drawing in her stomach, exhale sharply. The exercise should be repeated several times. First, a towel rolled up with a roller must be applied to the seam area.

How to reduce discomfort from poor bowel function?

Many patients after caesarean section suffer from constipation. To reduce pain, a woman in labor should exclude from the diet foods that contribute to the formation of gases in the intestines.

Foods that cause flatulence are:

• legumes ( beans, lentils, peas);
• cabbage ( white, Beijing, broccoli, colored);
• radish, turnip, radish;
• milk and dairy products;
• carbonated drinks.

The following exercise will help reduce the discomfort of bloating in the abdomen. The patient should sit in bed and make rocking movements back and forth. Breathing while swinging should be deep. A woman can also release gases by lying on the right or left side and massaging the surface of the abdomen. If there is no stool for a long time, you should ask the medical staff to give an enema.

How to reduce pain in the lower abdomen?

Discomfort in the uterine area can be reduced with non-narcotic pain relievers prescribed by a doctor. A special warm-up will help to alleviate the patient's condition, which can be carried out on the second day after the operation.

Exercises that will help to cope with pain in the lower abdomen are:

• Stroking the abdomen with the palm of your hand in a circular motion– iron in a clockwise direction, as well as up and down for 2 to 3 minutes.
• Massaging the chest- the right, left and upper surfaces of the chest should be stroked from the bottom up to the armpit.
• Stroking the lumbar region- hands need to be brought behind the back and the back of the palms massage the lower back from top to bottom and to the sides.
• Rotational movements of the feet- pressing the heels to the bed, you need to alternately bend the feet away from you and towards you, describing the largest possible circle.
• Leg curl- alternately bend the left and right legs, sliding the heel along the bed.

A postpartum bandage that will support the spine will help reduce pain. It should be borne in mind that the bandage should be worn for no more than two weeks, since the muscles must independently cope with the load.

Why is there discharge after a caesarean section?

Discharge from the uterus that occurs during the recovery period after surgery is called lochia. This process is normal and is also typical for patients who have undergone a natural childbearing procedure. Through the genital tract, the remains of the placenta, dead particles of the uterine mucosa and blood from the wound, which is formed after the placenta has passed, are removed. The first 2 - 3 days of excretion have a bright red color, then darken, acquiring a brown tint. The amount and duration of the discharge period depends on the woman's body, the clinical picture of pregnancy, and the characteristics of the operation performed.

What does a suture look like after a caesarean section?

If a caesarean section is planned, the doctor makes a transverse incision along the crease above the pubis. Subsequently, such an incision becomes hardly noticeable, as it is located inside the natural fold and does not affect the abdominal cavity. When carrying out this type of caesarean section, the suture is applied by an intradermal cosmetic method.

In the presence of complications and the inability to conduct transverse section the doctor may decide on a corporal caesarean section. In this case, the incision is made along the anterior abdominal wall in a vertical direction from the navel to the pubic bone. After such an operation, there is a need for a strong connection of tissues, so the cosmetic suture is replaced with a nodal one. Such a seam looks more sloppy and may become more noticeable over time.
The appearance of the suture changes in the process of its healing, which can be conditionally divided into three stages.

The phases of scarring of the suture after caesarean section are:

• First stage ( 7 – 14 days) - the scar has a bright pink-red color, the edges of the seam are embossed with traces of threads.
• Second phase ( 3 – 4 weeks) - the seam begins to thicken, becomes less prominent, its color changes to red-violet.
• final step ( 1 – 12 months) - pain disappears, the seam is filled with connective tissue, as a result of which it becomes less noticeable. The color of the seam at the end of this period does not differ from the color of the surrounding skin.

Is it possible to breastfeed after a caesarean section?

Breastfeeding a child after a caesarean section is possible, but may be associated with a number of difficulties, the nature of which depends on the characteristics of the body of the woman in labor and the newborn. Also factors that complicate breastfeeding are complications during surgery.

The reasons that prevent the establishment of the process of breastfeeding are:

• Large blood loss during surgery- often after a caesarean section, the patient needs time to recover, as a result of which the first attachment to the breast is delayed, which subsequently causes difficulties with feeding.
• Medical preparations- in some cases, the doctor prescribes medicines to the woman that are incompatible with feeding.
• Stress associated with surgery Stress can have a detrimental effect on milk production.
• Violation of the mechanism of adaptation in a child- at birth by caesarean section, the child does not go through the natural birth canal, which can adversely affect his sucking activity.
• Delayed milk production- with a caesarean section in the body of a woman in labor, the hormone prolactin, which is responsible for the production of colostrum, begins to be produced later than during natural childbirth. This fact can cause a delay in the arrival of milk by 3 to 7 days.
• Pain- the pain that accompanies recovery after surgery blocks the production of the hormone oxytocin, whose function is to release milk from the breast.

How to remove the stomach after a caesarean section?

During pregnancy, the skin, subcutaneous tissue and abdominal muscles stretch, so the question of how to restore shape is relevant for many women in labor. Helps to shed excess weight balanced diet and breastfeeding. A set of special exercises will help to tighten the stomach and restore muscle elasticity. The body of a woman who has undergone a cesarean section is weakened, therefore, such patients should start physical activity much later than ordinary women in labor. In order to prevent complications, you need to start with simple exercises gradually increasing their complexity and intensity.

Initial loads

For the first time after the operation, you should refrain from exercises that involve a load on the abdomen, as they can cause a divergence of the postoperative suture. Hiking in the fresh air and gymnastics contribute to the restoration of the figure, which should be started after consulting a doctor.

Exercises that can be done a few days after surgery are:

• It is necessary to take the initial position reclining or sitting on the couch. To increase comfort during exercise, a pillow placed under the back will help.
• Next, you need to proceed to flexion and extension of the feet. You need to perform exercises vigorously, without making jerky movements.
• The next exercise is the rotation of the feet to the right and left.
• Then you should start tension and relaxation. gluteal muscles.
• After a few minutes of rest, you need to start alternating flexion and extension of the legs.

Each exercise should be repeated 10 times. If discomfort and pain occur, gymnastics should be stopped.
If the patient's condition allows, starting from 3 weeks after caesarean section, you can start classes to strengthen the pelvis. Such exercises help to improve the tone of weakened muscles and at the same time do not put a load on the stitches.

The stages of performing gymnastics for the pelvic muscles are:

• It is necessary to strain and then relax the muscles of the anus, lingering for 1 - 2 seconds.
• Next, you need to tighten and relax the vaginal muscles.
• Repeat the alternation of tension and relaxation of the muscles of the anus and vagina several times, gradually increasing the duration.
• After a few workouts, you should try to perform the exercise separately for each muscle group, gradually increasing the strength of the tension.

Exercises for the abdominal muscles after a caesarean section

Exercises should be started after discomfort and pain in the suture area disappear ( not earlier than 8 weeks after surgery). Gymnastics should be given no more than 10 - 15 minutes a day, so as not to cause overwork.
For exercises on the press, you need to take a starting position, for which you should lie on your back, rest your feet on the floor and bend your knees. Place a small pillow under your head to relieve tension in your neck muscles.

Exercises that will help normalize the abdominal muscles after a cesarean section include:

• To perform the first exercise, you should spread your knees to the side, while clasping your stomach with your hands cross to cross. As you exhale, you need to raise your shoulders and head, and press your palms on your sides. After holding this position for a few seconds, you need to exhale and relax.
• Next, taking a starting position, you should take a deep breath, filling your stomach with air. As you exhale, you need to pull in your stomach, pressing your back to the floor.
• The next exercise should be started gradually. Place your palms on your stomach and raise your head while inhaling, without making sudden movements. On exhalation, take the starting position. The next day, the head should be raised a little higher. After a few more days, along with the head, you need to begin to raise your shoulders, and after a few weeks - to raise the entire body to a sitting position.
• The last exercise is the alternate bringing to the chest of the legs bent at the knees.

You should start gymnastics with 3 repetitions of each exercise, gradually increasing the number. 2 months after the caesarean section, focusing on the state of the body and the recommendations of the doctor, physical activity can be supplemented with sports such as swimming in the pool, cycling, yoga.

How to make a scar on the skin invisible?

You can reduce the scar on the skin after a cesarean section cosmetically using various medications. The results of this method are time-consuming and largely depend on the age and characteristics of the patient's body. More effective are methods that involve surgery.

Quick ways to reduce the visibility of the seam after a caesarean section include:

• plastic excision of the seam;
• laser resurfacing;
• grinding with aluminum oxide;
• chemical peeling;
• scar tattoo.

Suture excision from caesarean section

This method consists in repeating the incision at the suture site and removing coarse collagen and overgrown vessels. The operation is performed under local anesthesia and may be combined with the removal of excess skin to form a new contour of the abdomen. Of all the existing procedures to combat postoperative scars, this method is the fastest and most effective. The disadvantage of this solution is the high cost of the procedure.

Laser resurfacing

Laser suture removal involves 5 to 10 procedures, the exact number of which depends on how much time has passed since the cesarean section and how the scar looks. Scars on the patient's body are exposed to laser radiation, which removes damaged tissue. The process of laser resurfacing is painful, and after its completion, the woman is prescribed a course of drugs to eliminate inflammation at the site of the scar.

Aluminum oxide grinding ( microdermabrasion)

This method involves exposing the skin to small particles of aluminum oxide. With the help of special equipment, a stream of microparticles is directed to the surface of the scar at a certain angle. Thanks to this resurfacing, the surface and deep layers of the dermis are updated. For a tangible result, it is necessary to carry out from 7 to 8 procedures with a ten-day break between them. After completion of all sessions, the polished area should be treated with special creams that speed up the healing process.

Chemical peel

This procedure consists of two stages. First, the skin on the scar is treated with fruit acids, which are selected depending on the nature of the seam and have an exfoliating effect. Next, a deep cleaning of the skin is carried out using special chemicals. Under their influence, the skin on the scar becomes paler and smoother, as a result of which the seam is significantly reduced in size. Compared to grinding and plastic excision, peeling is less effective procedure, but more acceptable due to the affordable cost and the absence of painful sensations.

Scar tattoo

Applying a tattoo on the postoperative scar area provides an opportunity to hide even large scars and skin imperfections. The downside of this method is the high risk of infection and a wide range of complications that can cause the process of applying patterns to the skin.

Ointments to reduce the seam after caesarean section

Modern pharmacology offers special tools that help make the postoperative suture less noticeable. The components included in the ointments prevent further growth of scar tissue, increase collagen production and help reduce the size of the scar.

Drugs that are used to reduce the visibility of the suture after a caesarean section are:

• contractubex- slows down the growth of connective tissue;
• dermatix– improves the appearance of the scar, smoothing and softening the skin;
• clearwin- brightens damaged skin by several tones;
• kelofibrase– evens out the surface of the scar;
• zeraderm ultra- promotes the growth of new cells;
• fermenkol- eliminates the feeling of constriction, reduces the scar in size;
• mederma- effective in the treatment of scars, the age of which does not exceed 1 year.

Recovery of menstruation after caesarean section

The restoration of the menstrual cycle in the patient does not depend on how the birth was carried out - naturally or by caesarean section. The timing of the appearance of menstruation is influenced by a number of factors related to the lifestyle and characteristics of the patient's body.

Circumstances on which the restoration of menstruation depends include:

• clinical picture of pregnancy;
• the patient's lifestyle, the quality of nutrition, the availability of timely rest;
• age and individual characteristics of the body of the woman in labor;
• the presence of lactation.

The effect of breastfeeding on the recovery of menstruation

During lactation, the hormone prolactin is synthesized in the body of a woman. This substance contributes to the production breast milk, but at the same time, it suppresses the activity of hormones in the follicles, as a result of which the eggs do not mature? and menstruation does not come.

The timing of the appearance of menstruation are:

• With active breastfeeding- Menstruation can begin after a long period, which often exceeds 12 months.
• When feeding mixed type - the menstrual cycle occurs on average 3 to 4 months after a caesarean section.
• With the introduction of complementary foods- very often, menstruation is restored within a fairly short time.
• In the absence of lactation- Menstruation can occur 5 to 8 weeks after the birth of the child. If menstruation does not occur within 2 to 3 months, the patient should consult a doctor.

Other factors affecting the restoration of the menstrual cycle

A delay in the onset of menstruation may be associated with complications that sometimes occur after a caesarean section. The presence of a suture on the uterus, combined with an infectious process, inhibits the recovery of the uterus and delays the onset of menstruation. The absence of menstruation can also be associated with the individual characteristics of the female body.

Patients who may have a missed period after a caesarean section include:

• women whose pregnancy or childbirth took place with complications;
• patients giving birth for the first time, whose age exceeds 30 years;
• women in labor whose health is weakened chronic diseases (especially endocrine system ).

For some women, the first menstruation may come on time, but the cycle is established for 4 to 6 months. If the regularity of menstruation has not stabilized within this period after the first postpartum period, the woman should consult a doctor. Also, a doctor should be contacted if menstrual function occurs with complications.

Problems in the restoration of menstruation after cesarean section and their causes are:

• Changed duration of menstruation- short ( 12 o'Clock in the noon) or too long periods ( exceeding 6 - 7 days) can occur due to diseases such as uterine fibroids ( benign neoplasm) or endometriosis ( overgrowth of the endometrium).
• Non-standard volume of allocations- the number of discharges during menstruation, exceeding the norm ( 50 to 150 milliliters), can be the cause of a number of gynecological diseases.
• Smearing spotting of a prolonged nature at the beginning or end of menstruation- can be provoked by various inflammatory processes of the internal genital organs.

Breastfeeding causes a deficiency of vitamins and other nutrients that are necessary for the normal functioning of the ovaries. Therefore, after a caesarean section, the patient is recommended to take micronutrient complexes and follow a balanced diet.

After the birth of a child, the load on the mother's nervous system increases. To ensure the timely formation of the menstrual function, a woman should devote sufficient time to good rest and avoid increased fatigue. Also in the postpartum period, it is necessary to correct the pathologies of the endocrine system, since the exacerbation of such diseases causes a delay in menstruation after a cesarean section.

How is the subsequent pregnancy after caesarean section?

A prerequisite for subsequent pregnancy is its careful planning. It should be planned no earlier than a year or two after the previous pregnancy. Some experts recommend a break of three years. At the same time, the timing of subsequent pregnancy is determined individually based on the presence or absence of complications.

During the first two months after the operation, a woman should exclude sexual intercourse. Then during the year she must take contraceptives. During this period, the woman should undergo periodic ultrasound examinations to assess the condition of the suture. The doctor evaluates the thickness and tissue of the suture. If the suture on the uterus consists of a large amount of connective tissue, then such a suture is called insolvent. Pregnancy with such a seam is dangerous for both the mother and the child. With contractions of the uterus, such a suture can disperse, which will lead to instant death of the fetus. The condition of the suture can be most accurately assessed not earlier than 10-12 months after the operation. A complete picture is given by such a study as hysteroscopy. It is carried out using an endoscope, which is inserted into the uterine cavity, while the doctor visually examines the seam. If the suture does not heal well due to poor uterine contractility, the doctor may recommend physiotherapy to improve its tone.

Only after the suture on the uterus has healed, the doctor can "give the go-ahead" for a second pregnancy. In this case, subsequent births can take place naturally. It is important that the pregnancy proceeds without difficulty. To do this, before planning a pregnancy, it is necessary to cure all chronic infections, raise immunity, and if there is anemia, then take treatment. During pregnancy, a woman should also periodically assess the condition of the suture, but only with the help of ultrasound.

Features of subsequent pregnancy

Pregnancy after caesarean section is characterized by increased control over the condition of the woman and constant monitoring of the viability of the suture.

After a caesarean section, re-pregnancy can be complicated. So, every third woman has threats of termination of pregnancy. The most common complication is placenta previa. This condition aggravates the course of subsequent births with periodic bleeding from the genital tract. Frequent bleeding can be the cause of preterm labor.

Another feature is the incorrect location of the fetus. It is noted that in women with a scar on the uterus, the transverse position of the fetus is more common.
The greatest danger during pregnancy is scar failure, a common symptom of which is pain in the lower abdomen or back pain. Women very often do not attach importance to this symptom, assuming that the pain will pass.
25 percent of women experience fetal growth retardation, and children are often born with signs of immaturity.

Complications such as uterine rupture are less common. As a rule, they are noted when incisions were made not in the lower segment of the uterus, but in the area of ​​\u200b\u200bher body ( corporal caesarean section). In this case, uterine ruptures can reach 20 percent.

Pregnant women with a uterine scar should arrive at the hospital 2 to 3 weeks earlier than usual ( i.e. at 35-36 weeks). Immediately before childbirth, premature outflow of water is likely, and in the postpartum period - difficulties in the separation of the placenta.

After a caesarean section, the following pregnancy complications may occur:

• various anomalies of placenta attachment ( low attachment or presentation);
• transverse position or breech presentation of the fetus;
• failure of the suture on the uterus;
• premature birth;
• rupture of the uterus.

Childbirth after caesarean section

The statement "once a caesarean - always a caesarean" is no longer relevant today. Natural childbirth after surgery in the absence of contraindications is possible. Naturally, if the first cesarean was carried out for indications not related to pregnancy ( for example, severe myopia in the mother), then subsequent births will be through a caesarean section. However, if the indications were related to the pregnancy itself ( for example, the transverse position of the fetus), then in their absence, natural childbirth is possible. At the same time, the doctor will be able to tell exactly how the birth will take place after 32-35 weeks of pregnancy. Today, every fourth woman after a caesarean section gives birth again naturally.

How to make sure that you can return to a normal sexual life?

Doctors are sure that if there are no complications, then sexual activity can begin as soon as the bleeding after surgery (lochia) has ended, and there are no problems with stitches. In order to verify this, you need to conduct an ultrasound. This procedure shows how strong the stitches are and whether they will come apart during sex.

Even if a woman feels that she is ready for the resumption of sexual activity and she has a desire, consultation and permission from a doctor is necessary. Only a specialist will be able to determine how the postoperative suture heals.

In addition to the stitches, the fact is that after the placenta separates from the uterus, an open wound forms. Don't let it get infected. Therefore, any tampons are excluded, as well as sexual activity. Until the wound is completely healed.

Statistics

After caesarean, sexual activity begins no earlier than a month later. According to statistics, the bodies of 10 percent of women after surgery are fully restored in four weeks. And from the point of view of physiology, it is already possible to start living a sexual life again. Another 10% of women, due to the individual characteristics of the body and complications, cannot be rehabilitated even after 8 weeks. The remaining 80% recover after caesarean in the period from 1.5 to 2 months.

Physiological side

After a cesarean, a woman needs to listen to her body. Before resuming sexual life, you need to wait until the bleeding stops. After that, do an ultrasound and consult a doctor.

The first time you need to use contraceptives. But during the lactation period birth control pills most often contraindicated, and the spiral can be placed only six months after the operation. The best options are condoms or vaginal suppositories.

The beginning of sexual activity after caesarean should be gentle. A man must move very carefully, smoothly, in order to avoid damage to newly healed sutures. In the first months, sharp, rough movements, pressure and deep penetrations are excluded. Within six months, only classical poses are recommended.

At the first intimacy after surgery, a woman may feel discomfort. Pain often occurs after a caesarean section. But these feelings will pass with time. The ligaments, muscles and tissues of the body will stretch and tone. This takes time.

Some ardent couples in the very first months after the resumption of sexual life try to replace classic poses with others. This should not be allowed, since the penetration of fingers and even the tongue can bring bacteria into the body. Another danger is if a woman reacts violently. In this case, not yet strengthened seams may disperse from tension.

According to scientists, during breastfeeding, a woman produces hormones similar to those produced during sex. This often explains the reluctance to resume sexual activity. And this happens most often after a caesarean.

After caesarean, sexual life for women fades into the background. The thing is that the body of a woman in labor is not adapted to a quick return to sex. The partner will have to be patient, as prolactin (maternal hormone) makes a woman focus only on the newborn. The body is very busy at this time. He is engaged in feeding offspring. At the same time, sexual desire is not perceived by him as parallel and is considered less important. This state passes after some time.

After the operation, at first, a woman may not always experience an orgasm. For some, it takes about a year to experience the same pleasure again. But 40 percent of women note that after a while they began to experience an orgasm twice as often.

Psychological side

At first, when sexual life resumes after caesarean, a woman often experiences fear of sex. Fatigue, anxiety for the child, sleepless nights, depression are largely to blame. Most often, the first time after the resumption of sexual life, she will not deliver the same pleasure as before.

In such a situation, a woman needs to talk with her partner, talk about her fears. And a man should be patient and not only support her morally, but also help with household chores and give her as much sleep as possible.

A woman often feels unattractive. After childbirth, the abdomen and chest sag strongly. Overweight often gets in the way. But this can only be corrected with time. A man during this period needs to be more attentive to his soul mate. Over time, the desire will return. Doctors often recommend romantic dates or joint viewing of erotic films to "spur" them on.

Pain after caesarean section during sex

After a caesarean, you may experience pain during sex. Moreover, their localization often changes. They can also appear in the vagina. The thing is that the hormonal process of contraction of the uterus and vagina is launched, but it was not subjected to deformation. Discomfort during sex is just experienced due to excessive constriction.

Sex life after a caesarean section in the absence of lubrication can cause severe pain to a woman. Often the reason is psychological constraint. In such cases, you can use special hygiene gels or lubricants. If during sex there is a sharp pain or discharge begins, then you should immediately consult a doctor.

Do's and Don'ts after a caesarean

You can not start a sexual life if partners have sexual infections or inflammation. And also if the lochia is tightened and the stitches continue to bleed. Before starting sexual activity after the operation, the partner must undergo a complete examination. Anal sex and heavy lifting are strictly prohibited.

What can be done after a caesarean? It is necessary to use contraceptives to avoid pregnancy, since the next one can be planned only after two years. Over time, you can do the selection of poses. This must be done very carefully and gradually. The most successful will be those in which the woman herself can control her own movements. More often it is a pose "on top".

Recovery after cesarean

In the first period of recovery after cesarean, the woman is prescribed bed rest. In bed, she should lie from 3 to 12 hours. You need to get up carefully, without sudden movements, slowly and better gradually. Best in someone's presence. You can start sitting down only on the third day after cesarean.

If the operation took place under general anesthesia and gurgling and wheezing are felt in the chest, you need to cough to get rid of the mucus accumulated in the lungs. Rocking in your chair, deep breathing, and avoiding any food that can make you puffy and carbonated drinks will help to cope with gases.

If constipation has begun, physical activity (but moderate), dried fruits and vegetables, helps to normalize the stool. All of the above can be reflected in the psychological background of a woman. And during this period it is reduced.

During the recovery period after a caesarean, lubrication is often poorly produced. In this case, active petting helps a lot. You can use aphrodisiacs or incense. To minimize the load on the abdomen and hips in the first months, it is best to use the "back" or "missionary" position. You can try others gradually, but at the same time pay attention that there is no pain with pressure on the vagina.

Recovery after childbirth is not an easy process, even for women who have given birth through the natural birth canal. What can we say about caesarean section, when postoperative problems join all postpartum problems! We will talk about what a young mother can do to recover faster after this surgery.

Possible consequences of the operation

A caesarean section is an operation to deliver a fetus by removing the abdominal wall and uterus through an incision. The postpartum uterus returns to its original state within 6-8 weeks. Traumatization of the uterus during surgery, edema, hemorrhages in the suture area, a large amount of suture material slow down the involution of the uterus and predispose to the occurrence of postoperative purulent-septic complications in the pelvic area with involvement of the uterus and appendages in the process. These complications after caesarean section are 8-10 times more common than after vaginal delivery. Complications such as endometritis (inflammation of the inner layer of the uterus), adnexitis (), parametritis (inflammation of the periuterine tissue), further affect the reproductive function of a woman, because. can lead to disruption, pelvic pain syndrome, infertility.

The initial state of a woman's health, the choice of a rational method and technique for performing the operation, the quality of the suture material and antibiotic therapy, as well as the rational management of the postoperative period, the prevention and treatment of complications associated with operative delivery, determine the favorable results of the operation.

A transverse incision in the lower segment of the uterus is made parallel to the circular muscle fibers, in a place where there are almost no blood vessels. Therefore, it injures the anatomical structures of the uterus less, and therefore, to a lesser extent disrupts the course of healing processes in the operating area, and the use of modern synthetic absorbable threads contributes to long-term retention of the wound edges on the uterus, which leads to an optimal healing process and the formation of a rich scar on the uterus, which very important for subsequent pregnancies and childbirth.

Prevention of complications after caesarean section

Currently, in order to prevent maternal morbidity after cesarean section, modern highly effective broad-spectrum antibiotics are used, since microbial associations, viruses, mycoplasmas, chlamydia, etc., play a large role in the development of infection. reduce their negative impact on the child. In the postoperative period, preference is given to short courses of antibiotic therapy in order to reduce the flow of drugs to the child through mother's milk; with a favorable course of caesarean section after surgery, antibiotics are not administered at all.

On the first day after the cesarean section, the puerperal is in the intensive care unit under the close supervision of medical personnel, while monitoring the activity of her entire body. Algorithms for the management of puerperas after caesarean section have been developed: adequate replacement of blood loss, anesthesia, maintenance of the cardiovascular, respiratory and other body systems. It is very important in the first hours after the operation to monitor the discharge from the genital tract, because. there is a high risk of uterine bleeding due to impaired uterine contractility caused by surgical trauma and the action of drugs. In the first 2 hours after the operation, a constant intravenous drip of drugs that reduce the uterus is carried out: oxytocin, methylergometrine, an ice pack is placed on the lower abdomen.

After general anesthesia, there may be pain and sore throat, nausea and vomiting.

Removing pain after surgery is of great importance. After 2-3 hours, non-narcotic analgesics are prescribed, after 2-3 days after the operation, anesthesia is carried out according to indications.

Surgical trauma, entry into the abdominal cavity during the operation of the contents of the uterus (amniotic fluid, blood) cause a decrease in intestinal motility, paresis develops - bloating, gas retention, which can lead to infection of the peritoneum, sutures on the uterus, adhesions. An increase in blood viscosity during and after surgery contributes to the formation of blood clots and their possible blockage of various vessels.

In order to prevent intestinal paresis, thromboembolic complications, improve peripheral circulation, eliminate congestion in the lungs after artificial ventilation, early activation of the puerperal in bed is important.

After the operation, it is desirable to turn in bed from side to side; by the end of the first day, it is recommended to get up early: first you need to sit in bed, lower your legs, and then start getting up and walking a little. You need to get up only with the help or under the supervision of medical staff: after a sufficiently long lying down, dizziness and a fall are possible.

Not later than the first day after the operation, it is necessary to start medical stimulation of the stomach and intestines. To do this, prozerin, cerucal or ubretid is used, in addition, an enema is made. With an uncomplicated course of the postoperative period, intestinal motility is activated on the second day after the operation, the gases leave on their own, and on the third day, as a rule, there is an independent stool.

On the 1st day, the puerperal is allowed to drink mineral water without gases, tea without sugar with lemon in small portions. On the 2nd day, a low-calorie diet is prescribed: liquid cereals, meat broth, soft-boiled eggs. From 3-4 days after an independent stool, the puerperal is transferred to a general diet. It is not recommended to take too hot and too cold food, solid foods should be introduced into your diet gradually.

On the 5-6th day, ultrasound examinations of the uterus are carried out in order to clarify its timely contraction.

In the postoperative period, the dressing is changed daily, examination and treatment of postoperative sutures with one of the antiseptics (70% ethanol, 2% iodine tincture, 5% potassium permanganate solution). The sutures from the anterior abdominal wall are removed on the 5-7th day, after which the issue of discharge home is decided. It happens that the wound on the anterior abdominal wall is sutured with an intradermal "cosmetic" suture with absorbable suture material; in such cases, there are no external removable seams. Extraction is usually carried out on the 7-8th day.

Establishing breastfeeding after cesarean

Breastfeeding is often difficult after a caesarean section. They are due to a number of reasons, including pain and weakness after surgery, drowsiness of the child against the background of the use of painkillers or impaired adaptation of the newborn during operative delivery, the use of mixtures to give the mother "rest". These factors make it difficult to establish breastfeeding. Due to the need for a low-calorie diet for 4 days, the formation of lactation occurs against the background of a deficiency in macro- and microelements, which affects not only the quantity, but also the quality of milk. Thus, the daily secretion of milk after cesarean section is almost 2 times lower compared to spontaneous childbirth; milk has a low content of the main ingredients.

It is important to ensure that the baby is attached to the breast in the first 2 hours after the operation. At present, most obstetric institutions operate on the principle of joint stay of mother and child.

Therefore, if everything went without complications, you can express a wish to leave the baby next to you and start breastfeeding under the supervision of the staff, as soon as the anesthesia wears off and you have the strength to take your baby in your arms (approximately 6 hours after the operation). Women in childbirth who, for various reasons, postpone feeding to a later date (the birth of children requiring special treatment, the occurrence of complications in the mother), should resort to expressing milk during feeding hours to stimulate lactation.

One of the main conditions for successful breastfeeding after caesarean section is to find a position in which a woman is comfortable to feed her baby. On the first day after surgery, it is easier to feed lying on your side. Some women find this position uncomfortable because this causes the seams to stretch, so you can feed while sitting and holding the baby under your arm (“soccer ball from under your arm” and “lying across the bed”). In these poses, pillows are placed on the knees, the child lies on them in the correct position, while the load is removed from the area of ​​\u200b\u200bthe seams. As the mother recovers in the future, the mother can feed the baby while lying down, and sitting, and standing.

In order to stimulate lactation, physiotherapeutic methods of stimulating lactation are used (UVR of the mammary glands, UHF, vibration massage, ultrasound, sound "bioacoustic" stimulation), herbal medicine: a decoction of cumin, dill, oregano, anise, etc. To improve the quality of breast milk, it is necessary to introduce in the diet of a nursing mother nutritional supplements(specialized protein and vitamin products): "Femilak-2", "Milky Way", "Mama Plus", "Enfimama". All these activities have a beneficial effect on the indicators of the physical development of children during their stay in the maternity hospital, and the mother is discharged with well-established lactation.

Getting back in shape after a caesarean

Warm dousing of the body in parts from the shower is possible already from the 2nd day after the operation, but you can take a shower completely after discharge from the maternity hospital. When washing the seam, it is better to use fragrance-free soap so as not to injure the crust. You can immerse yourself in the bath not earlier than 6-8 weeks after the operation, because. by this time, the inner surface of the uterus completely heals and the uterus returns to its normal state. A trip to the bath is possible only 2 months after the doctor's examination.

In order for the postoperative scar to resolve faster, it can be lubricated with prednisolone ointment or contractubex gel. Numbness may be felt in the area of ​​the scar for up to 3 months until the nerves cut during the operation are restored.

Of no small importance is the restoration of physical fitness after a caesarean section. From the first day, it is recommended to wear a postpartum bandage. relieves lower back pain, helps to maintain correct posture, accelerates the restoration of muscle and skin elasticity, protects the seams from divergence, helping to heal the postoperative wound. However, it is undesirable to wear it for a long time, because. muscles have to work, contract. As a rule, the bandage is worn for several weeks after childbirth, focusing on the condition of the abdominal muscles and general well-being. Therapeutic exercises should be started 6 hours after the operation, gradually increasing its intensity. After removing the sutures and consulting a doctor, you can begin to perform exercises to strengthen the muscles of the pelvic floor and muscles of the anterior abdominal wall (exercise - compression and relaxation of the pelvic floor with a gradual increase in duration up to 20 seconds, retraction of the abdomen, lifting the pelvis and other exercises), which causes a rush blood to the pelvic organs and accelerates recovery. When performing exercises, not only the physical form is restored, but also endorphins are released - biologically active substances that improve the psychological state of a woman, reduce stress, feelings of depression, low self-esteem.

After the operation, it is not recommended to lift weights of more than 3-4 kg for 1.5-2 months. You can start more active activities 6 weeks after giving birth, taking into account the level of your physical fitness before pregnancy. The load is increased gradually, avoiding strength exercises on the upper body, because. this may reduce lactation. Active types of aerobics and running are not recommended. In the future, if possible, it is advisable to engage in an individual program with a trainer. After high-intensity training, the level of lactic acid can increase, and as a result, the taste of milk deteriorates: it becomes sour, and the baby refuses the breast. Therefore, engaging in any kind of sport for a nursing woman is possible only at the end of breastfeeding, and not for nursing women - after recovery. menstrual cycle.

Sexual relations can be resumed 6-8 weeks after the operation, by visiting a gynecologist and consulting about the method of contraception.

Subsequent births

The gradual restoration of muscle tissue in the area of ​​the scar on the uterus occurs within 1-2 years after the operation. About 30% of women after a caesarean section plan to have more children in the future. It is believed that the period 2-3 years after the caesarean section is more favorable for the onset of pregnancy and childbirth. The thesis "after caesarean section, childbirth through the birth canal is impossible" is now becoming irrelevant. For a number of reasons, many women attempt vaginal delivery after a caesarean section. In some institutions, the percentage of natural deliveries with a uterine scar after caesarean section is 40-60%.

We start with gymnastics
6 hours after the operation, you can start the simplest therapeutic exercises and massage of the chest and abdomen. You can perform them without an instructor, lying in bed with your knees slightly bent:

• circular strokes with the palm over the entire surface of the abdomen clockwise from right to left, up and down along the rectus abdominis muscles, from bottom to top and from top to bottom obliquely - along the oblique abdominal muscles - for 2-3 minutes;
• stroking the anterior and lateral surface of the chest from the bottom up to the axillary region, the left side is massaged right hand, right - left;
• hands are wound behind the back and the lumbar region is stroked with the back and palmar surfaces of the hands in the direction from top to bottom and to the sides;
• deep chest breathing, to control the palms are placed on top of the chest: at the expense of 1-2, a deep breath is taken with the chest (the chest rises), at the expense of 3-4, a deep exhalation, while lightly pressing on the chest with palms;
• deep breathing with the stomach, palms, holding the area of ​​\u200b\u200bthe seams, inhale at the expense of 1-2, inflating the stomach, exhale at the expense of 3-4, drawing in the stomach as much as possible;
• rotation of the feet, without lifting the heels from the bed, alternately in one direction and the other, describing the largest possible circle, bending the feet towards and away from oneself;
• alternate flexion and extension of the left and right legs, the heel slides along the bed;
• coughing, supporting the area of ​​\u200b\u200bthe seams with the palms.
  Repeat exercises 2-3 times a day.

Ludmila Petrova,
Obstetrician-gynecologist of the highest qualification
category, head of the maternity department
maternity hospital N 16, St. Petersburg

Today, pregnancy after a previous operative delivery is no longer a rarity. The question is no longer so much the satisfaction of the desire to have another baby, but the gap that a woman needs to endure before that. In addition, in the preparation and management of pregnancy after cesarean section, there are important points, and this must be taken into account by the expectant mother.

Content:

What is a caesarean section

Operative delivery, the essence of which is to cut the wall of the uterus and extract the newborn through it, is called a caesarean section. Sutures are applied to the dissected area, and a scar is formed in the process of wound healing. The wound is cicatrized in 3-4 months, but the full recovery of the uterus occurs a year after the operation. For a safe course of re-pregnancy, doctors advise planning it two years after the operation, but not earlier.

Early pregnancy can lead to various pathologies, among which the following are the most common:

• divergence of the scar during the period of bearing a child or during natural childbirth;
• attachment of the placenta to the scar;
• detachment of the placenta at any stage of pregnancy;
• low location of the placenta.

If the proper period is maintained between pregnancies, then, as a rule, there are no problems with bearing a baby. Otherwise, there is a high risk of divergence of the uterine suture, which leads to the death of the fetus, and if timely medical care- and mothers.

Features of pregnancy planning

Pregnancy after a caesarean section is often a significant risk, but with the right approach and constant supervision by a doctor, it passes favorably. The decision on the possibility of bearing a baby in this case is made by the gynecologist, for which the general condition of the woman is assessed, the reasons that led to the operation, and, most importantly, the condition of the uterine scar.

Doctors call the first stage of planning contraception, since repeated early pregnancy can be interrupted for medical reasons, which will adversely affect the condition of the uterine scar.

Not earlier than six months later, and better year after operative delivery, the following studies are carried out, giving an objective assessment of the condition of the scar:

1. Examination by a gynecologist with palpation of the suture, where its general condition is determined. On palpation, the doctor is able to determine whether the scar is sufficiently formed, whether there are softened areas on it, or whether pain is present.
2. Hysterography, or x-rays taken in several projections. A contrast agent injected into the uterine cavity before the procedure helps to determine the consistency of the scar.
3. Hysteroscopy, or visual diagnosis of the uterine cavity, carried out using an optical device. This method allows you to diagnose any intrauterine pathology and determine what tissue the scar is formed from.

It cannot be thought that after a long time, pregnancy after a cesarean section can be planned without going through the listed studies. The doctor must necessarily examine the scar formed on the uterus, assess its condition and make a conclusion about what tissue it was formed from.

Re-pregnancy is allowed if it is established that the scar is formed entirely from muscle tissue, while it should be almost invisible. If connective tissue is present or dominated in the resulting scar, then such a scar is considered insolvent, and a second pregnancy in this case will not be allowed. An incompetent scar can open when the uterus is stretched, as it is not able to withstand the load that pregnancy carries, often softens and diverges.

It is worth remembering that pregnancy after three caesarean sections is not at all acceptable. Already after the second operation, the doctor, most likely, will offer the woman in labor to use the cardinal method of contraception - sterilization, or tubal ligation.

Video: Obstetrician-gynecologist about complications from caesarean section and pregnancy planning after surgery.

Management of pregnancy

Pregnant women with a caesarean section are included in the so-called risk group for pregnancy management and further delivery. Such women often visit their leading doctor, they are assigned additional examination methods, especially in the third trimester of pregnancy:

1. During the examination, the gynecologist regularly checks the scar for soreness using the palpation method. Any softening or, on the contrary, seals cause alertness and give rise to hospitalization.
2. The condition of the scar on the uterus is regularly examined using ultrasound diagnostics with a vaginal sensor, so this type of examination is more often prescribed for pregnant women at risk.
3. Often the placenta is attached to the scar on the uterus, which affects the blood flow and nutrition of the fetus. Dopplerography helps to identify possible risks in time and prescribe the necessary therapy.
4. Particular attention is paid to a pregnant woman if she is expecting two or more babies. The risk of thinning of even a properly and well-formed scar increases.
5. At 34-35 weeks of pregnancy after a caesarean section, a woman is offered a hospital stay, as this is the time of the most intensive growth and development of the fetus, leading to increased uterine distension. The uterine scar during this period withstands the greatest loads, and the risk of its divergence increases significantly. With any suspicion of pathology, surgical delivery is performed.

The greatest risk in the management of pregnancy is an inconsistent scar, unable to withstand or resist stress when the uterus is stretched. This leads to a divergence of the scar in the process of bearing a child, so doctors suggest terminating such a pregnancy if this occurs on early dates, or decide on a second caesarean section if the threat of rupture of the seam occurs in the third trimester.

Childbirth after caesarean section

Vaginal or natural childbirth after caesarean section is considered possible if the reason for the previous operation was the peculiarities of the course of pregnancy: for example, the wrong position of the fetus or weak labor activity. In any case, this decision is made only by the doctor based on the studies and observations.

If there are no special prescriptions for a subsequent caesarean section, then natural childbirth is more preferable for both the woman and the child. However, it should also be taken into account that with a second pregnancy that occurs after a cesarean section in a year or even less, the doctor will not allow vaginal delivery, and delivery will take place by cesarean section. This is another argument in favor of waiting for a minimum interval between pregnancies.

The possibility of natural childbirth also depends on which caesarean section was performed the previous time. With a longitudinal scar (the so-called classic caesarean section), natural childbirth is considered unacceptable. In the presence of a transverse scar and no contraindications, vaginal delivery may be considered.

Natural childbirth is allowed in the following cases:

• the scar is formed correctly, there is no risk of discrepancy during childbirth;
• the placenta is not localized on the scar;
• with a transverse scar;
• the weight of the fetus does not exceed 3.5 kg;
• there is one fetus in the uterus;
• the previous caesarean section was caused by the peculiarities of the course of pregnancy.

Doctors decide how the birth will be carried out after 35 weeks. For this, not only the condition of the scar is assessed, but also the size and position of the fetus, the location of the placenta relative to the scar and the cervix of the uterus. It is worth noting that during a pregnancy that occurred after two operative delivery, the question of natural childbirth is closed for the third time.