A small caesarean section is an operation that is performed according to a plan or for urgent indications, when it is necessary to remove the fetus in a safe way to save the life of the mother or child. Extraction of the fetus by artificial means can be decided in advance by a doctor for medical reasons, if all he alth indicators are taken into account for this. It is also important to understand that cesarean delivery is often dangerous for women who have already had surgery or an abortion. Everything mothers need to know about the consequences of surgery is described later in the article.
History of occurrence
Caesarean section has been a part of medical manipulation since ancient times, and there are many legends about it. According to Greek mythology, Apollo removed Asclepius, the founder of the famous cult of religious medicine, from his mother's abdomen. Numerous references to cesarean section appear in ancient Hindu, Egyptian, Greek, Roman and other European folklore. Ancient Chinese engravings depict the procedure on seemingly living women. The Mishnagot and the Talmud forbade the offering of newborns tolife as a ritual when twins were born by caesarean section, but abandoned the rituals of cleaning women after surgery. Termination of pregnancy by caesarean section was not done at that time, since the fetus was removed “live”, taken out of the woman and separated from the walls of the uterus.
Nevertheless, the early history of caesarean section remains shrouded in myth and is of dubious accuracy. Even the origin of the term "caesarean section" seems to have become distorted over time. It is believed to be descended from the surgical birth of Julian Caesar, however this seems unlikely as his mother Aurelia is believed to have lived at the time of her son's invasion of Britain. At that time, the procedure could only be performed when the mother was dead or dying, as an attempt to save a child for a state wishing to increase its population. Roman law decreed that all women who gave birth this way had to have an incision, hence a section.
Other possible Latin origins include the verb caedare, meaning contraction, and the term caesones, which was applied to babies born after post-mortem operations. Ultimately, we cannot be sure where and when the term "caesarean" was derived. Until the sixteenth and seventeenth centuries, the procedure was known as a caesarean section. The term underwent changes with the publication in 1598 of Jacques Guillimo's book on midwifery, in which he introduced the term "section". Increasingly, after that, the word "section" was replaced by the concept of "operation".
Evolutiondevelopment of surgical intervention
Throughout history, caesarean section has meant different things at different times. Indications for it have changed dramatically from ancient times to the present day. Despite the rare prerequisites for operations on living women, the original goal was mainly to remove the child from a dead or dying mother; this was carried out either in the rather vain hope of saving the child's life, or, as is usually required by religious decrees, so that the child could be buried separately from the mother. First of all, it was a last resort, and the operation was not intended to save the life of the mother. It wasn't until the nineteenth century that such a possibility really came within the purview of the medical profession, when a small caesarean section became a chance for children to be saved.
However, there were sporadic early reports of heroic efforts to save women's lives. In the Middle Ages, during the period of stagnation in science and medicine, attempts to perform an operation to save the life and he alth of both the mother and the fetus did not stop. Perhaps the first report of a mother and child undergoing a minor caesarean section is a story that took place in Switzerland in the early sixteenth century, when a woman was operated on by Jakob Nufer. After several days of labor and the help of thirteen midwives, the woman in labor could not give birth to her child.
Her desperate husband ended up getting permission from the local authorities to perform a C-section. The mother lived and subsequently gave birth to five children, including twins. The child grew up and died at the age of 77. Insofar asthis story was written down over 80 years later, historians doubt its accuracy. A similar skepticism can be applied to other early reports of autopsies being performed by women on themselves.
Previously, operations could be performed without professional advice due to the lack of qualified doctors. This meant that a caesarean could be attempted at an earlier stage of gestation due to emergencies. Under these conditions, the chances of saving a woman in labor or a baby were higher. These surgeries were performed on kitchen tables and beds without access to hospital facilities, and this was probably an advantage until the late nineteenth century, as surgery in hospitals was "saturated" with infections transmitted between patients, often through the dirty hands of medical workers.
Improvement and development of medicine
Due to his work in animal husbandry, Nufer also possessed various anatomical knowledge. One of the first steps in performing any operation is understanding the connective organs and tissues, a knowledge that could hardly have been acquired before the modern era. During the sixteenth and seventeenth centuries, with the rise of the Renaissance, numerous works illustrated the human anatomy in great detail. Andreas Vesalius's monumental general anatomical text De Corporis Humani Fabrica, published in 1543, depicts normal female reproductive organs and abdominal structures. In the eighteenth and early nineteenth centuries, pathologists and surgeonsgreatly expanded their knowledge of the normal and pathological anatomy of the human body.
In later years, physicians gained wide access to human cadavers, and the emphasis in medical education changed, allowing medical students to learn anatomy through personal dissection and small caesarean sections on female cadavers. This hands-on experience improved the understanding of the human anatomy and better prepared doctors for operations.
At the time, of course, this new kind of medical education was still only available to men. With the accumulation of knowledge since the seventeenth century, the women on duty were demoted to doctors in children's departments. In the early 1600s, Chamberlain in England introduced obstetrical forceps to pull out fetuses from the birth canal that could not otherwise be destroyed. Over the next three centuries, male obstetricians gradually mastered the skills to perform such operations, and women were completely removed from such work. Later, they began to do medical abortion after a caesarean section, as a method of artificial extraction of the fetus. But this technique was considered extreme, so it became widespread decades later.
Abortion via caesarean section: surgery procedure
Caesarean section is a type of surgery used to remove a baby. The fetus is removed surgically through an incision in the mother's abdomen and then a second incision in the uterus. The most common indications for a small caesarean section are:
- Obesity.
- Diabetes.
- Age of the woman.
- Various diseases.
Other reasons are the use of epidurals and methods that cause difficulties in childbirth, because they cause complications that may lead to the need for surgery. Although a caesarean birth can save the life of both mother and baby, obstetricians and gynecologists have expressed concern that the operation may be excessive, and they have recommended that only emergencies should be avoided when such intervention is really required. On women's forums, a small caesarean section is discussed from different angles: someone is against it, someone had to carry it out several times because of the testimony.
However, studies have shown that women who have had caesarean sections while trying to give birth to their second child naturally had little to no risk of complications such as:
- needing a blood transfusion;
- unplanned hysterectomy.
One way to reduce the number of surgeries is to educate women about the benefits of natural childbirth. Previously, a third of children were born surgically, and the "fashion" went from the West, when it became popular not to spoil the figure and not to breastfeed.
Abortion after cesarean operation
Abortion after caesarean section is done only six to twelve months after the operation. How it will be carried out (by vacuum, medical or instrumental method) - only the attending physician decides. ATin the latter case, when the fetus is scraped from the uterus, women in labor may not always have children in the future. Many people think that an abortion by caesarean section is very convenient. However, before deciding on this, you need to weigh the pros and cons.
On the other hand, an unplanned pregnancy requires an abortion after a caesarean section, and this may be the only chance to save the mother's life. For example, she is not recommended to give birth at all or too early. In such cases, it is important to catch yourself in time so as not to aggravate your own he alth. Abortion after CS may also be recommended for those who have had heart and kidney failure. If a woman in labor is in danger of miscarriage, she may be advised to get rid of it.
Abortion after CS is done in the early stages of pregnancy, especially if a year or less has passed since the caesarean. In this case, the woman will not be able to carry the baby normally due to the risk of rupture of the suture on the uterus.
How to prepare a woman for surgery: the beginning and technique of cesarean delivery
To prepare for the operation, the woman in labor is injected through a dropper with all those vitamins and medicines that she will need while under anesthesia. Her belly will be washed and her pubic hair removed. A catheter (tube) is placed in the bladder to remove urine, and it will remain there until the day after the operation is over. Women are usually given a regional anesthetic or an epidural or spinal block, which relieves sensation in the lower body. But it keeps the mother awake andhear when a baby is born.
This is generally safer than general anesthesia when the woman is completely asleep during labor. The technique of a small caesarean section has long been studied, and in the last decades it has been used in this form in order to avoid cardiac arrest in a woman in labor. Obstetricians will use a surgical knife to make a horizontal incision in the abdominal wall - usually along the bikini line, which means it is placed low. This is also a new method, and it was created so that women do not feel embarrassed about their bodies on the beach or at home, putting on underwear. Some women in labor are given a vertical incision if the fetuses are not positioned correctly or there are more than 2-3 of them.
After the abdomen is opened, an opening is made in the uterus. Typically, a small caesarean section involves a lateral (horizontal) incision that ruptures the amniotic sac that surrounds the baby. Once this protective membrane is torn off, the baby is removed from the uterus, the umbilical cord is closed, and the placenta is removed. The fetus is examined and then returned to the mother for skin-to-skin contact.
After the baby is removed and the postpartum procedures are over, the incisions made in the mother's uterus are closed with stitches that will eventually dissolve under the skin. The abdomen is closed with stitches or staples that will be removed before the woman leaves the hospital.
A woman in labor usually spends one to two hours in the operating room, depending on whether there are any complications during childbirth. Aftersurgery, she will be transferred to the maternity ward of the hospital. If, after performing the caesarean section technique, threats to the life and he alth of the mother follow, such as removal of the uterus or tubes, the woman will be operated on again to save her life.
After a cesarean, a woman may spend two to four days in the hospital, but it may take up to six weeks to fully recover. Perhaps a premature baby was born, there are complications, illnesses, and so on. The stomach will hurt for a long time, as both the skin and nerve cells are damaged. Painkillers are given to women to relieve postoperative pain. All drugs are used approximately two weeks after the birth of the baby. Mothers may also experience bleeding for about four to six weeks after surgery, as can those who have given birth spontaneously. She is also advised to refrain from:
- sexual contact for several weeks;
- lifting weights over one kilogram;
- sports;
- stressful situations.
It is worth noting that all surgical interventions can be planned, when the birth of twins is expected, the mother has chronic diseases, or unscheduled, when the situation requires urgent measures, for example, a woman has a sharp increase in blood pressure.
When doing a small caesarean section - indications for surgery for various reasons
In some cases, the doctor will recommend a caesarean section instead of a natural birth. For example, you might need a scheduled operation if:
- Uyou have already had a caesarean section with a "classic" vertical incision of the uterus (this is relatively rare) or a horizontal one. Both of these factors greatly increase the risk of uterine rupture during pushing. If you've only had one horizontal uterine incision, you may be able to give birth on your own, but more often than not, women choose to have the operation themselves, expecting the suture to open.
- Have you had any other invasive uterine surgery, such as a myomectomy (surgical removal of fibroids), which increases the risk that the uterus may rupture during labor.
- You have already given birth to two or more children. It is possible that the technique of a small caesarean section will also be needed for those who have already given birth. The tone of the muscles of the uterus is weak, there may be complications. Especially if the mother is expecting twins.
- The baby is expected to be very large (a condition known as macrosomia).
- Your doctor is more likely to recommend a caesarean section if you have diabetes, or if you had a child who had a serious injury during childbirth. In order to avoid fetal complications, it is recommended not to take risks and trust a professional.
- Your baby is positioned upside down or across the body. In some cases, when the pregnancy is multiple, and one of the fetuses is downside down, the birth occurs in a mixed type - the baby, which descends into the birth canal with the buttocks, is born by the mother on her own, and the second is removed by cesarean. At the same time, there can be no discharge after a caesarean section, everything is going according to plan, as after a natural birth.
- Uplacenta previa (when the placenta is so small in the uterus that it covers the cervix).
- You have major fibrosis, making natural childbirth difficult or impossible.
- Baby has an anomaly that could make natural birth risky, such as some cases of open neural tube defects.
- You are HIV-positive and blood tests done at the end of pregnancy show that you have a high viral risk to the fetus.
Please note that your doctor will not schedule surgery until after 39 weeks unless you have a medical indication for a premature birth. For the operation to be successful, the mother must be examined in advance. As a rule, diagnostics are carried out immediately before childbirth or shortly before the planned date.
Unplanned cesarean: when is the urgent need for surgery?
You may need an unplanned operation. Indications for a small caesarean section in this case are the following conditions:
- You have a genital herpes outbreak. When the body is under extreme stress, the wounds expand, contributing to the involuntary infection of the child. A caesarean will help avoid infection.
- Your cervix stops dilating or your baby stops moving through the birth canal and attempts to stimulate contractions to help the baby move forward have failed. These are serious grounds for fruit extraction.
Separately, doctors single out an emergency operation, and shediffers from unplanned in that there is a threat to the life of the child. However, it is found not earlier than an hour or two before the birth itself. It is in such cases that obstetricians take emergency measures:
- The baby's heart rate is a concern and the fetus needs to be surgically removed to continue working the muscle.
- The umbilical cord wraps around the baby's neck, passing through the cervix (disappearing cord). If this is found, the fetus is removed immediately, without waiting for contractions. A missing "cord" can cut off oxygen.
- Your placenta is starting to separate from the wall of your uterus (placental abruption), which means your baby won't get enough oxygen.
Before urgent or unscheduled surgery, doctors must obtain consent from the child's spouse or father. If it is not available, permission is taken through the head physician. Relatives in such situations do not have the right to vote, since they do not legally relate to the fetus in any way. When it comes to saving a woman, the participation of the parents of the woman in labor is allowed. Then the anesthetist comes in to review the options for pain relief.
Performing an operation - how does it work?
General anesthesia is rarely prescribed these days, except in emergencies, if you don't respond to special drugs for some reason (like an epidural or spinal block). You will likely be given an anesthetic that will numb the lower half of your body but keep you awake during the delivery.
You may be introducedantacid to drink before surgery as a precaution. If there is an emergency, general anesthesia may be required, but vomiting may occur while you are unconscious. Vomit can involuntarily enter the lungs. The antacid neutralizes stomach acid so it won't damage lung tissue. Antibiotics will also be given to prevent infection after surgery. Anesthesia is administered and the screen rises above the waist so that the woman in labor does not have to watch the surgical procedure. If you wish to witness the birth, ask the nurse to lower the screen slightly so you can see the baby.
Once the anesthetic takes effect, the abdomen will be lubricated with antiseptic and the doctor will make a small horizontal incision in the skin over the pubic bone. When the surgeon reaches the abdominal muscles, they will separate them (usually by hand) and spread them apart to expose the uterus underneath. This is a complex type of operation, since the risk of hurting the fetus is high, and subsequent pregnancy depends on the skill of the doctor. No need to refer to the reviews - a small caesarean section is different for everyone.
When the doctor reaches the uterus, he will make a horizontal incision in the lower part of it. This is called an incision in the small transverse uterus. In rare cases, the doctor chooses a vertical or "classic" incision. This rarely happens, for example, when the baby is born prematurely or he needs urgent help in being born. Judging by the reviews, pregnancy after a small cesareandissection is possible thanks to innovative methods of extracting the fruit. Tissues heal and regenerate quickly.
Tissue closure and suturing
Once the cord is clamped, you will have a chance to see the baby, but not for long. While the staff is examining the newborn, the doctor will remove the placenta and start sewing up the tissues. Closing the uterus and abdomen will take much longer than opening, usually about thirty minutes. After the examination, the baby is not given to the hands so that the woman in labor does not strain. Relatives can immediately take the child in their arms, but more often it is given to the spouse, who shows the newborn to mommy. Then he is dressed, a pediatrician and a neonatologist issue a conclusion on the state of he alth. The baby also receives all vaccinations, blood sampling, tests and all measures are taken to establish and reveal hidden pathologies.
Some doctors recommend that a woman immediately start feeding in order to accustom the baby to the breast as soon as possible. Others advise delaying the start of breastfeeding, as a woman's milk may contain analgesic and antibacterial substances after surgery. To prevent the milk from disappearing, women in labor are advised to constantly express themselves. Often mothers complain that they are unable to start breastfeeding due to the lack of contractions in the uterine layer. However, this is a myth - all that needs to be done is constant breast massage, warm washing without soap and skin dryers.
The stitches used to close the incision in the uterus will dissolve. The final layer, the skin layer, can be closed with stitches or staples, which are usually removed.after three days or two weeks (the doctor may choose to use stitches that dissolve).
After the operation is completed, the woman in labor is placed in the intensive care unit for four to five hours to observe how the recovery is going and if there are any complications. If you are planning to breastfeed, try to do so right away. It is best to choose a comfortable position “on the side”, so that the abdominal muscles do not tense up, and the child can feel the warmth of the mother. Pain medications will be given for three days to reduce discomfort. Many are interested in the question of when you can get pregnant. A small caesarean section is a complex operation, and mothers are advised to carefully protect themselves for six months. The optimal period for the recovery of the uterus after surgery is considered to be five years, the body - three years.
Weather, a young couple can give birth, but only in the same way as in the previous case. Each subsequent section increases the chance of a premature birth of a subsequent child due to the inelasticity of the uterus and the "rupture" of the tissues. In a woman, menstruation after a small cesarean section will go in the same way as in a woman who has given birth naturally, they may be poorer or more abundant. It all depends on the age of the body and on the ability to recover. There is little discharge after a caesarean section among mothers over thirty years old, and in young girls the body is restored according to its biological cycle.
The doctor must advise the young mother on all issues before discharge, warning that infor 42 days after giving birth, she is still under the supervision and responsibility of the birth attendant.
According to reviews, a small caesarean section is an important operation for both mother and child. It can be prescribed in case of chronic diseases of the woman in labor, incorrect position of the fetus and other factors that may threaten the birth of a he althy baby. Recovery after CS is slightly more difficult than after natural childbirth. However, it all depends on the individuality of the mother's body.
