The birth of a little man is not always amenable to clear planning. Few babies appear at the time calculated by the gynecologist observing the pregnancy. Some decide to meet with their parents earlier than planned: already from 38 weeks the child is considered full-term, and becomes viable at 28 weeks. Other babies are delayed, being born at 42 weeks.
If the doctor told the expectant mother about the need for a planned caesarean section, then the parents will definitely know the date of birth of their baby a little in advance. Sometimes circumstances intervene already during childbirth (during the normal course of pregnancy) and you have to make a decision to perform an emergency operation.
According to what indications is a caesarean section performed in Russia? Next, consider all the nuances.
Arguments of doctors for the operation
For an obstetrician to perform an operation lasting 30-40 minutes is much easier thantake birth naturally. The process can take 12-14 hours or more. But this is not an easy operation that requires high professionalism from doctors. Not always a caesarean section goes without consequences, because such an intervention is associated with a greater number of complications than with natural childbirth. Therefore, a caesarean section is performed according to indications.
Why Elective C-Sections Are Increasing
Every woman has the right to choose the best way for her to give birth. In addition to natural and partner childbirth, as well as caesarean, some expectant mothers prefer childbirth in water or even at home, but the latter can be dangerous for the life and he alth of not only the woman, but also the baby. In choosing the type of childbirth, you need to rely on the recommendations of the doctor observing the pregnancy.
But there are situations when the doctor insists on a planned caesarean section during pregnancy. The list of indications is quite wide. Doctors recommend surgery more and more often, because the number of women who decide to have their first child only after 30 years has increased, and even in combination with chronic diseases accumulated over the years of life and possible gynecological diseases.
Also indications for caesarean section are pathologies of pregnancy, which now (due to the use of modern technologies and the latest diagnostic methods) can be detected earlier. In recent years, the list of indications for which the operation is performed in the interests of the fetus has been expanded, as well as in case of severe toxicosis in the third trimester, multiple or premature pregnancy, pelvicfetal presentation.
Common indications for caesarean section
Doctors resort to surgical intervention in the event that the bearing of a child for a woman is fraught with difficulties, and natural delivery becomes dangerous. If possible obstacles to natural childbirth are identified long before 38-40 weeks, then a cesarean is called planned. In this case, it is possible to plan a surgical intervention and prepare the expectant mother.
But sometimes labor starts normally, but there are certain difficulties in the process, so that the situation becomes dangerous. In this case, an emergency operation is performed. This is possible only on the prescription of a doctor, that is, for medical reasons. It is desirable to prepare for a caesarean section, but this is not always possible.
It is better if the expectant mother calmly weighs the pros and cons. It is advisable to contact several experts to hear different opinions. As a rule, women who are expecting a child are offered surgery for medical reasons. Indications for caesarean section in Russia are listed below.
Elective surgery: list of indications
The doctor may schedule a caesarean section for a woman with an anatomically narrow pelvis that cannot accommodate a normal-sized newborn's head. This indicator is measured in the antenatal clinic. The pelvis is considered narrow, the dimensions of which are less than the norm by 1.5-2 cm or more. But more important is the ratio of this indicator to the size of the fetal head. If the child is smallthen the narrow pelvis may be fully functional physiologically.
Another indication for caesarean section during pregnancy is severe toxicosis in the second half of pregnancy. Often, the condition is complicated by high blood pressure and other complications from the heart and blood vessels. This threatens the he alth of the mother. If the form of the disease is mild, then an anesthetic injection into the spine and the introduction of a special gel that stimulates labor can be prescribed. Caesarean section is indicated in cases where preeclampsia lasts more than three weeks or is complicated by other pathologies.
Complete placenta previa, which closes the baby's exit from the uterus, also forces the doctor to send the pregnant woman for a planned operation. With placenta previa during natural childbirth, bleeding or fetal hypoxia may occur. The list of indications for caesarean section includes other mechanical obstructions. So, if there are tumors that prevent the birth of a baby, surgery is performed.
Indications for caesarean section during pregnancy are some diseases, such as genital herpes in the active stage. With natural delivery, the infection can be transmitted to the baby and cause illness in him. Severe varicose veins during childbirth naturally threatens to bleed, and the list of indications for elective surgery includes severe myopia, retinal detachment, some diseases of the mother's heart and blood vessels or nervous system.
Surgery recommended for multiple pregnancypregnancy resulting from IVF or after infertility. Often, a caesarean section is performed for women over 30. Independent childbirth is not possible with pronounced narrowing of the vagina and cervix, the presence of scars after gynecological operations, and so on. In many cases, the decision is made on an individual basis.
The need to make an emergency decision
It is likely that a decision will have to be made after the start of natural childbirth. The transition to caesarean does not exceed 14% of births. The decision must be made, for example, due to fetal distress, inappropriate entry of the head or weakness of labor. In such cases, doctors, based on the readings of the equipment or their own experience, recommend an emergency caesarean. The woman signs the papers, but in some cases this procedure is omitted. There are situations that threaten the life of the patient. Then doctors are obliged to provide assistance even without obtaining written consent for surgical intervention.
Indications for emergency caesarean section
What are the indications for an emergency caesarean section? The list includes any complications of natural childbirth that threaten the life and he alth of a woman or child and are not amenable to other therapy. So, among the indications for caesarean section during childbirth are:
- the threat of rupture of the walls of the uterus;
- oxygen starvation (respiratory failure) of the fetus, which is not amenable to other therapy;
- premature abruption or placenta previa with profuse bleeding;
- narrow pelvis (if a small weight was setchild, then natural childbirth is possible, but not always the fetus really turns out to be of the same size as the doctors determined by the equipment);
- weakness of natural labor that does not respond to conservative therapy.
Selected indications for multiple pregnancies
The list of indications for caesarean section in multiple pregnancies is generally the same as if a woman is carrying one baby. Separate indications are the transverse position of twins, which is dangerous during the natural process of delivery, the birth of premature babies weighing less than 1800 grams, the breech presentation of the first child. The absolute indication for planned caesarean section in multiple pregnancy is its combination with any obstetric pathology.
Caesarean for second and subsequent pregnancies
In the event that the woman's first birth was by caesarean section, the same method may be recommended for the second time. Otherwise, the main indications for the second caesarean section are the same as for the first. A second natural birth after cesarean is possible if the diagnosis that led to the first operation has not been repeated, the fetus is not too large and lies head down, the pregnancy proceeds without complications.
The doctor will insist on a planned operation if the baby is large (weight - more than 4 kg), premature (less than 38 weeks), the patient has a history of more than two or three CS, there is a need for medical management of childbirth, or during pregnancy there werecomplications. Diseases that were the causes of the first operation and still exist (myopia, myopia, cardiovascular pathologies) will remain indications.
Absolute and relative readings
There are non-negotiable indications for caesarean section. Such situations happen relatively rarely, but the expectant mother should still be aware. The group of such indications includes prolapse of the umbilical cord, for example, with the outflow of amniotic fluid. In this case, the woman needs to take a position on all fours - this will reduce the squeezing of the umbilical cord, and the doctors will give time to urgently prepare the instruments and the operating room.
Another absolute indication for caesarean section is complete placenta previa, in which the placenta obstructs the baby's exit. At the same time, scarlet blood is released from the female genital tract, which is not accompanied by painful sensations. It is possible to reliably establish the position of the placenta with an ultrasound examination at the end of pregnancy. Often the condition is determined in the middle of the gestation period, but this is not considered an indication, since the placenta will most likely have time to take a safer position before delivery.
Placental abruption is an indication for immediate surgery. This usually causes severe pain in the abdomen, sometimes it can be accompanied by bleeding. Measures of emergency medical care are blood transfusions and emergency caesarean. With frontal and transverse presentation, which is established at the end of pregnancy, the doctor will also recommend a plannedoperation.
More often you can talk about relative indications, which are discussed with the gynecologist. Against the background of such reasons for the operation, a woman may decide to give birth naturally. Here, much depends on the professional experience of the doctor and midwife taking delivery, the age of the woman in labor, the protocols and regulations that exist in a particular clinic, the country's medical legislation, the woman's personal preferences, and so on.
Examples of relative indications: presence of scars from a previous cesarean, lack of progress during labor, large weight and size of the fetus, mismatch between the size of the fetal head and the mother's pelvis, gynecological diseases, breech presentation of the fetus.
The last reason for the operation, by the way, is a great example of how just one article published in a medical journal in 2000 turned the whole world upside down. The authors (based on statistical data) concluded that with breech presentation, a caesarean delivery has a more favorable outcome than natural childbirth. In this case, only breech and mixed breech presentation were studied. Since then, the number of doctors and midwives willing to receive a baby in a breech position has dropped significantly. Therefore, it is easier and calmer for a woman to agree to a planned caesarean than to give birth surrounded by frightened doctors.
Progress and description of the operation
The operation can be carried out both as planned and on an emergency basis. In the first case, the expectant mother should not eat or drink after midnighton the day of the operation. The intervention is performed under anesthesia. An incision is made on the abdominal cavity and the wall of the uterus, either horizontally or vertically. After the baby is removed, the uterus is pulled together with special absorbable threads, and the abdominal cavity with cosmetic sutures, which also dissolve over time. The operation lasts an average of 30-45 minutes, sometimes up to 60 minutes.
Anesthesia techniques for caesarean section
General or local anesthesia is used. The general immerses the woman in a medical sleep, anesthesia is administered through a tube into the respiratory tract. General anesthesia works faster, but after waking up, it causes nausea, drowsiness, shoulder pain and other unpleasant consequences. With local anesthesia, the woman will not feel pain, but only some pressure and twitching.
Consequences of caesarean section for the mother
Caesarean section is an operation, so the consequences are about the same as after any other surgical intervention. Bleeding after such an operation occurs twice as often as during natural childbirth. Perhaps accidental damage to the abdominal organs, infection, a negative reaction of the body to anesthesia, impaired functioning of the intestine. The risk of death from caesarean section is four times higher than from vaginal delivery.
After the operation, the woman will need to stay longer in the hospital. The mother and baby will be discharged no earlier than in five days. After six weeks, the woman needs to come for a check-up to the gynecologist. It is better to plan the next pregnancy no earlier than inone and a half to two years after surgery.
C-section care: in the hospital and at home
Features of care are individual. The baby is applied to the mother's breast with the permission of the doctor. In some cases, this is possible immediately after it is removed from the uterus. A woman may be prescribed painkillers, medicines for nausea. First, they will be allowed to drink water, after - light decoctions and diet food. Possible problems with the intestines, minor discomfort, pain from uterine contractions. The woman will be advised to wear compression stockings. Do not lift anything heavier than a child for two months after surgery.
Natural feeding allowed at home. It is not recommended to drive, lift weights, do heavy housework, insert tampons, have sex (until the first visit to the gynecologist). Showers are usually allowed, but baths are best saved for later. To avoid problems, you must follow all the recommendations given by the attending physician.
Caesarean section: pros and cons
If a woman has the opportunity to think about the need for a caesarean section and make a decision on her own (but, of course, based on the recommendations of her doctor), it is worth carefully weighing the pros and cons. Arguments for - is the impossibility of trauma to the genital organs and ruptures during surgery and rapid delivery. Among the disadvantages, women name the lack of a psychological connection with the child, pain in the places of suturing, limitation of motor activity and the needspecial care after surgery, scar.
Sufficiently serious and consequences after caesarean. This is the psychological state of the mother, and pain, a scar on her stomach, the inability to take a bath and resume sexual relations for several months, and restrictions on physical activity. There are also consequences for the child. It is possible that amniotic fluid will remain in the baby's airways, drugs for anesthesia will get into his blood. They also talk about the psychological consequences. It is generally accepted that children who were born by caesarean section are less able to adapt to environmental conditions.
