Cesarean section

Contents

Types of caesarean section
- Planned caesarean section
- emergency caesarean section
Indications for caesarean section
Suture after caesarean section
Belly after caesarean section
Anesthesia for caesarean section
Recovery after cesarean section
- Bandage after caesarean section
Breastfeeding after caesarean section
Menstruation after caesarean section
Pregnancy after caesarean section
Popular questions and answers

Who is shown the operation, and who is not, how to recover after it and when can I plan a new pregnancy? Dealing with an expert

According to the World Health Organization (WHO), the number of births by caesarean section has increased dramatically over the past 15 years (1). On the one hand, European trends, which are usually taken as a guide, sow the idea: caesarean section is the birth of the future.

On the other hand, doctors insist: if such a future ever comes, it will not be soon.

Each case is individual and the operation is not a whim, but a necessity, the doctor should prescribe it, weighing all the pros and cons: the health of the mother, her concomitant diseases, the condition of the fetus and the course of pregnancy. At the same time, caesarean section is one of the most common operations in obstetric practice. There is no need to demand it thoughtlessly, because “I want!”, No need to be afraid. But it will be useful to learn more about this operation.

Types of caesarean section

In medical practice, it is customary to talk about longitudinal and transverse caesarean sections, depending on the location of the incision. But this classification is more for practitioners.

For patients, it is more important that operations are divided into planned and emergency. The first is when a caesarean section is shown to a woman and it is prescribed in advance. And the second is carried out in special cases, when an urgent need appears right during childbirth.

Planned caesarean section

“A planned caesarean section is done if there are indications for surgery from the side of the mother, from the side of the fetus, or both,” says candidate of medical sciences, general director and obstetrician-gynecologist of the clinic «Crede Experto» Inessa Knysheva. – Indications are 100 percent, that is, without a caesarean, a woman cannot give birth. And there are relative, as they say, for a combination of reasons.

In our country, it is legally fixed that a caesarean section can be performed at the request of the woman in labor. If a woman categorically refuses natural childbirth, while not having medical indications for surgery, she cannot be refused. But, before planning a caesarean, doctors are obliged to send such a patient to a commission, where a psychologist will talk to her.

By the way, experts attribute the increase in the number of planned operations in recent years to two reasons. Firstly, with the increase in the number of women giving birth to their first child after 35 years of age, and those who have repeatedly tried to become pregnant through IVF. Secondly, with the improvement of the diagnosis of the condition of the fetus. (2)

emergency caesarean section

Sometimes a planned caesarean section turns into an emergency one. For example, when a patient who was scheduled for surgery begins to give birth prematurely.

“There is nothing wrong with that,” Dr. Knysheva reassures. – A woman with contractions comes to the hospital and she is operated on. As for the 100% emergency caesarean section, it is performed during childbirth. Indications for it can be both from the side of the mother and from the side of the child. On the part of the mother, this is an increase in blood pressure during childbirth that cannot be brought down, severe bleeding, which happened, for example, due to untimely placental abruption or uterine rupture. It is impossible to predict how the birth will go.

The main indication for emergency surgery on the part of the child is the development of acute hypoxia, that is, lack of oxygen.

Indications for caesarean section

There are many reasons why a woman may be given a caesarean section. For example, if she has a scar on her uterus from a previous operation. But this is not an absolute indication. And before prescribing a caesarean in such situations, the doctor examines the condition of the scar. And some patients with scars on the uterus give birth on their own.

But the incorrect position of the fetus in the last weeks of pregnancy is an absolute indication for a caesarean section.

– If the child lies across or obliquely, childbirth through the natural birth canal is impossible, – emphasizes Inessa Knysheva. – If the head is down, but the neck is curved so that the head will not pass, a caesarean section will also be scheduled.

The operation is also done with the wrong location of the placenta. For example, when it covers the cervix, as this can cause severe bleeding.

– There are indications for caesarean section in aggregate, – the expert adds. – The size of the child, breech presentation, the narrow pelvis of the woman in labor, her fragile physique and large fetus, the age of the mother, concomitant diseases. Each of these points is not an absolute indication, but together they lead to a planned operation.

A caesarean section is also prescribed when the mother has health problems that make natural childbirth impossible. If a woman cannot push: she has poor eyesight, heart disease, operations on internal organs, pelvic fractures, serious endocrine pathologies, mental illness, and so on.

“If a pregnant woman has an underlying disease or a serious concomitant, obstetricians always ask for a certificate from related specialists for the maternity hospital,” says Knysheva. – It should be clearly written what kind of childbirth is possible. And the doctor, on the basis of this document, is already making a prescription.

Suture after caesarean section

Physicians distinguish stitches depending on where the incision is made. It can be over the pubic area along the skin and in the lower segment of the uterus (used in a planned caesarean section) or from the navel to the pubis – the so-called “lower median or middle median laparotomy.” The latter are carried out in emergency cases, when seconds count and it is necessary to urgently cut the stomach in order to save the woman and the child.

During a planned operation, doctors try to make the seam as accurate as possible – cosmetic, so that in the future the scar is hardly noticeable. But, when it comes to life and death, there is no time for aesthetics.

“Now they mostly sew intradermally, apply clips,” emphasizes gynecologist Inessa Knysheva. – Each surgeon has his own suture technique, the result depends on it. It is also important how the suture heals and one must look at the features of the patient’s connective tissue. There are women prone to the formation of keloid scars. We tell such patients how to prevent the formation of scar-keloid tissue.

First, the seam needs to be processed. While the woman is in the hospital, nurses take care of her. But when the threads are removed (this usually happens 5-8 days after the operation), you will have to take care of yourself. How to do it? First, wash the scar with clean hands with water using a special gel for intimate hygiene. Then blot with a disposable paper towel and treat with chlorhexidine, diluted salicylic acid, or another disinfectant. After – process with greenery. And so 7-10 days.

2-3 weeks after the operation, the suture site can be lubricated with a regenerating agent. By the way, in the first week after removing the threads, the scar may become wet – this is normal, unless a liquid with an unpleasant odor oozes out of it. In this case, you need to urgently run to the doctor.

And the seam will hurt. Therefore, for some time you will have to take painkillers. It is estimated that, on average, a seam on a vertical section causes inconvenience for about two months, and on a horizontal one – one and a half. And you need to be prepared for the fact that the scar will be hard for a long time, and soften not earlier than in a couple of years.

“After a year or two, you can start grinding the seam with a laser,” advises obstetrician-gynecologist Inessa Knysheva. – The procedures will have to be carried out for a long time, but they give good results.

Belly after caesarean section

Many patients are worried about whether their abdominal muscles can sag after a cesarean. Every second woman is looking for the so-called “diastasis” – muscle separation. But not everyone needs to worry. The more operations on the abdomen and pregnancies, the higher the risk of muscle strain.

“Restoration of the anterior abdominal wall in patients after cesarean and after natural childbirth takes place in different ways,” our expert explains. – “Drawing” of the abdomen depends on the size of the uterus. It takes a long time to shrink back to its original state. Only after 2-3 months the woman returns to the state in which she was before childbirth, and even then not in everything.

– How quickly the stomach will go away depends on many factors: whether she is breastfeeding, what her hormonal background is, in what state of the tissue. Therefore, it is possible to determine muscle diastasis no earlier than 6-12 months after childbirth.

But this does not mean that nothing needs to be done at this time.

Proper nutrition, the use of postoperative and postpartum bandages and girdles will help prevent complications.

“A year after the cesarean, the patient calmly removes her stomach with the help of physical exercises,” the obstetrician-gynecologist reassures. – If there is a surgical diastasis, the surgeon may suggest surgical treatment. And you can get rid of everything else, for example, a “fat apron”, on your own – physical education, cosmetic creams and hardware massage.

Anesthesia for caesarean section

Anesthesia is chosen by the doctor depending on the situation. The fastest anesthesia option is endotrachial (general) anesthesia. That is, immersion in a state of deep medical sleep.

“Such anesthesia is done when doctors do not know how long the operation can last and what blood loss is,” explains Inessa Knysheva. – It is indicated in difficult situations: twins, placenta previa. There are practically no contraindications against endotrachial anesthesia.

In addition, this type of anesthesia is used in emergency cases: if the fetal heartbeat is not monitored, or acute hypoxia begins, or when the mother has severe bleeding. (3) While the patient is under endotracheal anesthesia, the machine breathes for him. The anesthesia is fast and effective.

The second option, the most commonly used, is spinal anesthesia. This is an injection of an anesthetic into the lumbar region of the spine, “turning off” the sensitivity of the lower body. They will be used when you have to do an emergency caesarean section, but the urgency is not associated with a threat to the life of the child or mother. For example, if the mother has a narrow pelvis, or the child turned around and took the wrong position.

“Almost all elective surgeries are performed under spinal anesthesia,” says the expert. – The patient is conscious, she does not feel pain, she feels pressure at most when the child is pulled out.

The drug with this type of anesthesia does not affect the fetus, the operation area is completely anesthetized, and the patient can breathe on her own – these are the main advantages of the “spine”.

Among the minuses, doctors call hypotension, a short period of exposure and headache as a side effect. (3)

– There are contraindications for spinal anesthesia, – reminds Inessa Knysheva. – Problems with the spine: hernias in the area where the injection is made, injuries, fractures, and so on.

The third type of anesthesia is epidural. Here, an anesthetic injection is also made in the region of the lumbar spine. It smooths out pain during contractions, but is considered more difficult to perform. It differs from spinal anesthesia in that it blocks the terminal sections of nerves, while spinal anesthesia causes blockade of an entire section of the spinal cord.

The advantages of “epidural” are the same as those of spinal anesthesia, and among the minuses is the risk of developing toxic effects when the anesthetic enters the bloodstream, since this can lead to convulsions and even death. (3) The skill of the anesthesiologist is essential in caesarean section.

The choice of the type of anesthesia always remains with the doctor, who always consults the patient before the operation. He also evaluates the risks and writes them down in the map.

Recovery after cesarean section

The recovery period is different for every woman. Normally, a woman after a cesarean spends only a day more in the hospital than a woman who gave birth naturally. When a young mother is discharged home, doctors explain to her three important rules, the observance of which will help her recover faster. The first is not to lift weights for six months after the operation (and with caution – up to a year). The second is not to sleep on your stomach, and the third is not to do abdominal exercises until the internal scar on the uterus heals. Usually it takes 1-2 months.

“Otherwise, the postpartum period is almost the same as for those who gave birth through the natural birth canal,” says obstetrician-gynecologist Inessa Knysheva. – There are also blood discharges, the uterus is contracting. But in women after surgery, this process may be worse, so they need to undergo a follow-up ultrasound on the 10-12th day after discharge. As soon as the bleeding ends, we allow the patients to swim, have sex, and have cosmetic procedures. As a rule, this happens 1,5-2 months after the operation, if there are no complications.

For a speedy recovery, you need to walk more. While still in the hospital, you should slowly walk along the corridor. And in the first 12 hours after the operation, until you are allowed to get up, it is recommended to turn over in bed more often to prevent the formation of adhesions.

In the first days after cesarean, it is better to walk slightly bent over so that the seam does not stretch. For the same reason, a woman needs to take care of the prevention of constipation. Malfunctions in the work of the intestines after childbirth are common, but it is better to deal with them. The chair of the mother who underwent the operation should be regular. To do this, the menu should include more cereals, vegetables and dairy products. Useful bread with bran. Be sure to drink plenty of fluids. In addition to pharmacy laxatives, decoctions of figs, nettles, valerian root and fennel will help.

As for the restoration of the figure, physical exercises should be introduced gradually, carefully and not earlier than 10 weeks after the operation. Start with light walking and stretching. And after 6-8 months, you can already switch to complexes that work out the muscles of the waist, abdomen and hips. Again – starting with the smallest loads, gradually increasing them.

Indicated for better massage recovery. Not only the back and neck, but also the abdomen. You can do it yourself – stroking the stomach in a circular motion. You can use a tennis ball for this.

Bandage after caesarean section

A medical bandage will help smooth out the pain in the uterus, which relieves the load from the muscles and prevents the organs from falling. But the decision to use it should be made by the doctor.

It is better to buy a bandage in a certified orthopedic salon, whose specialists will help you choose the size. The support belt should not fix the stomach well, but not squeeze it. It is imperative to take a postpartum bandage: there are universal models that, according to manufacturers, can be used both before and after childbirth, but for women who have undergone a cesarean section, such models are contraindicated, they strongly compress the stomach.

It is better to choose products that contain at least 60% cotton, with multi-level Velcro.

If there are no contraindications, you can put on a bandage already in the hospital. This should be done slowly and lying down, fastening the belt from the bottom up.

How long should a bandage be worn? Each woman has her own term, it depends on the speed of healing of the sutures. Someone puts on a bandage every day for two weeks, and this is enough, while someone wears it for two months. The doctor must cancel the bandage.

By the way, you should not sleep in a belt. This can harm blood flow.

Breastfeeding after caesarean section

“Breastfeeding after a caesarean section is no different from breastfeeding after a natural birth,” comments Dr. Inessa Knysheva. – But there are contraindications: mother’s diseases, infections that are transmitted through blood and body fluids. In such situations, you can not breastfeed the baby. And in the maternity hospital, lactation is immediately suppressed with the help of special preparations that help milk to leave.

Usually lactation begins 3-4 days after caesarean section. But in some cases, with the advent of milk, difficulties may arise. According to research scientists, the operation inhibits lactation. (4) Especially if the pregnancy ended with complications. The fact is that a caesarean section slows down the normal physiological adaptation of mother and baby to new conditions. Having studied the experience of clinics in 33 countries of the world, doctors have established a direct relationship between planned surgical delivery and the period of breastfeeding. (four)

Menstruation after caesarean section

The menstrual cycle after a caesarean section is restored in the same way as after a normal birth, that is, it largely depends on lactation. It is believed that with full breastfeeding, 6-8 times a day, the level of prolactin in the mother’s body is so high that it suppresses the hormonal secretion of the ovaries. And a woman does not start menstruating while she is breastfeeding.

“But everything is individual,” says Inessa Knysheva. – There are many patients who breastfeed a lot and often, and at the same time their menstruation begins a month after delivery. In this case, you must definitely consult a doctor who will do an ultrasound of the uterus and make a verdict – is this a variant of the norm or not.

In general, for breastfeeding mothers, menstruation begins after the number of feedings of the baby is reduced. If 2-3 months after a woman who has undergone a cesarean section does not start her period, she needs to go to the doctor. Consultation is also recommended after the resumption of the cycle.

– If menstruation begins against the background of lactation, no need to worry. It makes sense to talk about an unstable cycle, – emphasizes the obstetrician-gynecologist. – This is normal, because the level of prolactin changes and affects the regularity of menstruation. But I want to remind you that first a woman begins to ovulate, and then menstruation. Therefore, lactation cannot prevent pregnancy. Many women think that they cannot get pregnant until they have their period. It’s a delusion.

Pregnancy after caesarean section

Before the next pregnancy, time must pass – the scar on the uterus must be allowed to heal properly. Otherwise, during the bearing of a child, the seam may disperse.

“We never tell patients to terminate a pregnancy, the decision is always up to the mother,” emphasizes Knysheva. – But be sure to talk about the two main rules for planning pregnancy after cesarean. The first is contraception. The second – you need to withstand the time for the healing of the scar.

There are situations when the patient’s connective tissue did not heal well or the operation was performed incorrectly, or her sutures diverged due to the development of infectious complications. If a woman had to endure this, then before thinking about a new pregnancy, she definitely needs to do an MRI of the uterus. The scar after cesarean may be uneven or thinned, then you will definitely have to wait a little with the next pregnancy.

One of the long-term complications is called an ectopic pregnancy. In 2017, caesarean scar pregnancy was included in the classification of reported cases. Such facts are recorded infrequently – 1 in 2,5 thousand operations (5). But they must be remembered.