Small cesarean section is an operation that is performed according to plan or according to urgent indications when it is necessary to extract the fetus in a safe way to save the life of the mother or child. Removing the fetus artificially can be decided in advance by the doctor for medical reasons, if for this all health indicators are taken into account. It is also important to understand that caesarean is often dangerous for women who have already had surgery or abortion. Everything that mothers need to know about the consequences of surgery is described later in the article.
History of occurrence
Caesarean section has been part of medical manipulations since ancient times, and there are many legends about this. According to Greek mythology, Apollo seized Asclepius, the founder of the famous cult of religious medicine, from his mother’s stomach. Numerous references to Caesarean section appear in ancient Hindu, Egyptian, Greek, Roman and other European folklore. Ancient Chinese engravings depict the procedure on seemingly living women. The Mishnagoth and Talmud forbade bringing the newborns to life as a ritual when the twins were born by Caesarean section, but refused the rituals of cleaning women after surgery. Termination of pregnancy by caesarean section was then not done at all, since the fetus was removed “live”, removed from the woman and separated from the walls of the uterus.
Nevertheless, the early history of Caesarean section remains shrouded in myth and has dubious accuracy. Even the origin of the term “caesarean section” seems to have distorted over time. It is believed that he comes from the surgical birth of Julian Caesar, but this seems unlikely, since his mother Aurelia is believed to have lived during 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 the child for a state that wants to increase its population. Roman law decreed that all women who gave birth in such a way should have a cut, therefore a section.
Other possible Latin origins include the verb caedare, which means abbreviation, and the term caesones, which applied to babies born after post-mortem operations. Ultimately, we cannot be sure where and when the term "cesarean" was derived. Until the sixteenth and seventeenth centuries, the procedure was known as cesarean section. The term has changed since the publication in 1598 of a book by Jacques Gillimot about obstetrics, in which he coined the term "section". Increasingly, after this, the word "section" was replaced by the concept of "operation".
The evolution of surgical intervention
Throughout history, cesarean section at different times has meant different concepts. Indications for him have changed dramatically from ancient times to the present day. Despite the rare prerequisites for operations for living women, the original goal was mainly to get the baby out of a dead or dying mother; this was done either in the rather vain hope of saving the life of the child, or, as is usually required by religious decrees, so that the child could be buried separately from his mother. First of all, this was an extreme measure, and the operation was not intended to save the life of the mother. Only in the nineteenth century did such an opportunity really fall into the competence of the medical profession, and then a small cesarean section became a chance for children to be saved.
Nevertheless, there were sporadic early reports of heroic efforts to save the lives of women. In the Middle Ages, during the period of stagnation in science and medicine, attempts to conduct an operation to preserve the life and health of both the mother and the fetus did not stop. Perhaps the first report of a mother and child who survived a small Caesarean section is the story that happened in Switzerland at the beginning of the sixteenth century, when the woman underwent surgery by Jacob Nufer. After several days of labor and the help of thirteen midwives, a woman in labor could not give birth to her baby.
Her desperate husband eventually got permission from the local authorities to have a caesarean section. The mother lived and subsequently gave birth to five children, including twins. The child grew up and died at the age of 77. Since this story was recorded after more than 80 years, historians doubt its accuracy. Similar skepticism can be applied to other early abdominal autopsy reports performed by women on their own.
Previously, operations could be carried out without professional advice due to the lack of qualified doctors. This meant that cesarean could be undertaken at an earlier stage of gestation due to emergencies. In these conditions, the chances of saving a woman in labor or her baby were higher. These operations were performed on kitchen tables and beds without access to hospital facilities, and this was probably an advantage until the end of the nineteenth century, as hospital surgery was “saturated” with infections transmitted between patients, often through the dirty hands of medical personnel.
Perfection and development of medicine
Thanks to his work in animal husbandry, Nufer also possessed various anatomical knowledge. One of the first steps in performing any operation is to understand the connecting organs and tissues, knowledge that could hardly be obtained before the modern era. During the sixteenth and seventeenth centuries, with the heyday of the Renaissance, numerous works illustrate human anatomy in detail. The monumental general anatomical text by Andreas Vesalius De Corporis Humani Fabrica, published in 1543, depicts the normal female genital organs and structures of the abdominal region. In the eighteenth and early nineteenth centuries, pathologists and surgeons significantly expanded their knowledge of the normal and pathological anatomy of the human body.
By later years, doctors gained wide access to human corpses, the emphasis in medical education changed, which allowed medical students to study anatomy through personal dissection and small cesarean sections on female corpses. This practical experience has improved understanding of the human structure and better prepared doctors for operations.
At that time, of course, this new kind of medical education was still available only to men. With the accumulation of knowledge from the seventeenth century, women on duty were demoted to doctors in children's wards. In the early 1600s, Chamberlain in England introduced obstetric forceps into his work to pull fetuses from the birth canal, which otherwise could not be destroyed. Over the next three centuries, male obstetricians gradually mastered the skills for conducting such operations, and women were completely removed from such work. Later, they began to do medical abortion after cesarean section, as a method of artificial fetal extraction. But this technique was considered extreme, so it became widespread after decades.
Abortion via cesarean section: surgical procedure
Caesarean section is a type of surgery used to remove a child. The fetus is removed surgically through an incision in the mother’s stomach, and then a second incision in the uterus. The most common indications for a small Caesarean section are:
- Obesity.
- Diabetes.
- The age of a woman.
- Various diseases.
Other reasons are the use of epidural drugs and methods that cause difficulties during childbirth, because they cause complications that can lead to the need for surgical intervention. Although birth through a cesarean can save the life of both mother and baby, obstetricians and gynecologists have expressed concern that surgeries may be excessive, and they recommended that only emergency situations should be dispensed with when such intervention is really needed. At women's forums, a small caesarean section is discussed from different angles: someone is against, someone had to conduct several times because of the testimony.
However, studies have shown that women who had cesarean surgery trying to give birth to second children in a natural way had practically no risk of developing complications, such as:
- the need for blood transfusion;
- unplanned hysterectomy.
One way to reduce the number of operations is to educate women about the benefits of natural birth. Previously, a third of children were born by the surgical method, and the “fashion” went from the West, when it became popular not to spoil the figure and not to breastfeed.
Abortion after Cesarean Surgery
An abortion after cesarean section is done only six to twelve months after surgery. How it will be carried out (in a vacuum, medicamentous or instrumental way) - only the attending physician decides. In the latter case, when the fetus is scraped from the uterus, women in labor in the future may not always have children. Many people think that having an 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 cesarean 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 up on time so as not to aggravate your own health. Abortion after CS can also be recommended for those who have had heart and kidney failure. If a woman in labor is at risk of miscarriage, she may be advised to free herself from him.
An abortion after CS is done in the early stages of pregnancy, especially if a year or less has passed after cesarean. In this case, the woman will not be able to tolerate 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 caesarean
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 being under anesthesia. Her stomach 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 next day after the end of the operation. Women are usually given regional anesthesia or an epidural or spinal block is placed, which relieves sensitivity in the lower body. But this allows the mother to stay awake and hear when the baby is born.
It is generally safer than general anesthesia when a woman is completely immersed in sleep during childbirth. The technique of small cesarean section has been studied for a long time, and in the last ten years it has been used in this form in order to avoid cardiac arrest in women in labor. Obstetricians will use a surgical knife to make a horizontal incision on the abdominal wall - usually along the bikini line, which means it's low. This is also a new method, and it was created so that women do not be shy about their bodies on the beach or at home, putting on underwear. Some women in labor make a vertical incision if the fruits are not located correctly or there are more than 2-3 of them.
After the abdominal cavity is open, a hole is made in the uterus. Typically, a small caesarean section technique involves a lateral (horizontal) incision that breaks the amniotic sac surrounding the child. As soon as this protective membrane is torn, 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 completed, the incisions made in the mother’s uterus are sutured with sutures that will eventually dissolve under the skin. The abdominal cavity is covered 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. After the operation, she will be transferred to the maternity ward of the hospital. If, after performing the caesarean section operation technique, threats to the life and health of the mother, such as removal of the uterus or tubes, follow, the woman will be operated again to save her life.
After a cesarean, a woman can spend two to four days in the hospital, but it can take up to six weeks to fully recover. Perhaps a premature baby was born, there are complications, illnesses and so on. The abdomen will hurt for a long time, as both 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 well as those who give birth on their own. She is also advised to refrain from:
- sexual intercourse for several weeks;
- lifting weights over one kilogram;
- playing 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 unplanned when the situation requires urgent measures, for example, a woman has a sharp increase in blood pressure.
When a small cesarean section is done - indications for surgery for various reasons
In some cases, the doctor will recommend a cesarean instead of a natural birth. For example, a scheduled operation may be required if:
- You already had a cesarean section with a “classic” vertical uterine incision (this is relatively rare) or horizontal. Both of these factors significantly increase the risk of uterine rupture during attempts. If you had only one horizontal uterine incision, you can give birth on your own, but most often women themselves want surgery, expecting the suture to separate.
- You had some other invasive uterine surgery, such as myomectomy (surgical removal of fibroids), which increases the risk that the uterus may burst during labor.
- You have already given birth to two or more children. Perhaps the technique of the operation of small Caesarean section will be needed by those who have already given birth. The tone of the muscles of the uterus is weak, there may be complications. Especially if a woman in labor is expecting twins.
- The baby is expected to be very large (a condition known as macrosomia).
- Your doctor will probably recommend a cesarean if you have diabetes, or if you had a baby who had suffered a serious injury during childbirth. In order to avoid complications of the fetus, it is recommended not to take risks and trust a professional.
- Your baby is positioned downside down or across the body. In some cases, when the pregnancy is multiple, and one of the fetuses is located downside down, birth occurs in a mixed type - a baby who 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 little discharge after cesarean section, everything goes according to plan, as after natural childbirth.
- You have placenta previa (when the placenta is so small in the uterus that it covers the cervix).
- You have large fibrosis, which makes natural birth difficult or impossible.
- The child has an anomaly due to which natural birth can be risky, for example, some cases of open neural tube defects.
- You are HIV-infected, and blood tests done at the end of pregnancy show that you have a high viral risk to the fetus.
Please note that the doctor will plan the operation no earlier than 39 weeks, unless you have a medical condition for 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 there an 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 outbreak of herpes. When the body experiences extreme stress, the wounds expand, contributing to the involuntary infection of the child. Cesarean will help avoid infection.
- Your cervix stops expanding or your baby stops moving through the birth canal, and attempts to stimulate contractions to help the baby move forward have not yielded results. These are serious reasons for fetal extraction.
Doctors separately distinguish emergency surgery, and it differs from unplanned one in that there is a threat to the life of the child. However, it can be detected no earlier than an hour or two before the birth itself. It is in such cases that obstetricians take emergency measures:
- The child’s heart rate is worrying, and the fetus should be removed surgically to continue working the muscle.
- An umbilical cord wraps around the baby’s neck, passing through the cervix (a missing cord). If this is detected, the fetus is removed immediately, without waiting for contractions. A lost “cord” can block oxygen.
- Your placenta begins to separate from the uterine wall (placental abruption), which means that the baby will not receive enough oxygen.
Before an urgent or unplanned operation, doctors must obtain consent from the spouse or father of the child. If not, permission is obtained through the head physician. Relatives in such situations do not have the right to vote, since they are not legally related to the fetus. When it comes to saving a woman, the participation of the mothers is allowed. An anesthetist then comes to see the various options for dulling pain.
Operation - how does it happen?
General anesthesia is rarely prescribed these days, with the exception of emergency situations, if for some reason you do not respond to special medications (for example, epidural or spinal block). Most likely, you will be given an anesthetic that will help numb the lower half of your body but prevent you from falling asleep while taking the fetus.
You may be given an antacid to drink before surgery as a precaution. If an emergency occurs, general anesthesia may be required, but vomiting may occur while you are unconscious. Vomit can inadvertently enter the lungs. Antacid neutralizes stomach acid, so it will not damage lung tissue. Antibiotics will also be given to prevent infection after surgery. Anesthesia is introduced and the screen rises above the waist so that the woman in labor does not have to observe the process of surgical intervention. If you want to testify of the moment of birth, ask the nurse to lower the screen a bit so that you can see the baby.
As soon as anesthesia begins to act, the stomach will be lubricated with an antiseptic, and the doctor will make a small horizontal incision in the skin above the pubic bone. When the surgeon reaches the abdominal muscles, he will separate them (usually by hand) and open them to expose the uterus below. This is a complex type of operation, since the risk of hurt the fetus is great, and subsequent pregnancy depends on the skill of the doctor. No need to refer to reviews - a small caesarean section for everyone goes differently.
When the doctor reaches the uterus, he will make a horizontal incision in its lower part. This is called the incision of the small transverse uterus. In rare cases, the doctor chooses a vertical or “classic” incision. This rarely happens, for example, when a baby is born prematurely or needs urgent help in being born. Judging by the reviews, pregnancy after a small Caesarean section is possible thanks to innovative methods of fetal extraction. Tissues heal quickly and regenerate.
Closure and stitching
Once the umbilical cord is pinched, you will have a chance to see the baby, though not for long. While the staff examines the newborn, the doctor will get the placenta and begin to sew tissue. Closing the uterus and abdomen will take much longer than opening, usually about thirty minutes. After the examination, the baby is not given in her arms so that the woman in labor does not strain. Relatives can immediately take the baby in their arms, but more often they give it to their spouse, who shows the newborn to mom. Then he is dressed, the pediatrician and neonatologist give an opinion on the state of health. The kid also receives all vaccinations, blood sampling, tests and all activities are done to establish and identify hidden pathologies.
Some doctors recommend that a woman immediately start feeding, in order to accustom her baby to her breast as soon as possible. Others advise delaying the start of natural feeding, as women may have analgesic and antibacterial substances in their milk after surgery. So that milk does not disappear, women in labor are recommended to constantly express. Often mothers complain that they are unable to start feeding due to the absence of contractions in the uterine layer. However, this is a myth - all that needs to be done is a constant breast massage, a warm wash without soap and skin desiccants.
The stitches used to close the incision in the uterus will dissolve. The final layer - cutaneous - can be covered 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 for four to five hours in the intensive care unit in order to observe how the recovery is going and whether there are any complications. If you plan on breastfeeding, try to do it right away. It is best to choose a comfortable position “on the side” so that the abdominal muscles do not tighten, and the child can feel the mother’s warmth. For three days they will put painkillers to reduce discomfort. Many are interested in the question of when you can become pregnant. Small cesarean section is a difficult operation, and mothers are advised to carefully protect themselves for six months. The optimal period for the restoration of the uterus after surgery is five years, the body - three years.
A young couple can give birth to a weather, but only in the same way as in the previous case. Each subsequent section increases the chance of premature birth of the next child due to inelasticity of the uterus and “torn” tissues. In a woman, menstruation after a small cesarean section will go the same way as in naturally giving birth, they can be scarcer or more abundant. It all depends on the age of the body and on the ability to recover. Few discharges after cesarean section occur among mothers older than thirty years, and in young girls the body is restored according to its biological cycle.
The doctor must consult the young mother before discharge for all questions, warning that for 42 days after the birth she is still under the supervision and responsibility of the host.
According to reviews, a small cesarean section is an important operation for both mom and baby. It can be prescribed in case of chronic diseases of the woman in childbirth, improper position of the fetus and other factors that can threaten the birth of a healthy baby. Recovery after CS is slightly more complicated than after natural childbirth. However, it all depends on the personality of the mother's body.