The birth of a little man is not always amenable to clear planning. Few babies appear on time calculated by a gynecologist observing pregnancy. Some decide to meet with their parents earlier than planned: from 38 weeks the child is considered full-term, and becomes viable at 28 weeks. Other crumbs are delayed, being born on the 42nd week.
If the doctor informed the expectant mother about the need for a planned cesarean 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 decide on an emergency operation.
What are the indications for cesarean section in Russia? Next, we consider all the nuances.
Arguments of doctors for the operation
For an obstetrician, an operation lasting 30-40 minutes is much easier than taking a birth in a natural way. The process can last 12-14 hours or more. But this is a difficult operation, which requires high professionalism from doctors. Caesarean does not always go away without consequences, because such an intervention is associated with a greater number of complications than during natural childbirth. Therefore, a caesarean section is performed according to indications.
Why is planned caesarean carried out more often
Every woman has the right to choose the best delivery method for herself. In addition to natural and partner births, as well as cesarean, some expectant mothers prefer childbirth in water or even at home, but the latter can be dangerous to the life and health of not only a woman, but also a baby. In choosing the type of birth, one must rely on the recommendations of the doctor who is observing the pregnancy.
But there are situations when the doctor insists on carrying out a planned cesarean section during pregnancy. The list of indications is quite wide. Doctors recommend surgical intervention more often, because the number of women who decide on their first-born only after 30 years has increased, and even in combination with the chronic diseases and possible gynecological diseases that have accumulated over the years of life.
Also, indications for caesarean section are pregnancy pathologies, which now (through 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, as well as with severe toxicosis in the third trimester, multiple or premature pregnancy, and pelvic presentation of the fetus, has been expanded.
General indications for caesarean section
Doctors resort to surgical intervention if carrying a child is difficult for a woman, and natural delivery becomes dangerous. If possible obstacles to natural childbirth are identified long before 38-40 weeks, then cesarean is called planned. In this case, it is possible to plan a surgical intervention and prepare a future mom.
But sometimes childbirth begins normally, but in their process certain difficulties arise, 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 advisable 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 listen to different opinions. As a rule, women expecting a baby are offered surgical intervention for medical reasons. Indications for cesarean section in Russia are listed below.
Scheduled Operation: List of Indications
The doctor may plan to have a cesarean with an anatomically narrow pelvis in a woman through which the normal-sized head of the newborn will not pass. This indicator is measured in the antenatal clinic. A pelvis is considered narrow, the size of which is 1.5-2 cm or more less than the norm. But more important is the ratio of this indicator with the size of the fetal head. If the child is small, then 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 health 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 is indicated in cases where preeclampsia lasts more than three weeks or is complicated by other pathologies.
Full placenta previa, which closes the baby out of the uterus, also forces the doctor to send the pregnant woman for a planned operation. With placenta previa during natural birth, bleeding or hypoxia of the fetus 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, for example, genital herpes in the active stage. With natural delivery, the infection can be transmitted to the infant and cause illness. Severe varicose veins during childbirth naturally threatens with bleeding, and the list of indications for elective surgery includes severe myopia, retinal detachment, some diseases of the heart and blood vessels or nervous system of the mother.
Surgery is recommended for multiple pregnancies resulting from IVF or after infertility. Often a cesarean is performed for women over 30. Independent childbirth is not possible with severe narrowing of the vagina and cervix, the presence of scars after gynecological operations, and so on. In many cases, the decision is made individually.
The need to make an emergency decision
It is likely that a decision will have to be made after the onset of natural birth. The transition to cesarean does not exceed 14% of births. A decision must be made, for example, due to fetal distress, with improper entry of the head or weak labor. In such cases, doctors, relying on the testimony of equipment or their own experience, recommend emergency cesarean. A woman signs papers, but in some cases this procedure is omitted. There are situations that threaten the life of the patient. Then the doctors are obliged to provide assistance even without the written consent of the surgical intervention.
Indications for emergency caesarean section
What are the emergency indications for caesarean section? The list includes any complications of natural childbirth that threaten the life and health 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 detachment or placenta previa with heavy bleeding;
- narrow pelvis (if a small weight of the child was established, then natural birth is possible, but not always the fetus really turns out to be the same size as the doctors determined by the equipment);
- weakness of natural labor, which is not amenable to conservative therapy.
Separate indications for multiple pregnancy
The list of indications for cesarean section during multiple pregnancy is generally the same as in the case when a woman carries one baby. Separate indications are the transverse position of the twins, which is dangerous during the natural process of delivery, the birth of premature babies weighing less than 1800 grams, the buttock presentation of the first child. An absolute indication for elective caesarean section for multiple pregnancy is its combination with any obstetric pathology.
Cesarean during the second and subsequent pregnancies
In the event that the woman’s first birth was through Caesarean, the same method may be recommended a second time. Otherwise, the main indications for the second cesarean 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 is not repeated, the fetus is not too large and lies head down, 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 were complications. The diseases that were the causes of the first operation and still are (myopia, myopia, cardiovascular pathologies) will remain indications.
Absolute and relative readings
There are indications for caesarean section, which are not subject to discussion. Such situations are relatively rare, but the expectant mother should still be aware. A group of such indications includes umbilical cord prolapse, for example, when amniotic fluid is discharged. In this case, the woman needs to take a pose on all fours - this will reduce the compression of the umbilical cord, and the doctors will be given time to urgently prepare the instruments and the operating room.
Another absolute indication for cesarean section is the complete presentation of the placenta, in which it closes 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 study 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 before the delivery the placenta is likely to manage to take a safer position.
Detachment of the placenta - an indication for immediate surgery. Usually, there is severe pain in the abdomen, sometimes it can be accompanied by bleeding. Emergency medical measures include blood transfusion and emergency cesarean. With frontal and transverse presentation, which is established at the end of pregnancy, the doctor will also recommend a planned operation.
More often you can talk about the 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, a lot depends on the professional experience of the doctor and midwife, who takes birth, the age of the woman in labor, the protocols and regulations that exist in a particular clinic, the country's medical legislation, personal preferences of a woman, and so on.
Examples of relative indications: the presence of scars from the previous cesarean, the lack of progress during childbirth, the large weight and size of the fetus, the mismatch of the size of the fetal head and pelvis of the mother, gynecological diseases, pelvic presentation of the fetus.
The last reason for the operation is, by the way, 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 gluteal presentation a cesarean has a more favorable outcome than natural childbirth. In this case, only gluteal and mixed gluteal previa were studied. Since then, the number of doctors and midwives willing to accept a child in the buttock presentation has decreased significantly. Therefore, it is easier and calmer for a woman to agree to a planned cesarean than to give birth surrounded by frightened doctors.
The progress and description of the operation
The operation can be carried out both planned and in an emergency. In the first case, the expectant mother should not eat and drink after midnight on the day of the operation. An intervention is performed under anesthesia. An incision is made on the abdominal cavity and uterine wall, horizontal or vertical. After removing the baby, the uterus is pulled together with special absorbable threads, and the abdominal cavity with cosmetic sutures, which also absorb over time. The operation lasts an average of 30-45 minutes, sometimes up to 60 minutes.
Caesarean section anesthesia methods
General or local anesthesia is used. The general immerses the woman in a medical dream, anesthesia is introduced through the tube into the respiratory tract. General anesthesia is faster, but after waking up causes nausea, drowsiness, shoulder pain and other unpleasant consequences. With local anesthesia, a woman will not feel pain, but only some pressure and twitching.
Cesarean section for mother
A 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 organs of the abdominal cavity, infection, a negative reaction of the body to pain relief, impaired functioning of the intestine. The risk of death with caesarean section is four times higher than with natural childbirth.
After the operation, the woman will need to stay in the hospital longer. Mom and baby will be discharged no earlier than five days later. After six weeks, the woman needs to go to the gynecologist for an examination. The next pregnancy is better to plan no earlier than one and a half to two years after surgery.
Care after cesarean: in the hospital and at home
Features of care are individual. The baby is applied to the mother’s chest with the permission of the doctor. In some cases, this is possible immediately after it is removed from the uterus. A woman can be prescribed painkillers, medications for nausea. At first they will be allowed to drink water, after - light decoctions and diet food. Probable problems with the intestines, slight discomfort, pain from uterine contractions. A woman will be recommended to wear compression golf. Within two months after the operation, you can not lift anything heavier than the child.
At home, natural feeding is allowed. It is not recommended to drive, lift weights, do heavy housework, introduce tampons, have sex (until the first visit to the gynecologist). A shower is generally allowed, but bathtubs should be put off until later. In order to avoid problems, all recommendations given by the attending physician must be followed.
Caesarean section: pros and cons
If a woman has the opportunity to think about the need for a cesarean section and decide on her own (but, of course, based on the recommendations of the attending physician), it is worth carefully weighing the pros and cons. Arguments for - this is the impossibility of injuries of the genitals and ruptures during surgery and rapid delivery. Among the minuses, women call the lack of a psychological connection with the child, pain in the stitches, limitation of motor activity and the need for special care after surgery, a scar.
Serious enough and the consequences after cesarean. This is the psychological state of the mother, and pain, a scar on the abdomen, the inability to take a bath and resume sexual relations for several months, restrictions on physical activity. There are consequences for the child. It is possible that the amniotic fluid will remain in the baby’s airways, and drugs for anesthesia will get into his bloodstream. They also talk about the psychological consequences. It is generally accepted that children who were born through Caesarean section adapt worse to environmental conditions.