Caesarean section, possible complications

But it turns out that the data on this risk are ambiguous, and therefore there is no strict ban on food during childbirth (it is better to choose something small and satisfying – cookies, cheese and so on).

Water and other fluids do not carry an additional risk (on the contrary, drinking in childbirth is good), since they do not lead to a significant increase in the volume of the stomach and do not increase the risk of aspiration.

Where did all this talk come from? The ban on food and drink during childbirth is associated with the potential risk of aspiration of the gastric contents during anesthesia – a situation in which the contents of the stomach enter the respiratory tract, blocking them partially or leading to the development of pneumonia in the future.

Is it possible to eat and drink during childbirth (after all, the probability of cesarean is never equal to zero)

So, cesarean section is performed necessarily and urgently in the following cases:

• there is a danger to the life of the fetus: a slowing of the fetal heartbeat or a changing heart rate during childbirth, the release of meconium (the original feces) with an exploding fetal bladder, prolapse of the umbilical cord, etc.;
• there is a danger to the mother’s life: massive bleeding, a sharp increase in blood pressure, etc.;
• there are mechanical obstacles to the birth of a child: the narrowness of the birth canal of the mother and / or the fetus is too large. The dimensions of the mother’s pelvis are measured when registering in a antenatal clinic; if a woman has discovered one or another type of narrowing of the pelvis, careful monitoring of the estimated size of the fetus is carried out. The tactics of labor management is built taking into account the correspondence of the size of the birth canal of the mother and the fetal head;
• the weakness of labor activity (the absence of an increase in the strength of contractions and the corresponding advancement of the child along the birth canal), which is not amenable to medical correction.

Caesarean section is most often performed in the following cases:

• previous births were performed by caesarean section. But this is not always necessary, now in many maternity hospitals you can give birth on your own after a cesarean section;
• there is placenta previa – a situation in which the placenta is not the head or the pelvic end of the fetus, but the placenta to the internal pharynx (exit the uterus). In this case, when the cervix is ​​opened in the first period of labor, massive bleeding will be observed (almost always an indication for surgery);
• the fetus does not have a headache (pelvic, transverse position of the fetus). I note that a couple of decades ago, pelvic presentation was not an indication for surgery, but now in Russian regulatory documents, an indication for caesarean section is the fetal weight of less than 2,500 grams and more than 3,500 grams with pelvic presentation;
• in the cavity of the mother’s pelvic cavity there are large tumors / cysts;
• at the time of birth, the mother has exacerbated genital herpes and / or anogenous warts (condylomas), that is, there are herpetic eruptions or massive papillomas on the genitals;
• the mother has non-gynecological serious health problems, such as arterial hypertension, diabetes, retinal problems;
• as a result of childbirth came to light tr oynyashki and more of the fruit;
• the mother has HIV infection, then childbirth by cesarean section reduces the likelihood of infection of the child (under certain conditions, natural childbirth is possible).

How is the operation

Caesarean section is most often performed under epidural or spinal anesthesia. The incision is performed, as a rule, horizontally, in the lower abdomen. The scar after surgery is thin and inconspicuous; after healing, it hides quite well under the underwear.

Sometimes the incision is performed vertically, then the scar is larger and more noticeable. Fortunately, this situation is rare.

Such a cut is needed:

• if the previous cesarean is performed in this way;
• if it is technically impossible to make a horizontal cut;
• if there was a completely unforeseen and emergency situation (sometimes it’s faster to finish the birth).

If epidural or spinal anesthesia is used, the woman is conscious – she hears and sees her baby just a few minutes after the start of the operation (tissues are cut and bred quite quickly, but layer-by-layer suturing takes longer).

If everything goes well, the first attachment to the chest occurs immediately after the operation.

How is recovery after surgery

In the hospital

After the operation, the woman will have to spend some time in the intensive care unit, where doctors will monitor the main vital signs. However, this does not mean that you will have to wait a while with the start of breastfeeding (this should be discussed with the doctor in advance).

And yes, the seam will hurt. But heroism is not worth it – you can use painkillers. In general, you need to say if it hurts.

You will have to spend some time in bed, but very soon, often already on the first day, you can start to get up, although it will not be easy. Be sure to call someone (a nurse, doctor) before trying to get out of bed for the first time after surgery. When you can walk to the toilet yourself, the urinary catheter will be removed.

You can eat and drink whenever you want (with the permission of the doctor, of course).

Often after surgery, therapy is prescribed that regulates blood coagulation. You should be told and shown what drugs, how and how many days you need to take.

The discharge can be early (two to four days after delivery) or occur a little later (usually no more than seven days, if there are no complications). Check with your doctor when discharge is planned so that you can prepare for your return home.

At home, you need to take care and not allow yourself excessive loads in the first time after the operation. You should refrain from sex and sports for six weeks (if there is an urgent need, you should discuss this issue with your doctor). Do not forget about contraception when resuming sexual activity. The absence of menstruation (if the baby is breast-fed) does not mean that you cannot become pregnant. After cesarean section, it is especially important to prevent the next pregnancy from happening too early.

Pain in the suture can be troubling for several weeks, be sure to discuss with your doctor what you can use to relieve pain before discharge. Watch the seam. Increased pain, redness, the appearance of abundant discharge in the suture area, as well as a local or general increase in temperature – an occasion to see a doctor.

Do not wear tight clothing at home. Friction and excessive sweating in the seam area will not accelerate the healing process. It is because of this that it is better to avoid driving a car for some time (so that the seat belt does not come into contact with the seam). Many women after cesarean are more comfortable walking in the bandage, but if you are uncomfortable, hot or painful in it, you do not need to use it constantly.

Care must be taken at the seam; the maternity hospital will show how and what to do. It’s okay and complicated, but the ostrich position (not peeling off the patch and not looking that with a seam) is not the best tactic.

The seams, by the way, most often do not need to be removed (they will resolve themselves). If you used threads that have to be removed, you will definitely be informed about this.

What can be the complications

Fortunately, in the modern world, such complications are quite rare.

• infectious complications (from suppuration in the scar to sepsis);
• blood loss (and possible subsequent violations in the blood coagulation system);
• thrombosis, thromboembolism;
• bladder, bowel injuries;
• allergic reactions to the drugs used.

Carefully monitor your condition and be sure to inform your doctor if you have any unpleasant symptoms (fever, weakness, cough, pain in any area except the suture (or increased pain in the suture), problems with urination, bowel movements.

Pros and cons of cesarean section compared to natural childbirth

pros

• With caesarean section, the perineum does not rupture with severe consequences.
• Dilation of the shoulders is possible only with natural childbirth.
• For some women, cesarean section is the preferred method because of fear of pain during childbirth.

Minuses

• With caesarean section, the likelihood of severe complications (bleeding requiring removal of the uterus or blood transfusion, rupture of the uterus, cardiac arrest, thromboembolism, etc.) is three times higher.
• With caesarean section, the probability of death for a woman is three times higher.
• Amniotic fluid embolism is two to five times more likely with caesarean section.
• After a cesarean section, the risk is higher that the child will be in intensive care for various reasons.
• Abnormalities of the placenta are more common after cesarean section (the risk increases with each subsequent delivery by cesarean section).
• Perhaps (admittedly, very unlikely) a fetal injury with a scalpel.
• According to some reports, after a cesarean section, the fetus has a higher risk of respiratory disorders.

Meet with the same probability after natural birth, and after cesarean: urinary incontinence, postpartum depression.

It is worth mentioning right away: when we talk about risks after cesarean section, we must understand that cesarean is often (not always, of course) performed according to indications, that is, initially there are “aggravating” circumstances that affect the number of adverse consequences.

What you should know if you really want a natural birth, but there are suspicions that there will be a cesarean

Indications for childbirth (weak labor, impaired fetal heart rate, uterine rupture, bleeding)

No amateur performance – the doctor makes decisions in childbirth, he takes responsibility for you too! If the doctor suddenly after the start of labor says that it is now necessary to do a cesarean, then we must obey (for the sake of the health of the child in the first place).

Pelvic presentation of the fetus

It is possible (and shown) to attempt an external obstetric turn (turning the fetus at 37 weeks of gestation). Important: this manipulation should only be done by experienced doctors who can turn! As far as I know, in Russia there are not very many of them. Do not demand a turn from the doctor who never did it. The probability of success is small, but with a successful turn, natural birth in the head presentation is possible.

Large fruit

Yes, natural childbirth with a large fetus (especially in the case of the first birth) is hard. But if a woman wants to try, it is worth considering that cesarean is strictly shown with an estimated fetal mass of five kilograms or more (which happens extremely rarely). With a fetal weight below five kilograms, natural childbirth can be discussed (if the woman wishes, the experience and mood of doctors).

Small fruit

If, according to ultrasound, the child is too small (in the absence of developmental abnormalities), then this fact itself should not serve as an indication for cesarean: the outcome for such babies does not improve after cesarean section.

Twins

To begin with, we clarify that three or more fruits are an indication for cesarean section. No reasoning. But twins with the head presentation of the first fetus and any presentation of the second – the basis for an attempt at natural childbirth. Delivery by caesarean with this arrangement of fruits does not improve outcomes for mothers and children. Again – for the natural birth of twins you need a great desire of a woman and the experience of obstetricians!

Genital herpes

Herpetic eruptions on the genitals at the beginning of childbirth are a strong argument in favor of Cesarean. However, there are prophylactic regimens of antiviral drugs that help avoid rashes at the beginning of labor. Be sure to discuss the possibility or necessity of taking antiviral drugs, if ever, during or before pregnancy, you had genital herpes. Important: genital herpes, which bothered you during pregnancy (1-2 trimester), but does not bother at the beginning of childbirth, is not a reason for cesarean section.

Premature birth

Preterm birth is always a stress for a woman. If the condition of the child does not worsen, natural childbirth is possible – cesarean will not provide a better outcome for the child. But doctors must tell you that the baby is not suffering and there are no other indications for cesarean section, except for premature birth.

Mom’s weight

Control of body weight during pregnancy is important for many reasons: in particular, the more a woman gains during pregnancy, the higher the risk of cesarean. However, there is no BMI value above which only a caesarean section is shown. Therefore, it is worth monitoring the weight both during pregnancy and without it, in order to prevent obesity. But weight should not affect the choice of the option of childbirth without other aggravating circumstances.

HIV positive mom

Undoubtedly, every woman wants to minimize the risk of infection for her child. If a woman receives adequate therapy, and the viral load is low (below 50-400 copies / ml), a cesarean section does not give advantages in terms of the risk of infection of the baby, and therefore the choice between natural birth and cesarean should not be made only on the basis of the HIV-positive status of the mother. Moreover, for women who do not receive therapy and have a load of more than 400 copies / ml, caesarean is recommended.

Hepatitis B in mom

If a woman gives birth in a maternity hospital, which can provide proper manipulations for the baby after birth (immunoglobulin administration, vaccination), the risk of infection does not depend on the method of delivery, and therefore natural births are possible.

Hepatitis C in mom

Since a cesarean section does not reduce the risk of a baby becoming infected if the mother has hepatitis C, natural births are possible. But with HIV and hepatitis C infection, the risk of infection of the child is reduced by cesarean section, therefore, such women should undergo a cesarean.

– Women have different attitudes toward childbirth: someone wholeheartedly wants a natural birth, someone dreams of a cesarean section. Despite the fact that in the orders of the Ministry of Health there is no indication “at the request of a woman”, many international recommendations agree that if a woman is categorically tuned for a cesarean section, she has the right to it. If you are panicky afraid of natural childbirth, do not step over yourself.

Is it possible to influence the probability of emergency caesarean if childbirth has already begun

The main rule is to obey the doctors and listen to yourself. On the part of the woman, no special actions that will increase the chance of natural birth and lower the risk of cesarean are not yet invented.

But that does not affect whether the delivery will end in a Caesarean section:

• The activity of a woman in childbirth (want – go, do not want – do not go).
• The position of the woman in childbirth (on the back, sitting, upright, whatever).
• Finding a woman in the water.
• Use of epidural anesthesia.
• Acupuncture (before or during childbirth).
• Aromatherapy
• Hypnosis.
• Herbs in any form.
• Dietary supplement.
• Homeopathy.