It happens that sometimes pregnancy proceeds with some violations, because of which it is contraindicated for a woman to give birth by herself. In such situations, the doctor may prescribe a scheduled C-section.
There is no definite answer on when a planned cesarean section is done, since each pregnancy is individual. Therefore, the time of the operative birth is determined by the gynecologist individually for every woman.
A scheduled C-section is a pre-planned surgical intervention prescribed to pregnant women who have contraindications for natural delivery. The operation is appointed when there are absolute indications for its implementation. The question of the need for delivery in this way is decided by the gynecologist in advance.
A woman undergoes a thorough examination by a gynecologist, optometrist, general practitioner, endocrinologist and other doctors.
If specialists come to the conclusion that C-section is necessary, then the date of surgery is assigned to the woman, about a week and a half before which the patient is placed in the hospital. Also, a pregnant woman needs to determine in advance the type of anesthesia.
During the surgery, the peritoneum wall and uterus are cut, and then through the incisions made, the child is taken out.
Nowadays, with a scheduled c-section, a transverse incision is usually made. Such obstetric operations (scheduled C-section) are quite common, saving the lives of thousands of babies.
Caesarean section is a fairly serious surgical intervention. So, it is absurd to say that such a birth is much easier than natural birth. There are many risks associated with this surgery, and a decision for a cesarean section is made only if childbirth is through the natural birth canal threatens the life of a mother or a child. For this, there are certain indications, the list of which is clearly agreed and limited. There are indications from the mother’s and the child’s side.
Indications from the mother
- an anatomically narrow pelvis, when a child cannot pass through a narrow bony ring;
- clinically narrow pelvis – when a specific child is too big for a particular mother and cannot be born naturally;
- the location of the placenta in the pathway of the baby;
- pelvic and spinal injuries;
- perineal muscle injuries, perineal tears, perineal plastic surgery;
- pelvic tumors that interfere with the passage of the baby;
- pathology of other organs and systems, in particular cardiovascular, diseases of the organs of vision, and if there is a risk that during childbirth, an aggravation of the underlying disease of the woman may occur, which will entail serious complications;
- stillbirth in the past, along with some obstetric pathology during the current pregnancy, etc.
Indications from the child
- intrauterine suffering of the baby, in which he cannot be quickly born;
- his misrepresentation;
- other indications.
Proсess of the Scheduled C-section
In a scheduled c-section, a pregnant woman enters the maternity hospital a few days before the proposed date of surgery. In the hospital, an additional examination and medical correction of the revealed deviations in the state of health is carried out. The condition of the fetus is also evaluated; cardiotocography (registration of fetal heartbeats), ultrasound, etc. The estimated date of surgery is determined based on the condition of the mother and fetus. The gestational age is taken into account as well. As a rule, a scheduled c-section is performed at 38-40 weeks of pregnancy.
1-2 days before the operation, the therapist and the anesthesiologist must consult the pregnant woman, discussing with her the anesthesia plan and possible contraindications to various types of anesthesia. The doctor explains the approximate plan of the operation and possible complications, after which the pregnant woman signs the consent to the operation.
On the night before the operation, the woman receives a cleansing enema and, as a rule, sleeping pills. In the morning before surgery, the intestines are cleaned again and then a urinary catheter is placed. On the day before surgery, the pregnant woman should not have dinner. On the day of the operation you can neither drink nor eat.
Currently, when performing a caesarean section, regional (epidural or spinal) anesthesia is most often used. At the same time, the patient is conscious and can hear and see her baby immediately after birth. In some situations, general anesthesia is used as well.
The duration of the operation, depending on the technique and complexity, is on average 20-40 minutes. At the end of the surgery, ice is placed on the lower abdomen for 1.5-2 hours, which helps uterus contraction and reduce blood loss.
Normal blood loss during ordinary birth is approximately 200-250 ml. Such a volume of blood is easily restored by a woman’s body. With a caesarean section, blood loss is slightly more physiological: its average volume is from 500 to 1000 ml. So, during the operation and in the postoperative period, intravenous administration of blood-replacing solutions is carried out: blood plasma, red blood cell mass, and sometimes whole blood. It depends on the amount of blood lost during the surgery and on the initial state of the woman in labor.
Risks Associated with C-section
The conclusion about the need for cesarean section is taken doctors. In this case, a woman must sign a paper confirming consent to the operation and that she is familiar with the risks associated with the surgery, the most significant of which is the high mortality of women in labor (1 case per 1000 births).
Here Are the Main Risks for Mom
- Risk of infection of the pelvic organs, such as the bladder or kidneys.
- Increased blood loss.
- Poor functioning of the intestines. After surgery, the intestines do not work for several days, it may require the introduction of enemas.
- General anesthesia can sometimes cause pneumonia.
- Severe pain in the first days after surgery, which finally disappear somewhere in 2-4 weeks after childbirth.
- A longer recovery period, as well as a hospital stay.
- Reactions to anesthesia, such as a sharp drop in blood pressure or other complications.
- Risk of reoperation. For example, hysterectomy (removal of the uterus), restoration of the bladder, which may be damaged during surgery.
Risks for the Baby
- Premature birth. If, during a scheduled C-section, the date of the alleged birth was set incorrectly, then the child runs the risk of being born prematurely.
- Children born by caesarean section have a higher risk of developing problems with the respiratory system, for example, the occurrence of rapid irregular breathing during the first days of life, pneumonia, etc.
- The use of anesthesia in childbirth, especially general one, can lead to inhibition of the central nervous system. Children after cesarean section in the first months may have troubles with sucking and waking up for feeding.
- Sometimes children who have had C-Section suffer from breathing problems and have troubles maintaining normal body temperature.
- Intrauterine trauma. Despite the fact that such injuries are quite rare, the surgeon may accidentally injure the child during the dissection of the uterus.
Contraindications for Surgery
- There are no absolute contraindications to cesarean section surgery. All relative contraindications are associated with the development of inflammatory complications in the postoperative period.
- Any acute diseases or exacerbation of chronic diseases in a woman, a long anhydrous period (over 6 hours), the duration of labor over 12 hours and all immunodeficiency conditions are factors that increase the risk of inflammation.
- In these cases, during the operation, the doctors closely monitor the condition of the young mother, as a rule, they prescribe additional treatment, for example, antibiotic therapy, treatment aimed at stabilizing the immune system, etc.
Pregnancy after Cesarean Section
It is traditionally recommended to abstain from subsequent pregnancy for 2 years after surgery. Abortions during this period are also extremely unfavorable due to the effect on the tissue in the scar area. Therefore, a woman should take special care of contraception.
It is possible to assess the state of the uterus in the scar region by ultrasound (thickness in the scar region, tissue uniformity). If the indications for surgery were an anatomically narrow pelvis and somatic diseases of a woman (for example, high myopia or shortsightedness), subsequent deliveries will also be performed by cesarean section.
In the case of “transient” indications (incorrect insertion of the head, pelvic presentation, violation of the fetus, etc.), the situation requires analysis at the moment.
Natural childbirth after a cesarean section is possible with a full scar on the uterus, the absence of absolute and relative indications for repeated surgery and the desire of the woman herself to enter the birth on her own. Of course, such a woman in labor requires special attention. If any complications occur, doctors should be prepared to proceed with a cesarean section.