C-section: pros and cons
Many pregnant women are interested in c-section, its pros and cons, as is carried out cesarean section. Let’s look at everything in order.
A caesarean section is abdominal surgery that is medically indicated. The surgeon makes a cut in the abdominal wall and uterus, through which the baby is removed. Often, the decision is made by the doctor if the woman in labor has appropriate indications that make impossible natural childbirth or are a threat to the health and life of the mother or baby.
Indications for cesarean section are divided into indications from the mother and from the fetus. Absolute indications (operation is inevitable) and relative (issue is decided in favor of natural childbirth or operation after a comprehensive analysis of the situation) are also distinguished.
Absolute indications from the mother:
- Anatomically narrow pelvis (3rd and 4th degree of constriction).
- Full placenta previa (placenta is located above the internal pharynx, the passage of the fetus through the birth canal becomes impossible).
- Threatened and started uterine rupture (emergency situation requiring slow delivery to save the mother’s life).
- Bleeding from the genital tract placenta puff, incomplete placenta previa, when the placenta partially obstructs the exit of the uterus with unprepared birth canal, which is also a threatening condition for the life of both the mother and the child.
- Defective uterine scar (the threat of divergence of the scar, existing after a previous operation on the uterus).
- Severe forms of preeclampsia in unprepared birth canal — a serious complication of pregnancy, which is characterized by vasospasm of many organs and systems. This complication is often manifested by increased blood pressure, the appearance of edema, protein in the urine, in very severe cases a woman develops an attack of seizures — eclampsia.
- Severe varicose veins in the vagina (passage of the fetus through the genital tract can cause bleeding in the background of even minimal tissue damage)
- Obstacles along the birth canal (cicatricial changes of the cervix, vagina, pelvic tumor).
- High myopia (myopia); retinal detachment may occur on the background of generic activity.
- Diseases of the cardiovascular system (heart defects), etc.
Relative indications from the mother:
- Clinically narrow pelvis (in childbirth there is a mismatch between the head of the fetus and the size of the pelvis of the mother).
- Weakness of labor, which leads to protracted traumatic labor.
- Incorrect insertion and presentation of the fetal head (the head is inserted not in the smallest size, as is normal, this results in a clinically narrow pelvic situation or childbirth is accompanied by other complications such as injury to the mother during labor, perineal rupture, deterioration of the fetus.
- The transverse position of the fetus (the fetus in the uterus is not longitudinally, but across).
- Pelvic presentation in combination with other aggravating factors (it is not the head of the fetus that is presented to the birth canal, but the pelvic end, which creates difficulties during childbirth, especially when the weight of the fetus exceeds 3500 g).
- The first birth at the age of over 30 years in combination with one of the above pathologies.
- Hypoxia of the fetus (lack of oxygen and nutrients), chronic placental insufficiency, which is not amenable to medical correction (decrease in oxygen supply to the fetus through the placenta, which disrupts the process of normal development of the child).
- Prolonged infertility.
- Prolonged pregnancy1 in combination with another pathology (during a prolonged pregnancy, the fetus is worsened if labor induction does not give the desired effect.
- A scar on the uterus after interventions (cesarean section in the past, removal of uterine fibroids).
Absolute evidence from the fetus:
- Acute hypoxia of the fetus in the absence of conditions for immediate delivery.
- The transverse position of the fetus after the use of amniotic fluid.
- Extensive (irregular) insertions of the fetal head (if normally the fetal head is bent to the chin, which ensures its promotion with the smallest head size, then with the extensor insertions the fetal head moves with the forehead or little face).
- Death of a mother with a live fetus.
Relative indications from the fetus:
- Chronic placental insufficiency (decrease in blood circulation to the mother-fetus system).
- Pelvic presentation of the fetus with its mass over 3500 g.
- Multiple pregnancy with pelvic presentation of the fetus.
Benefits of C-section
The unconditional advantages of caesarean section for the mother include:
- The ability to plan the appearance of the baby up to the day;
- Childbirth is relatively fast and not so painful;
- These are relatively safe deliveries in women with clinically narrow pelvis;
- In cases where natural childbirth threatens the health or even the life of the mother or child, the harm from cesarean section is much less than from possible complications during natural childbirth;
- After cesarean section there are no problems with sex life, since the vagina does not stretch, there are no seams on the perineum from episiotomy;
- Caesarean section helps to avoid hemorrhoids and pelvic organ prolapse.
Risks for c-section
However, there are also disadvantages to performing a cesarean section:
- Some chance of infection in the abdominal cavity of a woman;
- In some cases, the likelihood of serious, including fatal complications for the mother is about 10 times higher than at birth through the birth canal, therefore, you must first consult with your doctor who monitors the pregnancy;
- In some cases, there is difficulty at the beginning of lactation;
- A woman will feel pain for a while in that part of the abdomen where the sutures are applied;
- A scar on the uterus after a cesarean section causes a long break between the events and the next birth (if you plan two or more pregnancies), since during contractions at the next birth the contractions of the uterine muscle layer are so strong that the scar in some cases (according to statistics 1-2 %) does not stand up and breaks. This problem can be solved if the doctor immediately after cesarean section starts the necessary therapy for the rapid healing of the uterine incision site, that is, it is necessary to take care of the next pregnancy in the first hours after the delivery;
- Sometimes after such an operation, the mother has stress with the development of psychosis due to the so-called “incompleteness” of the physiological process of natural childbirth.
Pregnancy after c-section
Many women are afraid to become pregnant after cesarean section, because the bearing of the fetus in the uterus, which has a postoperative scar, is not easy. Doctors insist that the second pregnancy after surgery should be no earlier than 2 years. However, if the pregnancy occurred earlier, this does not mean that it will have to be interrupted — just more often and carefully observe the doctor, take care of yourself, prevent the uterus tone and regularly visit the ultrasound, especially in the third trimester.
If you are going to plan your childbirth, set yourself up for a period of 2 years, this is precisely this period that the female body can fully recover from the experience, and a strong scar will appear on the uterus that will not lose its viability during the birth of the baby. If the scar is untenable, the life of the mother and the life of the child will be in danger.
Obstetrician-gynecologists recommend to undergo an examination, during which it will be determined what is the thickness of the scar. To do this, make histoscopy and intravaginal ultrasound of the uterus. The doctor also determines what tissue the scar consists of: if the muscle is of the next child, the woman can give birth naturally, and if of the connective, this can be an indication for the second cesarean section.
Pregnancy in women who have undergone a cesarean section, proceeds according to the same scenario, just the doctors will monitor these patients more closely. At each appointment, in addition to the usual examination, the gynecologist palpates the suture on the uterus and carefully examines it. Natural childbirth is possible if the operation was not planned, for example, placental abruption began. If this is related to the patient’s state of health, then the second birth will most likely be artificial. It also depends on the condition of the scar. Of course, if there are no contraindications, natural childbirth is preferable — the body will recover from them faster.
Also, doctors take into account the fact of what operation was performed: if the scar is longitudinal, then childbirth is naturally not allowed, the transverse scar is more favorable for childbirth. Check in advance with all this from the doctor who will give you an extract: your caesarean section, the duration of the birth, the indications for surgery, possible complications, the method of prevention, the amount of blood loss should be indicated on your card.