The proportion of abdominal births has increased, and today one in five pregnancies ends in a caesarean section rather than a vaginal birth. The operation has its unconditional pros and cons. We will talk about the advantages and disadvantages of surgical childbirth, and how likely complications are to develop after it, in this article.
Who is the operation indicated for?
Caesarean section is an alternative method of delivery in which the baby is born not in the traditional way, but through incisions in the anterior abdominal wall and uterus. The operation, despite its apparent simplicity and widespread use, belongs to the category of complex surgical abdominal interventions. And therefore in Russia it is not carried out at will, at least in state maternity hospitals, perinatal centers and clinics. Only a few private clinics provide for the possibility of an elective caesarean section (surgery at will women). In these clinics, such a service costs about half a million rubles.
A list of situations in which it is safer and wiser to give birth surgically, stipulated and approved by the Ministry of Health of Russia (letter of the Ministry of Health dated 2014 No. 15-4/10/2-3190). Thus, a caesarean section is prescribed routinely in the following situations.
- low location of the placenta with complete overlap of the internal os or incomplete overlap, as well as presentation with signs of abruption and bleeding;
- premature detachment of the “baby place” from the wall of the uterus, while the location of the placenta does not play a role;
- two births carried out by caesarean section in the past, as well as any operations on the uterus, if scars remain after them;
- fetal weight more than 3.6 kg with the baby in the wrong position in the uterine cavity (sitting, positioned transversely);
- incorrect positioning of one baby of twins;
- multiple (often singleton) pregnancy that occurs after IVF;
- post-term pregnancy (at 41-42 weeks of gestation), if other methods of inducing labor have had no effect;
- any mechanical obstacles to the passage of the child through the birth canal - tumors, large groups polyps, scars after cervical ruptures;
- a state of severe gestosis (with edema, large weight gain, signs of increased blood pressure);
- prohibition on pushing (for myopia, some diseases of cardio-vascular system, transplanted donor kidney, etc.);
- state of acute oxygen starvation of the fetus (of any origin);
- umbilical cord prolapse;
- genital herpes of the primary type;
- HIV infection in the mother, if during pregnancy the woman for some reason did not receive maintenance treatment;
- a narrow pelvis, in which independent childbirth will be difficult;
- bleeding disorders of the mother and fetus;
- malformations of the baby - omphalocele, gastroschisis, etc.
As for emergency surgery, there are other indications for it. An unplanned operation will be urgently performed on a woman in labor whose contractions suddenly weaken during childbirth, the cervix does not dilate, there is secondary weakness in pushing, the placenta has separated, and bleeding has begun. This will be an operation to save the lives of the mother and her long-awaited baby.
Technique
The operation is performed using anesthesia. The patient has every right to choose general anesthesia, in which she will sleep soundly during all surgical procedures. But most of Surgical births in Russia today are carried out under epidural or spinal anesthesia, in which anesthetic drugs are injected into the epidural or subarachnoid space of the spine using a lumbar puncture. During an emergency caesarean section, when every minute counts, general anesthesia is usually given, since there are practically no contraindications to it, and the state of unconsciousness occurs faster.
After the woman is anesthetized or given general anesthesia, the surgical team begins the operation. During a planned intervention, they try to make a horizontal incision in the abdomen just above the pubis in the lower uterine segment. In an emergency operation, if the child is in danger of dying, a vertical incision may be made in the center of the abdomen through the navel.
After opening abdominal cavity the doctor frees up space for himself for further “maneuvers” - he takes him aside muscle tissue And bladder. After this, an incision is made in the uterus, the fetal sac is pierced and the amniotic fluid is drained. Then the surgeon carefully removes the baby, head first, through the incision.
The baby's umbilical cord is cut and the baby is handed over to neonatologists. The woman is reconstructed in stages, first the uterus, applying internal sutures, then the abdominal cavity, returning the muscles and bladder to their original anatomical state and applying sutures or staples to skin outside.
The woman, if she is not under general anesthesia, will be able to see her baby right away. If she is fast asleep, then the meeting will be postponed and will take place only a few hours after the birth.
In the ward intensive care the new mother remains for several hours after the operation, after which she is transferred to the postpartum ward in a regular ward, where already 8-10 hours after the intervention she can begin to sit down, stand up, and walk.
Advantages
The undoubted advantage of cesarean section can be considered the relatively predictable outcome of the intervention. Probability birth injuries for both the child and his mother is minimal. The child does not need to pass through the narrow birth canal, and therefore there is practically no chance of getting a neck or head injury during surgical childbirth. Whereas with a narrow pelvis or a large baby in a breech presentation, injuries to the newborn and his mother during a natural birth would be much more likely.
Caesarean section gives the opportunity to become mothers for women who are contraindicated natural childbirth. And today the quality of materials for suturing fabrics and surgical technique make it possible to quickly give birth to not one or even two children, but as many as the woman wants.
During a caesarean section, a woman does not feel labor pain, which frightens pregnant women most of all and the memories of which are never erased from memory. Women in labor have some fear of what is happening when using epidural anesthesia, but it is more psychological.
If general anesthesia is used, then the woman simply falls asleep and wakes up in the status of a mother.
The use of spinal or epidural anesthesia allows you to correct the deficiency that long years was irremovable - the woman gets the right to see the baby immediately after he is removed from the womb, and also has the opportunity to put the baby to the breast, which is very important for the early establishment of lactation and full subsequent breastfeeding.
A caesarean section, if done routinely, does not leave gross, disfiguring scars on the patient’s abdomen. Doctors do everything possible to ensure that the stitch is neat, inconspicuous, cosmetic, located in an area that is usually well covered by panties or swimming trunks. Each subsequent operation, if a woman decides not to limit herself to one child, is carried out on the same scar; no new scars appear on the abdomen and uterus.
Caesarean section provides the opportunity to perform additional surgical procedures. If there is a need to ensure lifelong contraception, then tubal ligation is performed at the same time, and tumors in the uterine cavity can be removed.
The duration of a surgical birth usually does not exceed 45 minutes, while a natural birth can last up to a day or even more.
Flaws
Caesarean section is not a natural birth; it is always a gross intervention in the functioning of the female body. If the operation is carried out as planned, then often the mother’s body is not yet ready for childbirth (contractions have not started), so removing the child using the abdominal method is a huge stress for both the mother’s body and the baby’s body.
The drugs that anesthesiologists use to relieve pain during surgical procedures affect not only the woman, but also the baby, even if we are talking about spinal anesthesia. A baby born with the help of a surgeon cannot have an Apgar score of 9 in principle, since he is always more inhibited and lethargic - he is affected by anesthetics and muscle relaxants that were administered to the mother for anesthesia. True, after a few hours this effect wears off.
The baby is deprived of the opportunity to follow the path prepared for him by nature - he does not overcome the resistance of the reproductive tract in order to be born, and this, according to some experts, is bad and will certainly affect the formation of his character in the future. Thus, it is argued that such children are less proactive, afraid of difficulties, and have less resistance to stress.
Many questions have not yet been fully studied, but the fact that without passage through the genital tract a baby is deprived of the opportunity to gently adapt to the new conditions in which he will live is indisputable.
The statements of some opponents of cesarean section that children then grow up with developmental delays, need correctional programs, and get sick more often, do not correspond to reality, and therefore cannot be considered as a disadvantage.
Caesarean section is dangerous due to its complications, and their likelihood compared to physiological independent childbirth increases several tens of times. The recovery and rehabilitation period lasts much longer than after childbirth, breast milk arrives a few days later. Tubal ligation, if performed, lengthens both the operation time and the recovery time of the woman’s body.
After a caesarean section, a woman for more than 2 years is not recommended to become pregnant again, whereas after a physiological birth there is no such prohibition. Lifting heavy objects is harmful, and in the absence of au pairs, routine household chores and caring for a newborn become a very difficult task.
The harm from the operation, of course, does not exceed the benefits, but still you can never be sure that complications and negative consequences will bypass you.
Possibility of complications
Complications are possible at any stage of the operation, as well as after it. During surgical procedures, bleeding may occur from the vessels of the anterior abdominal wall, in case of injury vascular bundle Mechanical injury to the bladder, ureters, and intestines can also occur. If complications arise during the operation itself, the woman will not be placed in the intensive care ward, but in the intensive care unit, where her condition will be monitored for several days, if necessary, a blood transfusion will be given, and the necessary medications will be administered. The frequency of such complications does not exceed 0.01%.
Postoperative bleeding, as well as impaired contractility of the uterus (hypotonia or atony of the reproductive organ), can also have dangerous consequences. In this case, medical assistance will be required and removal of the uterus is possible; if its muscles do not respond to the introduction of contractile drugs, the uterus does not shrink.
A severe vital complication of cesarean section is infectious inflammation. It can lead to the death of the new mother. Symptoms of inflammatory infectious complications – heat, abdominal pain, atypical discharge, wound suppuration, increased leukocytes in the blood test. More often than others, inflammation of the endometrium of the uterus (endometriosis) develops after surgery, but other situations cannot be excluded. Peritonitis is considered the most dangerous of all. In practice, given the sterility of modern operating rooms and the precision of the surgical team, such complications do not occur so often - only in 0.7-1% of cases.
The danger to the child lies in the short-term effects of anesthetics, which can lead to respiratory failure(0.003% of cases). Much more often, respiratory failure develops in newborns if the intervention was performed at 36 weeks of pregnancy or earlier, but it is no longer associated with the operation itself, but with the gestational immaturity of the fetal lung tissue.
Much depends on a properly organized postoperative period.
Preventing problems
For prevention inflammatory processes if they suspect their likelihood, doctors prescribe antibiotics to the woman in the early postoperative period. Since complications most often occur in obese women, systemic concomitant diseases, with low social status And bad habits, as well as with impaired blood clotting, these are the women who fall into the zone special attention medical personnel.
To avoid hypotension or atony of the uterus, early latching of the baby to the breast is recommended, as well as the introduction of contractile and analgesic drugs. If a woman has had 3 or 4 such operations, more careful monitoring of the uterine scar area throughout the year is recommended, as it is thinner than in those who have had one or two operations.
A woman should not lift heavy objects, and she also needs to protect herself. You can begin to be sexually active only when the discharge from the genitals stops, no earlier than 2 months after the birth of the baby. It is strongly not recommended to become pregnant within 2 years; the scar on the uterus during this period is in the stage of intensive formation.
During pregnancy, 4 months or a year after cesarean section, weak and thin connective tissue the area of the incision may not be able to withstand the intense growth of the uterus, which can lead to rupture muscular organ even during gestation.
According to reviews of women left on thematic forums on the Internet, there were no complications after the caesarean section. Due to the fact that they do not occur so often, reviews with descriptions negative consequences almost not. Women for the most part note that the recovery went well, the scar on the abdomen healed approximately 3 weeks after the operation.
IN last years The topic of cesarean section, the pros and cons of this operation is actively discussed by pregnant women. Quite understandable fear of childbirth, apparent “ease” and painlessness surgical method childbirth, the desire to maintain a figure and avoid birth injuries - all this attracts the attention of future mothers.
Today modern medicine provides the opportunity to choose whether to give birth naturally or surgically. IN medical statistics a standard has been adopted for the percentage of cesarean sections out of the total number of births. This figure should not exceed 15%. But, as practice shows, the number of cesareans is much higher, which indicates an increasing desire of women to give birth through surgery. Doctors are concerned about this trend, because the main reason for surgery should be absolute or relative medical reasons, which we will look at in more detail.
Absolute indications for caesarean section
Such indications are pathologies that arise during pregnancy and create a serious threat to the life and health of the mother and child during childbirth. Doctors prescribe a caesarean section for the following abnormalities:
- Placenta previa or premature abruption;
- Tumors in the pelvic organs;
- Late toxicosis;
- Oxygen starvation (hypoxia) of the fetus;
- Beginning uterine rupture;
- Discrepancy between the sizes of the fetus and the mother's pelvis, etc.
Relative indications for operative delivery
If the obstetrician-gynecologist believes that the normal condition of the child or mother during childbirth will be at risk, he will also insist on a cesarean section. Relative indications for surgery include:
- Incorrect presentation of the fetus;
- Pathologies labor activity;
- Chronic diseases;
- Age of the woman in labor, deviations in obstetric history, etc.
The question of prescribing a cesarean section should be considered taking into account all risk factors for both the life of the mother and the health of the newborn. In all of the above cases, surgical intervention has undeniable advantages over all the disadvantages of a cesarean section, because it allows a woman to experience the joy of motherhood. But if you do not have objective medical indications, is it worth resorting to surgical delivery? What really hides behind the apparent ease of non-physiological childbirth?
Disadvantages of a cesarean section for a woman in labor
Every woman who decides to give birth surgically and does not have medical indications for this should know what responsibility she takes on and what risks await her.
You should not think that general anesthesia, under which the operation is performed, is a harmless remedy. Coming out of it, with severe nausea and dizziness, can be very difficult. Against the background of general physical weakness, problems with the digestive, respiratory and reproductive organs may arise.
After the operation, the woman in labor spends at least a day in intensive care; she can feed the baby after two days and only if the caesarean section was completed without unforeseen complications. At the same time, women who give birth naturally put their newborn to the breast from the first day and within a week are actively involved in everyday life.
One of the main disadvantages of a cesarean section is the long period of postoperative rehabilitation. Only after six months the pain in the lower abdomen and discomfort in the suture area finally disappear. In addition, after such an intervention, adhesions usually form in the abdominal cavity, which can provoke:
- Pelvic pain;
- Pain in the lower abdomen;
- Infertility;
- Intestinal obstruction;
- Adhesive disease.
Many surgeons believe that the only way to get rid of adhesive disease is through surgery. However, even this does not guarantee that new adhesions will not appear.
After a cesarean section, a postoperative scar remains, which heals over time. How aesthetically pleasing it will look depends on the skill of the surgeon. Another important disadvantage of a cesarean section is the possibility of infection. No matter how sterile the operation is, the uterus and other genital organs come into contact with air, which can lead to infectious inflammation.
Listed above are the main physiological factors that negatively affect the health of a woman in labor. But besides this, there is also psychological problems arising as a result of the operation.
The period from conception to childbirth is an amazing process, thought out to the smallest detail by nature. As it naturally began, so naturally it should end. There is nothing more beautiful than immediately seeing your baby, hearing his first cry and feeling his tiny body on your chest. Isn't this the pinnacle of happiness?
Women who give birth by Caesarean section will forever be deprived of the opportunity to experience these unique moments. Thus, from a psychological point of view, the natural process remains unfinished, which can cause difficulties during the mother-child adaptation period. In addition, each subsequent birth will take place only through abdominal surgery, and the woman will never be able to experience the joy of contemplating the first minutes of her baby’s life, which for some can be the biggest disadvantage of a cesarean section.
Now let's try to figure out what pitfalls await a child during such a rapid birth.
Above we talked about objective indications for caesarean section, and, of course, the absolute advantage of this operation is that it allows you to preserve the health and life of the baby in such cases. But at the same time, rapid birth can result in problems in the newborn’s adaptation to extrauterine life.
It is known that the fetus in the womb does not breathe through the lungs; they contain fertilized (fetal) fluid. During passage through the birth canal, the baby pushes it out of the lungs, thus completing the maturation process respiratory systems s. During surgery, the baby is removed too quickly. As a result, the lungs do not have time to get rid of fluid and adapt to new conditions. This often leads to the development of pneumonia. Premature babies undergoing cesarean section may experience respiratory distress syndrome. Depressed breathing, in turn, leads to a lack of oxygen. 4.6 out of 5 (56 votes)
Caesarean section has pros and cons, like any operation. Of course the most important advantage of a caesarean section– the birth of a child in cases where otherwise he or the mother would risk their lives. Therefore, let us repeat once again when it comes to caesarean section medical indications, there is simply no question about the disadvantages of the operation.
It is possible to talk about what is worse and what is better, and what are the pros and cons, only when there is a more or less equal choice between a cesarean section or a natural birth.
We often hear that giving birth by caesarean section is painless and quick - the mother and child avoid labor pains, so caesarean section is generally preferable.
Of course, the operation is performed with pain relief. But the pain after surgery is much worse than after a vaginal birth, and lasts much longer. Even with tears or incisions during vaginal delivery, the pain is less than in a surgical wound.
As for the speed of childbirth, the situation is also twofold. The operation itself lasts less time than natural childbirth, but the time of restrictions after it is much longer. Recovery from anesthesia, healing of a wound on the abdomen, pain, recovery from blood loss, increased likelihood of infectious complications, problems with milk supply, restrictions on movement, a ban on lifting the child, taking him in your arms when he cries - all this significantly complicates the life of a postpartum woman after a cesarean section. sections.
Another minus caesarean section– after the operation, my mother is happy for a long time will not be able to cope with the child on her own - so at least for the first month it is better to find a nanny, or ensure the constant presence and help of one of your relatives.
Finally, the undoubted disadvantage of a cesarean section is the psychological state of the postpartum mother, which is explained not even so much by the active Lately propaganda of natural childbirth, as much as hormonal problems. The body does not receive a signal that childbirth has passed, which is why there is a feeling of incompleteness and incorrectness of what is happening. In addition, the uterus does not contract as intensely as after a vaginal birth, especially if the woman is not breastfeeding.
Regarding breastfeeding, we need to say something separately. If some time ago the majority of “Caesareans” were artificial, now the situation is changing.
With a normally scheduled caesarean section using epidural anesthesia, the woman is immediately given a baby to feed. This helps both the contraction of the uterus and the establishment of breastfeeding, in addition, it is useful for psychological state mother and, of course, indispensable for the baby. The use of modern antibiotics does not require cessation of breastfeeding.
Talking about pros of caesarean section, in addition to the most important thing, which has already been discussed, we can say that after a caesarean section the vagina does not stretch, there are no tears or stitches in the perineum, and then there are no problems with sexual life. There are also no sprains and prolapse of the pelvic organs (bladder), cervical ruptures, exacerbation of hemorrhoids and related problems.
To summarize, we can once again say that, if necessary, a caesarean section is a salvation for mother and child. If there are no indications, then most doctors categorically do not advise going for surgery only because of fear of childbirth.
If there is no urgent need for surgery, then there is no need to think about the pros and cons of a cesarean section - natural birth is preferable for both mother and child, and a cesarean section should remain only as a medical operation for certain indications.
It is no secret that almost all women, especially those who are going to give birth to a child for the first time, experience fear of childbirth. Every second patient of mine turns to me with a request to perform a surgical delivery, not taking into account the fact that in any operation there are much more disadvantages than positive aspects.
On the one hand, the CS seems like a simple event - you fell asleep under the influence of anesthesia, woke up, and the baby was already nearby. In fact, there are plenty of disadvantages to a caesarean section for the baby and the mother. Therefore, gynecologists almost unanimously insist on natural childbirth if there are no indications for surgery. But not everyone listens to such a reasonable opinion, and many women go to give birth in private clinics, where CS can be done without any indication for a fee. Is this a reasonable decision? Let’s look further, finding out in detail why a caesarean section is dangerous for the mother, and the pros and cons for the child.
Why is a caesarean section dangerous for a baby?
The most important harm lies in the child’s difficulties in adapting to atmospheric pressure. When passing through the birth canal, the baby gradually prepares to meet the world, and his body produces the hormones necessary for this process. What is dangerous about a caesarean section in this matter is that the baby’s blood pressure increases sharply, which can cause a minor cerebral hemorrhage.
Anesthesia also affects the newborn. If it occurs, the risk is zero, while the general one can penetrate the walls of the placenta, which is why the baby may be lethargic and weak for the first time after birth.
It is easier for a baby born naturally to start breathing, since the amniotic fluid leaves on its own. For Caesar babies, this fluid is sucked out by neonatologists. Therefore, such children are more prone to diseases of the bronchi and lungs.
In a newborn whose mother gave birth via CS, the intestinal microflora populates more slowly, which can cause dysbiosis. But if an emergency caesarean section was performed after the water broke, then the baby receives a certain dose of the necessary bacteria. During a planned, i.e., essentially “sterile” operation, the fetus does not receive such bacteria from the mother. Therefore, in such situations, it is very important for a woman to establish milk supply as quickly as possible in order to compensate for their deficiency together with milk.
From the above we can judge whether a caesarean section is dangerous for the baby. But this is the extent of the impact of surgery on children's body is not exhausted.
How does caesarean section affect the baby?
Before I tell you how the operation affects the baby’s health in the future, let’s briefly consider the effect of a cesarean section on the child’s body.
It is important to understand that, if indicated, a cesarean section is less dangerous for a child than a natural birth. Despite the fact that it is much easier for a doctor to carry out an operation in half an hour than to go through the entire process of bringing a baby into the world, which can drag on even for a day, not a single specialist will resort to surgical intervention without the need.
Consequences of caesarean section for a child
So, what could be the consequences and what causes them after a cesarean section for a child? In fact, it is difficult to identify any common inevitable complications. It all depends on how the birth took place, what lifestyle the mother led during pregnancy and, of course, on the professionalism of the doctors.
The most common consequence for the baby is the risk of damage to its skin during the cutting of the uterus. According to statistics, 2% of Caesar babies receive minor injuries during childbirth. But with proper and timely care, the wounds heal quickly without any complications.
Above I also mentioned possible difficulties with children’s breathing, their susceptibility to infections, and a deficiency of essential bacteria. In general, cesarean does not have global or serious consequences for the child.
It is also worth noting that some consequences of cesarean section appear in children even years later. But I will return to this issue in more detail a little later.
Consequences of caesarean section for the mother
If the percentage of the likelihood of complications occurring in a child during a caesarean section is very low, then for the mother the consequences are almost inevitable. A woman will have to go through a rather difficult one, during which she must limit herself in many ways.
Another disadvantage of CS for the mother, although very unlikely, is possible infertility. But sometimes doctors themselves prohibit a second pregnancy if the suture that remains on the woman’s uterus is ineffective and there is a high risk of its divergence.
Does caesarean section affect the development of the child?
Young mothers often ask me how intervention in the birth process affects the child in the future. I can say with one hundred percent certainty that the “Caesareans” are no different from other children. It only takes place psychological aspect, which, however, has not been fully confirmed.
According to Western psychologists, a child after a cesarean section:
- afraid of change;
- touchy;
- hot-tempered;
- absent-minded;
- anxious;
- weak-willed;
- hyperactive.
It is also believed that it is difficult for “Caesarians” to plan and control anything on their own, they often experience attention deficit, and are not inclined to achieve high results in what they love. But, I repeat, all this is just speculation, not confirmed by anything. Based on many years of experience, as well as the point of view of most of my colleagues, I am ready to assert that cesarean does not affect the development of the child.
Doctors' opinion
The topic of the dangers of CS for a child is one of the most discussed in medical forums. Here's what the gynecologist says about it highest category, Lecturer at the Department of Obstetrics and Gynecology, Elena Mishchenko: "Naturally, surgical birth have their own characteristics and carry certain consequences. A baby born this way is more difficult to adapt to environment, all systems of his body function more slowly, problems with breathing, peristalsis, etc. may arise. But if the mother led healthy image life, followed all the instructions of the attending physician, the risk that the operation will somehow affect the fetus is minimal. Therefore, everything is in the hands of the woman, and especially the condition of her unborn child.”
As the birth approaches, all expectant mothers are overcome by fears. Some are afraid of pain or worried about the baby’s health, others are thinking about how long the recovery will take. Panic often occurs due to lack of information. What are the benefits and risks of normal labor and cesarean section? Why do some women choose to give birth on their own while others choose surgery?
Caesarean section - what is it?
A caesarean section (CS) is an operation that allows you to remove a baby through an incision in the peritoneum and uterus (for more details, see the article: caesarean section: how long does the operation last and what anesthesia is used?). Currently, this manipulation is performed in 20% of patients. The operation can be:
- planned, when it is prescribed during pregnancy if indicated;
- emergency, carried out during childbirth in the event of various complications.
The surgery lasts about 40 minutes. It includes several stages:
- inserting a catheter into the bladder to drain urine;
- use of spinal anesthesia or general anesthesia;
- fixing the arms, legs, installing a screen at chest level and lubricating the abdomen with an antiseptic;
- making a skin incision and subcutaneous fat, spreading the abdominal muscles, making an incision of the uterus;
- opening amniotic sac, extraction of the child and placenta (this stage lasts a maximum of 8 minutes);
- suturing.
Despite the fact that the operation has been practiced for a long time and is routine, it is considered quite complex. However, thanks to the constant improvement of surgery and the emergence of new antibiotics, it does not pose a danger to the life of the baby or mother. The scar heals in about a week.
Indications for surgery
Sometimes a woman is not able to give birth naturally, and she is prescribed a CS. The planned operation involves hospitalization at 37 weeks - this allows doctors to additionally examine the expectant mother and fetus. Indications for surgical delivery are:
- narrow pelvis (in the case when it is pathologically narrowed and does not allow birth naturally);
- myopia with a high risk of retinal detachment;
- genital herpes;
- large fruit with an estimated weight of more than 4.5 kg;
- the age of the woman giving birth is more than 35 years (especially if this is the first birth);
- previous operations on the cervix;
- 2 or more scars on the uterus;
- ovarian tumors or uterine fibroids;
- post-term pregnancy;
- poor medical history (stillbirth, repeated miscarriages, etc.);
- position of the fetus across the uterus;
- twins with one baby in breech presentation;
- Vaginal varicose veins.
Indications for emergency caesarean section are:
- acute oxygen starvation baby;
- early leakage of amniotic fluid;
- abnormalities of labor that cannot be corrected with medications;
- placental abruption;
- threatened or incipient uterine rupture;
- gestosis or eclampsia;
- weak labor activity;
- sudden bleeding;
- loss of umbilical cord loops;
- a sharp deterioration in the condition of the woman in labor due to disruption of the cardiovascular, respiratory systems, etc.
Pros and cons for baby and mother
The passage of a child through the birth canal is provided for by nature. If the woman behaves correctly, delivery will take place with minimal discomfort for her and the child. Its advantages:
- from 38 to 40 weeks the fetus is considered full-term - the baby will be born when all the systems of his body are ready for this;
- when the water breaks, the baby instinctively begins to prepare for the difficulties that await him at birth, so this process does not come as a shock to him;
- as the child moves through the birth canal, the intestines, skin and mucous membranes of the child are colonized beneficial bacteria mothers;
- during childbirth female body secretes hormones that help stimulate lactation and contraction of the uterus;
- breastfeeding allows the baby to receive colostrum, and the woman to start the process of milk production;
- although natural childbirth is more painful, it is better - it is the logical end of the process of bearing a fetus with the subsequent appearance of the maternal instinct;
- the mother begins caring for the child immediately after giving birth.
Disadvantages of childbirth:
- severe pain during contractions;
- the likelihood of perineal ruptures;
- birth injuries of the baby.
The tactics of caesarean section are constantly being improved - this is an operation that has saved millions of lives during complicated births. The advantages of this type of delivery:
- in some conditions and diseases, caesarean section is the only way to deliver the baby;
- the risk of birth injuries in the baby is minimal;
- no pain during contractions;
- the operation lasts 45 minutes, natural childbirth can last up to a day;
- childbirth for a woman will take place without rupture of the perineum or the formation of hemorrhoids.
Cons of a cesarean section:
- long recovery period;
- heavy bleeding, often leading to anemia;
- the negative impact of anesthesia on the body of the mother and baby;
- pain in the area of the postoperative scar;
- bed rest interfering with child care;
- a long ban on sports, which complicates the process of returning to physical shape;
- difficulties with feeding due to the inability to put the baby to the breast early;
- the risk of pathogenic microbes entering the newborn’s body, which leads to illness, digestive problems, etc.;
- refusal of pregnancy in the next 2 years.
Danger of complications
During a normal birth, as with a caesarean section, a woman may experience complications. If she has to give birth on her own, she must be ready to breathe correctly and follow the doctors' recommendations, otherwise soft tissue ruptures will appear or there will be a need to cut them to facilitate labor. Perineotomy may also be necessary in cases of rapid labor or abnormal fetal advancement, for example, with limb prolapse.
If contractions are unstable, the baby may get stuck in the birth canal. This threatens hypoxia and neurological disorders in the future, as well as injuries due to the need to use radical techniques to save the child’s life.
With surgical fetal extraction, the risk of postpartum complications is 12 times higher. These include:
- the impossibility of predicting the outcome of the operation - complications, including death, are possible;
- a long recovery period (up to six months) with the risk of skin folds forming over the suture;
- abrupt termination of pregnancy is stress for the body, which causes hormonal disbalance, disruption of the lactation process and the menstrual cycle;
- inflammation may develop, leading to chronic pain, the appearance of adhesions in the abdominal cavity and infertility;
- postoperative suture divergence;
- the risk of a fistula due to incomplete dissolution of catgut applied to the muscles - a repeat operation is required to remove necrotic tissue.
Caesarean section or natural childbirth - which is better?
The question of whether to choose a cesarean or natural birth arises when there are deviations in the course of pregnancy. Doctors analyze the patient’s condition and may suggest giving birth herself or performing surgery. It is impossible to say which option will be better or worse, since the choice depends on many factors. Comparative characteristics methods of delivery for some problems:
| Problem | Conditions for natural childbirth | Conditions for cesarean section |
| Fruit weighing more than 4–4.5 kg | The mother is large, the examination showed that the pelvic bones will easily separate, she already has children born with ER. | The woman in labor has a narrow pelvis, the baby's head is larger than her pelvic ring. |
| Twins | Mom is completely healthy. | Fetal presentation, age over 35 years. |
| ECO | The woman is young, the cause of infertility was in her partner. | Women chose caesarean section themselves, have chronic diseases or threatened miscarriage, multiple pregnancy or infertility treated for more than 5 years. |
| Asthma | You need to consult a doctor 3 months before giving birth, EP is possible. | The patient may begin to choke during childbirth. Increased risks require surgery. |
| Polycystic kidney disease | Feeling good expectant mother and absence of exacerbations of the disease. | It is carried out in most cases to prevent complications. |
| Breech presentation of the fetus | The woman is under 35 years old and has no chronic diseases. | Fulfilled in 90% of cases. |
The choice between a cesarean section or a normal birth is up to the woman, but the doctor should explain in detail all the benefits and risks. If elective surgery is necessary, it is performed at 39 weeks.
Breastfeeding after caesarean section
Colostrum and breast milk contain many nutrients and antibodies - breast-feeding reduces the risk of colic in a baby and supports his immunity. A caesarean section involves anesthesia and subsequent antibiotics to prevent inflammation of the wound, so the mother will not be able to feed the baby for the first few days. In addition, after such births, milk comes later. How many days will he have to wait? Lactation after a planned CS begins on days 5–10, after an emergency – on 2–3, but sometimes milk does not appear at all.
While the woman is taking medications, the child is fed formula milk. If she does not try to maintain lactation by pumping, she simply will have nothing to feed the baby, and the baby himself may refuse to make efforts to extract milk from the breast, as he will get used to the silicone nipple.
Experts' opinion
In Russia, approximately 10 out of 100 women in labor insist on a caesarean section. However, the opinion of experts is clear - they are against surgery if there is no indication for it. This position is confirmed by a number of facts:
- surgery is always a risk;
- A CS does not make the birth of a baby more comfortable for the mother;
- the next pregnancy should be no later than 10 years later;
- Milk production is poor, you cannot start feeding the baby right away, and then it is more difficult to teach him to suck the breast;
- There is a hormonal imbalance, and later the maternal instinct awakens.
If the patient had a cesarean section, the next pregnancy will also end in surgery. A woman will be able to give birth herself if she finds an experienced doctor, and he will not see any contraindications to this and will be able to monitor the condition of the suture.
