The proportion of abdominal deliveries has increased, and today one in five pregnancies ends with a caesarean section rather than a natural birth. The operation has its unconditional pros and cons. We will discuss in this article about the advantages and disadvantages of surgical delivery, how likely it is to develop complications after them.
Who is the operation indicated for?
Caesarean section is an alternative method of delivery, in which the baby is not born in the traditional way, but through incisions in the anterior abdominal wall and uterus. The operation, despite its seeming simplicity and widespread use, belongs to the category of complex surgical cavitary interventions. That is why 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 cesarean (surgery at a woman's own will). In these clinics, this service costs about half a million rubles.
The list of situations in which it is safer and more reasonable to give birth by surgery is stipulated and approved by the Ministry of Health of Russia (letter of the Ministry of Health of 2014 No. 15-4 / 10 / 2-3190). So, a cesarean section is prescribed routinely in the following situations.
- low location of the placenta with complete overlap of the internal pharynx or incomplete overlap, as well as presentation with signs of detachment and bleeding;
- premature detachment of the "child's place" from the uterine wall, while the location of the placenta does not play a role;
- two births carried out by cesarean section in the past, as well as any operations on the uterus, if scars remain after them;
- the weight of the fetus is more than 3.6 kg with an incorrect position of the child in the uterine cavity (sitting, located across);
- the wrong location of one of the twins;
- multiple (often singleton) pregnancy that occurs after IVF;
- post-term pregnancy (at 41-42 weeks of gestation), if other methods of stimulating labor have not had an effect;
- any mechanical obstacles to the child's passage through the birth canal - tumors, large groups of polyps, scars after ruptures of the cervix;
- a state of severe gestosis (with edema, large weight gain, signs of increased blood pressure);
- a ban on attempts (with myopia, some diseases of the cardiovascular system, transplanted donor kidney, etc.);
- a state of acute oxygen starvation of the fetus (of any origin);
- prolapse of the umbilical cord;
- genital herpes of the primary type;
- HIV infection in the mother, if during pregnancy the woman for some reason did not receive supportive treatment;
- a narrow pelvis, in which independent childbirth will be difficult;
- blood clotting disorders of the mother, fetus;
- malformations of the baby - omphalocele, gastroschisis, etc.
As for the emergency operation, there are other indications for it. An unplanned operation will be urgently performed on the woman in labor, whose contractions unexpectedly weakened during childbirth, the cervix does not open, there is a secondary weakness of attempts, the placenta has exfoliated, bleeding has opened. 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 the surgical deliveries in Russia today are performed under epidural or spinal anesthesia, in which anesthetic drugs are injected into the epidural or subarachnoid space of the spine using a lumbar puncture. In 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 sets in faster.
After the woman is anesthetized or given general anesthesia, the surgical team proceeds to the operation. With planned intervention, they try to make a horizontal incision of the abdomen just above the pubis in the lower uterine segment. In an emergency operation, if the child is in danger of death, a vertical incision can be made in the center of the abdomen through the navel.
After opening the abdominal cavity, the doctor frees himself up space for further "maneuvers" - he removes the muscle tissue and the bladder. After that, an incision is made in the uterus, the fetal sac is pierced and the amniotic fluid is drained. Then the surgeon gently pulls the baby head first through the incision.
The umbilical cord is cut to the baby and the baby is handed over to neonatologists. The woman is gradually restored first to the uterus, applying internal sutures, then the abdominal cavity, returning the muscles and the bladder to the anatomical initial state and placing sutures or staples on the skin from the outside.
A woman, if she is not under general anesthesia, will be able to see her child immediately. If she is fast asleep, then the meeting will be postponed and will take place only a few hours after giving birth.
The newly-made mother is in the intensive care unit for several hours after the operation, after which she is transferred to the postpartum ward in a regular ward, where, after 8-10 hours after the intervention, she can begin to sit down, get up, walk.
Advantages
The undoubted advantage of a cesarean section can be considered a relatively predictable outcome of the intervention. The likelihood of birth trauma for both the baby and his mother is minimal. The child does not need to pass through the narrow birth canal, and therefore, he also has practically no chance of getting a neck or head injury during a surgical delivery. Whereas with a narrow pelvis or a large baby in the breech presentation, injuries in the newborn and his mother during natural childbirth would be much more likely.
Caesarean section makes it possible to become mothers to women who are contraindicated in natural childbirth. And today, the quality of materials for tissue suturing and surgical techniques make it possible to give birth to quickly not one or even two children, but as many as a woman wants.
With a cesarean section, a woman does not feel the pain of labor, which most frightens pregnant women and the memories of which are never erased from memory. Some fear of what is happening in women in labor when using epidural anesthesia, but it is more psychological.
If general anesthesia is used, then the woman simply falls asleep and wakes up already in the status of a mother.
The use of spinal or epidural anesthesia allows you to correct a deficiency that was unavoidable for many years - a woman gets the right to see the baby immediately after it is removed from the womb, and it also becomes possible to attach the baby to the breast, which is very important for the early development of lactation and full subsequent breastfeeding.
Cesarean section, if done routinely, does not leave gross, disfiguring scars on the patient's abdomen. Doctors do their best to ensure that the seam is neat, inconspicuous, cosmetic, located in an area that is usually well covered by panties or swimming trunks. Each subsequent operation, if the woman decided not to limit herself to one child, is performed on the previous scar, new scars on the abdomen and uterus do not appear.
Caesarean section makes it possible to carry out additional surgical procedures. If there is a need to ensure lifelong contraception, then at the same time the ligation of the fallopian tubes is performed, tumors in the uterine cavity can be removed.
The duration of a surgical delivery usually does not exceed 45 minutes, while a natural birth can last up to a day or even more.
Disadvantages
Caesarean section is not a natural delivery, it is always a gross interference in the work of the female body. If the operation is carried out in a planned manner, then often the mother's body is in fact not ready for childbirth (contractions have not begun), therefore, removing the baby by 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 surgical procedures affect not only the woman, but also the baby, even when it comes to spinal anesthesia. A baby born with the help of a surgeon cannot have 9 Apgar points in principle, since he is always more inhibited, sluggish - anesthetics and muscle relaxants, which were administered to the mother for anesthesia, act on him. True, after a few hours this action passes.
The baby is deprived of the opportunity to walk the path prepared for him by nature - he does not overcome the resistance of the genital tract 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 stress resistance.
Many issues have not yet been fully studied, but the fact that a baby without passing through the genital tract is deprived of the opportunity to softly adapt to the new conditions in which he will live is indisputable.
The statements of some opponents of the caesarean section that children then grow up with developmental delays, need correction programs, are more likely to get sick, do not correspond to reality, therefore they cannot be considered as a disadvantage.
Caesarean section is dangerous for its complications, and their likelihood, compared with physiological independent childbirth, increases several tens of times. The recovery and rehabilitation period lasts much longer than after childbirth, breast milk arrives several days later. Ligation of the fallopian tubes, if carried out, lengthens both the operation time and the recovery time of the woman's body.
After a cesarean section, a woman for more than 2 years is not recommended to become pregnant again, whereas after physiological birth there is no such prohibition. Lifting weights is harmful, and in the absence of domestic helpers, routine household chores and caring for a newborn becomes very difficult.
The harm from the operation, of course, does not exceed the benefit, but still you can never be sure that complications and negative consequences will bypass you.
The likelihood of complications
Complications are possible at any stage of the operation, as well as after it. During surgical manipulations, bleeding from the vessels of the anterior abdominal wall may occur; if the vascular bundle is injured, mechanical injury of the bladder, ureters, and intestines may also occur. If complications arise during the operation itself, the woman will be placed not in the intensive care unit, but in the intensive care unit, where they will monitor her condition for several days, if necessary, make a blood transfusion, and administer the necessary drugs. The incidence of such complications does not exceed 0.01%.
Postoperative bleeding and impaired contractility of the uterus (hypotension or atony of the reproductive organ) can also have dangerous consequences. In this case, medication will be required and the removal of the uterus is not excluded, if its muscles do not respond to the introduction of reducing drugs, the uterus does not decrease.
A severe vital complication of cesarean section is infectious inflammation. It can lead to the death of a newly-made mother. Symptoms of inflammatory infectious complications are high fever, abdominal pain, atypical discharge, wound suppuration, increased leukocytes in the blood test. More often than others, after surgery, inflammation of the endometrium of the uterus (endometriosis) develops, but other situations are not excluded. Peritonitis is considered the most dangerous of the possible. In practice, given the sterility of modern operating rooms and the sophistication of the operations of the surgical team, such complications are not so common - only in 0.7-1% of cases.
The danger for the child lies in the short-term exposure to 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 and earlier, but it is no longer associated with the operation itself, but with gestational immaturity of the fetal lung tissue.
Much depends on a properly organized postoperative period.
If the requirements and recommendations of the doctor are not followed, the woman risks no longer becoming a mother, since an insolvent scar will form on her uterus, which simply will not allow her to bear the next child.
Problem prevention
To prevent inflammatory processes, if their likelihood is suspected, doctors prescribe antibiotics to a woman in the early postoperative period. Since more often than other complications occur in women with obesity, systemic concomitant diseases, low social status and bad habits, as well as with impaired blood clotting, it is these women who fall into the area of special attention of medical personnel.
To exclude hypotension or uterine atony early attachment of the baby to the breast is recommended, as well as the introduction of contraction and pain medications. If a woman has had 3 or 4 such operations, it is recommended that more careful monitoring of the area of the uterine scar for a year is recommended, since it is thinner than in those who have had one or two operations.
A woman should not lift weights, she also needs to be protected. Sexual life can begin to live only when the discharge from the genitals stops, not 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, weak and thin connective tissue in the area of the incision may not withstand the intensive growth of the uterus, which can lead to rupture of the muscular organ even during gestation.
According to the reviews of women left on thematic forums on the Internet, there were no complications after a caesarean section. Due to the fact that they are not so common, there are almost no reviews describing the negative consequences. Most women say that the recovery went well, the scar on the abdomen healed about 3 weeks after the operation.
For the pros and cons of a cesarean section, see the following video.
