If a woman is about to give birth by caesarean section, along with a host of other nuances, she is also worried about the timing of the operation.
Knowing the estimated time frame allows a woman to plan a lot, including choosing the exact date of birth of her baby. In this article, we will look at when women in labor are operated on and what these terms may depend on.
Clinical guidelines
For surgeons, it is considered most preferable if the operation is performed on the relaxed muscles of the uterus, that is, before the onset of regular labor - contractions. That is why they rarely wait until 40 weeks, when their spontaneous onset is most likely. They try to set the date for a planned caesarean section at the optimal time that will suit everyone.
A baby is considered full-term from 37 weeks of gestation, accordingly, his birth at this time will not be regarded as an extraordinary situation.
But a baby at this time is not always ready for birth, and this must also be taken into account. A sufficient amount of surfactant, a substance produced by the alveolar vesicles, should accumulate in the child's lungs. It will provide easy deployment of the lungs for the first breath.
Precisely because the risk of respiratory failure at 37 weeks is higher than at 40, but at 40 natural physiological contractions may begin, the Ministry of Health of Russia has defined clear clinical recommendations, which are set out in a letter dated May 6, 2014 No. 15-4 / 10 / 2-3190, which was sent to all obstetric institutions, antenatal clinics and hospitals to develop uniform standards for providing medical care to women in labor.
There is no double answer in this document to the question of when to have a planned caesarean section.
The Ministry of Health strongly recommends that surgery be scheduled any day after obstetric week 39. It is from this period, as indicated in the explanation to the document, that the risk of fetal respiratory failure will be the smallest.
How does it work in practice?
An emergency caesarean section, which is done to save the life of the mother and the fetus, is not regulated by any time frame.
If necessary, if there is a threat of death of the baby, his traumatization, with the development of weakness of labor, with abruption of the placenta ahead of time, with the discharge of water and a long anhydrous period, as well as with the loss of the umbilical cord loops, with the development of acute oxygen deficiency in the baby (hypoxia), an operation is performed for health reasons. It can be done both at the 7th month of pregnancy, and at the 8th month, and already directly in childbirth, if the woman cannot give birth on her own.
Another approach to elective surgery. When choosing a term, the doctor needs to take into account not only the interests of the woman in labor, but also the interests of the baby. The term should be such that the potential benefits of delivery to the mother and fetus are many times greater than the harm. This choice can be difficult, especially with multiple pathologies of pregnancy.
The first cesarean section for medical reasons is usually tried to be prescribed at 39 weeks of gestation, as required by the Russian Ministry of Health. 2 cesarean section in the absence of alarming signs requiring an earlier delivery, they also try to appoint at 39-40 weeks of pregnancy.
3 and 4 cesarean sections are technically more complicated, and the risk of uterine rupture is significantly increased due to the scar that has become thinner during previous operations.
Therefore, women are tried to be hospitalized earlier and operated on at 38-39 weeks of pregnancy in the absence of pathologies. If the operation is the fifth in a row, it is considered better to operate at 37-38 weeks, it is extremely rare to wait until 39 weeks.
What affects the date?
Doctors can deviate from clinical recommendations only if there are compelling circumstances. With an emergency caesarean section, everything is more or less simple: there was a need - they had an operation. But why can the date of a planned operation be changed?
It's all about the peculiarities of the current pregnancy. Some complications of bearing a fetus require earlier or later surgery.
Before 39 weeks, surgery may be prescribed if:
- there are signs of smoothing, shortening of the cervix, which increases the likelihood of the onset of independent contractions and the onset of labor;
- other "harbingers" of childbirth appeared - the mucous plug has moved away or began to move away in parts, the woman has frequent training contractions;
- the woman and the fetus have a Rh conflict, which is confirmed by a blood test for an antibody titer in the maternal blood, and the titer has reached high values;
- there were signs of a threat of rupture of the previous scar (in the third trimester, pregnant women with a scar on the uterus should do an ultrasound scan every 10 days);
- a woman has severe gestosis, edema, increased blood pressure, there is a significant pathological weight gain and a suspicion of preeclampsia;
- according to the results of CTG, the fetus shows signs of severe, threatening trouble.
In this case, the doctor assumes the potential risk of the child's distress syndrome. The likelihood of developing respiratory failure after birth is higher, but it is even more dangerous for a baby to remain in the womb, since the likelihood of his intrauterine death or severe damage to the central nervous system is higher than the corresponding possibility of a lack of surfactant in the lungs.
Later 39 weeks of pregnancy, a cesarean section is performed for women who do not have objective signs of the body's readiness for childbirth - the cervix is immature when viewed at 38-39 weeks, the mucous plug is in place, the tone of the uterine muscles is not increased, the discharge is normal.
The state of the fetus according to the results of CTG does not cause concern. It is always better for a child if he stays in the mother's womb as long as nature has prepared for him. In the case of a cesarean section, almost the same.
In some cases, doctors try to deliberately postpone the time of the caesarean section if they have reason to believe that it will be better for the child. So, when a part of the water leaks or leaves for a period of up to 36 weeks of pregnancy, they try to extend the pregnancy by at least a week or two, in order to give the baby time to gain weight and acquire a sufficient supply of surfactant in the lungs. All this time, the woman lies in a sterile room, she is forbidden to get up, support is provided by hardware, medication. The baby is monitored around the clock in real time.
Slow COP and fake labor
Recently, women have been widely discussing new techniques for performing CS. So, some specialists in the field of obstetrics are of the opinion that it is better to wait for the onset of contractions, and only then carry out a cesarean section, since this will be most natural for the child, his stress from the sudden birth without passing through the birth canal will be lower.
Surgeons with many years of experience argue that it is rather difficult to judge the effect of such tactics on a child, but the likelihood of postpartum complications due to surgery on the contracting uterus can be much more pronounced.
Slow caesarean section is a method that is gaining momentum and is in great demand among women in Europe.
The essence of the operation is that the surgeon makes an incision in the uterus, but very small, through which the entire child cannot be reached at once. The woman is under epidural or spinal anesthesia. The task of the doctor is to create the most natural conditions for the birth of a child. Through a small incision, it is taken out little by little, gradually, similar to the smooth movement of the fetus along the birth canal during natural childbirth.
This cesarean section lasts longer, and also requires high skill from the surgeon and anesthesiologist. The first one needs to avoid bleeding, and the second one needs to provide an adequate level of anesthesia for the woman, because spinal anesthesia itself is not designed for long-term operations.
In Russia, a slow cesarean section is still far from being done everywhere and not by everyone. But if you set a goal, you can find a doctor who will undertake such an operation. The search area should be limited to perinatal medical centers that provide paid services to pregnant women and women in labor, since doctors in an ordinary maternity hospital will not violate the recommendations of the Ministry of Health regarding the technique of performing a caesarean section.
Reviews
According to women, the doctors of antenatal clinics have nothing to do with the choice of the date of the operation. This issue is decided by doctors in the maternity hospital, where a woman before a planned cesarean section needs to go to bed 7 days before the onset of 39 weeks. That is, if there are no special indications for reducing the time, you need to go to the hospital at 38 weeks. Analyzes, examinations, control ultrasound, a conversation with an anesthesiologist and premedication - this is just an incomplete list of what lies ahead in the process of preparing for the operation.
For the most part, according to reviews, doctors perform the operation for a period of 39-40 weeks, while women are allowed to choose the date of birth on their own.
You can learn more about the technique for performing the operation and the timing in the following video.
