2 caesarean section at what time. The second caesarean section - features of the conduct and possible risks. Is it possible to give birth on your own

Contrary to popular belief, if the first birth was surgical, the second cesarean during a second pregnancy is not prescribed for every woman. I, like any specialist, make a decision about operative obstetrics only after carefully analyzing many factors.

A second (emergency or planned) caesarean section is prescribed if:

The patient has a history of diseases such as asthma or hypertension, there are endocrine disorders.
The woman has recently suffered a serious injury, she has pathological visual impairment, problems with the heart or blood vessels, malignant tumors.
The future woman in labor has a deformed or too narrow pelvis.
Previously, a woman was made a longitudinal incision, there is a threat of violating the integrity of the old suture, there are keloid scarring.
After a previous CS, the patient did artificial or she had a miscarriage.
Pathologies were found: a large fetus or its incorrect presentation, overbearing, poor labor activity.
The patient is expecting twins.
The age of the mother is 35+ or after the birth of her first child, a very short period has passed - no more than 24 months.

If none of this list is found in the patient, I allow (and even insist) to give birth on her own.

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When is the second caesarean section done?

Here you need to start from the reasons indicating the need for an operation. But in any case, in order to minimize the risks, the deadlines are shifted. For example, if a woman in labor has an oversized belly, then the baby is large and significantly stretches the walls of the uterus. That is, the threat of a seam rupture is quite high. The operation in such cases is carried out at 37-38 weeks.

The period at which the second caesarean section will be done depends even on the woman's blood pressure. If the blood pressure is very high and is not brought down by medication, then the operation can take place as early as the 39th week. In any case, we try to schedule childbirth on the date that is closer to 40-41 weeks, after discussing this issue with the future mother in advance.

In patients with complicated pregnancy, contractions may begin as early as the 35th week. In such cases, for my part, I make every effort to help the expectant mother bring the baby to at least the 37th week. Of course, during this period, therapy is prescribed that stimulates the maturation of the fetal respiratory system.

Every second of my patients is sure that if she has already undergone surgery once, then the second caesarean section will go “like clockwork”. I should note that a positive attitude and calmness in this case is already half the battle. But such confidence must necessarily be supported by the actions of the expectant mother. Excessive negligence and frivolity can lead to disastrous consequences. If you already know that CS is imminent, take action.

During pregnancy

It is important to foresee absolutely everything that a second caesarean may be associated with. Here are some tips I give to my patients:

Sign up for special courses for expectant mothers who are going to have a CS.
Tune in to the fact that you may need to stay in the hospital for a long time before and after childbirth. Decide in advance where and with whom your eldest child will be all these days, so that later you don’t have to worry about him, which is extremely undesirable in your position.
Consider and discuss with your spouse the option of partner birth. If an epidural is used and you are awake, you may find it easier and more enjoyable to endure the whole process when a loved one is nearby.
In no case do not miss the scheduled examinations prescribed by the doctor.
Do not be afraid to ask your gynecologist all the questions that concern you (about when the second CS is done, and why you are scheduled for delivery on this particular date, what tests you need to pass, do you have any complications, why did the doctor prescribe certain drugs to you, etc. .). This will give you the confidence and peace you need.
Get in advance the things that you and your baby will need in the hospital.

Be sure to find out what type of blood your relatives have (this is especially important if you have it rare). There are situations in which a woman in labor suffers large blood loss during surgery. The reason for this may be coagulopathy , preeclampsia, abnormal placental presentation, etc. In such cases, a donor may be urgently needed.

A few days before surgery

As a rule, in the last stages of pregnancy, the patient is in the hospital. At least two days before the operation, it is necessary to refrain from solid food and products that cause gas formation. 12 hours before delivery, it is generally forbidden to drink and eat, since the anesthesia used during the CS can cause vomiting. And most importantly, the expectant mother must get enough sleep. Keep in mind that this time it will be more difficult to recover than after the birth of your first child, so proper rest is a necessary measure.

Stages of the operation

Naturally, experienced mothers who give birth not for the first time with the help of surgeons already know how a planned caesarean section is done. Operations are really identical and follow the same scenario. So don't expect surprises. So, let's take a step-by-step look at how a second caesarean is done.

Preparing for the operation

Even if the caesarean section will be for the second time, I still give a detailed consultation to each patient. I answer all questions, talk about the advantages and disadvantages of surgical intervention, possible complications.

Immediately before the birth itself, the nurse also helps the patient to prepare for the operation, who:

Checks the main indicators of a woman's health: temperature, cardiac activity (pulse), blood pressure.
Gives an enema to empty the stomach and thus prevent regurgitation during the birth process.
Shaves the pubic area so that the hair, falling into an open wound, does not cause inflammation.
Installs a dropper with, the action of which is aimed at preventing infection, and with a special composition that prevents dehydration.
Inserts a catheter into the urethra.

Surgical stage

If childbirth is carried out surgically, it doesn’t matter if they are the first or second, be prepared for the fact that there will be a lot of doctors in the operating room. As a rule, a “team” works in the delivery room, consisting of:

two surgeons;
an anesthesiologist;
anesthesiology nurse;
neonatologist;
two operating room nurses.

First of all, the anesthesiologist introduces anesthesia - local or general. When the anesthesia takes effect, surgeons begin to work - they perform a longitudinal or transverse incision (depending on the indications). After gaining access to the uterus, doctors use special equipment to suck out the amniotic fluid and take the baby out of the womb. After this, the neonatologist or nurse takes the child for primary care (cleaning the mouth and nose of mucus and fluid, Apgar measurements, examination and medical attention, if any).

All these manipulations take no more than 10 minutes. After that, the surgeon removes the placenta, checks the uterus and sutures. The organs are sewn together for quite a long time - about an hour. After that, the patient is administered drugs that promote uterine contraction.

The dangers of a second caesarean section

The risks that a second caesarean carries are individual. It all depends on the characteristics of the course of pregnancy, and on the general health of the woman in labor. In a mother who gave birth again through surgical procedures, the suture may be disturbed, inflamed,. Rarely, complications such as anemia and thrombophlebitis occur.

For a child, the consequences can also be different, ranging from circulatory disorders to hypoxia caused by prolonged exposure to anesthesia (since the repeated CS always lasts longer than the previous one).

But any complications are very easy to avoid if you properly prepare for the operation and follow all the recommendations of the attending physician.

Second caesarean section: what is important to know

As I said above, any operation is individual, and childbirth cannot take place in the same way. But these differences should not cause excitement and panic in the woman in labor. The main thing is to get acquainted with them and properly set yourself up before the operation.

So, the second caesarean section: what is important to know:

How many weeks? Most often - at 37-39, but if there is evidence for this, the doctor may insist on an earlier delivery.
When are they sent to the hospital? If the pregnant woman and the fetus are absolutely healthy - a couple of days before the appointed date. But better - in a week or two.
What anesthesia is used? Both local and general, but the dose is stronger than at the first CS, since repeated births last longer.
How are they cut? On the old scar, so a new scar will not appear.
How long does the process take? A little longer than the first birth, about 1-1.5 hours.

It should also be borne in mind that the recovery process in this case will be longer and more complicated. This is due to the fact that the skin, which is excised again, heals longer. Uterine involution is also slower, causing discomfort. But if you follow all the rules of the rehabilitation period, it will pass as soon as possible.

Previously, obstetricians and gynecologists were almost unanimously opposed to repeated surgical births. Laparotomy according to Pfannenstiel (that's what this operation is scientifically called) does have its own risks and consequences. But modern medicine has come a long way. And already today, the CS is perceived as a completely normal variant of delivery. Of course, before deciding to have a child in this way, it is necessary to consult a doctor in detail so that he determines if there are indications and / or contraindications. A woman should definitely once again study the possible outcomes of surgical procedures, taking into account that she will have to face difficulties not only during childbirth, but also when the baby is already born. After all, the recovery period during a second operation is more difficult, the seam left after the second cesarean will heal for a long time, the cycle does not normalize immediately. And only after weighing all the pros and cons, you can make a final decision.

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A repeat caesarean section is recommended for women who cannot or do not want to have a second child on their own, since the mere fact of having a first operation does not preclude the possibility of giving birth on their own in a second pregnancy. If the second surgical childbirth is coming, it is important for a woman to know some of their peculiarities. In this article, we will tell you how long the second operation is performed, how it differs from the first.

The need for a second operation

A second birth after a caesarean section does not have to be performed surgically. Under certain conditions, a woman may well be allowed to give birth on her own. But no more than a third of pregnant women with one caesarean section in history go for this. The categorical objection of the patient to physiological childbirth with a scar on the uterus is the first and most compelling reason for repeated surgical delivery.

But even when a pregnant woman wants to give birth on her own, she may not be allowed to do this if there are absolute indications for a second operation.

A short or long period of time after the first birth. If less than 2 years or more than 7–8 years have passed, then the “reliability” of the connective tissue of the uterine scar will cause reasonable concern among doctors. Only 2 years after the birth of the first child, the place of scar healing becomes quite strong, and after a long break it loses its elasticity. In both cases, the danger is the probable rupture of the reproductive organ at the site of the scar at the time of strong contractions or attempts.

Complications after previous births. If the rehabilitation period after surgical delivery is difficult: with fever, inflammation, associated infections, hypotension of the uterus, then the second child will most likely also have to be born on the operating table.
Invalid scar. If at the time of pregnancy planning its thickness is less than 2.5 mm, and by the 35th week it is less than 4–5 mm, then there is a possibility of uterine rupture during independent childbirth.
Large baby (regardless of its presentation). Multiparous after caesarean section can give birth to a baby through natural physiological routes only with an estimated baby weight of less than 3.7 kg.
Incorrect position of the baby. Options with a manual turn of the baby for a woman with a scar are not even considered.
Low location of the placenta, placenta previa on the scar area. Even if the "children's place" edge affects the area of the scar, you can not give birth - only to be operated on.
Vertical scar. If the incision was made vertically during the first delivery, then independent labor activity is subsequently excluded. Only women with a wealthy horizontal scar in the lower uterine segment can theoretically be admitted to independent childbirth.

In addition, irremovable causes that led to the first operation are considered absolute indications for repeated surgical childbirth: a narrow pelvis, anomalies of the uterus and birth canal, etc.

There are also relative indications for a second operation. This means that a woman will be offered a caesarean section for her second pregnancy, but if she refuses, a natural delivery method may be chosen. Such indications include:

myopia (moderate);
oncological tumors;
uterine fibroids;
diabetes.

The decision to repeat the operation, if the woman does not object to this method of delivery and there are absolute contraindications, is taken when the pregnant woman is registered. If there are no contraindications, the woman wants to give birth herself, then they will choose the method of childbirth after the 35th week of pregnancy at a medical consultation.

Dates

The Ministry of Health of Russia strongly advises maternity hospitals and clinics to adhere to clinical recommendations when performing a caesarean section. This document (Letter of the Ministry of Health of the Russian Federation dated May 6, 2014 No. 15-4 / 10 / 2-3190) prescribes an operation after the 39th week of pregnancy. This applies to both the first and repeated caesarean sections. As justification, the risk of possible immaturity of the lung tissue of the fetus before 39 weeks is indicated.

In practice, they try to carry out the second caesarean section a little earlier than the first, since the independent onset of childbirth, the contractions that have appeared can be a mortal danger for the child and mother associated with uterine rupture. Most often, the second surgical birth is done at 38–39 weeks of gestation.

If, at a scheduled examination at a later date, the doctor finds precursors in a woman: cork discharge, readiness and maturity of the cervix, its smoothing, the timing of the operation can be rescheduled to an earlier time.

For emergency indications, surgery for a second pregnancy is performed at any time to save the life of the fetus and mother. Emergency situations include prolapse of the umbilical cord, signs of the onset of uterine rupture during gestation, premature abruption of the placenta, signs of acute hypoxia and other fetal distress, in which it is deadly for him to remain in the mother's womb.

If a woman is a supporter of the opinion that CS should be done as close as possible to the expected date of birth, then theoretically the operation can be performed (in the absence of contraindications for expectant management) at any time from 39 to 40 weeks.

Training

Preparation for the second planned operation begins during pregnancy. A woman with a uterine scar should see her OB/GYN more often than other pregnant women. In the third trimester, it is necessary to monitor the condition of the scar in order to notice possible signs of its thinning in time. To do this, every 10 days it is recommended to do an ultrasound with Doppler.

In the maternity hospital, a woman is hospitalized in advance. If during the first planned operation you need to go to the hospital about a week before the operation, then for a second CS you need to go to the hospital under the supervision of doctors at 37-38 weeks to prepare for the upcoming birth.

Doctors prepare in their own way: they must once again examine the pregnant woman, establish the exact location of the scar, its features, take tests, and agree on the method of anesthesia with the patient.

The day before the operation, the anesthesiologist conducts a conversation with the woman. On the evening before the operation, premedication begins: the expectant mother is given a strong sedative (usually barbiturates) so that she can sleep as well as possible and rest at night. This will protect her under anesthesia from drops in blood pressure.

On the morning of the operation, the woman is shaved her pubis, given an enema to cleanse the intestines, and may be recommended to bandage her legs with elastic medical bandages to prevent thrombosis.

Features of the operation

The main feature of a second caesarean section is that the operation lasts a little longer than the first one. The woman should warn relatives about this so that they do not worry in vain. Additional time is needed for surgeons to remove the first scar. Each subsequent surgical delivery is carried out on the previous scar. Therefore, situations are completely excluded in which, after the first operation, the woman had a vertical seam, and after the second it will be horizontal.

If the operation was with a longitudinal incision, then the second time the incision will be made in the same place, excising the old connective tissue so that a new scar can form freely. Needless to say, with each caesarean section, the scar becomes thinner and thinner, and the risks for bearing increase!

If a woman no longer plans to give birth, then she can sign a consent to surgical sterilization in advance. After removing the baby, doctors begin to ligate the fallopian tubes - the onset of a subsequent pregnancy becomes impossible. This simple manipulation can extend the total time the patient spends in the operating room by another 10-15 minutes.

Having opened the abdominal cavity, the doctor carefully, so as not to injure, removes the muscle tissue, as well as the bladder, to the side. Then an incision is made directly on the walls of the uterus, the fetal bladder with amniotic fluid and the baby is pierced. The water is drained, the child is taken out of the incision, the umbilical cord is cut off and transferred to neonatologists. If a woman is not in a state of deep medical sleep (general anesthesia), then at this stage she can look at her baby, touch him. Such an opportunity is given by such types of anesthesia as epidural or spinal anesthesia.

While the mother admires the child or sleeps soundly under general anesthesia, the doctor separates the placenta with his hands, checks if there are any particles left in the uterine cavity and puts several rows of internal sutures on the reproductive organ. In the final part of the operation, the normal anatomical arrangement of the muscles and the bladder is restored and external sutures or brackets are applied. At this point, the operation is considered completed. The puerperal for the next few hours is determined in the intensive care unit for close monitoring of her in the early postoperative period. The baby is sent to the children's department, where he will be treated, bathed, examined by doctors, and blood tests will be taken from the baby.

How is the recovery going?

The recovery period after repeated caesarean section also has its own characteristics. A woman recovers longer than after the first operation, and this is quite natural, because the muscles of the uterus are more stretched, and the repeated opening of this muscular organ makes it difficult for the postpartum involution of the uterus. After the operation, the uterus remains quite large, but more like a deflated balloon or an empty sac. She needs to shrink back to her original size. This process in involution is considered the most important.

To help the puerperal, doctors from the first hours after the transfer from the operating room to the intensive care unit begin to administer contracting drugs to her. A few hours later, the woman is transferred to the general postpartum ward, where she is advised not to lie down for a long time. It is optimal to rise already 10-12 hours after the operation. Physical activity will promote uterine involution. For the same purpose (and not only for this!) It is recommended to attach the baby to the breast as early as possible. The baby will receive nourishing and healthy colostrum, and the production of his own oxytocin in the body of his mother will increase, which will certainly have a positive effect on the contractility of the uterus.

The woman is shown a diet up to 4 days after the operation, aimed at preventing constipation and intestinal pressure on the injured uterus. The first day is only allowed to drink, on the second day you can eat broth, jelly, white croutons without salt and spices. Only by the fourth day a woman can eat everything, but avoid foods that stimulate the production of intestinal gases.

Lochia (postpartum discharge) after the second operation usually ends completely by 7-8 weeks after the operation. The sutures are removed 8–10 days after the operation (in consultation at the place of residence), the woman is discharged from the maternity hospital if there are no complications on the fifth day, as in the case of the first surgical birth.

A second caesarean section is often given to women who have had a baby through surgery. This operation is performed for medical reasons. The assessment of the condition of the expectant mother is carried out by a doctor in the second trimester. Some patients give birth in this way of their own free will, but this situation is rare.

The determination of the timing of the surgical intervention is carried out by a specialist. The doctor assesses the general characteristics of the patient's health and the presence of indications for a caesarean section. It is also necessary to consider the health of the fetus. If the child has various health problems, then the woman is scheduled for a second caesarean section.

A caesarean section is scheduled for the second time according to the presence of indications. Often this procedure is performed after childbirth, which took place with surgical intervention.

In this case, there is scar tissue on the uterine wall. The scar is made up of cells that change the properties of the tissue. In the damaged area, the walls are not amenable to reduction, and there is also a lack of elasticity.

The operation is also performed with large fetal sizes. If the estimated weight of the child exceeds 4.5 kg, surgery is necessary. In this case, the pelvic bones cannot move apart to a sufficient size. The fetus may become stuck in the birth canal. To avoid a possible complication, a second caesarean section is needed.

Operational exposure is carried out with multiple pregnancy. The birth of two or more children may be accompanied by a risk to the life of the mother. Children may also have problems. Saving the life of the woman in labor and children is the main criterion when choosing the type of childbirth. For this reason, doctors resort to a surgical type of childbirth.

A caesarean section is performed when the child is in the wrong position in the uterine cavity. If the fetus has taken a transverse position or is located in the lower part of the uterus, an operation should be performed. Natural labor activity can cause fetal death. Death occurs when a child passes through the birth canal. Due to lack of oxygen, hypoxia occurs. The child is suffocating. To avoid death, it is necessary to carry out a section.

Also, the physiological structure of the pelvis can also be the cause. Bones before the approach of childbirth gradually move apart. The fruit is shifted to the bottom. But if the pelvis is narrow, then the child cannot move along the way. Prolonged stay of the fetus in the uterus without amniotic fluid can lead to death.

Relative reasons for the appointment of the operation

There are a number of relative reasons why a second caesarean section is performed. These reasons include the following pathologies:

Many women suffering from high myopia are scheduled for a second planned caesarean. The process of childbirth can be accompanied by strong attempts. Improper observance of attempts causes an increase in intraocular pressure. Women with myopia may lose their sight completely. Also, patients with myopia have problems with the vessels of the brain. Attempts also affect the state of the vascular system. To eliminate further complication of vision, the patient is recommended surgery.

Cancer is not always the reason for recommending a caesarean section. When assessing the condition of a woman, it is necessary to examine the neoplasm. If cancer cells multiply actively, then a woman should not give birth on her own. If the tumor does not develop, surgery can be avoided.

Diabetes causes various health problems in people. The disease has a negative impact on the condition of tissues and blood vessels. The walls of blood vessels become thinner. There is increased fragility of capillaries. During natural childbirth, excessive blood pressure on the walls of blood vessels can lead to rupture of the veins. This phenomenon is accompanied by blood loss. Blood loss leads to a serious deterioration in the condition of the mother. The risk of losing a child during childbirth increases. For diabetics, surgery is also dangerous. For this reason, the doctor needs to weigh all the positive and negative aspects of both types of childbirth. Only then can a decision be made.

Modern girls often face the problem of prolonged absence of pregnancy. Planning is delayed for several months. There are problems with conception and a second child. The onset of pregnancy can break at any time. To preserve the fetus, the woman undergoes maintenance therapy. Such medical intervention can affect the correct course of childbirth. Often there is a strong fixation of the fetus in the uterus. The patient needs stimulation of activity or section.

Sometimes there is a lack of labor activity. The mother's body does not respond to stimulation therapy. The process may not appear even after the bubble is punctured. In this case, the expansion of the cervix is observed. If during the day the uterus does not open by 3-4 cm, it is necessary to perform an operation.

Timing of the surgery

The doctor calculates the average term of pre-delivery. The preliminary date of natural childbirth is set at the end of the 38th week of pregnancy. The normal period can vary from 38 to 40 weeks. With a caesarean section, the time of the PDR should be taken into account. It indicates the approximate time of the onset of natural labor. To prevent this, the operation is scheduled for the end of the 38th week.

At what time do the second caesarean section, many mothers ask. Secondary intervention is also carried out at the end of the 38th week. If there are additional indications for surgery or pregnancy has occurred less than three years after the last pregnancy, the section is carried out from 36 weeks.

Sometimes there are dangerous situations with the general condition of a woman. In this case, the secondary intervention is carried out at the time that allows you to save the life of the mother and child.

Characteristics of the surgical intervention

The section is carried out in two ways. The operation depends on the location of the incision. The following types of section are distinguished:

horizontal;
vertical.

The horizontal section is the most common form of surgery. During the operation, the suprapubic area is dissected. In this area, it has a fetal convergence of the muscular, epidermal and uterine layers. Such an incision avoids various forms of postoperative complications.

Vertical intervention is carried out according to medical indications. The incision is made from the bottom of the pubic bone to the top of the diaphragmatic muscles. With this type of operation, the doctor has access to the entire abdominal cavity. The healing of such an incision is more problematic.

Women who have undergone the procedure are interested in how a second caesarean section is done. In this case, the incision is made over the area of the previous scar. This will prevent additional injuries to the uterine wall and preserve the appearance of the abdominal area.

Before the start of the operation, preparatory measures are taken. The woman must go to the hospital 2 days before the scheduled procedure. During this time, a complete study of the condition of the patient and the doctor is carried out. For the study of the patient, a sample of blood and urine is taken. If there is a suspicion of a bacterial infection, it is necessary to take a smear of the vaginal microflora. A day before the intervention, a special diet is prescribed, which allows the intestines to cleanse themselves. On this day, a cardiotographic examination of the fetus is performed. The device allows you to set the number of heartbeats of the child. 8 hours before the operation, the woman is forbidden to eat. For 2 hours, you should stop drinking.

The operation is simple. The average duration of the surgical intervention is 20 minutes. The time depends on the nature of the anesthesia. With full anesthesia, the woman is immersed in a state of sleep. The doctor puts his hand into the incision and pulls the child out by the head. After that, the umbilical cord is cut. The child is transferred to obstetricians. They assess the condition of the fetus on a ten-point scale. The doctor at this time removes the placenta and the remnants of the umbilical cord. The sutures are applied in reverse order.

If the second caesarean delivery is prescribed for the first time, then incomplete anesthesia can be performed. In this case, the woman can see the child, but pain is not felt.

Possible Complications

After a caesarean section, a variety of complications can occur. Often they occur with repeated intervention. The following types of probable pathologies are identified:

development of the inflammatory process;
bleeding;
endometrial lesion;
the appearance of adhesive tissue.

The development of the inflammatory process is observed against the background of fluid accumulation in the uterine cavity. Inflammation of the postoperative suture may also be observed. Bleeding is a common problem. Blood loss occurs against the background of severe inflammation. If it not stopped in a timely manner, the risk of death increases.

Sometimes there is another problem. It accompanies the vertical seam. The incision in this case is made between the diaphragmatic muscles. During the recovery period, prolapse of the rectum into the hernial orifice may occur. The hernia in this case develops rapidly.

Postoperative recovery

The second caesarean section requires a longer recovery period, which is important for patients to know. With the first surgical intervention, recovery occurs within one and a half months. The second intervention disables the body for two months.

Particular attention is paid to health in the first week after childbirth. The first day a woman should not eat food. It is allowed to drink water without gas. From the second day you can eat liquid food and rye unsalted crackers. Nutrition must be treated with special attention. If the food is not selected correctly, then constipation may occur. It is undesirable in the first month after the operation. You should also refrain from carrying heavy loads. The first week the patient should not carry the baby in her arms. Wearing weights is allowed on the 8th day after the removal of stitches.

Childbirth is a natural physiological process. But they are not always possible. If a doctor prescribes surgery, he has a reason for it. Therefore, one should not refuse to repeat the surgical intervention. It will keep the mother and child healthy.

During childbirth, circumstances are not always successful. There are situations when a child cannot be born naturally. And then the doctors have to intervene in the immutable laws of mother nature and do everything possible and impossible in order to save the life of the mother and baby. In particular, with the help of surgery.

All this does not pass without consequences, and often with a second pregnancy it is necessary to prescribe a second caesarean section in order to eliminate the risk of rupture of the suture on the uterine wall. However, contrary to myths, the operation in this case is not shown to everyone.

The doctor decides on a second operation only after a thorough analysis of a wide variety of factors that accompany pregnancy. Everything matters here, mistakes are unacceptable, because the life and health of a woman and a child are at stake. Here are the most common indications for a second caesarean section, which usually lead to surgical intervention in the birth process.

The woman's health status:

diseases such as hypertension, asthma;
serious vision problems;
recent traumatic brain injury;
oncology;
pathological disorders of the cardiovascular or central nervous systems;
very narrow, deformed pelvis;
age after 30 years.

Seam features:

longitudinal suture imposed during the first caesarean section;
doubtful if there is a threat of its divergence;
the presence of connective tissue in the scar area;
abortion after the first caesarean section.

Pathologies of pregnancy:

incorrect presentation or large size of the fetus;
multiple pregnancy;
after the first operation, too little time has passed: up to 2 years;
overwearing.

If at least one of the above factors occurs, a second caesarean section is inevitable. In other cases, the doctor may allow the woman to give birth naturally. Some of the indications for a second operation are already known in advance (the same chronic diseases), and the young mother knows that she cannot avoid a second operation. In this case, she should prepare for such a crucial moment in order to prevent all dangerous consequences and minimize risks.

If you are scheduled for a planned second caesarean section (i.e., the indications for it were identified during pregnancy), you should know how to prepare for this difficult operation. This will allow you to calm down, set yourself up for a successful outcome, put your own body and health in order.

This is very important, since in 90% of cases the negligent and too frivolous attitude of a young mother to repeated surgical intervention leads to sad consequences. As soon as you know that you will have a second CS, be sure to take the following measures.

During pregnancy

Attend antenatal courses specifically dedicated to caesarean section.
Get ready for the fact that you have to lie in the hospital for a long time. Think in advance about the questions to whom you will leave your older children, pets, and home during this period of time.
Consider partnerships. If you have a local anesthetic for your second caesarean and stay awake, you may be more comfortable with your spouse around.
Regularly undergo examinations prescribed by a gynecologist.
Ask the doctors all the questions you are interested in (what tests are prescribed, at what time is the second planned cesarean section done, what kind of drugs are prescribed for you, if there are any complications, etc.). Do not be shy.
There are cases when a woman loses a lot of blood during a second caesarean section (due to incorrect placenta previa, coagulopathy, severe preeclampsia, etc.). In this case, a donor is required. It would be nice to find him in advance from among his close relatives. This is especially true for those who have a rare blood type.

1-2 days before surgery

If by the time of the scheduled date you are not in the hospital, prepare things for the hospital: clothes, toiletries, necessary papers.
Two days before the second caesarean, you will need to give up solid food.
Get a good night's sleep.
For 12 hours, you can neither eat nor drink: this is due to anesthesia, which is used during cesarean. If vomiting begins under anesthesia, the contents of the stomach can enter the lungs.
Take a bath the day before your second caesarean section.
Find out about the type of anesthesia you will be given. If you don't want to miss the moment your baby is born and want to stay awake at that time, ask for local anesthesia.
Remove makeup and nail polish.

The preparatory stage for the second caesarean section is very important, as it helps a woman to focus on her own body and put her health in order. This leads, as a rule, to a successful outcome of childbirth. For her own peace and tranquility, the expectant mother can find out in advance how this operation is done, so as not to be surprised in the process and adequately respond to everything that the doctors offer to do.

Stages: how the operation goes

Usually, women going for a second caesarean section do not ask how this operation goes, because they have already experienced all this. The procedures differ little from each other, so you should not be afraid of any surprises and something supernatural. The main steps remain the same.

Preoperative stage

Medical consultation: the doctor should once again talk about the reasons for the second caesarean, its advantages, disadvantages, risks, consequences, and also answer all your questions.
You will be asked to change into a special dressing gown.
The nurse will conduct a mini-examination: check the pressure, pulse, temperature, respiratory rate of the woman in labor, and the baby's heartbeat.
Sometimes an enema is given to empty the stomach.
An antacid drink is suggested to prevent regurgitation during surgery.
The nurse will prepare (shave) the pubic area. This is necessary so that the hair does not get into the abdomen during the operation, as they can provoke an inflammatory process.
Installation of a dropper through which antibiotics (cefotaxime, cefazolin) will enter the body to prevent infection and liquid against dehydration.
Insertion of a Foley catheter into the urethra.

Surgical stage

Many are interested in the question of how the incision is made during the second caesarean section: exactly along the seam that was made for the first time.
To avoid blood loss, the doctor cauterizes torn blood vessels, sucks amniotic fluid from the uterus, and takes out the baby.
While the baby is being examined, the doctor removes the placenta, sews up the uterus and skin. This lasts about half an hour.
Bandage over the seam.
The introduction of the drug for better contraction of the uterus.

After that, you may be given a sedative, hypnotic drug so that the body rests and gains strength after the stress. At this time, professional and experienced medical staff will look after the baby.

It must be borne in mind that any surgical intervention depends on many factors, so that each of them can go its own way, not like the others. And yet, there are certain features of this operation: what is important for a woman in labor to know about the second cesarean?

Features: what is important to know?

Despite the fact that a woman has already gone through all the stages of a caesarean section during her first pregnancy, the second operation has its own characteristics, which are better to know in advance. How long the operation lasts, when it is done (terms), whether it is necessary to go to the hospital in advance, what kind of anesthesia to agree to - all this is discussed with the doctor 1-2 weeks before the operation. This will avoid unpleasant consequences and shorten the recovery period.

How long does it take?

The second cesarean lasts longer than the first, as the incision is made along the old suture, which is a rough area, and not a complete skin cover, as before. In addition, re-operation requires much more caution.

What kind of anesthesia is used?

For a second caesarean, more powerful pain medications are used.

How long do they do it?

The most important feature of a caesarean section, which was already scheduled for the second time, is the timing of how many weeks the second planned caesarean section is done. They shift significantly to minimize risks. The larger the belly of the woman in labor, the larger the fetus, the more the walls of the uterus will stretch, and in the end, if you wait a long time, it can simply burst at the seam. Therefore, the operation is carried out at about 37-39 weeks. However, if the baby's weight is small, the condition of the doctor's suture is quite satisfactory, he can prescribe a later date. In any case, the planned date is discussed in advance with the expectant mother.

When to go to the hospital?

Most often, 1-2 weeks before the second cesarean, a woman is admitted to a hospital for preservation in order to avoid unforeseen situations. However, this is not always practiced. If the condition of the mother and baby does not cause concern, she can spend the last days before giving birth at home.

How long does it take to recover?

It must be borne in mind that recovery after a second caesarean section is not only longer, but also much harder. The skin has already been cut in the same place again, so it will heal longer than the first time. The seam can hurt and ooze for 1-2 weeks. The uterus will also contract longer, causing unpleasant, uncomfortable sensations. It will even be possible to remove the stomach after the second cesarean section only after 1.5-2 months through minor physical exercises (and only with the permission of the doctor). But if you stick to it, everything will go faster.

The above listed features of the second caesarean section need to be known to the woman in labor in order for her to feel calm and confident. Her state of mind before giving birth is very important. This will affect not only the outcome of the operation, but also the duration of the recovery period. Another important point is the risks associated with repeated surgical intervention.

Effects

Doctors do not always tell the expectant mother how dangerous the second caesarean section is, so that she is ready for the possible undesirable consequences of this operation. Therefore, it would be better if you know about it yourself in advance. The risks are different and they depend on the state of health of the mother, intrauterine development of the baby, the course of pregnancy, and the characteristics of the first caesarean.

Consequences for the mother:

menstrual irregularities;
, inflammation in the suture area;
injury to the intestines, bladder, ureters;
infertility;
after the second caesarean section, the frequency of complications such as thrombophlebitis (most often pelvic veins), anemia, endometritis increases;
removal of the uterus due to severe bleeding;
high risk of complications in the next pregnancy.

Consequences for the child:

violation of cerebral circulation;
due to prolonged exposure to anesthesia (the second caesarean lasts longer than the first).

When asked if it is possible to give birth after a second caesarean section, any doctor will answer that it is not desirable because of too many complications and negative consequences. Many hospitals even offer women sterilization procedures to prevent future pregnancies. Of course, there are happy exceptions when “caesarites” are born for the third, and even for the fourth time, but you need to understand that these are isolated cases that you do not need to focus on.

Found out you're having a second caesarean? Do not panic: in close cooperation with the attending physician, following all his recommendations and proper preparation, the operation will take place without complications. The main thing is the life that you managed to save and give to the little man.

Natural childbirth is the usual way of birth provided by nature. But sometimes, for a number of reasons, giving birth naturally can be dangerous for the life and health of a woman and her child. In this case, doctors solve the problem surgically and resort to a method such as a planned caesarean section. This is the name of the delivery operation, common in obstetric practice. Its meaning lies in the fact that the child is removed through an incision in the uterus. Despite the fact that it is performed frequently and saves the lives of thousands of children, complications after it also happen.

Sometimes the operation is performed urgently. Surgical emergency delivery is resorted to if complications arise during natural childbirth that threaten the life and health of the child or mother.

A planned caesarean section is an operation that is prescribed during pregnancy. It is carried out only for serious indications. When is a planned caesarean section prescribed, for how long is the operation performed and how to avoid complications?

Indications are divided into absolute, that is, those in which the possibility of independent childbirth is excluded, and relative.

List of absolute indications:

fetus weighing more than 4,500 g;
operations on the cervix in the past;
the presence of two or more scars on the uterus or the failure of one of them;
deformation of the pelvic bones due to previous injuries;
breech presentation of the fetus, if its weight exceeds 3600 g;
twins, if one of the fetuses is in a breech presentation;
the fetus is in a transverse position.

List of relative indications:

uterine fibroids;
high myopia;
diabetes;
the presence of malignant or benign tumors;
weak labor activity.

As a rule, a decision on a planned cesarean is made if there is at least one absolute indication or a set of relative indications. If the indications are only relative, it is necessary to weigh the risk of surgery and the risk of complications that may occur in natural childbirth.

When is the operation performed

At what time a planned caesarean is done, the doctor decides in each case, but there are still certain recommended frameworks. It is necessary to compare the date of the last menstruation, how many weeks the fetus is developed, what condition the placenta is in.

Based on this information, they decide when exactly to start delivery.

Sometimes doctors in the maternity hospital, when asked by the patient, when they do a planned cesarean section, answer that it is advisable to wait for the first light contractions to begin. In this case, the woman is hospitalized in the maternity hospital in advance, so as not to miss the onset of labor.

A pregnancy is considered full-term when it reaches 37 weeks. Therefore, before this time, it is too early to carry out the operation. On the other hand, after 37 weeks, contractions can start at any time.

The date when a planned caesarean section is made is tried to be as close as possible to the expected date of birth. But, since by the end of the period the placenta is aging and begins to perform its functions worse, in order to prevent the fetus, the operation is prescribed for a period of 38-39 weeks.

It was at this time that a woman is hospitalized in the antenatal department of a maternity hospital to pass all the tests necessary before the operation.

The surgical method of childbirth is not a contraindication to repeated pregnancies. But if a woman already has a scar on her uterus, then the second child will be born in the same way. Observation of the pregnant woman in this case is especially careful.

The second planned caesarean section is also done at 38-39 weeks, but if the doctor has doubts about the viability of the first scar, he may decide to operate on the patient earlier.

Preparing for a planned caesarean section

It is necessary to prepare for the appearance of a baby in such an unusual way. Usually, when a planned cesarean is done, the pregnant woman is hospitalized a couple of weeks before the day of the expected birth. To prepare for a planned caesarean section, they will take urine and blood tests from her, determine the blood type and Rh factor, and check the vaginal swab for purity. It is necessary to monitor the condition of the fetus. For this purpose, ultrasound and cardiotocography (CTG) are performed. Based on these studies, conclusions are drawn about the well-being of the child in the womb.

The specific date and time of the operation is determined by the doctor, having on hand the results of all tests and studies. Usually, all planned operations are carried out in the first half of the day. The day before the scheduled date, the anesthesiologist meets with the patient to discuss what type of anesthesia will be used, to find out if the woman is allergic to any medications.

On the eve of the caesarean section, food should be light, and after 18-19 hours it is forbidden not only to eat, but also to drink.

In the morning, a cleansing enema is performed and the pubic hair is shaved off. Care must be taken to prevent deep vein thrombosis. For this purpose, the legs are bandaged with an elastic bandage or the woman in labor is asked to put on special ones.

The patient is brought into the operating room on a gurney. On the operating table, a catheter is inserted into the urethra, it is removed already in the postoperative ward. The lower part of the abdomen is treated with an antiseptic solution, a special screen is installed at the level of the chest to close the woman's view of the surgical field.

Operation progress

To reduce anxiety before surgery, it is helpful to know how an elective caesarean section is performed. After giving anesthesia, the surgeon makes two incisions. The first incision cuts the abdominal wall, fat, connective tissue. The second incision is the uterus.

The cut can be of two types:

Transverse (horizontal). It is made a little above the pubis. With this incision method, there is a low chance that the intestines or bladder will be affected by the scalpel. The recovery period passes more easily, the formation of hernias is minimized, and the healed suture looks quite aesthetically pleasing.
Longitudinal (vertical). This incision extends from the pubic bone to the navel, while providing good access to the internal organs. The abdominal cavity is dissected longitudinally, if it is necessary to perform the operation urgently.

A planned cesarean section, no matter how long it is done, provided that there is no threat to the life of the fetus, is performed more often using a horizontal incision.

The surgeon removes the placenta from the uterus, and the incision is sutured with synthetic materials. In the same way, the integrity of the abdominal wall is restored. A cosmetic seam remains at the bottom of the abdomen. After it is disinfected and a protective bandage is applied.

If there are no complications during the work of surgeons, the operation lasts from 20 to 40 minutes, after which the patient is transferred to the postoperative ward.

Possible complications and their prevention

Complications may occur during surgical delivery and in the postoperative period. They do not depend on how long a planned caesarean section is done.

Common complications are the following:

Big blood loss. If a woman gives birth herself, 250 ml of blood is considered acceptable blood loss, and during surgical delivery, a woman can lose up to one liter of it. If the blood loss is too great, a transfusion will be required. The most formidable consequence of heavy bleeding that cannot be stopped is the need to remove the uterus.
The formation of adhesions. This is the name of seals from the connective tissue, which "splice" one organ with another, for example, the uterus with the intestines or intestinal loops among themselves. After abdominal intervention, adhesions almost always form, but if there are too many of them, chronic pain in the abdominal region occurs. If adhesions form in the fallopian tubes, the risk of an ectopic pregnancy increases.
Endometritis is an inflammation of the uterine cavity, provoked by the ingress of pathogenic bacteria into it. Symptoms of endometritis can manifest themselves both on the first day after surgery, and on the 10th day after childbirth.
Inflammatory processes in the suture area, due to the penetration of infection into the suture. If antibiotic therapy is not started on time, surgery may be required.
Seam divergence. It can be provoked by a woman lifting weights (over 4 kilograms), and the divergence of the seam is a consequence of the development of an infection in it.

To prevent the occurrence of complications, doctors take measures even before the start of operations. To prevent the development of endometritis, a woman is given an antibiotic injection before the operation.

Antibacterial therapy continues for several days after. You can prevent the formation of adhesions by attending physiotherapy and doing special gymnastics.

Recovery period

After childbirth, the uterus returns to its previous state after 6-8 weeks. But the recovery period after surgical birth lasts longer than after natural birth. After all, the uterus is injured, and the suture does not always heal safely.

In many ways, the recovery period depends on how the planned cesarean went, how well it was done.

At the end of the operation, the patient is transferred to the recovery room or intensive care unit. To prevent the occurrence of infectious complications, antibiotic therapy is carried out.

To relieve pain, painkillers are given. Both general and spinal anesthesia slow down the bowels, so in the first 24 hours after the intervention, you can only drink water.