Can I have a baby after a caesarean? How should you prepare for natural childbirth? Indications for repeat cesarean

On what indicators depends, it is possible or not.

If the indications for caesarean section in the past concerned precisely the situation in childbirth, and not directly to you. Then, if everything is fine in this pregnancy, then natural childbirth is possible.
If the scar on the uterus after the first cesarean allows you to give birth. This is determined on and the doctor, based on the results of the ultrasound, decides whether you can try or not.
If in the past a pregnant woman had a natural birth, and then there was a caesarean. Provided that the scar on the uterus is wealthy, the presence of natural childbirth in the past is a favorable factor for future natural childbirth. Cervix, birth canal, - already "giving birth".
If the child is large, with a large weight (more than 3500), then doctors may insist on an operation.
If the indications for the previous cesarean were related to the mother herself, and did not disappear during this time. For example, if the mother had (and remained, of course) a narrow pelvis. Then the doctors will recommend a caesarean section this time as well.

Note. A frequent indication for caesarean section used to be a certain degree of myopia (myopia) in combination with a certain condition of the fundus (now myopia in itself is not a direct indication for caesarean section). This problem does not go away with moms over time. However, there are many cases where (with a rich scar on the uterus), with this eye condition, women give birth naturally after a caesarean. They are taught to “correctly” push, directing efforts not to the face and eyes. The possibility of natural childbirth in such a situation must be considered by both the gynecologist and the ophthalmologist.

What is the difference between conventional natural childbirth and natural childbirth after caesarean section

There are no special differences; for a woman in labor, everything happens in the same way as in normal natural childbirth. There are several "related" moments.

Until the very moment of childbirth, the doctor will monitor the condition of the scar on the uterus, according to the results of ultrasound.
The attending physician must be ready to perform the operation at any moment. caesarean section, if needed. The ward for the operation must be (just in case) prepared, and the operating team is ready.
During childbirth, the doctor must monitor the heartbeat of the fetus. This is done using electronic fetal monitoring (cardiotocography). A baby's heartbeat may be a sign possible problems with a scar. By itself, the scar on the uterus is a violation of the integrity of the uterus. If the scar on the uterus becomes thinner during childbirth, then the tone of the uterus increases, the contractions are more active, painful, and therefore the fetus experiences oxygen starvation, respectively, the heartbeat of the child suffers.

The weight

So that the child is not too large.
So that mom is not overweight ( excess weight, or obesity may be an indication for a caesarean section).

It is important to eat right and high quality throughout pregnancy. In recent months, you need to eat very fractionally and as useful as possible. Therefore, you should choose and buy in the Mom's Shop for pregnant and lactating women, which you can take with you to the hospital or eat after the baby is born. These products have an excellent composition, and most importantly, a balance between fats, proteins and carbohydrates. .

Note. Return of food and cosmetics at our expense is only possible with undamaged packaging.

maternity hospital

If you have decided on natural childbirth, then you will need to take it seriously. The selected maternity hospital should support this practice and create conditions for you to successful delivery. Unfortunately, this is by no means available in every maternity hospital, since it is easier and more reliable to carry out a planned cesarean, referring to the fact that there is already a scar on the uterus and there is no need to take risks.

Doctor

The choice of a doctor is very important in this situation. We need a doctor who supports your decision, and will create the maximum for this safe conditions. Therefore, look for reviews of the same women in labor.

mood

According to the reviews of many mothers who gave birth naturally after a cesarean, the right attitude does real miracles. You need calmness and confidence in your choice, as in the right one, for yourself and your baby. The only "but". Try to be healthy upcoming birth and look at them only as a means of bringing a child into the world. The type of childbirth is not an assessment of you and not an assessment of you as a mother or as a woman. Therefore, it’s not right to tune in this way: I give birth naturally, no matter what happens, I’m a real woman. And so: I will do everything so that the child is born naturally, provided that it is safe for me and the child.

Prepare well for breastfeeding and pastime from a few days to a week in the hospital. Buy at Mom's Store:

(according to the doctor's indications);
and for comfortable feeding.

What are the consequences of natural childbirth after caesarean

There is a possibility of divergence of the previous scar on the uterus. According to statistics, such a complication occurs in one case per 200 such births. In the event of such a discrepancy, is done. Everyone first possible ways the uterus is sutured, if it does not bleed, then everything is fine, the uterus is preserved. With multiple ruptures, significant hematoma or large intra-abdominal bleeding, which threatens the life of a woman, the issue of removing the uterus is being decided. The main danger of suture divergence is that it is often accompanied by bleeding in abdominal cavity or into the muscle of the uterus, which threatens the life of the child and mother.

All other consequences relate simply, and not specifically to natural childbirth after cesarean, I will list them below.

Pain in the perineum, often requiring stitches.
Possible urinary incontinence in the first two to three months after childbirth.
Possible uterine prolapse. To avoid this complication, you need to regularly perform exercises to strengthen the pelvic floor.

It is imperative that after childbirth it is necessary to keep the whole body clean, especially use exclusively, and pay attention in Mom's Store to (nipple creams, recovery oils female body after childbirth, oil for tissue healing from ruptures and caesarean sections, oil for prenatal perineal massage, etc.).

Note. Return of food and cosmetics is possible only if the packaging is intact.

When shopping in we guarantee pleasant and fast service .

Approximately one third of women whose babies were born with the help surgical intervention, would like to give birth to another, and maybe more than one child in the future. Doctors say that absolute contraindications to get pregnant again after a caesarean does not exist, although they warn that each subsequent operation will be more difficult, with more likely complications. However, there are cases when repeated pregnancy and childbirth are not accompanied by medical indications, due to which an operation was previously prescribed, the physiology of the woman and the fetus is normal and the woman can give birth natural way.

Let's talk in more detail about how safe a second pregnancy is after a cesarean, what complication can occur during childbirth, when is the best time to plan a re-conception, is it possible to immediately have a second child.

The best time for re-pregnancy

If previous births were carried out by caesarean section, then a second pregnancy can be planned no earlier than in 25-30 months. During this time, the scar on the uterus will completely overgrow, the tissues of its walls will strengthen, and the body will recover after the load. Throughout this period, it is important to devote Special attention contraception to avoid unauthorized conception. Early pregnancy after a cesarean section is very dangerous, since a poorly fused scar can disperse or cause a rupture of the uterine wall.

And abortion during the recovery period is also undesirable, because the mechanical effect on inner surface uterus a few months after childbirth can lead to the appearance inflammatory process, thinning or rupture of the wall.

But it’s also not worth delaying with a second pregnancy, if a woman dreams of another baby. The reason for this is that over time, atrophy of the scar tissue occurs and the suture becomes less durable. Such changes begin to occur about 10 years after the operation, so doctors advise planning a second pregnancy after a caesarean section between 3 and 10 years after birth.

Before the doctor decides on the admissibility of a second pregnancy, a qualitative examination of the condition of the scar tissue should be carried out. For this, methods such as:

hysterography,
hysteroscopy,
Ultrasound diagnostics.

After 10-15 months after the operation, you can go through one, or better, two examinations at once to find out the condition of the scar. By this time, its formation is already over, and in the future it will practically not change.

In addition to the condition of the scar, it is important to determine the type of tissue from which it is formed.

The ideal option is a scar from muscle tissue, but connective or mixed tissue will be a much worse option. It will depend only on the results of hysteroscopy whether it is possible for a woman to become pregnant again.

Edema during pregnancy: is it dangerous or not

How can you give birth after a cesarean?

In Soviet medicine, there was a dogma: "all births following a caesarean section can only be carried out in the same way." However modern technologies allow women, in the absence of medical indications to surgical delivery, to give birth to a child naturally. Doctors do not consider the presence of a scar on the uterus as a mandatory reason for a second cesarean. Truth, we are talking only about a transverse scar, with a longitudinal section, the option of natural childbirth is excluded.

Natural childbirth is much more beneficial for both the woman in labor and the baby. A child born naturally develops better, is less prone to stress, malfunctions in the functioning of the respiratory and nervous systems, in the future, less likely to suffer from allergies, scoliosis. There is no risk in these deliveries. postoperative complications, the recovery of the body of the woman in labor occurs faster, milk begins to arrive earlier and its quality is better.

Of course, in order for the doctor to allow repeated childbirth without surgical intervention, he must observe the woman throughout all months of pregnancy and be sure of perfect condition scar on the uterus.

It should be noted that natural childbirth is allowed mainly for women who have had only one caesarean.

If there are several scars, then the doctor, as a rule, does not risk exposing the woman in labor possible complications and insists on another operation.

Statistics say that after a cesarean, seven out of ten women safely give birth to a second child in a natural way. You can try to give birth a second time and more than twice on your own if the reason for the operation was problems directly related to the course of the previous pregnancy, which did not recur during a second pregnancy, for example, such as:

malposition of the fetus
toxicosis in the second half of the term,
fetal pathology,
acute form of genital infection,
narrow pelvis.

The latter problem is most often caused by weak labor activity, and during subsequent births, the likelihood of its recurrence is low. If the first birth was carried out by caesarean section due to problems with vision, heart or other similar reasons, which do not disappear anywhere either in a month or a year and are still present in the anamnesis of the pregnant woman, then the doctor, of course, will prescribe a second operation.

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When can a doctor allow natural childbirth?

Since self-delivery after cesarean requires special care and responsibility from the attending physician, often women who want to give birth in this way are subject to strict requirements:

the interval between the first birth and re-pregnancy should be more than three, but less than ten years,
the suture on the uterus should be transverse (horizontal),
the placenta should be as high as possible and preferably near the back wall,
Pregnancy must be singleton
necessarily head presentation of the fetus,
good condition of the scar, confirmed by several ultrasound data.

Subject to the above requirements and the absence of contraindications, a woman can be allowed to give birth naturally. It should be remembered that during the time of childbirth, stimulation or anesthesia will be contraindicated for a woman in order to avoid the risk of a strong contraction of the uterus, which can cause it to rupture.

How big is the danger

Most of all, women who have previously given birth by cesarean are afraid of uterine rupture during repeated births, if they will pass in a natural way. According to statistics, no more than a third of women in our country decide to give birth a second time on their own, although in developed Western countries the number of such pregnant women reaches 70%. Moreover, medicine knows cases when pregnant women dared to give birth to a baby on their own even after two surgical interventions.

The reason for this fear lies in the following. The first operations by caesarean section were carried out through a longitudinal incision in the upper part of the uterus, that is, where the pressure on it is the strongest and the risk of rupture is high. Modern operations performed with a transverse incision in the lower part of the uterus. The load that he experiences during uterine contraction is directed in such a way that virtually eliminates the possibility of tissue rupture.

The risk of damage to the uterus during vaginal delivery in the presence of a transverse incision does not exceed 0.2%.

In addition, the threat of such damage is detected in a timely manner with the help of ultrasound and CTG during the period of 8-9 months of pregnancy. Therefore, the facts of rupture of the uterine scar during childbirth and the health problems caused by them for the mother or baby have not been found in modern practice for a long time.

Much greater risk for a woman's health is pregnancy a year after cesarean, when the body as a whole and the uterus in particular have not recovered from the previous operation. In this case, both termination and continuation of pregnancy are dangerous, so the woman will have to make a very difficult decision.

Features of breastfeeding during pregnancy

Pregnancy planning

It is recommended to find a second child at the planning stage a good specialist specializing specifically in the management of repeated pregnancies after caesarean, as his experience and knowledge are very important for the health of the mother and the unborn baby.

In addition, preparing to become pregnant, a woman must perform the following recommendations doctors:

give up bad habits a few months before getting pregnant,
stop taking hormonal contraceptives if they were used to prevent unwanted pregnancy,
get rid of chronic, infectious and inflammatory diseases,
consult with a therapist and immediately go through necessary research: fluorography, general analyzes blood and urine, measure blood pressure and hormone levels,
be examined by narrow specialists and a gynecologist,
take a course of immunotherapy, drink vitamin - for a month mineral complex, preferably including important trace elements.

Regardless of how the second birth will be carried out, during the pregnancy of a woman after a cesarean section, she will be given much more attention than other patients. antenatal clinic. Do not worry if the doctor is often interested in how the pregnant woman feels and prescribes additional examinations.

A caesarean section is not at all a reason not to dream about motherhood a second time and refuse to experience the joy of rocking the crumbs in your arms, excitement from the first step, happiness to tears from the first word: “Mom”. But the thought of the terrible scar that marred the stomach, which had just become invisible, of the bleeding, ligature fistulas, pain - all this recreates a completely undesirable picture in the imagination. But any mother dreams of seeing her baby as soon as he was born, hearing his first cry, with which he calls her, giving mother's milk to the baby right in the delivery room. So is natural childbirth possible after a previous caesarean section?

Subsequent births after artificial delivery

Some time ago, women who once underwent surgery, at the birth of their second child, were “doomed” to fall under the surgical knife again. The view of modern physicians on childbirth after caesarean section has changed dramatically. Now, in many cases, expectant mothers are allowed to give birth on their own, as nature originally intended, but only if there is no certain contraindications(we will consider them later).

Natural childbirth after cesarean is allowed only when the body has fully recovered from the previous surgical intervention. This should take two or three years. By this time, the scar on the uterus will form with a predominance of muscle tissue and become almost invisible, the woman will gain strength, get stronger, get rid of anemia (bleeding, which is inevitable after cesarean, always leads to sharp decline hemoglobin). If a woman, for some reason, cannot postpone her next pregnancy for such a period, then doctors recommend keeping at least 18 months, but then independent childbirth come under the big question. Even earlier repeated pregnancies definitely subject to artificial delivery.

More recently, doctors categorically denied the ability of a woman to give birth herself after a cesarean. With the development of medicine and the accumulation of relevant experience in this field, this refutation ceased to be valid.

When is it impossible to give birth after a cesarean?

If you have any of the following pathologies, then avoid reoperation there is no possibility. Absolute :

features of the anatomical structure;
myopia, traumatic brain injury;
pregnancy with several children;
hypertension and diabetes;
complications in primary caesarean and scar failure.

How long can you not get pregnant and give birth after a cesarean?

Doctors insist on the absence of pregnancy and abortion for 2-3 years after the operation. This period is given for complete healing of the internal, restoration of the elasticity of the muscles of the uterus and normalization general condition organism. It is assumed that after a caesarean section, you can give birth after a year and a half, but only if there is a full-fledged and wealthy scar.

Is it possible to give birth after a cesarean?

Yes, you can. But in the presence of a number of conditions established by the medical consultation. Those who gave birth themselves after cesarean on their own were under the vigilant supervision of doctors, went to the antenatal ward in advance and underwent a lot of confirmatory studies.

The problem of whether it is possible to give birth after a cesarean in a natural way has always caused a lot of controversy among doctors, since there is no single tactic of behavior in this situation. Therefore, before thinking about whether it is possible to give birth after a cesarean on her own, every expectant mother must weigh the pros and cons and, together with her doctor, evaluate the benefit-risk ratio.

Is there a chance of giving birth after two cesareans?

The question is whether it should be done. Saying that “I want to give birth myself after a cesarean” and not knowing the consequences is a huge irresponsibility for the condition of myself and the child. It must be understood that each operation causes certain and ever-increasing damage to the uterus. Its walls are thinning endometritis, thrombophlebitis and anemia appear. Therefore, you can try to give birth after a caesarean couple yourself, and this is a laudable desire, but it is better not to risk it.

How long can you give birth after caesarean?

In the recent past, doctors limited mothers to three pregnancies with delivery by caesarean. The development of medicine and technology has allowed a woman to take part in deciding whether she can give birth after a cesarean, and how many children to have in the future. But in any case, this issue requires caution and careful medical supervision.

Caesarean section, as a method of delivery, has been known for a very long time, since antiquity. Despite such a venerable age, such surgical intervention remains relevant in the modern world.

Today, childbirth by caesarean section is carried out by every fourth woman in labor. Naturally, these data show a picture in those regions in which such statistics are kept.

Prevalence

in America and European countries considered to be developed long time cultivated image successful person, women. So many of the fair sex prefer to devote more time to their careers. The first birth after 30 or even after 35 years is quite common for economically developed regions.

Contribute to the tendency to give birth late and insurance payments. Their size for the operation is noticeably higher than for natural childbirth. Perhaps this is the most significant reasons the fact that caesarean section has become very popular in the civilized world.

As for the post-Soviet space, the number of operations performed in our country has also increased, and often a woman goes for an operation not when there is a real need for it. Relatively recently, it was even fashionable. A significant proportion of women decide to have surgery because of the fear of physiological childbirth.

But time runs and the doctors are leaning more and more towards more strict choice indications for operative delivery and return to natural, natural way birth. Of course, if there are no factors health threatening mother and child.

After natural childbirth (EP) recovery period goes faster. Plus, there are no risks of postoperative complications, which significantly aggravate the care of a baby for a mother who has just given birth.

What should you beware of?

Many women become mothers with the help of a surgeon. In this case, serious difficulties can arise if there is a desire to have another baby:

Repeated operative delivery is always more difficult. Regardless of the type of anesthesia and the course of the operation.
The woman is getting older. If there is a significant interval between pregnancies, the presence of the first scar complicates the work of the surgeon.
Recovery after surgery takes longer.
The uterus already has less contractility.
The woman has to take antibiotics, which interferes with early breastfeeding.
With age, the risk of postoperative complications also increases.
Due to the fact that the subsequent operation is longer in time, a longer anesthesia is required. This may also affect the condition of the child.

Therefore, if it is possible, according to the indications and with the support of a doctor, to conduct a natural birth, you should choose this path. The decision is made easier if the woman has had experience of natural delivery prior to having a caesarean. Yes, even if there is no such experience, but the prognosis for physiological childbirth is favorable, you need to consciously take this step.

Is it possible to give birth naturally if there was a caesarean section before? Doctors give a positive answer in many situations. You can give birth after a caesarean section if you have everything favorable conditions, there are no strong recommendations for delivery only by caesarean section, when more than 2 years have passed from the operation.

Contraindications to EP

Previously, if a woman had already given birth once by caesarean section, the next birth was carried out only by surgery. Today, many women in labor, if the problems that led to emergency operative obstetrics for the first time, are not observed during the current pregnancy, they are offered to try to give birth physiologically.

To whom can obstetrician-gynecologists say a categorical “no” in response to the question: is it possible to give birth after a cesarean? Women who have:

There are scars on the uterus from surgeries (more than two).
The scar is thinned, insolvent.
special anatomical structure(narrow pelvis, deformities of the pelvic bones).
Multiple pregnancy (triplets or more).
Myomatous nodes in large numbers.
Pathology of the cervix.
Breech or more dangerous - transverse presentation.
Large fruit weight.
Pregnancy that occurred earlier than one and a half years after the surgical section.
Serious somatic (extragenital) diseases ( diabetes, complicated myopia, CVS pathology).
Complete placenta previa. Or incomplete, but with episodes of bleeding.
Pathological development of the fetus.
Other predictable complications of physiological childbirth.

The greatest threat is insolvent scar connective tissue structure after a previous operation on the uterus. No one can give guarantees that he will withstand the load in the process. labor activity, active uterine contractions.

An inconsistent scar can lead to rupture of the body of the uterus during contractions. This is already directly dangerous for the life of the woman in labor and the child, threatens at least with massive bleeding.

So the nature of the scar is necessarily determined and taken into account by the doctor in preparation for next pregnancy. It is common practice to review the previous intervention protocol to see if there were any complications and how smoothly the procedure went. postoperative period. Ultrasound is performed, but this study is not very revealing, it can determine the size and parameters of scar tissue.

Other indications may be used instrumental techniques. In doing so, preference is given to endoscopic procedures. X-ray studies for obvious reasons, are carried out in the most extreme cases.

It is necessary to examine the postoperative scar no earlier than 8-10 months after the intervention. If he is characterized as wealthy and there are no other contraindications, then the doctor will answer whether it is possible for this woman to give birth after a cesarean in the affirmative.

When planning the next pregnancy after a caesarean section, a woman is recommended to use contraception for 2 years before recovery. normal functions body, use contraceptives. abortion and diagnostic curettage thin out muscle layer uterus and injure the scar, which reduces the chances of a natural delivery. If such manipulations have occurred, the doctor should be informed.

Training

Offering to give birth on your own after a cesarean section is a big responsibility of the doctor. It happens that for the first time they operate on emergency indications.

Then, in subsequent pregnancies, it is necessary to pay close attention to examinations in the consultation. If there is reason to consider the scar from the previous caesarean section as well-founded and elastic, then the probability of success in physiological childbirth is quite high.

If a doctor you trust gives you a strong recommendation to have a vaginal birth after a caesarean section, you have been examined and there are no absolute contraindications, why not give yourself the opportunity to give birth naturally? It is possible to give birth with a scar on the uterus and the percentage of successful births is very high. Risks are low if:

Pregnancy occurred after two or more years from the operation.
There is a good strong scar on the uterus.
Fruit weighing up to 3.5 kg.
The development of the baby took place without pathology.
Pregnancy proceeds within the physiological norm.
The fetus is located in the optimal position (head presentation).
The placenta is attached to the posterior or anterior wall of the uterus. Ideally, not in the area of the scar.
The pelvis meets the parameters of the norm (not narrow).

Vaginal delivery after a caesarean section comes with certain risks. A woman should carefully monitor her condition throughout her pregnancy, be set for success and be psychologically ready for normal childbirth. Family members are of great help and support. professional doctor. She must know that in any case she will be given qualified assistance and believe in your success.

Immediate activities

Childbirth after two transferred caesarean sections significantly complicate the situation. Two scars (not counting abortions, curettage) are much worse than one. And the risks are doubled accordingly.

Two stitches on the uterus are taken away more area in normal muscle fibers. In such cases, only qualified doctors can assess the situation. Statistically, physiological deliveries after two caesarean deliveries promise a 60% success rate.

Childbirth after surgery is always a risk. Therefore, to natural childbirth in such a situation, you should prepare thoroughly and expectant mother and the doctor of her choice.

Preparation of childbirth with a scar on the uterus is the cost of additional efforts and the provision of safety options.

It is necessary to conduct an ultrasound just before the onset of labor to make sure that everything goes according to plan: the fetus is located correctly head down, the placenta is not attached next to the scar, there are no prerequisites for its early detachment, the scar is ready to bear the load. The condition of the fetus is constantly monitored. A woman is required to have strong faith in the success of the event.

Features of conducting

Epidural anesthesia may be required to relieve tension and adequate cervical dilatation. Be sure to prepare the operating room and resuscitation - in case you need to urgently operate.

In childbirth in natural childbirth, women with a postoperative scar on the uterus are not stimulated with oxytocin. This makes it possible to prevent possible gap uterus in the area of cicatricial tissue changes. Dangerous is not what will disperse connective tissue- She is very durable. A rupture may occur at the site of attachment of muscle fibers to it.

In addition, it is prohibited to use obstetric forceps, change in position (rotation of the fetus) when it is in the wrong position.

If the waters have broken, there is a weakness in labor activity and there is no cervical dilatation for more than 15 hours - these are indications for a second caesarean section, in which case the waiting policy is unacceptable. If something doesn't go according to plan, it's dangerous to wait.

Making a decision to conduct emergency operation not subject to discussion in cases where:

Fetal hypoxia was noted.
The waters receded 15 hours ago or more.
There is insufficient opening of the cervix.
The presence of bleeding of any origin.
There was an immediate threat of uterine rupture.
Break in progress.

Despite such dangers, a woman going for a natural birth after a cesarean should feel the help and attention of the staff. Trust the doctor, knowing that in any situation she has powerful support.

Undoubtedly, if there is a high chance of giving birth naturally, then you should strive for this. The main task is healthy child and healthy mother.