Everything is not as scary as it might seem at first glance. If the operation was successful and without complications, the doctors recommend waiting a year and a half before trying to get pregnant again. This is a period of time "with a margin." Usually the incision is cicatrized in three months, and in six months the uterus returns to normal. Precautions are associated with the fact that the more time has passed since the operation, the greater the chances of avoiding such problems as low placental location due to a scar on the uterus, placental abruption in later pregnancy or a seam problem in the process of vaginal delivery with the next toddler. In most cases, if you become pregnant one year after a cesarean section or later, your pregnancy and childbirth will not be nearly the same as usual. Repeated cesarean and weakness of labor is a topic of publication.
The second pregnancy
If the healing of the scar was normal, then your pregnancy is not in danger. Despite the fact that in the process of bearing the baby the uterus greatly increases in size, there is practically no risk that the seam will disperse. However, there is the possibility of complications of a different kind. They should not be frightened. Just your pregnancy requires special attention from the doctor, who prepares you for childbirth and accepts them. The most dangerous complication is the rupture of the uterus along the rumen. This is possible not only after cesarean section, but also after conservative myomectomy (operative removal of uterine fibroids), after removal of the ectopic pregnancy (the method of excision of the uterine angle), after numerous abortions.
Placental abruption
This also happens with those who do not have a cesarean section in history, but the risk of this complication is still increasing. In this case, doctors will have to do an emergency cesarean to save the baby.
Increment of the placenta
To determine whether it occurred before the birth begins, it is impossible. The essence of this phenomenon is that in the last period of birth, parts of the placenta can not separate from those tissues where the scar is located. As a result, in the postpartum period, profuse bleeding may open, and doctors will have to apply emergency measures.
Low location of the placenta
Its cause may also be a scar on the uterus.
Routine cesarean
If you want to give birth naturally after cesarean section, consult a doctor. In most cases, nothing prevents vaginal birth. Although there are situations when cesarean is better to repeat on medical grounds. The doctor will insist on a second cesarean in certain cases.
- If the previous cesarean was corporal (it is made by a vertical incision from the womb to the navel, and not horizontal in the lower segment of the uterus), then this is unambiguous - an indication for a cesarean. Such a section is resorted to in extreme cases: if the child is in the uterus horizontally, or if it is extremely unripe, or for any other reason for emergency operative delivery (eg, prolapse of the umbilical cord, acute fetal hypoxia).
- The condition of the scar on the uterus (according to ultrasound). The scar should be predominantly of a homogeneous structure, without "niches", entanglements and deformations. The thickness of the scar at 38-39 weeks - not less than 4 mm.
- Incorrect position of the baby in the womb. In the horizontal position, vaginal delivery is impossible, with pelvic presentation - it is forbidden, if there is a cesarean in an anamnesis.
- Unavailability of the birth canal. Quite often, maturation of the cervix does not occur due to the inconsistency of the scar on the uterus.
- Contraindication for natural childbirth after cesarean is a large fetus: the weight of the child by ultrasound should not exceed 3800.0 g.
- Two or more cesarean. The more the scars on the uterus, the higher the risk of complications. In particular, the separation of the placenta can be complicated, if it "grows" into a scar, there is a risk of divergence of the seam in the process of fights.
- Low location or presentation of the placenta. In this case, as a rule, an operation is recommended, as with ordinary births such a placenta can exfoliate, which will lead to an oxygen starvation of the baby. If you do not have a medical indication for a second cesarean, decide whether to try to give birth naturally.
- There is a reason why you had an operation last time. For example, you have a retinal detachment, and increasing eye pressure on attempts may worsen your eyesight.
Vaginal delivery after cesarean
The fundamental difference between the usual births after the birth of a cesarean is that such births do not stimulate: they should normally flow themselves, without injections of oxytocin or enzaprost, since any stimulation of labor can provoke a rupture. Also, such births try not to anesthetize them so as not to mask the clinical picture of the uterine rupture. Simply put, with anesthesia, mother will not be able to complain about unpleasant symptoms, and doctors may not be in time to help her. The mechanism of vaginal delivery after cesarean is the same as for normal. You will not be restricted in free behavior during fights: you can take a comfortable position, do respiratory gymnastics, hold a period of bouts in the shower or in a special pool to reduce pain. However, it will also be quite reasonable for physicians to observe the baby's heartbeat with the help of a monitor, as is done in many cases, when there is a need to closely monitor the condition of the baby.
Advantages of vaginal birth before a second cesarean
- You will quickly get in shape. It will be easier for you to take care of the baby and serve yourself.
- Birth naturally helps the baby to activate active life processes, for example, breathing.
- In vaginal births, the risk of infection is much lower.
- You will be able to return home a week earlier, and you will not have to look after the scar in the bikini area.
- In the event that the cesarean section is carried out under general anesthesia, you can not immediately see the baby, establish contact with it and attach it to the chest, which is useful for the health of the crumbs and for your uterus to become normal in the postpartum period.
- Excess scar on the uterus increases the level of risk for subsequent babies and reduces the likelihood that it will be possible to carry out vaginal birth.
- Every subsequent cesarean is more difficult to spend without danger to health. There are women who give birth to three or more children by caesarean, but this sometimes leads to bleeding and the need to transfuse blood, and removal of the uterus may be required.
- Any cavitary operations lead to a commissural process. This means that the tissues of the internal organs are fastened together, which limits their mobility and can cause severe pain. In rare cases, spikes can occur in the fallopian tubes, which can lead to problems with conceiving. It does not matter if you have to repeat cesarean or you will give birth naturally - the baby should appear in the light as it will be safer for him and your health.
note
The disadvantages of vaginal delivery include problems with the perineum, which not everyone can avoid, regardless of whether there was a cesarean or not. There is the possibility of episiotomy, weakness of the urethra in the postpartum period, stretching or lowering of the vaginal walls and postnatal pain. Pay attention, even in those countries where, on the whole, they are positive about both vaginal birth after cesarean and home birth, do not recommend giving birth to those who have this history in the out-patient institution. Despite the fact that the risks are minimal, doctors nevertheless consider it necessary to observe the baby's condition in this situation more carefully, in order to take all necessary measures if there is a threat to his life or your health.
Program of Action
So, if you already had a cesarean section, you need to remember some points. If the previous operation was less than half a year ago, consult a specialist to watch your pregnancy especially carefully. After the 30th week of pregnancy, discuss with the doctor the tactics and strategy of labor management. If the doctor insists on a second cesarean, discuss with him the testimony, find out why it is impossible to carry out vaginal birth. Starting from the 36th week, it is advisable to visit the doctor weekly, if possible, to conduct 2-3 additional ultrasound examinations of the scar status on the uterus, for example, at 38 and 39 weeks of pregnancy, to determine its consistency. If the previous operation was performed a year or more ago, treat your pregnancy as usual, but it is advisable to monitor the condition of the scar on the uterus during planned ultrasound. If the doctor recommends that you try the birth in a natural way, do not set yourself up too bluntly: "As good as if only not Caesarean!" Remember that any woman may need surgery - she will help protect you and the baby from various problems and complications .