In some circumstances, a caesarean section may indeed be the only way to save the life of mother and child. But we believe that in at least half of the cases it can be avoided if parents take responsibility for the birth. You can do the following.

1. Choose the right person to give birth, as well as the place where it will take place.. Determine who can provide you with the safest and most prosperous birth. We cannot recommend that everyone give birth at home, since the conditions for this have not yet been created in the healthcare system. But you have three places where you can give birth: home, family center and maternity hospital. Hospital births are more likely to end in cesarean.

Talk to your obstetrician and make sure he or she is not adamant about giving birth in the supine position. Otherwise, this doctor is not suitable for you. Also find out what he thinks about walking during contractions and vertical birth. Will you be allowed to give birth squatting or lying on your side? Is the doctor calm about you or does he expect serious complications? Does he have experience of vaginal birth after cesarean? How often does he perform a caesarean section himself? If this figure exceeds 15 percent, then most likely the surgical approach to childbirth prevails. Ask about mandatory tests and procedures during childbirth. Does your doctor use continuous EMF? What percentage of his patients required permanent EMF?

2. Hire a professional assistant. If you, like most women in labor, decide to give birth in a maternity hospital, then hire a professional birth assistant. This will help you significantly reduce your chances of having surgery.

3. Think vertical. Erase the following picture from your imagination: a woman lies on her back, and the doctor sits comfortably in front of her. The supine position is the position for caesarean section. And the more you stay in it, the more likely it is that they will do it for you. Studies have shown that in an upright position the uterus works better, labor time is reduced, the cervix dilates more easily and childbirth is more prosperous. The more mothers and doctors overcome the “horizontal” approach and begin to think “vertically”, the more children will be born as expected. Stand up during labor. The recumbent position is the root cause of a long and painful labor, which may well end in the operating room. The horizontal position is a legacy from the past, when childbirth was carried out under anesthesia, when forceps were used, and mothers were unable to give birth on their own. In a vertical squatting position, the volume of the pelvis increases and the force of gravity is used. However, thinking vertically doesn't mean you can't lie down to rest during labor. Many women can lie down from time to time, propping up pillows and enjoying the caresses of their partner. If such rest does not bring you relief, try using a bath. Freedom of choice during birth is the best way to avoid a cesarean section.

4. Walking. If you start thinking vertically, start moving. Studies have shown that walking not only speeds up labor, but is also good for the baby.

5. Use EMFs and IV fluids correctly. Proponents of mandatory electrical fetal monitoring say it can reduce the number of stillbirths and children born with brain damage. EMT became a standard procedure even before its usefulness was proven. Currently, doctors are afraid not to do EMT because they are afraid of liability before the law. But numerous studies have shown that during normal childbirth there is no difference for mother and child whether to listen to the fetal heartbeat using this device or a regular fetoscope. According to the same studies, they found that when using EMF, women were twice as likely to have a cesarean section than in the group of women in labor who did not undergo such examination. Moreover, according to recent studies, the majority of cases of cerebral palsy are explained by premature cesarean sections (ie, the operation was performed before labor began). EMT should be done only if there are serious indications. Remember, as soon as you are connected to some kind of monitor, the chances of getting a cesarean increase dramatically. However, in some cases, EMF, on the contrary, can help avoid cesarean section. If the doctor suspects complications (for example, when labor stops), and the monitor provides information that everything is fine with the baby, then they will most likely give you the opportunity to continue giving birth and will not rush to operate. When used correctly, technology can be your friend.

6. Be careful with epidural anesthesia. Epidural anesthesia, like fetal electrical monitoring, can be your friend and your enemy. A study of five hundred primiparous women showed that those who received epidural anesthesia were more likely to end up on the operating table due to incoordination of labor. However, other studies do not find that an epidural increases the chances of a C-section. We were present at the birth, when timely epidural anesthesia helped the mother relax and give birth naturally. On the other hand, too frequent use of this “divine miracle” (as some women in labor call epidural anesthesia) can have a depressing effect on the contractile function of the uterus. With such anesthesia, you lose a very important assistant - gravity. Plus, you're lying on your back, meaning you're halfway into the operating room.

7. Take your time. During childbirth, as during sex, you should not rush. Don’t let yourself be convinced that you need to give birth quickly so as not to delay other people. At the moment of birth, you are a star, and everyone else is just your retinue. Childbirth is too important an event in your life to look back on in time. Very often, “discoordination of labor” is nothing more than the doctor’s unwillingness to wait. There is no evidence that a long labor is dangerous for the baby, nor are there any restrictions on the timing of labor. Although there are tables that show the average length of labor, these are just averages and may not apply to you personally. Your uterus has not seen these tables. Long labor causes concern, as it is believed that with each contraction the amount of oxygen reaching the baby is reduced. That is, the longer the contraction, the less oxygen your baby receives. However, this assumption has never been scientifically confirmed.

8. Trust (and act on) your intuition about how to manage your labor.. While there is a return to natural childbirth, women are faced with a new phenomenon. On the eve of the calculated date of birth, the pregnant woman is examined for the absence of pathology and readiness for childbirth and sent to the maternity hospital. There she receives a Pitocin shot and an epidural. That is, such births are artificially stimulated, checked and accepted. After a very short time (about 12 hours), parents and child return home without signs of fatigue. Before you happily vote for such births, think about how many of them will not go according to such a wonderful plan and end up in the operating room.

Advocates for predictable births believe this can reduce the number of Caesarean sections. In one study, timely induction of labor with pitocin helped reduce the number of cesareans from 20 to six percent. That is, stimulation was carried out before the woman in labor became exhausted and lost the ability to continue childbirth on her own, without surgical intervention. However, if a woman is well prepared for childbirth, has mastered relaxation techniques and knows how to recognize her body's signals, she will be better able to cope with a prolonged labor. She knows how to avoid fatigue and is able to carry out her birth plan without the fear of ending up on the operating table. Before you go into labor, be aware that Pitocin-induced contractions are more painful than natural hormone-induced contractions, and they often come faster than a woman can prepare for them.

9. Demand that doctors be free to make decisions. Doctors also need “painkillers”! According to obstetricians (and in our opinion too), the number of caesarean sections could be lower if doctors were not afraid of liability before the law. Those obstetricians we spoke with on this topic believe that the number of such operations could be reduced from 25 (in some areas 30) to 10 percent, if there is no fear of being accused of mishandling the patient. There was a time when doctors acted only in the interests of the mother and child, without taking into account legal proceedings. But the increase in the number of verification commissions quickly cooled their ardor. If in some cases the indications for caesarean section are obvious, in others they are very doubtful and require the doctor to make a responsible decision. However, fear of the law almost always forces the doctor to send the woman in labor to the operating room. Sometimes the doctor has to use much more intuition during a natural birth than when deciding whether to have surgery. Natural childbirth requires an understanding of the natural process. If labor is delayed, the doctor must call on all his experience to help the woman in labor cope with it. But as long as doctors are afraid of responsibility, the situation with risky natural childbirth will not change. Doctors are not going to reduce the number of caesarean sections. This means that women themselves must do this.

10. Be aware of your vulnerability. Think through everything in advance. When, during labor, you are offered a caesarean section instead of experiencing the torment of hell for a couple more hours, you are unlikely to be able to think rationally. As you prepare for childbirth, you should understand exactly what situations make a cesarean section inevitable, and when it is quite possible to give birth without surgery. In addition, you should understand the advantages and disadvantages of intervention, and know what ways you can correct the situation if things do not go according to plan. It is in this case that a professional assistant can be of great help. If you have tried everything in your birth plan, you can make the decision to have surgery without regret or guilt.

Childbirth does not always end with a caesarean section - there must be good reasons for this. But, currently, in absolutely all perinatal centers (maternity hospitals), caesarean sections are performed both planned and emergency.

Delivery through surgery, carried out in a planned manner, has either obstetric indications or indications from a number of specialists (ophthalmologist, neurologist). For example, if a woman has poor vision, then during natural childbirth, she may lose it even more. Therefore, a caesarean section cannot be avoided.

Obstetric indications mean: placenta abruption and accreta. There are also conditional indications for the operation: a woman can already go into natural labor, but her health (in particular, the cardiovascular system) does not allow her to give birth on her own, then an emergency caesarean section is performed.

Why do they carry out an emergency? In this case, the operation is performed in case of acute fetal hypoxia (when the child begins to choke and this condition leads to irreversible consequences). Hypoxia can be judged by CTG data and changes in the state of amniotic fluid. Other indications for emergency caesarean section are the clinically narrow pelvis of the woman in labor: the fetal head is incommensurate with the anatomical parameters of the woman’s body structure. That is, a woman in labor will not be physiologically able to give birth to a baby on her own.

There is another indication that leads to surgical delivery - persistent weakness of labor. In this condition, the woman is so weak that she does not have enough strength to give birth to a baby without consequences for her health and the child. The strength of the contractions may not be enough to push the fetus out and pass through the birth canal. Experienced obstetricians-gynecologists will never put either the expectant mother or the child at risk - if the life and health of both are at risk, then a caesarean section cannot be avoided.

Important! Caesarean section is the only method to save the baby if something threatens him.

Of course, if there are no indications for surgery, the doctor will insist on a natural birth. Why? Because such a birth is natural for a child. The process of inhalation in a child who has passed through the birth canal and in one who was born in a different way - through surgery - is different.

Complications after surgery

We must not forget that a caesarean section is a surgical abdominal operation, which, like any other, can result in complications. Why? During surgery, one should not exclude the possibility of bleeding, inflammatory and infectious complications.

Why is a uterine scar not always a contraindication for natural childbirth?

When a patient comes to the doctor with a repeat diagnosis, the doctor’s task is to collect anamnesis. We need to understand what the doctors encountered during the first birth, why the operation took place, and perhaps there were any contraindications from other specialists? All these processes need to be fully answered.

How to avoid surgery?

If a woman sets herself the task of avoiding a caesarean section, then she needs to prepare for the process of natural childbirth. How?

Say no to epidural anesthesia

It would seem, what’s wrong with helping yourself give birth to a baby and numb this process? But the whole point is not in childbirth as such, but in the hormonal changes that they cause in a woman’s body. Doctors tell us that with the onset of labor, the expectant mother is faced with a whole cocktail of hormones that naturally anesthetize the entire process. Ask experienced obstetricians and gynecologists about how childbirth usually goes. This often happens: labor was normal and healthy, but after an injection of anesthesia it suddenly stopped, and the question of a caesarean section arose. For some women, even a dose of oxytocin did not help - and this hormone, for reference, harms the child’s central nervous and circulatory system. The baby may be born with severe hypoxia.

You should not go to the maternity hospital early if your pregnancy proceeds without complications or complaints on your part. There is nothing wrong with the fact that you are already 40 weeks pregnant and labor has not started. The preliminary date of birth may have been incorrectly set for you, especially if before pregnancy, like most women, you had complaints of weak labor. The fetus inside you develops and is born regardless of the numbers on the calendar, but exactly at the moment when it is vitally capable.

Important! If labor is artificially induced, it will most likely end in an emergency caesarean section.

Explore more useful information

Be sure to informatively prepare for childbirth - read more information about how labor begins, what complications may occur, what to do to avoid a cesarean section. Do not blindly trust one doctor who told you that the easiest way to end your pregnancy is through surgery. Always defend your right to reliable information and do not trust gynecologists. It is advisable to consult several specialists at once before giving birth and make a decision on how to give birth and with which obstetrician-gynecologist. Even if something goes wrong and a caesarean section cannot be avoided, you, having complete information, will know that you did everything possible.

Courses for pregnant women

If possible and for health reasons, be sure to attend courses for pregnant women. Especially the part where they will tell and show you how labor begins, what a woman should do at this moment, how to behave to loved ones, how to help the baby be born. As a result, this will give you even more confidence that the birth will end well and without consequences.

Remember that your decision to give birth naturally or through surgery determines the entire birth process. If there are no indications for surgical intervention from the medical side, then why don’t you try to give birth as your body tells you?

In some situations, a caesarean section saves the lives of mother and baby, but we are convinced that in at least half of cases, surgical intervention can be avoided if the expectant parents take responsibility for the birth.
1. Choose wisely the place of birth and assistants. Reread Chapter 3. After assessing your situation, ask yourself what kind of people and settings are most likely to provide you with a safe and satisfying birth. Due to the lack of an organized health insurance system, we do not recommend that absolutely everyone opt for a home birth, but you should remember that of the three possible birth options (at home, in a birth center or in a hospital), a hospital is the most likely to have a cesarean section. great. For information and help on how to avoid a caesarean section, attend ICAN meetings (see Sources of information about caesarean sections).
Ask your doctor to make sure he doesn't advocate horizontal birth. Otherwise, this OB/GYN is not the right doctor for you. How does he feel about walking during labor and giving birth in an upright position? Is squatting or lying on his side acceptable? Is the doctor calm, or is his head busy with countless questions “what?”, “if?”. What is his success rate for vaginal birth after cesarean section? Make sure this figure does not fall below 70 percent. What is this doctor's caesarean section rate? A figure exceeding 15 percent indicates “surgical” thinking. Ask about “standard” procedures. Does this include continuous electronic fetal monitoring? What proportion of this doctor's patients “need” a fetal monitor?
2. Invite a professional assistant. If you're one of the majority of mothers-to-be who choose to have a hospital birth under a doctor's supervision, you'll be less likely to have a C-section if you have the help of a professional birth attendant. (See Chapter 3 for the benefits of having a professional assistant.)
3. Consider the possibility of giving birth in an upright position. Imagine this: a woman gives birth lying on her back with her legs secured in special stirrups, and the doctor sits comfortably at the foot of her bed. The supine position is a prerequisite for a caesarean section. The more time you spend in this position during labor, the more likely you are to need a C-section. Studies have shown that the upright position of a woman in labor increases the efficiency of the uterus, promotes the dilation of the cervix, and also shortens labor and makes it less painful. As expectant mothers and doctors move away from the horizontal position, more babies are being born naturally. Stand up for your own birth. The horizontal position of the woman in labor is the main cause of long and painful labor that ends in the operating room. The horizontal position is a legacy of the era of general anesthesia and forceps, when women were drugged during labor and unable to stand up or help push their baby out. The squatting position, for example, expands the pelvic opening; in this case, the mother is helped by gravity. Being upright doesn't mean you shouldn't lie down and rest during labor. Many women periodically lie on their side, supported by pillows, and a loving spouse massages their back or face. If this type of rest is not suitable for you, try resting in a bathtub with water (see section “Water Birth”). Freedom to choose your birth position is the best prerequisite for vaginal birth. (More information about the postpartum position can be found in Chapter 11.)
4. Move. Having made a choice in favor of a vertical position, do not sit still. Studies have shown that walking speeds up labor and is good for the baby.
5. Be smart about electronic fetal monitoring and IV fluids. Proponents of mandatory electronic fetal monitoring say it reduces stillbirths and newborn brain damage by alerting doctors to possible problems ahead of time. Electronic fetal monitoring became standard practice even before its usefulness was proven, and doctors are now afraid to deviate from accepted norms for fear of being sued. However, numerous studies of women not considered at high risk have found no difference in the condition of newborns when using a fetal monitor and when listening to the fetal heartbeat using a fetoscope. Moreover, these same studies showed that women who took advantage of modern technology were twice as likely to have a surgical birth. According to the most recent data, most cases of cerebral palsy are caused by impaired development of the child even before the onset of labor. The evidence gathered is sufficient to stop the widespread use of fetal monitors. Remember that once the sensor from the monitor is on your stomach, the likelihood of a cesarean section increases. However, in some cases, electronic fetal monitoring can save a woman in labor from having a cesarean section. If, in the event of complications (when labor is suspended), the monitor shows that everything is fine with the baby, the doctor will not rush into a cesarean section, but will allow you to give birth on your own for some time. If used correctly, modern technology can be a friend, but if used incorrectly, it can be an enemy.
6. Consider the issue of epidural anesthesia carefully. Like electronic fetal monitoring, epidurals are part of the friend-foe dilemma. A study of five hundred first-time mothers found that those who chose an epidural were more likely to have a Caesarean section due to labor interruption. Other studies do not support the conclusion that epidural anesthesia increases the risk of surgery. We have seen births where a well-timed epidural helped calm the anxious mother and facilitated a successful vaginal birth. On the other hand, abuse of this “gift from heaven” (this is what some of our patients called epidural anesthesia) can reduce the efficiency of the uterus; By receiving epidural anesthesia, you lose a valuable assistant - gravity. You are lying flat on your back and may already be on your way to the operating room. (See Epidural Anesthesia section.)
7. Take your time. Childbirth, like sex, cannot be rushed. You shouldn't feel pressured to give birth as quickly as possible based on averages or the experiences of others. On this stage, you are the star, and everyone else is relegated to supporting roles. Childbirth is too important an event to be limited by a time frame. Very often, “suspension of labor” is nothing more than the doctor’s inability to wait. There is no evidence that prolonged labor itself is harmful to the baby. It is impossible to set any time limits for each specific birth. Of course, there are charts of “normal” labor that indicate what stage the average woman is in labor after a certain time has passed, but these are just averages and have nothing to do with you. Your uterus knows nothing about them. Concerns about prolonged labor are based on the idea that each contraction reduces the baby's oxygen supply, and therefore the longer the contractions, the less oxygen the baby receives. There is no scientific evidence for this claim.
In addition, we should not forget about the economic pressure that forces women giving birth in a hospital to speed up their labor as much as possible. Some types of insurance limit the time a woman can spend in the hospital. A hospital administrator recently told us, “We can no longer afford prolonged vaginal births.” For those planning a hospital birth, it is best to spend most of the first stage of labor at home, deliver your baby in the hospital, and then quickly return home.
8. Be wary of controlled births. Currently, in addition to the tendency to return to nature and to non-interference in the process of childbirth, there is a force pushing women towards the option of childbirth, called managed. A woman whose pregnancy is proceeding normally and is approaching the end sets an expected due date. She comes into the hospital in the morning and receives IV Pitocin to induce labor and an epidural to relieve pain. Such labor is stimulated by chemicals, monitored by monitors, and controlled by equipment. Parents and child return home that evening - presumably in good health. However, before you turn to this new birth option, consider that a disproportionate number of these births will be mismanaged and end up in the operating room.
Proponents of managed birth say it sometimes reduces the risk of C-section. In one study, researchers intervened in labor early, when labor was not progressing properly. By administering Pitocin and pain medications before laboring women became exhausted, the researchers reduced the rate of C-sections from 20 percent to 6 percent. Waiting too long—until fear and fatigue take over—increases the likelihood that both mother and doctor will abandon vaginal birth and resort to surgery. A woman who is well prepared for childbirth, who knows how to relax and understand her body's signals, will better endure a long and exhausting labor. She knows how to avoid exhaustion and is able to stick to the original plan without getting scared or asking for a C-section. Before you opt for a controlled birth, consider two things: 1) Pitocin-induced contractions are often much more painful than those induced by natural hormones because they increase faster than the mother can adapt to them; and 2) the American birth system is unable to provide the midwife care needed for this birth option (see Actively Managed Birth for more information on managed birth).
9. Advocate for an end to prosecutions. Doctors also need painkillers! Obstetricians and gynecologists are convinced that the number of caesarean sections will not decrease significantly until the fear of prosecution disappears. Experts we spoke with believe that the rate of C-sections could be reduced from 25 percent (in some regions 30 percent) to less than 10 percent if this fear is addressed. Once upon a time, a doctor was able to make decisions based solely on the best interests of mother and child and without regard to what a jury would believe. However, after numerous lawsuits, doctors no longer think so. Some indications for caesarean section are absolutely clear, while others are vague and require confirmation from a doctor. The fear of prosecution puts pressure on the doctor and forces him to take the position “No accidents!”, which is a direct path to the operating room. It often takes more courage not to have a caesarean section than to do it. In addition, it requires a desire to help a woman through a difficult birth, as well as a deep understanding of this natural process. Pilot programs have successfully demonstrated that there are better alternatives to the current situation, such as a special insurance fund that pays compensation for unfavorable birth outcomes. Unless things change, OB/GYNs will continue to avoid risky vaginal births. Doctors are not going to reduce the number of caesarean sections - mothers must do that.
10. Be aware of your vulnerability. Plan ahead. When you are offered a caesarean section as an alternative to "two more hours of hell", your condition does not always allow you to make a reasonable choice. Part of your preparation for childbirth should include becoming familiar with the indications for caesarean section: which ones are absolute and which ones are not. Also make sure you are aware of the advantages and disadvantages of different types of interventions and that you are aware of alternative ways to manage labor if the process does not go as planned. A professional assistant will provide you with invaluable assistance with this. If you have exhausted all of your birth plan options, you can participate in the decision to have a caesarean section—without guilt, regret, or lingering trauma. (For more information on how to avoid a C-section, see How to Improve Your Chances.)
IS A CESAREAN SECTION MANDATORY FOR BREACAL PRESENTATION?
Problem
Approximately 4 to 5 percent of C-sections are due to a breech baby. The logical basis for surgical intervention is as follows: “No accidents.”
Modern obstetric science claims, based on statistical data from some studies, that a breech baby is more often injured during vaginal birth than during cesarean section. In 1970, only 12 percent of breech babies were born by Caesarean section. By 1987, this share had increased to 87 percent. There are different opinions as to what is best for mother and baby. In some regions (usually those where the fear of prosecution is especially high), with breech presentation, absolutely all children are born as a result of a surgical operation. In others, some “brave” people are trying to select those breech babies for whom vaginal birth does not pose a risk.
Since caesarean section for all breech babies is perceived by society as a certain standard, in the event of an unfavorable birth outcome, any deviation from this standard is fraught with prosecution by the doctor. Although the College of American Obstetricians and Gynecologists has recommended vaginal birth in selected cases of breech birth, experienced providers who can manage such births are often unavailable - they are unwilling to do so or have retired. If a young obstetrician-gynecologist is practicing in a medical center where all breech babies are born by caesarean section, it is quite understandable that he will not start working independently without having experience in managing vaginal births with breech presentation or even having never seen how it's done.
Solution
A woman can choose one of two options. If your due date is approaching and your baby is still in the breech position, you may be able to avoid surgery. Try one of the following alternatives.
Turn for the better
It must be remembered that at the beginning of pregnancy, approximately half of the children are in the breech position, and most of them independently turn head down before the due date (usually by the thirty-second week). However, 3 to 4 percent of babies remain breech when labor begins.
If the baby does not roll over on his own, the doctor may try to turn him over using a technique called external rotation. Typically, the doctor will wait until the thirty-seventh week before attempting this because some babies end up turning over on their own, and the turning procedure carries some risks and can cause premature labor. Using an ultrasound scanner, a fetal monitor, and IV fluids to help relax the muscles of the uterus, the obstetrician-gynecologist manipulates the mother's abdomen, trying to turn the baby head down. With an experienced specialist, 60–70 percent of children roll over. Some return to their original position and require a second attempt, while others simply remain in the breech position despite the doctor's best efforts.
Look for a specialist who is not afraid of breech presentation
It cannot be found in the yellow pages of newspapers. Be prepared that most obstetricians and gynecologists will tell you that they do not accept vaginal births for breech babies. One woman, surprised by the approach of a doctor who habitually considered vaginal birth with a breech presentation impossible, complained to us: “He ordered a caesarean section for me - as if it were a game of golf.” Before you let your doctor determine what your breech birth should be like, do your homework and try to find a provider who has experience with this type of birth. Consider this paradox: Doctors who dare to deviate from accepted practice advance medical science, but in some circles their actions amount to incompetence. It is likely that most doctors who have experience in vaginal births with breech presentation are no longer young and gained their experience at a time when most such children were born naturally. You can go to a university hospital that has clear criteria for a vaginal birth for a breech baby, such as when the baby weighs less than nine pounds and is a pure breech or mixed breech.
Find a midwife who is experienced in breech births
Another option is to find a midwife who is experienced in breech birth, preferably in a hospital setting. Some states do not allow certified midwives to attend breech births at home. Check what the rules are in your state. You may want to first consult with an obstetrician/gynecologist who has experience with this type of birth. Even if he does not agree to give birth to you, he can express his thoughts about the safety of attempting a vaginal birth - based on ultrasound and other tests. Once cleared, find a midwife who is experienced in breech birth.
Steps to a safe vaginal birth for breech babies
Below are safe and often successful steps taken by an obstetrician/gynecologist who has experience managing breech births. Birth purists may object to this high-tech approach, but the risks associated with breech vaginal birth justify these precautions.
Before labor begins. An outward rotation is attempted first. If it fails, it is followed by examination of the mother and child. Is the maternal pelvis adequate (assessed using pelvimetry or the more modern pelvic to fetal size ratio index, see Chapter 5 “Screening test”)? Where is the placenta located and are there any abnormalities in the structure of the uterus (assessed using ultrasound)? Is the pregnancy progressing normally (that is, without diabetes or hypertension)? Is the fetus in a pure or mixed breech position? Does the fetus weigh more than nine pounds? A breech birth and a weight greater than nine pounds are usually indications for a cesarean section. Is the baby's head too long? If all these safety conditions are met, some obstetrician-gynecologists will agree to attempt a vaginal birth.
After labor begins. It is recommended to use electronic fetal monitoring, but in such a way that it does not interfere with the woman in labor walking or changing body position. If labor progresses normally (the cervix dilates at a rate of one centimeter per hour, and slightly slower in breech presentation), and the fetal monitor does not detect any abnormalities, then no intervention is required. If progress is unsatisfactory, then Pitocin is considered. During vaginal birth with breech presentation, the presence of a professional assistant is mandatory.
During the second stage of labor. If labor progresses normally and the fetal monitor shows that both mother and baby are tolerating well, there is no need for intervention. However, during the first and second stages of labor, care must be taken to ensure that the umbilical cord does not pass through the cervix and is not pinched. In addition, in order to stimulate the dilatation of the cervix, the membranes are not artificially ruptured until the very end of the first stage. If epidural anesthesia is necessary or desirable, it is turned off in the second stage so that the woman in labor can assume an upright position and push the baby out independently. An obstetrician-gynecologist often invites a neonatologist or pediatrician in case the child needs help immediately after birth.
It is important to find a specialist who has extensive experience in vaginal birth with breech presentation - he is confident in himself, and this confidence is transferred to the mother in labor. In a breech birth, the fear factor is critical because once the cervix has dilated enough to accommodate the baby's shoulders, there is a chance that the cervix will contract, pinching the baby's head. This condition is caused by fear.
Taking responsibility for your own birth means being informed about your options and weighing the risks involved in each case. Any birth is associated with risk, but in some cases the danger is greater, and in others less. Some obstetricians and gynecologists remain convinced that in the case of breech presentation, for some mothers and children, vaginal birth - accompanied by an experienced specialist - is safer than a cesarean section.

Caesarean section is a serious test for any woman. How to cope with feelings and what to prepare for in advance so that the operation and recovery period are as easy as possible?

For all 9 months, my husband and I were preparing for a partner birth. During the courses, we were told how to breathe correctly and do pain-relieving massage, about the benefits. In the end, I learned not to be afraid of hypothetical pain, my husband - women giving birth. Everything was going well, but towards the end of pregnancy, by some miracle, I fell into those 3-5% of women whose children take the wrong position. In this situation, natural childbirth posed a serious threat to the child’s health and was therefore not discussed at all. There was no turning back (as you know, no one has ever left the maternity hospital pregnant), I had to gather my courage and endure the operation. Here are top tips for those who are also going through a planned caesarean section.

Discuss the surgery with your doctor and loved one

Most women are afraid of having a caesarean section, and this is normal. Discuss in detail with your obstetrician-gynecologist how the operation will take place, ask all your questions. “If you can’t cope with your worries, talk about the upcoming birth with a loved one over a cup of tea,” advises clinical psychologist Maria Shendyapina. - The purpose of such a conversation is to “catch by the tail” unconscious fears and anxieties imposed by the opinions of others (which is not always the only true and suitable one for each person). Perhaps after this conversation you will change your view of the upcoming operation.”

Think of surgery as a long-awaited meeting with your child.

Yes, a caesarean section is an abdominal operation. Yes, it sounds terrible, especially for those who have been afraid of injections all their lives. But remember: doctors have managed to accumulate sufficient experience to carry out surgical births at the highest level (according to the World Health Organization, in the modern world, caesarean section has become one of the most common surgical interventions). Before the operation, try to concentrate on the fact that very soon you will have a long-awaited meeting with your baby, this will help you cope with anxiety and abstract yourself from the operating room environment.

In my case, the operation began at 9:00, and at 9:05 little Maria was born. I didn’t feel pain, I heard her first cry, I had the opportunity to kiss her and put her to my chest. When remembering these moments, tears of happiness still well up in my eyes.

Ask your child's father to support you

Perhaps you also dreamed of, and the need for a planned cesarean section confused all your cards. Most maternity hospitals prohibit outsiders from entering operating rooms, but the husband can be present in the antenatal department, and during the operation he can be in the next room (although he will need to take tests in advance that meet the requirements of the maternity hospital). The advantage of such a “partnership” cesarean is not only that you receive additional psychological support, but also that the father will be able to get to know the baby in the first minutes of his life.

Get ready for a difficult recovery period

During natural childbirth, the woman receives the main dose of acute pain before the birth of the child, in the case of a cesarean section - after. Missed contractions and attempts will catch up with you 4-5 hours after birth, when the epidural anesthesia stops working. Breathing techniques will help cope with pain at this stage - for example, deep intense inhalation and long, slow exhalation (10-15 repetitions). In addition, smartphones are not prohibited from being taken into the intensive care ward. You can download, for example, relaxing music for yourself in advance. Try to pass the time and remember: very soon you will be transferred from intensive care to a regular ward, and you will again be able to admire your newborn child.

Over the next few days, you will need to relearn how to sit, walk and, most difficult of all, laugh, cough and sneeze. Every movement will result in severe pain in the lower abdomen; a postoperative bandage helps better than pills at this point. From the 3rd day of my daughter's life, I managed to do without any medications. Yes, it was painful (not only in the first days, but also in the first couple of months after giving birth), but it was tolerable.

How to avoid depression?

With the onset of pregnancy, many women begin to look for information about what a caesarean section is and for what indications the operation is performed. Expectant mothers are worried about their health, afraid of future births and fear that they may need such intervention.

A Caesarean section is a surgical operation in which the baby is delivered through an incision in the woman's abdomen. Childbirth this way began a very long time ago. The first successful operation took place in 1500. It was made for his own wife by Jacob Nufer, a poor Swiss man who castrated pigs. Thanks to his work, he had a general understanding of anatomy. When Yakov realized that he would lose his wife during childbirth, he performed a caesarean section on her. The woman and child remained healthy and lived a long life.

Myths and legends about the operation go back centuries. You can read about the birth of children in this way in the history of ancient India, Greece and, of course, Rome. Many have heard that the famous emperor Julius Caesar was extracted from the belly of his dead mother. Some historians believe that this event gave the name to the operation, since translated from Latin, the word “Caesar” means “lord.”

According to other sources, the name was influenced by the decree of Julius Caesar, in which he ordered healers to save newborns in the event of the death of their mother, removing them from the cut abdomen.

Barbaric methods are a thing of the past. In some countries, caesarean section is performed at the request of the mother. In our country, doctors do not approve of this approach. They rightly believe that, having gotten rid of pain during childbirth, a woman will subsequently have many problems. After all, a caesarean section prevents you from quickly establishing lactation, and after it you need a long recovery period. Therefore, the Ministry of Health requires that surgery be prescribed if it is truly necessary.

In what cases is surgery performed?

There are two types of surgical intervention: planned and emergency. If doctors insist on surgery, then it’s necessary, don’t be alarmed. Anxiety can harm your unborn baby and make you depressed. Consult with several experts and listen to their advice. When you can’t do without surgery, try to tune in and don’t be afraid of anything. Experienced doctors will do everything for the safety of mother and newborn.

A caesarean section is necessary when the gynecologist discovers serious pregnancy problems.

• Pelvic, transverse or oblique position of the fetus in the uterus. Natural childbirth in this case carries a great risk for mother and child.
• Severe myopia of a woman. Pushing and contractions can lead to retinal detachment.
• The pelvis is too narrow, through which the baby will not be able to squeeze through during childbirth.
• Chronic fetal hypoxia.
• Pronounced toxicosis in late pregnancy.

Doctors consider diabetes mellitus, lung and heart diseases, and Rh-conflict in the mother to be serious indications for surgical intervention. The reason for a cesarean section may be a large fetus or the presence of twins, especially when one of the babies is in the wrong position.

If a woman has undergone surgery once, the second pregnancy will most likely also end in a cesarean section. There are cases when natural childbirth is successful, but often doctors do not want to take risks, because during contractions the suture on the uterus may come apart.

Sometimes a caesarean section is performed urgently. This happens when labor leads to life-threatening complications:

• there is a threat of uterine rupture;
• placental abruption occurs;
• a woman begins an attack of eclampsia;
• the baby is acutely suffering from lack of oxygen;

The reasons vary. If a doctor detects an unforeseen situation during childbirth, he acts immediately to preserve the life and health of his patients.

What happens in the operating room?

A planned caesarean section requires the expectant mother to go to the hospital in advance. She should be examined again, talk with an anesthesiologist and choose an acceptable anesthesia option. Our maternity hospitals use general and epidural anesthesia.

• For planned interventions, epidural anesthesia is often used. A fully conscious woman can immediately see the newborn and attach it to her breast.
• General anesthesia is usually administered in emergency cases when surgery needs to begin immediately.

A planned caesarean section is performed in the morning. The woman is brought into the operating room, dressed in sterile clothes, placed on a special table and anesthesia is administered.

The abdominal incision is made in two ways. It happens:

• Longitudinal, passing from the navel down. Allows you to quickly remove the baby, so it is often used in emergency situations.
• Transverse. The incision runs along the pubic line. It is considered more aesthetic. It is done during planned operations if there are no scars from longitudinal intervention.

Having made an incision in the skin, the muscles are carefully cut layer by layer, then the uterus and the baby is removed from it. The doctor separates the placenta, injects oxytocin into the uterus to contract its walls, and also stitches up the damaged tissue one by one. Internal sutures are placed using a thread that gradually dissolves. The external incision is connected with special staples or nylon threads.

After the operation, which lasts about 40 minutes, the woman is gradually revived and placed in the intensive care ward. The baby is examined by a neonotologist, the midwife carries out treatment and takes the newborn to the children's department.

What happens after?

To minimize complications, it is recommended to sit up and get out of bed after 6 hours under the supervision of medical staff. This improves uterine contractions and normalizes intestinal function.

• On the first day, any food is excluded. You are allowed to drink mineral water in small sips without gas bubbles.
• On the second day, if the doctor sees positive dynamics, vegetable broth and liquid porridge are introduced into the diet.
• Starting from the fourth day, the young mother should follow the usual diet of nursing women.

For successful recovery, it is important to chew food thoroughly and eat small portions 6 times a day. If the patient adheres to the doctor’s recommendations, but her abdominal bloating does not go away, it means that intestinal motility has been disrupted as a result of surgery. In this case, a laxative or enema is prescribed.

When a caesarean section takes place without complications, on the second day after it the baby is placed with the mother if she feels well. Now you can care for your newborn on your own and begin full breastfeeding. After a week, the scar on the skin is almost formed. The woman's stitches are removed and she is sent home.

The young mother will need time to recover. You need to take care of yourself, do not lift weights and try not to get pregnant again within 2 years. During this period, the body will fully recover after the operation.

If you have to go through such a test, don't stress yourself out. Try to relax, walk more, have positive emotions, eat wholesome healthy foods and fully follow your doctor's instructions. This will greatly increase the chance that the caesarean section will take place without consequences.