Operation C-section It is often performed repeatedly, since giving birth with a uterine scar is not always safe. However, natural childbirth is also possible. True, it is not easy to find such specialists who will agree to accept them. A repeat caesarean section is not technically difficult to perform. However, complications after it are more likely to occur than after the first. But, of course, this does not stop operated women who want to give birth to a second, third, and sometimes even fourth child.

The dangers and complications of a repeat cesarean section include: high risk heavy bleeding during and after surgery, slow contraction of the uterus, which may cause acute endometritis(inflammation of the uterus), venous thrombosis ( compression hosiery need to be worn longer), peritonitis and others. Therefore, to perform a second cesarean section, strict indications are needed, as for the first operation. This is not a whim. And it is not the woman who decides that she will have such a birth, but the doctors, having compared all the benefits and risks of the operation.

A woman must understand that such a delivery is most likely more difficult for her than a natural birth. Heavy postpartum period and very likely problems with next pregnancy, which is also recommended to be planned no earlier than in 2 years. Most likely, the birth will again not be natural. Although in some cases, in the presence of experienced doctors, the ability to urgently operate if necessary, a natural repeat birth after cesarean section may be recommended, especially if the woman already had a successful spontaneous birth before the operation.

Here are some situations after which a woman may be allowed to give birth herself:

• pelvic or transverse position of the fetus in the uterus (it is not a fact that during the next pregnancy it will also be positioned incorrectly);
• premature detachment placenta or complete placenta previa;
• severe form of gestosis (it often repeats during the next pregnancy, but not always);
• loss of umbilical cord loops or other condition that threatens the death of the child;
• post-term pregnancy, when stimulation of labor is impossible or does not produce results;
• weakness of labor;
• long water-free period.

At what time is a repeat planned caesarean section performed and what are the absolute indications for it? The operation is performed as close as possible to the expected date of birth if:

• the woman has an anatomically narrowed pelvis (the operation will be carried out regardless of the weight of the child estimated by ultrasound and the size of the uterus);
• there is a large uterine fibroid;
• there are heavy cardiovascular diseases;
• Very poor eyesight etc.

A caesarean section is performed for the second time at less than 40 weeks’ gestation or urgently if the woman begins to have spontaneous labor activity. On the one hand, this situation is good, since the child is born at his “right” time, determined by the body and nature. But emergency operations always involve greater risk than planned ones. And the consequences of a repeat cesarean are usually more severe if it is an emergency. It is better if a woman enters the maternity hospital as planned. 1-2 weeks before the expected date of birth. There she gives everything away necessary tests, undergoes an ultrasound, ECG, consults with an anesthesiologist and doctors of other specialties if they have any diseases.

But even if doctors consider a second operation safer, there is no need to worry about cosmetic defects. Most likely, the stitch from the repeat cesarean section will be above the first one, that is, two scars will not remain.

In order for the operation to take place on time and successfully, nothing threatens the mother and child, it is advisable that at least 2 and no more than 5 years have passed after the first operation. Pregnancy after a cesarean section should be planned again only after undergoing an ultrasound, during which the doctor will confirm the consistency of the uterine scar (internal). This serves as a kind of guarantee that it will not separate during pregnancy.

Each pregnancy in a woman proceeds in a new way, different from the previous one. Childbirth, accordingly, also goes differently. If the baby was born for the first time with the help of gynecological surgeons, this does not mean that now everything will happen according to the same scenario. What to do if you have a second caesarean section? What is important for a woman to know? Is it possible to avoid surgery? Today's article will answer these and some other questions. You will learn about the period at which a planned second caesarean section is performed, how the body recovers after manipulation, whether it is possible to plan a third pregnancy and whether it is actually possible to give birth on your own.

Natural birth and caesarean section

Let's find out how a second caesarean section is performed and what indications it has. What is important to know? The natural birth of a child is a process intended by nature. During childbirth, the baby goes through the appropriate paths, experiences stress and prepares for existence in the new world.

Caesarean section involves the artificial birth of a child. Surgeons make an incision in the woman’s abdomen and uterus, through which they remove the baby. The baby appears abruptly and unexpectedly, he does not have time to adapt. Let us note that the development of such children is more difficult and complex than those born with natural childbirth.

During pregnancy, many expectant mothers are afraid of the cesarean section procedure. After all, preference has always been given to natural childbirth. A few centuries ago, a woman had no chance of survival after a Caesarean section. At an earlier time, manipulation was carried out only in patients who had already died. Now medicine has made a big breakthrough. Caesarean section has become not only a safe intervention, but in some cases necessary to save the life of the child and mother. Now the operation lasts only a few minutes, and the anesthesia capabilities allow the patient to remain conscious.

Second caesarean section: what is important to know about the indications?

What does the doctor pay attention to when choosing this route of delivery? What are the indications for a second intervention in the natural process? Everything is simple here. The indications for the second cesarean section are the same as for the first operation. The manipulation can be planned or emergency. When prescribing a planned caesarean section, doctors rely on the following indications:

• poor vision in a woman;
• varicose veins of the lower extremities;
• heart failure;
• chronic diseases;
• diabetes mellitus;
• asthma and hypertension;
• oncology;
• traumatic brain injury;
• narrow pelvis and large fetus.

All these situations are grounds for the first intervention. If after the birth of the child (the first) the diseases have not been eliminated, then the operation will be performed during the second pregnancy. Some doctors are inclined to this opinion: the first cesarean section does not allow the woman to give birth again on her own. This statement is wrong.

Is it possible to give birth on your own?

So, you are recommended for a second cesarean section. What is important to know about him? Which ones are there? real readings to perform an operation if everything is in order with the woman’s health? Repeated manipulation is recommended in the following cases:

• the child has ;
• less than two years have passed since the first caesarean section;
• the suture on the uterus is incompetent;
• During the first operation, a longitudinal incision was made;
• abortions between pregnancies;
• presence connective tissue in the scar area;
• location of the placenta on the scar;
• pregnancy pathologies (polyhydramnios, oligohydramnios).

Emergency surgery is performed in case of unexpected scar divergence, weak labor, in serious condition women and so on.

You can give birth yourself if a second caesarean section is recommended. What is important to know? Modern medicine not only allows a woman the natural process of childbirth, but also welcomes it. It is important that the expectant mother is thoroughly examined. The conditions for natural childbirth after cesarean section are the following circumstances:

• More than three years have passed since the first operation;
• the scar is wealthy (predominantly muscle tissue, the area stretches and contracts);
• thickness in the seam area is more than 2 mm;
• no complications during pregnancy;
• a woman's desire to give birth on her own.

If you want a second child naturally, then you should take care of this in advance. Find a maternity hospital that specializes in this issue. Discuss your condition with your doctor in advance and get examined. Attend your appointments regularly and follow your gynecologist's recommendations.

Pregnancy management

If the first birth took place via cesarean section, then the second time everything can be exactly the same or completely different. Expectant mothers after such a procedure should have individual approach. As soon as you find out about your new situation, you need to contact a gynecologist. Features of managing such a pregnancy are additional research. For example, in such cases, ultrasound is done not three times during the entire period, but more. Diagnosis before childbirth is becoming more frequent. The doctor needs to monitor your condition. After all, the entire outcome of the pregnancy depends on this indicator.

Be sure to visit other specialists before delivery. You need to see a therapist, ophthalmologist, cardiologist, neurologist. Make sure there are no restrictions on natural childbirth.

Multiple and regular caesarean section

So, you are still scheduled for a second cesarean section. At what time is such an operation performed, and is it possible to give birth on your own during a multiple pregnancy?

Let's assume that the previous delivery was carried out surgically, and after that the woman became pregnant with twins. What are the forecasts? In most cases, the outcome will be a second cesarean section. The doctor will tell you at what time it is done. In each case, the individual characteristics of the patient are taken into account. The manipulation is prescribed for the period from 34 to 37 weeks. In case of multiple pregnancy, do not wait longer, as a rapid natural birth may begin.

So, you are pregnant with one child, and a second cesarean section is scheduled. When is the operation performed? The first manipulation plays a role in determining the deadline. Repeated intervention is prescribed 1-2 weeks earlier. If the first time a cesarean was performed at 39 weeks, now it will happen at 37-38.

Seam

You already know at what time a planned second caesarean section is performed. The cesarean section is repeated using the same suture as the first time. Many expectant mothers are very concerned about aesthetic issues. They worry that their entire stomach will be covered in scars. Don't worry, that won't happen. If the manipulation is planned, then the doctor will make an incision where it was made the first time. Your number of external scars will not increase.

Otherwise the situation will be with the cut reproductive organ. Here, with each repeated operation, you select new area for the scar. Therefore, doctors do not recommend giving birth using this method more than three times. For many patients, doctors offer sterilization if a second cesarean section is scheduled. When admitted to the hospital, gynecologists clarify this issue. If the patient wishes, dressing is performed fallopian tubes. Don’t worry, doctors will not carry out such a manipulation without your consent.

After surgery: recovery process

You already know when a second caesarean section is indicated and at what time it is done. Reviews from women report that recovery period practically no different from the one after the first operation. A woman can stand up on her own in about a day. A new mother is allowed to breastfeed her baby almost immediately (provided that no illegal drugs were used).

Discharge after the second operation is the same as during natural childbirth. Within one or two months, the discharge of lochia is observed. If you had a caesarean section, it is important to monitor your well-being. Contact your doctor if you experience unusual discharge, increased temperature, worsening general condition. Discharged from maternity hospital after the second cesarean section, approximately 5-10 days, the same as the first time.

Possible complications

With repeated surgery, the risk of complications certainly increases. But this does not mean that they will definitely arise. If you give birth on your own after a cesarean section, then there is a possibility of scar dehiscence. Even if the suture is strong, doctors cannot completely exclude this possibility. That is why in such cases artificial stimulation and painkillers are never used. This is important to know.

When performing a second cesarean section, the doctor faces difficulties. The first operation always has consequences in the form adhesive process. Thin films between organs make the surgeon's work difficult. The procedure itself takes longer. This could be dangerous for the child. Indeed, at this moment, potent drugs used for anesthesia penetrate into his body.

A complication of a repeat cesarean can be the same as the first time: poor contraction of the uterus, its inflection, inflammatory process and so on.

Additionally

Some women are interested: if a second caesarean section is performed, when can they give birth for the third time? Experts cannot answer this question unambiguously. It all depends on the condition of the scar (in this case two). If the suture area is thinned and filled with connective tissue, then pregnancy will be completely contraindicated. With sufficient scars, it is quite possible to give birth again. But, most likely, this will be the third caesarean section. The possibility of natural childbirth decreases with each subsequent operation.

Some women manage to give birth to five children by caesarean section and feel great. A lot depends on individual characteristics and surgical techniques. With a longitudinal incision, doctors do not recommend giving birth more than twice.

In conclusion

A caesarean section performed during the first pregnancy is not a reason for repeat procedure. If you want and can give birth on your own, then this is only a plus. Remember that natural childbirth is always a priority. Talk to your gynecologist about this topic and find out all the nuances. Best wishes!

How and when is the operation performed?

Very often, during the second and subsequent pregnancies, long before giving birth, a woman is prepared for the fact that surgical intervention will again be required to give birth to a second child. But this is not always really necessary - during the period of bearing a child, a thorough examination, which will help answer the question about choosing a method of delivery.

In order to make a decision and develop labor management tactics, the doctor must:

• assess the condition of the uterine scar. If a second pregnancy occurs earlier than 3 years after the previous birth, then surgery really necessary. During such a period of time, high-quality scar tissue does not have time to form;
• find out what the order of a caesarean section will be - if surgery on the uterus was performed 2 or more times, then vaginal delivery is impossible. Before the third cesarean section, doctors may suggest that the woman undergo tubal ligation along with surgery;
• clarify whether there were abortions or surgical manipulations in the uterine cavity in the interval between the cesarean section and the present pregnancy, since, for example, curettage of the uterine mucosa inevitably worsens the condition of the scar;
• carry out comprehensive examination condition of the pregnant woman - if any serious illnesses who required a cesarean section, or have anatomical features organism, then the “royal birth” remains the only way delivery (indications for surgical intervention remain);
• determine the number of fetuses during pregnancy, the characteristics of their position and presentation. During multiple pregnancies, the walls of the uterus stretch much more, and the scar tissue becomes thinner and becomes functionally inferior;
• determine the location of the placenta - when it is attached to the scar area, it is necessary to resort to surgical intervention;
• A caesarean section is also necessary if a transverse incision was made on the uterus during the first operation - in this case the scar cannot be intact, but this intervention technique is technically easier. Currently, doctors prefer to make a transverse incision of the anterior uterus in its lower segment - such a scar always turns out to be denser.

If it is nevertheless necessary to resort to a repeat caesarean section, the date of its implementation is shifted a week or two earlier than the planned date of birth of the child. Doctors usually do a second caesarean section at 38 weeks..

How is the operation performed?

The fact that the expectant mother had previously undergone a caesarean section, the doctor antenatal clinic or the maternity hospital will find out at the first visit of the pregnant woman. The doctor’s task is to find out the indications for repeated surgical delivery throughout the entire period of pregnancy.

In the vast majority of cases cesarean section 2 time is carried out as planned, we have to take into account the fact that repeat execution surgery presents greater difficulties than primary intervention.

Dangers of repeat surgery

If it is necessary to perform a second cesarean section, the doctor must take into account the fact that the first intervention always causes the development of adhesions in the pelvis and the scar area on the uterus - with the current level of development of medicine, it is impossible to prevent this complication.

Very often, a second caesarean section causes bleeding from the uterus, which is very difficult to stop, so in order to save the woman’s life, the doctor may have to decide to remove the uterus.

Surgical intervention poses a danger to the child as well - from the moment the operation begins until the moment the child is born, longer time than with the primary intervention, and the fetus is under the influence of potent drugs for a certain time.

This is why doctors do not consider repeat caesarean section a mandatory method of delivery. In each specific case, measures are taken to minimize the risks for the mother and her child.

Delivery through cesarean section has long ceased to be an innovation or anything unusual. And it is thanks to a caesarean section that many women receive real opportunity become full-fledged mothers. Definitely this method childbirth has both its adherents and people who do not accept it. And no wonder, since this method has a lot of advantages and many disadvantages. In cases where the first birth took place with the help of which there were any objective reasons, a reasonable question arises - what will need to be expected from all subsequent pregnancies and, accordingly, from childbirth.

Once a C-section is always a C-section?

Unfortunately, for many years in our country the answer to such a question remained exclusively affirmative. Indeed, among doctors it was authoritatively believed that after the first caesarean section, a second similar birth could not be avoided by a woman. And even more than that, after that women were offered to either have their tubes tied, thereby making her infertile, or were asked to remove the uterus altogether, in order to avoid problems associated with subsequent pregnancies. And all because the scar left on a woman’s uterus literally with each new cesarean section brought such a woman closer to the most fatal consequences.

Fortunately for us, today doctors are not only in no hurry to suggest removal of the uterus (which in itself can be called monstrous!), but are also trying to convince women that it is quite possible to avoid a repeat cesarean section, subsequently giving birth to a healthy toddler using natural birth canal. Valid in modern practice obstetrics knows a huge number of cases when, after a caesarean section, repeatedly pregnant women gave birth to their second and even third child without resorting to surgical intervention. In fact, the attitude towards repeat cesarean section procedures has changed dramatically. Today, with the right approach and correct implementation procedures, experienced gynecologists will be able to “get” even the third or fourth toddler from the mother’s womb.

It is extremely important to only fulfill strictly defined conditions, which doctors always stipulate. The most important thing is no abortions in the period between pregnancies, as well as no abortions after the first cesarean section, and at least three years must pass after the first birth (after all, this is the amount of time needed female uterus in order to fully recover). Today, doctors try to encourage literally every pregnant woman to give birth naturally, regardless of whether it is her first birth or perhaps her tenth. And, nevertheless, such desires of ours may not always perfectly coincide with our capabilities, and often, a repeat cesarean section cannot be avoided, no matter how hard you try.

Medical indications for repeat caesarean section

Absolute medical indications for a cesarean section include those indications due to which a woman will not be able to give birth through the natural birth canal, either in the first or in all subsequent pregnancies. Along with this, there are also relative medical indications to perform a repeat cesarean section, which, by the way, may well arise directly in the process itself absolutely.

Among them:

• Anatomically or clinically, a woman’s pelvis is too narrow. And if during pregnancy doctors clearly give you such a “diagnosis”, then, unfortunately, a caesarean section cannot be avoided. However, in many civilized European countries women with narrow pelvis manage to give birth healthy children without any surgical intervention.
• Various deformations of the woman's pelvic bones and some discrepancy between the female pubic bones, the extent of such problems is especially important.
• Serious oncological diseases detected in the expectant mother (possibly pelvic or ovarian tumors, for example).
• Physiologically incorrect presentation of the fetus itself (for example, transverse presentation or possibly breech presentation), too large a fetus with such a presentation (fetus weighing over four kilograms).
• Physiologically incorrect (especially presentation into a previous scar left on the uterus), as well as premature.
• Serious illnesses detected in the expectant mother (diseases of the nervous or cardiovascular system, serious problems with vision systemic diseases type diabetes mellitus, exacerbation of a disease such as genital herpes and others).
• Previous problems with the scar on the uterus or its failure after the first cesarean section (perhaps this is the predominance of connective tissue directly in the scar area, and insufficient formation of muscle tissue).
• Certain problems related to the child’s health (for example).
• The mother's labor is too weak.

Possible risks of repeat caesarean section for mother and baby

Almost all modern doctors speak with confidence about the possibility of risks and complications during natural childbirth after a primary cesarean section. However, what is important is that, as a rule, very little is said about the consequences of such a repeat cesarean. And if they do talk, then, as a rule, about the risks of uterine rupture in a woman, but such information will understandably frighten many women, and seriously, and because of this, many women do not dare to have repeat pregnancies, depriving society of new ones. residents, and the pleasure of becoming a mother, twice or thrice.

Indeed, before you finally decide to get pregnant again and go to childbirth after initial implementation caesarean section, it is extremely important for a woman to think everything over as carefully as possible. And if everything is decided, then it is imperative to prepare for a second pregnancy in advance and as thoroughly as possible. As previously mentioned, it will be safer to perform a repeat cesarean section (both for the mother herself and for her baby) not earlier than three years after the successful first operation. And besides, you should always first of all consider the possibility of giving birth to a second or possibly third baby without the use of surgical medical intervention. Moreover, this is quite real and even safer for you than having a repeat caesarean section.

Of course, almost all doctors and even pregnant women themselves are afraid of possible uterine ruptures directly in the area of ​​the primary scar, but it is important to remember that with such a rupture, doctors usually save both the woman and her child. And at the same time, when performing a repeat cesarean section, the risks of developing uterine bleeding. Moreover, this can very often be the reason complete removal a woman's uterus. And in general, performing a repeat cesarean section is fraught with many real complications(so this may well be certain injuries to the intestines, as well as bladder, it could be anemia or endometritis, the formation of large adhesions, and other troubles is possible).

Extremely negative consequences and are prevented from performing a repeat caesarean section procedure at each stage. Anesthesia for the mother may well become a real cause of violations cerebral circulation in a newly born baby. And the baby’s scores on the generally accepted Apgar scale after such a procedure will be extremely low. As a rule, when re-execution cesarean section procedures, newborn babies are born somewhat premature, which means that the risks of developing a variety of diseases (including asthma) actually increase.

We hasten to console expectant mothers, because all these “terrible diagnoses,” even though they happen and are often heard, are nevertheless real life don't occur very often. Believe me, by giving such examples, we in no way want to scare you or dissuade you from repeat pregnancies. In any case, the woman will make the final decision exclusively independently in the circle of her family. Neither we nor any doctor will ever be able to force a woman to give birth on her own naturally, or, conversely, to undergo a cesarean section again. However, each of the modern gynecologists will be obliged to give you the most complete and most importantly reliable information about all sorts of risks and complications encountered, both after repeated dissection of the cavity, and actually after delivery through the natural birth canal.

Good luck to you dear women!

Quite often, due to various factors, a woman cannot give birth naturally. That's when a caesarean section is used. If this is the second pregnancy after a previous cesarean section, then for the most part, delivery is carried out the same way. Therefore, often women who have previously had a similar operation ask about the timing of the second caesarean section and what determines the time of its implementation.

Before determining at what time to perform a second cesarean section, doctors have to develop tactics for carrying out such an operation. To do this you need:

1. Assess the scar on the uterine wall that remains after the first cesarean section. In cases where pregnancy occurred earlier than 3 years after the birth of the first child, then surgical intervention for repeated delivery is simply necessary.
2. Check with expectant mother, was there any time between the first Caesarean and repeat pregnancy abortions or surgical interventions on the uterine cavity. For example, curettage of the endometrium sharply worsens the condition of the uterine scar.
3. Determine the number of fetuses in multiple pregnancies, as well as their location in the uterus and the type of presentation. As is known, during multiple pregnancy, the uterine wall is overstretched, which also negatively affects the condition of the scar.
4. Also, in cases where the placenta is attached to the uterus in the area of ​​the previous incision, surgery is the only method of delivery, because high risk of uterine rupture.
5. In cases where a transverse incision was performed during the first birth, the second birth should also be performed by caesarean section.

Taking into account all these factors, doctors decide on the time of cesarean section. If we talk about when a second planned caesarean section is performed, then, as a rule, this operation is prescribed 1-2 weeks earlier than the first time. In most cases, this is 38 weeks of pregnancy. It is by this time that a surfactant begins to be synthesized in the baby’s body, which helps to expand the lungs during the first breath.

What are the dangers associated with a repeat cesarean section?

When carrying out a repeated similar intervention, doctors have to take into account the fact that in most cases, after the first cesarean section in the woman’s body, this circumstance somewhat complicates the course of the operation and increases its duration, because access to the uterus can be blocked by adhesions formed between the pelvic organs.

In addition, sometimes when a second planned cesarean section is performed, bleeding in the uterus develops, which is difficult to stop. In cases where blood loss is great, doctors decide to remove the reproductive organ, to save a woman's life.

We must not forget that during a cesarean section the fetus itself is at great risk. Medications used for anesthesia have a certain effect on the baby, especially if for some reason the operation is delayed (incorrect presentation, the head is outside the pelvis, etc.).

Thus, we can say that determining at what time a woman will have a second planned cesarean section depends on many of the above factors. In this case, as a rule, the woman learns in advance about the date of this operation, because It also takes time to prepare for it.