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Multiple caesarean sections are controversial, and the number of acceptable, safe sections still remains the subject of much debate. The main concern is the risk of rupture of the uterine wall due to postoperative scars from previous cesarean sections, which weaken the uterine muscle and reduce its ability to stretch.

Caesarean section - multiple , but also one-off, despite the common misconception, is a major surgical procedure with the risk of many complications, including a threat to the life and he alth of both mother and child . It should not be performed on request, because despite the improvement of the surgical technique, it is still burdened with more complications in terms of childbirth and natural forces.

Problems may arise already at the stage of epidural anesthesia. Nevertheless, there is a growing trend towards just such a method of terminating pregnancy, and in many countries there is a possibility of the so-called on-demand cuts, where the main reason for the operation is the patient's fear of physiological delivery.

Of course, mortality among women and children is low, but deaths occur more often than in the case of traditional childbirth, about which the doctor is obliged to inform the patient.

Main indications for cesarean section

The list of indications for termination of pregnancy by caesarean section includes

  • pelvic-head disproportionate - which means too large dimensions of the fetal head in relation to the pelvic bone dimensions, which does not guarantee the progress of labor.
  • multiple pregnancy, although in the case of the head position of both fetuses, physiological delivery is possible, which is rare
  • fetal pelvic position
  • child's condition or mother's disease excluding the possibility of childbirth through natural means (cardiovascular diseases, diabetes, pre-eclampsia)
  • severe obesity in labor
  • bearing leading, premature separation of bearing
  • history of cesarean section, but for reasons that cannot be modified in the current pregnancy, for example abnormal pelvic bone dimensions

The above list is for elective caesarean section, where the method of delivery is discussed much earlier. But there are situationsobstetric, when a caesarean section is planned due to the so-called lack of progress in labor, i.e. during a physiological labor that is not progressing for some reason. The most common problems include: umbilical cord prolapse, insufficient opening of the cervix or the risk of uterine rupture.

A woman's body after a cesarean section

The so-called period convalescence after the surgery, and therefore the regeneration of the body takes about 6 months. It is also the contractual break time between the next pregnancy. This prevents the risk of uterine rupture. Childbirth through the ways and forces of nature after a prior caesarean section is actually possible after about 1.5 years' break. It is believed that only then is the uterine muscle fully regenerated.

Recommendations for labor after cesarean section

In fact, it's still a moot point. However, there is a preconceived belief among the majority of specialists that after the second operative delivery, the gynecologist should make the patient aware of the increased risk of obstetric complications during the next attempt at cesarean delivery. Therefore, the decision about a planned next pregnancy should be made very carefully, out of concern for the life of the mother and child.

The risk of complications is closely correlated with the technique of the surgery, the most important here is the technique of incising the uterine muscle, as well as the healing process of the surgical wound. The most common complications of multiple caesarean section include: uterine rupture, placenta previa, adnate (connections with uterine muscle fragments), haemorrhage.

The next pregnancy after a previous cesarean section should be carefully monitored, and any disturbing symptom should be reported to the attending physician so that appropriate action can be taken as soon as possible.

Important

Position of the Polish Gynecological Society on labor after cesarean section

Childbirth by means of natural means and methods after a prior cesarean section is possible, of course, provided that the mother and the fetus are in good condition. Nevertheless, the obstetric team should be prepared for a possible caesarean section.

It is important to evaluate the scar from the previous cesarean section. For this purpose, a detailed interview is collected with the patient in terms of perceived possible pain, especially in the lower uterine segment. Ultrasound examinations are also performed routinely.

In the case of natural and natural delivery after cesarean section, constant monitoring of the fetal heart rate is necessary. Oxytocin can be used to stimulate labor, and prostaglandin only when diagnoseddied pregnancy.

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Childbirth