Are natural births possible after cesarean section and what should be taken into account?

Every fifth Russian woman has to give birth surgically. If before the cesarean section was a relative rarity, now the list of indications for such a delivery is extended, and there is nothing surprising in the fact that the pregnancy ends on the operating table. But after a few years, a woman may have a desire not only to become a mother again, but also to try to give birth on her own. Is this possible, we will tell in this article.

Normal physiological labor after cesarean section is possible. But only if there is only one operative delivery in the history of the pregnant woman. The opportunity to ask the doctor about a full-fledged birth is reserved for the woman by the recommendations of the Ministry of Health. But the doctor may have good reasons for refusal.

The fact is that a lot depends on the reason why a cesarean section was first performed on a woman. If the operation was planned due to narrow pelvis, myopia, cardiovascular disease of the woman or the presence of scarring in the uterus from other operations that were performed before the first pregnancy, the reason is not considered to be eliminated and there is no reason to allow delivery through the physiological way. The second birth must pass, as the first - through surgical intervention.

If the cause of the first operation was in the weakness of the labor forces, in the placenta previa, the wrong location of the fetus in the uterus, other pathologies of pregnancy, the second birth through the birth canal is possible, if the obstetrician-gynecologist considers the condition of the woman during the second pregnancy to be satisfactory and will not find any specific contraindications to childbirth.

Each subsequent cesarean section is carried out on the first scar, that is, the uterus is dissected in the same area, removing the old connective tissue. Therefore, with each subsequent pregnancy, the uterine scar becomes thinner. For this reason after two cesarean sections, vaginal delivery is not permitted under any circumstances. The risk of rupture of the uterus along the scar in the process of contractions and attempts is too great. A rupture of the reproductive organ can mean death both for the child and for his mother, since the bleeding from the first seconds becomes massive, the blood loss is great and it is almost impossible to make up for it.

Even 20 years ago in obstetrics independent birth after cesarean was not taken. A woman who once underwent a similar operation could only become a mother again in the same way. But the recent trends in world medicine, the development of obstetrics, the emergence of new methods of childbirth and pregnancy have made possible natural childbirth after a CS operation, first in European countries and now in Russia.

The decision about whether a woman can resolve to give birth in a natural way, if the former were a cesarean section, is primarily affected by the elimination of the root cause. If for the first time a woman had an operation due to a pelvic presentation of the fetus, and the second pregnancy the baby is positioned correctly, there are no reasons for refusal.

Next, pay attention to the time elapsed after the first operation. If less than 2 years pass, independent delivery is not allowed, because the connective tissue of the scar does not inspire confidence in the doctors. For complete scarring and restoration of elasticity, you need at least 2 years, during which the woman after the first operation is not recommended to become pregnant, to undergo abortion, surgery on the uterus.

If more than 8 years have passed since the birth of the first child, the probability that birth is possible by natural means tends to zero - the connective tissue in the area of ​​the scar has become coarse, and therefore the risk of rupture during contractions is also quite high.

After the 20th week of pregnancy, the most accurate examination will be the scar itself for consistency. Of course, it is optimal to make hysteroscopy or hydrography before pregnancy, at the planning stage, but in practice, alas, it does not always work that way. If a woman becomes pregnant with a scar on the uterus, in the second trimester, doctors will do an ultrasound scan to evaluate the scar, its uniformity, structure and thickness once a month, and in the third trimester - once every 10 days.

If the scar thickness is sufficient (at least 3-4 mm) at the final stage of gestation, then childbirth can be allowed. If the rumen is untenable, even gestation itself is dangerous; therefore, childbirth is not a matter for itself.

Very much in the decision of the doctor will depend on how the previous operation was performed. Upon discharge from the maternity hospital after the first birth, the doctor will be able to get a complete picture of which suture material was used for the inner scar, how the rehabilitation and recovery process went, how the uterus was reduced, whether there were no postpartum infections and bleeding. In general, vaginal delivery after the first cesarean section will be allowed if:

• after the first birth from 2 to 6-7 years;
• the scar is homogeneous, has no thinning, does not show "niche" and perforations, has a sufficient thickness (from 3 mm);
• the first operation was performed by the method of transverse horizontal section in the lower uterine segment;
• the woman had no complications in the postoperative period;
• current pregnancy is not accompanied by pathologies;
• the child is in head presentation, there is no entanglement with the umbilical cord and knots on the umbilical rope;
• the placenta is not fixed on the area of ​​the scar, even its partial approach by the edge to the area of ​​the scar is excluded;
• estimated fruit weight does not exceed 3.7 kg;
• the age of the pregnant woman at the time of delivery does not exceed 36 years.

An important factor is the psychological readiness of women to give birth on their own. It is with this that sometimes difficulties arise. According to statistics, up to 45% of women who were determined to give birth to a second child on their own, at the last moment are asked to make a cesarean section because they are psychologically very afraid that the uterus will rupture during contractions.

There are quite a few cases when a woman receives a guaranteed refusal to allow independent birth:

• the reason that became the basis for the first operation has not been eliminated, that is, it remains in the current pregnancy;
• pregnancy came too soon or after a long break;
• in the current pregnancy, the woman lay on the conservation, pathologies of gestation or fetal malformations were identified;
• the second child in the womb, according to ultrasound specialists, is large (weight is over the norm or more than 3.7 kg two weeks before giving birth);
• the scar is insolvent;
• after the first operation, the puerperal was recovering heavily, with complications;
• negative Rh factor of the mother in the presence of antibody titer in the blood, which may indicate a Rhesus-conflict between the mother and the fetus.

If there is a great desire to give birth independently, without a surgeon's scalpel, it is important to approach the issue of planning a second pregnancy as responsibly as possible. Within two years, a woman should be protected to exclude unplanned pregnancy, abortion, diagnostic curettage. It is necessary to strictly follow all the recommendations that relate to the recovery period after cesarean section - do not lift weights, do not start living too early sex life, visit a gynecologist for a routine examination.

Before becoming pregnant, a woman needs to do an ultrasound of the pelvic organs, donate microflora of the vagina, and also be examined for possible infections. Separately, you need to pay attention to the examination of the uterine scar. Ultrasound alone is not enough, it is necessary to make a hysteroscopy.

Only after the doctor has approved the planning, you can proceed to the most pleasant part of it - conceiving a baby. When the test shows two strips, you need to register with the antenatal clinic as soon as possible. With a scar on the uterus, it is imperative for a woman to visit the gynecologist more often and to do an ultrasound scan, to undergo various tests so as not to miss any pathological changes, if they occur.

At the 35th week of pregnancy, the doctor who leads the pregnancy, with all examinations and test results, will gather a consultation, which will include other obstetrician-gynecologists and the head of the consultation, as well as the doctors of the maternity hospital where she is supposed to give birth. So it will be decided whether to allow a particular woman to give birth naturally.

At 37 weeks, if the decision was positive, the woman is hospitalized. In the hospital, she is examined again, clarifying all the nuances of the current pregnancy.

Births after the first COP usually try to stimulate medication for a period of 39 weeks. Do not wait for the onset of labor, because childbirth can begin at any time of the day. And given that a woman at any time may need a ready-made operating room and a free surgical team for the operation, if something goes wrong, the beginning of labor is tried to fit in the daytime.

A woman, if she is opposed to interfering in the affairs of nature, can express her categorical disagreement with medication stimulation, and then doctors will give her the opportunity to wait for the onset of physiological labor.

Delivery after the COP require great skill on the part of doctors and obstetricians. From the first bouts, the condition of the baby and the parturient woman is observed very carefully. That is why independent delivery after the previous operation on the uterus is not recommended at home. If the generic activity is, but it is weak, stimulants can be used, but in no case do not introduce prostaglandin-based products (Dinopriston, in particular, is contraindicated). The ban is associated with the need to eliminate intense and strong contractions, which can lead to divergence of the scar.

In childbirth, a woman can use any method that can ease the pain (breathe, massage the sacrum), but you can not count on pain relief with medicines. If anesthesia is carried out, the woman may not feel the moment of rupture of the uterus along the scar if this happens.

After the baby is born, obstetricians must manually carefully examine the area of ​​the scar on the uterus to eliminate possible tears and damage. The woman will not feel this process, because it is customary to carry out palpation only after intravenous administration of anesthetic that will immerse the puerperal for 10-15 minutes in a sound medication sleep.

Need to understand that An emergency caesarean section can be performed at any stage of such delivery. The recovery period usually proceeds without significant features.

According to women, many of the choice of natural childbirth after the first caesarean stops the fear of pain and rupture, complications and injuries for the child. Only every third woman who allows natural childbirth agrees to take advantage of this opportunity.

Those who agreed, usually remain very satisfied in the first place with themselves. A woman is no longer tormented by the hidden feeling of her maternal and female inferiority, which almost everyone has after a cesarean section. Many of the advantages are referred to as easier recovery in the postpartum period and faster lactation than it was after the first operative labor.

Whether vaginal delivery is possible after cesarean section, see the following video.