When natural childbirth presents risks to the mother or the unborn child, a planned cesarean section is frequently advised. Physicians plan ahead for this procedure so that parents have time to get ready for the birth of their child. However, a little bit of certainty can be reduced by knowing the exact time and method of the surgery.
A planned cesarean section is usually carried out at approximately 39 weeks of pregnancy. This timing minimizes the risks associated with a natural labor while allowing the baby to grow to full term. However, the mother’s and the baby’s health may have an impact on the precise timing.
The mother receives either spinal or epidural anesthesia to ensure her pain-free and awake during the procedure. The actual surgery is usually completed in 30 to 60 minutes. Following surgery, the mother and child are closely watched to make sure everything heals properly.
Depending on the mother’s and baby’s health, a planned cesarean section is usually scheduled between 37 and 39 weeks of pregnancy. The process, which typically takes 45 minutes, entails making an incision in the abdomen and uterus to deliver the baby. The incisions are stitched after the baby is carefully delivered after preparation, including anesthesia. In order to ensure her and the baby’s health, the mother remains under close observation while she recovers in the hospital. This method ensures a safe delivery by helping to manage specific medical conditions or complications.
- Types of surgery and indications for it
- When they do it?
- Preparation for surgery
- Anesthesia
- Execution technique
- Features of a repeat operation
- Rehabilitation
- Video on the topic
- 4 main myths about cesarean section
- At what stage is a cesarean section usually done and what does it depend on?
- PLANNED CESAREAN SECTION | Who needs and how is a planned cesarean section performed
- What is the difference between a planned cesarean section and an emergency cesarean section?
Types of surgery and indications for it
An abdominal incision is made during a cesarean section to remove the baby and placenta during childbirth. For vital signs and unexpected situations that developed out of the blue and rendered physiological childbirth risky or impossible, the procedure can be carried out urgently. If circumstances are found to be direct or relative indications for surgical delivery during pregnancy, the procedure is carried out on a planned basis.
A planned cesarean section is different from an emergency one because it is well planned and not hurried. Following a scheduled operation, complications are less frequent. Furthermore, distinct surgical intervention types suggest distinct indications. The indications for a planned operation are more extensive if an emergency caesarean section is performed primarily in cases of weak labor forces, lack of effect from stimulation at one of the stages of physiological labor that has begun, with premature placental abruption, or with acute fetal hypoxia that threatens the baby’s life.
In these situations, a planned caesarean section is carried out.
- The "baby"s place" is located below the normal level, there is presentation. The placenta completely or partially covers the internal os, there is a high probability of bleeding.
- A scar on the uterus left from a previous caesarean or other surgery on the uterus can be dangerous in terms of the possibility of uterine rupture during childbirth.
- A healthy scar, but two or more caesareans in the anamnesis.
- Obstacles that can be considered mechanical. Normal childbirth will be impeded by a narrow pelvis of the mother, injured or deformed bones and joints of the pelvis, tumors of the uterus, ovaries, multiple polyps.
- Divergence of the pubic bones – symphysitis.
- Pregnancy of the fetus inappropriate for physiological childbirth (this includes breech, oblique or transverse, as well as breech-footed position of the baby relative to the exit from the uterus), an aggravating factor – the expected large weight of the fetus (more than 3600 g).
- Pregnancy with twins, if one of the children is in an incorrect presentation or the baby is in a breech position, which is closer to the exit from the uterus.
- Pregnancy with monozygotic twins, if the children are located inside one amniotic sac.
- Pregnancy (including multiple pregnancy), which became possible as a result of a successful treatment cycle of in vitro fertilization.
- traumatized cervix, scars on it and in the vagina after previous difficult births.
- Severe fetal growth retardation, significant developmental delay of the baby in terms of time.
- Post-term pregnancy – after 42 weeks, if stimulation was ineffective.
- Severe gestosis.
- Diseases in the mother, in which pushing is strictly prohibited – myopia, cardiovascular problems, transplanted kidney.
- State of chronic oxygen starvation in the fetus.
- Genital herpes.
- Problems with hemostasis in a woman or child.
- Some fetal malformations.
In Russia, only a few private clinics perform cesarean sections at the laboring woman’s request. The cost of an elective cesarean section may approach one million rubles. Free of charge, that is, maternity hospitals and perinatal centers only perform the procedure under the mandatory medical insurance policy if there are strong medical justifications for surgical childbirth as opposed to physiological childbirth. This is because there is a high chance of complications, which the mother and unborn child won’t experience if the intervention’s potential benefits outweigh the risk.
When they do it?
The decision regarding whether a cesarean section is necessary and when to perform one is usually made between 34 and 35 weeks of pregnancy, as doctors need to gather as much information as possible regarding the health of the expectant mother and her unborn child. This mostly pertains to circumstances where determining the baby’s estimated weight is required, such as when the infant is found inside the uterus in an abnormal presentation or breech. However, the decision to recommend an operation is made automatically if there are specific signs during the first few months of pregnancy, such as the impending third or fourth surgical birth. In these cases, the issue is not brought up.
Some people believe that a cesarean section, which is performed once a woman starts experiencing contractions on her own, is more physiologically similar to childbirth and more natural. Surgeons with experience and caution would rather do the surgery before regular contractions start. Postoperative complications are less likely the more relaxed the uterine muscles are.
The Russian Ministry of Health has prescribed to perform a planned operation after 39 weeks. Theoretically, the baby is viable earlier, after 36-37 weeks, but in practice there are risks of developing respiratory failure due to a possible small amount of surfactant in the lungs. Therefore, during the first birth, the operation is performed at 39-40 weeks. A repeat C-section can be performed at 39 weeks, and a third at 38-39 weeks. The difference is due to the fact that subsequent gestations of a fetus with a scar on the uterus are associated with increased risks of scar divergence at the latest stages, and there is a higher probability of early onset of contractions.
The child’s interests are taken into consideration in addition to the expectant mother’s when determining the date of the procedure.
It is possible to move up the planned surgical birth date by a few days if there are indications of his illness. Even in cases where a patient gives birth for a fee, elective surgeries are not carried out on weekends prior to the agreement for the provision of compensated medical services.
For a variety of reasons, the anticipated date of the procedure could change. The woman may require an earlier intervention, for example, if her cervix appears ready for labor, if the mucus plug has been released or amniotic fluid is leaking, if there are worrying indications of a potentially dangerous rupture of an old scar on the uterus, if gestosis has made her condition worse, if the baby appears to be oxygen starved based on CTG and ultrasound findings, or if the umbilical cord is wrapped around her neck.
At 38 weeks of pregnancy, the patient is referred to the maternity hospital from the antenatal clinic, as hospitalization prior to the scheduled procedure is done beforehand.
Preparation for surgery
A woman is admitted to the maternity hospital between 38 and 39 weeks of pregnancy in order to await a scheduled surgical delivery. To get as ready as possible for the impending surgery, a trip to the hospital is imperative. In the maternity hospital, preparations will involve a further general examination, as well as CTG, ultrasound, and blood and urine tests.
Without a doubt, the woman will undergo a coagulogram, which is a blood test for clotting factors. This is critical to the operation’s planning. When she has to choose the kind of anesthesia, she will also speak with the anesthesiologist. A set of elastic bandages or compression stockings for bandaging the legs to prevent thrombosis during and after the procedure must unavoidably be in the bag the woman packs for the maternity hospital before the cesarean section. A disposable razor is something you can bring with you; it will come in handy on the day of the procedure.
The woman is roused early in the morning, her pubis is shaved to avoid hair getting on the wound surfaces, and an enema is administered to clear her intestines, which will aid in the uterus contracting more quickly. Morning operations for elective procedures start.
Anesthesia
Three different forms of anesthesia exist. Recently, spinal and epidural anesthesia have become the most popular. By using these techniques, anesthetics and muscle relaxants are injected into the subarachnoid or epidural spaces of the spine. Using a long, thin needle, the anesthesiologist administers the injection while the patient is either sitting or lying on their side. The lumbar spine is the site of puncture. The place to insert the needle is between the vertebrae. With epidural anesthesia, pain relief happens in about 15 minutes, and with spinal anesthesia, it happens nearly instantly.
The body’s lower regions become insensitive and numb. The procedure can start, and in the event that it takes longer than expected, the anesthesiologist will leave a catheter at the lumbar puncture site so that more medication can be given. The woman is completely conscious, able to interact with medical professionals, witness the amazing event of the baby’s birth, and even have the chance to nurse the child on the operating table straight away.
A woman undergoing general anesthesia is put into a deep, drug-induced sleep. She receives an intravenous anesthetic in the operating room, which puts her to sleep. A tracheal tube is then placed and attached to a respirator. Medication to sustain drug-induced slumber can be injected intravenously through a catheter left there, or it can be vaporized and delivered through the tube. Under general anesthesia, a woman will not be able to see or hear anything.
When there are specific circumstances in which epidural or spinal anesthesia cannot be used, or when the patient herself requests to be put into a deep sedative sleep during the procedure—not everyone enjoys hearing about and seeing surgeons perform their work—general anesthesia is administered.
Execution technique
In order to preserve the woman’s attractiveness as much as possible, they attempt to perform a planned procedure. The incision is horizontal and is no longer than ten centimeters. The pubis and the incision line are parallel. During uterine manipulation, the surgeon must use a scalpel to shield the muscles and bladder from potential accidental injury after severing the skin, adipose tissue, and muscle tissue of the aponeurosis. After repositioning them, he secures them with clamps.
In the lower uterine segment, the uterus is dissected. The possibility of the woman becoming a mother multiple times is preserved because this segment is the least stretched. The uterus is opened, the amniotic sac is opened, the amniotic fluid is drained, the baby’s head is gently removed from the world by the doctor using his hand to hold it in the occipital region. The fetal cord is severed.
After that, the placenta is manually separated, and the stitches are placed backwards. On the uterus initially, and then on the muscle tissue. Finally, the abdominal skin is sutured. Typically, it takes no longer than 40 minutes to complete an operation in the normal mode from the start.
Features of a repeat operation
A follow-up procedure might take a little bit longer than the initial one. This is because a new suture needs to be formed and the old scar on the uterus has to be removed. The truth is that the old scar is followed for any further surgical births. Only rarely, and only for specific reasons, is it necessary to deviate from this rule, which is applicable in 99.99% of cases.
Some women consent to fallopian tube ligation during their second or third cesarean section in order to prevent the possibility of a subsequent pregnancy, as the risks associated with each one increase. Repeated surgical births can take up to 50–60 minutes because this procedure adds approximately 10 minutes to the overall operating time.
Rehabilitation
A great deal of the new mother’s future health will depend on how well the rehabilitation program is set up. The laboring woman is kept under close medical observation in a special intensive care unit during the initial hours following her surgery. Everything matters: the woman’s blood pressure, body temperature, and the speed at which the uterus will reverse involution (contraction) after she awakens from anesthesia.
The woman is already receiving contraction medications in the intensive care unit, which are intended to make her uterine contractions stronger. Without fail, doctors administer painkillers; if they believe there is a high risk of developing postoperative complications, they may also prescribe antibiotics.
Five or six hours later, the woman is moved to a general ward. After a few more hours, she will be able to roll over on her side, sit up, and eventually stand up and walk for the first time. For uterine contractions, it is best for the laboring woman to get up and start moving around moderately as soon as possible to facilitate a quicker recovery.
It is recommended that a baby bond to the breast at an early age. The sooner the baby starts to nurse, the quicker the woman’s body’s hormonal balance returns to normal, increasing the production of oxytocin and improving the uterine contraction.
A special diet is prescribed to the woman for the first three days. There was only still water the first day, and homemade white crackers devoid of salt and spices, jelly, and compote the following day. You can have vegetable puree and porridge on the third day. The woman is moved to the general table on the fourth day, but it is advised that she stay away from foods that can result in bloating, gas buildup in the intestines, or constipation. discharged on the fifth day following a scheduled cesarean section without incident. On days seven and eight, the woman has her stitches taken out at the prenatal clinic where she lives.
Stage | Description |
Before the procedure | The doctor schedules the cesarean section for around 39 weeks of pregnancy to avoid risks to the baby and mother. |
During the procedure | A spinal block or epidural is given to numb the lower body. The doctor makes an incision in the abdomen and uterus to deliver the baby. |
After the procedure | The mother is monitored while recovering in the hospital, and the incision site is cared for to prevent infection. |
When a natural birth would be dangerous for the mother or the unborn child due to medical reasons, a planned cesarean section is usually scheduled. To ensure the baby’s development while avoiding any complications that might arise from waiting longer, the timing is typically set around 39 weeks of pregnancy.
The actual procedure is simple: to safely deliver the baby, an incision is made in the abdomen and uterus. The procedure is carried out under anesthesia, and the mother is typically awake throughout, allowing her to see her child soon after birth.
Modern medical procedures guarantee that both mother and child receive the care they require for a speedy recovery, even though recovery from a cesarean section can take longer than that of a natural birth. To aid in the body’s healing and return to regular activities, getting enough sleep and adhering to post-surgery instructions are crucial.