How long is the second cesarean section and what is important to know?

The thought of undergoing another cesarean section while expecting your second child may raise a lot of concerns. A lot of parents are curious about how long the second C-section takes and whether there are any changes from the first one. Gaining an understanding of the procedure can make you feel more relaxed and ready.

While most second cesarean sections go similarly to the first, it’s vital to remember that every surgery is different. Your overall health, the scar tissue from the initial surgery, and the method used by your doctor can all have an impact on the experience and timing. The actual surgery usually takes between thirty and sixty minutes, but recovery and preparation take longer.

This post will go over what to anticipate from a second C-section, important things to know, and how to get ready for the procedure. It’s useful to know what to expect, regardless of whether your first surgery went well or you’re worried about any complications.

The need for repeated operation

Performing surgery on the second birth following a cesarean section is not recommended. A woman may very well consent to giving birth on her own, subject to specific requirements. However, this only represents a third of expectant mothers who have had one prior cesarean section. The first and most compelling reason for repeated operational genera is categorical disagreement of the patient for physiological childbirth with a scar on the uterus.

However, if there are clear signs that she needs a second operation, the pregnant woman may refuse to allow herself to give birth even if she has dreams of doing so.

• A small or large period of time after the first birth. If less than 2 years or more than 7-8 years have passed, then the “reliability” of the connective tissue of the uterine scar will cause reasonable concerns among doctors. Only 2 years after the birth of the first child, the healing site of the scar becomes quite strong, and after a long break it loses elasticity. In both cases, the danger is a possible rupture of the reproductive organ at the site of the scar during strong contractions or pushing.

• Complications after previous births. If the rehabilitation period after surgical birth is difficult: with an increase in temperature, inflammation, additional infections, hypotension of the uterus, then the second child, with a high probability, will also have to be born on the operating table.
• Insolvent scar. If at the time of pregnancy planning its thickness is less than 2.5 mm, and by the 35th week – less than 4-5 mm, then there is a possibility of uterine rupture during natural childbirth.
• Large baby (regardless of its presentation). Multiparous women after a cesarean section can give birth to a baby through natural physiological pathways only if the expected weight of the child is less than 3.7 kg.
• Incorrect positioning of the baby. Options with manual turning of the baby for a woman with a scar are not even considered.
• Low location of the placenta, placenta previa on the scar area. Even if the edge of the "baby"s place" touches the scar area, you cannot give birth – only undergo surgery.
• Vertical scar. If the incision during the first delivery was made vertically, then independent labor in the future is excluded. Only women with a satisfactory horizontal scar in the lower uterine segment can theoretically be allowed to give birth independently.

Furthermore, absolute indications for repeated surgical births are defined as irreversible causes of the initial operation, such as birth canal and uterine anomalies, narrow pelvis, etc.

Relative signs for a second operation are also present. This implies that if the woman declines the offer of a cesarean section during her second pregnancy, a natural delivery method may be used. Among these signs are:

• myopia (moderate);
• oncological tumors;
• uterine fibroids;
• diabetes mellitus.

When the pregnant woman is registered, the decision about a repeat operation is made, provided that the patient has no objections to the delivery method and there are no absolute contraindications. The method of delivery will be decided upon at a medical consultation following the 35th week of pregnancy, if the woman wishes to give birth on her own and there are no contraindications.

Time of the procedure

When performing a cesarean section, the Russian Ministry of Health strongly advises maternity hospitals and clinics to follow clinical recommendations. The procedure should be carried out after the 39th week of pregnancy, according to this document (May 6, 2014, No. 15-4/10/2–3190, from the Russian Federation’s Ministry of Health). This holds true for both the initial and follow-up cesarean sections. The risk of potential lung tissue immaturity in the fetus before the 39th week serves as justification.

Since the spontaneous onset of labor can put the mother and child in grave risk of uterine rupture, in actuality, they attempt to perform the second cesarean section a little earlier than the first. The second surgical birth typically occurs between weeks 38 and 39 of pregnancy.

The timing of the operation can be moved up if the doctor discovers precursors in the woman during a routine examination at a later time. These precursors include the plug’s discharge, the cervix’s maturity and readiness, and its smoothing.

In order to preserve the life of both the mother and the fetus, the procedure during the second pregnancy is carried out whenever there are emergency indications. Prolapse of the umbilical cord, early placental abruption, indications of acute hypoxia, and other fetal distress are examples of emergency scenarios where the fetus is in grave risk of dying while still inside the mother’s womb.

Theoretically, a C-section can be done at any point between 39 and 40 weeks if the woman believes that the procedure should be done as soon as possible before the anticipated date of birth (provided there are no contraindications for expecting mothers).

Preparation

Pregnancy is the time when preparations for the second scheduled surgery start. Compared to other pregnant women, a woman with a scar on her uterus should see her obstetrician-gynecologist more frequently. It’s important to keep an eye on the scar’s health during the third trimester to spot any early warning indications of thinning. It is advised to perform a Doppler ultrasound on this every ten days.

The woman is admitted ahead of schedule to the maternity hospital. If you have to visit the hospital a week or so prior to your first scheduled operation, you must visit the hospital under the care of medical professionals at 37 to 38 weeks pregnant in order to get ready for the impending birth if you need a repeat C-section.

Physicians get ready in their own unique ways: they have to reexamine the expectant patient, pinpoint the precise location and characteristics of the scar, perform tests, and consult with the patient regarding the anesthetic technique.

An anesthetist speaks with the woman the day prior to the procedure. Before the procedure, premedication takes place in the evening. The expectant mother administers a potent sedative (typically barbiturates) to herself in order to maximize her quality of sleep and relaxation during the night. This will prevent blood pressure drops while she is under anesthesia.

On the morning of the procedure, a woman shakes the pubis, administers an enema to clean the intestines, and suggests bandaging the legs with elastic medical bandages to avoid thrombosis.

Similar to the first cesarean section, the second one typically takes 30 to 60 minutes, though recovery times can change based on specifics. It’s crucial to understand that the healing process may differ slightly and that scar tissue from the initial surgery may have an impact on the procedure. Parents can make well-informed decisions about their birth plan by knowing the advantages and disadvantages of repeat C-sections, and doctors will closely monitor for any complications. Getting advice from your healthcare provider is essential to ensuring a safe delivery and a quick recovery.

Features of the operation

The prolonged duration of the procedure is the primary characteristic of the repeated cesarean section. In order to spare her family members from needless worry, the woman should inform them of this. Surgeons will need more time to remove the initial scar. Every further surgical delivery is performed in accordance with the prior scar. As a result, circumstances where the woman had a vertical suture following her first procedure and a horizontal suture following her second are totally ruled out.

If a longitudinal incision was used during the procedure, the same location will be used for the second incision, which will remove the old connective tissue to allow for the formation of the new scar. It goes without saying that the scar gets thinner after each cesarean section and that the chances of becoming pregnant rise!

A woman can give her consent for surgical sterilization in advance if she no longer intends to become pregnant. Doctors start tying the fallopian tubes after the baby is removed, making it impossible for a subsequent pregnancy to begin. The patient may spend an additional 10 to 15 minutes in the operating room with this straightforward adjustment.

The doctor opens the abdominal cavity and removes the bladder and muscle tissue with extreme caution so as not to damage any tissue. The baby is then punctured and an incision is made directly on the uterine walls, the fetal bladder filled with amniotic fluid. After draining the water and removing the infant from the incision, the umbilical cord is severed and the baby is given to the neonatologists. At this point, the mother can already look at and touch her child if she is not in a deep drug-induced sleep (general anesthesia). Pain management techniques like spinal or epidural anesthesia offer this chance.

While the mother admires the child or sleeps soundly under general anesthesia, the doctor separates the placenta with his hands, checks if there are any particles left in the uterine cavity and applies several rows of internal sutures to the reproductive organ. In the final part of the operation, the normal anatomical position of the muscles and bladder is restored and external sutures or staples are applied. At this point, the operation is considered complete. The mother is placed in the intensive care unit for the next few hours for careful monitoring in the early postoperative period. The baby is sent to the children"s department, where he will be treated, bathed, examined by doctors, and blood tests will be taken from the baby.

How the recovery goes?

There are unique aspects to the recuperation phase following a repeat cesarean section. It is normal for a woman to recover from her first operation longer than she did the second, as repeated opening of the uterus causes strain on its muscles, which in turn complicates the uterus’s involution after giving birth. The uterus is still quite large after surgery, but it now more closely resembles an empty sac or a deflated balloon. It must contract to its initial dimensions. This is thought to be the most significant step in the involution process.

To help the paletical manner, the doctors from the first hours after the transfer from the operating room to the intensive care unit begin to administer reducing drugs to it. A few hours later, the woman is transferred to a general postpartum ward, where she is advised not to lie around for long. Optimally rise 10-12 hours after surgery. Physical activity will contribute to the involution of the uterus. For the same purpose (and not only for this!) It is recommended to put the baby to the breast as early as possible. The baby will receive nutritious and healthy colostrum, and the production of its own oxytocin in the mother"s body will increase, which will definitely have a positive effect on the contractility of the uterus.

In order to minimize constipation and intestinal pressure on the injured uterus, a woman is given a diet to follow for up to four days following the procedure. Only alcohol may be consumed on the first day; on the second, broth, jelly, and white crackers devoid of salt and spices may be consumed. A woman can eat anything by the fourth day, but she should stay away from anything that encourages the production of gas in the intestines.

After the second procedure, lochia (postpartum discharge) typically ends completely 7-8 weeks later. The woman is released from the maternity hospital on the fifth day, provided there are no complications, similar to the first surgical birth, after the stitches are taken out 8–10 days after the procedure (at the local consultation center).

A repeat cesarean section can take a variety of lengths, but typically takes 30 to 60 minutes. Due to the medical team’s familiarity with the procedure and the possibility of fewer unknowns during surgery, this is frequently shorter than the initial cesarean.

It’s crucial to discuss any worries you may have with your doctor prior to the procedure in order to get ready for it. Anxiety can be lessened and a more seamless experience can be guaranteed by being aware of what to anticipate regarding anesthesia, recovery, and hospital stay.

Because scar tissue from the first surgery may make recovery from a second cesarean more difficult, it’s critical to heed your doctor’s recommendations regarding rest, wound care, and postpartum activities. Since every woman’s recuperation is different, self-care and patience are essential during this period.

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