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Pregnancy and childbirth after caesarean section. Repeated caesarean section. How long can you get pregnant after a caesarean section

A second pregnancy after a caesarean section always carries some risk, but having surgery doesn't mean you won't have any more children, or you don't have a chance at all to have a second baby on your own.

According to statistics, cesarean section is used in 10-20% of cases of all births, depending on the profile of the institution. In maternity hospitals focused on difficult births (in the regional, for example), this percentage is always higher, because a difficult pregnancy means a greater likelihood that a woman will not be able or will not be able to give birth herself.

Depending on the reason for which the surgical route of delivery was chosen for the first time, the doctor decides whether a second pregnancy is possible after a caesarean section.

Usually, in relation to contraception and plans for the future, recommendations are given even in the hospital. If you have been operated on because of a serious general health condition, for example, if you have a serious heart disease, and childbirth is contraindicated in the future, sometimes a radical method of solving issues of protection against a new conception is offered even before the operation - sterilization. During the CS, the tubes can be tied, then an unexpected re-pregnancy after a cesarean section will definitely not threaten you.

If the indications were complications of this particular pregnancy and childbirth, for example, malpresentation of the fetus or the presence of genital herpes at the time of childbirth, then there are no obstacles to the fact that in the future a second, third child would appear in your family, of course, no.

As a result of the CS, a scar remains on the uterus. To extract the baby, doctors have to cut the wall of the uterus in its lower part, and then this wound heals with the formation of dense connective tissue. The scar is characterized by low extensibility and high strength, but it does not immediately become good and dense.

It is believed that the best time to conceive a second child is 2 years after the intervention. Early pregnancy after caesarean section is dangerous due to the possible inconsistency of the scar on the uterus. By this term, doctors refer to the inability of the scar to resist the load when the uterine wall is stretched, which can ultimately lead to its rupture during pregnancy or childbirth.

If you do not protect yourself and pregnancy occurs immediately after a cesarean section, most likely you will be offered to terminate it in order to avoid this complication, although there are cases when women successfully carried a second baby even if the pregnancy occurred a month after cesarean. Such cases should be considered the exception, not the rule, and not put yourself at risk.

Planning for pregnancy after caesarean section

Preparing for pregnancy after a caesarean section begins with ... contraception. Careful protection is a vital necessity if you want to give birth safely again. The uterus needs rest and the opportunity to heal its wounds, and this takes time.

The incision, of course, will heal quickly, but for a long time the connective tissue here will be tender and not strong. For example, if you get pregnant in the first year after the baby is born, the risk of complications will be slightly higher than if you do it after two years.

A few statistics that are likely to reassure you in many ways:

Doctors have repeatedly and widely investigated the problem of uterine rupture along the scar, and in almost all studies the risk is confirmed, not exceeding 0.5-1% for women who have had only one caesarean section performed in the lower segment of the uterus (this is if the second time the woman will give birth on their own). At the same time, all women were included in the studies, even if it was a twin pregnancy after caesarean with spontaneous delivery or breech presentation, which in itself significantly increases the risks, or even if the pregnancy occurred six months after cesarean.

If there was a classic caesarean with a longitudinal incision of the uterine wall, which is now used extremely rarely, then the risk is slightly increased. The third pregnancy after two cesarean sections increases the risk of rupture of the uterine wall along the scar by 3 times, up to 1.8%, so if you had 2 operations or a corporal cesarean, tune in that you will definitely not be allowed to give birth on your own.

Planning a pregnancy after a caesarean section requires a preliminary consultation with a doctor, that is, without a visit to the gynecologist, you should not “do” the baby. Usually a woman is examined, an ultrasound of the uterus is prescribed to clarify the condition of the scar. If it is good, dense and durable, of sufficient thickness, the gynecologist will allow the pregnancy.

Ideally, you need to plan conception 2-2.5 years after childbirth, at this time the scar is the most durable, it is also not worth postponing pregnancy for a longer period - because over time, the strength of the scar decreases, it atrophies.

How is pregnancy after caesarean?

Signs of pregnancy after a cesarean in the past are a reason to register with a gynecologist as soon as possible. Ultrasound is often done during such a pregnancy, especially at a later date or if it is unusual, for example, you are carrying two or more babies. Having multiple pregnancies after a caesarean means a slightly higher risk because the uterine wall stretches too quickly and it is more difficult for the scar to adapt to the rapidly increasing load on it.

You should know that an early re-pregnancy after a cesarean, even if it is not desired, puts doctors in a very difficult situation. The fact is that carrying a baby is dangerous, and having an abortion is also dangerous. Medical termination of pregnancy after cesarean for up to 5-6 weeks has almost no risks, as with normal pregnancy, but if the period has already exceeded the allowable for the use of mifegin and other drugs, and instrumental abortion is required, after cesarean this may even call into question your ability to have children in the future, the risk of complications is very high.

The next pregnancy after a caesarean means that you should never give birth at home. Rupture of the uterus along the scar is not a myth, it is a possible reality, therefore, the child should be born only in the maternity hospital, where you can be helped in case of complications. Not all maternity hospitals allow independent childbirth after a caesarean section, if you want to give birth to a baby naturally, this point must be clarified in advance. One caesarean - always caesarean, this has long ceased to be true, because most expectant mothers are quite up to the task of giving birth to a baby naturally.

Childbirth after cesarean is carried out gently, avoiding stimulation. Indications for reoperation in the absence of other direct indications for operative delivery are most often:

1. An early, too early pregnancy, for example, a year after a cesarean, when the scar is still weak.

2. Pregnancy after the second caesarean section

3. History of corporal CS

4. Age over 30

Possible complications of pregnancy and childbirth:

1. Rupture of the uterus along the scar during pregnancy (at a late stage) and during childbirth. The onset of this complication is manifested by acute pain in the lower abdomen in the area of ​​the scar.

2. True increment of the placenta. The complication is associated with the failure of the endometrium of the uterus in the area of ​​the scar, it is thinned here and cannot give the chorion villi necessary for safe attachment, they grow into the wall of the uterus. The complication is extremely rare, but formidable, is detected in the 3rd stage of labor, after the birth of a child.

In most cases, pregnancy and childbirth after caesarean section proceed safely, ending with the birth of a healthy, full-term baby. Don't worry if you've had surgery in the past, it didn't make you inferior or defective, no. You can perfectly cope with the task of carrying a child, and even more than one.

Re-pregnancy after a caesarean section has a number of nuances. A scar is formed at the site of the incision on the uterus. Any impact on it can lead to irreversible consequences. Planning a second pregnancy immediately after the first is strictly prohibited. In this case, careful preparation and restoration of the body is required.

Pregnancy planning

Women who want to have a large family, after delivery, begin to think about when it is possible to plan a pregnancy after a cesarean. In some situations, doctors may impose a complete ban on repeated births. The reason is the presence of a certain risk. Childbirth can endanger the life of a woman and her baby.

The main contraindications for re-pregnancy after cesarean section are the following diseases:

  • diabetes;
  • serious violations of the respiratory system;
  • infectious diseases of the genitourinary system;
  • heart diseases;
  • dysfunction of the thyroid gland;
  • scar divergence.

The main reason for imposing a ban on pregnancy is the divergence of the scar. The seams are divided by location and shape. There is an outer and inner seam. The first is located directly on the stomach, and the second - in the pelvis, on the uterus. The divergence of the internal scar is characterized by pulling sensations. There is a possibility of internal bleeding. This condition can lead to serious consequences.

The incision can be vertical or transverse. In most cases, the second option is practiced. It is also called a Pfannenstiel laparotomy. The advantage of the seam lies in its location in the natural fold of the skin. This makes it as invisible as possible. The vertical seam is located from the pubis to the navel. This type of suture is characterized by long healing and a tendency to increase over time.

Planning a pregnancy is recommended only after the approval of the doctor. The body needs time to fully recover. The optimal duration of bringing the body back to normal is 2 years. At this time, the question is relevant - how to protect yourself from pregnancy after a cesarean. Each woman has the right to choose the most optimal option for herself.

There are the following methods of contraception:

  • Taking oral contraceptives;
  • Setting the uterine spiral;
  • condoms;
  • Coitus interruptus;
  • calendar method.

Experts say that the most effective ways are to use a spiral and take oral contraceptives. The calendar method and coitus interruptus do not provide one hundred percent protection against unwanted pregnancy. This issue should be taken seriously. When an unplanned conception occurs after a caesarean section, medical termination of pregnancy is the most successful option.

Surgical intervention in the presence of an unhealed suture after a cesarean can lead to unpleasant consequences. Therefore, it is very important to diagnose pregnancy in time. Signs of pregnancy after a caesarean section may differ from the symptoms of the first conception. The main reference point is menstruation. If the menstrual cycle after childbirth did not have time to return to normal, a woman should be vigilant. It is advisable to use tests that determine the level of hCG every month.

The danger of pregnancy after caesarean section is as follows:

  • Stretching of the walls of the uterus can lead to rupture of the scar;
  • After the operation, the body is depleted. This may affect the course of the next pregnancy - the likelihood of a miscarriage increases;
  • There is a risk of placental abruption;
  • There may be complications during delivery.

Preparing for pregnancy after a caesarean section involves regular visits to the gynecologist's office. In the process of restoring the body, the following manipulations are performed:

  • Visual inspection of the seam by palpation;
  • Analysis of the state of the uterus using x-rays (hysterography);
  • Research using a special optical device (hysteroscopy).

The doctor will give permission for a second pregnancy only if the scar after a cesarean section is completely formed from muscle tissue and has become almost invisible.

The course of pregnancy

The nature of the course of pregnancy depends on how much time has passed since the operation. Pregnancy after caesarean section after 3 months requires special monitoring by medical personnel. The likelihood of developing a missed pregnancy after a cesarean increases. A weak condition of the suture can lead to damage to the walls of the uterus, which is fraught with the loss of a large amount of blood. Successful outcomes are very rare.

Pregnancy after cesarean after 6 months is possible only if the scar has healed completely. This is extremely rare. More often than not, recovery takes longer. In the first six months after the operation, doctors will insist on an abortion. The risks of possible complications completely fall on the shoulders of the patient.

Pregnancy after caesarean section after 9 months can proceed normally. Expectant mothers need to take care of their well-being. It is recommended to adhere to the following principles:

  • Register at the antenatal clinic as soon as possible;
  • Avoid physical exertion on the body;
  • Frequent visits to the gynecologist will be required, which will ensure proper control over the state of the body;
  • It is necessary to resort to ultrasound diagnostics more often than usual;
  • Even minor deterioration in well-being should be reported to the attending physician;
  • Despite how the second pregnancy goes after a caesarean section, a woman is advised to avoid stress. They have a negative impact on the development of the child.

A woman may notice changes that characterize a second pregnancy after a caesarean section. Feelings will often cause feelings of anxiety. It is advisable to listen to them. It is especially important to pay attention to the following factors:

  • the intensity and frequency of the baby's movements;
  • sensations in the uterus (there should be no cutting and sharp pains);
  • the nature of the discharge.

A third pregnancy after two caesarean sections is the most dangerous option. Compliance with the necessary intervals between pregnancies in this case is extremely important. During the bearing of the third child, a woman may experience pain in the uterus. The chances of miscarriage increase several times. Delivery in this case should be carried out at 37-38 weeks with the help of surgery.

Possible complications during pregnancy and childbirth

No one is immune from pregnancy complications. But during a second pregnancy after a caesarean section, the likelihood of developing unpleasant consequences increases. Childbirth by caesarean section can affect a woman's health.

With the development of the inflammatory process after surgery, the patency of the fallopian tubes may be impaired. This is fraught with ectopic pregnancy. To avoid it, it is advisable to conduct a comprehensive examination of the reproductive organs before planning.

The most common problems in early pregnancy after a caesarean section include:

  • fading pregnancy;
  • miscarriage in the early stages;
  • seam break;
  • the possibility of placental abruption;
  • development of fetal hypoxia;
  • complications of labor activity in case of self-delivery.

Pregnancy a year after caesarean section does not cause much controversy among representatives of medicine. But even in this case, there is a possibility of possible complications. The first year after the operation is considered the most important for a woman's health. The recovery process should not be hindered.

A positive way for the rehabilitation period is the intake of vitamins and a decrease in physical activity. The nature of the course of the next pregnancy depends on how much time has passed since the surgical intervention, and how the healing process took place.

Natural childbirth after cesarean

Women who are faced with the difficulties of the recovery period after a caesarean section are interested in giving birth a second time on their own. Natural delivery in the second pregnancy is quite possible. But for this, the following conditions must be met:

  • no risk of seam divergence;
  • singleton pregnancy;
  • the weight of the child should not exceed 3.5 kilograms;
  • the scar must have a transverse position;
  • no other indications for caesarean section.

If all conditions are met, and more than 1-2 years have passed since the previous birth, then the doctor may give consent to delivery in a natural way. Otherwise, surgery is inevitable.

Many women are worried about pregnancy after a caesarean section, because not everyone knows how long to wait before conceiving a child. A woman may want to get pregnant again. That is why it is useful to know how long it takes to get pregnant after a cesarean, how long to wait. It is important to remember that when planning a future pregnancy, several important factors must be taken into account, as this should be safe not only for the health of the woman, but also for the unborn baby. It is worth considering the fact that during the first pregnancy, the body experienced severe stress, while a thorough restructuring takes place in the body, and in order for it to return to its previous form, it is necessary to give it some time. That is why, when you plan to become pregnant, it is recommended to plan 3 months after the new birth, as the body is not yet ready for such tests.

There are no absolute contraindications to a new pregnancy after cesarean, and about 30% of women plan to have more children in the future. It is believed that a more favorable period for the onset of pregnancy and childbirth is after 2-3 years, since it is during this time that muscle tissue is restored in the area of ​​the scar on the uterus. At this time, very reliable contraception is necessary, because with an early onset of pregnancy, a weak scar can disperse and cause tearing of the uterine wall. Abortion during this period also cannot be done, any mechanical stretching or impact on the wall of the uterus can weaken it and provoke a rupture or inflammation.

Natural childbirth after caesarean section

The rule "one caesarean - always caesarean" has long lost its force. In itself, the presence of a scar on the uterus is not an indication for surgery. Moreover, expert organizations in Europe and the United States assure that natural childbirth is desirable for women who have had a caesarean section. As a rule, natural childbirth is possible after one caesarean section. After two cesareans, the doctor will insist on an operation.

The chance of a successful natural birth after a caesarean section is about 60 - 70%. This largely depends on the reason for the previous operation. It is worth trying if the reasons for caesarean were associated only with the course of the previous pregnancy, and did not recur in the next one:

    breech presentation of the child;

    toxicosis of the second half;

    pathological condition of the fetus;

    active stage of genital herpes.

In the case of a "clinically narrow pelvis" in a previous pregnancy, it is also possible to give birth without the help of a surgeon. This diagnosis often hides simply the weakness of labor, so there is a chance that it will not happen again.

The most important thing is to adhere to one important rule, from the moment of cesarean section to the next pregnancy, at least 18 months must pass. In addition, this period of time is recommended to wait even if the birth took place naturally.

The course of childbirth after caesarean section

In Russia, doctors are still reluctant to undertake vaginal delivery after a cesarean. Especially if the minimum period after cesarean is not observed.

Often there are a number of stringent requirements for pregnancy:

    The time between the first caesarean and the second pregnancy should be at least 3 and not more than 10 years;

    The incision on the uterus is preferably horizontal (transverse);

    The placenta should be located high enough, preferably along the back wall;

    The fetus must be in head presentation;

    The condition of the seam according to ultrasound should be good.

If all these conditions are met and there are no contraindications, then you are likely to be allowed a natural birth. During natural childbirth after cesarean, stimulation and anesthesia should not be done. This can increase uterine contractions and increase the chance of rupture.

There are times when a woman simply cannot wait the recommended 18 months and wants to give birth again. Therefore, before pregnancy, you must first consult with a gynecologist, since the body may simply not be ready for a new test.

Should I try to give birth on my own?

Is it worth the pain of trying to give birth a second time after CS, if in the end you still have to cut? This question can be answered like this: your baby would thank you for your efforts. Firstly, in order for everything to work out, you always need to tune in to the best. Secondly, children born by caesarean section, but after the onset of contractions, are easier to adapt to the environment than their peers who were born before the onset of childbirth. They have much better breathing after childbirth and better hormonal levels.

Pregnancy 6 months after caesarean section

After a caesarean section is done, a characteristic scar will remain on the uterus, which can disperse during a new pregnancy, and this is a real disaster, which as a result leads to the inevitable death of the fetus, and in the most severe cases of the woman. That is why it is recommended to refrain from a second pregnancy for some time (preferably two years, since it is during this time that a full-fledged scar tissue is formed). After a cesarean section, it is necessary that the second pregnancy is planned, and of course, proceeds correctly, so that undesirable consequences can be avoided. Even before the second pregnancy occurs, a woman needs to consult with a specialized specialist who can conduct an objective assessment of the resulting scar. Today, research methods such as hysteroscopy and hysterography can be used.

Hysteroscopy - is a visual examination, during which the study of the scar formed on the uterus is carried out. For this procedure, an endoscope is used, which is inserted directly into the uterine cavity approximately 8 or 12 months after the operation.

Hysterography is a procedure for taking x-rays, both in lateral and frontal projections. To do this, a special contrast agent is injected into the uterus. However, this study can be carried out not earlier than six months after the last operation, and in some cases even at a later date.

It is advisable to undergo such a procedure no earlier than six months after the last operation, while these two studies are important. A year later, the scar will not change. It is important to remember that before planning a new pregnancy, it is imperative to undergo a hysteroscopy procedure, as soon as after that it becomes possible to establish as accurately as possible the favorable time for pregnancy, or it is worth waiting a little longer.

A favorable time comes at a time when there is practically no scar visible on the uterus, which is the main sign of body recovery. Other indicators will also be evaluated, for example, the tissue from which the formation of the scar itself occurred. It is desirable that not mixed or connective, but muscle tissue prevail here.

Pregnancy one year after caesarean section

Childbirth is a completely natural process, but at the same time, there are situations when you simply cannot do without a caesarean section. However, do not worry, because even after such an unconventional method of childbirth, in the future it will be possible to give birth to a baby again, but for this it is worth waiting a little.

Without fail, after the second pregnancy, it is necessary to plan a new one and consult with your doctor. In the event that the child was born by caesarean section, it is advisable to plan a second pregnancy no earlier than two years later, but in some cases it is possible even earlier.

First of all, this is due to the fact that after a caesarean section, a scar is formed, which must be fully formed. It is worth remembering that if pregnancy occurs about a year later, after the first pregnancy, when the muscle tissue did not have time to completely heal, then there is a threat of a scar rupture. This situation is dangerous not only for the unborn baby, but also for the pregnant woman herself. After a caesarean section, pregnancy planning should begin with a visit to a doctor who can examine the condition of the scar on the uterus. This examination is carried out approximately six months or a year after the operation.

The doctor can give permission for a second pregnancy, after a caesarean section, only if the scar itself has completely formed from the muscle tissue and has become almost invisible. A little worse may be the situation when the scar was formed directly from mixed fibers. In the case when it is the connective tissue that significantly predominates in the scar, it is considered insolvent, therefore, a second pregnancy is strictly prohibited, since the risk of scar divergence increases significantly.

Rupture of the uterus

The main reason for refusing natural childbirth after caesarean is the fear of uterine rupture. In Russia, only 30% of women give birth after a caesarean section by natural means (for comparison, in some clinics in the West, the number of such women approaches 70%). However, this risk is largely exaggerated. There are cases when women gave birth naturally even after two operations on the uterus. The fact is that many years ago, an incision in the uterus was made longitudinally in its upper part, that is, where the probability of rupture during childbirth is greatest. Now almost always it is done transversely in the lower part and almost cannot cause a rupture.

According to official data, the risk of uterine rupture in the case of a transverse incision is only 0.2%, respectively, the probability of a successful outcome of childbirth is 99.8%! In addition, no woman or child in our time dies from a uterine rupture, no matter what the incision was. Fortunately, the threat of an incipient rupture can be easily detected by ultrasound and CTG, its condition is determined at 36-38 weeks and before delivery.

How many times can you have a second caesarean section?

Usually, doctors undertake to do a caesarean section no more than three times, but sometimes you can meet women with a fourth. After how many years can you give birth again? There is no exact answer. Each operation weakens and thins the uterine wall. If you are planning a third caesarean, then it is worth talking with your doctor about the possibility of surgical contraception using tubal ligation right during the operation. This method will reliably protect against subsequent pregnancy and possible surgery on the uterus.

Sex after caesarean section

Before we talk about how long you can have sex after a caesarean, let's find out why gynecologists advise women in labor to temporarily abstain from sexual intercourse. It is worth noting that sex after a cesarean section is rarely prohibited, however, a woman who has undergone an operation will not be able to enjoy her sexual life at first due to pain in the wound area and not only. Even if the operation was successful, and the suture on the abdomen heals quickly, the internal suture that is placed on the uterus is tightened much later. That is why many women experience discomfort during sex even after the wound on the skin of the abdomen no longer bothers. The second possible reason for delaying sex is complications after surgery. In such cases, doctors will not be able to tell the woman in labor exactly when it is possible to have sex after a caesarean, and sexual intercourse is “prohibited”. Everything here will depend on the results of control examinations.

Gynecologists answer the question “How long can you not have sex after a cesarean?” They answer that at least a month. And then sex a month after cesarean is possible only for those who quickly heal the wound on the uterus, which is more common in young mothers. Mature women in labor, those over 30, are allowed to have sex no earlier than one and a half months after the operation. As all mothers know, after childbirth, women have bloody discharge, which is called “lochia”. So all doctors unanimously recommend that women abstain from sexual relations for a while until they are completely over. In addition, if the wound on the uterus has not yet healed, then during sexual contact it can become infected. In order to find out about the condition of the scar, it is necessary to be routinely examined in the uzist's office, who will be able to tell you when it is already possible to have sex after a cesarean. Thinking about how long you can have sex after a cesarean, a woman needs to understand that hormonal changes have occurred in her body during pregnancy and childbirth, and the body needs to be restored. The first sex after a cesarean for a woman can be painful, not only because of the wound on the uterus. Hormonal disorders can cause dryness in the vagina, and therefore, during sexual intercourse at first, care must be taken.