Pregnancy after cesarean. If it was a caesarean, is it possible to give birth naturally? What you need to know about caesarean section

25.04.2019

These days, it is not uncommon for a woman to plan another conception after surgery during her last birth. However, in order for a healthy child to be born, some rules must be observed. Still, pregnancy after a caesarean section is something that needs to be approached with all responsibility.

When can I get pregnant after a surgical delivery?

Usually this question is asked by couples who either want children of the same age, or because of their age they are afraid of not having time to have another child.

It is already clear to everyone that in connection with the postponed pregnancy, the woman's body is subject to heavy loads. It is also possible that the moral state of the woman giving birth requires subsequent restoration. But the main thing here is that the previous births were completed by caesarean section. This means that in order to extract the child, the abdominal cavity, the uterus were damaged, and subsequently sutures were placed, requiring complete healing. And as this healing progresses, a scar is formed on the muscular membrane of the uterus, consisting of dense connective tissue. In order for it to be able to withstand a new pregnancy, at least 12-16 months must pass, when it will be completely or predominantly formed from muscle tissue. Therefore, there can be no talk of a second pregnancy a month after a cesarean section.

In addition, at first, contraceptives should be used, since the abortion procedure will be highly undesirable, since any stretching of the walls of the uterus can lead to a rupture or inflammation. In total, experts advise to refrain from re-pregnancy for a period of 2-2.5 years, when the woman's body and scars on the abdominal cavity and uterus will be in perfect condition.

Features of pregnancy after surgery

If conception is only planned, first of all it is necessary to visit a gynecologist. The specialist will check the condition of the scar, the level of hormones in the body and, in general, the woman's ability to endure a new pregnancy. And only after that the doctor will make a decision regarding re-conception. In the event that it was resolved, it should be understood that this pregnancy will be different from the previous one. More frequent examinations and a higher level of monitoring of the course of gestation are coming. As soon as a woman finds out about the onset of pregnancy, she will immediately have to register with an obstetrician-gynecologist, where she will be given instructions on how to proceed. At the very least, this is diet, timely rest, restriction of physical activity. From the latter, the pregnant woman will be instructed to limit herself twice as much as during normal gestation.

If more than 5 years have passed since the previous gestation, the next pregnancy will not differ in any way, except for the question of independent childbirth. But if pregnancy occurs a month after a caesarean section, or even six months later, the doctor will advise you to interrupt it. It will be safer for the life of the mother herself, since there is a high probability of uterine rupture.

Possible complications of pregnancy

As it was already possible to understand, the most dangerous thing in pregnancy a year after cesarean is the divergence of the uterine scar. It is very unwise to ignore pain and discomfort in the abdominal region, a woman should immediately go to the hospital. Other symptoms of this complication include nausea and vomiting. The gap can be either complete or partial, and at any stage of pregnancy and even after it. If it happens, it will be dangerous both for the life of the child and for the mother herself, since there is a risk of heavy bleeding. The only way to stop it is through surgery.

Natural birth or reoperation

There are a number of arguments in favor of having a baby naturally. It is believed that children born in this way adapt better to the environment, their hormonal background normalizes faster and breathing improves. It is also important that the body of a woman in labor recovers faster after natural childbirth and tolerates them more easily than CS. In addition, depending on the health of the woman, there will not be such an urgent need to delay the next pregnancy for at least 1 year.

According to statistics, every 3 women are able to give birth on their own during the second pregnancy after a caesarean section. However, this is only allowed under certain conditions:

Wealthy scar more than 4 mm thick.
CS was held 2 years ago.
The absence of a pregnant woman with pathologies that prevent natural childbirth.
The size of the fruit does not exceed the average parameters.
Mild pregnancy.
The fruit is located as expected.
The placenta is not adjacent to the scar.

The decision on the method of the birth of the child will take place from 25 to 33 weeks of gestation. And meanwhile, you should know in which cases the next surgical intervention will be inevitable:

The age of the woman in labor is over 35 years.
Multiple pregnancy.
Conceiving a child less than 12 months after CS.
The presence of chronic diseases and pathologies in the mother during pregnancy.
Third pregnancy after two CS.
The presence of a longitudinal lower median incision.

Possible complications of childbirth

It is worth considering: in the case of natural childbirth, it is likely that the woman in labor will be contraindicated in their stimulation with the help of medications, as well as the use of painkillers. This is explained by the fact that these interventions can provoke unnecessary uterine contractions with subsequent trauma, even if pregnancy occurs a year after cesarean section.

Also, problems are possible due to the scar of the uterus, which can rupture during childbirth and cause heavy bleeding, as mentioned earlier. In this regard, during the entire process, doctors will have to monitor his condition using the method of palpation through the abdominal wall, or using an ultrasound machine. Weakening contractions, pain in the navel, nausea and vomiting can indicate the opening of the scar. If there are doubts about its viability and reliability, a decision will be made to conduct a second operation.

2 pregnancy after caesarean section

What precautions should be taken by a pregnant woman who becomes pregnant for the second time? Subject to all the doctor's prescriptions and the terms necessary for the restoration of the body and the full healing of the scar, most likely, a second pregnancy after a cesarean section will be allowed. In this case, after conception, it will be necessary to adhere to some rules:

More frequent ultrasound procedure, which will be prescribed by an obstetrician-gynecologist.
Careful observation by a doctor and the strictest observance of recommendations for bearing a fetus.
Refusal of physical activities that can cause unwanted complications for pregnancy.

During the birth of a child, if it appears naturally, the doctor will monitor the state of his heartbeat, and, as mentioned earlier, look at the scar after a caesarean. Pregnancy, in case of complications, will again be resolved with the help of surgical intervention.

3 pregnancy

As for the 3rd pregnancy after a caesarean section, it is considered extremely risky, and not a single doctor who cares about the health of patients and the life of their unborn children will agree to a natural birth. Therefore, the third surgical intervention will be inevitable. In the event of this pregnancy, in addition to all the necessary tests, two procedures will also be prescribed:

Hysterography. For its implementation, a contrast agent is introduced into the uterine cavity, after which X-ray is used and the state of the organs of the reproductive system is clarified.
Hysteroscopy. It is carried out using a special device with a video camera to view the condition of the genital tract and uterus from the inside.

Nowadays, pregnancy after CS is already in the order of things, but be that as it may, the main thing is that it be planned and carried out after the permission of the obstetrician-gynecologist. Only then can you be sure of the safety of your own and your unborn child.

How many times can you have a second caesarean section?

In some sources, you can find such a statement that the number of permissible caesarean sections is practically unlimited. Indeed, there are cases when women underwent 7-8 or more operations, but such a risk can hardly be called justified. The fact is that after each surgical intervention, the area of the scar and the wall of the uterus gradually become thinner. Both in the process of gestation and during childbirth, this problem, sooner or later, can lead to the death of the fetus or even the death of the woman in labor. Therefore, the average woman is better off with three caesarean sections.

Depending on the characteristics of the body, some of them may not be able to conceive a fourth child after three CS at all, since the reproductive organ will already become unusable. And given certain circumstances, a woman who has undergone a total of three surgeries may be offered a sterilization procedure after her last pregnancy. This measure is necessary in order to preserve her own health.

Surgical Delivery Options

Depending on the course of childbirth and the complications that have arisen during this process, different types of incisions can be performed during caesarean section. Each of them will entail certain methods of care and the duration of healing, which the doctor will definitely have to tell about.

Vertical. Surgical intervention is referred to as corporal or classical. It is carried out quite rarely and only in emergency cases: if the woman in labor has profuse bleeding or the fetus is diagnosed with acute hypoxia. The consequences of such a delivery are not very beautiful, since the scar stretches from the pubic area to the navel and is prone to compaction in the future.

Horizontal. It is done during a planned operation, transversely and above the pubis. Its advantages lie in the fact that the abdominal cavity is not opened during the incision and it is carried out in a natural skin fold. Considering also how the wound is sutured, after a while, the scar becomes almost invisible.

As for the uterus, in 90% of cases, the incision on it is transverse. It heals well, and its ruptures are rare and only because some women after surgery do not always follow the precautions. With a longitudinal incision, the uterine wall weakens, and during the next pregnancy, the suture after caesarean may rupture, so it is hardly used.

A woman who wants to get pregnant again after a cesarean section should develop some habits for herself and learn certain rules. Thus, she will protect herself and the unborn child from possible disastrous consequences. The list of basic recommendations for bearing a fetus and preparing for this process:

Do not pick up an older child. To do this, you need to enlist the help of relatives or close people, or if the child's age allows it, you can begin to teach him to be independent.
Regular visits to the antenatal clinic and additional ultrasounds, as well as informing the doctor about any changes in the body.
After giving birth, a woman will have spotting, called lochia, for some time. It will be necessary to monitor their nature, color, quantity, and in case of deviation from the norm, immediately consult a doctor.
You can not carry a stroller and other heavy objects yourself, if necessary, you should ask for help from passers-by.
The most dangerous period of gestation is the third trimester. At this time, the fetus begins to actively gain weight and be active in the womb. Therefore, you need to be more attentive to your feelings, and if the doctor advises the woman in labor to go to the hospital, then it is better to obey him.
If a bandage is used after surgery to restore the figure, it is necessary to ensure that the body rests from it from time to time. Therefore, you need to remove the device before going to bed and every three hours during the rest of the time. Thus, the muscles of the uterus and abdomen will recover on their own, which is more beneficial for them.

Careful adherence to all the rules and instructions of doctors is the key to an easy pregnancy and childbirth without any complications. But without the advice and help of a competent specialist, it will be difficult to achieve the goal. Therefore, finding a good obstetrician-gynecologist and establishing contact with him is also the key to obtaining the desired result at the next conception.

Any operation, including a caesarean section, is a serious injury to the body. But this does not mean that pregnancy after a caesarean section is impossible or has little chance of a successful resolution. According to statistics, almost 20% of births are resolved by surgery, and more than 30% of women plan to have a second or subsequent child in the future.

Planning for conception after caesarean section

Planning for pregnancy after a caesarean section must be approached very responsibly. Here, first of all, one should focus on the reason why the doctors decided to carry out the operation. If the aggravating factor was the general state of health, the presence of chronic diseases (especially the cardiovascular system), further conception may be contraindicated. If the caesarean section was performed according to the indications of a particular current pregnancy, then there are no obstacles to becoming a mother one or more times.

A caesarean section is an operation in which the lower part of the uterine wall is cut. It is through this incision that the baby is removed. It takes a long time for the incision to heal. Usually, doctors recommend thinking about it no earlier than 2-3 years after surgery. During this time, a dense and durable scar is formed at the incision site, characterized by low extensibility.

An earlier pregnancy after cesarean is fraught with various complications, the main of which is the rupture of the scar on the uterus when it is stretched during fetal growth or during childbirth. This condition may occur due to the inability of the scar to resist the emerging load.

In medicine, there are cases when women became pregnant immediately after a cesarean section, successfully carried a fetus and gave birth to a healthy baby, but this is rather an exception to the rule: doctors usually recommend terminating a pregnancy that occurred shortly after the operation. However, it should be remembered that abortion can also cause serious harm to a scar that has not yet formed. The slightest impact on the wall of the uterus can provoke a rupture of its wall or an inflammatory process.

Preparing for conception

If, having given birth to a child by caesarean section, a woman plans to have one or more babies, she should begin preparing for this immediately after leaving the hospital.

First of all, you need to think about reliable contraception: this is the main condition for future successful birth. It is required to provide the uterus with complete rest in order for the incision to heal and a strong postoperative scar to form.

In the past, after a caesarean section, women practically did not give birth on their own. All subsequent births took place with the help of surgical intervention. Today, this practice is no longer used: if the state of health and other indications allow, women can give birth on their own and after a uterine incision.

For example, obstetricians in the United States and European countries even argue that women who have had a caesarean section should give birth naturally. It should be noted that this statement applies only to those who underwent the operation once. After two or more operations, natural childbirth is not allowed.

Planning pregnancy after cesarean provides for a preliminary consultation with a gynecologist. Without going to him, you should not try to conceive a baby. The doctor must confirm that the body is ready for all the loads that will be placed on it during gestation. It is recommended to do an ultrasound, with which you can clarify the thickness and size of the postoperative scar. If the condition of the connective tissues is normal, the scar has the desired density, strength and thickness, the doctor will allow the pregnancy.

As already noted, the best time for re-conception is 2-3 years. Postponing the birth of a child to a later date is not recommended, as the condition of the scar worsens over time. Tissues can thin, weaken, and atrophy, which increases the risk of ruptures during pregnancy and childbirth.

Features of the course of pregnancy and childbirth after cesarean

Many women, upon discovering that they are pregnant, are in no hurry to visit a doctor. In the case of pregnancy after a caesarean section, this is unacceptable.

It is necessary to register as early as possible, because the operation on the uterus is, although a small, but an aggravating factor that increases the risk of complications.

As a rule, the management of pregnancy after a caesarean section is slightly different from the usual cases. For example, ultrasound is prescribed quite often. Thus, doctors can constantly monitor the condition of the scar during the growth of the fetus, especially in the later stages. Increased attention is also given to multiple pregnancies. Since the scar tissue may not be able to withstand the load on it too quickly, doctors must constantly monitor its condition.

Childbirth after caesarean section should be gentle, as a rule, the use of stimulants and painkillers is prohibited. The probability of scar rupture is small, but still exists, so giving birth at home is highly undesirable. The baby should be born in a specialized institution where qualified personnel can provide assistance in any non-standard situation.

The following factors are considered contraindications to natural childbirth:

emergency pregnancy after cesarean (from 12 to 24 months);
pregnancy after multiple operations;
age after 30 years;
history of corporal caesarean section.

Possible complications during childbirth and pregnancy

In most cases, gestation after caesarean section is successful, ending with the birth of active and healthy children. Despite this, there are a number of complications that can threaten women who have had a caesarean section. The most serious of them:

Rupture of the uterine scar in late pregnancy or during childbirth. It is characterized by sudden acute pain in the lower abdomen in the area of the postoperative scar.
Failure of the endometrial layer in the scar area, manifested by a true increment of the placenta. It is characterized by the germination of chorionic villi into the wall of the uterus and manifests itself during childbirth after the baby is born.

Many women refuse natural childbirth, fearing a scar rupture. If there are no contraindications to self-delivery, this should not be done. According to statistics, the risk of rupture of the uterine wall does not exceed 0.2%. Even if it does occur, the condition is not considered life-threatening. Modern diagnostic procedures will make it possible to identify an incipient gap even at the threat stage. Usually, the condition of the scar is checked using CTG and ultrasound for a period of 36-38 weeks and immediately before childbirth.

No matter how unpleasant the caesarean section is, it does not prevent a woman from knowing the joy of motherhood again. Proper planning of pregnancy after cesarean, attentive attitude to your body and timely contact with a specialist will make the process of bearing a child and childbirth safe and successful.

In recent decades, there has been a trend towards expanding indications for operative delivery.

Moreover, more than half of the women who were performed in the future.

In this regard, questions about the management of pregnant women of this risk group are becoming increasingly relevant.

In order to understand the features and risks of managing pregnant women after, it is necessary to understand the course of the operation.

The first step is the dissection of the anterior abdominal wall.

Layer by layer: skin, subcutaneous tissue, aponeurosis, muscle separation, parietal peritoneum. And only after all these layers is access to the abdominal cavity.

The most important step is to make an incision on the uterus.

Usually it is performed as follows: the wall of the uterus in the lower segment is incised with a scalpel, after which the surgeon continues the incision with his index fingers.

Such access is justified by the fact that the risk of damage to the vascular bundles located along the uterine rib is minimal. With a corporal incision, the uterus is dissected longitudinally.

Then the fetus is gently removed from the uterine cavity.

This is followed by manual removal of the placenta. Remains of placental tissue are removed with a curette.

Before suturing the uterine wall, it is necessary to make sure that the outflow of bleeding will be complete - for this you need to check the opening of the cervical canal.
Suturing the uterus.

Proper technical execution of this stage of the operation largely affects the further prognosis. At the moment, preference is given to suture material - vicryl. It is strong enough due to the fact that it consists of several woven threads, and is also an absorbable material. The time of its complete resorption ranges from 60-90 days, which is enough for the fusion of the walls of the uterus.

After the revision of the abdominal organs, successive suturing of all layers is performed in the reverse order.

When do stitches fuse after caesarean section?

The healing time of the external and internal sutures does not match. On the skin, the seam grows together much faster, which is associated with the contact of the skin tissue with the air. The longest time is the healing of the suture on the uterus. The type of incision on the uterus is important.

Features of scar formation in the lower segment

This is due to the fact that the incision runs parallel to the muscle fibers, which means that most of the smooth muscle cells retain their integrity, and therefore functionality.

In addition, due to the good blood supply to this area, the healing process is faster and better.
Another argument in favor of access in the lower segment is the peculiarity of uterine contraction in the postpartum period.
The processes of involution (reverse reduction in size) of the uterus take place in such a way that the area of the lower segment is almost completely reduced, which means that the area of the scar is noticeably reduced.
In general, within 3 months, regeneration processes take place in the suture area.

"Scar phenomenon" after corporal caesarean section

Completely different processes occur with longitudinal access. This area is much worse blood supply. In addition, with this incision, a large number of muscle cells are dissected, which leads to a noticeable decrease in the contractility of the uterus.

Moreover, it has been proven that for a long time after the operation, almost complete replacement of the scar tissue suture site gradually occurs. This means that with a longitudinal incision along the suture, there are practically no muscle cells left, their almost complete atrophy occurs.

This is the "phenomenon of the scar on the uterus" after corporal access. After a long period of time, it does not become stronger. The principle "the longer the better" does not work here.

But this does not mean that with this access it is necessary to plan pregnancies earlier than two years after the operation. Too early onset of pregnancy is also dangerous with the risk of uterine rupture along an inferior scar.

Thus, the process of regeneration of the uterus after a corporal incision proceeds much more slowly, worse, often with the formation of an inferior scar, and many years after the operation, the suture site is almost completely represented by connective tissue.

A second pregnancy after caesarean is possible after 2-6 years. Many women neglect this rule and try to get pregnant a year after a cesarean. Although for some this does not happen planned. Early pregnancy after caesarean has its own risks, as the uterus is not yet ready for re-carrying the fetus.

How quickly does reproductive function recover after surgery?

It is no secret that caesarean section is an alternative method of delivery, which was completely not conceived by nature.

This circumvention of physiological processes that occurs with a woman during childbirth was not provided for at all. It is for this reason that the so-called "scissors" arise.

The restoration of the reproductive function of the body occurs much earlier than it can be done in practice.

So, for example, in the absence of breastfeeding, the first menstruation (and hence the restoration of the menstrual cycle with possible ovulation) can occur as early as 2 months after the operation.

However, the suture on the uterus by this time is completely “not ready” for the processes of myometrium stretching during the onset of pregnancy. Of course, it is not possible to get pregnant immediately after a caesarean, as the reproductive function of the body needs time to recover, but still, the ovaries can begin to ovulate as early as 40-50 days after the operation.

Relationship between ovulation and lactation

If a woman is breastfeeding her baby, then the likelihood of pregnancy is much lower. Since the process of lactation leads to the suppression of ovulation.

While maintaining breastfeeding, you must adhere to the following rules: feeding should be every 3-4 hours, at regular intervals.

In such a situation, the likelihood of ovulation is reduced. But you can't rely on breastfeeding alone. In women after surgery, early onset of gestation is very dangerous, so it is recommended to use contraceptive methods.

How long can you get pregnant after a caesarean?

The most optimal period for the onset of pregnancy is considered to be 2 years after the operation.

This period of time was chosen for many reasons: in 2 years, the final formation of a scar on the uterus occurs, in addition, the woman's body has time to recover.

This period is defined with some "margin" to minimize the risk of complications.

However, this does not mean that any pregnancy that occurs before this period is subject to termination. The main factor determining the outcome of the onset of pregnancy is the assessment of the viability of the scar. In other words, with an unplanned pregnancy, it is necessary to apply an individual approach. So how long after a caesarean can you get pregnant?

In general, if pregnancy occurs a year after the operation in the lower uterine segment (with a satisfactory condition of the scar), then such a woman has a high chance of safely bearing the baby.

The situation is different with corporal caesarean section. Usually one year is not enough to form a strong scar. Therefore, in this situation, the decision to maintain pregnancy is made on the basis of methods for assessing the postoperative suture.

Steps "on thin ice" or what to do if pregnancy occurs within the first year after surgery?

Despite the fact that doctors advise not to plan a pregnancy in the first 2 years after the operation, it happens that an unplanned pregnancy occurs. Most importantly, don't panic! All risks should be weighed and a full examination should be carried out.

What to do if a woman becomes pregnant 6 months after the operation?

If pregnancy occurs six months after cesarean, this situation should be taken very seriously. This pregnancy must be carried out under close monitoring of the condition of the suture on the uterus. It is important to remember that a woman must be admitted to a hospital in advance at 35 weeks.

Pregnancy occurred 3-4 months after the operation

In such a situation, a woman is offered an abortion, since its preservation is highly undesirable. There is a very high probability of uterine rupture, placental tissue ingrowth into the site of the postoperative suture. These complications pose a serious threat to the life of the mother.

What to do if pregnancy occurs 2 months after cesarean

Pregnancy after 2 months is strictly subject to interruption, since the risk of complications is extremely high. 2 months - a period insufficient for the formation of a scar on the uterus.

Such a strict approach to the possibility of maintaining pregnancy after surgery is due to the danger to the mother, and in some situations - the emergence of a real threat to her life. Uterine rupture is the most urgent (emergency) situation in obstetrics. The volume of blood loss in a matter of seconds reaches the entire circulating volume of blood in a woman's body!

Is it worth saying after that that the severity of the doctor during pregnancy, which occurred in an unacceptably early period after the operation, is due precisely to the care of the woman?

In such a situation, the method of abortion deserves special attention.

None of the abortion methods is safe. Any technique has its drawbacks.

The most dangerous is the classical surgical method, so the probability of perforation of the uterus with a curette is high (especially in the presence of endometritis).
Medical abortion also carries a risk, since the uterus with a scar has a reduced ability to contract, which means that the fetal egg is not always eliminated (removed). In addition, drugs used in medical abortion can also cause the sutures to come apart.
Vacuum aspiration is the "lesser evil", but this method is also not safe.

Given all the risks of early pregnancy after surgery, as well as the dangers of its interruption, the use of contraception is considered necessary in this category of women.

It is preferable to use either barrier methods (condoms) or hormonal preparations that are allowed during lactation (Charozetta, Laktinet, Exkluton).

Compliance with the optimal time interval after surgery to the desired pregnancy, as well as the use of methods for assessing the scar on the uterus, significantly reduces the risk of possible complications. A favorable course of pregnancy and careful delivery contribute to the preservation of a woman's reproductive potential.

Statistics show that the number of births by caesarean section is constantly growing. Naturally, one can endlessly argue about the cause of this phenomenon, but the result will be the same - today a large number of women go to this method of childbearing. Many of them often ask the question: "How then to get pregnant?". First you need to find out what risks may appear after a cesarean section during pregnancy.

Risks of Pregnancy

Everyone knows that a fresh scar is fragile, and pregnancy entails constant stretching of the uterus. Therefore, doctors do not recommend conceiving a child after surgery in the early stages. This can lead to separation of the scar tissue. This phenomenon can provoke the death of the unborn child and poses a threat to his mother. So, you can get pregnant after surgery only after the scar has healed.

Another negative factor in early conception is the possibility of the baby developing disorders of the respiratory system. This is due to the fact that during childbirth with the help of surgical intervention, a woman loses much more blood than during natural childbirth. This usually leads to anemia (iron deficiency). Its insufficient amount has a negative impact on the health of the child. Therefore, you need to remember that pregnancy after surgery should be well planned.

When can you get pregnant after a caesarean?

Experts say that a period of 2-3 years is considered a necessary break between this pregnancy and the previous one. Although there are times when certain life situations appear that do not make it possible to wait for the period recommended by doctors, while the mother feels great. As practice shows, there were cases when women gave birth to healthy children who were conceived six months after the operation.

If a woman decides after a caesarean section for a new pregnancy, it should be planned only after visiting a gynecologist. The specialist must necessarily examine the condition of the scar. Only after that will be able to say whether or not to plan a pregnancy.
Now medicine uses modern methods of examining women in labor - hysterography and hysteroscopy. Hysterography is an x-ray of the uterus. It is done after the introduction of a contrast agent into her cavity. Hysterography is performed no earlier than six months after cesarean. The second method is an endoscopic examination of the uterine cavity and scar. It is carried out approximately 8 months after the operation.