The break between cesarean is 7 years. What is important to know about a second caesarean section? Is it possible to give birth naturally after a cesarean section?

Larisa (name has been changed) considered herself the happiest woman, because after almost 10 years of waiting, she became a mother for the second time. Forgotten tears due to several miscarriages - a little daughter slept in the cradle. And what was the surprise of our heroine when, 2 months after giving birth, she felt familiar symptoms. In disbelief, she saw two strips on the pregnancy test and was confused. The third pregnancy was difficult, with numerous threats of miscarriage, but after 9 months a boy was born in the family.

Larisa considers her weather a reward for years of waiting and believes that she made the right decision, refusing to terminate her third pregnancy, which came almost immediately after giving birth. What is the optimal break between pregnancies by obstetricians-gynecologists so that a woman can fully recover and her body is prepared for a new pregnancy?

According to a study conducted with the participation of over 170 thousand
children, in babies conceived with an interval of less than 6 months or more than 120 months
between pregnancies, there was an increased risk premature birth, low
weight of the baby at birth or abnormalities in the development of the fetus during pregnancy.

Break arithmetic between two pregnancies

Break for pregnancy ended in natural childbirth
According to obstetricians and gynecologists, the optimal interval between pregnancies, if the previous one ended in independent childbirth, is 2-2.5 years. The following are taken into account:

• 1 year - baby feeding breast milk;
• 9 months - restoration of a woman's body after a period of breastfeeding.

However, in order to minimize possible complications during the subsequent pregnancy, it is advisable to maintain an additional pause of another 6 months. Thus, the ideal childbirth gap is 2.5 years.

Break for pregnancy ended with caesarean section
If the previous pregnancy ended in childbirth by caesarean section, then it is important for parents not to attempt to conceive for 3 years next baby... During this time, the scar remaining on the uterus after the operation should form and "get stronger". After all, there are cases when the place of attachment of the ovum fell on the area of \u200b\u200bthe postoperative scar. With the growth of the uterus during pregnancy, the "fragile" scar can become thinner and even disperse from the load, which will adversely affect the course of pregnancy and the health of the fetus.

To minimize potential threats to the current another pregnancy, women who have undergone a cesarean section are advised to do an ultrasound of the uterus before choosing the optimal time for conception, during which the doctor will assess the condition of the postoperative scar on it.

The recovery process of the female body after childbirth

During 9 months of pregnancy, a woman's body spends all its energy on carrying a baby. After giving birth, her body begins to recover and return to its previous state. And this period is quite long, since the following should return to normal:

• organs of the reproductive system (uterus, ovaries, cervix, vagina and perineum, mammary glands);
• pelvic floor muscles;
• the endocrine system, in particular the ovaries, which produce female sex hormones - estrogens and progesterone;
• menstrual cycle - it should become regular;
• composition and amount of blood;
• the level of vitamins and minerals;
• protein level.

A short break between pregnancies: pros and cons

For a short break:

• giving birth to weather children means to quickly leave sleepless nights ( breast-feeding, changing diapers, potty training, problems with colic and teething) in the past;
• children born with a short interval of time will be closer to each other in interests and hobbies;
• the opportunity not to interrupt your career again because of maternity leave and parental leave.

"Against" a short break:

• having a child under 3 years old will not allow a pregnant woman to monitor her health as fully as in a previous pregnancy;
• with the onset of a new pregnancy, you will have to interrupt the breastfeeding of the already born baby, as this can provoke an increase in the tone of the uterus and cause a threat of termination of pregnancy;
• doing daily household chores and caring for a child under 3 years old can cause physical and psychological distress in the face of a new pregnancy.

American scientists studied information on childbirth of 400 thousand women and came
to the conclusion that a 3-year gap between pregnancies is beneficial not only
children, but also expectant mothers. The next time they carry a baby, they are almost
do not experience anemia, blood pressure surges or bleeding.

To be or not to be another pregnancy?

Although gynecologists recommend that women give themselves the opportunity to recover from childbirth, many choose to re-experience the joy of motherhood in less than 2-2.5 years after giving birth. And confirmation of this is a considerable number of weather children.

Expert:Irina Isaeva, obstetrician-gynecologist
Elena Nersesyan-Brytkova

There are practically no pregnant women who are indifferent to cesarean section: some want to give birth naturally, even if there is indications for operative delivery. Others, on the other hand, ask for a caesarean, despite the lack of evidence. Both the one and the other approach cannot be called rational, since the decision should be made according to the circumstances, and not at the request of the woman. And in order to decide on the basis of the circumstances, you need to know enough about the caesarean section.

The timing of the caesarean section

Caesarean section can be performed at different dates pregnancy. It is considered optimal to carry out an operation for a full-term pregnancy with the onset of labor. This is called a scheduled cesarean section. A planned cesarean section is performed when birth through a natural route is not possible, but circumstances allow you to wait until the child himself decides to be born.

There is a planned cesarean section. It can be carried out at a period of 38 weeks, when the onset of labor is undesirable, but nothing threatens the health of the fetus and the woman, for example, with placenta previa: it practically does not affect the course of pregnancy, but placenta detachment can occur during contractions. Sometimes a planned cesarean section is performed with a premature pregnancy. This is done in cases where prolongation of pregnancy can be dangerous. For example, in severe forms of gestosis.

An emergency caesarean section can also be done for full-term and premature pregnancies. In a full-term pregnancy, the decision about an emergency caesarean is made during childbirth, for example, if bleeding occurs. It happens that an emergency caesarean has to be done in case of premature pregnancy, for example, in the case of a beginning rupture of the uterus, when urgent delivery is needed to save the mother and fetus, and the count goes for minutes.

Indications for cesarean section

Indications for surgery are divided into two groups: absolute and relative. With absolute indications, natural childbirth is impossible, and with relative indications, it is possible, but can be dangerous for the mother and fetus, especially if there are several indications at once.

Absolute indications for maternal caesarean section:

• anatomically narrow pelvis of the third and fourth degrees of narrowing,
• threatening or incipient rupture of the uterus,
• full placenta previa,
• bleeding with placental abruption,
• eclampsia with premature pregnancy,
• varicose veins of the vagina,
• high myopia,
• tumors small pelvis,
• heart defects.

Absolute indications for a cesarean section from the fetus:

• fetal asphyxia,
• transverse fetal position after the break fetal bladder,
• extensor insertion of the head,
• death of the mother with a living fetus.

Relative indications for caesarean section:

• clinically narrow pelvis,
• malposition,
• weakness of labor, not amenable to drug correction,
• first birth after thirty years,
• chronic placental insufficiency,
• chronic fetal hypoxia,
• multiple pregnancy,
• scar on the uterus,
• post-term pregnancy,
• prolonged infertility.

If there is only one relative indication, then in many cases natural childbirth is possible, and caesarean is performed, as a rule, in the presence of several relative indications.

Contraindications for a cesarean section

After a Casarean section, inflammatory processes may occur, therefore, factors contributing to the development of inflammation may be a relative contraindication to surgery:

acute bacterial and viral diseases,
long dry period,
the duration of labor is more than 14 hours,
immunodeficiency states.

An absolute contraindication to a cesarean section may be a blood clotting disorder and intrauterine death fetus.

Cesarean section

A cesarean section is done with a corporal incision or with an incision in the lower uterine segment. The corporal incision runs vertically from the navel to the bosom along the midline of the abdomen. The incision in the uterus goes through the entire body, also vertically. With this method, the muscle fibers of the uterus are irreversibly injured, and significant blood loss occurs, but this method allows you to get better access to the fetus during the operation. Therefore, a corporal cesarean section is used in emergency cases when labor needs to be completed as quickly as possible. This method is also used for delivery before twenty-eight weeks of pregnancy. In all other cases, an incision is made in the lower uterine segment. With this type of operation, the incision runs along the growth line of the pubic hair, and the incision is also transverse in the uterus. In this case, blood loss is less, and uterine fibers are better restored.

And with a corporal incision and an incision in the lower uterine segment, the course of the caesarean section is the same: first, the abdominal wall is opened in layers, then the uterine muscle fibers are dissected and the fetus is removed. After that, the membranes and placenta are removed. The whole operation takes about forty minutes. Removal of the fetus takes place in the first five minutes of the operation, the rest of the time is taken by suturing the incision in the uterus and layer-by-layer restoration of the integrity of the abdominal wall.

Postoperative period

The first 12-24 hours after the cesarean section, the woman spends under supervision in the intensive care unit. It is advisable to get out of bed on the first day to improve the supply of blood to the uterus. From the first days, it is recommended to wear a postpartum bandage, although in maternity hospitals it is often the abdomen that is pulled down with a diaper instead. This reduces soreness. In addition, the first days a woman is given pain medications. If the sutures were imposed with non-absorbable sutures, then they are removed on the sixth to seventh days. They are discharged on the eighth to tenth days, provided that the postoperative period was uneventful.

Caesar's

During a cesarean section, several factors affect the child:

• general anesthesia drugs enter the fetal bloodstream,
• no fluid is squeezed out of the lungs, since there is no compression of the chest in the birth canal,
• with a planned caesarean section, the child leaves the womb when the doctors decide, and not himself.

In children, born by Caesarean section, more often problems with the respiratory system occur, muscle hypertonicity is often observed. Therefore, in the first year of life, such Caesareans need to be monitored by a neuropathologist, swimming and massage are desirable. Although, in recent years, almost all the unfavorable factors of the influence of cesarean section on the fetus have been taken into account by doctors and are neutralized during childbirth: epidural anesthesia is more often done, and not general, therefore, narcotic substances do not get to the fetus, fluid from the lungs is squeezed out, and the operation is performed with birth naal activities. If all these conditions are met, children after a cesarean section do not differ from babies born through a natural birth canal.

Pregnancy after cesarean section

How the next pregnancy will proceed after a cesarean section largely depends on how the scar on the uterus has formed. If there was inflammation in the postoperative period, then the scar may be untenable, that is, unable to withstand stretching during the next pregnancy.

It is recommended to take a break between the caesarean and the subsequent pregnancy at two years. But if you've gotten pregnant earlier, don't worry too much. There are many examples when women gave birth to children normally, becoming pregnant 3-4 months after a cesarean section. An abortion after a cesarean section can be much more dangerous than a repeated pregnancy, since there is a direct gross mechanical effect in the area of \u200b\u200bthe scar.

After a cesarean section, birth through natural routes is possible in the absence of indications for reoperation, a full-fledged scar on the uterus and the woman's mandatory desire to give birth on her own.

Sterilization after cesarean section

It is not recommended for a woman to have more than three cesarean sections, but some have had eight or ten such operations! Therefore, the doctor before the third cesarean section or even before the second or first, if there are any contraindications to subsequent pregnancies, may suggest sterilization together with the operation - creating an artificial obstruction of the fallopian tubes. However, the decision is made only by the woman, and sterilization without her consent cannot be carried out.

Caesarean section at the request of the woman

Now many women, not wanting to "suffer in childbirth", ask them to have a caesarean section at will. It's not too much a good ideasince cesarean is an abdominal operation. This operation can have negative consequences for both the mother and the fetus, although they happen extremely rarely, so it should be carried out strictly according to indications and only in cases where natural childbirth is impossible or too dangerous.

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Caesarean section is often used in maternity hospitals. After the procedure, a long recovery process begins, but when it passes, many mothers start thinking about having another child. However, not all of them are sure whether it is possible to become pregnant after a cesarean section. When can you get pregnant and what complications can there be?

An ideal break after cesarean, which is recommended before getting pregnant for the second time for three years. In a certain situation, the gynecologist may allow the planning of the child a little earlier than this period. The condition of the mother and the postoperative scar can influence the doctor's decision. When can you get pregnant after having a cesarean delivery, and can there be any complications with a second delivery?

Physiological aspects of the body's readiness for childbirth

If you evaluate the characteristics of the female body at the physiological level, then you can get pregnant with the onset of the menstrual cycle, that is, when breastfeeding ends. However, doctors concluded that it is best to take a two or three year break between pregnancies before conceiving again.

It takes about a year and a half for rehabilitation after the first birth, carried out with the help of cesarean. To avoid possible complications when carrying a second baby, childbirth after cesarean a year later better not to plan. If you still managed to get pregnant before full recovery, then you should not despair, especially to have an abortion. The fact is that when scraping out during this period, the postoperative scar is severely injured. This leads to its thinning and rupture.

In medical practice, there are cases when a woman became pregnant just nine weeks after she underwent a cesarean, and such gestation ended with a completely successful delivery. Therefore, you should not think that childbirth after cesarean in a year will be complicated, especially if the pregnancy is supervised by a qualified specialist.

The prognosis of when it is possible to become pregnant after childbirth depends on the condition of the postoperative scar and the doctor's verdict. The scar for the next conception should be completely tightened by muscle tissue. The condition of this seam can be assessed using the following examinations:

1. Hysterography.Direct and lateral x-ray of the uterus. For this study, a special contrast is injected into the uterus;
2. Hysteroscopy.The uterus is examined with an endoscope.

1. If a longitudinal scar was produced on the uterus during a cesarean. In this case, the subsequent pregnancy may be accompanied by serious problems. We are talking about a high probability of rupture of the uterus, even at early dates gestation.
2. The longitudinal incision is usually formed by connective tissue, which is also a contraindication to the second conception.

Features of the second cesarean section

There is no definite answer to the question Second cesarean section, how long is it? ... The fact is that most women, after undergoing this operation, give birth to full-term babies. At the same time, the duration of pregnancy can reach 39 weeks without any problems.

In the absence of indications for independent childbirth, doctors recommend consenting to a repeated cesarean. During this operation, a new incision is not made, abdominal cavity dissected along the old scar. Because of this circumstance, a woman will recover longer. After a second incision, the suture heals more painfully. This process must be controlled, since suppuration, the appearance of adhesions and other bad consequences are not excluded.

Some women in labor say that the second cesarean was much easier for them than the first. There was no overhanging of the skin over the seam, and the scar itself became almost invisible. This suggests that each mom's recovery is individual. In addition, the level of medicine is now growing and, possibly, in the near future, a third birth will be possible after two caesarean ones.

If the second delivery is also carried out with the help of cesarean, then the following complications are allowed:

1. Cutting tissue in the intestines, ureters, or bladder
2. Development of anemia, thrombophlebitis of the pelvic veins and endometritis;
3. Increased likelihood of open hypotonic bleeding that does not stop. In this case, doctors remove the uterus;
4. For a baby, this operation is dangerous due to the development of hypoxia and impaired blood circulation in the brain due to the woman's long stay under anesthesia. In addition, the second cesarean takes longer than the first, which also affects the health of both the baby and the mother;
5. After completing the second caesarean pregnancy, the woman will be offered complete sterilization, since subsequent conceptions will pose a danger to her life.

Is vaginal delivery possible after a cesarean section?

Mom can give birth herself if:

1. The kid weighs no more than three and a half kilograms;
2. A three-year break between pregnancies is observed;
3. The baby is considered full-term and is in a cephalic presentation;
4. The postoperative scar is healed and is in excellent condition in all respects;
5. Only one child is carried, that is, there is not a multiple pregnancy;
6. The placenta is attached high from the location of the scar;
7. The first caesarean was caused not by the physiological characteristics of the woman, but by the current situation (entwining the body with the umbilical cord);
8. The uterus has only one transverse, not longitudinal, incision;
9. The woman does not have severe myopia, diabetes mellitus, and she did not receive traumatic brain injury.

If during the first birth the baby was born by surgery, then you should not worry that you will not be able to get pregnant again. With proper planning of conception and a timely visit to a gynecologist, it is possible to give birth to a full-term and healthy baby.

Having already gone through a serious complication of childbirth, a cesarean section, women who decide for a second birth ask many questions: how to give birth, how many weeks, how to prepare themselves for childbirth, and others. We will try to answer the main ones.

To do or not to do?

The first thing that worries expectant mothers is whether a planned second cesarean section is required. In principle, situations often occur when women, after the first cesarean of their second child, give birth naturally. Of course, attention to such a woman in labor should be more intent, but the fact that this is really a fact. If your doctor, conducting an examination before childbirth, concludes that you are able to give birth yourself, then you should not be afraid: the doctor definitely knows better. Before making a conclusion, your gynecologist:

• Assess the condition of the scar on the uterus, whether it has matured enough and formed. If your subsequent pregnancy occurred no earlier than 2-3 years from the previous one (that is, the first cesarean was performed at least 2 years ago), spontaneous childbirth is likely, however, in the presence of other complications, a cesarean section is also possible.
• Find out how many pregnancies ended in childbirth, and what features they had. If you have given birth with the help of cesarean more than once, surgery will also be needed in these births.
• Will summarize your overall health. If you had your first cesarean section for medical reasons that have already been eliminated, your diseases have been cured, and your health is at a good level, then it is quite possible that you will have to choose - a natural birth or a second cesarean. If the reason for the cesarean was the characteristics of the body that did not allow giving birth, then the question is removed by itself: the doctor insists that the second delivery be also with the help of a cesarean section.
• Draw conclusions about the state of the fetus (its presentation, size), location of the placenta, single or multiple births. If these parameters allow you to give birth on your own (correct presentation, singleton pregnancy, low weight of the child, placenta far from the scar area), then you will most likely be able to give birth to a second child without a cesarean.
• Draws attention to the technique of the previous operation. If a longitudinal incision was used (which is technically easier), a second cesarean section is practically guaranteed to you, and also a longitudinal one, and if you had a transverse incision, then such a scar, due to its density, may allow you to plan a natural birth.

Pregnancy after cesarean is observed more carefully from the first weeks, such a woman is more often sent for an ultrasound scan, her condition is monitored. Responsible young ladies attend the consultation more often than they should, this applies to the second and third trimester, especially in the last weeks.

Timing of delivery through repeated cesarean

Of course, it is important for pregnant women to know how long the planned second caesarean section is performed in order to prepare, and how it goes. It depends on the condition of the pregnant woman and the fetus: the more difficult the pregnancy, the larger the fetus, the thinner the scar, the earlier a planned cesarean is prescribed. It is also important how many children you carry: if the pregnancy is multiple, the operation is prescribed earlier than usual. Most often, the period of surgery is set a couple of weeks earlier, that is, for a period of 38 weeks, but in special cases it can be prescribed even for a period of 37 weeks and earlier, if there is an indication for such an early delivery.

There are times when a woman does not even wear up to 36 weeks: the scar is diverging. If such a complication of pregnancy is detected by a doctor, then the patient is immediately sent to the operating table, and it does not matter how many weeks of her pregnancy, since it is primarily about saving the life of the woman in labor.

If you would like to know how long it takes for most women to have a second cesarean, you can read their reviews about the procedure. On pages in Internet blogs, on forums, ladies lively discuss the topic of "repeated caesarean", share their experience, give each other advice, unite in groups by city and even write contacts of specialists whose work they liked.

Complications

When preparing for an operation such as a second planned caesarean section, a woman should be prepared for various complications. Firstly, the second time, interference with the integrity of the tissues of the uterus can lead to serious bleeding, and the doctor, if necessary to save the mother's life, will have to resort to complete removal of the organ - a hysterectomy is done.

Also, any surgical intervention can lead to the development of adhesions in the pelvic area, which means that the second cesarean will be complicated, and precious time is spent on excising old scars (if necessary).

For a child (albeit a planned one), a cesarean section (especially the second and subsequent ones) is also a very risky undertaking: he is in the womb, which is anesthetized with potent drugs, which means he receives a serious dose of them, regardless of what kind of anesthesia is done - epidural or general. With the second cesarean childbirth begins in advance, so the child is not yet fully developed, and his vital systems are started with some lag. There is even a danger of asphyxiation (lack of oxygen), which can lead to serious consequences.

In addition to all of the above, after a woman has a second planned cesarean section, it is simply dangerous for her to become pregnant again. Even if the previous pregnancy ended successfully, the woman is still offered voluntary surgical sterilization - removal of the uterus. During pregnancy after the second cesarean, the risk of rupture of the scar or of the uterus itself is too high, and even with a favorable outcome of the next birth, the risk of developing immunodeficiency, inflammatory processes of the pelvic organs, urinary and genital tract infections increases several times.

You need to think about whether you want to do a second cesarean or whether it is important for you to give birth on your own, from the first weeks of pregnancy. The choice is always yours, it directly depends on how many more children you will have. We hope it will be correct.

Despite the warnings of gynecologists, many women decide on a third pregnancy, having two cesarean sections behind them. Is it possible to do a third cesarean section after 2 cesareans and what dangers can this manipulation entail?

Pregnancy after the second cesarean: when is it prohibited?

After the second caesarean section, most doctors insist on tubal ligation - sterilization. Such a manifestation of concern for a woman's health is not accidental - not everyone is able to endure a third pregnancy without complications after two surgical deliveries. Problems can begin as early as the first weeks. To keep them to a minimum, pregnancy should be planned with a doctor.

Why are obstetricians-gynecologists so worried when it comes to the third pregnancy after 2 surgical deliveries? There are several reasons for this.

First, the previous cesarean, like any abdominal surgery, can lead to formation.

Adhesions are cords of connective tissue that can change the position of internal organs, tighten the fallopian tubes and thereby narrow their lumen. Pelvic pain in those who have undergone surgery is an indirect indicator of the development of the adhesive process. In such a situation, even getting pregnant becomes problematic.

Secondly, a frequent consequence of cesarean is genital, which reduces the chances of becoming a mother. But even if the pregnancy has taken place, there is a threat of spontaneous miscarriage. The probability of a tragic outcome in the early stages is especially high, but also for more later dates there is a risk of abortion.

Thirdly, a scar on the uterus can become an obstacle to the normal attachment of the placenta. In search of a suitable place, the placenta can migrate along the wall of the uterus. Another related complication is the ingrowth of villi, which leads to.

Placental attachment disorders can lead to chronic placental insufficiency and fetal hypoxia, which is dangerous with intrauterine growth retardation.

The most formidable complication is uterine rupture - an acutely developing condition that is accompanied by massive bleeding. Often the child does not survive after this, all efforts of doctors are aimed at saving the mother's life.

When the uterus ruptures, the syndrome of disseminated intravascular coagulation develops: first, increased blood coagulability develops, then a transitional state occurs, in which blood clots alternate with the liquid part, then hypocoagulation and severe bleeding develops, which is almost impossible to stop.

Before getting pregnant for the third time, you need to weigh the pros and cons. The combination of the third pregnancy - the third cesarean with signs of inconsistency of the scar on the uterus is absolutely contraindicated. These include:

1. The presence of cavities according to the results of ultrasound.
2. Thickness 1.5-2.5 mm.
3. Edema in the area of \u200b\u200bthe scar.

The list of other contraindications corresponds to those when planning any pregnancy. Mainly:

• chronic diseases of internal organs of high severity;
• diseases in the stage of decompensation;
• autoimmune diseases;
• infectious diseases in the acute stage.

What is the danger of the third cesarean?

Any operation carries a latent threat. This also applies when the third caesarean section is performed.

Fears of doctors about the course and results of the operation are related to the following:

• adhesions after previous interventions increase the risk of bowel or bladder injury;
• perhaps a true increment of the placenta - in this case, the operation is completed by removing the uterus without appendages.

Despite the dangers of having a caesarean section, you shouldn't even think about having a natural birth. The presence of two or more scars on the uterus is an absolute indication for surgery.

Features of the third cesarean and possible complications

How is the third cesarean performed? In general, the procedure is the same as in the previous ones. However, there are some peculiarities:

• The operation is performed within the existing scar on the uterus.
• During manipulation, it is very important to control hemostasis in order to prevent the development of bleeding from the vessels of the uterus or abdominal cavity.
• The uterus with a scar contracts worse, therefore, prevention of hypotonic bleeding is carried out - intravenous administration of oxytocin.

What week of pregnancy is the third cesarean done? It depends on the condition of the mother and child. By medical standards, delivery is possible from week 38. In some maternity hospitals, they prefer to carry out a subsequent cesarean at the same time as the previous one.

For health reasons, the operation is performed at any time.

Various complications can arise after surgery:

• bleeding in the postoperative period;
• intestinal hypotension;
• purulent septic infection;
• thrombotic complications;
• subinvolution of the uterus;
• scar failure;
• anemia.

When to plan a pregnancy after 2 cesareans?

If a woman is planning children, then a third pregnancy a year after a cesarean section is not the most suitable option. It is recommended to wait 2-3 years, be carefully examined and only then decide on the next birth.

However, if pregnancy occurred within a year after the second caesarean, abortion is not a safe way to solve the problem! In this case, it is necessary to investigate the state of the scar on the uterus using the ultrasound method and visit the obstetrician-gynecologist.

Any intervention in the uterine cavity can lead to serious consequences and worsen the prognosis for pregnancy. Therefore, it is important to choose the most suitable method of contraception for yourself after childbirth.

Yulia Shevchenko, obstetrician-gynecologist, specially for the site

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