I went through this myself a week ago. Here is the story: Natural birth after cesarean section after 1 year and 3 months. I did it!!! and it turns out there are a lot of people willing.
ZY those who are categorically against EP after the CS, please either pass by or express your opinion without attacks
Myth No. 1. Doctors can give the go-ahead for EP only if many years have passed since the CS (according to various sources, up to 8).
Those who don't know say this. The doctor at the RD said nothing to me and didn’t tell me that the term was only 1 year and 3 months. Decisive factor It is not the duration, but the consistency of the scar, it is formed within a maximum of 6 months, and then does not change. Therefore, if in a year he is not wealthy, then in 5 years he will be the same.
Myth No. 2. The maternity hospital will require an extract from the institution where the CS was performed, indicating the used suture material, currents postoperative period and God knows what else.
In fact, they didn’t demand any kind of extract from me, but only verbally asked about the reasons for the previous CS and whether there were any problems later, but sometimes they ask. Make a copy of the exchange card, that's enough.
Myth No. 3. You can give birth yourself only if the scar at the time of birth is larger than 3 mm.
Yes, my scar was 3 mm. But for many it was 2.5 and even a friend gave birth with 1.8 mm. The main thing is that it is homogeneous and correctly formed.
Myth No. 4. In the case of ER after CS, early hospitalization is required for a period of 37-38 weeks.
I went to bed at 39 weeks, but just to get examined. They let me go for walks until I was 40 weeks exactly, until August 1st. She arrived on the evening of July 31 and gave birth in the PDR)
Myth No. 5. During ER after CS, stimulation is not used as a matter of principle - supposedly this can provoke uterine rupture and other complications.
In fact, I don’t know about oxytocin, but stimulation in the form of active preparation of the cervix (Halidor tablets, Buscopan suppositories, Papaverine injections, valerian) and bladder puncture are used with all their might. And they pierced me as soon as I got into the labor room, so there’s less stress.
Myth No. 6. During ER after CS, anesthesia is not used, because you can miss the threat of uterine rupture by the scar.
They actually use it. They gave me an epidural and they said if everything is fine, then it’s okay.
Myth No. 7. During EP with a scar, you must constantly lie down, because They do ultrasound and CTG all the time.
In fact, after the bladder puncture, I was strongly advised to walk around, I lay down myself, it was easier for me. But the CTG was always connected. An ultrasound was done only before childbirth.
Myth No. 8. For ER after CS, episiotomy is always used.
In fact, the doctor told me in plain text - I’d rather cut you there than do a CS. But my child was large, big-headed. At first I let her try it herself, but they realized that I couldn’t do it. So we did an episodic
Myth No. 9. After birth, the uterus is manually monitored for ruptures. general anesthesia.
In fact, some yes, some no. Under general anesthesia there was nothing like that, they injected more painkillers and looked at the uterus manually, but I was conscious and didn’t feel anything. Then they did an ultrasound. Some people only get an ultrasound.
Myth No. 10. Judging by the descriptions of maternity hospitals on the website “www.rodi.ru,” you can give birth yourself after a CS in almost every second maternity hospital in Moscow.
In fact, it is also written on the fence. But in practice, there are only one or two such places in Moscow - and there are no more. It is better to trust not descriptions, but specific stories from specific people. For example from here or from here. There are doctors, but it’s very difficult to get in touch with them.
Myth No. 11. EP after a CS is an extremely scary and risky event.
In fact, for me personally, everything turned out to be somehow not so difficult, and quite quickly, they even delivered a rapid labor. In general, childbirth is already a risky undertaking. The same uterine rupture during childbirth occurs in women without a scar. Here it’s destined for everyone.
Absolute indications for caesarean section in women with a scar on the uterus .
- Scar on the uterus after corporal caesarean section(i.e. carried out in the body of the uterus, which is rare: since 1930 in our country, preference has been given to caesarean section in the lower uterine segment).
- Incompetent scar on the uterus according to clinical and echoscopic signs.
- Placenta previa in the scar (in this case, the danger lies not in uterine rupture, but in placental abruption).
- Truly narrowed or deformed pelvis.
- In Russia - two or more cesarean sections in history - as a rule, the second cesarean section is performed over the first scar. (However, in many countries this indication is not absolute; women give birth vaginally after two or even three caesarean sections).
Among relative readings for repeat cesarean - large fetus, anatomically narrow pelvis in a woman, high myopia, other extragenital diseases.
I would like to talk about my experience of natural birth (VB) after cesarean section (CS), I think there are those who would like to know a little more about this process.
If I tell you briefly about my first pregnancy, it went well for me, the birth was supposed to be natural, but at 39 weeks my placental abruption began, bleeding began and I urgently The operation was performed under general anesthesia.
Words cannot express the feelings of despair and helplessness that I experienced when I found out that the CS operation was inevitable, because it was like thunder among clear skies. I was so mentally depressed that it all seemed terrible and wrong. Now, of course, I understand that there was no other way out, and the main thing is that my healthy child was born.
Apparently, after giving birth my emotional condition was not very stable, thanks to my family for their support, for the moral and physical help they provided. My mother-in-law looked after me and my grandson for all 40 days. But at that moment I decided that my next birth would be natural.
There are many factors that influence ER after a CS, we will focus on them point by point:
- At least 3 years must pass between the first and second pregnancy (in my case, I gave birth when my son was exactly 3 years old, which means I became pregnant after 2 years and 3 months);
- The operation was carried out on relative rather than absolute terms;
- The postoperative period was calm, without complications;
- The child after the CS is absolutely healthy;
- There is only one scar on the uterus, in the lower uterine segment and only after a CS, and not, for example, after a myomectomy (removal of uterine fibroids);
- The second pregnancy proceeded without complications;
- According to ultrasound, the placenta is located in the scar area;
- There are no thickenings, or, conversely, thinning of the wall of the lower uterine segment;
- The weight of the child during full-term pregnancy does not exceed 3800-3900 g;
- The scar is uniform along its entire length and its thickness is 3-6 mm (according to ultrasound), the scar should not hurt;
- There were no miscarriages or abortions after the CS.
Of course, all these indicators are individual, but they are basic.
An important role is played by your decisive attitude, which neither doctors, nor obstetricians, nor ultrasound specialists can bring down.
By the way, in my case, it was the ultrasound doctor who betrayed my self-confidence, which cannot be said about the doctor who was supposed to deliver the baby.
As you understand, the amount was also discussed with the doctor, since I was afraid that if I didn’t pay, I would be sent for surgery.
So, the doctor reminded me at every opportunity that if something went wrong, they would cut me off.
And when I went to check the consistency of the suture on the uterus (it is checked at 38-39 weeks), the ultrasound doctor recommended that I try to give birth myself, since the indicators were good ( good timing between births, age, consistency of the suture 3-4 cm around the entire perimeter), besides, the cervix was already ready, and why not take the risk, they will always have time to do a CS.
Always be decisive, analyze all the pros and cons, do not be afraid to contradict the doctor and ask what, how and why. If you are confident in yourself, in your health and in the health of your child, you will be able to give birth on your own even after a CS.
Now I know this for sure, and I wish you good luck.
P.S. I gave birth in the PDR, my water broke at 00:00, at 04:30 in the morning I gave birth to my baby.
Natural birth after caesarean section
Behind last years Caesarean section has moved from the category of operations performed to save the life of mother and child, to standard methods delivery. Today, doctors and society as a whole treat surgical intervention during childbirth as another “upper” way of bringing a child into the world. Many people do not see anything wrong with the fact that the baby will be born via caesarean section, even if the indications for such an operation are quite vague. Sometimes the women themselves, fearing severe pain or complications, they are asked to have a caesarean section. In many ways, this perception of CS was formed due to the lack of reliable information about the possible negative consequences of the operation, both for the mother and the child. Caesarean section is presented by some obstetricians as a blessing, as an opportunity to avoid all the “horrors” of natural childbirth.
What can we say about our society’s perception of vaginal birth with a uterine scar. Women who decide to do such an “abnormal” act, from the point of view of doctors, are either very frivolous or completely selfish, who do not care at all about the health of their own child. "Why You Need It?" - the main question that is asked to a woman who is determined to natural childbirth with a scar on the uterus.
In fact, natural childbirth after a CS is not only possible, but also preferable for a woman and her child. Since the seventies of the 20th century, the percentage of caesarean sections has steadily increased in both European and developing countries. For example, in the USA, the percentage of CS increased from 3% in 1981 to 28% in 1996, and continues to increase. In the 90s, Russia also joined this race. Unfortunately, there are no general statistics for our country on this topic. However, it is known that in Russia, CS in many maternity hospitals has become the same natural alternative to vaginal birth. There are many factors behind the increase in surgeries. This includes improving the technology and materials for the operation; the emergence of modern, less “heavy” anesthesia; desire to minimize risks severe complications during childbirth; or abdicate responsibility if complications arise during vaginal birth. The number of CSs around the world has now reached such a level that it is alarming to many doctors. The latter, under the pressure of research, public organizations and press publications, they are beginning to think about introducing measures to reduce the number of caesarean sections.
Natural childbirth, according to experts, is available to 60 to 85% of women whose first child was born as a result of CS surgery. The likelihood of giving birth vaginally is higher in those women in labor whose subsequent pregnancy does not repeat the diagnosis that led to CS (for example, the first child was in a breech position, and the second in a normal cephalic position) or in those who have already given birth on their own.
Women who decide to give birth with a uterine scar may have many reasons for this. Some people want to feel the whole process of childbirth and gain a sense of completion; for others, repeat CS surgery may be riskier than natural childbirth; others do not want to go through a long and painful recovery period after surgery again.
With natural childbirth, the risk of bleeding, thrombosis and infection is lower. Newborns are less likely to have breathing problems and are better able to adapt to environment. After vaginal birth, it is easier for women to establish lactation, and newborns themselves suckle better.
There is a study conducted by British and Scottish scientists that proves that a woman with a uterine scar should be wary of other things rather than scar divergence during childbirth. It turned out that the risk of sudden fetal death after 39 weeks in women who had a cesarean section is twice as high as the risk of uterine rupture.
The type of incision you had during your first C-section may be the starting point in your attempt to have a natural birth. The classic incision (made vertically from the navel to the womb) is practically not used today, since there is a high probability of bleeding, infection, and in subsequent pregnancies the suture is more often recognized as ineffective. The classic vertical incision significantly increases the risk of uterine rupture. With a lower horizontal incision, your chances of giving birth on your own are significantly higher; with a classic vertical incision (done only in cases of extreme necessity), the doctor may not allow you to give birth vaginally. The main problem that may arise during childbirth with a uterine scar is the divergence of tissue at the site of the suture. The probability of rupture is only 1-2%, but we must not forget about it.
Although some doctors use induction for natural births with a scar on the uterus, many studies suggest that the use of stimulant drugs seriously increases the risk of uterine rupture. For example, women with a uterine scar who are induced during labor are three times more likely to have a uterine rupture than those whose labor was not induced and started naturally. Therefore, doctors are advised to use prostaglandins and oxytocin with great caution during such births.
If you want to give birth vaginally after your first CS, still early stages pregnancy, it is worth discussing this possibility with your doctor and finding out his point of view on such childbirth. Some doctors are initially skeptical about vaginal birth after cesarean. Then you better look for someone who is more optimistic and who has experience in managing labor after a cesarean section.
Yes, scar dehiscence is indeed possible, but with a quick response from doctors and a CS performed immediately after a rupture, problems can be avoided. That is, childbirth with a uterine scar should be carried out in a hospital with a ready team of doctors who can quickly perform an operation at any time and save the mother and child. A study was published in 2004 that followed 34,000 women who gave birth to their second child between 2000 and 2003. About 18 thousand women decided to give birth vaginally with a uterine scar, another 16 thousand chose to have a second operation. Among the first group, 74% of women managed to give birth independently, 16% had a CS. 0.7% of these women (the first group) had a uterine rupture, seven children (this represents 0.04% of all planned vaginal births) were diagnosed with brain damage associated with fetal hypoxia (a consequence of uterine rupture), and two children, that is, 0.01%, died.
As for maternal mortality, twice as many women died during repeat CS than during vaginal birth with a scar (7 and 3 deaths, respectively).
The conclusion that the researchers made is that for a woman who chooses a vaginal birth with a uterine scar, the risk of an unfavorable birth outcome compared with repeat surgery is only 0.046% higher.
Latest Research, published in 2006 (May-June) in the Annals of Family Medicine, reports that maternal mortality rates are approximately the same for both vaginal births after CS and repeat CS. The same indicators were identified for child mortality (these figures fully apply to children whose weight has reached at least 1.5 kg). For smaller children, vaginal birth with a uterine scar, according to scientists, is more dangerous than a repeat CS.
So, as you prepare for a vaginal birth after a cesarean section, remember to consider the following positive and negative factors that may affect your ability to give birth on your own:
Positive factors:
Age – less than forty years;
- You have given birth at least once on your own (or you had a natural birth with a uterine scar);
- Childbirth began on its own;
- The diagnosis that led to the first CS is not repeated.
More than two CS in history;
- fetal immaturity (gestational age less than 38-40 weeks);
- large child (over 4 kg);
- labor is induced or stimulated with medication.
If you decide to give birth on your own and want to use pain medications such as an epidural or other medications, be sure to consult with your doctor well before your expected due date. Painkillers can be used when giving birth with a uterine scar, but with some caution. Some doctors believe that an epidural may slow down birth process, and then you will need a second operation. However, other evidence suggests that if the use of an epidural is delayed until the cervix has dilated to five fingers, the likelihood surgical intervention falls sharply. As for painkillers, they cannot harm you or increase the risk of CS, but they can harm the baby, as they easily penetrate into the blood and then into the placenta.
As for artificially induced labor, it is much more difficult than spontaneous labor. Often, epidural anesthesia or oxytocin is used to induce labor in such cases, which disrupts the natural course of labor and often leads to various medical interventions or KS. The widespread use of artificial induction methods seriously increases the risk of caesarean section.
