Infection (from the Latin word: infectio - pollution) is a broad concept that characterizes the penetration of a pathogenic (disease-causing) agent (virus, bacteria, etc.) into another, more highly organized plant or animal organism and their subsequent antagonistic (hostile) relationship.
Infectious diseases is a large group of diseases caused by pathogenic pathogens. Unlike other diseases, infectious diseases can be transmitted from an infected person or animal to a healthy one and are capable of widespread spread.
The human body is constantly faced with a huge number of microorganisms. Some of them can cause infectious diseases. These microorganisms bind to the surface of cells and invade them. After the intracellular cycle of existence, the pathogenic microorganism destroys the cell, producing toxins. Toxins act on nearby cells and contribute to the development of the disease. Some microorganisms “know how” to prevent the production of antibodies - i.e. suppress the immune system, and the human body cannot fight the developing infection.
Infectious diseases are diverse. Based on the type of pathogen, they are usually divided into several groups:
Of course, pregnant women suffer from the same infectious diseases as non-pregnant women. However, in the last months of pregnancy and before childbirth, the body is less resistant to infections. Therefore, a pregnant woman needs to exercise maximum caution, excluding any contact with persons who have signs of an infectious disease.
Influenza and ARVI are perhaps the most common of all the listed infectious diseases. Considering that the peak incidence occurs in the off-season - autumn and spring - we will focus on them. So, what awaits a woman who falls ill just before giving birth?
What is an observational department?
If a pregnant woman enters maternity hospital with signs of an infectious disease, she is hospitalized in the observation department. Why do they do this?
The observation (or, as it is also called, the second obstetric) department is a miniature maternity hospital. This department admits pregnant women, women in labor and postpartum, who can be a source of infection for others (fever of unknown cause, carriage of antibodies to viruses B and C, a long anhydrous period - more than 12 hours, any infectious disease, postpartum purulent-septic diseases - endometritis, suppuration of the perineal sutures, etc.). Sick pregnant women from the first obstetric department are also hospitalized in this department. Here are also children born in the second obstetric department, children whose mothers were transferred from the first obstetric department, and children born outside the maternity hospital.
The structure of the observation department differs from the structure of the first (main) obstetric department. It definitely has its own maternity unit, its own operating room and its own department for newborns. At the same time, pregnant women and postpartum women are always in separate rooms. The rooms are usually designed for two people.
The sanitary regime here is more strict than in the first obstetric department: the wards are cleaned 3 times a day: 1 time - with detergents and 2 times - with disinfectant solutions and subsequent bactericidal irradiation. Surgical instruments used in the department are disinfected in two stages - first in the department itself and second in the central sterilization room or sterilization department. In observational departments, disposable materials are widely used - scalpels, towels, etc.
A certain regime also exists for medical personnel. Daily change of robe is required. Masks are changed every 4 hours. Replaceable shoes are wiped with disinfectant solutions daily (therefore, wearing woven shoes is not allowed). Doctors from other departments change their gown, mask and shoes when visiting the observation department. Pregnant and postpartum women have their bed linen changed twice a week.
The neonatal ward also adheres to a stricter sanitary regime, similar to that in the observation ward itself.
In the second obstetric department, the presence of mother and child together is excluded. This is explained by the fact that the mother has an acute infectious disease or a purulent-septic postpartum complication and there is a high probability of infection of the child. The issue of breastfeeding in the second obstetric department is decided strictly individually. Some pathogens, even during pasteurization of breast milk, can be transmitted to the baby, while others, on the contrary, do not penetrate into the baby. breast milk. If there are contraindications for breastfeeding, women express breast milk to prevent lactostasis and stimulate milk production for further breastfeeding (after recovery).
In this way, the infection of a pregnant woman in the observation department with any other disease is prevented, the transmission of infection to other pregnant and postpartum women is prevented, and complications and infection of the child are prevented.
ARVI and flu before childbirth
Influenza and ARVI are transmitted by airborne droplets and their manifestations are largely similar. Both of these diseases begin acutely - with a headache, severe weakness, weakness, pain in the muscles of the arms and legs. Sometimes nausea and vomiting may bother you. On the 2-3rd day, as a rule, a sore throat, dry cough and runny nose appear. The fever lasts 3-7 days (with influenza the temperature rises to 40°C), and a drop in temperature is accompanied by profuse sweating. These diseases are often accompanied by a herpes virus infection ("fever" on the lips). In some pregnant women, influenza and acute respiratory viral infections are accompanied by abdominal pain and stool disorders (diarrhea).
In the observation department of the maternity hospital, the pregnant woman is given appropriate treatment (usually symptomatic - reducing general intoxication, antipyretic therapy at temperatures above 39°C, restorative therapy with the use of vitamins, drugs that boost immunity). The duties of the medical staff include maintaining a temperature sheet and measuring blood pressure(several times a day). Considering that at high temperatures and general intoxication of a woman’s body, some complications for the fetus may develop (for example, intrauterine hypoxia), appropriate therapy is carried out.
If a pregnant woman was admitted to an obstetric hospital before giving birth, then this management tactic in the observation department helps prepare the woman’s body for childbirth and prevention possible complications.
If a pregnant woman with ARVI or influenza in the acute stage is admitted to a maternity hospital with contractions, then childbirth is carried out through the natural birth canal (if there is no acute obstetric pathology, for example, a functional discrepancy between the fetal head and the mother’s pelvis, etc.).
The influence of the disease on the birth process
High temperature during childbirth, as a rule, does not affect the course of normal birth process. Complications that arise (weakness of labor, etc.) are due to the lack of acute flu or ARVI, but by the pathology of pregnancy, the presence of risk factors for the development of these complications. During childbirth, a woman spends great amount energy. And even if childbirth began against the background high temperature, then after them, taking into account the body’s energy consumption, body temperature drops to normal and even slightly reduced numbers.
They try to conduct childbirth with influenza and ARVI against the background of intoxication using anesthesia. This allows the woman in labor not to waste energy during contractions and to push fully in the second stage of labor.
After childbirth, a woman with manifestations of ARVI and influenza is given (or continues to be given) treatment, which will now be aimed at preventing postpartum complications(such as endometritis, suppuration of perineal sutures, if they were applied, etc.).
With a normal, uncomplicated course of the postpartum period, after recovery, mother and baby are discharged home.
Prevention
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Childbirth with influenza and ARVI. Childbirth with influenza and ARVI. Childbirth in the observation department of the maternity hospital. Print version. How to get sick correctly, or What not to do when you have the flu?
Flu and viral infection!!! Medical issues. Pregnancy and childbirth. 7 questions and answers about ARVI and influenza. What questions do we usually ask ourselves on the eve of the flu epidemic, which comes to our cities almost every year?
In chapter Pregnancy, Childbirth to the question Do they do the planned C-section for a cold? given by the author There is a part! the best answer is no, postpone until symptoms disappear.
Source: anesthesiologist, former obstetrician.
Answer from Emixam[guru]
I don’t think so))))) this is not an indication for CS)))))
Answer from Elena el[guru]
why caesarean? wait for the contractions and give birth yourself
Answer from Moli[guru]
no, of course... it’s just that the child’s lungs may not open after being put on oxygen if the mother is sick and he is sick
Answer from If Your Life Is Your Ass, Do OpaOpa[guru]
Yes. but it's terrible. There is no greater pain in the world than coughing or sneezing in the first week after surgery... especially coughing...
Answer from Anastasia Perminova[master]
If I understood you correctly, then you already had an indication for a planned CS, you just caught a cold at the wrong time...? If so, then they will do it, if there is no temperature... BUT! After the operation it will not be sweet for you, to put it mildly. My experience: I gave birth in June 2008 and, as always, I caught a cold in the summer. Not only did I give birth for almost 3 days and, as a result, the birth was resolved by means of a CS (painful back and complete cessation of labor at 7 cm dilation), but I was also covered in snot, with a rubbed red nose, coughing and sneezing.. .. In short, after the operation I had accumulated sputum, it’s clear that no one blows her nose on a woman stretched out on the operating table)))) Damn, that was tough. The first hours after the operation I was already out of breath. With one hand pressing the seam with the other, covering her nose and mouth, she sneezed as “gently” as possible and coughed in the same way. It became easier only on the second day. 1 KS I had an emergency, as you understand. You have it planned, which means there is no point in rushing and doing it if you have a cold. If it is possible to postpone the CS date by at least 2 days... talk to the doctors... It's worth it so you don't have to suffer later. Believe me, you will cough, sneeze and everything else through your tears. . this is very painful.
Caesarean section for colds, Pregnancy
I had residual effects, coughed up. During the operation, she could easily clear her throat. But the most interesting thing began later. The seam, it hurts to cough, it really hurts me. threw up. I was injected in intensive care. lazolvan. and were given sucking lollipops to make breathing easier. It all went away in 2 days. But it is better to go into surgery healthy. Get well!
It is better to operate without a cold. Ideally, have an agreement with a doctor who will come on shift if necessary and perform the operation. Then you can go to the maternity hospital calmly with contractions. The first days it hurts with the stitch, especially since everyone has an individual pain threshold. I'm after regional, not general anesthesia The first night after the operation I couldn’t sleep because of the pain; I was given additional painkillers. I can imagine if you also cough.
If you need a prescription for a cough - this is possible during pregnancy; a bronchitis cough goes away in two to three days - please contact us in a private message.
GIRLS, HELP WITH ADVICE. 24.07. SCHEDULED CESAREAN section in maternity hospital No. 9, and I have a runny nose, a swollen nasopharynx, an abscess on the tonsil for 2 days, and today I’m also 37.8 S. What should I do? - Call a doctor, or be hospitalized (they won’t take me that way)? I am already treating myself with everything possible and impossible. - bioparox, paracetamol, Viferon suppositories, rinsing with salt and soda, oxalin, Fleming's ointment. I hoped that I would be cured in a week, but since the temperature came out. You can’t get to the local police officer. I apologize if this topic has already been discussed, or if I’m writing somewhere in the wrong place!! I’m a newbie.
This threatens either the 16th maternity hospital or a cesarean section. If not urgently, but planned. Do you have a paid birth? You can call the maternity hospital and get advice. Well, or where you are registered. In the district regiment they will “disown” you and send you to a residential complex
I had a one-on-one situation, a planned CS on March 14, and within 3 days I just fell ill: 010. It was impossible to put it off, you have at least 5 days, I got myself back on my feet in 3 days, remembered all the folk remedies, breathed over potatoes, onions in my ears, woolen socks, milk with honey at night and sweat, caressed my throat, Herbal infusions drank, as a result, only the runny nose persisted, there was no fever, and my health improved.
The operation went well, the only thing was that when I recovered from the anesthesia, my nose was very stuffy, and in intensive care I asked for drops.
She didn’t tell the doctor anything, she was afraid that they would suffer it, or something else, if it had gotten worse, she would have informed her of course, but the main symptoms were relieved. However, it was impossible to bear it, I had already started to open that day, but I couldn’t give birth myself.
Cesarean is paid, so I’m afraid that they won’t let me in (((and at the housing complex they already gave me a referral without a number and said that they have a big appointment! I’m very worried, they’ll even take me for surgery for a cold? and what should I do if it starts earlier - will they take me or not?
Mom of two girls
They definitely won’t take you with a cold at 9, you’ll go at 16 and there’s nothing wrong with that.
If the temperature has already risen, then you can’t eat potatoes. And the abscess on the throat is no hotter at all. It's better cold)) The faster the abscess is removed, the better. Get well. flower:
C-section
Description
During a caesarean section, the baby is born through an incision in the abdominal cavity mother. About 15%-40% of all births in developed countries occur by caesarean section.
When is a caesarean section performed?
A caesarean section may be required in the following situations:
Possible complications during cesarean section
A caesarean section is a surgical procedure and there are risks associated with it. The estimated risk of death for a woman after a caesarean section is less than one in 2,500. The risk of death after a vaginal birth is less than one in 10,000. Other risks include:
- What needs to be done and what can be taken if a nursing mother gets sick.
- When is the best time to take medications?
Indications for caesarean section
Caesarean section is surgical intervention when childbirth does not occur naturally, and the surgeon makes an incision in the mother and takes out the child. If previously caesarean sections were performed only when indicated, today about a quarter of all births occur surgically.
A caesarean section must be performed in following cases:
too much narrow size pelvis of a woman in labor. This feature A woman’s physiology is determined by ultrasound. It should be noted that a thin woman does not always have a narrow pelvis. In many cases, the dimensions of the pelvis fall within the required parameters.
there is a danger of uterine rupture. This danger may arise if a woman has already had a caesarean section in a previous birth. The risk of uterine rupture is also determined by ultrasound. Rupture can occur during contractions, when the uterus begins to contract strongly. Its rupture is very dangerous and fraught with great complications.
a woman has mechanical obstacles to giving birth naturally. Such obstacles usually include ovarian tumors and uterine fibroids. located near the isthmus.
there is placenta previa. Diagnosed by ultrasound. If the placenta blocks the exit for the fetus during labor, a caesarean section must be performed at 38 weeks.
the mother has been diagnosed with diseases that may pose a threat to her health during childbirth. Such diseases include cardiovascular diseases, kidney diseases, diabetes mellitus, nervous system, malignant tumors and some other diseases.
Do they do caesarean section for colds?
Is it possible to have a caesarean section “at will”?
Even those who have never read the Bible know that a woman’s destiny is “to bear her children in pain.” And this is scary. Out of fear, a fashionable trend appeared - caesarean section “by at will" On the other hand, on the contrary, some refuse the necessary cesarean section, believing that childbirth should be natural. Who is right?
Оригинал: Город (812)&subject=Можно R»Рё делать RєРµСЃР°СЂРµРІРѕ SЃРµС‡РµРЅРёР µ “РїРѕ собственному жеДанию”? — Город (812)” target=”_blank” title=”Publish on your blog livejournal.com”>
N and this question is answered by Online812 chief physician maternity hospital No. 9, Ph.D. Vladimir ATLASOV.
— Why is there an increasing number of women who, without medical indications, want their child to be born by caesarean section? And they are even willing to pay for it. Is it correct?
- I believe that the doctor should listen to this “own desire”, because the woman knows, and perhaps feels, that it is better for her and for the child if the birth ends with an operation. This is the position of not only Russian obstetricians and gynecologists. In many countries, even some European ones, a woman has the right to choose. But Japan was the first to go down this path. South Korea, China. In Venezuela, in general, the caesarean section rate reaches 60%.
Now among us, among specialists, they are increasingly saying that it is necessary to give a woman the opportunity to choose the way her child is born: through the birth canal or a surgical incision. If there is any deviation in the health of the child, more precisely, the fetus, or the woman herself, we meet it halfway. Because of this, the rate of caesarean sections is actually increasing. And it is right.
Is it possible to breastfeed if you have a cold?
Almost everyone has ever encountered such a diagnosis as ARVI, influenza and other colds. Many are not worried about this fact, because the main thing is to start treatment on time and correctly. But for some categories of people, for example, nursing mothers, colds can be a problem. After all, there is still an opinion that a sick mother should wean her child from the breast so as not to infect him. In this article we will refute this stereotype.
Let's look at a few questions about breastfeeding with a cold that most concern mothers.
Be sure to consult a doctor, he will prescribe medications compatible with feeding. There is no need to self-medicate, because... There are medications containing herbs that reduce lactation. Imagine if your milk runs out, it won’t make your baby feel any better. You can drink 1 glass of cranberry juice once a day, do inhalations, take vitamins, but do not overdo it, because... There may be an overabundance of them and this will all come out in the form of an allergy on the baby’s skin. Maintain personal hygiene: wash your hands often, shower and bathe daily, when in close contact with a child, wear a mask and change it every 2 hours.
- Is it possible to feed a baby with a cold?
Answer: it is possible, even necessary. When the mother is ill, they are produced in milk, even while still incubation period, antibodies that enter the child’s body through milk and protect him from colds. It has been proven that children whose mothers did not separate them during illness are much less likely to get sick.
Surgery and anesthesia for cough, runny nose, sore throat, fever
Is it possible to perform surgery and anesthesia if you have a runny nose, cough, sore throat or fever? In the old manuals on anesthesiology there was no clear answer to this question, so each doctor (anesthesiologist, surgeon) came out of the current situation in his own way - someone performed the operation, commenting that a cold is not a disease, but a mere trifle, someone on the contrary, fearing potential complications, he postponed surgical treatment for a certain period. Today the question of surgery and anesthesia for colds, flu, bronchitis and other acute infectious diseases respiratory system is considered resolved. Modern research clearly prove a significantly greater number of complications in the case of anesthesia against the background of cold symptoms (runny nose, cough, sore throat, fever).
What Dangers of anesthesia for colds. Carrying out surgery and anesthesia against the background of a cold (rhinitis, pharyngitis, laryngitis, tracheitis, bronchitis), as well as within 2-4 weeks after recovery, can lead to serious consequences. side effects and reactions, primarily various types of respiratory complications.
Inflammation associated with a cold respiratory tract leads to their hypersensitivity to external stimuli, including the effects of anesthesia. Contact of an endotracheal tube, laryngeal mask or anesthetic gas with the mucous membrane of the respiratory tract can lead to their spasm (closure) with the development of acute respiratory failure. Acute respiratory failure is a very serious complication of anesthesia, accompanied by a sharp drop in blood oxygen levels and leading to acute oxygen starvation brain, heart and other organs of the body.
CONSCIOUS CESAREAN SECTION
Conscious caesarean section is practiced in maternity hospitals. Although it is not done as often as surgery under general anesthesia. On medical language this is called a caesarean section using epidural anesthesia. But such an operation is prescribed only if the decision to have a cesarean section is made before the onset of labor. If it is taken during childbirth to save the baby's life, epidural anesthesia cannot be used. Because it usually takes about an hour before the medicine begins to take effect, and waiting that long during an emergency operation is unsafe for the mother and baby.
Planned caesarean section
There are cases when the decision about surgery is made in advance. That is, before the onset of labor: from several months to several hours. Here are some reasons for a planned cesarean:
Anatomically narrow pelvis;
If the normally located placenta begins to separate prematurely;
If the fetus experiences a lack of oxygen;
Severe toxicosis in the mother;
Complex diseases of the pregnant woman (heart disease, diabetes mellitus, hypertension, high degree of myopia, etc.);
The consequences of numerous abortions (as a result of which ruby changes are formed in the uterus, inflammatory processes, and this leads to placental insufficiency and weakness of labor).
What should pregnant women take for a cold?
The cold can be called the most common disease among pregnant women. This is explained by the fact that during pregnancy, the body of even the healthiest woman experiences suppression of the immune system, as a result of which the woman becomes more susceptible to seasonal diseases.
However, a cold, like any other illness during pregnancy, can harm the unborn child. Therefore, it is necessary to begin treatment for a cold after the first symptoms appear. After all, not only the cold virus itself can harm the baby, but also the symptoms of the disease themselves: fever, aching joints, runny nose, loss of appetite, etc.
When and how to start treatment
The first symptoms of a cold during pregnancy may be:
After the first day, the condition may worsen, so it is necessary to prevent the development of the disease and begin treatment immediately. As a rule, a cold causes the greatest discomfort for the first 2-3 days, after which (with proper treatment) the disease begins to recede.
The causes of a cold can be hypothermia of the body or viruses and bacteria that already lived in the body expectant mother, but appeared under favorable conditions. Both causes can be equally dangerous for the child, especially in the first trimester, when the fetus is just beginning to form.
First steps when cold symptoms occur must be:
Caesarean section: pros and cons of the operation, consequences, indications, recovery
It happens that giving birth naturally is not the best option.
C-section - surgical procedure, which allows the baby to be removed through an incision in the abdomen rather than through the vagina. IN Lately about 30% of births occur by caesarean section. In some cases, this is done electively due to pregnancy complications or because the woman has already had a caesarean section. Some women prefer a caesarean section to a regular birth. However, in many cases the need for a cesarean section becomes apparent only during labor.
Knowing what to expect will help you be better prepared if surgery is necessary.
Caesarean section is a surgical procedure that allows you to remove a baby from the mother's womb. In this case, he is not born naturally, but takes his first look at the world through the incision that is made when the uterus is opened. In Germany, 20 to 30 percent of babies are born by caesarean section every year.
Indications for cesarean section can be absolute and relative. But for the most part, the decision to undergo surgery stems from many factors at once, such as a combination of medical assessments on the part of the doctor and midwife, and personal wishes on the part of the woman giving birth. Fortunately, pregnant women have plenty of time to think things through and figure out exactly how they would like to give birth. Emergency situations cases where a caesarean section becomes unavoidable are rare.
If you decide to have a caesarean section, you must confirm your consent to the operation in writing. But first, the doctor will give you the most detailed explanations. During this conversation, everything should be discussed in detail possible risks so that you really feel well prepared. Therefore, do not hesitate to ask again if something is not clear to you.
Medical indications for cesarean section include:
Partial anesthesia for caesarean section
Currently local anesthesia is a universally accepted standard. The operation is performed using spinal anesthesia or, for a planned caesarean section, epidural-spinal anesthesia (see page 300). General anesthesia is recommended only in cases where other anesthesia is not possible for medical reasons.
When is a caesarean section performed?
There are many reasons why a caesarean section is performed. Sometimes this is due to the health of the mother, sometimes due to concerns for the child. Sometimes surgery is done even if both mother and baby are fine. This is an elective caesarean, and there are mixed feelings about it.
Childbirth is not going well. One of the main reasons why a caesarean section is performed is because labor is not progressing normally - too slowly or stopping altogether. The reasons for this are manifold. The uterus may not contract vigorously enough to fully dilate the cervix.
The child's heart function is impaired. In most cases, the baby's heart rate allows us to expect a successful outcome of the birth. But sometimes it becomes obvious that the child does not have enough oxygen. If there are such problems, the doctor may recommend a cesarean section.
Heart problems can occur if the baby is not getting enough oxygen, the umbilical cord is pinched, or the placenta is not functioning well. Sometimes violations heart rate occur, but nothing indicates a real danger to the child. In other cases, serious danger is obvious. One of the most difficult decisions for doctors is deciding how great this danger is. The doctor can try different methods, for example, massage the head, and see if the heart function improves.
The decision to have a caesarean section depends on many factors, such as how long labor will continue or how likely there are complications other than heart problems.
Unfortunate position of the child. If the baby enters the birth canal legs or buttocks first, it is called breech presentation. Most of these babies are born by caesarean section, as there is a high risk of complications with normal childbirth. Sometimes the doctor is able to transfer the child to correct position, pushing it through the abdomen before labor begins, thereby avoiding surgery. If the baby lies horizontally, this is called transverse presentation and is also an indication for cesarean section.
The baby's head is positioned poorly. Ideally, the baby's chin should be pressed to the chest so that the part of the head with the smallest diameter is in front. If the chin is lifted or the head is turned so that the smallest diameter is not in front, the larger diameter of the head should pass through your pelvis. Some women have no problems with this, but others may have difficulties.
Before performing a cesarean section, the doctor may ask you to get on all fours - in this position, the uterus drops forward and the baby can turn around. Sometimes the doctor may want to turn the head during a vaginal examination or using forceps.
You have serious health problems. A caesarean section may be done if you have diabetes, heart disease, lung disease or high blood pressure. With such diseases, a situation may arise when it is preferable to give birth to a child at a later date. early stage pregnancy. If labor cannot be induced, a caesarean section may be necessary. If you have serious health problems, discuss your prospects with your doctor well before the end of your pregnancy.
Occasionally, a caesarean section is performed to prevent the baby from contracting a herpes infection. If a mother has herpes in her genitals, it can be passed on to her baby and cause serious illness. Caesarean section avoids this complication.
You are having a multiple pregnancy. About half of twins are born by Caesarean section. Twins can also be born in the usual way, depending on the weight, position and duration of pregnancy. With triplets it's a different story. Most triplets are delivered by caesarean section.
Each multiple pregnancy is unique. If this is your case, discuss your birth prospects with your doctor and decide together what is best for you. Remember that everything is changeable. Even if both babies are lying head first, the situation may change after the first one is born.
There are problems with the placenta. In two cases, a cesarean section is necessary: placental abruption and placenta previa.
Placental abruption occurs when the placenta separates from the wall of the uterus before labor begins. This can pose a threat to both your life and your child's. If electronic monitoring shows that there is no immediate danger to the baby, you will be admitted to the hospital and will be closely monitored. If the baby is in danger, an urgent delivery is necessary and a caesarean section will be used.
The placenta cannot be born first, because then the baby will lose access to oxygen. Therefore, a cesarean section is almost always done.
There are problems with the umbilical cord. When your water breaks, the umbilical cord may slip out of your cervix before the baby is born. This is called umbilical cord prolapse and is great danger for a child. As the baby pushes through the cervix, pressure on the umbilical cord can cut off oxygen supply. If the umbilical cord slips out when your cervix is fully dilated and labor has begun, you can give birth normally. Otherwise, only a caesarean section can save the situation.
Also, if the umbilical cord is wrapped around the baby's neck or between the head and pelvic bones, if the water has broken, each contraction of the uterus will compress the umbilical cord, slowing blood flow and reducing the supply of oxygen to the baby. In these cases, a cesarean section is the best option, especially if the umbilical cord is compressed for a long time or very strongly. This common reason problems with the heart, but it is usually impossible to know for sure how the umbilical cord is positioned until labor begins.
The child is very big. Sometimes the baby is too big to be successfully delivered in the normal way. Baby size can be an issue if you have an abnormally narrow pelvis that the head cannot fit through. Occasionally, this may be a consequence of a pelvic fracture or other deformities.
If you develop diabetes during pregnancy, your baby may gain a lot of weight. If the baby is too big, a caesarean section is preferable.
Child's health problems. If a child is diagnosed with a defect such as spina bifida while still in the mother's womb, the doctor may recommend a cesarean section. Discuss the situation in detail with your doctor.
You've already had a caesarean section. If you've had a C-section before, you may have to do it again. But this is optional. Sometimes a normal birth is possible after a caesarean section.
How does a caesarean section happen?
Before your planned cesarean section, your gynecologist or anesthesiologist will talk to you about the procedure and anesthesia in advance. If something is unclear to you, clarify and ask again! On the appointed day, you must arrive at the hospital in advance. It is best to avoid eating: You should not eat for six hours before surgery.
First of all, the doctor and midwife will check your baby’s condition using ultrasound and CTG. Take this opportunity to express your wishes and ideas for the upcoming birth. Then preparations for the operation will begin: your hair will be shaved off in the incision area, compression stockings will be put on you and spinal anesthesia. Later, in the operating room, the surface of the abdomen will be disinfected and a catheter will be inserted into the bladder. Before the operation begins, your entire body, except for your abdomen, will be covered with sterile drapes. To prevent you from seeing what is happening and to prevent infection, the nurses will pull a sheet over your upper abdomen. Although you will be able to see the heads of the operating team members, you will not be able to understand what they are doing with their hands. After the anesthesia begins to take full effect, the doctor will make the first incision.
For cosmetic reasons, as well as for better wound healing, a skin incision is made directly above the symphysis (pubic joint) along a vertical line, the length of the incision is 10 cm. The subcutaneous adipose tissue is divided in the middle. Above the abdominal muscles there is a very elastic and strong connective tissue membrane (fascia), which the surgeon opens with a scalpel in the center. Then he pulls the abdominal wall upward with his hand and moves the abdominal muscles to the side. To open the peritoneum, the doctor uses only his fingers. At the same time, he must make sure that he does not injure either the intestines or the bladder. Finally, the doctor makes a transverse incision with a scalpel lower segment uterus. Now all that remains is to get the baby out of the womb and you can say hello to your baby. After separation and removal of the placenta operating team sews up the wound. Meanwhile, your partner is already accompanying the child to the first examination. In total, the operation lasts from 20 to 30 minutes.
Misgav Ladakh Method
The method described on the previous pages, the so-called “soft” surgical technique, developed at the Israeli hospital Misgav Ladach, is used today, with minor deviations, in all maternity clinics.
Risks of caesarean section
A caesarean section is a major operation. Although it is considered completely safe, as with any surgery, there are certain risks. It is important to remember that caesarean sections are often done to avoid life-threatening complications. However, certain complications may also arise after surgery.
Risks for you. Having a child is always a risk. With a caesarean section it is higher than with a normal birth.
Risk to the child. A caesarean section is also potentially dangerous for the baby.
What to expect with a caesarean section
Whether your caesarean section is planned or done as needed, it will go something like this:
Preparation. Some procedures will be done to prepare you for surgery. In urgent cases, some steps are shortened or skipped altogether.
Methods of pain relief. An anesthetist may come to your room to discuss anesthesia options. For a caesarean section, spinal, epidural and general anesthesia are used. With spinal and epidural anesthesia, the body loses sensation below the chest, but you remain conscious during the operation. In this case, you practically do not feel pain, and practically no medicine reaches the child. There is little difference between spinal and epidural anesthesia. For spinal pain, a pain reliever is injected into the fluid surrounding the spinal nerves. With an epidural, the agent is injected from the outside of the fluid-filled space. Epidural anesthesia lasts 20 minutes and lasts a very long time. Spinal is done faster, but lasts only about two hours.
General anesthesia, in which you are unconscious, may be used for an emergency caesarean section. Some amount medicine may reach the child, but usually does not cause problems. Most children are not affected by general anesthesia because the mother's brain absorbs the drug quickly and in large quantities. If necessary, the child will be given medications to relieve the effects of general anesthesia.
Other preparations. Once you, your doctor, and the anesthesiologist have decided which type of pain relief to use, preparations will begin. Typically they include:
Operating room. Most caesarean sections are performed in operating rooms specifically designed for this purpose. The atmosphere may be different from that of the birthplace. Since operations are a group effort, there will be many more people here. If you or your child has serious medical problems, doctors from a variety of specialties will be present.
Preparation. If you are having an epidural or spinal anesthesia, you will be asked to sit with your back rounded or lie on your side curled up. The anesthesiologist will wipe your back with an antiseptic solution and give you an anesthetic injection. He will then insert a needle between the vertebrae through thick fabric surrounding the spinal cord.
You may be given one dose of pain medication through a needle and then have it removed. Or a thin catheter will be inserted through the needle, the needle will be removed, and the catheter will be covered with adhesive tape. This will allow you to receive new doses of pain medication as needed.
If you require general anesthesia, all preparations for surgery will be made before you receive pain relief. The anesthesiologist will administer pain medication through an intravenous catheter. You will then be placed on your back with your legs secured. A special pad may be placed under your back on the right side so that your body tilts to the left. This shifts the weight of the uterus to the left, which ensures good blood supply.
The arms are extended and fixed on special pads. The nurse will shave your pubic hair if it might interfere with the operation.
The nurse will wipe the stomach with an antiseptic solution and cover it with sterile napkins. A drape will be placed under your chin to keep the surgical site clean.
Abdominal wall incision. When everything is ready, the surgeon makes the first incision. This will be an incision in the abdominal wall, about 15 cm long, cutting through the skin, fat and muscle to reach the lining of the abdominal cavity. Bleeding vessels will be cauterized or bandaged.
The location of the incision depends on several factors: whether your C-section is an emergency and whether you have any other scarring on your abdomen. The size of the baby and the location of the placenta are also taken into account.
The most common types of cuts:
Birth. When the uterus is open, next step is the opening of the amniotic sac so that the child can be born. If you are conscious, you may feel some tugging and pressure as the baby is pulled out. This is done in such a way as to keep the incision size to a minimum. You won't feel pain.
Once the baby is born and the umbilical cord has been cut, he will be given to a doctor who will check that his nose and mouth are free of fluid and that he is breathing well. In a few minutes you will see your baby for the first time.
After birth. Once the baby is born, the next step is to separate and remove the placenta from the uterus and then close the incisions, layer by layer. Sutures on internal organs and tissues will dissolve on their own and do not require removal. For the skin incision, the surgeon may place sutures or use special metal clips to hold the edges of the wound together. You may feel some movement during these activities, but no pain. If the incision is closed with clamps, they will be removed with special forceps before discharge.
When you see the baby. The entire cesarean section operation usually takes 45 minutes to an hour. And the baby will be born in the first 5-10 minutes. If you are conscious and willing, you can hold your baby while the surgeon closes the incisions. Or you might see the baby in your partner's arms. Before giving the baby to you or your partner, doctors will clean the baby's nose and mouth and perform an initial Apgar score, a quick assessment of the baby's appearance, pulse, reflexes, activity and breathing one minute after birth.
Postoperative ward. There you will be monitored until the anesthesia wears off and your condition stabilizes. This usually takes 1-2 hours. During this time, you and your partner can spend a few minutes alone with your child and get to know him.
If you decide to breastfeed, you can do so for the first time in the recovery room if you wish. The sooner you start feeding, the better. However, after general anesthesia, you may not feel well for several hours. You may want to wait until you are completely awake and have pain relief before you start feeding.
After a cesarean section
In a few hours you will be moved from the recovery room to the birthing room. Over the next 24 hours, doctors will monitor your well-being, the condition of your stitches, the amount of urine you produce, and postpartum bleeding. Your condition will be closely monitored throughout your hospital stay.
Recovery. Typically, you will spend three days in the hospital after a caesarean section. Some women are discharged after two. It is important that you take good care of yourself both in the hospital and at home to speed up your recovery. Most women usually recover from a cesarean section without any problems.
Pain. You will receive pain medication at the hospital. You may not like it, especially if you plan to breastfeed. But painkillers are necessary after the anesthesia wears off to make you feel comfortable. This is especially important in the first few days, when the incision begins to heal. If you are still in pain when you are discharged, your doctor may prescribe pain medication for you to take at home.
Food and drink. In the first hours after surgery, you may only be given ice cubes or a sip of water. When your digestive system will start working normally again, you will be able to drink more fluids or even eat some easy to digest food. You'll know you're ready to eat when you can pass gas. This is a sign that your digestive system is awakened and ready to get started. You can usually eat solid food the day after surgery.
Walking. You will most likely be asked to walk around a few hours after surgery, if it is not yet overnight. You won't want to, but walking is beneficial and an important part of your recovery. It will help clear your lungs, improve blood circulation, speed up healing, and bring your digestive and urinary systems back to normal. If you are bothered by bloating, walking will bring relief. It also prevents blood clots, a possible post-operative complication.
After the first time, you should take short walks at least twice a day until you are discharged.
Vaginal discharge. After your baby is born, you will have lochia, a brownish or colorless discharge, for several weeks. Some women after a cesarean section are surprised by the amount of discharge. Even if the placenta is removed during surgery, the uterus must heal and discharge is part of the process.
Healing of the incision. The bandage will most likely be removed the day after surgery, when the incision has healed. Your wound will be monitored while you are in the hospital. As the incision heals, itching will occur. But don't scratch it. It's safer to use lotion.
If the incision was connected with clamps, they will be removed before discharge. At home, shower or bathe as usual. Then dry the cut with a towel or hairdryer on low heat.
The scar will be tender and painful for several weeks. Wear loose clothing that does not chafe. If clothing irritates the scar, cover it with a light bandage. Sometimes you will feel twitching and tingling in the area of the incision - this is normal. While the wound is healing, it will itch.
Restrictions. When returning home after a caesarean section, it is important to limit your activity for the first week and focus primarily on yourself and your newborn.
Possible complications.
Tell your doctor right away if these symptoms appear while you are at home:
Emergency caesarean section
An emergency caesarean section is performed only if the life of the mother or child is threatened.
The decision on an emergency operation or a secondary caesarean section is made only when there is really no other choice, since this is associated with a high risk for the pregnant woman (intubation, bleeding, damage to neighboring organs, infection).
Indications for emergency surgery:
If one of these complications unexpectedly occurs, you need to act very quickly. If the supply through the umbilical cord is interrupted, the doctor has only a few minutes to prevent significant harm to the baby's health. The obstetric team must take all measures to ensure that the birth takes place in the next 20 minutes. An interruption in oxygen supply that lasts longer than 10 minutes can damage the baby's brain.
Once the doctor decides on an emergency caesarean section, the induction of anesthesia and the operation are performed without delay and without long preparation. Surgical intervention can also be performed in maternity ward, if there is enough space and the necessary equipment is available.
Women always hope that they will give birth while maintaining dignity, will be able to endure pain, sometimes even smile when they push for the last time, giving life to the child. Many people try very hard to give birth naturally, choosing doctors whose practice has had few cesarean sections, go to courses for pregnant women, play sports during pregnancy, trying to gain only required weight, sometimes even hiring a doula to be with you in the delivery room. However, there are a lot of caesarean sections, more than ever before.
How to deal with anxiety
No matter how hard you tried, whether you had a normal pregnancy without complications, you may need an emergency caesarean section. You will be disappointed. You might feel like a failure. However, it is very important to remain forward-thinking. Caesarean section does pose a risk, as does normal operations, for example, during it, internal bleeding may begin, blood clots may appear, infection or damage may occur internal organs. Some babies experience minor breathing problems after a caesarean section. But because surgical techniques and pain management have improved, there are very few dangers associated with a caesarean section, and of course, giving birth to a healthy baby is much more important than trying to give birth naturally.
Reasons for emergency caesarean section
Most often, the indication for an emergency cesarean section is an unexpected abnormal position of the baby (if he is positioned with his legs or buttocks forward) or lateral presentation. Another reason is heavy bleeding that occurred before childbirth and suspicion of premature abruption or placenta previa. The most common reason for cesarean sections is the risk that the baby may not survive the birth; If the baby's cardiogram shows possible abnormalities, a cesarean section will be safe and in a fast way give a birth to a baby.
Emergency caesarean section procedure
It may happen that everything will happen quickly and chaotically. The lower abdomen will be prepared for surgery. Your stomach will be washed, your hair may be shaved, you will be given antibiotics and other fluids intravenously. The anesthesia will be either epidural (with a dose adjusted for caesarean section), or spinal, and maybe even general. If a woman has an epidural or spinal anesthesia, she will not feel anything from her toes to her chest; at the same time, she will be conscious, but will not feel the doctor making the incision. Most likely, she will not see this, because a special fence will be placed between her and the doctor, or maybe because the baby will be born very quickly.
Caesarean section by woman's choice
Some healthy women They prefer a caesarean section for their first birth - usually to avoid pain and possible complications during childbirth. Sometimes the doctor suggests a caesarean section so that the baby is born at a time that is more convenient for the woman, the doctor, or both.
This caesarean section is not done due to health problems. The reason is fear or a desire to avoid difficulties. And these are not the best reasons for a caesarean section.
However, women are increasingly choosing a caesarean section, and this raises a number of questions.
Is there a limit?
Many women successfully undergo up to three operations. However, each subsequent caesarean section is more difficult than the previous one. For some women, the risk of complications - such as infection or heavy bleeding- increases only slightly with each caesarean section. If you had a long and difficult labor before your first cesarean section, a repeat cesarean section will be physically easier, but the healing process will take just as long. For other women - who have developed large internal scars - each subsequent C-section becomes more and more risky.
Many women have a repeat cesarean section. But after the third, you need to weigh the possible risks and your desire to have more children.
Facing the unexpected
The unexpected news that you need a caesarean section can be a shock to both you and your partner. Your ideas about how you will give birth will suddenly change. To make matters worse, this news may come when you are already exhausted from long hours of contractions. And the doctor no longer has time to explain everything and answer your questions.
Of course, you will have concerns about what it will be like for you and your baby during surgery, but don't let those concerns overwhelm you completely. Most mothers and children undergo surgery safely with a minimum of complications. Although you may have preferred to have a natural birth, remember that the health of you and your baby is more important than how it is delivered.
If you have concerns about a planned repeat caesarean section, discuss this with your doctor and your partner. This will help you worry less. Tell yourself that you've already been through this once - and you can do it again. This time you will have an easier time recovering from surgery because you already know what to expect.
Caesarean section: partner involvement
If the caesarean section is not urgent and requires general anesthesia, your partner can come to the operating room with you. Some hospitals allow this. Some people like the idea, others may be afraid or disgusted. It is generally difficult to be present during an operation, especially when it is performed on a loved one.
If your partner decides to attend, they will be given a surgical gown. They can watch the procedure or sit at the head of the room and hold your hand. Perhaps his presence will make you feel calmer. But there are also difficulties: men sometimes faint, and doctors have a second patient who needs immediate help.
In most maternity hospitals, the baby is photographed and doctors can even take pictures for you. But in many places this is not allowed. Therefore, you should ask permission to take photos or videos.
Caesarean section by choice
Some women who have a normal pregnancy choose to give birth by Caesarean section even though they have no complications or problems with the baby. Some of them find it convenient to accurately plan the due date. If you're used to planning everything in your life down to the minute, waiting until the unknown day your baby arrives can seem impossible.
Other women choose a caesarean section due to fear:
If this is your first child, childbirth is something unknown and it's scary. You may have heard horror stories about childbirth and women suffering from urinary incontinence when coughing or laughing after giving birth. If you've already had a vaginal birth and it didn't go smoothly, you may be worried about a repeat.
If you are inclined to choose a caesarean section, discuss this openly with your doctor. If your main motivator is fear, having a frank conversation about what to expect and attending a birthing school can help. If they start telling you about the horrors of childbirth, politely but firmly say that you will listen about it after your baby is born.
If your previous natural birth was really like this terrible story, remember that all births are different and this time everything may be completely different. Think about why labor was so difficult and discuss this with your doctor or partner. Perhaps something needs to be done to make the experience more positive this time.
If your doctor agrees with your choice, the final decision is yours. If the doctor does not agree and will not perform a cesarean section, he may refer you to another specialist. Learn more about the pros and cons of both birth methods and discuss them with experts, but don't let fear be the deciding factor.
What should you consider?
Elective caesarean section is controversial. Those who are in favor say that a woman has the right to choose how she wants to give birth to her child. Those who are against it believe that the dangers of a C-section outweigh any of it. positive sides. There is currently no convincing evidence in the medical literature that cesarean section is the preferred option. good medical practice generally rejects procedures - especially surgical ones - that do not provide undoubted benefit to the patient. In addition, there is little research on this issue.
Because everything is ambiguous, you may find that doctors' opinions differ widely. Some are ready to have surgery. Others refuse, believing that a caesarean section could be dangerous and thus contrary to their oath to do no harm.
The best way to make a decision is to gather as much information as possible. Ask yourself why you are attracted to this option. Study the issue, consult with experts and carefully weigh the pros and cons.
Benefits and risks
Many experts believe that with the current level of development of surgical technology, a cesarean section is no more dangerous than a normal birth if this is your first child. If this is already the third birth, the situation is different. A caesarean section is more likely to cause complications than a normal birth. Here is a list of the benefits and dangers of this operation:
Benefits for the mother. Positive consequences of an elective caesarean section may include:
Risk to the mother immediately after surgery
There are certain inconveniences and dangers associated with a caesarean section. You will have to stay in the hospital longer. The average length of stay in the hospital after a cesarean section is three days, and after a normal birth it is two.
Increased chance of infection. Because this surgery, the risk of infection after a cesarean section is higher than after a normal birth.
Postoperative complications
Since a cesarean section is an abdominal operation, there are certain risks associated with it, such as infection, poor healing of sutures, bleeding, damage to internal organs, and blood clots. There is also a higher risk of complications after anesthesia.
Reducing the possibility of early connection with the baby and initiation of breastfeeding. For the first time after surgery, you will not be able to care for your child or breastfeed him. But this is temporary. You will be able to bond with your baby and breastfeed once you recover from surgery.
Payment for insurance
Your insurance may not cover elective C-sections, and they will cost more than a normal birth. Before making a decision, check whether this surgery is covered by your insurance.
Risks for the mother in the future
After a cesarean section, the following troubles are possible in the future:
Future complications. With multiple pregnancies, the likelihood of complications increases with each subsequent one. Repeat caesarean sections further increase this likelihood. Most women can safely have up to three surgeries. However, each subsequent one will be more difficult than the previous one. For some women, the risk of complications such as infection or bleeding increases only slightly. For others, especially those with large internal scars, the risk of complications with each subsequent caesarean section increases significantly.
Uterine rupture in the next pregnancy. Having a Caesarean section increases your risk of uterine rupture in your next pregnancy, especially if you decide to have a normal birth this time. The likelihood is not very high, but you should discuss this with your doctor.
Problems with the placenta. Women who have had a Caesarean section have a higher risk of placenta-related problems, such as breech, in subsequent pregnancies. In case of previa, the placenta closes the opening of the cervix, which can lead to premature birth. Placenta previa and other related problems caused by cesarean section greatly increase the risk of bleeding.
Increased risk of hysterectomy. Some placenta problems, such as accreta, where the placenta is too deeply and firmly attached to the wall of the uterus, may require removal of the uterus (hysterectomy) at birth or shortly after.
Damage to the intestines and bladder. Serious bowel and bladder injuries are rare during a caesarean section, but they are much more likely to occur than during a normal birth. Complications related to the placenta can also lead to bladder damage.
Dangers to the fetus
Dangers to the baby associated with a cesarean section:
Decision-making
If your doctor doesn't accept your request for a C-section, ask yourself why. Doctors and surgeons have a duty to avoid unnecessary medical interventions, especially if they may be dangerous. The lack of scientific evidence to support elective caesarean section makes this procedure unnecessary. Although, from a physician's perspective, scheduling convenience, efficiency, and financial rewards favor a cesarean section, a physician you trust should be at least cautious about the procedure.
All over the world there is a clear trend towards gentle delivery, which helps preserve the health of both mother and child. The tool that helps achieve this is the cesarean section (CS). A significant achievement was wide application modern methods of pain relief.
The main disadvantage of this intervention is considered to be an increase in the incidence of postpartum infectious complications by 5-20 times. However, adequate antibacterial therapy significantly reduces the likelihood of their occurrence. However, there is still debate about in which cases a caesarean section is performed and when physiological delivery is permissible.
When is surgical delivery indicated?
A caesarean section is a major surgical procedure that increases the risk of complications compared to a normal vaginal birth. It is carried out only according to strict indications. At the request of the patient, CS can be performed in private clinic, but not all obstetricians-gynecologists will undertake such an operation unless necessary.
The operation is performed in the following situations:
1. Complete placenta previa is a condition in which the placenta is located in the lower part of the uterus and closes the internal os, preventing the baby from being born. Incomplete presentation is an indication for surgery when bleeding occurs. The placenta is abundantly supplied with blood vessels, and even slight damage to it can cause blood loss, lack of oxygen and fetal death.
2. Occurred prematurely from the uterine wall - a condition that threatens the life of the woman and child. The placenta detached from the uterus is a source of blood loss for the mother. The fetus stops receiving oxygen and may die.
3. Previous surgical interventions on the uterus, namely:
- at least two caesarean sections;
- combination of one CS operation and at least one of the relative indications;
- removal of intermuscular or on a solid basis;
- correction of a defect in the structure of the uterus.
4. Transverse and oblique position of the child in the uterine cavity, breech presentation (“bottom down”) in combination with an expected fetal weight of over 3.6 kg or any relative indication to operative delivery: a situation where the child is located at the internal os not by the parietal region, but by the forehead (frontal) or face (facial presentation), and other location features that contribute to birth trauma in the child.
Pregnancy can occur even during the first weeks of the postpartum period. The calendar method of contraception is not applicable in conditions of an irregular cycle. The most commonly used condoms, mini-pills (gestagen contraceptives that do not affect the child during feeding) or regular ones (in the absence of lactation). Use must be excluded.
One of the most popular methods is. Installation of an IUD after a cesarean section can be performed in the first two days after it, however, this increases the risk of infection and is also quite painful. Most often, the IUD is installed after about a month and a half, immediately after the start of menstruation or on any day convenient for the woman.
If a woman is over 35 years old and has at least two children, at her request, during the operation, the surgeon can perform surgical sterilization, in other words, bandaging fallopian tubes. This is an irreversible method, after which conception almost never occurs.
Subsequent pregnancy
Natural birth after cesarean section is allowed if the formed connective tissue on the uterus it is strong, that is, strong, smooth, able to withstand muscle tension during childbirth. This issue should be discussed with your attending physician during your next pregnancy.
The likelihood of a subsequent birth normally increases in the following cases:
- the woman gave birth to at least one child vaginally;
- if the CS was performed due to incorrect fetal position.
On the other hand, if the patient is over 35 years old at the time of subsequent births, she has excess weight, concomitant diseases, discrepant sizes of the fetus and pelvis, it is likely that she will undergo surgery again.
How many times can you have a caesarean section?
The number of such interventions is theoretically unlimited, but to maintain health it is recommended to do them no more than twice.
Typically, the tactics for repeated pregnancy are as follows: the woman is regularly observed by an obstetrician-gynecologist, and at the end of the gestation period a choice is made - surgery or natural childbirth. During normal childbirth, doctors are ready to perform emergency surgery at any time.
It is better to plan pregnancies after a cesarean section at intervals of three years or more. In this case, the risk of suture failure on the uterus is reduced, pregnancy and childbirth proceed without complications.
How soon can I give birth after surgery?
It depends on the consistency of the scar, the age of the woman, concomitant diseases. Abortions after CS have a negative impact on reproductive health. Therefore, if a woman does become pregnant almost immediately after a CS, then with a normal course of pregnancy and constant medical supervision, she can carry a child, but delivery will most likely be operative.
The main danger early pregnancy after CS there is a failure of the suture. It is manifested by increasing intense pain in the abdomen, the appearance of bloody discharge from the vagina, then signs of internal bleeding may appear: dizziness, pallor, drop in blood pressure, loss of consciousness. In this case, it is necessary to urgently call an ambulance.
What is important to know when having a second caesarean section?
Planned surgery usually performed at 37-39 weeks. The incision is made along the old scar, which somewhat lengthens the operation time and requires stronger anesthesia. Recovery after a CS may also be slower as scar tissue and abdominal adhesions prevent the uterus from contracting well. However, with a positive attitude of the woman and her family, and the help of relatives, these temporary difficulties are completely surmountable.
