Natural delivery after cesarean section

The main question that interests women who gave birth to the firstborn by dissecting the uterus and extracting the child through this incision is whether natural births after cesarean are possible?

The obstetricians can not answer this question at once: they should know for what specific reasons the previous births of a woman required surgical intervention. That is, only on the basis of complete information about the "childbearing parameters" of the patient and her obstetric anamnesis doctors can give an approximate assessment of the chances of successful natural birth after cesarean section.

[1], [2]

The reasons for the impossibility of natural delivery after cesarean section

According to the World Health Organization, the normal rate of cesarean delivery is within 10% of all deliveries, including both emergency operations and planned ones. Although in the United States "Caesarea" at least 29% of women in childbirth.

Recall that the need for emergency removal of a child from the womb of the mother with the help of surgeons is most often associated with unforeseen complications arising in the process of already begun labor. Among such complications, obstetricians note: anomalies of labor activity (including, its insufficient activity or sudden complete cessation of contractions); too early detachment of the placenta; threat of rupture of the uterus; intrauterine hypoxia of the fetus.

In cases of urgent cesarean section, a vertical median laparotomy of the anterior abdominal wall is made (cut from the suprapubic fold to the near-buccal zone), but access to the uterus is performed through a horizontal incision in its lower segment (except for the presence of twins or abnormal fixation of the placenta). In this case, the risk of rupture of the uterus during subsequent physiological birth is estimated at 6-12%. With a planned caesarion, the dissection is only horizontal, which reduces the threat of a uterine rupture by an order of magnitude during future pregnancy and childbirth.

Obstetricians-gynecologists consider vaginal, that is, natural births after cesarean section impossible for the following reasons:

• anatomical features (too narrow small pelvis or vagina);
• abnormal presentation of the fetus (oblique, gluteal, foot);
• the placenta is located in the lower segment of the uterus;
• a large fetus or a multiple pregnancy;
• premature birth or a delayed pregnancy;
• the need to stimulate the onset of labor;
• fetal distress;
• presence of cardiovascular pathology in the mother, hypertension, diabetes mellitus, renal failure, severe nearsightedness and retinal detachment;
• cervical cyst;
• an active herpes virus was detected in the genital area;
• obesity in pregnant women;
• pregnancy after 40 years;
• term less than two years from the time of surgical delivery.

Natural births after cesarean section are successful if the woman had at least one physiological birth or had already had such births after cesarean; if the root causes of this operation are not repeated in the pregnancy; a woman does not have major medical problems; the size of the fetus and its position do not deviate.

Preparing for natural childbirth after caesarean section

Anticipating or planning the possibility of having children after surgical intervention during childbirth, a woman needs to know that the preparation for natural childbirth after cesarean involves determining the condition of the scar on the uterus before a new pregnancy - a maximum of 1-1.5 years after the abdominal delivery.

For this purpose, hysterography (X-ray of the uterus with radiopaque substance) is prescribed, as well as hysteroscopy, endoscopic examination of the rumen. This is especially important if the cesarean section was corporeal (that is, with a longitudinal dissection of the peritoneum and uterus).

Making a natural decision to give birth after cesarean, a woman should realize that observation at a gynecologist - with all the examinations and taking tests - is necessary and presupposes the medical accompaniment of pregnancy literally from her first days. And prenatal patronage will be the same as with any other healthy pregnancy. And the organism of the pregnant woman prepares for the appearance of the child in advance: under the action of the hormone relaxin, the elasticity of the muscle fibers increases, the symphysis ligaments gradually loosen, the pelvic bones slightly divorce, and so on.

The final conclusion can be made by the physician starting from the 36th week of the gestation period - after ultrasound, which is designed to determine the size of the fetus, its position in the uterus, the condition of the placenta and the scar on the uterus.

Features of natural childbirth after cesarean

The main features of natural births after cesarean are that the attention to their progress on the part of the medical staff is increased, and the surgeon with the anesthesiologist - in case of unforeseen complications - should be ready for the caesarean section at any time.

Leading specialists in the field of obstetrics emphasize the importance of the natural course of labor, despite the possibly longer process of natural extension of the birth canal during fights, and warn of the danger of their stimulation.

However, most often such births stimulate. First, an amniotomy is performed, that is, an amniotic fluid is opened by artificial means. Such a procedure is supposed to promote the activation of labor due to increased irritation of the uterine receptors after contact with the head of the fetus.

Further, to increase uterine contractions, uterotonic drugs may be used: Oxytocin, Ergometrin (Methylergometrin), Dinoprostone (Dinoprost, Misoprostol).

Western studies conducted by Western obstetrics showed that prostate gland stimulators based on prostaglandins (Dinoproston and others) should not be used after vaginal deliveries after cesarean, as this may lead to an increased risk of rupture of the uterus by 1-1.9%. Specialists of the American College of Obstetricians and Gynecologists (ACOG) believe that with the weakness of labor in the active phase of labor, it is permissible to use Oxytocin, although, of course, this can lead to undesirable consequences.

The greatest concern for women who had a cesarean section in their last births is the threat of the fact that during the vaginal birth the uterus may not sustain the strength of the contractions of the muscle layer and "burst along the seam". Indeed, such a risk exists, and, according to ACOG, if the cross section was transverse and low, the probability of uterine rupture in physiological births is 0.2-1.5% (approximately one chance out of five hundred).

And according to WHO statistics, natural births after cesarean section are successful in 7-9 cases out of 10.

[3], [4], [5], [6], [7], [8]