At what time is a cesarean section usually done and what does it depend on?

If a woman is going to give birth by caesarean section, along with a host of other nuances, she is also concerned about the time within which the operation will be performed.

Knowing the estimated time period allows a woman to plan a lot, including choosing the exact date of birth of the baby. In this article, we will look at when women in labor are operating and what these periods may depend on.

For surgeons, it is considered most preferable if the operation is performed on the relaxed muscles of the uterus, that is, before the onset of regular labor activity - contractions. That is why up to 40 weeks, when their spontaneous offensive is most likely, they rarely wait. They are trying to set the date of a planned cesarean section for optimal terms that will suit everyone.

The baby is considered full-term from the 37th week of pregnancy.accordingly, his appearance at this time will not be regarded as an extraordinary situation.

It is precisely because the risk of respiratory failure at 37 weeks is higher than at 40, but at 40 natural physiological contractions can begin, the Ministry of Health of Russia defined clear clinical guidelines, which are set out in a letter of May 6, 2014 No. 15-4 / 10 / 2-3190, which was sent to all obstetric institutions, antenatal clinics and hospitals to develop common standards for providing medical care to women in childbirth.

This document does not have a double answer to the question of when to perform a planned cesarean section.

Emergency cesarean section, which is done to save the life of the mother and fetus, is not regulated by any deadlines.

If necessary, when a threat of death of the baby, its trauma occurs, with the development of weakness of labor, with placental abruption before the deadline, with the discharge of water and a long anhydrous period, as well as with the loss of umbilical cord loops, with the development of acute oxygen deficiency in the baby (hypoxia), an operation is performed for health reasons. Make it can and on 7 months pregnant, and on the 8th month, and already directly in childbirth, if you yourself can not give birth to a woman.

Another approach to planned operations. When choosing a term, a physician must take into account not only the interests of the woman in labor, but also the interests of the baby. The term must be such that the potential benefit of delivery for the mother and fetus exceeds the harm by several times. This choice is not easy, especially in case of multiple pathologies of pregnancy.

For medical reasons, the first cesarean section is usually tried at the 39th week of pregnancy, as required by the Ministry of Health of Russia.2 cesarean section in the absence of warning signs that require earlier delivery, also try to appoint 39-40 week of pregnancy.

3 and 4 cesarean sections are more complex technically, moreover, the risk of uterine rupture due to the scar thinning in previous operations increases significantly.

Therefore, women are trying to hospitalize earlier and operate on 38-39 weeks of pregnancy in the absence of pathologies. If the fifth operation in a row, it is considered better to operate on the 37-38 week, up to 39 weeks is extremely rare.

Doctors can retreat from clinical recommendations only if there are weighty circumstances. With emergency caesarean section, everything is more or less simple: it became necessary - they operated on it. But why can change the date of the planned operation?

Before 39 weeks, surgery can be prescribed if:

• there are signs of smoothing, shortening of the cervix, which increases the likelihood of the onset of independent contractions and the onset of labor;
• other “precursors” of childbirth appeared - the mucus plug departed or began to move away in parts, the woman had frequent training fights;
• the woman and the fetus have Rh-conflict, which is confirmed by a blood test for antibody titer in maternal blood, and the titer has reached high values;
• there were signs of a threat of rupture of the previous scar (in the third trimester, pregnant women with a scar on the uterus should do an ultrasound every 10 days);
• a woman has a strong preeclampsia, edema, increased blood pressure, there is a significant pathological weight gain and suspected preeclampsia;
• According to the results of CTG, the fetus shows signs of severe, threatening ill-being.

In this case, the doctor assumes the potential risk of distress syndrome in the child. The likelihood of respiratory failure after birth is higher, but it is even more dangerous for the baby to remain in the womb, because the probability of its prenatal death or severe damage to the central nervous system is higher than the corresponding possibility of a lack of surfactant in the lungs.

The state of the fetus according to the results of CTG does not cause concern. It is always better for a child if he stays in the womb as much as is intended for him by nature. In the case of cesarean section - almost as much.

In some cases, doctors try to deliberately postpone the moment of cesarean section, if they have reason to believe that it will be better for the child. For example, when water leaks or leaves for a period of up to 36 weeks of pregnancy, they try to prolong the pregnancy for at least a week or two, to give the baby time to gain weight and acquire an adequate supply of surfactant in the lungs. All this time, a woman lies in a sterile ward, she is forbidden to get up, support is provided by the hardware, medication. The baby is monitored around the clock in real time.

In recent years, women have been widely discussing new methods in conducting the COP. So, some experts in the field of obstetrics hold the opinion that it is better to wait for the onset of contractions, and only then perform a caesarean section, since this will be most natural for the child, his stress from a sudden birth without passing through the birth canal will be lower.

Surgeons with years of experience claim that it is rather difficult to judge the impact of such tactics on the child, but the likelihood of postpartum complications due to the operation on the contracting uterus can be much more pronounced.

Slow caesarean section - a method that is now gaining momentum and is in great demand among women in Europe.

The essence of the operation lies in the fact that the surgeon makes an incision in the uterus, but very small, through which the child can not be taken all at once. The woman is under epidural or spinal anesthesia. The task of the doctor is to create the most natural conditions for the birth of a child. Through a small incision, it is taken out little by little, gradually, similarly with the smooth progress of the fetus through the birth canal during natural childbirth.

In Russia, slow cesarean section is not done everywhere at all, and not all. But if you aim, you can find a doctor who will undertake such an operation. The search area should be limited to perinatal medical centers that provide paid services to pregnant women and women in childbirth, since the doctors of the usual maternity hospital will not violate the recommendations of the Ministry of Health regarding the technique of performing a cesarean section.

According to the opinions of women, doctors of women's clinics have no relation to the choice of the date of the operation. This question is decided by doctors in the maternity hospital, where a woman needs to go to bed before a planned cesarean section 7 days before the onset of 39 weeks. That is, if there are no special indications for reducing the time, you need to go to the hospital at 38 weeks. Analyzes, examinations, control ultrasound, a conversation with an anesthesiologist and premedication - this is just an incomplete list of what is to be in preparation for the operation.

For the most part, according to reviews, doctors perform surgery for a period of 39-40 weeks, while women are allowed to choose the date of birth independently.

More information about the technique of the operation and the timing can be found in the following video.