Statistics er after ks. Natural birth after caesarean section. So what can you choose

Systematic review of the Maternity Center Association’s Systematic Review & Education & Quality Improvement Campaign. Caroll Sakala, MD, MPH, and Maureen P. Corry, MPH.
http://www.childbirthconnection.org/article.asp?ck=10271&ClickedLink=200&area=2
Results. The authors systematized more than 300 research reports, which allowed them to draw the following conclusions:
1. Risks and adverse consequences depend on the method of delivery
2. The results support vaginal birth
3. Medical intervention during childbirth is associated with a number of adverse consequences.

In general, spontaneous vaginal birth is the most beneficial for mother and fetus.

Study results show absolute risks

Short-term adverse effects on mothers caused by caesarean sectionCompared to vaginal birth, the risk increases:

maternal deaths due to surgery or due to anesthesia (less commonly)
emergency hysterectomy (removal of the uterus);
thromboembolism;
damage internal organs related to the operation;
longer hospitalization;
re-hospitalization (in some cases);
infections;
more severe and prolonged pain.

Social and emotional harm to mothers:

dissatisfaction with childbirth;
later contact with the newborn;
passive attitude towards the child at first;
psychological trauma (unplanned caesarean section);
depression;
deterioration mental health, decreased self-esteem;
deterioration in overall performance.

Long-term harm to the mother's body:

pain in the pelvic area;
difficulty in intestinal motility (intestinal obstruction) due to adhesions.

Risks to the child associated with the operation C-section :

accidental injury with a scalpel during opening of the uterus;
respiratory problems ranging from mild to more severe;
later the lactation mechanism starts;
asthma in early childhood and adolescence.

Threats for mothers in subsequent pregnancies after a previous CS:

secondary infertility;
voluntary infertility (forced abstinence from pregnancy for a certain period);
ectopic pregnancy;
placenta previa;
placenta accreta (the result of partial or complete absence of the spongy layer of the decidua due to atrophic processes in the endometrium);
placental abruption;
uterine rupture;
mother's death.

Risks to infants in subsequent pregnancies:

fetal death shortly before or after birth;
lower birth weight, risk of premature birth;
developmental defects;
damage to the central nervous system.

Some benefits associated with an unplanned cesarean section:

speed of operation compared to vaginal birth (advantage for the mother);
less emotional distress.

A planned caesarean section is still a “major operation”.

Risks associated with elective CS:

complications associated with tissue scarring and adhesions (the same applies to unplanned cesarean section);
in subsequent pregnancies, uterine rupture along the scar is possible (the same applies to an unplanned cesarean section);
the likelihood of iatrogenic respiratory problems in the child and the risk of developing respiratory distress syndrome due to the rapid removal of the child from the uterus to avoid the negative effects of anesthesia on him.
negative birth experience;
psychological trauma (traumatic symptoms, post-traumatic syndrome);
sexual problems;
decreased overall performance/long recovery period.

Adverse effects on the mother when labor is induced:

perineal ruptures 3 and 4 degrees;
severe bleeding with blood transfusion;
readmission;
infectious process;
pain in the perineum (consequences of episiotomy);
urinary and fecal incontinence;
intestinal problems.

limit intervention during childbirth:
maintain childbirth assistance skills;
avoid routine episiotomy;
Offer a caesarean section if it appears that a major procedure is to be performed.

Adverse consequences for newborns when interfering with the natural process of childbirth:

traumatic brain injury;
brachial plexus injury (also during unstimulated labor).

Adverse maternal consequences of induced and natural vaginal birth:

pain in the perineum;
urinary incontinence;
incontinence of intestinal contents;
problems of pelvic floor dysfunction caused by intervention.

Damage to the pelvic floor leads to:

instrumental childbirth;
pushing in a supine position;
strong, directed attempts;
pressure on the fundus of the uterus to expel the fetus from the uterus;
perineal pressure;
multiple vaginal births;
routine, widespread use of episiotomy (for example, in 2002, in New York City hospitals, episiotomy was used in 1% to 88% of all vaginal births).

Vaginal birth and later life with incontinence problems:

incontinence problems that increase after childbirth go away over time;
the difference between groups of women after cesarean section and after vaginal delivery in terms of urinary and bowel incontinence disappears by age 50;
High rates of long-term incontinence are associated with other factors.

Factors influencing incontinence, not related to pregnancy and childbirth:

overweight;
smoking;
hormone replacement therapy;
hysterectomy(uterus removal);
urinary tract infections;
some chronic diseases;
some medications;
limited mobility;
genetic factors.

Today we will share the opinion of specialists and mothers from our forum on the topic of preparing for natural birth (NV) after cesarean section (CS).

Experts' opinions

Caesarean section is the most common abdominal operation worldwide, surpassing even appendectomy in frequency. The greatest danger is uterine rupture during repeated pregnancy and childbirth. The frequency of which is 69.5%. Rupture occurs only when the scar on the uterus is incompetent, its degenerative changes and/or chronic inflammation. Placenta accreta into the scar area is also dangerous. If the scar is strong, the pregnancy proceeds normally, without any complications, this percentage is no more than 4.
Contraindications to vaginal delivery in women with a uterine scar are:
Anatomically narrow pelvis;
- attachment of the placenta in the scar area;
- breech presentation fetus;
- polyhydramnios;
- large fruit;
- complicated course of the previous operation;
- gestosis, preeclampsia, eclampsia;
- a scar on the uterus after conservative myomectomy, with entry into the uterine cavity, removal of multiple myomatous nodes.
When is vaginal delivery possible:
In an uncomplicated previous pregnancy with a well-established uterine scar.
How to assess the health of a scar. The approach to assessment should be comprehensive, which includes taking an anamnesis:
When and for what reason was the CS performed, how did the postoperative period proceed?
- data on the study of the scar outside pregnancy, as well as during it;
- hysteroscopy outside pregnancy;
- the number of pregnancies between the CS and the real pregnancy is specified;
- you need to know about the course of this pregnancy;
- Ultrasound assessment of the uterine scar in dynamics;
- assessment of the consistency of the uterine scar according to ultrasound data. This criterion is by far the most important and reliable.
A postoperative scar with a thickness of 3 to 5 mm is considered to be consistent with a uniform echostructure. The scar is considered incompetent if the echostructure is heterogeneous, with hyperechoic inclusions, less than 3 mm thick.
If the pregnancy is normal, the condition of the fetus is satisfactory and there are no signs of scar failure at 38 weeks, the patient should be hospitalized in the department of pathology of pregnant women of the maternity hospital. The maternity hospital must be highly equipped. There the question of the method of delivery will be decided.

If the CS happened, then the doctors had reasons for this. But in the next pregnancy, perhaps everything will turn out more favorably, and future mom can discuss the EP option with your doctor. Remember, your desire is a serious component for EP. But first of all, you need to focus on the goal: the well-being of the child and mother after childbirth. And if there is even the slightest risk for one of the two, doctors will recommend a CS again.
It must be admitted that doctors are not very fond of giving permission for ER after a CS, despite the fact that women often ask for it. As a rule, women in labor do not know all the obstetric nuances. The doctor evaluates the entire medical history and must weigh the pros and cons for the fetus and mother. Of course, if a woman decides to have EP, contrary to the advice of doctors, then no one can stop her. After all, the operation requires her written consent. Therefore, it is very important that doctors explain everything to you in great detail, so that it becomes clear whether there really is a risk in EP.
In addition, you need to know that in a situation where a woman in labor arrives at the maternity hospital with her “head in the pelvis” and there are 20-30 minutes left before the end of labor, a CS can no longer be performed. But such cases are extremely rare, and there is no need to specially provoke them.
And another important component for natural childbirth after a caesarean section is preparation! Agree, if you need to prepare for a normal birth, then in this special case especially. These women will have to not only breathe, move, use different ways to combat pain, they will have to do it all perfectly! No room for error! And if there is an assistant-partner next to them, then he should be well versed in the situation and take on part of the work himself.

I want to talk about giving birth with a uterine scar. For some reason, many people think that these are some other births. Let's figure it out. If it so happened that your first or second birth ended in a CS, by your will or according to indications, then this does not mean at all that you only need to do a cesarean section. It used to be like this, however. But now world standards have changed. Giving birth after a CS is no surprise to anyone now.
What is important to understand and do:
It would be good to be 100% sure that you want to give birth naturally. When I hear even a hint of doubt, I don’t even undertake to lead such a woman;
- lead healthy image life. Swimming, yoga, nutrition, sauna. The body must also be confident;
- choose the right doctor who will not see the problem and persuade you to have a CS;
- visualization of your scar. I always do this test. I ask the woman to close her eyes and see her mark from the CS. Please describe. If you see a wound, torture, a black square, etc., then you need help in overcoming your fears. This must be done before giving birth, otherwise there will be a CS again.
There are features of labor management after a CS. It is better not to stimulate such labor. Plus, CTG during pushing should be mandatory. After childbirth, the doctor can examine the scar under IV anesthesia for integrity. This lasts 5-7 minutes. Russian practice. In Europe they simply do an ultrasound. Otherwise, it's a normal birth. By the way, as world practice shows, childbirth through ER is possible after two or three CS. Each woman has her own characteristics; it is better to consider them individually, taking into account the differences between pregnancies, ultrasound results and health status.

Maternity hospitals and doctors practicing ER after CS (according to the LV forum)

16 maternity hospital (all ER doctors are taken after CS)

Filatova Marina Petrovna.
Kleschelskaya Liliya Petrovna.
Vartanyan Ruzanna Albertovna.
Khamzalatova Aina Zalimkhanovna.
Dolzhenkova Nina Leonidovna.

Bobrova Galina Aleksnadrovna.
Balykova Nadezhda Dmitrievna.

Kulikova Natalya Alexandrovna.
Filippova Irina Gennadievna.
Poponina Taisiya Nikolaevna.
Pirogov Vladimir Georgievich.

Vakulenko Natalya Alekseevna.
Alekseeva Elena Viktorovna.

17(11) maternity hospital

Yankevich Yulia Vladislavovna.
Shman Vera Valerievna.

Maternity hospital of Gatchina.

Shuvalova Larisa Renatovna (Shkredik).

Shubina Nadezhda Dmitrievna.

Maternity hospital on Furshtatskaya

Dulikova Victoria Gennadievna.
Pankova Larisa Borisovna.

Reports from forum members about EP after CS

In contact with

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Have you had a baby in the past and now want to consider a natural (vaginal) birth? Natural childbirth after cesarean section (hereinafter referred to as EP after CS) can become good decision for many women. Every woman and every birth is unique. And the following information will help you, your doctor or midwife decide whether ER after CS is good option for you and your baby.

From 60 to 80% of American women who decided to have EP after a CS successfully gave birth to babies naturally. For the remaining 20-40%, the birth took place by caesarean section already during labor. For example, if labor does not progress or the baby’s condition worsens, a CS will most likely be performed.

You have a choice

When you start discussing your baby's upcoming birth with your doctor or midwife, you'll likely want to discuss your options.

So what can you choose:

Try to give birth naturally after a CS;
Scheduled CS.

Quality medical care

ER after CS should only occur in a hospital staffed by well-trained medical personnel who specialize in this category of birth.

Is ER after CS suitable for you?

There are many factors that you will need to think about. It is better to discuss everything with your doctor or midwife in advance, because this way you will have enough time to make the right decision for both you and the baby.

Why choose EP after CS?

In what cases should you choose a repeat CS?

Uterine rupture: if you experienced such a complication during a previous birth, you cannot be a candidate for ER after a CS;
Pregnancy with complications: If you have certain problems during pregnancy or the situation is such that ER may be risky, you most likely will not be a candidate for ER after a c-section.

There are certain risks

During ER after CS, a complication such as suture rupture may occur. abdominal cavity and the uterus, which happens quite rarely. As a rule, this does not cause significant complications for the mother or child. However, very rarely such a gap can cause serious harm for both mother and baby. Your doctor will tell you if you are at high risk of rupture. If you are at risk, EP after CS is not recommended for you.

You are a good candidate for EP after CS under the following conditions:

Previous EPs: you have had a vaginal birth in the past;
Spontaneous contractions: your contractions begin on their own, without the need for stimulation with medications or other means;
Non-recurring reasons for a previous CS: During your previous birth, you had a CS for a reason that most likely will not happen again (for example, breech presentation).

You may still be a candidate for EP after CS in the following cases:

You may not be a candidate for EP after CS if the following factors exist:

Be prepared to change your birth plan

The birth of a child can never be completely planned. Therefore, it is important to be prepared to reconsider your birth plan if circumstances change during labor.

Where is ER practiced after CS in the USA?

There are very few hospitals and doctors in the USA who undertake VBACK. By the way, this is what natural childbirth after a cesarean section is called. Can be deciphered as vaginal back. According to American requirements, during vback, an anesthesiologist, a doctor and other personnel must be constantly near the ward. In a normal case, there will also be medical staff near you, but the anesthesiologist will not sit at the door, he will be called in advance for epidural anesthesia and after the end of the procedure he will return to his office, and the doctor will come only when the dilation is 8-10 cm. With vback, everyone should be prepared for an emergency caesarean section. Many hospitals cannot afford this financially, and doctors refuse to accept such births, and even if you find a hospital that practices ER after CS, the second step will be to find an affiliated doctor in it who will agree to this option. There are only 3 places in Houston where you can try to give birth naturally - The Woman's Hospital of Houston, Texas Children's Hospital, Katy Memorial Hermann Hospital.