In short: A planned cesarean section (CS) is scheduled in advance if there are medical indications. This is a planned surgical operation that is performed under spinal anesthesia. The scar heals in 6-8 weeks. Caesarean is not an "easy way", but a full-fledged operation with a recovery period. The decision on the need for a CS is made by the doctor based on clinical data.
What is a planned cesarean section
Caesarean section (CS) is a surgical operation in which the baby is removed through an incision in the anterior abdominal wall and uterus. A planned C-section is prescribed in advance, usually at 38-39 weeks of pregnancy, if there are medical indications that exclude or make undesirable natural childbirth.
Unlike emergency CS, which is carried out during labor that has already begun when the life of the mother or fetus is threatened, planned CS is a manageable situation. This allows you to carefully prepare, choose the optimal time, anesthesiologist and surgeon.
Indications for planned cesarean section
Indications for planned CS are divided into absolute (natural childbirth is impossible or life-threatening) and relative (natural childbirth is possible, but the risks are increased).
Absolute indications from the mother:
Complete placenta previa (the placenta completely overlaps the internal os of the cervix).
Scar on the uterus after a previous CS in a number of situations (incompetent scar, two or more CS in anamnesis).
Severe heart defects, decompensated diseases of other organs, in which pushing is dangerous.
Some ophthalmic diseases (retinal detachment, severe myopia with retinal changes).
Anatomically narrow pelvis of 3-4 degrees.
Complete placenta previa (the placenta completely overlaps the internal os of the cervix).
Scar on the uterus after a previous CS in a number of situations (incompetent scar, two or more CS in anamnesis).
Severe heart defects, decompensated diseases of other organs, in which pushing is dangerous.
Some ophthalmic diseases (retinal detachment, severe myopia with retinal changes).
Anatomically narrow pelvis of 3-4 degrees.
Indications from the fetus:
Transverse position of the fetus.
Breech presentation under a number of conditions (large fetus, narrow pelvis, extension of the head).
Multiple pregnancy with breech presentation of the first fetus.
Confirmed fetal malformations (gastroschisis, some CNS malformations).
Chronic placental insufficiency with impaired blood flow.
Transverse position of the fetus.
Breech presentation under a number of conditions (large fetus, narrow pelvis, extension of the head).
Multiple pregnancy with breech presentation of the first fetus.
Confirmed fetal malformations (gastroschisis, some CNS malformations).
Chronic placental insufficiency with impaired blood flow.
Relative indications are a combination of several factors in which the risks of vaginal birth exceed the risks of CS: age of the primiparous woman, prolonged infertility, uterine scar after myomectomy, large fetus, burdened obstetric anamnesis.
Timing of a planned cesarean
Planned CS in singleton pregnancy is usually carried out at 38–39 weeks. Earlier terms are indicated for specific conditions: placenta previa at 36-37 weeks, monochorionic twins at 36 weeks, trichorionic triplets at 35 weeks. It is important to allow the fetus to ripen as much as possible, while avoiding the onset of labor, which can complicate the operation.
How is a planned cesarean section performed?
Anesthesia. In most cases, spinal anesthesia (spinal block) is used: the anesthetic is injected into the spinal canal, the lower half of the body is completely anesthetized. The woman remains conscious and can immediately see and hear the baby. General anesthesia – only in case of emergency or contraindications to spinal anesthesia.
Surgery. Duration - 30-60 minutes. The incision is made transversely (horizontally) above the pubis - the so-called Pfannenstiel incision. Through the incision in the uterus, the child is removed in 5-10 minutes, then the obstetrician-gynecologist sutures the uterus and abdominal wall in layers.
Child. In a stable condition, immediately after birth, the child is placed on the mother's chest ("skin to skin") - this is possible even with CS. Early attachment to the breast helps to start lactation. Read more about breastfeeding in the corresponding section.
Preparation for a planned cesarean
On the eve of surgery:
Do not eat 6-8 hours before surgery (usually from midnight).
Do not drink for 2-4 hours.
Shower, removal of hair in the pubic area and lower abdomen (or it will be done in the maternity hospital).
Remove nail polish (the anesthesiologist controls oxygenation by nail color).
Do not eat 6-8 hours before surgery (usually from midnight).
Do not drink for 2-4 hours.
Shower, removal of hair in the pubic area and lower abdomen (or it will be done in the maternity hospital).
Remove nail polish (the anesthesiologist controls oxygenation by nail color).
Documents and things: a full set of documents for the maternity hospital, things for stay (gown, slippers, compression stockings). Compression stockings are worn before or immediately after surgery - they reduce the risk of thrombosis.
Postoperative period and recovery
The first day. After the operation, 2-4 hours in the intensive care unit. The catheter in the bladder is removed after 12 to 24 hours. You can get up as early as 6-12 hours after surgery - early activation reduces the risk of complications.
Pain. In the first days, pain in the scar area is normal and manageable with painkillers (paracetamol, ibuprofen, stronger drugs if indicated). After 3-4 days, the intensity of pain decreases significantly.
Scar. Healing of the skin suture is 5-7 days. Full healing of the scar on the uterus is 6-8 weeks. During this time, you should not lift weights, engage in intense physical activity. The next pregnancy is recommended no earlier than in 18-24 months.
Breastfeeding. Caesarean section does not interfere with breastfeeding. Milk comes a little later than after vaginal birth (due to the absence of hormonal "release" when passing through the birth canal), but with regular attachments, lactation is established normally.
Caesarean and the next pregnancy
A scar on the uterus after a CS is an important factor in the next pregnancy. With a good scar and spacing (18-24 months), vaginal birth after cesarean (VBAC) is possible under certain conditions. However, in most Russian maternity hospitals, if there is a scar on the uterus, a second CS is recommended. Discuss this with your doctor when planning your next pregnancy.
When to see a doctor
Consult a doctor immediately after discharge if:
Signs of scar inflammation: redness, swelling, discharge from the suture, fever.
Severe abdominal pain that cannot be relieved by analgesics.
Heavy bleeding from the vagina.
Signs of thrombosis: pain and swelling of the leg, shortness of breath.
Signs of scar inflammation: redness, swelling, discharge from the suture, fever.
Severe abdominal pain that cannot be relieved by analgesics.
Heavy bleeding from the vagina.
Signs of thrombosis: pain and swelling of the leg, shortness of breath.
Frequently Asked Questions
Is it possible to ask for a cesarean section without medical indications?
In Russia, under compulsory medical insurance, a planned CS is not carried out without medical indications. According to the clinical recommendations of the Ministry of Health, the "patient's desire" is not an independent indication for surgery. In the presence of pronounced anxiety before childbirth, psychological support and counseling are recommended. Discuss your concerns with your doctor – many fears are quite solvable.
Caesarean or vaginal birth: which is better?
In the absence of indications for cesarean delivery, vaginal birth is preferable for most women and children: shorter recovery, lower risk of respiratory complications in the newborn, better formation of the microbiota. CS is a justified and necessary operation if there are indications. The WHO considers the optimal frequency of CS to be 10-15% of all births; in Russia, this figure is higher - about 28%.
Conclusion
A planned cesarean section is a safe and well-practiced operation if there are medical indications. It requires preparation, competent anesthesia and full recovery. If the doctor recommends a C-section, discuss the causes, do not be afraid to ask questions and trust the specialists. If you want a vaginal birth, but you are prescribed a planned CS, you have the right to get the opinion of another specialist.
Bibliography
- WHO Statement on caesarean section rates. WHO, 2015. https://www.who.int/publications/i/item/WHO-RHR-15.02
- ACOG Practice Bulletin No. 205. Vaginal Birth After Cesarean Delivery. Obstet Gynecol. 2019. https://pubmed.ncbi.nlm.nih.gov/30629583/
- NICE Guideline NG192. Caesarean birth. NICE, 2021. https://www.acog.org/womens-health/faqs/cesarean-birth
- Ministry of Health of the Russian Federation. Clinical guidelines: Caesarean section. Ministry of Health of the Russian Federation, 2021. https://cr.minzdrav.gov.ru/
- Sandall J, et al. Short-term and long-term effects of caesarean section on the health of women and children. Lancet. 2018;392(10155):1349-1357. https://pubmed.ncbi.nlm.nih.gov/30322585/
This material is for informational purposes only and does not constitute medical advice and is not a substitute for medical advice. If a child's sleep is accompanied by alarming symptoms, a pronounced deterioration in health, problems with breathing, feeding or weight gain, it is necessary to consult a qualified medical specialist as soon as possible, and not rely only on information from the Internet.
