How do you want to give birth by caesarean section?

How do you want to give birth by caesarean section? The day of meeting the baby in your belly is coming. Have you decided on your mode of production when you are full of expectations? A mode of production that suits others may not suit you. For expectant mothers who are still hesitating, this magazine specially planned and invited three senior obstetricians and gynecologists to make a simple and comprehensive analysis of the characteristics and precautions of natural delivery and caesarean section. At the end of the article, a comparison table is attached, so that you can fully understand the advantages and disadvantages of the two production methods and the common problems before and after delivery, so that you are no longer confused. I wish all expectant moms a smooth delivery! Natural delivery & Advantages and disadvantages of caesarean section Director Wang Peizhong said that natural delivery is the most natural mode of production, and caesarean section is a surgical operation to intervene in the production when the mother and fetus have unexpected situations. Although part of the health of the mother and fetus may be sacrificed, it should still be given priority when the doctor evaluates the necessity; On the contrary, if caesarean section is not needed, it is recommended to give priority to natural delivery.

As for the simple comparison of advantages and disadvantages, basically, caesarean section doctors can control more diseases and less natural delivery; If the mother's condition is suitable for natural delivery, then natural delivery will be better for the health of the fetus and the wound will be smaller. In principle, natural delivery is the main method, and caesarean section can be used if there are special circumstances. At present, the choice of domestic production mode is probably: natural delivery accounts for 2/3, caesarean section accounts for 1/3. In other words, an average of 3 parturients have 1 caesarean section, which has become the norm. Social and medical progress, the progress of surgical materials, and the rescue of mother and fetus in emergency are all reasons for the increase in the proportion of caesarean section. With the invention of fetal monitor, the proportion of caesarean section has increased year by year. In fact, once the fetal heart sounds are found to be unstable, but if there is no obvious immediate harm, there is no need for caesarean section immediately, so you can continue to observe first; If the instability persists, caesarean section should be taken.

What is the indication of caesarean section in line with the indication of caesarean section paid by medical insurance, and the prospective mommy does not have to pay for the delivery herself? Director Wang Peizhong pointed out that the indications of caesarean section can be roughly divided into 10 directions:

How do you want to give birth by caesarean section? (3) Patients who have undergone major pelvic or spinal surgery. (4) pregnant with multiple births. (5) Mother is seriously ill. (6) The fetus has abnormal problems. * For example, if the fetus has a tumor or gastroschisis, and the head caused by water brain is too large, it is also recommended to change to caesarean section. (7) The uterus has undergone major surgery. * For example, I have had hysteromyoma surgery or bilateral uterine plastic surgery. Because there may be a risk of rupture after surgery, caesarean section is recommended. (8) There is something wrong with the placenta. * For example: placental abruption (abnormal function) or placenta previa (abnormal position). Placenta problem is the absolute indication of caesarean section, regardless of natural delivery. (9) Abnormal fetal position. * Ovarian tumors, uterine fibroids, umbilical cord entanglement and other reasons may cause fetal dislocation. Do you want to have a caesarean section if the fetal position is not correct? Opinions vary, in fact, it depends on the maternal status, the number of weeks of pregnancy, the number of births and so on. For example, if the fetal position is abnormal after 28 ~ 30 weeks of pregnancy, then up to 80% of the fetuses will turn back to normal fetal position, and only 20% of the fetuses will still have fetal position.

If it is a normal cephalic delivery, in fact, the mother is the main one, and the doctor only provides assistance; If it is breech delivery, the doctor is the main one, and the role of the parturient is changed to cooperate with the doctor, which requires higher technical requirements for the doctor. Knee-chest supine position may correct fetal malposition, but it may not be successful, so there is no need to force it. If you are pregnant with the first child, because even if the fetal position is correct, you may not be able to give birth naturally, so don't forcibly give birth when the fetal position is incorrect; After the second child, you can discuss with your doctor whether to try natural delivery. In the past, multiparas could try natural delivery even in breech position. However, because of the risk of transposition during delivery, most of the cases with abnormal fetal position will take caesarean section to ensure safety.

(10) Prenatal caesarean section. * "Cesarean section for the first child, whether this fetus must be delivered by caesarean section" is also a controversial issue. Although it meets the indications of health insurance, some private insurance companies may not pay for caesarean section, so pay attention to the relevant provisions. If you have never given birth to a child in a natural way before and the first few births are caesarean sections, doctors generally do not recommend a natural birth. If you have had a successful delivery and have had a caesarean section, you can try a natural delivery when the indication of caesarean section caused by the previous fetus disappears.

How do you want to give birth by caesarean section? Do not meet the indications, but the reasons for self-funded caesarean section? Director Wang Peizhong explained that many women obviously do not meet the indications of caesarean section and have no doubt about their health, but they still have to have caesarean section. There are three main reasons to sum up:

Fear of pain and fear of the unknown: in fact, both natural delivery and caesarean section will hurt, and the only difference is "pain before natural delivery and pain after caesarean section" Compared with the degree of pain, in fact, caesarean section generally hurts (within 3 days after delivery). It is only because postoperative analgesia is more convenient to perform that the parturient will have the illusion that caesarean section seems less painful.

Worried about * * * relaxation: natural products do have the possibility of * * * relaxation, just like a rubber band stretched for too long, which will naturally relax if it exceeds the elastic limit. However, as long as the baby can pass through the birth canal as soon as possible, it will not take a lot of time and cause no damage to the birth canal, and it will not have much impact on the * * * and pelvis, and it will not necessarily face the problem of * * * relaxation.

How to use the 3-P equation of natural childbirth to make the baby be born as soon as possible and give birth smoothly? We must master 3P (power, passengers, ways), that is, the physical strength of the mother and the strength of uterine contraction, the size and health of the fetus, the space of the birth canal and so on. In order to give birth smoothly. If the pelvis is not injured, there is no need to worry about relaxation. First of all, my mother's physical strength is good, and she should maintain moderate exercise during pregnancy and participate in mother's classroom courses held by major hospitals. Diet and weight during pregnancy should also be controlled, so as not to gain too much weight, so as to avoid the fetus being too large, resulting in a smaller relative birth canal, resulting in birth canal pressure and natural production risks.

Look at the time: China people often like to look at the date of birth, which is actually quite unnecessary. Especially in the case of giving birth in the middle of the night, there are relatively few resources and insufficient manpower to ask for help in case of situation. In addition, the mental state of medical staff is not as good as during the day, and caesarean section in the middle of the night is not encouraged, so as not to affect the health of mother and fetus.

Dr. Li Zhongyuan added, "If you look at the time, others may look at the same time." If everyone watches the same auspicious time, the next parturient waiting for caesarean section will be under pressure from the previous operation time for fear of missing the time. Doctors may be busy, mishandled, and the interval between two operations is limited, which may lead to incomplete disinfection of surgical instruments. In addition, if the selected time period is the outpatient period of the surgeon, the surgeon may be under pressure because he has to rush back to the outpatient clinic to see a doctor, and the operation risk is relatively high. Especially for high-risk pregnant women or multiple births, caesarean section is not recommended.

Is it easy to urinary incontinence after natural delivery? Director Wang Peizhong said that the relaxation of pelvic structure may lead to urinary incontinence. The probability of urinary incontinence after natural delivery is indeed higher than that after caesarean section. But five common causes of urinary incontinence are analyzed: age (older people are more likely), obesity, pregnancy, mode of production, chronic cough or chronic constipation (due to increased abdominal pressure). The mode of production is only one of the reasons, and there are other factors that cause urinary incontinence, not a single factor.

In fact, the wound of caesarean section is easy to leave scars, subcutaneous fat and subcutaneous hematoma, and abdominal organs may be sticky, which is also a problem that may be encountered after caesarean section. In addition, after caesarean section, there is often the trouble of unclean menstruation (because there are scars caused by caesarean section in the uterine cavity, which will form a cavity to accumulate menstrual blood), resulting in menstrual period lasting for many days, so caesarean section should be performed again when there are indications, focusing on the health of the mother and fetus.

How do you want to give birth by caesarean section? Director Wang Peizhong explained that if the risks of various production conditions are evaluated, the best and ideal situation for maternal prognosis is natural delivery; The next level is direct caesarean section; The second kind of situation is that the natural production process is not smooth, but it is still born smoothly; Needless to say, the situation with the highest risk is that it can't be delivered naturally, so caesarean section (natural delivery+caesarean section, commonly known as "eating the whole meal") is urgently adopted. Although the risk is great, it is still inevitable to "eat a whole meal" in an emergency. If the parturient wants to avoid eating the whole meal as much as possible, it is suggested that the principle of threesome must be mastered, and the chance of natural production is greater. In recent years, people in China eat too much and lack exercise, which may easily lead to problems such as large fetus, poor physical strength of mothers and overweight mothers. , resulting in poor conditions for threesomes, and the risk of dystocia in natural production will increase.

Do elderly women need caesarean section? Because of poor physical strength and stiff pelvis, elderly women may have a higher chance of "eating a whole meal", but many elderly women can still give birth naturally. Therefore, it is not necessary for elderly women to have a caesarean section, but it depends on whether it meets the indications of caesarean section.

It takes about 6 to 8 weeks for the uterus to return to its pre-pregnancy size. Whether it is a natural delivery or a caesarean section, it is encouraged to get out of bed as soon as possible after delivery; Normal activities can be gradually resumed in about 3 days to 1 week, but it still depends on the individual's recovery; Moderate exercise should wait until postpartum 1 month (for example, stretching, etc. ); As for strenuous exercise, it takes about 2 to 3 months after delivery to do it; On average 1 month after delivery, you can start having sex. If there is no wound in natural delivery, it can be 1, 2 weeks after delivery.

Do you want to cut the perineum and give birth naturally? There is no absolute conclusion whether to cut the perineum, it depends on the doctor's habit. It is recommended to discuss with the doctor first. Director Wang Peizhong pointed out that personally, most people still cut the perineum to avoid irregular opening of the wound, especially in the case of midwifery. Moreover, if the perineum is not cut, the fetal head may stay in the birth canal for too long, and the baby is prone to problems, and the mother is prone to urinary incontinence in the future.

How do you want to give birth by caesarean section? Pregnant women should still maintain moderate exercise habits. Generally, pregnant women should still exercise within their physical strength, and don't stop their original exercise habits because of pregnancy. Doctors will find pregnant women, a high-risk group, through prenatal examination. Once there is a risk of premature birth or a high-risk group, be sure to stay in bed and have regular prenatal examinations according to the doctor's advice. Other pregnant women need moderate exercise to train their physical strength during childbirth.

Nursing care of wounds after caesarean section At present, most caesarean section wounds are stitches-free (covered by medical insurance). Although there is no need to go back for stitches, it is recommended to go back for a follow-up visit 1 week after delivery. The doctor will observe the recovery of the wound and evaluate whether it is possible to take a bath with water (avoid taking a bath with water in postpartum 1 week to avoid bacterial infection, but you can take a bath if the wound is covered with waterproof stickers). Shampoo is fine. Pay attention to keep the wound dry and easy to wash after delivery, and take the principle that the wound does not touch water. Dr Li Zhongyuan reminded that the wound after caesarean section must be kept dry. If there is abnormal purulent secretion or oozing blood, you should return to the clinic as soon as possible to confirm whether the wound is infected. 65438+ 0 to 2 weeks after delivery, you can consider using scar gel or patch to reduce the chance of scar.

Observe whether there is redness, swelling, heat and pain in the wound after caesarean section. If there is, return to the clinic as soon as possible (redness, swelling, heat and pain are inflammatory symptoms), indicating that the wound may be infected or inflamed; If not, continue to observe. If the wound is wet or oozing blood, the dressing must be changed; You can also change your dressing every day. How to change the dressing? Cotton swab, gauze, breathable adhesive tape, iodine, etc. Should be prepared at home. The purpose of dressing change is to avoid bacterial infection and let the wound recover as soon as possible. Postpartum 1 ~ 2 weeks can be bathed in water, indicating that the epidermal wound has healed and no dressing change is needed.

Naturally, after childbirth, you should go to the toilet before washing. Because there is a wound in the perineum, you should wash it after going to the toilet (defecation and defecation). Wash the boiled warm water in the irrigation bottle from front to back, and the water temperature should not be too hot. Apply antibiotic ointment to perineal wound after irrigation to reduce the chance of infection. It is suggested to flush perineum after going to the toilet within 6 weeks after delivery, and then ask the doctor if it is still necessary to continue flushing until 6 weeks later.