Author: Li Shan (Attending Physician of Obstetrics and Gynecology)
There is a saying that goes: there is no real empathy in this world. Unless you go through exactly the same thing, you will realize that it looks light and light on others, effortlessly, and when you really come to yourself, you find that you can't bear the weight.
In a woman's life, childbirth can be said to be the biggest test, and the popularity of caesarean section surgery makes the "childbirth" thing seem to seem simple.
In the eyes of outsiders, caesarean section is: the mother enters the operating room - the child comes out—--- the mother comes out, so that some people will have a kind of illusion of "is not a child cessation, a trip there to lie down the doctor to do everything, how simple" illusion!
However, only the people on the operating table know what the caesarean section is going through.
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Before preparing for a cesarean section, a preoperative examination is performed, followed by a preparation of skin catheterization. Catheterization is the first sour before caesarean section, when the urinary catheter is inserted, no matter how graceful the lady can not avoid the displacement of the facial features, and when you carry your own urine bag into the operating room, lie on the operating table and hold yourself into a stooped prawn, the anesthesiologist begins to anesthetize you, and this caesarean section begins.
Normal needles, adults basically will not be afraid, but such a ten centimeters long needle, are you afraid or not?
At present, the most common method of anesthesia used in caesarean section is lumbar-hard combined anesthesia. Anesthetic drugs are not injected into the blood vessels, but through a catheter into the subarachnoid or epidural space of the spinal canal.
Because the fat layer of the mother is often relatively thick, and the catheter needs to be placed into the spinal canal, so the anesthesia needle is long and thick, although the anesthesiologist will first carry out local anesthesia before the needle is inserted, but the "creaking" sound of the needle inserted into the spinal canal makes people feel hairy when they listen.
After the anesthesia is over, the operation really begins, in fact, the "opening" of the cesarean section is not only a knife in the stomach, but also a knife in the uterus.
A knife above the stomach is to open the abdominal cavity to expose the uterus, the scalpel cuts the skin, the subcutaneous fat layer, separates the rectus abdominis sheath, and then opens the large omentum in turn, enters the abdominal cavity, and the round uterus will be displayed in front of everyone. Subsequently, the lower part of the womb will undergo another stab, and at this time, the baby will really meet the world.
The amniotic fluid gushes out, the doctor will take the baby out by hand, cut the umbilicus and hand it over to the doctor offstage, on the operating table, waiting for the mother is to deal with the placenta and suture.
Although the pain is not obvious under the action of anesthesia, the mother will still feel the pulling sensation in her stomach, and the uterus contracts after the placenta is peeled off, and after cleaning, it is time to start preparing for sutures.
There is a saying called "easy to open up and difficult to sew up" that actually means that caesarean section, from opening the abdominal cavity and uterus to removing the fetus, may only take less than five minutes, and sutures may take forty to fifty minutes.
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Because of the suture, it needs to be sewn layer by layer, first of all, the incision above the uterus should be sewn, the length of this incision is generally about ten centimeters, in case of an unexpected situation, it may also need to do some extension.
Traditional caesarean section is divided into 2 layers when suturing the uterus, including the full lamination of the uterine muscles and the serous layer, first with a slightly wider needle spacing continuous suture and then with a slightly denser mattress suture, this suture method is more conducive to the healing of the uterine incision than the single-layer suture. The stitched womb, which at first looked like a smooth watermelon, turned into an orange with a wrinkled wound.
After the uterus is sutured, the doctor will check the appendages and the condition in the abdominal cavity, and will also carry out intra-abdominal irrigation, at this time many mothers will feel uncomfortable, some people will feel nauseous, vomiting, and some people will have chills.
After the rinsing, the suture continues, first the peritoneum is sutured, then the abdominal wall is sutured, and the suture of the abdominal wall alone is three layers, first suturing the front sheath, then suturing the subcutaneous tissue, and finally the skin.
This is not necessarily enough, some mothers are fatter, subcutaneous fat is very thick, this time in order to heal the wound better, reduce the tension of the wound and the risk of fat liquefaction, the doctor may add another layer of suture.
The little doctor who just started to have a caesarean section knows that the most tiring thing about a caesarean section is not surgery, nor is it to take the child, but to suture. If the training is less than the strength of the hand, after an operation, the tired soreness of the hand is also a common thing.
As the number of caesarean sections increases, the long-term risk of postoperative complications increases, for example, caesarean section significantly increases the risk of placental abnormalities in later pregnancies, and this risk increases with the increase in the number of caesarean sections.
One study showed that in the general obstetric population, after 1 caesarean section and after 3 caesarean sections, the risk of placenta previa was 4/1000 births, 10/1000 births, and 28/1000 deliveries, respectively.
Women with placenta previa and caesarean sections greater than or equal to 3 times have a significantly higher risk of developing adhesive placenta (3.3% to 4% vs 50% to 67%) compared with women with placenta previa but no history of caesarean section. Even without placenta previa, the more frequent previous caesarean sections there are, the higher the risk of developing adhesive placenta.
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The formation of adhesions after caesarean section is common, and the extent and density of adhesions increase with the increase in the number of repeated caesarean sections: the incidence of adhesions is reported to be 12% to 46% in women with the 2nd caesarean section and 26% to 75% in women with the 3rd caesarean section,
Women who have experienced repeated caesarean sections have a higher incidence of uterine rupture in women who have had vaginal trial deliveries after caesarean sections. Scars from uterine incisions or abdominal wall incisions can also cause complications such as scarring diverticulum, caesarean section scarring pregnancy, pelvic pain, dysmenorrhea, dyspareunia, and so on.
Caesarean section is definitely not "to lie there" of the cloud breeze, the most suffering is still the mother, although the current caesarean section surgery has been very mature, the probability of complications is relatively low, but mothers still need to bear the risk of anesthesia and surgery, such as bleeding, infection, surgery may bring damage and so on.
After the anesthetic faded, the pain caused by the seven-layer suture was unimaginable to people who had not experienced it. Even if the wound heals well, the numbness and pain around the scar, and the uncomfortable itching when it rains on a cloudy day can still bother the mothers for a long time.
We often say that childbirth is a woman's greatest sacrifice, whether she is a vaginal birth or a cesarean section, when she conceives life and brings new life into the world, all this experienced by the mother bears great pain.
Don't say "Isn't it just a caesarean section" again, after reading this, I hope we can all be nicer to all the mothers, a little better, whether it is their own wives or their own mothers, how good it is not too much, because they are worth it.
Bibliography:
Marshall NE, Fu R, Guise JM. Impact of multiple cesarean deliveries on maternal morbidity: A systematic review. Am J Obstet Gynecol 2011; 205:262.e1.
WANG Hongbin. Effect of uterine suture mode of caesarean section on pelvic adhesion and incision healing[J]. Journal of Practical Medicine, 2014, 31(001):24-24.
Uptodate: Postoperative problems with caesarean section
Soltan MH, Al Nuaim L, Khashoggi T, et al. Sequelae of repeat cesarean sections. Int J Gynaecol Obstet 1996; 52:127.
Makoha FW, Felimban HM, Fathuddien MA, et al. Multiple cesarean section morbidity. Int J Gynaecol Obstet 2004; 87:227.
Morales KJ, Gordon MC, Bates GW Jr. Postcesarean delivery adhesions associated with delayed delivery of infant. Am J Obstet Gynecol 2007; 196:461.e1.
Uygur D, Gun O, Kelekci S, et al. Multiple repeat caesarean section: Is it safe? Eur J Obstet Gynecol Reprod Biol 2005; 119:171.
Hesselman S, H gberg U, R ssj EB, et al. Abdominal adhesions in gynaecologic surgery after caesarean section: a longitudinal population-based register study. BJOG 2018; 125:597.
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