Complications during delivery and surgical childbirths

Is the hospital ready to cope with all complications arising during delivery?
We can manage all pregnancy complications, and beginning with 34th week of pregnancy also all complications arising during delivery, including surgical management, forceps or vacuum assisted delivery, caesarean section, etc. The hospital provides night and/or weekend services by two gynecologists, one neonatologist, one anesthesiologist, a team of midwives, neonatal nurses, an anesthesiology nurse, a surgical nurse, and an attendant on continuous duty. In cases of serious complications two on-call duty doctors are also available.


Is cesarean section performed in this hospital?

Quite naturally, we are ready to deal with all delivery complications and surgical childbirths.  C-section may be indicated before the delivery due term because of mother’s medical conditions based on orthopedic, ophthalmologic and other reasons, as indicated by the particular specialist. A form confirming the indication should be presented. Prior delivery, c-section may be indicated by the obstetrician on medical grounds (your baby is in a breech position - his bottom or feet are facing down - or in a transverse position, or if you had c-sections in two previous pregnancies). Such indication may arise at any time during labor (serious health risks to your baby, non-progressing labor, etc.) C-section is not performed on every maternal request. Only in case of women who fear too much it may be done. According to our philosophy, through evolution, a woman has been adapted to vaginal births, so a  C-section is performed only if no other option exists, naturally, in the interests of the mother’s and  baby’s health.


How is cesarean section performed?

Cesarean section is performed under certain circumstances, whenever the natural birth is not possible or risky for the mother or the baby.  In some borderline situations, natural birth might occur even when a cesarean section has been considered. It is performed in general or local anesthesia by spinal or epidural analgesia, and by cutting the front abdominal wall. The skin incision runs alongside the pubic bone, as low as the pubic hair, or from umbilicus down to the pubic bone, if necessary. Then the urinal bladder is moved a little bit down and the uterus is opened. In some cases the head of the baby must be extracted by means of obstetrical forceps or vacuum extractor. After clamping and cutting the umbilical cord, the newborn is given to a neonatologist for further examination.  The placenta and amniotic membranes are separated from the uterus, which is then closed, and the rest of the abdominal cavity is closed, too.


Which are the possible complications in cesarean section?


Complications of the procedure are the same as in other abdominal surgeries. General complications accompanying the surgery, such as bleeding during or after the procedure, injury of the urinary bladder, infection and suppuration of the incision site, are quite rare today thanks to the use of advanced techniques. If they do occur despite every effort taken, there are modern means to handle them. The same also applies in case of urinary bladder inflammation.


Another post-surgery complication is the risk of formation of blood clots, especially in the legs, which may migrate to the pulmonary tract.  This risk is considerably reduced by means of anticoagulants by wrapping the legs with elastic bandage and by making the patient return to physical activity as soon as possible.  In exceptional cases the blood lost during surgery may be replaced by transfusion after the surgery.


Under the usual circumstances, the procedure will be completed in absence of any complications. However, due to the changed anatomical positions of the neighboring organs, or due to previous surgeries and diseases, some injury of  urinary bladder, urethra, or the intestine are difficult to be avoided despite the surgeon’s concentrated efforts and skills. These problems will be treated during surgery, although different post-surgery treatment may be required to manage the particular problem.

In some cases bleeding may be a life threatening condition, and if it cannot be brought under control, removal of the uterus (hysterectomy) must be performed to save the mother.


Cesarean section does not increase any risks for the baby, but occasionally, as a result of the general anesthesia or a preceding emergency during which the baby was deprived of adequate supply of oxygen due to which cesarean section was performed, the baby may need further medical treatment and monitoring (assisted breathing, mucus suction or medication).



What is the impact of cesarean section on next pregnancies? Is natural birth possible?

A spontaneous vaginal delivery after cesarean section is possible, where no complications occur in postoperative period, such as inflammation of the surgical site, or absence of any other conditions requiring cesarean section again. The next spontaneous vaginal delivery will require a closer follow-up because of a higher risk of uterine rupture in the former scar, and the uterus walls must be examined also after birth. In our hospital the experience with vaginal birth after cesarean is very good. Over 70% of women with a cesarean section in their medical history have vaginal birth in our hospital. Those who have experienced c-section, speak highly of natural vaginal deliveries.



Can the woman influence success in her effort to have a natural birth after a cesarean and how?
According to the findings of the University of California the women wishing to give birth by natural vaginal delivery after cesarean sections have a higher chance of not undergoing a repeated cesarean when compared to the less motivated women. A positive approach and optimism play significant roles in the process of natural childbirth in women who previously had a cesarean. Those who gained weight after their first cesarean, have 8-12% lesser chance for a natural vaginal birth in future pregnancies. The women who gained excess weight after their first child by a c-section have a better chance, after excess weight loss, to succeed in having a natural childbirth. This has been corroborated by the studies made in Seattle in the US.

Risks of complications increase in women getting pregnant shortly after a previous cesarean section. The ideal healing time of post cesarean uterine wound is one year, and the minimum is six months. The risks of complications are three times higher in women giving birth less than 18 months after previous cesarean delivery. Therefore any mother should plan a future pregnancy at least one year after a cesarean section. Interestingly, only 28% of all women undergoing postnatal examinations who have been instructed on the options of the methods of pregnancy prevention feel adequately informed on the use of contraceptives in this period. Careful planning of future pregnancy clearly increases the success of the future natural birth.

As each post-cesarean delivery is considered risky, such women are always questioned by the hospital management staff about their present conditions and their ideas concerning childbirth. Such questioning interviews take place every Tuesday at 7:45 AM on the third floor.


What options are there for labor pain relief?

As labor is hard work accompanied by pain there are some medical pain relief options commonly used for relieving pain and contractions. Additionally, there is also another method of labor pain relief, namely epidural analgesia. This method, however, may be used when the labor progresses and the cervix is at least 3 cm open. But your wish not to get any pain relief medication will be respected, of course. Contractions may be more easily tolerated when walking, sitting on a fit ball or taking a warm shower. 

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