Caesarean section is performed with an incision in the mother’s abdomen to get the fetus. There are indications and contraindications (relative and absolute) that make the method necessary.

In general, practice varies from country to country and is determined not only by medical but also socio-economic criteria. In emergency situations, when the baby has to be born immediately, caesarean section is mandatory and life-saving: severe preeclampsia, placental abruption, major bleeding, fetal bradycardia. Multiple pregnancy, abnormal projection (e.g., sciatica), previous uterine surgeries (removal of fibroids) are also currently indications of cesarean section since numerous studies have shown superiority in the safety of the method.

During a childbirth the necessary prerequisites are the normal fetal pulses and acceptable progress (dilation). And of course, the good state of the pregnant woman. She, the partner and the environment itself must be armed with patience to allow sufficient time for nature and its work. The obstetrician needs experience and knowledge to distinguish the really difficult cases that require caesarean section in order not to be used as the easy solution. It is the duty to respect the guidelines of official scientific bodies of the medical community. But this is always adapted to the specific incident. Every pregnant woman is different and unique.

Pre-caesarean section is not an absolute indication for caesarean section. The woman can try if she wishes for normal childbirth (VBAC – Vaginal Birth After Caesarean). The chances of success must be explained in a realistic way, as well as the boundaries that must not be overcome by catastrophic complications.

You will need to carefully study the conditions that led to the previous Caesarean. (These are two completely different scenarios if one woman had reached 9cm and had cesarean section due to bradycardia or bleeding, while the other remained 2cm and could not progress.)

Requirements for VBAC

-Good, uncomplicated pregnancy (single pregnancy, head projection)

– Normal (for mom’s data) estimated fetal weight

-Automatic start of labor (no need to induce labor and use of oxytocin)

-Organized, appropriate environment (in the maternity ward, not at home!)

-Continuous cardiographic monitoring

-Alert for emergency caesarean section

Note that in the past progress in the caesarean section has weakened the arguments for vaginal birth at all costs:

-Complications such as thrombosis and postoperative infections have been dramatically reduced with the systematic use of heparin and antibiotics.

-General anesthesia is replaced by epidural (which also provides adequate postoperative analgesia).

-There is an improvement in techniques to make a smaller incision above the pubic symphysis with a very good aesthetic effect, less post-operative trauma, less hospitalization, faster recovery.
The Doctor

Dr. Nikolopoulos maintains a private practice in ATHENS, while collaborating exclusively with MITERA’s maternity hospital and the new HYGEIA IVF Athens Assisted Reproduction Unit. At the same time, he is in charge of the Fertility and In Vitro Fertilization clinic at City Hospital, in the city of KALAMATA.