Parto naturale dopo cesareo
È possibile avere un parto naturale dopo cesareo? Nonostante spesso si pensi di no, in realtà sì, è possibile. In passato avere un parto naturale dopo un taglio cesareo non era una scelta saggia, oggi invece in molti casi non c’è alcun impedimento. Il termine tecnico per indicare questa procedura è VBAC, acronimo inglese che sta per Vaginal Birth After Cesarean, ovvero “parto vaginale dopo cesareo“. Secondo le linee guida dell’Istituito Superiore di Sanità, a tutte le donne che hanno già avuto un parto cesareo deve essere data la possibilità di avere un travaglio di prova e partorire per via vaginale, ovviamente in assenza di controindicazioni specifiche. È anche vero, però, che non tutte le donne riescono ad avere un parto naturale dopo il cesareo, ma solo circa il 60-80% . Oltre a complicazioni della gravidanza, spesso a impedire il parto naturale è lo stesso ospedale, in quanto non fornito del personale o delle risorse necessarie per gestire un eventuale cesareo d’urgenza.
Parto naturale dopo cesareo: come avviene
Avere un parto naturale dopo il cesareo non è privo di rischi, per questo innanzitutto bisogna parlarne con il proprio ginecologo, che saprà valutare il vostro caso. È importante, poi, scegliete di partorire in un ospedale che sappia gestire l’eventualità di un cesareo d’emergenza, con una valida equipe chirurgica e sala operatoria disponibile 24 ore su 24, oltre alla disponibilità di effettuare trasfusioni di sangue. Detto questo, vediamo nei dettagli come avviene un parto naturale dopo un parto cesareo. Non appena le acque si rompono o iniziano le contrazioni, è necessario il ricovero in ospedale, dove verrà effettuato un monitoraggio continuo per controllare il battito del bambino e le condizioni della mamma. Durante il travaglio, è possibile somministrare l’anestesia epidurale, mentre è controindicato l’uso di farmaci che stimolano le contrazioni, in quanto contrazioni troppo forti potrebbero provocare la rottura dell’utero. In caso di travaglio molto lungo e difficoltoso, può essere necessario ricorrere ad un secondo cesareo per evitare rischi.
Parto naturale dopo cesareo: quando si può fare
Come abbiamo anticipato, non sempre è possibile avere un parto naturale dopo il taglio cesareo e deve essere il ginecologo a valutare caso per caso. In line di massima, però, possiamo dire che le possibilità che il parto naturale dopo cesareo vada a buon fine aumentano se:
- la gravidanza procede senza problemi e mamma e bambino sono in salute,
- il travaglio è iniziato spontaneamente,
- il parto è a termine,
- avete solo la classica cicatrice trasversale da cesareo sull’utero,
- avete già avuto un altro parto naturale.
Parto naturale dopo cesareo: quando non si può fare
Il parto naturale dopo un cesareo è sconsigliato quando la gravidanza presenta delle complicazioni, che interessano la mamma e/o il bambino. In particolare, è meglio optare per un secondo taglio cesareo se:
- soffrite di placenta previa,
- il bambino è in posizione podalica o trasversa,
- in precedenza avete avuto tre o più tagli cesarei,
- avete avuto un taglio cesareo o altri interventi all’utero che vi hanno lasciato cicatrici longitudinali o a forma di T,
- avete avuto lacerazioni all’utero,
- i termini della gravidanza sono scaduti,
- il bambino è molto grande,
- siete obese,
- si tratta di gravidanza gemellare.
Parto naturale dopo cesareo: rischi e benefici
In conclusione, per scegliere se optare per un parto naturale e un altro cesareo dopo il primo, è bene valutare tutti i rischi e i benefici che partorire naturalmente comporta. I principali rischi che si corrono avendo un parto naturale dopo cesareo sono:
- infezione all’utero,
- insuccesso e conseguente cesareo d’urgenza,
- rottura dell’utero in corrispondenza della cicatrice del precedente cesareo
- incontinenza dopo il parto, a causa di un indebolimento dei muscoli del pavimento pelvico.
Di contro, i benefici sono:
- minor rischio di complicazioni come infezioni ed emorragie rispetto al cesareo,
- convalescenza post parto più breve,
- maggior partecipazione al parto, con la possibilità di prendere in braccio e allattare il bambino subito.
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