Author｜Pudding's Patch
Source｜Medical World Obstetrics and Gynecology Channel
At some point, choosing a date for childbirth became a trend. Welcoming a new life should be a natural and inevitable process, but it has been forced to happen earlier because of our various ideas. Even when it happens early, most people still choose cesarean section, and few people use oxytocin to induce labor. But does this really lead to a better outcome?
What has bewitched the pregnant women around us?
According to incomplete statistics, approximately 6.2 million unnecessary cesarean sections are performed worldwide each year, and China's "achievement" is among the highest in this category. What is it that makes us so fond of this procedure?
—From the perspective of pregnant women
(1) Incomplete understanding of medicine - There is always a subconscious telling you that the contractions during childbirth are extremely unbearable, so it is better to have a C-section, which is faster and there is anesthesia and pain relief after the surgery; the inner anxiety about the delivery process, the fear that you will not be able to deliver naturally and will have to have another C-section, which is a double torment;
(2) Interference from traditional concepts - Children are absolutely not allowed to be born on Qingming Festival. If it is an auspicious day, it is even better. Children should start school early so that they can't lose at the starting line.
—From a doctor's perspective
(1) Indirect protection of oneself - The case of a Peking University doctor being beaten by his family for refusing to perform a cesarean section without medical indication is a case in point. In the context of the tense doctor-patient relationship in China, some doctors will inevitably choose to agree to cesarean section delivery under the strong demands of their families. Relaxing the indications is an indirect protection of oneself.
(2) Inconsistent medical technology - Not all hospitals are adequate in their assessment of pregnant women and monitoring of labor. Limited technology may force vaginal delivery to be converted to cesarean section.
(3) The lure of economic benefits - Cesarean section has a short delivery time and high surgical cost, which means less worry and more money. Why not do it? Some hospitals' lax management and doctors' pursuit of economic benefits may lead them to agree to the requests of patients and their families without thinking, and may even actively induce them to choose cesarean section.
Think twice before you act; these truths are important to know.
1
Which is more painful, vaginal delivery or cesarean section?
A cesarean section uses local anesthesia to block pain sensation, but tactile sensation remains, and the pressure during delivery still causes some discomfort to the pregnant woman. Does this temporary disorientation truly eliminate pain? Do you think my nerve cells are stupid? Once the anesthesia wears off, coupled with postpartum uterine contractions and pressure on the uterus, you'll still feel persistent pain at the cesarean section incision site—it's quite an unpleasant experience.
Natural childbirth can be a very long process for some people. The baby stays inside and doesn't want to come out, while the expectant mother suffers greatly from contractions. Many women even say on the delivery bed that they'll never give birth naturally again, but feel a great sense of relief afterward. Moreover, natural childbirth generally leads to a faster recovery for the mother. Enduring the pain now will make things easier later, and even shorten the interval between pregnancies. Isn't the increasingly popular painless childbirth also a great option?
2
Which is safer, vaginal delivery or cesarean section?
Cesarean section surgery carries the risk of complications such as anesthetic allergy and anesthetic accidents during anesthesia. Cesarean sections without indication for delivery can lead to a significantly higher risk of complications compared to vaginal deliveries, including postpartum hemorrhage, infection, bladder injury, bowel injury, uterine incision rupture, venous thrombosis, endometriosis, and amniotic fluid embolism. It is also well known that the scarred uterus resulting from a cesarean section can pose unseen risks to both mother and child in subsequent pregnancies.
For the fetus, an overdose of surgical anesthetic drugs may endanger its safety, and the possibility of surgical damage cannot be ruled out. During vaginal delivery, regular uterine contractions and the pressure of the birth canal not only promote the expulsion of amniotic fluid and mucus from the fetal respiratory tract, but also greatly reduce the incidence of neonatal wet lung and aspiration pneumonia. Cesarean sections do not offer these benefits.
How to decide when faced with a request for a cesarean section without indication?
The "Expert Consensus on Cesarean Section (2014)" formulated by the Obstetrics Group of the Obstetrics and Gynecology Branch of the Chinese Medical Association has clearly pointed out the corresponding indications for cesarean section. Let's take a look.
1. Fetal distress: refers to acute or chronic fetal distress in late pregnancy caused by complications or comorbidities, and acute fetal distress during labor in cases where vaginal delivery is not possible in the short term.
2. Cephalopelvic disproportion: Absolute or relative cephalopelvic disproportion in women who have failed a full vaginal delivery.
3. Scarred uterus: Women who have had two or more cesarean sections and are pregnant again; women who have had uterine fibroid removal surgery that penetrated the uterine cavity.
4. Abnormal fetal position: transverse lie, breech presentation in primiparous full-term singleton pregnancies (estimated birth weight >3500 g), and footling presentation.
5. Placenta previa and vasa previa: Placenta partially or completely covering the internal cervical os and vasa previa.
6. Twin or multiple pregnancies: Cesarean section should be performed if the first fetus is not in a cephalic presentation; complicated twin pregnancies; conjoined twins; or multiple pregnancies of triplets or more.
7. Umbilical cord prolapse: The fetus may be viable, but the assessment results indicate that vaginal delivery cannot be performed quickly. An emergency cesarean section should be performed to save the fetus as soon as possible.
8. Placental abruption: If the fetus may be viable, fetal heart rate should be monitored and an emergency cesarean section should be performed as soon as possible to deliver the fetus. In severe placental abruption, where the fetus has died, an emergency cesarean section should also be performed.
9. Pregnant women with serious comorbidities and complications, such as heart disease, respiratory diseases, severe preeclampsia or eclampsia, acute fatty liver of pregnancy, thrombocytopenia, and severe intrahepatic cholestasis of pregnancy, who cannot tolerate vaginal delivery.
10. Pregnant women with macrosomia: Pregnant women with gestational diabetes whose estimated birth weight is >4250g.
11. Cesarean section on maternal request: The American College of Obstetricians and Gynecologists (ACOG) defines cesarean delivery on maternal request (CDMR) as a cesarean section performed at the request of a full-term singleton pregnancy without medical indication.
(1) A pregnant woman’s personal request is not an indication for cesarean section. If there are other special reasons, they must be discussed and recorded in detail.
(2) When a pregnant woman requests a cesarean section without understanding her condition, she should be informed in detail of the overall advantages, disadvantages and risks of cesarean section compared to vaginal delivery, and the information should be recorded.
(3) When a pregnant woman requests a cesarean section due to fear of the pain of vaginal delivery, psychological counseling should be provided to help alleviate her fear; labor analgesia should be used during labor to reduce the pain of labor and shorten the labor process.
(4) Clinicians have the right to refuse a request for cesarean section without clear indication, but the pregnant woman’s request should be respected and alternative suggestions should be provided.
12. Birth canal malformations: such as high-level complete vaginal septum, post-vaginoplasty, etc.
13. Vulvar diseases: such as severe varicose veins in the vulva or vagina.
14. Severe infectious diseases of the reproductive tract: such as severe gonorrhea, genital warts, etc.
15. Pregnancy complicated by tumors: such as pregnancy complicated by cervical cancer, giant cervical fibroids, lower uterine segment fibroids, etc.
It's not that we won't have a cesarean section, it's just that the conditions aren't right yet. A pregnant woman's request for a cesarean section without indication should be respected, but this choice is based on her belief that it will meet her needs. Faced with such a choice, only a doctor can give the best answer.
From a medical perspective, doctors will consider the specific circumstances of the pregnant woman and fetus to choose the appropriate delivery method to maximize benefits. By explaining the situation rationally and emotionally, clearly analyzing the pros and cons, and fully alleviating her anxiety, it's clear that no one would risk their health. As long as you give your doctor your full trust, they will undoubtedly safeguard the health of you and your baby.
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