Earlier I wrote a piece of science called “Why not to have a cesarean” to bring awareness to the fact that cesarean delivery as a procedure has risks.
But risk is relative, and when you face greater risk than a cesarean during pregnancy and delivery, then a cesarean may be the right choice.
In 1892, the end of the Qing Dynasty, Guangzhou, a woman from an ordinary family. She was 29 years old at the time and was giving birth to her third child, having struggled hard for a day and a night at home. “The abdomen vibrates and the fetus can’t go down”, until the breath is dying, the stable mother also can’t stand it, take the initiative to the maternal family idea: I heard that Western medicine can see, or go to the hospital to see? The family took her by boat to the foreign-owned Boji Hospital, where she was received by a male foreign doctor who examined a tumor in the birth canal. “There is no way, this has to be a C-section” “Now the C-section still has a chance to survive, otherwise the fate is not good”. Thus, this ordinary woman became the first recorded person to undergo a cesarean section in China.
Unfortunately, the woman died of postpartum infection.
In the first half of the 19th century, the mortality rate of cesarean sections for women in difficult labor in Europe was around 75%, but in the last two decades of the 20th century, due to advances in anesthesia, sterilization, antibiotics, and other medical advances, this figure has dropped to 0.6 per 1,000, and this is not entirely due to the cesarean section itself, but also to patients who had serious complications before the operation.
Although cesarean delivery is a very risky procedure, it has saved the lives of countless mothers and children over the century.
In November 2007, Li Liyun, 22 years old, accompanied by her “husband” Xiao Zhijun, came to the respiratory medicine department of Beijing Chaoyang Hospital, Beijing West Branch, with a preliminary diagnosis of severe pneumonia and 36 weeks of pregnancy. After Li Liyun was admitted to the hospital, due to her critical condition, which could endanger the life of the mother and fetus at any time, the doctor recommended that a cesarean section be performed immediately to terminate the pregnancy in order to save the life of the mother and child. Xiao Zhijun signed that he “refused to have a baby by C-section and was responsible for the consequences.” Doctors repeatedly persuaded him to sign the surgical consent form, Xiao Zhijun always refused. Eventually, Li Liyun’s resuscitation failed and both mother and child died. At that time, the case was a sensation in China, and Li Liyun’s case has been very controversial in society, and once triggered a public debate on the surgical signature system, Li Liyun’s case was also called by some media as “refusal to sign the surgical signature to cause the death of pregnant women”.
We will not discuss the issue of the signature system today, I just want to let ordinary non-medical workers know at what critical moment we should accept the doctor’s recommendation for cesarean delivery.
Let’s start by understanding the difference between a cesarean and a vaginal birth.
The fetus does not leave the mother’s womb because the fetus thinks it should come out and “walks” out on its own, it is the mother’s body that receives the signal to deliver the fetus, the uterus starts contracting, the fetal room gets smaller and smaller, and the fetus is “pushed” out of the birth canal. The fetus is passive. The smoothness of this process is determined by 1. the force of squeezing should be just right. The fetus should not be too big, the door is only 10cm wide, it is very difficult to come out. 4, the fetus should be in the right position, there is no way to come out horizontally. 5, the mother should be healthy, this process is very long, need physical strength, also need the mother’s The fetus should be healthy, the fetus is passive, but each contraction will produce strong pressure on the fetus, the fetus will be briefly deprived of oxygen. If the fetus is unhealthy, then the fetus will be in great danger during the process.
If, however, the mother has already initiated labor, then the process takes 8-24 hours, and if the mother has not yet initiated labor, then it may take longer from the time the doctor wants the baby to be born to the time of birth.
What is the case with a cesarean delivery? It is when the fetus does not go through the natural door, but quickly breaks through the wall and comes out. It takes only 5 minutes from the start of the procedure to the birth of the child, and from the time the doctor decides to operate to the birth of the child, including all the preparations; sterilization, anesthesia, and fluids, it can be done in as little as 30-60 minutes. During a cesarean section, the mother is also passive and does not need to use her strength. Under anesthesia supervision, the body systems, especially the cardiovascular system, will be smoother.
So when should I have a cesarean section?
When the mother is suffering from various medical diseases or serious obstetric complications. If the mother has heart disease, kidney disease, renal insufficiency, abnormal liver function such as acute fatty liver in pregnancy, and severe pre-eclampsia, early termination of pregnancy may be necessary to prevent further aggravation of the condition. These diseases can only worsen if the pregnancy continues, and termination of pregnancy is one of the methods of treatment, while cesarean delivery can both end the delivery quickly and avoid the long physical exertion of natural delivery, which further aggravates the disease.
Some congenital anomalies of the fetus or restricted fetal development. Of course, if the fetus some congenital anomalies that are not viable after birth, try to deliver vaginally to ensure a smooth birth next time. However, there are some cases where a cesarean section has to be performed, such as conjoined babies, huge tumors of the fetus, etc., which cannot be delivered naturally through the vagina. Fetal growth restriction, which means that the fetus is relatively small or premature, may be considered for cesarean delivery because the fetus is more lacking in the ability to tolerate hypoxia and vaginal delivery may be dangerous.
If there is a lot of bleeding before delivery, such as placenta abruptio, the placenta will be partially aborted before the fetus is delivered, and in serious cases, the fetus will die in the uterus, and it will also cause the current postpartum bleeding. Anterior placenta. Under normal circumstances, the placenta is located far away from the uterine orifice, and during delivery the fetus comes out first, and after it starts breathing, the placenta abrupts and does not supply oxygen to the fetus. However, in some cases, the placenta blocks the opening of the uterus, and once labor starts, there is bleeding, and possibly hemorrhage, and a cesarean section is also necessary.
The fetus is too large. If the fetus is more than 8 pounds, it is a huge baby, and delivery may be difficult. Some people do not control their eating during pregnancy or develop diabetes, and the child will be very large. If the baby is too big, shoulder dystocia may occur during delivery. What is a difficult shoulder birth? As we all know, when a newborn baby has a big head, the head comes out so much during delivery, and the body then comes out without difficulty. However, if the baby is too big, mainly because it is fat and has a lot of meat on the shoulder and abdomen, sometimes the head comes out, but the shoulder is stuck. At this time, the doctor will be anxious, because the child can not breathe, but the umbilical cord is also pressed, can not supply oxygen to the fetus, the fetus will soon suffocate. The fetus faces a situation where it can’t go up or down. Sometimes, after some pulling and squeezing, the child does not suffocate but has a fractured clavicle, nerve damage in the arm, and limited arm movement.
The fetus is not in a normal position. Breech position is now also a more common cause of cesarean delivery. Of course, there are some who can deliver in breech position, so I won’t go into details. A transverse position is absolutely impossible to deliver vaginally. It is equivalent to taking a pole out of the house horizontally. In the cephalic position, the fetus must be in the right position, lying in the mother’s birth canal. If the face is up, or if the neck is tilted too far back and sideways, it may lead to a prolonged labor and a cesarean delivery. This written position of the head position usually needs to be judged at the time of labor, because at the beginning of labor, it may self-correct, and only at the end of labor if it cannot be corrected will surgery be needed. This is the reason why many mothers will complain of suffering twice.
The fetus suffers from hypoxia during labor. Childbirth is a test for the mother and a test for the fetus. That is why the doctor has to listen to the fetal heartbeat once without 15 minutes in labor and do fetal heart monitoring if necessary. Once the signs of hypoxia are found in the child, the fetus must be allowed to be born immediately, and if it is a prodromal one, then the forceps will be used, and if it is still far from the end, then only a cesarean section can be performed.
Abnormal birth canal. Some mothers have congenital narrowing of the birth canal, which makes it difficult to deliver if the fetus is a little too large. Some mothers have a transverse septum, a longitudinal septum or a large tumor that may prevent the birth of the fetus and require a cesarean section. These conditions can be detected at the first check-up.
Umbilical cord prolapse. This is a very urgent case. If the amniotic fluid has broken, the umbilical cord will come out into the vagina, then once the contraction is complete, the fetus will jam the cord and the fetus will be deprived of oxygen. This happens, often when labor has just begun. If it is not treated, fetal death can occur in the uterus. There was a case in our hospital where the midwife felt the umbilical cord during a vaginal examination, and as a result, she was afraid to come out with her hand and pressed it upward against the fetal head so that the cord would not be pressed. Because the hand could not leave and the mother could not move, an emergency cesarean was performed on the delivery bed and the baby was born successfully.
Some other cases, such as the mother has had a cesarean section, uterine surgery, thoracic deformity, physical disability, high myopia, etc.
These are the situations that require a cesarean section. There are some cases where the patient will think that the fetus is more dangerous and will use this as a reason to request a cesarean section, such as the umbilical cord being wrapped around the neck or the premature rupture of the membranes, for example.
These two cases do not require a cesarean section. Cord winding is very common, usually due to the length of the umbilical cord, but as long as the baby does not show signs of hypoxia, it does not require special treatment. What about premature rupture of membranes? It means that the amniotic fluid comes out before the stomach pain. Usually, labor will start soon after the membranes are broken. If the labor does not start after a long time, the doctor will use oxytocin to help you start the labor. Only if there is a possibility of intrauterine infection after rupture of membranes, the doctor will not ask you to wait for labor or induce labor, but will perform a cesarean section for a quick delivery.
As a medical act, doing or not doing a cesarean section should depend on whether there is a medical reason for it, and it should certainly be left to the doctor’s judgment. But childbirth is a necessary experience for every woman, and we should be knowledgeable about them. It is when we are faced with these issues that we can make the right decision quickly.
I support natural vaginal birth, but am not fixated on having a natural birth with it. Any choice is a decision based on a balance of pros and cons. When “nature” can hurt us, I choose medical treatment against nature. Cesarean section is a medical option.
The process of pregnancy and childbirth is like a ship sailing to the other side, and the obstetrician is the escort ship. When you are sailing smoothly, I just accompany you silently. And when you deviate from the course, only then will I step in to help.