Generally speaking, natural childbirth is a relatively safe and less damaging way of delivery for most mothers. However, for some special non-medical reasons, such as fear of pain, fear of affecting the figure or even wanting to pick an auspicious time, the demand for a cesarean delivery is extremely insufficient. The choice of delivery method after pregnancy should be strictly in accordance with the clinical medical treatment regulations, and the doctor should decide the final delivery method according to the pregnant woman’s own conditions, the development of the fetus and the progress of labor after entering the labor process. However, the pursuit of natural childbirth is not always the best choice.
The decision
Once she was pregnant, Maggie was very concerned about the method of delivery. She heard many stories of mothers who were afraid of pain, hard work, or destroying their bodies …… and asked for a cesarean section because they were afraid to choose a natural birth, and heard that the percentage of cesarean sections in China far exceeded the international standard. Because it is always the best process to follow the nature.
However, when I look around, some of my friends were determined to have a C-section from the beginning; some were hesitant and heard that someone who didn’t give birth for two days ended up having a C-section and suffered twice. There are also those who chose to have a cesarean section because of the fetal position, the size of the fetus, the umbilical cord bypass, and so on. Natural childbirth? Not too many.
In fact, Maggie was also afraid of pain and worried whether she would be able to go through the whole process of natural childbirth, but when she thought of all the benefits for her baby, when she brushed her hand over her slightly bulging belly and could feel her baby moving with the gentle rhythm of her breathing, what was there to doubt? Of course, you want to give your baby a perfect birth.
The benefits of natural childbirth for the baby.
After the contraction of the uterus and the extrusion of the birth canal, the amniotic fluid and mucus in the lungs and respiratory tract can flow out, reducing the occurrence of amniotic fluid and meconium aspiration pneumonia in newborns.
The thorax is subjected to rhythmic compression and expansion, prompting the lungs to produce something called alveolar surface active substance, and the alveoli are elastic and easily expandable after birth.
The head is constantly compressed, stimulating the respiratory center and facilitating the establishment of normal breathing after birth.
Skin nerve endings are massaged by stimulation, their nervous and sensory systems are better developed, and the development of the whole body functions is better.
After the extrusion of the birth canal and the bacteria of the birth canal, and then exposed to the outside world, the immunity will be stronger.
Natural childbirth is certainly a better choice for the mother. The simplest point: natural childbirth basically guarantees the integrity of the body. Cesarean delivery is a kind of surgery anyway, which involves cutting open the abdominal and uterine cavities, and it is always damaging to the mother’s body.
Benefits of natural childbirth for the mother.
There are only wounds in the perineal area; there are also fewer complications and after-effects.
Better contraction of the uterus and less bleeding after delivery.
The body recovers quickly, you can get out of bed and walk around on the day of delivery, you can eat and breastfeed immediately, you can be discharged from the hospital in 3-5 days, and you can have more energy to take care of your baby.
Body recovery is also fast. Some expectant mothers worry that natural childbirth will make their pelvis bigger, which is unfounded. It has nothing to do with the method of delivery.
Preparation
During the initial examination, the doctor said that Maggie’s pelvis was narrow and that it would be best if the baby did not exceed 7 pounds if she wanted to have a natural birth. Therefore, throughout her pregnancy, she was careful to control her diet and her weight and baby weight were basically increasing according to the standard range written in the textbook. She was still swimming when she was 7 months pregnant because she heard it would be good for her future baby and she wanted to improve her strength and stamina. Her friends who knew her before said that she had changed a lot, knowing that she had never been a person who had anything to do with exercise, and that she had no regular meals and rest, but now she had changed everything for the sake of the baby.
At 34 weeks of pregnancy, the baby was in breech position, a position not suitable for normal delivery. She tried to do the “cat stretch” (medical term for chest and knee position) every day under the guidance of her doctor. It was really tiring at the beginning, but I hoped it would help the baby to adjust to a better position. After working hard for half a month, the baby finally changed his head at the 36th week when the doctor thought, “If we can’t adjust it, we can’t do anything else”. But at the same time, the ultrasound found that the umbilical cord was wrapped around the neck, but it was only one turn, and the doctor said, “It should not matter, and the baby is the right size, so try to give birth by yourself!
To have a natural birth, pay attention to several aspects.
Age between 24 and 35 years old. If the mother-to-be is younger than this age, the tissues of her body are not mature enough, especially the pelvis is not fully fixed and formed, which is not good enough for the mother and the fetus; if the mother is older than this age, the joints of the pelvis become hard and not easy to expand, and the contraction force of the uterus and the stretching force of the vagina are also poor, which will lead to a longer delivery time and easy to have a difficult delivery.
Reasonable nutrition and weight control during pregnancy. If too much nutrition and too much fat intake cause the fetus in the womb to grow too large, especially if it exceeds 4 kg, the chances of difficult delivery will increase greatly. The ideal pregnancy weight is to gain 2 kg in early pregnancy (within 3 months) and 5 kg each in the middle (3-6 months) and end (7-9 months), for a total increase of about 12 kg.
Do more exercise. Proper exercise is not only good for weight control during pregnancy, but also helps smooth delivery. Mothers who exercise regularly can maintain their physical and cardiorespiratory fitness at a certain level, and those who are physically fit have a higher tolerance for labor pains. Mothers-to-be can maintain their usual exercise habits, as long as they are careful not to choose intense sports.
Do prenatal checkups regularly. Observe the fetal development and physical changes of the pregnant woman at each stage continuously, such as whether the fetus is growing and developing normally in the womb, whether the pregnant woman is well nourished, etc. It is also possible to find out the common complications of pregnant women, such as gestational hypertension, diabetes, anemia, etc., so as to get timely treatment and prevent the disease from developing into a serious stage and affecting the vaginal delivery.
Correction of fetal position. If the fetal head is bent down and the occipital bone is in front, the head is the first to reach into the pelvis during delivery, and the delivery is generally smooth in this position, while in other cases, the fetal position is not correct. Usually, the fetal position found before 7 months of pregnancy can be corrected by observation, because the fetus is still small compared with the uterus and there is more amniotic fluid in the uterus, so the fetus has room to move and will correct the fetal position by itself.
Comprehensive assessment. Every hospital will carefully examine the mother and the fetus in the late pregnancy to see if the mother’s pelvis fits, if the size of the pelvis (the width of the narrowest meridian in the pelvis) and the size of the fetus (biparietal diameter) are compatible, to see the position of the fetus (whether there are problems with breech circumference, transverse position, etc.), to estimate the weight of the fetus, and if everything is appropriate and there are no other obstetric complications, the doctor will encourage natural delivery. The doctor will encourage a natural birth.
Unexpected
After the 36-week checkup, everything seems to be going well. With the last month to go, the pace of work and life already starting to slow down, and the last really stressful moments still to come, Maggie’s mood was completely relaxed. She was in no hurry to pack the items she needed for the baby and the various precautions she would need for the post-graduate baby, wanting to enjoy this last time all to herself.
However, something unexpected happened: on the night of the 37-week checkup, her water broke. My husband rushed her to the hospital in the middle of the night, made her lie down and performed the appropriate tests as requested by the doctor, and by the time everything was arranged properly, it was already dawn. They looked at each other and smiled: could it be that the baby couldn’t resist coming into the world sooner?
But the next day, the whole day, there was no sign of contractions. On the morning of the third day, the doctor hooked her up to an oxytocic injection, and the pain gradually came on, and she tried to relax as much as she could with the breathing method she vaguely remembered. She thought, “It’s finally time to give birth! However, as the time passed, the pain increased and the opening of the uterus was slow. By late afternoon, she was already turning over in bed and could not help crying and screaming. But when the oxytocic injection stopped, the labor process stopped. It was getting dark, and I was sent to the delivery room after the opening of 3 cm, and I chose to have a painless delivery. The opening of the uterus was still very slow.
After staying up until midnight, with no improvement in the situation, a chief doctor was called in for a consultation, and after examining the baby, advised, “The amniotic fluid is bad, and the baby’s head has developed a labor tumor, so we may end up having a forceps assisted delivery.” After the doctor explained the situation to Maggie and her husband, Maggie chose to have a cesarean section.
The basics of natural childbirth
A natural birth is a full-term birth. It is the process of delivering the fetus and its appendages (placenta and umbilical cord) vaginally at full term. There are three main factors that determine natural birth: labor force, birth canal and fetus. The force of labor includes the contraction of the uterus, the contraction of the abdominal wall muscles, the contraction of the diaphragm and the contraction of the pelvic floor muscles, of which the contraction of the uterus is the most important. The birth canal includes the bony birth canal and the soft birth canal. The bony birth canal refers to the true pelvis, which is medically divided into three imaginary planes, namely the pelvic inlet plane, the mid-pelvic plane and the pelvic outlet plane. The midpoints of the three imaginary pelvic planes are connected to form a pelvic axis. If the combined force of various labor forces coincides with the pelvic axis, the labor force can “push” the fetus along the pelvic axis. The soft birth canal refers to the lower part of the uterus, the cervix and the vagina. The fetus includes fetal size, fetal position and whether the fetus is malformed. Generally speaking, the size of the fetus is an important factor in the decision to deliver a baby during a natural birth. If the fetus is too large, the first part of the fetus may be obstructed in one of the pelvic planes and cannot enter the pelvis, causing cephalopelvic disproportion and resulting in a difficult delivery. Generally speaking, the mother’s pelvis is like a nut, and the fetus’ head is like the head of a screw. If the nut is smaller than the head of the screw, no amount of external force will be able to screw the screw into the nut. In addition, fetal position is also a common reason for natural delivery.
The period from the start of regular rhythmic contractions to the delivery of the fetus and its appendages is clinically called the total labor. The total labor process is clinically divided into three stages, namely the first, second and third stages. The first stage of labor is from regular contractions to full opening of the cervix. Generally speaking, it takes 11-12 hours for first-time mothers and 6-8 hours for menstruating mothers. The second stage of labor is from the opening of the cervix to the delivery of the fetus. It takes 1-2 hours for primiparous mothers and only a few minutes or occasionally 1 hour for menstrual mothers. The third stage of labor is from the delivery of the fetus to the delivery of the placenta. It usually takes 15-30 minutes. It should not exceed 30 minutes.
As you can see, natural childbirth is an extremely complex and natural process. The whole process includes medical techniques, as well as many mechanical principles and psychological factors for the medical staff, the pregnant woman and her family. Failure of any of these factors can lead to the failure of natural childbirth.
Despite the fact that the doctor informed that, according to all the circumstances, it might be detrimental to the baby to continue the natural delivery and suggested to change it to a cesarean, Maggie and her husband agreed to this option and signed the operation notice, but, when making this decision, she knew in her own mind that intolerance of pain played a big role – At that time, she was already in pain and wanted to give up more and more, and had even discussed with her husband the possibility of changing to a cesarean section. When the doctor said “continue to wait for labor, you may need forceps to assist labor, or you can change to cesarean delivery”, she chose to deliver by cesarean, and at that time she even had a feeling of “relief at last” in her heart. In hindsight, she felt that her inability to deliver the baby smoothly was related to her lack of psychological preparation, lack of understanding of the whole birth process, and retreating from the battle. She couldn’t really let go of this feeling until long after her baby was born.
What other conditions require a cesarean delivery.
Narrow pelvis or asymmetry between the fetal head and the pelvic cavity. Women who have structural pelvic abnormalities, such as those with polio, a history of pelvic fractures, too small or dwarfism, should be delivered by cesarean section because of abnormal pelvic exits that do not allow the fetus to pass smoothly. Asymmetry between the fetal head and the pelvic cavity is relative, which means that even if the mother’s own pelvic cavity is not abnormal or narrow, a cesarean section must be performed because the fetal head is too large to pass smoothly through the birth canal.
Fetal malposition. If the fetus is not in the right position in the first trimester, a cesarean section should be performed. Generally speaking, if the fetal malposition is confirmed at full term, a cesarean section can be scheduled in advance; however, if the fetal malposition is found after the onset of labor, an emergency operation may have to be scheduled directly. However, if the fetus is in a breech position and the mother wants to have a vaginal birth, she can still try various methods of delivery, but a breech vaginal birth is still a high risk and should only be performed after discussing its advantages and disadvantages with the attending physician.
Multiple births. If the mother is carrying twins and the fetal positions are normal, a natural birth can be attempted, but in the case of triplet or more pregnancies, a cesarean delivery is recommended as a priority.
Placental factors. The position and changes of the placenta are also related to the mode of delivery, for example, the placenta is too low, blocking the opening of the cervix, placenta praevia or premature abruption of the placenta from the uterine wall resulting in hemorrhage or fetal distress are possible causes of cesarean delivery.
A history of cesarean delivery. In general, women with a history of fetal cesarean delivery have a significantly increased risk of uterine rupture after another pregnancy, especially in classical cesarean deliveries. Therefore, most obstetricians and gynecologists will advise pregnant women with a history of cesarean delivery to opt for a cesarean delivery when possible for a second delivery.
Those with a history of uterine surgery. In addition to a history of cesarean delivery, some women have had injuries such as myomectomy and uterine trauma perforation.
The mother is unfit for vaginal birth. A cesarean section is also an option if the mother has a significant medical condition of her own, such as pre-eclampsia or a serious medical condition (heart disease, etc.) that is assessed by a physician to preclude a vaginal birth.
Oversized fetus. A large baby is defined as a fetus weighing equal to or more than 4 kg. During the prenatal examination, if the obstetrician assesses that the fetus is coming over and the chances of being able to deliver by natural birth are low, a cesarean section can also be arranged to avoid a difficult delivery.
Pregnant women whose height is less than 150 cm, or whose weight is less than 40 kg, or whose weight is more than 70 kg are considered to be at high risk of pregnancy, and obstetricians and gynecologists may also recommend cesarean delivery to terminate the pregnancy.
Problems after cesarean section.
After all, cesarean delivery is an invasive surgery that involves opening the abdominal and uterine cavities, which objectively carries certain risks, such as the possibility of postoperative infection, and complications such as local adhesions and endometriosis. In addition, after a cesarean delivery, according to medical statistics, it takes about 2 years for the wounds of the uterus to heal. In case of another pregnancy within 2 years, the gestational sac tends to adhere to the scar of the incision and may bleed profusely if you choose to abort, or endanger the life of the fetus if you are ready to give birth to the child. Of course this is not inevitable, just that the risk will increase quite a bit. There are mothers who have conceived again just 7 months after the cesarean and everything went well, just be careful to schedule more intensive follow-up visits, pregnancy tests, and make sure the safety of mom and baby is paramount.
A casual conversation about cesarean section.
The cesarean section style is divided into classical cesarean and lower uterine cesarean depending on the site of the uterine incision. In classical cesarean delivery, the uterine incision is made in the body of the uterus. Because of the thick muscles of the uterine corpus, rich blood sinuses and heavy bleeding, this procedure is basically not performed nowadays, but only in very special cases, but it must be repeatedly explained to the patient and the family afterwards and “classical cesarean section” must be written very clearly in the medical documents handed to the patient. This is for future reference and warning in the management of other diseases! Lower uterine cesarean section is the most common surgical procedure used today. In other words, the fetus is delivered by incising the uterus at the lower part of the uterus, where the peritoneum is reflexed. As the lower part of the uterus is formed in late pregnancy, it is thin and has relatively few blood sinuses, so there is less bleeding and less damage.
In addition, the cesarean section can be divided into intraperitoneal and extraperitoneal depending on whether or not the abdominal cavity is entered. The classical and currently the most commonly used lower uterine section are both cesarean sections that enter the abdominal cavity. There is some disturbance and impact on the abdominal cavity, especially the intestinal canal. Extraperitoneal cesarean delivery is performed without entering the abdominal cavity, by pushing the bladder down at the extraperitoneal peritoneal reflex, freeing part of the lower uterine segment and cutting the lower uterine segment to deliver the fetus. This type of surgery does not disturb the abdominal cavity and the recovery is faster, especially for pregnant women with a risk of uterine infection. However, this procedure requires a high level of skill and carries certain risks and indications, so it is rarely used in clinical practice. It is a “dying procedure”!