From Yunnan New Oriental female teacher “Putian” hospital delivery death, to Hunan Xiangtan maternal death from amniotic fluid embolism, the recent cesarean section surgery in the life of the woman’s disease, frequently attract the public eye. Cesarean section, a delivery method once considered safer, more advanced and less painful for mothers, has also raised many doubts in the community.
In the opinion of Li Kui, deputy chief physician of the Department of Obstetrics and Gynecology at Peking University First Hospital, cesarean delivery is only a modern medical solution to difficult labor and is not a normal way of delivery. He cautioned mothers and families that natural childbirth is hard but not difficult, and that the mother’s faith and the support of her family play a decisive role to some extent.
Caesarean sections without indications should not be done
According to statistics, the average C-section rate in China’s medical institutions is more than 50 percent, and even as high as 90 percent in some private hospitals.
”Such a high cesarean rate is abnormal.” According to Li Kui, “from the medical point of view, the high rate of cesarean delivery somehow represents the strengths and weaknesses of a medical institution’s obstetrics level.”
It is understood that the relevant authorities in China have very strict control over the cesarean delivery rate of large public hospitals. In the First Hospital of Peking University, for example, the cesarean section rate in the obstetrics department is around 30 percent. In Europe and the United States, the cesarean section rate is usually no more than 30 percent to encourage natural birth.
”From the hospital’s point of view, an ordinary cesarean section takes only one to two hours. In contrast, an initial natural birth takes at least eight hours, and it requires the doctor to keep an eye on the woman’s delivery during this time.” Li Kui explains, “In terms of price, a cesarean section is usually two times more expensive than a natural birth.” As a result, performing a cesarean delivery is undoubtedly less burdensome and more profitable for doctors.
Currently, large public hospitals in Beijing are prohibited from performing C-sections without indications. Doctors will only recommend a cesarean if the woman is not eligible for a natural delivery. Li Kui said, “There are not many absolute indications for cesarean delivery in the clinic.” Among them, the more common ones are central placenta praevia, multiple births, etc., or if the mother has other diseases that make her less tolerant and unable to deliver naturally.
”In fact, natural childbirth is not that difficult, and most women can complete it successfully.” Li Kui said.
Sleeping through labor? Cesarean delivery is actually uncomfortable
People still have a common misconception about cesarean delivery, thinking that it is easier and more relaxed than natural delivery because there is no prolonged pain.
However, according to Li Kui, women do not completely pass out during the actual cesarean section. Although she receives anesthesia, the woman is awake throughout the surgery and can feel every operation the doctor performs during the surgery completely clearly even without pain. “The resulting nerve reflexes can easily cause a strong discomfort response in the mother.” Li Kui said.
In Li Kui’s words, “Natural childbirth is first bitter and then sweet, while cesarean delivery is first sweet and then bitter.” After a cesarean section, the mother’s wounds need more time to recover. To expel abdominal distension after surgery, women need to move around with painful wounds and are not allowed to eat. In contrast, after a natural birth, the mother is able to eat quickly, regain her strength and produce breast milk, which is very beneficial for both the mother and the baby.
Li Kui also explained that during pregnancy, the uterus is rich in blood and has more large blood vessels around it, which can increase bleeding if the incision is prolonged due to special circumstances during the cesarean section, which means that the risk of postoperative infection is also increased. To avoid infection, the mother needs to use antibiotics and other medications, which are safe for both mother and baby, but may still have some negative effects on the mother and the baby’s breastfeeding.
For the fetus, a natural delivery of a baby after vaginal compression not only helps stimulate the baby’s brain development, but also allows for the natural extrusion of amniotic fluid from the baby’s lungs, which promotes lung maturation. However, babies born by cesarean section do not undergo this extrusion process and may suffer from wet lung or amniotic fluid aspiration after birth.
In addition, babies delivered by cesarean section are more likely to develop integration disorders and hyperactivity, according to research statistics. “Infants may have uncoordinated limbs in the early stages of learning to crawl and walk.” Li Kui said, “However, most children can return to normal with practice.”
Surgery carries risks “only in case, not in case.”
In Li Kui’s opinion, cesarean delivery is not as safe as one might think. “After all, it’s surgery, and as long as it’s surgery, there are bound to be risks.”
According to statistics, among the causes of maternal death, the first cause of death listed is postpartum hemorrhage, and amniotic fluid embolism is one of the causes of postpartum hemorrhage. The probability of postpartum hemorrhage is significantly higher in cesarean sections than in natural births, and amniotic fluid embolism is overwhelmingly seen in cesarean sections.
According to Li Kui, postpartum hemorrhage is diagnosed when the bleeding exceeds 500 cc in natural delivery and 1000 cc in cesarean delivery within 24 hours of delivery. The most common cause of postpartum hemorrhage is weak contractions, in addition to excessive nutrition during pregnancy resulting in a large fetus, advanced maternal age, twins or multiple births are also common factors that trigger postpartum hemorrhage.
However, Li Kui said that most postpartum hemorrhages can be treated in a timely manner as long as the bleeding is actively observed and treated by doctors in large regular hospitals.
In addition, the recent spate of amniotic fluid embolism is known as the “death spell” of cesarean delivery mothers. Although the incidence of amniotic fluid embolism is only 4 to 5 per 100,000, the mortality rate is as high as 70 to 80 percent.
According to Li Kui, during delivery, the amniotic fluid may flow into the blood vessels from the incision and enter the heart and lungs through the mother’s blood circulation. As the amniotic fluid contains a large number of substances such as fetal hair and lipid particles, these substances can, on the one hand, block the mother’s lungs, causing respiratory distress and heart failure, and on the other hand, cause a kind of violent allergic reaction causing shock, and can also trigger diffuse intravascular coagulation, resulting in a large consumption of blood clotting substances, triggering more than bleeding.
”When an amniotic fluid embolism occurs the mother may suddenly cough and then her blood pressure plummets to zero.” Li Kui described, “The mother may die quickly even within minutes.”
Resuscitation of amniotic fluid embolism requires an adequate blood bank, advanced anesthesia support, and timely administration of clotting substances, cardiotonic and tracheodilator agents to the mother. Li Kui said, “The treatment of amniotic fluid embolism relies on both the extensive clinical experience of physicians and the close cooperation of multiple departments. It depends to some extent on the level of obstetrics technology in this hospital, or even in the region.”
In addition to the most aggressive conditions listed above, intestinal tube injuries and anesthesia accidents can also occur during a cesarean section. The risk of cesarean delivery is even greater if the mother has previously undergone other surgical procedures.
In fact, the probability of surgical risk is “one in a million, not one in 10,000”. Li Kui explained that even if it is only one in 10,000 for someone, no one knows who will be “1” and who will be “9999”, “for a woman, the surgical risk is It’s a 100 percent chance.”
The key to a normal birth is maternal strength, and family members should give “positive energy”
”Giving birth is indeed a ghostly gate, in ancient times, but also today with the advanced level of medical technology.” Li Kui often cautions mothers-to-be in this way.
According to Li Kui, the key to a successful natural birth lies in the mother’s own strong faith, while the support of her family is also crucial.
Mothers-to-be need to prepare themselves psychologically during pregnancy, be clear about the pain they are about to endure, and stay calm before and during labor. Family members should not be overly worried and anxious during labor and delivery, as this irritability can easily affect the mother and affect the uterine contractions. It may even lead to postpartum hemorrhage.
Doctors will guide pregnant women to take proper nutrition during pregnancy and to control the weight of the fetus so that natural delivery can be completed smoothly. Li Kui also encourages mothers-to-be to engage in appropriate activities. He suggests that if the mother is not engaged in heavy physical labor, she can stick to her normal work. This is because maintaining proper physical activity helps mothers maintain their strength and withstand the tremendous physical and mental exertion they face during labor.
Li Kui also told reporters that in the clinic, there are often pregnant women with information downloaded from the Internet or exchanged among friends and relatives to seek advice from doctors, many of which are so-called “pregnancy tips” are biased, or even completely lack of medical basis.
In this regard, professional and accurate scientific knowledge is particularly important. He recommends that pregnant women and their families receive pregnancy information from professional doctors during pregnancy. It is important for women and their families to have the belief that a natural birth will be successful, but also to be prepared physically and psychologically.