How a woman can help yourself during labor? What medical interventions are justified and which are not? Is there a relationship between physical education and women in successful child birth? What is the percentage of successful vaginal delivery after the first cesarean section? His medical experience is divided Olesya Albertovna Golikova , Head of the Division of paid medical services obstetric branch №1 Clinical Hospital №13 (former hospital №15 Dubrovka).
Olesya Albertovna, as we know, the first birth lasts an average of 8-10 hours to days. Why in this case, some women give birth to two days?
This is due to the fact that often women in this figure includes also the harbingers preceding childbirth, which can be quite painful, but it is not labor. And sometimes it’s not the harbingers, and the so-called pathological preliminary period – irregular dragging pain in the abdomen, which do not lead to cervical dilatation. If they are very painful, long lasting, prevent the woman to relax, then you need to stop them with medication or other means, otherwise there is a risk that by the time of this birth a woman is too tired, and labors will be weak. The child in this case, too, can suffer. In any case, the decision on this matter takes the doctor, so that if such a state is better to come to the hospital and show him. It is very important to be in contact their doctor and trust him.
What do you think about the use of epidural anesthesia during childbirth? On the one hand, it helps to relieve the pain, on the other hand, it is believed that it is unsafe for a child. I would like to hear the opinion of a doctor with a lot of practical experience.
For the child in immediate danger of the introduction of the drug into the spinal canal do not have a mother, because the drug does not fall to the child. The danger rather comes from the method of anesthesia. It is very difficult manipulation, and there could be some complications.
The courses for pregnant women sometimes say that using an epidural mom gets relief, while the child at this time of suffering. It’s true?
No, this is not the case, the child does not suffer. Put it this way: if there are any complications, the child will suffer indirectly.
What can be complications?
Classical complication – an allergy to the drug. Also, there are complications associated with the introduction of up to anaphylactic shock, respiratory failure, paralysis of the lower limbs. All this is very serious.
In your practice, there were such cases? Or is it a rarity?
There were. They rarely occur – usually talking about 0.001%, but they do happen. Because of the potential complications which women naturally fear the number of births in general anesthesia are now declining. If 5-10 years ago, this method is very widely used, 90% of women use them, but now the percentage is lower.
How do you feel about the amniotomy procedure, ie opening of membranes? It is believed that after the pain significantly worse in the battles.
Amniotomy – an operation. So it just never do. Amniotomy can do for the purpose of non-drug rodostimulyatsii, if it is needed – thereby seeking doctors gain contractions that can actually be more painful. There are pathological conditions related to the amount of amniotic fluid and membranes when amniotomy shown. For example, when the amount of water is small, and it interferes with the normal development of labor. Or, again, amniotomy is assigned to determine the nature and color of amniotic fluid. There is an alternative solution – amnioscopy when the color of the waters can be viewed using the device, but it is not always carried out. In this case, the only method of obtaining information – is an autopsy of membranes.
The next type of medical intervention in childbirth – the use of oxytocin. Many women are also now it is abandoned. Is it justified, from your point of view?
Oxytocin – this medicine, chemical drug that is used for other purposes in the case of diagnosis of uterine inertia or weakness of any attempts. Its use depends on the situation. Pediatricians say that long-term use of oxytocin still has some influence on the child. My opinion: sometimes it is better still to give birth to the stimulation than do a cesarean section. With the help of oxytocin we sometimes saved by surgery.
When dealing with pregnant women, sometimes you can hear a point of view: “It is better to do a caesarean – it’s fast, and you do not feel pain. What is the difference, as the child will be born. ” What do you think of it as a doctor?
My opinion is that women childbirth – it’s completely natural and physiological. She was born to bear children, and her body will withstand any pain intensity. Operation – it is an artificial intervention.
Unlike the US, Russia caesarean section on request of the woman does not happen. Again, the operation is terrible that this operation. We are afraid of the side effects of anesthesia, drugs that are used for sedation, pain management, as well as all the consequences that may be in operation.
That is, you believe that all are able to give birth naturally?
Yes. Just worth noting that there is a group of pregnant women with severe obstetric complications or medical conditions that cesarean section is absolutely indicated.
You say that a cesarean section in our country do not at the woman’s request. Imagine this situation: a woman gives birth, the fight long and painful, her strength is running out, and the hysteria begins. In this case, it is not going to take on the operation?
No, not lucky. In this case, we resort to explanations, tell what happens inside and out. Soothing. My experience suggests that work rational arguments and explanations, as well as psychological support.
And if she says, “All that I can not continue to give birth themselves, and I went.”
Usually we always agree, more kindly, but sometimes you have to be strict. Subsequently, such a situation and remember the woman and medical staff with a smile.
Is there any relationship between exercise, body physically prepared and successful delivery?
On this issue, there are different points of view, but there is no research in this area has not yet been conducted. Doctors and midwives are paying attention to the fact that not all exercise is useful in childbirth. It is certain that the professional athletes giving birth is not very good because of its excessive natrenirovannosti. Physical activity should be, it is useful, but it is important not to pump the muscles and develop flexibility, plasticity. But, again, under the flexibility and plasticity everyone understands different. Important to the body as little as possible the clamps, as they can have psychological causes. Therefore, it is important to prepare the body and mind.
How best to behave during childbirth? One of the doctors said that it is best to lie quietly, others – that it is better to walk, to actively change the posture, use improvised means like feetball …
It is necessary to do so, as you want a woman as it is more convenient. Someone is convenient to experience the fight standing, someone – lying curled up. In this sense, there is no general recommendations. Now everything is going to ensure that the woman acted on the free fights, listening to their feelings.
If we talk about the period of attempts, now practiced as a traditional pose on a couch, and a vertical position. What, in your opinion, is more preferable?
It is preferable to carry out deliveries in a position convenient woman. Most births now occur in the supine position. This long-standing practice, based on the control of bearing-down period, the prevention of birth trauma. Although the vertical position is not negated, and a quarter of the total number of births is carried out in this way. In each case, the doctor and the midwife watched over childbirth and decide on the tactics of their conduct.
In the period of maternity attempts often do an episiotomy – a surgical incision of the perineum to avoid profound breaks and child trauma. However, there is a view that natural breaks better. Obviously, it is better that there was neither the one nor the other, but if you choose between episiotomy and natural breaks, what is preferable?
Currently, maternity wards no longer made routine episiotomy. This operation, for which there are indications and contraindications, it will never do for a reason. A natural breaks can be quite serious. In relation to episiotomy, I would not be so categorical. It seems to me, do not be afraid to the point and not let the doctor do the operation if necessary. The main thing is that the seam then heals well, and the scar is almost invisible.
When a woman is about to give birth for the first time, the more often it is afraid of, first of all, for the life of the child, and, secondly, the forthcoming pain. Are there any natural pain relief methods during labor?
Yes, of course, such as breathing techniques, different postures that women need to look at the birth process, guided by their own feelings, a warm bath, aromatherapy, and others. All of this works. But the main factor – the belief that it will help. I believe that it is very important to go on training courses for childbirth, where everything is explained and give practical advice. A woman should be prepared, know the stages of labor, to know how to relieve the pain.
Deliveries with a uterine scar after cesarean section – this is a very risky business in terms of both doctor and patient. Thus now this question very deeply and seriously studied, constantly there is a discussion of this subject, written dissertations within the medical community. Maternity hospital, where it is practiced not so much, but they are becoming larger every year. This is what we do, what we boast, it is considered progressive.
But at the same time it is quite impossible to give any general advice for everyone to understand woman, fit it or not. It is very individual. We must get to the professionals who are engaged in an institution that has the relevant experience and all employees who are set to such deliveries, as well as a complete examination. Not every woman who wants a natural birth after cesarean section can in principle be admitted to these genera, but of those who admitted, not all give birth to themselves.
What percentage of women giving birth on their own?
In our institution of all those who want a natural childbirth with a uterine scar, giving birth alone, every third patient. Factors of success are many, so it all depends on the specific situation.
Is there, in your practical experience, the relationship between the age of women giving birth and easily, or it is outdated stereotypes?
It all depends on the state of health of the desires of the spirit. I absolutely do not see the difference, and I believe incorrect to call a woman starorodyaschimi. Just the older a woman is, the more carefully it is observed during pregnancy, the more it demands attention.
What do you consider most important when preparing to leave? What would you advise all pregnant women?
For me important is the psychological mood and theoretical preparedness. A woman should not superficially, but in detail, know that it will happen. It is important that a woman has had his own opinion on how it sees its birth, what it wants and that it is crucial for her.
Now they are becoming increasingly popular partner childbirth along with her husband or other relative. Good or bad, with the doctor’s point of view? What motives should ideally be guided by the pair of taking such a decision?
I am convinced that when labor is present some of accompanying – whether an obstetrician, spouse, sister or another relative, the woman is much easier to relax. The main thing that the man she trusted that she was with him, a nice touch.
As for the motive, it is important that accompanies he wanted to attend the birth. In no event it is impossible to force anyone, because it’s not a sight for the faint of heart. A man, if he wants to be at the birth of his wife, to be theoretical training, he should discuss in advance with the wife of her wishes.
And partners in labor – is, first of all, the woman partner. In no case do not need to interfere in the doctor’s actions to try to control the process and so on. Contact your doctor should be the minimum. The role of accompanying – in psychological support of women.
Personal question: why do you want to go work for this specialty, as an obstetrician-gynecologist – a very difficult profession? Where do you see the meaning of his work?
I work in the hospital just because of the fact that I was involved in a miracle. Even though giving birth is not my patient, I can always see this miracle – the birth of a child. Actually, none of the medical profession is no longer seen.
That is, the doctors, despite the huge number of births, still continue to experience them as something amazing?
Yes exactly. Moreover, I have noticed that when a child comes into the world when he published his first cry, then no matter how many doctors, midwives and nurses may be in the room, all smiles. It is impossible to get used to the miracle. That is why we are here and work.
Thank you very much, it was very interesting!
Interviewed by Anastasia Hramuticheva