The first thought of every pregnant woman is how she would be born. Bahçeci Clinic Gynecology & Obstetrics, Diagnosis and Treatment Center Op. Dr. Esra Aksoy Jozwiak “First of all, the mother's wish is the status of the pregnancy, the evaluation of the baby and the placenta, the anatomical structure of the mother and the type of birth that is suitable for her health status. The decision should be shaped according to the doctor's recommendations. ”
: What are the birth methods?
Kiss. Dr. Esra Aksoy Jozwiak The baby's birth can be realized in two ways; normal delivery or caesarean section. Birth is an event that begins with a series of involuntary contractions of the uterus after 37 weeks of gestation and ends with the vaginal leave of the baby's mother's body. Although the mechanisms leading to birth are not known in detail, the complex originating from the mother and the baby depends on many factors. A caesarean section is not a vaginal delivery of a pregnant woman, but a method of delivery by opening the abdominal cavity surgically. Cesarean section is one of the most performed surgeries in the world in recent years and cesarean delivery rate increases gradually.
: When is cesarean section necessary?
Kiss. Dr. Esra Aksoy Jozwiak Cesarean section has become an extremely safe and easy operation due to the change in the anesthesia techniques, the improvement and the availability of newer anesthetic drugs, the provision of more sterile conditions in the operations and the presence of strong antibiotics against infections, advances in suture materials and the advancement of surgical techniques. Caesarean section can be performed at the request of the mother or in the case of a mother or baby.
: Is optional cesarean section increased?
Kiss. Dr. Esra Aksoy Jozwiak In recent years, optional cesarean rates in hospitals have increased, of course… The most common optional cesarean section is that the mother is afraid of normal birth, does not want to suffer pain, does not want to risk her baby, and wants to avoid long-term complications of normal birth (such as uterine and bladder prolapse) and a special day for the couple. (Anniversary of marriage, birthday of one of the parents, 04.04.04, such as the choice of easy to remember days) is due to want to perform birth.
: In which cases is it necessary to perform caesarean section?
Kiss. Dr. Esra Aksoy Jozwiak
The baby does not come with the channel head: Normally, in 95% of all pregnancies, the baby progresses, while other conditions; lateral, breech, or diagonal occurrence occurs in 5%. In this case, the physician takes caesarean section decision in order not to put the baby at risk.
Spouse completely closes the cervix: In this case, progression of the baby in the birth canal will cause bleeding and risk the mother and baby's life.
Early separation of the spouse: If the placenta is separated from the uterine wall before the birth of the baby, it disrupts the flow of oxygen and nutrients to the baby. As the life of the mother and baby due to bleeding are at risk, the baby should be delivered by cesarean section immediately.
Coarse baby: If the birth weight of the baby is found to be more than 4000 grams, which can be detected by ultrasound, the baby should be delivered by cesarean section. Normal birth can cause serious trauma to the mother and baby.
Mismatch between the baby's head and the bony structures of the expectant mother (CPD): This is popularly known as 'roof stenosis'. Caesarean section is also recommended in such cases.
Multiple pregnancies: Cesarean section is preferred especially if there are three or more infants. Vaginal delivery is avoided. In twin pregnancies, vaginal delivery may be possible if the conditions are appropriate…
Some anomalies in the baby: Caesarean section should be preferred if the abdominal wall of the baby is not closed and the internal organs are outside, such as gastroschisis and omphalocele and neural tube defect in the baby.
Fibroids: If there is uterine fibroids in the localization that makes vaginal delivery impossible by narrowing the birth canal, delivery is performed by cesarean section.
Cases where the mother should not be pushed: Caesarean section is preferred as it may cause strains in severe heart diseases and brain aneurysms.
Herpes infection: If the mother has an active genital herpes infection, the baby should be delivered by cesarean section as it may catch the infection while passing through the birth canal. Some of the surgeries your mother had: Previous cesarean section, myomectomy, lumbar hernia or vaginal aesthetic operations may require cesarean section.
Vaginismus: Vaginismus is a condition of involuntary contractions of the vagina during sexual intercourse and requires caesarean section.
Baby's getting into trouble: Urgent caesarean section may be necessary if NST examinations performed before or during labor have data indicating that the baby is in distress. Intrauterine growth retardation requires strict pregnancy monitoring. If the baby's distress increases further, urgent cesarean section may be required.
No progress of labor: Although the uterine contractions are regular and strong, the cervix does not open or if the baby's head does not come down, a cesarean section may arise.
Cord sag: When the amniotic sac is opened, the baby's umbilical cord may hang out of the cervix. In this extremely urgent situation, the cord may become trapped and cause the baby to die. Emergency caesarean section is required in this case.
Advanced maternal age and post-treatment pregnancies: Direct cesarean section is preferred in cases where the pregnancy is very difficult or the chance of a second pregnancy is low, advanced maternal age and pregnancy after IVF.
: If we compare cesarean section and normal birth, what are the advantages and disadvantages?
Kiss. Dr. Esra Aksoy Jozwiak Normal delivery or cesarean section; both are not innocent. Both methods have advantages and disadvantages.
: What are the advantages of normal birth?
Kiss. Dr. Esra Aksoy Jozwiak
-The most important advantage is that it is normal and physiological. After birth, the mother can return to normal activity within a few hours and begin to breastfeed immediately.
-Emotional contact between mother and baby starts sooner and stronger.
- The mother may leave the hospital soon after delivery.
- Following normal birth, the mother can return to her pre-pregnancy life in a shorter period of time.
The advantage of normal birth for the baby is that the baby's lungs are more prepared to breathe. In addition, emotional contact between mother and baby begins in a shorter time and stronger.
: - What are the disadvantages of normal birth?
Kiss. Dr. Esra Aksoy Jozwiak
- When everything goes well, the baby may get stressed, heartbeats may slow down, or even be lost. For this reason, normal birth should be performed in hospital conditions and in an environment that can be passed to cesarean section as soon as possible.
- One of the most feared complications of normal birth is wearing the baby's shoulder. Here, after the baby's head is born, the shoulders are attached to the bones of the mother and possibly the baby is lost.
- Excessive prolongation of the action may cause the baby to become deoxygenated and then to retard both intelligence and motor functions.
- Risks in terms of maternal ruptures may occur during birth. These tears may cause problems in stool retention in the future. Even millimeter windows that can be opened between the mother's intestines and vagina can cause feces to come from the vagina.
- Bladder prolapse due to normal delivery may cause future urinary incontinence complaints. Correction requires surgery.
: - What are the advantages and disadvantages of cesarean section?
Kiss. Dr. Esra Aksoy Jozwiak The most important advantage of cesarean section is that it minimizes the risks for the baby. Most of the disadvantages mentioned in normal delivery by cesarean section are eliminated. However, babies born by cesarean section are more likely to develop respiratory distress in the first few days. Cesarean delivery is more problematic for the mother than for normal birth. There is a very low risk of general anesthesia. This risk can be eliminated with epidural anesthesia. It takes 2-3 hours for the patient to regain consciousness and start breastfeeding after the operation, and the mother's oral feeding takes about 6-8 hours later. Generally, he should be hospitalized for 2 days after surgery. It usually takes 3-4 days for the patient to return to normal life. The first few hours after surgery are quite painful. The mother should avoid heavy labor for at least 6 weeks after surgery. In the long term, pain at the sutures and adhesions due to surgery in the abdomen are other complications. The common complication of both births is the risk of infection. There is always a risk of infection in places with sutures, whether normal delivery or cesarean section.
: What do you think is the reason for the increase in interest in delivery with epidural anesthesia recently?
Kiss. Dr. Esra Aksoy Jozwiak It is important for the mother to be very motivated and motivated in this direction for normal birth. In this case, epidural anesthesia, which has become widely used in recent years, provides the mother and doctor with utmost comfort. With this form of anesthesia, the mother does not feel the birth pains at all and can easily perform her birth.