Is cesarean section better or natural birth? What preparations should be made before cesarean section?

Author: Wang Shaowei, chief physician of Beijing Hospital

Member of the Nutrition and Metabolic Disease Committee of the Perinatal Medicine Branch of the Chinese Medical Association

Reviewer: Duan Hua, Chief Physician, Beijing Obstetrics and Gynecology Hospital, Capital Medical University

Standing Committee Member of the Obstetrics and Gynecology Branch of the Chinese Medical Association

Many pregnant mothers wonder whether natural birth or cesarean section is better when they are about to give birth.

In fact, whether to give birth naturally or by cesarean section requires an assessment by an obstetrician. The doctor will decide the final method of delivery based on the condition of the pregnant woman and fetus. Pregnant mothers just need to cooperate with the doctor.

Cesarean section has only a history of two or three hundred years. It is the best way to solve difficult labor problems. So far, there is no other way to replace it. However, cesarean section is not the best way of delivery. The vast majority, more than 85% of pregnant women can give birth vaginally, that is, natural delivery.

Compared with vaginal delivery, cesarean section saves time and effort. A cesarean section operation can be completed in half an hour at most. Vaginal delivery may take dozens of hours for a first-time mother and consumes manpower and physical strength. However, we must look at the long-term and see what the long-term prognosis is.

For the mother, cesarean section first has to bear the risk of anesthesia and the trauma of surgery, which will leave scars. Not only will scars be left on the abdominal skin, but also on the uterus. When pregnant again, the fertilized egg may implant in the scar, resulting in a scar pregnancy. The risk of placenta accreta disease will also increase, and the mother will face great risks and need to terminate the pregnancy.

The amount of blood loss during a cesarean section is twice that of a vaginal delivery, there is also a risk of infection, and postoperative recovery is also slower than a vaginal delivery.

For children, the probability of cesarean section children suffering from allergic diseases is 6 times that of vaginal delivery. Allergic diseases include asthma, hives, urticaria, etc. Severe allergic diseases may affect the child's life. The probability of cesarean section children suffering from autism, autism, and emotional disorders is 6 times that of vaginal delivery.

During vaginal delivery, the baby will swallow, and the beneficial bacteria in the vagina will enter the baby's digestive tract, and the initial immune stimulation will be established. The intestinal flora will be almost complete six months after birth. Babies born by cesarean section do not have this process, so the intestinal immunity is established later and the probability of intestinal diseases is higher, such as diarrhea and constipation.

In addition, for children born vaginally, the scalp is squeezed and stimulated, which is beneficial to the development of cerebellar coordination. Children born by cesarean section are 6 times more likely to suffer from motor coordination disorders than those born vaginally.

Cesarean section has so many risks, so it is not recommended to choose cesarean section without any medical indications. So, which pregnant women need cesarean section? What preparations need to be made before cesarean section?

1. Which pregnant women are suitable for cesarean section?

The four major factors that affect childbirth are: labor force, birth canal, fetus and psychological factors of pregnant women. If there is a problem in any of these links, it may cause accidents in the production process. If the doctor estimates that an accident may occur, he will recommend pregnant women to choose cesarean section.

Figure 1 Original copyright image, no permission to reprint

In general, doctors will recommend a cesarean section if the mother has the following signs:

Maternal factors: problems with the birth canal, such as obvious pelvic deformity, excessively narrow birth canal, scars on the uterus after complex surgery, etc., which make it impossible to tolerate canal delivery.

If the mother has serious complications, such as severe gestational hypertension, severe heart disease, or cerebrovascular disease, a cesarean section may also be required.

Fetal factors: If the fetus is too large, the mother's pelvis is relatively narrow, the fetus cannot pass through the birth canal, or the fetus is in an abnormal position, a cesarean section may also be required.

In addition, for some premature fetuses, a cesarean section is also required to improve the survival rate of the fetus.

Emergency: If an emergency occurs during delivery, such as placental abruption, placenta previa, heavy bleeding in the mother and other unexpected situations, a cesarean section may be required to save the lives of the fetus and the mother.

2. What preparations need to be made before cesarean section?

Cesarean section operations are mainly divided into two categories: one is elective cesarean section, which means making an appointment in advance for cesarean section; the other is emergency cesarean section, which means that the operation must be performed immediately after the mother is admitted to the hospital, otherwise it may endanger her life.

Preparation for cesarean section generally requires completing necessary examinations first, such as blood pressure, pulse, height, weight, heart and lung auscultation, liver palpation, uterine condition, blood routine, urine routine, etc.

These examinations are closely related to the choice of anesthesia during surgery, the choice of surgical method, postoperative treatment, etc. For example, if the mother's coagulation function is not good, epidural anesthesia is not suitable.

At the same time, the doctor will also carry out preoperative preparations, such as the selection of incisions, local cleaning of the incisions, skin preparation, etc.

In addition, before the operation, the doctor will make an emergency plan to deal with emergencies during the operation, such as preparing blood in advance and using antibiotics prophylactically.

3. When is the best time for a cesarean section?

From a medical point of view, no matter what method of delivery is chosen, the most important thing is to ensure the safety of the mother and child to the greatest extent possible.

The same is true for cesarean section. Generally speaking, if the mother's physical condition allows, the baby should be carried to full term as much as possible, that is, 37 weeks. It is best to have a cesarean section at 39 weeks of pregnancy.

If the mother has complications, such as gestational hypertension, and the mother's disease cannot be completely resolved if the child is not born, in this case, early termination of pregnancy is more beneficial to the mother's health.

At this time, the doctor will take comprehensive considerations to maximize the health benefits of the mother and child. In simple terms, this means that while ensuring the mother's safety, the child is more likely to survive. This is the best time for a cesarean section.