Broadcast of the parental portal Snoznono.Ru with neurologist Mikhail Vladimirovich Golovach.
Labor manipulation and an increase in the number of pathologies in children
Stimulation of labor, "squeezing out the baby", vacuum and forceps
Such different "natural childbirth"
The consequences of childbirth interventions may not appear immediately.
Puncture of the fetal bladder
EVELINA GEVORKYAN:
Hello, this is the first broadcast of the parental portal Snoznono.Ru, my name is Evelina Gevorkyan and today we will be our guest Mikhail Vladimirovich Golovach- a neurologist who will tell from his side, based on his experience, about the consequences of interventions in childbirth, in the physiology of childbirth and the natural process of childbirth. (...)
I will also add, Mikhail Vladimirovich Golovach - a neurologist, a member of the organization "Assistance to the protection of the rights of persons with disabilities with the consequences of cerebral palsy" and an expert of the "Interregional Alliance of Mothers and Midwives".
The broadcast has begun, and, Mikhail Vladimirovich, the first question I would like to start with. The topic of your research is "Physiology of Childbirth". I would like to ask - why do you, as a neurologist, in principle associate interventions in childbirth with problems in children?
MANIPULATION IN LABOR AND INCREASE IN THE NUMBER OF PATHOLOGIES IN CHILDREN
MIKHAIL GOLOVACH:
In my own person, I represent those neurologists who, over the past 40 years, have faced the growth of various neurological pathologies in children. When we analyze the cause of a disease, we always try to find the basis of this disease.
What happens to the nervous system? In principle, we find how the deviation manifests itself, we see it, sometimes we try to treat it, but when we try to establish the cause, then, of course, in the case of a child's illness, we often have to analyze how the child was born.
It so happened that the growth of the disease in children in the nervous system over the past 40-50 years coincided with those cardinal changes that have occurred in obstetrics itself. For example, Professor Radzinsky called modern obstetrics aggressive obstetrics.
What has appeared during these 40-50 years in obstetrics? Obstetricians now have powerful tools that affect the process of childbirth, and in a certain way, the use of these funds, as we can see from the statistics, coincided with an increase in the number of neurological diseases of children in our country. Such figures can be cited related to the growth of cerebral palsy: 1964 (data presented by Professor Semyonova, the luminary of cerebral palsy issues), the number of cerebral palsy per 1000 children under 15 years old was less than 1 person (0.64 people). At present, in 2007, the number of cerebral palsy reaches 21-23 children per 1000 children.
What means were in the hands of obstetricians in order to interfere in the process of childbirth - to induce childbirth, to speed up labor? It is worth listing them: since the end of the 60s, we have oxytocin- it is a hormonal drug, but artificial; it does not correspond to the hormone oxytocin, which is part of the hormone of the posterior lobe of the pituitary gland, which is directly involved, apparently, in childbirth in a woman. This purified oxytocin has its own artificial properties, for example, natural oxytocin, which works in a woman in childbirth - it lives for seconds, and then it decays; artificial acts when administered intravenously for up to half an hour or more.
In the 70s, such a group of funds appeared as prostaglandins- they are actively used today during the ripening of the cervix. These artificially created prostaglandins also do not match the natural prostaglandins that appear to be involved in a woman's labor. If only because natural prostaglandins live in the blood of a woman during childbirth for a few minutes; artificial prostaglandins, which are introduced in the form of gels, ointments, suppositories, intravenously, drip, live for hours. For example, if a gel is applied, then the action of such prostaglandins lasts for 6-8 hours ...
And when you talk about interventions, do you mean only these medicinal ones that have been used in Russia for the past several decades?
For now, I indicate what means - the most powerful - have appeared in the hands of obstetricians precisely from the time when the obvious growth of pathologies of the nervous system in children began. Of course, in the hands of obstetricians there are also means of manipulative influences on the process of childbirth, and there are manipulative influences that have long been known, and there are also new ones.
It has long been known - this is a puncture of the fetal bladder, this is the stretching of the cervix with the hands during contractions, this is squeezing out the fetus with weak attempts. These are all manipulative influences. Of the new ones that have appeared since the 80s is the use of kelp (a substance obtained from algae, which, when inserted into the cervix, swells and has a stretching effect on the walls of the cervix).
Is this how they do it in maternity hospitals?
They do it in maternity hospitals, and plus they had a way of stretching and affecting the cervix before they had a method of stretching and affecting the cervix - this is a catheter with a balloon, which inflates and also affects the wall of the cervix, that is, it exerts constant pressure, and, according to obstetricians, this should lead to the so-called ripening of the cervix, if it does not mature, and according to the timing of the woman it is already time to give birth. That is, the 40th week has already arrived or even more. These are the so-called mechanical dilators. Dilators are dilators.
For a layperson, this all sounds ominous, scary, but I suppose professionals use it exactly when it is really necessary, when it comes to saving the life of a child and a mother?
Yes, accordingly, midwives took part in childbirth until the 60s and 70s. After the most powerful means for influencing the birth process appeared, an increasing number of births began to be accompanied by obstetricians. That is, not a single childbirth in the hospital can do without their participation. That is, a mandatory examination and appointment for each birth by a doctor.
To assess how this or that remedy from the ones I have listed will work, whether it be oxytocin, prostaglandin or a mechanical dilator, or a puncture of the bladder - no obstetrician can predict how this remedy will work. because every birth is an individual process, and, despite the fact that the process of childbirth itself follows the law that is written in every woman at the level of genes, everything goes sequentially one after another.
The obstetrician, when intervening in childbirth, can never predict how this intervention will end. Your question is how justified is this intervention, what indications does the doctor give for the intervention? Unfortunately, at the last all-Russian forum of obstetricians-gynecologists "Mother and Child-2010", the same questions still stand, as they did many years ago: the protocol of labor management is discussed, natural childbirth and childbirth with complications not comforting and not convincing in terms of what obstetricians do in maternity hospitals.
For example, Professor Baev, in his report on the protocol for the management of childbirth, admits that there is no single protocol for the management of childbirth in Russia, that each maternity hospital, each region has its own protocols.
But you yourself say that every woman gives birth individually? What protocol do you want to fit everyone into?
This is not what I want. The labor management protocol provides that if childbirth suddenly went unnatural, then this, accordingly, needs to be recorded and clearly, justified, for which oxytocin was injected, for which the gel was applied.
That is, the protocol is needed in order to record the very moment on the basis of which the obstetrician decided to use this or that effect on childbirth. There is no such clarity. In addition, there is no concept of natural childbirth, which would be generally recognized in our country. That is, the definition of natural childbirth - without intervention - is not, and childbirth with amniotomy - a puncture of the bladder is referred to natural childbirth in maternity hospitals in our country (that is, if nothing besides amniotomy is used, then this is considered natural childbirth). With the preparation of the cervix "Mifegin" or prostaglandins (if nothing else has been done, then this is considered natural childbirth). The perineal incision - episiotomy - is also a "natural" delivery. Epidural anesthesia during labor is also a "natural" birth.
That is, most obstetricians do not consider such interventions in the birth process unnatural. Moreover, most women consider the births that occurred through the natural birth canal to be natural births, and those births that occurred through the caesarean section as unnatural.
And, unfortunately, the awareness of women on the part of obstetricians when carrying out certain interventions in childbirth is minimal or absent altogether. Therefore, the situation turns out to be insoluble. When a woman goes to a maternity hospital to see a doctor, she hopes for qualified help, but awareness is minimal. The doctor says that he decides everything himself. But if childbirth goes naturally, then the doctor has nothing to decide, he must simply provide this natural birth.
I myself, as a woman who has been to the hospital, I can say that legally, getting to the hospital in the admission department, few people pay attention to this, but we sign a paper on several sheets, which begins: "I agree ..." and then a list of possible manipulations and medical interventions, which, if something happens, doctors can perform.
Thus, the woman is formally informed, and then the doctors act according to what their professionalism tells them. What do you think is wrong in this system and what would need to be changed for the better?
In this system, there must be a proviso that any action and appointment of a doctor: the doctor must explain to the woman in labor or her legal representatives if she gives birth with her husband or with one of the relatives.
But when a woman gives birth, it is impossible to think with her head about what to do now.
That's right, therefore, legal representatives or relatives. Because it is desirable, of course, and modern legislation allows a woman to be accompanied by someone close to her in childbirth, and not even in a contract delivery, but in any childbirth, in any maternity hospital. Precisely due to the fact that childbirth is a kind of process in which a woman directs all her forces to birth, and not to think, weigh and choose something, she needs serious psychological support, and, accordingly, to decide the appointment of certain manipulations or medications is necessary for the doctor for a reason, but at least with the consent of the accompanying woman.
In addition, there should be a strict record of this conduct - why did the doctor begin to do this? So that later you could analyze - was it necessary to do this?
Again, we all know that all the cards, medical documents are filled out most often after the fact, and the doctor can then write that there was such and such, so he prescribed such and such. This is the formal side of the matter, and every doctor will find a way out.
Another question is that when doctors do all these manipulations - I just imagine that now some doctors are watching or listening to us - they will definitely say that they are doing this for the good of the woman. And actually why are we now raising this topic - if they finished their honey. universities, they act from the height of their medical knowledge, and they help a woman and a child, because now women give birth badly, the time is such, and they, accordingly, help everyone to survive.
SUCH DIFFERENT "NATURAL DELIVERY"
At the expense of giving birth badly: I immediately return to the conference I spoke about - "Mother and Child - 2010", to the report of Professor Baev on the protocol of childbirth. Such figures were given by the professor: in 2009, from 70 to 80% of women had a completely normal pregnancy, not complicated by anything, and they had to give birth in the so-called low-risk group. Childbirth in a low-risk group is a completely natural childbirth in which no intervention is required, but only the ability to properly set up a woman psychologically and guide her through childbirth psychologically correctly, so that she is sure that everything will be safe. Such childbirth does not require a bladder puncture, preparation of the neck, i.e. everything should go naturally and, in principle, there should be no medical interventions.
However, in 2009, more than 65% of births ended with complications during the labor process. Those. 65% of women received some type of intervention in childbirth. Why did these interventions take place? Hard to say. They could, for example, as an explanation that something is wrong with childbirth and the doctor decides that it is necessary to intervene. But the fact is that even a bladder puncture, by the decision of a doctor who can speed up labor, can lead to a variety of consequences: from the fact that labor will simply stop and then the next intervention will have to be used - injecting oxytocin. Or, on the contrary, a puncture can speed up labor so much that it will go badly and you will have to restrain it, and inject no-shpu or other substances, because the child will suffer from a violent birth.
Those. it turns out that the boundaries between the manipulations and appointments that the doctor carries out during childbirth and the complications that arise from this are very difficult to draw. There is no such clarity. And the numbers speak for themselves: 70-80% of women in maternity hospitals had to give birth on their own, with the participation of midwives, a doctor was not needed, but 65% gave birth with complications.
Moreover, of the remaining 35%, bladder puncture and episiotomy are considered normal. I wonder how many women gave birth without any intervention at all - this history is silent, such figures are not given to us.
As a neurologist, could you explain exactly what disorders occur? What are the consequences of these very interventions that you listed?
It is worth explaining right away what happens to the child's central nervous system. In a child, at birth, the central nervous system is sufficiently developed in terms of the number of cells, everything is inherent in the child's body in the central nervous system, however, not all parts of the brain work in the child. The cerebral cortex of a child after birth works with low activity, the cells of the cortex practically do not work. They consume little oxygen, little nutrients, i.e. thus, they are protected by nature from the moment in childbirth when, at the time of contractions, blood and oxygen are usually supplied to the child and he must endure these contractions without damaging the central nervous system. That is, the cells of the cortex are most protected.
However, the reflexes with which a child is born are innate reflexes - they are all provided with the work of those nerve cells that are located in the subcortex and in the brain stem. Due to these reflexes, the baby makes movements during pregnancy in the mother, passing in the stomach; due to these reflexes, he is usually located head down - with the back of the head to the exit - before childbirth. Thanks to these reflexes, he makes those rotational movements that are necessary for him in order to pass the birth canal during childbirth. And it is these reflexes that neonatologists and neurologists first of all evaluate when examining a child.
Accordingly, if there is damage to the nervous system, then it is not the cortex or the trunk that suffers, but those parts of the brain that are very important in the future in order to establish a connection between the cerebral cortex and the underlying parts - the cortex with the subcortex.
CONSEQUENCES OF INTERFERENCE IN LABOR MAY NOT BE IMMEDIATELY
Do I understand correctly that the consequences of interventions in childbirth are not immediately visible - "at the exit" of the child, not immediately at his birth, but appear only after a while?
Yes, and I have not yet finished the thought that, unfortunately, the central nervous system of a child develops after birth. Initially, she is alone, and then, during her life, she develops. During the first year - one and a half years of life, the child develops physical activity, that is, movements are formed. He must overcome the gravity of the Earth, he must stand on his feet. All this is in the genes, it must be consistently developed in the child.
And the parts of the brain that are responsible for this must work consistently. If there is any damage, first of all, between the cerebral cortex and the underlying sections, then there are not enough connections of the cerebral cortex with the underlying sections for these movements to develop correctly.
And neurologists often see deviations in these cases - not immediately after childbirth, but in dynamics. For example, it is supposed to show a child to a neurologist at 1 month, at 3 months, at 6, 9, 12 months. Evaluating already in a month, we can assess the state of the inborn reflexes in a child, and how much those acquired reflexes that should appear in the child by this time, how pronounced they are, how much they correspond to this monthly age.
Accordingly, if we see a lag in the development of these reflexes, we see violations, we make certain neurological diagnoses.
Official medicine does not associate these very consequences (list then all these diagnoses that, as you think, are associated with the pathological management of childbirth) with childbirth?
Those violations, if they are insignificant in the development of tone and reflexes in a child, are observed by neurologists for up to a year - we see how often these reflexes are normalized, and almost all pathology goes away, because the child's cerebral cortex develops. As a result, she still takes control of the movements on herself. Usually, such children do not have neurological problems as such after a year and a half, and orthopedic problems remain.
Because a violation of tone and reflexes leads to the fact that the formation of the musculoskeletal system is disturbed in the child: the formation of bends of the spine, limbs, which are embedded in the genes of the child.
If the tones and reflexes were somehow violated, it means that a violation of the development of the musculoskeletal system may occur. Accordingly, this is an orthopedic problem, for the solution of which they go to orthopedists, surgeons, not neurologists.
What could it be?
Scoliosis, kyphosis, clubfoot, walking on toes, feet inward. That is, problems that require orthopedic correction.
And this may be due to the fact that the mother was given an injection during childbirth?
I started with the fact that neurologists see the manifestation of the disease, they can suggest where the disorder occurred, and neurologists are trying to answer why it happened. First of all, it would be necessary to assess those moments when damage to the nervous system could occur. And there is a coincidence, which I have already mentioned: as soon as obstetrics began to use active management of childbirth in the 60s, using not only manipulative interventions, but also medication, and there was a sharp increase in these neurological problems in children. From the lightest toned reflexes to the most severe - cerebral palsy, autism, hyperactivity, epileptic syndrome.
Moreover, this growth is associated with all neurological diseases. Regarding cerebral palsy, I said, regarding autism, I can say: in 65, autism in our country was less than 1 person in 10,000, and by 2001 the growth of autism was 15,000 times! Ecology, food: what happened to humanity in Russia?
Well, yes: both the ecology and nutrition - everything was getting worse ...
Was it getting worse? I would not say that: the ecology is improving, this is evident from the way in which all harmful enterprises in our country have been closed and taken out of the cities; nutrition now is also quite selective: those who are planning a pregnancy try to eat right. There may be drug addicts and smokers, but they are a minority, and due to them, the growth of neurological pathologies will not work.
This brings up the following question. And is it right: instead of a woman going through a very difficult, protracted and traumatic childbirth, it would be better to choose a cesarean section? Is it a safer way for a child to be born quickly and not get these very injuries?
At the expense of a cesarean section, the following remark is immediately made: among 65% of complicated births in 2009, 25-35% (depending on the region) is an emergency cesarean section. That is, this is not the cesarean section you thought about. That is, this is an emergency caesarean section in order to save a child who has already begun to suffer. Therefore, caesarean cesarean section is different. You probably meant a planned cesarean section.
You, that is, you think, is a planned cesarean section, which is done in 2 weeks - is it better?
They are now trying to do a planned cesarean section almost on the day of the due date - once so that the child reaches maximum development; secondly, a planned cesarean section does not solve all problems, firstly, because it is an operation, and accordingly, the risk for the mother increases; secondly, the choice of anesthesia, anesthesia, anesthesia for cesarean section is very important.
What's the safest option?
According to what anesthesiologists offer on their websites, in their work, general anesthesia under halogen-containing modern gases is considered the safest. This anesthesia is 3 times more expensive than epidural anesthesia, and it carries a risk for the mother, since the intubation is in progress. In the hands of an experienced anesthesiologist, of course, the risk is small, but all the same - intubation, breathing for mom is a risk for mom.
For a child, the risk is much less than with epidural or spinal anesthesia, because these modern halogen-containing gases do not affect blood circulation, hemodynamics, or pressure. That is, the pressure, hemodynamics, heartbeat in the mother and the baby are stable during anesthesia.
I can imagine what a flurry of objections can be now, because a mother who is being taken out of consciousness, who will then establish breastfeeding, can it really be better?
These modern gases differ in that the mother wakes up in 2-3 minutes, that is, after a few minutes, the mother wakes up after such anesthesia, and the baby also begins to breathe on its own after the umbilical cord is clamped in a few minutes.
That is, it is not practiced in our maternity hospitals?
It is practiced, but according to certain indications. Here the anesthesiologist decides. Unfortunately, such materials in the literature, where there was a discussion between anesthesiologists and obstetricians, and neonatologists-neurologists - and what the child should choose, which cesarean section for the mother to offer so that the baby does not suffer - I have not seen in our literature. What I'm talking about now about safety is a link to an anesthetic site for foreign works and publications.
In order not to get away from the topic of our conversation and not go deep into a cesarean section, after all, summing up: is this operation in itself safer than the risks of natural vaginal birth?
Strange as it may seem, the risk to the child's health is minimal for the health of the child with the correct anesthesia. As far as the development of the child is reflected - there are some research works, how the difference in the development of children after a cesarean section and after a normal birth is connected with immunity and other points. Something the child receives less, not being born normally. But what he will definitely not get is the severe neurological pathologies that he can get from ordinary childbirth, in which he will intervene; and such childbirth may have already ended with an emergency caesarean section, when the child began to suffer.
And this is already bad.
This is already bad.
I will ask a question from the listener Svetlana Penkina: “What harm is caused by the injection given during childbirth, the so-called“ REM sleep ”? And how does this remedy affect the child? "
It is believed that what is used for sleep - I do not know what exactly the person who asked the question - "what is injected?" - both drugs and diphenhydramine are injected. In principle, all of these funds I have listed weaken the course of childbirth. But they give the woman a rest during childbirth, according to obstetricians, to restore strength.
Contraindication of the introduction: it is difficult to say, because the intervention in childbirth that occurred, with medications, it was not confirmed by those studies of the birth itself, which should have been performed. That is, the physiology of childbirth is completely incomprehensible and unknown to obstetricians. Those theories according to which the generic process takes place are still called hypothetical. As they were assumed in 52 by the British, they remain at the same level; this is when ultrasound and other types of research appear.
There are domestic scientists working with ultrasound in childbirth with pregnant women, pathologists, obstetricians directly working with the uterus in childbirth, operating, performing a cesarean section, who made a very interesting discovery on what the true mechanism of childbirth is. Their discovery can be called the hemodynamic mechanism of childbirth. Hemodynamic comes from the word "circulation".
According to these scientists, in childbirth, blood circulation in the uterus and placenta is of primary importance. Childbirth itself does not require that heavy mechanical work, which, as is usually imagined, must be done by a woman in order to give birth. Because the uterus with the hemodynamic mechanism, if taken as the main one, does not perform mechanical work. Each contraction of the uterus in childbirth is a contraction without changing the size of the uterus, that is, the so-called isotonic contraction. Such a contraction does not reduce the volume of the uterus, however, the modern idea among obstetricians that childbirth can be compared with the action of a piston. Due to the contraction of the walls of the uterus, the child is squeezed into the birth canal.
Nothing like this happens in childbirth! And this has already been established by scientists. They say: "No, the uterus does not change its size." What's changing? At each contraction, the accumulation of blood in the wall of the uterus and in the placenta changes, and the blood does not accumulate just like that, but accumulates in the vessels, which grow in huge quantities in the uterus and in the placenta during pregnancy and before childbirth.
You say that this natural process of childbirth itself has not been studied enough or has been little studied.
No, I want to say that it has been studied by domestic scientists, but not accepted and continues to be studied by the official obstetrics that recommends sleep, stimulation, programmed childbirth, preparation for childbirth. If this study began, apparently, many things with intervention in childbirth would have been forced to revise the official obstetrics. First of all, because we see how this intervention affected the health of the central nervous system of children.
So all the same, when doctors use these very methods, as it follows from your words, they sometimes use them too often - nevertheless, when it comes to saving a child, they must take some measures? Speed up childbirth, so that the child is born faster, stops suffering inside, some other manipulations ...
BIRTH STIMULATION, "PUSHING THE BABY", VACUUM AND TONGS
I want to say right away that if you take an annotation for any drug - oxytocin, prostaglandins, bladder puncture - if the child suffers, if hypoxia, distress, confirmed by CTG, that is, palpitations and other signs, this is a direct contraindication to any stimulation.
That is, if the mother is told that your child is suffering there, suffocating, is in hypoxia, but they have to pierce a bubble or urgently put a dropper, it means that the doctor is cunning, it means that the doctor is misinforming the woman. He just intimidates her. There is nothing of this, but if, in principle, the doctor makes these drugs, these drugs say: "side effect - a violation of the tone of the uterus, impaired uteroplacental circulation, hypoxia and fetal distress."
As I said, each birth is individual, individual in the sense that we do not know how the same drop of oxytocin will affect a particular woman and a particular baby. This is the peculiarity of childbirth. Therefore, the doctor, prescribing the drug, takes risks, but he is sure that he is doing the right thing, because he is not prohibited by instructions not to inject these drugs. It is allowed, but under certain conditions, if there is hypoxia, fetal distress, then not a single doctor, if he acts according to the instructions, will not inject drugs that stimulate labor or pierce the bladder. Moreover, he should not squeeze out the child.
Professor Radzinsky at this conference cited very interesting figures related to the squeezing of a child: in Australia for many years there has been a law according to which a written statement of a woman or relatives is enough that during childbirth an obstetrician or midwife pressed her on her stomach, like this obstetrician for the rest life is deprived of practice.
And you say - what then to do? He cited a comparison of our numbers and the American ones for 2009: in the United States, in a situation where a child is not born on pains, and the mother does not have enough strength, it is too late to perform a cesarean section, in this case obstetricians must give anesthesia to the mother, which removes any labor activity, and pull the baby out with forceps or vacuum. In 2009, forceps in the USA pull out more than 6 percent, vacuum - 12-16%. It is less traumatic than squeezing.
But in itself it sounds ominous: tongs and vacuum!
Ominous, but more ominous than this squeeze. I started with Australia: you just need a statement, you don't need a prosecutor, you don't need proof. A statement from a woman that she was pressed on her stomach is enough. And this obstetrician loses his license.
Because putting pressure on the stomach is knowingly taking a risk, maybe it will slip through, but knowingly going at the risk of injury for the child, what kind of injury: a child stuck in the bony part of the birth canal, accordingly, his head does not crawl through, when pressed, he will be born, but this compression of the head will result in injury. He may receive a slight concussion, or there may be such a compression of the brain that he can be compared with falling from the fifth floor, it will be cerebral palsy. This is what it means to squeeze out a child stuck in the birth canal.
And the use of forceps, vacuum?
The percentage of trauma is less, firstly, since there is relaxation, that is, labor is removed, and secondly, the vacuum is less traumatic, oddly enough by the results. In Russia, forceps in 2009 were used 0.03%, vacuum - 0.02%. With 65% of labor complications and 30% of caesarean sections, what should the rest of us do? Radzinsky says: "Extrusion, comrades obstetricians." However, no documents prohibiting extrusion were adopted. It was just recommended to use tongs and, first of all, vacuum, as a safer way.
Question from Alina Fedosova: “To what extent does CTG correctly show the state of the fetus? The sister had attempts, but according to the results of CTG they decided to "caesare".
In general, clear criteria for CTG, of course, are not enough. They exist, it is impossible for us to discuss them, at such an amateurish level, but I can say that when pathological indications for CTG appear, this suggests that the child's brain suffers. Changes in CTG are ongoing, so there should be time-based criteria, that is, not a few seconds, but a minute or two.
There is an interesting point here: apparently, there were serious changes in CTG, and it was decided that in order to save the child, it was necessary to stop the process of contractions, because anesthesia immediately interrupts the grasping process. That is, the blood circulation is restored, and it is necessary to do a cesarean, apparently under general anesthesia, since it is urgent.
Do you share the opinion of experts that the use of CTG in itself is negative, since a woman is initially attached, cannot relax if she is monitored all the time?
Now there is a KTG that works remotely, this is already a matter of technical support, without wiring. Secondly, if a woman is allowed into a programmed birth, she is smeared with a gel with prostaglandins. Naturally, doctors do not know how this particular substance will affect this woman, her childbirth. They know that there is, as a side effect, an increase in the tone of the uterus and the suffering of the child, therefore they are forced to keep such women on CTG without any fights. It's absurd, but they go for it so as not to miss something.
If a woman gave birth naturally, then there is no point in doing CTG without certain interventions. And if the obstetrician conducts any treatment, intervention in childbirth, he is forced to control himself in order to know how this substance, which he introduces, or this technique, will have an effect on this woman. First of all, for the child, because all this was started by nature for the sake of the child, pregnancy and that's it.
BUBBLE PUNCHING
We have a question about a bladder puncture, we have repeatedly talked in our conversation today about this manipulation, which is harmless by modern standards. What's so special about her?
This is not a harmless manipulation. This manipulation is very serious for the childbirth process. In a scientific article by the same professor Radzinsky, it is said about the consequences of a bladder puncture with a small opening of the cervix.
If we take the recommendations of the 50s, pre-war obstetricians, then the bladder was pierced at least only when the cervix was fully opened. Now the bladder can easily be punctured with minimal dilatation of the cervix in order, they believe, to stimulate the process of childbirth. Stimulation of the labor process may not go, but on the contrary, weak labor will occur. A long anhydrous period can end with the stimulation of labor with a more serious remedy - oxytocin. So this is not a harmless manipulation at all.
Modern manuals, which are written for obstetricians by Sidorova and other professors, it is recommended to pierce the bladder at 6-8 cm of cervical dilatation. A completely unfounded recommendation. Why? She has it below, and in any foreign manual it is written that after a bladder is punctured, there is a sharp increase in the tone of the uterus, and for at least half an hour this is reflected in an increase in blood circulation in the uterus and placenta, that is, it turns out that the child can receive hypoxia during this time ...
That is, this is not some kind of indifferent to the process of childbirth, but first of all, for the child, the simplest manipulation! For some reason, obstetricians do not talk about this when they puncture the bladder. However, this is fixed. After the tone of the uterus is normalized, blood circulation can be restored, and further childbirth, perhaps, will go its own way, and the baby will be born usually, without any intervention.
The so-called Apgar scale, which is so often referred to, is an assessment of the child's condition after childbirth - it will be normal. But when such a baby is brought to the neurologist a month, he will be found to have a violation of the tone of muscle reflexes.
That is, as I said earlier, the cerebral cortex cannot establish normal connections. That is, the brain suffered. Bladder puncture may be one of the reasons that led to this. Although further, it seems, the child was born normal. Therefore, this manipulation must be strictly justified. And these rationales are often insufficient, because obstetricians often do not understand the consequences of their actions. The process of childbirth is important to them, it is important that childbirth goes on. It's good that no cesarean, but what about the child ...
If everything is bad on CTG, this already means that the birth is going badly, the child suffers from such birth. But these consequences for the child of obstetricians do not apply later. If the child is still born and does not end up in intensive care, then these consequences from a puncture of the bladder, from prostaglandins that were injected to prepare the cervix for childbirth - this will all be seen later, when the child's nervous system begins to develop. Neurologists see these consequences.
That is, the doctor with his programmed childbirth received a living child and a woman, then he is not responsible for them ...
On the Apgar scale. Foreign study - 50,000 children participated. About 100 people had a low score and scores on the Apgar scale, and were admitted to intensive care. Of these 100 people, 18% of children developed cerebral palsy, 30% of children had neurological problems, and 50% of children had no problems at all. That is, they received a low Apgar score not because of damage to the nervous system, but because of respiratory or circulatory disorders. And for those 50,000 children who had cerebral palsy, with severe damage to the NA, according to the Apgar scale, the majority - more than 80 percent - in general, everything was fine. That is, future patients with cerebral palsy had excellent scores, up to 8 and higher, on the Apgar scale at birth.
This means that the damage to the brain that occurs when the bladder is punctured, when stimulating the dilatation of the cervix, it may not affect the overall scores that are assessed at the birth of children. And then we see from the development of the nervous system that this damage has occurred. Apgar scale does not reflect the state of the nervous system. It reflects the child's ability to breathe independently and shows how well the child's blood circulation is functioning normally.
The scale was invented by anesthesiologists, when they gave a harmful anesthesia to a woman in the 50s: not only did the mother wake up badly, but also the child, who was removed after a cesarean section. He could not breathe after such a severe anesthesia, he had to artificially breathe for him. So, for this, the Apgar scale was invented.
We have listed all these critical moments that are in modern Russian obstetrics, meanwhile, the question arises: why do doctors need all this? Why is such a system successful? What motivation might they have?
I doubt all doctors are such villains who deliberately want to harm mom and baby. I'm sure the opposite is true. They help, but ...
I want to end with the words of Professor Radzinsky, who said at this conference, repeated what obstetricians have been repeating for many decades: "Obstetrics is a field of medicine that does not belong either to science or art, but occupies some middle position."
I can say that these are not conscious actions of obstetricians, but this lack of normal scientific knowledge in their actions led to what they do. That is, obstetrics should become more and more scientific in terms of what they use.
At the same time, obstetrics should be an art, and normal childbirth is those childbirth in which no medical, manipulative actions are used. And to accompany a normal childbirth, you need art, you need specialists in the reception and conduct of normal childbirth. There are no such people in maternity hospitals, due to the fact that midwives there are relegated to the background: they do not participate in the active delivery of childbirth as before - in the pre-war, post-war times, in the 60s.
Now doctors are in charge of everything. But midwives had no right to pierce bubbles or do any manipulations, but they had the right to make a psychological impact on a woman, give advice on breathing, movement, that is, what can be called art. There are very few skilled people who could accompany natural childbirth in maternity hospitals, this is very sad. And at the same time, it is the scientific level of obstetrics that requires much to be desired, because even those discoveries that have recently been made by their own colleagues, obstetricians do not discuss and do not draw appropriate conclusions from their work.
At this forum "Mother and Child" there was not a single discussion on the hemodynamic mechanism of childbirth, which I told you about. Accordingly, neurologists were not invited to this forum, that is, obstetricians are boiling in their own world.
Thank you very much. Today, neurologist Mikhail Golovach told us about the consequences of childbirth interventions.
The article tells about how squeezing during childbirth can affect the well-being of the baby.
Admission Kristeller, and this is how the obstetric manual technique is called to accelerate the expulsion of the baby from the womb, consists in strong pressure on the fundus of the uterus through the abdomen during the next push or directly during the eruption of the head. This method was invented at the beginning of the last century.
Dr. Kristeller's proposal sounded something like this: "For timely assistance during childbirth, a woman in the process of pushing needs to support the fundus of the uterus with her palm, but at the same time not exert any pressure on it." The purpose of this action is to help the baby push off from the support with his legs and quickly move along the birth canal. In fact, obstetricians in some cases carry out something similar. But, unfortunately, most cases can rather be attributed to the full squeezing of the baby, but not as help in natural childbirth.
Squeezing out during childbirth in our country was officially banned back in 1992, however, despite this ban, judging by the complaints of successful mothers, doctors periodically still use the squeezing method. Why wait, if you can cut the perineum, press hard on the stomach, then the child will "fly out" like a cork from a bottle. Moreover, such would-be doctors are not at all afraid of even all kinds of complications, and in fact they can be very dangerous.
Complications for the child:
broken bones in the arms and collarbone;
spinal cord injury;
compression of the spine;
nerve damage;
breathing disorders;
increased intracranial pressure.
Complications for the mother:
broken ribs;
the risk of rupture of the muscles of the uterus and anus;
breathing disorders;
liver damage.
It is worth noting that in France, since 2007, any report that a doctor uses such a method as squeezing a child during childbirth may deprive him of the right to continue to practice obstetric practice. However, in Russia, unfortunately, doctors often do not bear any responsibility for the consequences of actions performed in the process of their delivery.
It is for this reason that if the doctor asks you to “press lightly on your stomach” or tries to make such attempts on your own to speed up delivery, we strongly advise you to refuse this help and give birth on your own. Remember that for the sake of the health of your own child, you can be patient and get rid of the burden without using the Christeller method.
Childbirth in women can take place in different ways, and it is not always possible to cope without the intervention of doctors. If the process goes with complications, obstetricians have to use additional methods, and one of them is to squeeze out the fetus.
Specificity of the Christeller method
Extrusion of the fetus is officially called the Christeller technique, after the name of the doctor who first applied this method. They began to resort to it in the case when it was required to artificially reduce the period of attempts, but today doctors around the world refuse this method, citing too great a risk to the health of the baby and mother.
Here are the main reasons why it is better to refuse to squeeze out the fruit - this method can lead to such consequences as:
- rupture of the uterus;
- premature placental abruption;
- a state of shock in a woman in labor;
- birth trauma in a child.
It is no coincidence that in many European countries, doctors are forever deprived of their rights to obstetric activity after using this technique.
Important!In Russia, Christeller's reception is still used in individual maternity hospitals, although this is denied by official statistics.
The main causes of injury
The main danger of taking Kristeller lies in the principle of pressure on the abdomen of the woman in labor - the obstetrician rests his hand on the bottom of the uterus and presses on the fetus towards the exit from the pelvis. What do these actions lead to?
From strong pressure, the child's spine bends in the area of the cervical vertebrae and the base of the skull, which is why in 99% of newborns, there is a displacement of the skull bones and damage to the cervical vertebrae. In the future, such injuries lead to extremely negative consequences, in particular, to a decrease in the blood supply to the brain.
For a woman, squeezing the fetus is also not useful, since strong pressure can stretch the diaphragm and lower the pelvic organs. One of the consequences of such manipulations is urinary incontinence after childbirth.
When the Christeller is usually used:
- the woman is very tired and cannot make attempts on her own;
- the pushing reflex is completely absent;
- weak contractions.
How to avoid birth trauma
It is unlikely that doctors choose the Christeller method simply because they wanted to, the reason is always the same - the problem with natural childbirth. However, in fact, the choice of this method speaks of the low qualifications of the doctor, who could not correctly assess the woman's endurance and did not make the decision on a cesarean section in time.
To make childbirth as easy as possible, it is important to listen to yourself and trust nature as much as possible:
- pain relief should be abandoned, if possible, since anesthesia reduces straining reflexes;
- it makes sense to give up the supine position during childbirth.
Squatting or half-sitting postures will allow gravity to help in labor, moreover, in this case, doctors will not be able to apply the method of squeezing the fetus.
Dr. Samuel Christeller in 1967 proposed a new method of obstetrics at that time - squeezing out the child. In Russia, since 1992, this method has been banned, but at the same time, it is used by doctors without fear of punishment.
Squeezing a baby out during childbirth - the story of the idea
Kristeller believed that taking it would significantly reduce mortality among newborns and women in labor and preserve their health. I understood the risks of admission, but considered them unjustified. The indications were:
- vaginal delivery with fetal retrieval instrumentation
- cesarean section
- severe hypoxia when the head is low
- second with anesthesia
- if the fetus is in the pelvic position.
Kristeller also noted contraindications to the use of the method:
- location of the placenta at the bottom of the uterus
- fetal shoulder presentation
- vaginal delivery after cesarean section
- incomplete dilatation of the cervix.
It is now known that taking Kristeller seriously threatens health. Most childbirths with the use of extrusion ended in complications in the mother or child; in some cases, children were born with serious disorders of the central nervous system.
In our country, admission was banned in 1992, but despite this, it continues to exist in maternity hospitals with good presentation.
Sometimes labor is successful and sometimes it is not. Meanwhile, women who gave birth using this method tend to defend obstetricians in the event of a successful completion of labor, however, the practice of squeezing the child indicates that an inattentive mistake was made.
Only a cesarean section will exclude such an intervention, but if time is lost, the specialist has no choice but to apply a prohibited action. This is beneficial, since the baby will remain alive and may even be healthy, and the obstetrician will not be deprived of his professional activity and will not be sent to prison.
In 2016, an obstetrician-gynecologist applied extrusion, which led to a tragedy. The woman died of great blood loss when the uterus ruptured, and the child suffocated before birth. The doctor was sentenced to three years in prison.
Not a very severe punishment, right? The fact is that in medicine it is difficult to prove guilt or to toughen a sentence, a specialist will always find the necessary information, rewrite the patient's history, and colleagues will be on his side.
Important! Not to be confused with another method
Kristeller's reception is as follows - the doctor uses his hands to exert pressure on the fetus (mother's abdomen) towards the cervix for 5-8 seconds several times in a row until the head comes out.
A similar, but different method is actively used by Russian obstetricians and has a different purpose - to show a woman how to push during labor.
The method is as follows - the obstetrician taking delivery puts his hand on the woman's belly and asks the patient to move her abdominal press while trying. Thanks to this, the expectant mother will quickly realize where to direct the forces, which are not so many.
Kristeller's reception - consequences
Negative consequences for the baby are broken bones, intracranial bleeding, disruption of the central nervous system, premature placental abruption, hypoxia, and sometimes death.
For a woman, it is no less dangerous - possibly damage to the liver and perineum, broken ribs, rupture of the uterus, internal bleeding.
How to avoid this trick?
First of all, you need to find a responsible doctor and discuss all the methods that you refuse. Take a dated and signed receipt from him, where the specialist indicates that he will not use the specified methods. Consider partner birth as a safe option with the least medical intervention.
The partner will follow the actions of the medical staff until the meeting with the baby. Home birth can also help avoid such interventions, provided that the ambulance is at home and the pregnancy is not abnormal.
“Doctors helped me to give birth. And in the literal sense: during the attempts, the obstetrician pressed his hand on his stomach and squeezed out the child. I felt a great relief and even sincere gratitude to the doctors for a happy ending ”- Nadezhda, who became a mother last year, shared her story.
At that moment, the woman from Minsk did not know that she gave birth using a method that is prohibited in Belarus. In stories about special motherhood, the word "squeezing" flashes through one, and women very often associate the consequences with the pressure of doctors. Sorted it out, is it really so?
Photo source: pixabay.com
For reference
Pushing the baby out of the uterus, or the Christeller method, originated in the 19th century to speed up labor. It was used in situations when a woman, for some reason, could no longer push, and the baby experienced hypoxia. Today, in most developed countries of the world, this method is prohibited, and in France, for example, a message about the use of Kristeller by a doctor may deprive him of the right to practice obstetric practice for life.
Story 1. "The head flew out of me like a machine gun"
Telling her story, Nadezhda immediately makes a reservation: she treats doctors with great respect and is categorically against home birth. Her pregnancy was going well, but at 40 weeks, on the instructions of a gynecologist with high blood pressure, she went to the pathology department. The next day she was told: we will give birth.
I reacted normally to the fact that at the beginning of labor, my bladder was punctured, and then I was put on a drip with oxytocin. I suffered, but endured, because doctors know better what to do. Of course, I was confused by the phrase that "I should have time to give birth before 10 pm." What if I don't have time?
When it came time to push, the nurse was unhappy with the way I did it. "Ditch the child," she said. I got scared.
"What if so?" the doctor said casually and pressed sharply on his stomach. The child's head flew out of me like a machine gun. The clock was half past ten - we were a little late, but in general everything went according to plan.
I remember exactly that I didn’t push myself for long (three attempts at most) and I’m not sure that such drastic manipulations were necessary. What if it’s the other way around? If not for the help of a doctor, would the child suffer and experience hypoxia? Then why is this method prohibited? There are more questions than answers.
After giving birth, the child was found to have a cephalohematoma (hemorrhage under the periosteum) on the head, says Nadezhda. And it was then, having googled information about the birth trauma, for the first time she found out that one of the possible reasons is “squeezing out” (as well as rapid childbirth and much, much more).
The child and mother were lucky: the cephalohematoma quickly resolved itself. At first, the kid was slightly behind in development, but by the year he caught up with his peers.
I am very glad that the squeezing didn’t affect my son, but I’m afraid to give birth a second time. I'm not sure that I can now trust the doctors 100%.
Story 2. Broken collarbone and injured ribs
Hope is not the only one who was pressed on the stomach during childbirth. There are a lot of such stories among women in labor. It has already been 8 years for Catherine after giving birth, but she still remembers everything in the smallest detail.
Photo source: spina-sustav.ru
This was my second birth. I arrived at the hospital with full disclosure and active contractions. Why did my perfect birth at home end up with an extrusion, a broken collarbone for my son and injured ribs for me?
Doctors would probably say: “Weak labor activity! She didn't push at all! We did everything we could to give birth to this child! "
In principle, I can understand them ... If you forget that these were my ribs and my child. Sunday evening, I want peace, and here the aunt is at 43 weeks, with a scar on the uterus, which for some reason did not give birth to a child from the third attempt. I would like to get rid of such an aunt as quickly as possible and, since the dropper is prohibited, squeeze this child out like paste from a tube - the least of evils. It is her own fault, since she does not want to give birth according to the protocol.
Excuse me, but what kind of leveling? Why is 42 weeks the norm, and 43 - a post-term pregnancy? Why, like in a fairy tale, you only have three attempts, otherwise episiotomy, extrusion or even forceps?
Everything ended well for Catherine: the collarbone grew together, a couple of months in a corset - and the ribs fell into place. All the negativity from childbirth was blocked by the joy of being the mother of an extraordinary boy.
Could I give birth myself? In that particular situation, no. I think this was the most correct way out of the impasse carefully built by doctors.
Doctors: we are saving children with this method!
Are such accusations against doctors substantiated? We talked with several obstetricians-gynecologists to understand why a method prohibited by law is used today.
As expected, for many, this topic turned out to be taboo. The doctors agreed to speak openly about this only on condition of complete anonymity. And they admitted: today there is hardly a single obstetrician-gynecologist who has never used the Christeller method.
At the same time, the opinion that doctors are doing this in order to quickly go home is completely groundless, the interlocutors unanimously stated.
We do this when there is a threat to the life of the fetus, when we see on the sensor that the child is suffering, the heart rate drops, and we understand that we need to speed up the process. There is also a weakness in labor, when a woman pushes weakly or does it wrong, or does not want to, or cannot. And the child stands in one place for a long time, he begins to suffer, the head of the fetus is pinched. We are saving the child - and there are no other goals here and cannot be. If you do it as it should, according to the instructions, then the children will be bad, heavy.
Officially, in an emergency, the doctor must use either a vacuum or forceps. But this is not always the ideal solution.
Photo source: http://sofloquento.ru
The vacuum can be applied only when the fetal head has already come to the exit, and the situation can arise when the fetal head is high. Theoretically, you need to do an emergency caesarean section, but from experience I can say that removing the child in this situation can become an even more traumatic factor for both the child and the woman.
If the doctors are putting pressure on the stomach, then something has gone wrong. There is no purpose for which the doctor can do this for another reason, why should he hasten labor already during attempts? The faster the delivery, the higher the trauma, vaginal rupture, for example. Why would a doctor specifically go for this?
Christeller is dangerous for doctors, so young people prefer vacuum
According to doctors, the Christeller method is not as scary as people say about it. For a child, he practically does not carry a danger, rather for a woman.
There were several cases at once in different countries, almost one-time, of rupture of the liver and injuries of internal organs in women, therefore the method was banned. In fact, such serious complications can occur if force is applied thoughtlessly. And a well-conducted Kristeller does badly only to a doctor.
“Only a doctor is bad” is another discovery that we learned about from a conversation with doctors. It turns out that by pressing on the bottom of the uterus, the doctor unevenly distributes the load - and later many experienced obstetricians have serious back problems, this is their weak point. Therefore, young people today are increasingly abandoning Christeller.
Exactly! Not because everyone suddenly realized that this was bad for a woman in labor, but because young doctors see from their senior colleagues how badly this affects their health. And the reality is that there will be many more vacuums and fewer Christellers in the future. Is it good or bad? Time will show.
How was your birth? Share your stories in the comments!
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