According to relevant news reports, He Yingdong, an obstetrician and gynecologist at Peking University First Hospital, and 3 other doctors refused the caesarean section request of a family member of an elderly pregnant woman who did not have a caesarean section indication, and as a result, they were continuously beaten by the pregnant woman's family, Dr. He was the most seriously injured, multiple facial fractures (eye frame fracture, mandibular fracture), and currently has clinical manifestations of post-traumatic stress, and has been hospitalized for clinical work.
The pregnant woman is 44 years old, the child is already in college at a normal college in Beijing, and the first child is a smooth birth. According to the "top three fax" WeChat public account information revealed that although the pregnant woman has chronic hypertension and pregnancy, but after the obstetric director rounds discussion, considering the patient's blood pressure control is stable, there has been a history of vaginal delivery, no clear indications for caesarean section were found, so it is recommended that pregnant women try to have a vaginal delivery.
Judging from the current reports, the pregnant woman herself had no objection at that time. But the family members of pregnant women may not understand: if you want to have a caesarean section, why don't you pay more for the hospital?
However, people with a little knowledge of pregnancy know that in general, a vaginal birth is better than a caesarean section. For pregnant women who can have a normal birth, the doctor refuses to have a caesarean section, which is really considering the pregnant woman and the fetus, and is a good doctor with a good conscience.
In the words of Peking University Shenzhen Hospital Obstetrician and Gynecologist Big V @ Miao Ge Story Club:
"In normal labor, more than a dozen doctors, nurses, and midwives are afraid to guard the labor process for more than ten hours, and charge hundreds of dollars;
Caesarean section, two doctors plus two nurses, fast more than 20 minutes to complete, charge thousands of dollars. ”
If the doctor really only considers his own economic benefits, caesarean section is easy and more expensive, why bother to persuade patients to have a smooth delivery?
The same is the dispute caused by the vaginal birth and the caesarean section, and the news of the jumping of the pregnant woman in Yulin, Shaanxi Province, a year ago, i think everyone still remembers it vividly.
The pregnant woman in Yulin, Shaanxi Province, jumped off the building because her family refused to give a caesarean section
The situation was the opposite of what it is now.
The doctor found that the fetal head was too large, recommended a caesarean section, the mother was in pain and hoped for a caesarean section many times, but the family insisted on a smooth delivery. As a result, the mother could not bear it and jumped off the building to die.
Shun or section, who has the final say? If this question is not clear, more tragedies will occur.
What are the indications for caesarean section?
China's "Expert Consensus on Caesarean Section Surgery (2014)" points out [1] that the indications for caesarean section surgery refer to the pathological or physiological conditions that cannot be delivered vaginally or are not suitable for vaginal delivery. There are more than a dozen specific situations:
1． Fetal distress.
2． The head basin is not weighed.
3． Scarred uterus: Pregnant women who are pregnant again after 2 or more caesarean sections, or who have previously had a fibroid removal that penetrates the uterine cavity.
4． Fetal position abnormalities:
Transverse fetal position, gluteal position of a single fetus at the first term (estimated fetal birth mass >3500 g), and prelude.
5． Placenta previa and previa:
Placenta partially or completely cover the inner cervical orifice and the previa vessels.
6． Twin or multiple pregnancies:
The first fetus to emerge is non-cephalic; complex twin pregnancy; conjoined twin, triple and more multiple pregnancies.
7． Umbilical cord prolapse:
The fetus is likely to survive, and the evaluation concludes that vaginal delivery cannot be made quickly, and emergency caesarean section should be performed to save the fetus as soon as possible.
8． Placental abruption:
If the fetus is likely to survive, the fetal heart rate should be monitored and emergency caesarean section should be performed as soon as possible to deliver the fetus. Severe placental abruption, the fetus has died, and emergency caesarean section should also be performed.
9． Pregnant women have severe comorbidities and complications:
If you have heart disease, respiratory disease, severe preeclampsia or eclampsia, fatty liver in acute pregnancy, thrombocytopenia, and intrahepatic cholestasis in severe pregnancy, you cannot afford vaginal delivery.
Image source: Stand Cool Helo
10. Pregnant macrosomia:
Pregnant women with gestational diabetes mellitus have an estimated fetal birth mass > 4250 g.
11. Caesarean section requested by pregnant women:
The American Association of Obstetricians and Gynecologists (ACOG) defines a cesarean delivery onmaternal request (CDMR) as "a full-term singleton, caesarean section performed without medical indications for a pregnant woman's request." That is to say, it should have been smooth but had to choose to cut. This situation exists not only in China, but also abroad.
(1) If it is only a personal request of the pregnant woman, it is not used as an indication for surgery for caesarean section. If there are other special reasons, they must be discussed and recorded in detail.
(2) When a pregnant woman requests a caesarean section without understanding the condition, the doctor should inform in detail the overall pros and cons and risks of caesarean section surgery compared with vaginal delivery, and record.
(3) When pregnant women request caesarean section surgery (that is, "fear of pain") because of fear of the pain of vaginal delivery, psychological counseling should be provided to help alleviate their fear; during labor, the method of analgesia in childbirth should be used to reduce the pain of childbirth and shorten the course of labor.
(4) The doctor has the right to refuse the request for caesarean section delivery without clear indications. Of course, the requirements of pregnant women should also be respected and advice on secondary selection should be provided.
12. Birth canal malformations:
Such as high vaginal complete transphrasum, after artificial vaginoplasty, etc.
13. Vulvar diseases:
If severe varicose veins occur in the vulva or vagina.
14. Severe infectious diseases of the genital tract:
Such as severe gonorrhea, genital warts, etc.
15. Pregnancy with tumors:
Such as pregnancy with cervical cancer, huge cervical fibroids, lower uterine fibroids and so on.
Why is a vaginal birth better than a caesarean section?
The main reason is that caesarean section poses greater short- and long-term risks than vaginal delivery.
In its 2015 Global C-Section Rate Survey[2], the WHO reported that pregnant women with vaginal midwifery and caesarean section had a significantly higher risk of serious complications and death than pregnant women who gave birth naturally vaginally.
"When medically indicated by caesarean section, caesarean section can be effective in preventing maternal death and perinatal death and related diseases. However, there is no evidence that caesarean section of a pregnant woman who does not meet the indications still benefits the mother and the child. ...... Caesarean section should be performed only if medically necessary".
In addition, caesarean sections can have long-term effects that are not highlighted until many years after caesarean section, and can have an impact on the health of the mother and child, and even on the woman's future pregnancy.
Compared with vaginal delivery, women have been found to have a 3- to 5-fold higher risk of death by caesarean section, a 4-fold higher risk of hysterectomy, and a 2-fold higher risk of intensive care and hospital stays longer than 7 days [3].
It has also been found that caesarean section of the first child may increase the risk of unexplained stillbirth of the second child [4].
"Smooth or dissected" is a question of assessing risks and weighing the advantages over the disadvantages or the disadvantages outweighing the benefits. Caesarean section is chosen only if the assessment finds a greater risk of vaginal delivery.
Some people will ask, what if the mother is afraid of pain?
Isn't the caesarean section less painful?
Again, this is a misconception. In fact, the caesarean section is only painful after the operation, but it will also experience the pain caused by the surgical scars after the operation, but the pain time is postponed. And this pain is pathological pain, which may be more unbearable than the physiological pain of childbirth pain, and some people even go into shock because of it.
In short, if there is no indication for caesarean section, women who can have a vaginal birth are recommended.
If a healthy pregnant woman requests a caesarean section, the doctor has the right to refuse. Similarly, if a pregnant woman must have a caesarean section to ensure the safety of the mother and child, the family still insists on a smooth delivery, and the doctor has the right to refuse.
However, in the face of unreasonable people, these sciences, morals, and norms are pale and weak.
I only hope that this injury incident can repay Dr. He's justice, and don't let our doctors chill. You know, to protect doctors is to protect each of us.
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