Caesarean section plays an important role in reducing maternal mortality and perinatal mortality. However, relevant data at home and abroad show that caesarean section has increased to a certain level (20% to 30%), and the case fatality rate of perinatal infants has indeed decreased significantly, but the caesarean section rate continues to increase (40% to 50%), which not only cannot reduce the perinatal mortality rate, but will increase the perinatal mortality rate, the reason is that caesarean section has an adverse effect on newborns.
Further reduction of perinatal mortality is obviously not solved by caesarean section capacity alone, but also needs to strengthen the prevention and treatment of high-risk pregnancies, improve the maternal and child health care system and the implementation of neonatal asphyxia resuscitation.
One
Caesarean section syndrome
Caesarean section can quickly free the fetus in a state of hypoxia from the danger, free from the influence of uterine paroxysmal contractions or umbilical cord factors, and is conducive to reducing the asphyxia rate of newborns. However, due to the influence of anesthesia and supine hypotension syndrome during surgery, the blood flow to the uterine placenta is reduced, which can cause or aggravate fetal hypoxia. Newborns delivered by caesarean section, because they are not squeezed by the birth canal, are prone to pulmonary hyaluronic membrane disease and respiratory distress, which is called caesarean section syndrome.
The clinical feature of caesarean section syndrome is normal at birth and onset 4 to 6 hours after birth. Progressive dyspnea occurs, and gradually cyanosis with breathless moaning and other hypoxia-based syndromes appear. Newborns are more likely to occur in preterm, FGR, and diabetic mothers.
To prevent caesarean section syndrome, it is best to choose around 39 weeks for elective caesarean section. During the operation, the left side should be taken to the recumbent position, pay attention to the depth of anesthesia, and transfer high-risk newborns to pediatrics for treatment after delivery.
Two
Increased iatrogenic preterm births
In the case of elective caesarean section, except for those who need to terminate the pregnancy due to illness, such as the surgical delivery time is determined solely based on the gestational age, sometimes the gestational age does not match the actual gestational age, resulting in unnecessary iatrogenic preterm birth.
Three
Neonatal injuries
Obstetric injuries caused by caesarean section are not uncommon clinically, mainly skin cuts and fractures. Skin lesions are more common on the scalp, face and buttocks; neonatal fractures are more common when the foot and hip position are delivered, and the surgerer is caused by improper traction, and the femur and humerus fractures are more common.
Four
Neonatal wet lung and pulmonary hyaluronic membrane lesions
During vaginal delivery, when the fetal chest and abdominal cavity is squeezed by the birth canal, the fluid in the fetal lungs and respiratory tract can flow out from the mouth and nose after birth, which can reduce the occurrence of neonatal wet lungs, amniotic fluid, and meconium aspiration pneumonia. Selective caesarean section, no contractions, fetal head and chest wall is not squeezed, after delivery of the newborn by atmospheric pressure stimulation to promote lung breathing, easy to occur amniotic fluid or meconium inhalation, resulting in neonatal breathing disorders, idiopathic respiratory distress syndrome, some scholars call it caesarean section syndrome. If there is more fluid left in the alveoli, it is easy to have wet lungs after birth, and substances that cannot be evaporated in the fluid in the alveoli can be adhered to the alveoli and bronchi walls, forming a red membrane of eosinophilia, hindering gas exchange and causing dyspnea, called pulmonary hyaluronic membrane.
Five
Increased jaundice in newborns
It has been reported that caesarean section may be one of the causes of hyperbilirubinemia in newborns. Wang Xuemei et al. divided 2382 newborns into caesarean section group and non-caesarean section group, and analyzed the results of micro serum bilirubin monitoring, and the incidence of high bilirubin in the caesarean section group was significantly higher than that in the non-caesarean section group.
Six
Immunocompromised
The content of immune factors (IgG, IgA, IgM, C3, C4) in caesarean section infants is significantly lower than in vaginal delivery. Therefore, newborns delivered by caesarean section have lower resistance to infection than newborns delivered in the birth canal, are susceptible to infectious diseases, and have a high mortality rate, which increases the case fatality rate of caesarean section babies.
Seven
Effects on brain function in children
The hypotension of the mother under anesthesia during caesarean section will cause the fetus to be hypoxic, and when the fetal head is delivered, the external pressure suddenly decreases the cerebral vasodilation, and the lungs are not compressed, which is prone to pulmonary hyaluronic membrane disease causing breathing difficulties and cerebral hypoxia. This series of ischemic and hypoxic processes inevitably affect the brain function of newborns, with 20 behavioral nerves of newborns scored, caesarean section on the 7th to 14th day after birth are lower than natural delivery, because caesarean section does not go through the natural squeezing process of delivery, which affects the maturity of cranial nerves. However, with the increase of daily age, the brain nerve function basically returned to normal at 28 days.
Eight
Effects on children's perception
The powerful contraction and squeezing process that a fetus undergoes at birth is the earliest and most important sensory learning experience for the fetus. Foreign studies have reported that caesarean section affects the olfactory learning ability of newborns, caesarean section is an interventional delivery, so that the fetus is passively delivered quickly in a short period of time, lack of necessary stimulation test, especially the skin muscles and joints are not stimulated process, affecting the effective combination of children's various sensory stimulation information in the central nervous system, resulting in sensory integration disorders. It is manifested by sensory integration disorders such as proprioception and poor sense of position and a series of psychological and behavioral problems.
Nine
Effects on neuropsychiatric disorders
Foreign epidemiological surveys have found that many children and even adult neuropsychiatric diseases are closely related to adverse factors in the perinatal period. Obstetric complications are related to a history of schizophrenia, especially in people with a history of birth by caesarean section, early-onset schizophrenia (onset before the age of 22 years) is 10 times higher than late-onset schizophrenia, suggesting that caesarean section causes neurodevelopmental abnormalities, leading to disorders of the central nervous system transmitter dopamine, making the risk of neuropsychiatric diseases in childhood and adulthood increased.
Ten
Effects on school-age children
There were no statistically significant differences in the intelligent development of newborns between caesarean section and natural delivery, but there were significant effects on sensory, motor, and auditory perception in post-caesarean section school-age children. Some post-caesarean section school-age children have sensorimotor and auditory impairments such as motor incongruity, resulting in learning disabilities in some children, a decline in learning ability, and a decline in some social adaptability. Caesarean section plays an important role in addressing obstructed labour and pregnancy complications and complications, and in reducing maternal and infant mortality. However, the excessive caesarean section rate and the relaxation of the indications for caesarean section not only cannot reduce the mortality rate of mother and child, but also affect the health of mother and child. Therefore, medical workers should have a high sense of responsibility, exquisite technology, good medical ethics, strict grasp of the indications for caesarean section surgery, to ensure the safety and health of mothers and children, and to reduce complications.
Childbirth is a normal, natural experience for women, and caesarean section should only be used to end the pregnancy as soon as possible if the fetus or mother has some abnormal problems.
Caesarean section is far more damaging to the mother's body than natural delivery, and will delay the mother's postpartum breastfeeding and recovery. Pregnant mothers should believe in the power of nature and their own potential, strengthen the confidence of natural childbirth, and experience the complete experience of a woman and a mother. When you have gone through this journey, you will be proud of your strength and bravery!