Most of the medical disputes related to childbirth that Mr. Lin is exposed to have objections to the hospital's insistence on choosing a vaginal delivery method, and this is the reason for the dispute, they believe that if caesarean section is adopted or caesarean section is used in time, obstetric injuries such as brachial plexus nerve injury, neonatal cerebral hemorrhage, neonatal asphyxia and other situations will not occur. So should hospitals respect the opinion of pregnant women about caesarean sections?
First, there is a reason why hospitals are reluctant to give pregnant women a caesarean section.
(1) The state has established assessment standards.
According to statistics, the caesarean section rate in mainland China was 5% in the 1980s, no more than 10% in the 1990s, and as high as 36% to 58% in 2010. While the World Health Organization sets a safe limit of 15 percent for caesarean section, China has surpassed it a lot. Therefore, the National Health Commission in the "2011-2020 China Women and Children Development Outline Implementation Plan" will "increase the rate of natural delivery, reduce the rate of caesarean section" into the scope of assessment of modern hospitals. If the doctors of the hospital casually allow pregnant women to undergo a caesarean section, it will be difficult to complete the goal, affecting the assessment standards of the hospital, and this risk is actually a risk that many doctors dare not easily disclose.
(2) Medical treatment does not support caesarean section without indications.
According to the Expert Consensus on Caesarean Section Surgery (2014), indications for caesarean section are pathological or physiological conditions that cannot be delivered vaginally or are not suitable for vaginal delivery.
1． Fetal distress: refers to those who cannot deliver vaginally in the short term due to acute and chronic fetal distress due to comorbidities or complications in the third trimester of pregnancy and acute fetal distress during childbirth.
2． Cephalic not scale: Absolute cephalic not scale or relative to the head basin is not weighed in the full vaginal trial failure.
3． Scarred uterus: re-pregnancy after 2 or more caesarean sections; previous uterine fibroid removal penetrated the official cavity.
4． Fetal abnormalities: transverse fetal position, gluteal position of a single fetus at the first term (estimated fetal body mass > 3 500 g), and first exposure of the foot.
5． Placenta previa and previa: placenta partially or completely covering the inner orifice of the cervix and the anterior vessels.
6． Twin or multiple pregnancies: the first fetus is non-cephalic; complex twin pregnancies; conjoined twin, triple and more multiple pregnancies should be performed by caesarean section.
7． Cord prolapse: the fetus is likely to survive, and the evaluation results determine 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: the fetus is likely to survive, and fetal heart rate should be monitored and emergency cesarean 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 with serious comorbidities and complications: such as complicated heart disease, respiratory disease, severe preeclampsia or eclampsia, acute pregnancy fatty liver, thrombocytopenia and severe pregnancy intrahepatic cholestasis, etc., can not withstand vaginal delivery.
10. Pregnant macrosomia: pregnant women with gestational diabetes mellitus estimated fetal birth mass > 4 250 g.
11. Caesarean section required by pregnant women: The American Association of Obstetricians and Gynecologists (ACOG) defines cesarean delivery onmaternal request (CDMR) as a full-term singleton, caesarean section performed without medical indications due to maternal requirements.
(1) Only the personal request of the pregnant woman is not used as an indication for caesarean section surgery, and other special reasons must be discussed and recorded in detail.
(2) When a pregnant woman requests a caesarean section without understanding the condition, the overall pros and cons and risks of caesarean section surgery compared with vaginal delivery should be informed in detail and recorded.
(3) When pregnant women request caesarean section surgery because of fear of the pain of vaginal delivery, psychological counseling should be provided to help alleviate their fear; during labor, labor analgesia methods should be applied to alleviate the pain of delivery of pregnant women and shorten the course of labor.
(4) Clinicians have the right to refuse requests for caesarean section delivery without clear indications, but the pregnant woman's request should be respected and a recommendation of secondary selection should be provided.
12. Obstetric deformity: such as high vaginal complete transphrasum, post-artificial vaginosis, etc.
13. Vulvar diseases: such as severe varicose veins in the vulva or vagina.
14. Serious 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, etc.
Second, the hospital informs pregnant women that there are certain defects in whether they can have a caesarean section.
Most of the medical disputes related to childbirth that Mr. Lin was exposed to, and the patients had objections to the hospital's insistence on choosing a normal delivery method, which was the cause of the dispute, and they did not understand why the hospital was so resistant to pregnant women to undergo caesarean section. Therefore, fully explaining the choice of normal delivery methods and obtaining the understanding of pregnant women is conducive to alleviating the contradiction between doctors and patients and reducing the occurrence of medical disputes.
Third, caesarean section has certain harms.
Due to the mode of delivery of caesarean section, it is easy to cause harm to the mother, as follows:
(1) Injuries of anesthesia.
Caesarean section surgery will mostly use semi-anesthesia (spinal anesthesia and epidural anesthesia), unless in the case of emergency will be used in general anesthesia, and anesthesia may cause some side effects, such as dizziness, headache, nausea and vomiting, etc., may also affect blood circulation, resulting in insufficient blood oxygen.
(2) Injuries during surgery.
Because the caesarean section is directly cut open the mother's belly into the uterus to take out the fetus, which is very challenging the doctor's medical skills and surgical environment, if in the whole process, there are some small mistakes, there may be infection, endangering the safety of maternal and fetal life, blood loss and unexpected situations in surgery are much higher than the vaginal birth.
(3) Postoperative injuries.
Since caesarean section is not a natural way of childbirth, the recovery rate will be much slower than that of a normal birth, such as a normal birth can freely get out of bed on the first day and feed the child, while a caesarean section needs to be supported by a family member on the second day before it can get out of bed and move around. In addition, caesarean section will leave wounds and scars on the abdomen and uterus, if the incision is not completely healed, it is easy to form a scarred uterus, and when pregnant again, there is a risk of uterine rupture, premature birth, the probability of miscarriage will increase accordingly.
(4) Harm to the baby.
Because the fetus is not squeezed out of the mother's birth canal with the help of the force of contractions during the caesarean section, but is directly carried out by the doctor from the womb, it will have a certain impact on the baby, as follows. 1. Hurts body sensitivity. Since no parts of your baby's body are squeezed by a curved and narrow birth canal, the touch and sensitivity of his body may be lower than that of a vaginal birth. 2. Respiratory system is affected. Because the baby's head, lungs, etc. are not squeezed by the mother's birth canal, and do not breathe under the action of atmospheric pressure, it is easy to lead to amniotic fluid inhalation and respiratory problems in the lungs. According to statistics, the probability of inhalation pneumonia in babies born by caesarean section is much greater than that of babies born vaginally. 3. Immune system. Because the baby does not ripen and is squeezed by the birth canal, the body's tissues and organs have not been fully exercised, resulting in immunity is not as strong as the baby who gave birth to the baby, and studies have shown that there are 27 kinds of microorganisms in the birth canal of Chinese women of the right age, which will promote the phylogenetic development of the baby.
Therefore, it is reasonable and legal for the hospital to refuse the request for a pregnant woman's caesarean section under normal circumstances, and pregnant women and their families should understand.