On January 22, Shakira gave birth to her son Milan. The birth was news here in Babies and more because the baby was born by scheduled caesarean section, which was the method that the singer and Piqué had decided from the beginning, basically because it was a surgical intervention that should be carried out only if necessary.
There are several risks involved and that is why we wanted to deepen this topic by talking with Blanca Solé, an expert physiotherapist in obstetrics and Urogynecology who is in charge of "Mab Tot per la Dona", which among many other things has told us that fails to understand Shakira and Pirqué's decision to give birth by caesarean section.
Shakira was born on February 2, 1977, just like Piqué, only that he was born ten years later. This coincidence must have seemed so magical that they wanted their son to be born also on February 2. Apparently, the doctors told them that the baby would not hold so much and that is why they decided to have it on January 22, as a combination of the two doses of their dates, a fact that seems to confirm that the caesarean was the result of a choice of parents. What did you think to know this news?
Sincerely, at the beginning ... speechless. I don't care about the lives of Shakira or Piqué. A few seconds later I started reading everything related to pregnancy and the birth plan, because that interests me, and I shouted in the sky: OTHER WOMEN CAN TAKE THEIR ACTS AS A REFERENCE !!!! After a few minutes I tried to understand why, and I still haven't succeeded. I accept and respect your decision but I don't share it at all.
It is assumed that health professionals have a duty to inform patients / pregnant women (a pregnant woman is not a patient, since she does not suffer from any pathology, so she should not be treated as such but we must inform her). We believe that in the case of qualified professionals they were correctly informed of the pros and cons of this intervention and despite this they decided on an unnecessary scheduled caesarean section… a reflection that unfortunately there is still a long way to go and many things to change in the maternity homes of this country and in society in general, as far as this field is concerned.
Within that way to go would be doing caesarean section only when medically indicated instead of giving parents the option to choose, as has happened in this case?
Of course. But this case is a fairly isolated fact, usually scheduled C-sections are always performed by "medical indication", what you need to review are those "medical indications" (big baby, small pelvis ...) for example, a true case: The doctor tells the pregnant woman: how are you doing this week and the first one was by caesarean section and I will not be on those dates, I schedule you for the previous week. According to the doctor in case the little one comes big as the first. Then it turned out to be a totally normal 3.5 kg baby to be a vaginal birth. The doctor put his vacation before the woman and the baby, does not mean that it is always so but in this case yes and the woman accepted. I must admit that the maternity hospitals in Tarragona compared to other cities are quite good. From Mab, we seek to respect and humanize births, to think more about the mother and the baby and less about the needs of health workers. Another example: Woman who comes to my office for urinary incontinence of 35 years, I ask you to tell me about the delivery. The rest of the dilation was stretched, the pelvis could not move to allow the baby to pass (the movement facilitates the birth process). They take her to the delivery room, they push her, the baby doesn't come down, they leave, they come back again, the baby doesn't come down, they leave, they come back (in a total interval of about an hour), the third time is the charm : They tell him to take his legs, to get up by catching his legs while holding air and making a force to defecate and someone pushes his gut from above ... does it sound like you? ... that's the majority of expulsives ... It costs her a lot, they cut her and they tell her at the end, she asks: How many points do I have? They answer: You better not know. Let's analyze this last point. The expulsive (physiological has an approximate duration of one hour, 45 minutes in which the baby has not yet crowned, that is, the hair is seen on the vulva, so you have to finish lowering by yourself and about 15 minutes of bids) In these 45 minutes (it can be more, a woman at home was 5 hours, everything depends on the woman but for us to get an idea), she needs us to keep moving (but usually in this situation they already put them in gynecological position and still it's not the time to bid). When it is necessary to bid it should be done with the help of the abdominal muscles, which is what accompanies the contraction of the uterus. Not with classic abs, nor as if defecating. This hurts the pelvic floor (women with a history of constipation are more likely to suffer from urinary incontinence, please do not teach your children to defecate by force!). Defecating and bidding "is the same", the correct way to bid is: we take air and let go. In this way the abdomen is contracted in a reflex way, we add contraction of the serratus muscle (instead of taking the legs as if to join us, we put them on the knees as if to move away), try now ... does not the gut get hard? (Pregnant women under 38 weeks do not do it, remember we are favoring the contraction of the uterus and if you are under 38 weeks is not appropriate). In fact, women in physiological (natural) labor usually emit sounds and gasp, that is, they release the air (as if making love….: P). On the other hand, in a lying position, gravity is not favorable, so how can the baby go down? and they add the Kristeller Maneuver (gut thrust) advised against by WHO for causing incontinence and prolapse (pelvic organs fall). And with all this panorama ... how can they not perform episiotomy? that virtually no woman needs her, but of course, if you are anesthetized the muscles do not respond so you have many numbers to be cut. I say it that hard, because it is that way, more clearly impossible. And like this example many more, but it would be an interview too long for the reader. In Mab we fight against these practices but we do not impose ideologies. We simply instruct them in human anatomy and functions and they draw their own conclusions.
Arrive at the hospital 3 cm dilatation without breaking the bag, it is soon. In my opinion they should have sent it home but they didn't. They break the bag without any explanation (probably to speed up the process). They put the epidural analgesia, they say that just in case something happens and you have to run. At this time the woman is not informed correctly and previously they have already intervened in the natural course of childbirth by breaking the bag, a practice that can lead to complications, in addition women usually, unless you are an expert in the subject, they are ignorant of the correct and incorrect procedures in the course of childbirth and abide by professional decisions for fear that something might happen to your baby.
Blanca SoléMany people think that a C-section is better because the child suffers less and because the mother has fewer problems secondary to childbirth. What do you think?
Let's see, here are two very large points: It is also influenced by dopamine (the pleasure hormone) and serotonin (well-being hormone), that is, it has a love rush (they are the same sex hormones). This does not happen in a scheduled C-section where you have not produced oxytocin or your baby adrenaline.. In addition, the first contact is late (in most hospitals, by protocol) so that attachment and breastfeeding will be more difficult. Second, the problems arising from childbirth: I think you just have to see that the days of hospitalization vary from a vaginal birth (1-2 days) to a C-section (4-5 days): we can get to the idea that they can arise more complications in a surgical intervention such as caesarean section than in a vaginal delivery. The baby may not be ready to leave. Let's remember: It's the babies who give the signal to start the delivery. In the days following a C-section, problems such as post-operative fever, wound infection, urine infection, excessive blood loss, possible injury to neighboring structures (bladder, intestines ...) may arise. It is also a risk factor for future pregnancies (may cause placenta previa). And not least the fact that it hinders attachment and breastfeeding, many women report feeling a great vacuum after a C-section. Later, more complications may arise from this intervention ... THE SCAR! ... THE SCARS! (plural) internal. Normally we only look (doctors and midwives included) on the external and if the appearance is correct, ready! High. But if the internal scars are not treated, adhesions can appear between the different layers (from the skin to the uterus) and / or fibrosis (fiber cords, difficult to break), which alter the internal dynamics of the area and can derive in the long term in digestive pathologies such as constipation or pelvic (from structural as weakness of the abdominal musculature, which will result in low back pain, which can evolve to the appearance of a herniated disc or pelvic floor as prolapses, stress urinary incontinence ...). And if we add to this that nobody (except the specialized physiotherapist) if there is diastasis in the rectus abdominis (separation of the muscular partitions) and that nobody tells us what exercise we can do and which not, the mother will go running to lose weight and will do classic abs to have a "flat stomach." These two exercises are risk factors for suffering from the pelvic floor unless
First, in a vaginal birth the baby does not suffer as long as it shows no signs of it (increased heart rate); What happens is that it has an adrenaline rush (in a good way). This catecholamine is essential for survival because it cleanses the lungs and prepares them for breathing, increases metabolism, guarantees blood supply to the brain and causes the baby to be alert and at the time when skin is placed against skin with the mother, vigorously look for the source of food (this does not happen if the mother has been under the effect of analgesics since the babies leave more numb and much less in a scheduled caesarean section). In turn, the mother has a rush of natural endorphins and secretes the love hormone (oxytocin), as the renowned French obstetrician Michael Odent calls it.
that are carried out under the supervision of a professional (not fitness, but health).
Putting it in time, how long can it take a woman to be recovered after childbirth and how long after a C-section? (and I don't talk about weight, but about physical and physiological conditions).
Technically, when the uterus has returned to its original size (uterine involution) it could be said that it is already recovered. This happens at the end of quarantine. For me it is three years necessary to recover the muscles. In fact, when I treat a patient for pelvic floor problems, the first thing I say is that it will be a long and slow process in terms of obtaining results. That doesn't mean I have to come every week; There is an "acute" period in which you have to work hard and then you can start spacing the sessions until you stay in a maintenance with control injuries. It is the same if it has been a vaginal or cesarean delivery.
However, in the first days and weeks the difference is noticeable, isn't it?
If much, in a vaginal delivery the next day you can practically go for a walk. If they don't move much from home, it's because of the process of adapting to the new life. From night to day they happen to have a baby in their arms that demands continuous attention and adapting to it is difficult. In caesarean sections all that first week, it is a week of medical control for possible complications that may occur as we have already commented. They find it hard to stand up, the annoying scar, pulls, hurts ... The implantation of breastfeeding is more difficult and to that is added the process of adapting a new person in your life. They can feel helpless, tired and without strength. In a vaginal birth you can also feel this way, there is also a lot of hormonal effect, but physical recovery is faster and everything else becomes more bearable. Don't misunderstand me every woman is a world I am generalizing.
Do women come to Mab Tot per la Dona who have given birth by caesarean section to make some kind of recovery?
The truth is that less than we would like ... the problem is that there is hardly any information and generally until the pathology becomes noticeable many many years can pass, but when it appears it does so in style! We advise that although there are no symptoms after quarantine (three months if they are infants), a part of the gynecologist and midwife's exams go to an expert physiotherapist where the clinical history and external, vaginal and anal examination will be performed. Depending on the results, one thing or another will proceed.
How can you have a caesarean section affect an upcoming pregnancy?
Everything comes as a result of not treating the scar, as I have commented previously. One of the problems is at the structural level, the entire musculoskeletal and visceral system is altered. In physiotherapeutic terms we are concerned about internal adhesions, as well as the vascularization and innervation that runs between the various layers that cover viscera and muscles. Following caesarean section may occur difficulty of conception, internal tensions that congest the pelvis causing pain, impossibility of another vaginal birth ...
In medical competitions, there are several studies that reveal that in women with previous C-sections there is a higher prevalence of babies with low weight, rupture of the uterus (due to the scar), more postpartum infections, abnormal placental development (placenta previa) ... but no I will expand on these issues since it is not my competition. They say it is not very common, but pregnant women with a previous C-section have more “winning” tickets.
Do you meet women who come to prepare for childbirth who prefer caesarean section rather than vaginal delivery?
No. Normally who comes to the center or has been advised by a friend or before they have already informed and know our work philosophy, so generally they are women who do not want a caesarean section at all. And if they are pro epidural or pro artificial lactation or simply do not know much about the subject, they leave with a more neutral vision towards non-epidural, non-episiotomy, breastfeeding and porting, but I repeat: nothing unfounded. We limit ourselves to teaching anatomy, and always within the framework of physiological delivery, the medical issues for doctors and midwives that are there.
