All of the above occurs under normal circumstances, when there are no complications. However, the unexpected can happen at any stage of labor. Bleeding or rupture of the placenta may occur, and part of the placenta may remain in the uterus after childbirth, which can lead to profuse bleeding. It is possible that the uterus does not contract after childbirth, while the internal wound surfaces continue to bleed, and the woman may die from blood loss. Although rare, uterine rupture can occur during contractions. nine0003

Approximately 5% of women develop so-called pre-eclampsia in late pregnancy, which poses a threat to the life of both mother and child. This mystical state still does not find a full explanation. Pre-eclampsia is manifested by the swelling and headaches often seen in normal pregnancies, making it easy to miss the true symptoms of this formidable condition. In a word, for physicians, some women in labor seem to be "powder kegs", with which one must always be on the alert. nine0003

In addition, infectious complications can seriously threaten the life of the woman in labor and the fetus. After the outpouring of amniotic fluid, the likelihood of bacteria entering the uterus increases every hour. In the 19th century, people began to realize that doctors themselves often spread the infection by examining the uterus without washing their hands. Bacteria penetrated into the body of pregnant women and caused blood poisoning (sepsis), threatening the life of both the fetus and the mother. Before the era of antibiotics, puerperal sepsis was the leading cause of maternal death. Even today, if delivery does not occur within 24 hours after amniotic fluid discharge, the probability of infection is about 40% .

Serious problems can be associated with so-called pathological births. For example, a large fetus with a post-term (more than 40 weeks) pregnancy can pose a great threat, especially against the background of the small size of the mother's pelvis. In some cases, the fetus may be located across the birth canal, which is why its handles fall out first. nine0003

There may be a breech presentation, in which the child enters the birth canal not with the head, but with the pelvis, while pressing the legs to the chest. This situation creates an obstacle to the further progress of the child through the birth canal. There is a so-called foot presentation, in which the feet come out first, and the fetus is wedged in the canal at chest level with handles above the head. A situation is possible when the fetal head appears, but further progress is blocked due to the incorrect position of the head. Sometimes the head is completely born, and the shoulders are wedged by the pubic bone of the mother's pelvis. When a baby gets stuck in the birth canal, the umbilical cord gets pinched or pinched over time. This can lead to suffocation (asphyxia) of the newborn. nine0003

Labor pains sometimes last so long that women become weak and die without giving birth. Prolonged labor itself comes with many risks. Even today, if labor continues more than 24 hours after the release of amniotic fluid, there is a 40% risk of infectious complications. Princess Charlotte - the only adored daughter of the British King George IV died during a prolonged (more than 50 hours) childbirth as a result of bleeding. The royal throne was transferred to his brother, and in the subsequent niece - this is how the legendary queen came to power in England by the will of fate Victoria.

By the beginning of the 20th century, many methods and means had been invented to ensure a favorable outcome of childbirth. It seemed that the main risks associated with childbirth were quite surmountable. For example, antiseptics and obstetric forceps were invented. Netflix's historical television series The Crown shows how obstetrical forceps were relatively recently used during childbirth by the current British Queen Elizabeth. Blood transfusion has been introduced into medical practice. A drug (ergot) was created to stimulate labor and contract the uterus after childbirth to stop bleeding. They began to create special maternity wards of hospitals, entire maternity hospitals, and home births became a rarity. nine0003

However, despite all this, there was no significant reduction in mortality from childbirth at that time. Doctors often missed obvious signs of bleeding, violated the norms of antiseptics, allowed uterine ruptures and bacterial infections with improper application of forceps.

To Caesar is Caesar's, but to the doctor - saving a life

In this case, we are talking about saving two lives: a mother and a child. That is a huge responsibility. One of the ways for a relatively safe delivery is a caesarean section. It is a surgical operation that allows a child to be born by removing it from the abdomen of a mother who cannot give birth in the usual way. nine0003

The name "caesarean" was given to this type of operation on the basis of the legend, according to which it was in this way that Aurelia gave birth to the Roman king Caesar (Caesar). However, historians regard this story as more of a myth, since Aurelia lived long after Caesar's birth. Ancient Roman laws of the 7th century BC forbidden to bury pregnant women. They demanded that the child be removed from the mother's womb in the hope that he would survive. In 1614 Pope Paul IV issued a decree requiring the baptism of any child born alive. However, a caesarean section performed on a living woman was considered a criminal offence. This was due to the fact that in almost all cases, caesarean section ended in an unfavorable outcome due to bleeding and infectious complications. Only in the 19th - early 20th century, after the invention of anesthesia and antiseptics, as well as due to the introduction of the double-layer suture technique that prevents bleeding, did it become possible in medical practice to perform a relatively safe caesarean section. nine0003

This is how a modern physician would describe the entire process of a caesarean section surgery. With a scalpel blade, a transverse incision is made in the lower abdomen of the woman in whose womb the fetus is located. First, a golden-colored fatty layer opens, which can be separated from the skin with a few precise movements of the scalpel. In this case, slight bleeding may occur, which is stopped with a gauze swab. Next, the so-called "fascia" opens - a fibrous membrane of the abdominal wall, similar to a wrapper. After its dissection, two vertical stripes of the rectus abdominis muscle of red color are opened. With the help of tools called "retractors", they are pulled apart like curtains. Then the peritoneum opens - a thin, almost transparent shell that covers the internal organs. The peritoneum is excised, and the uterus appears - a large plum-colored muscular organ. With a scalpel, a small initial incision is made, and then, to speed up the process, they resort to scissors. It feels like cutting through a thick, leathery fruit. nine0003

What follows is seen as a surreal picture. You run your hand inside and feel for the moving fingers, heel, knee, and then the entire leg of the fetus. And suddenly you realize that a new human life is beating in your hands. In doing so, you almost forget about the mother lying on the table. If the fetal head is deep in the birth canal, then you need to confidently take the baby by the waist and pull. Sometimes it is required that the assistant from the bottom pushes the head. The baby is then released from the mother's womb and the umbilical cord is cut by an assistant. nine0003

After the next uterine contraction, you remove the placenta (afterbirth) and pull it out. Use a sterile gauze swab to clear the uterus of blood clots and other debris. The uterus is sutured with two layers of dense threads, which subsequently dissolve on their own. With another thread, sew up the fascia, and then the skin. That's all.

Once a rarity, this procedure has now become quite routine. Many obstetricians are able to perform a caesarean section without any problems. Today, the caesarean section is fairly standardized and performed with remarkable uniformity. Gone are the days when obstetricians often had to use manual techniques for various cases: with prolapse of the legs, breech presentation, clamping the head in the pelvis, and more. Each of these techniques has its own difficulties and is accompanied by risks. Today, for all these problems, one solution is a caesarean section. nine0003

First of all, do no harm

"Primum non nocere" (first of all, do no harm) - says the main principle of the doctor, formulated by the father of medicine Hippocrates in the collection of postulates named after him ("Hippocratic Corpus", 430-330 BC. e.). The principle prescribes not to cause more harm to the patient by treatment than the disease itself. Doctors are guided by this to some extent when they undertake a caesarean section. However, no matter how simple the operations, they are still associated with certain risks. In some women, caesarean section is complicated by pneumonia, and the recovery process is generally more protracted than with conventional childbirth. During the operation, the intestines may be damaged. Sometimes there is severe bleeding or a blood clot breaks off. The stitches may open or become infected. nine0003

If, after a caesarean section of the next child, a woman tries to give birth through the birth canal, the probability of rupture of the scar on the uterus is approximately 1 in 200 cases. In addition, the placenta can attach itself to the scar, which can lead to severe bleeding when it is separated. Nevertheless, it must be borne in mind that a caesarean section is a surgical operation with associated risks and possible complications.

But you can't do without a caesarean section. We have reached the point where, in any doubt, doctors resort to cesarean section simply because it is faster, more reliable and less troublesome. If a woman is carrying a child weighing more than 4.5 kg or she has twins, triplets, usually go for a caesarean section. Caesarean section is recommended for transverse fetal position, breech presentation, and a range of situations that indicate a high risk of adverse outcome. Doctors are becoming increasingly reluctant to accept the risks associated with natural childbirth, even if they are insignificant - it is easier to do a caesarean section.

Today in many clinics about 30% of babies are born by caesarean section. In most cases, this approach is fully justified. At the same time, it is important to note that elective caesarean sections are less risky than emergency ones, when the operation must be carried out quickly, in critical conditions. A recent American study questioned the safety of elective caesarean sections. However, two other European studies have actually shown that maternal mortality is lower for caesarean sections than for vaginal delivery. nine0003

Still, there is something unsettling about this fact. With a cesarean section, the connection with another natural process of life, which has a thousand-year tradition, is lost. Scientists believe that at birth, a child must ingest a lot of beneficial bacteria contained in the birth canal. These bacteria create the very basis for the formation of a healthy microbiome. This is the advantage of natural childbirth compared to caesarean section, in which the child does not pass through the natural birth canal. Physicians recognize that the sterile environment, which was previously sought as a condition for the healthy development of the child, is not justified. We begin to realize that we are too carried away by the fight against microbes and, as they say, we throw out the baby with the water, in this case, beneficial bacteria. nine0003

We are witnessing the decline of the art of traditional childbirth. Over the centuries, the skill of midwifery needed to help the baby to be born through the natural birth canal has been developed. It seems that soon this art will be carried away into oblivion by modern medicine.

Childbirth is an art and craft

Today it is clear to everyone that it is not enough just to have knowledge and apply technology. Midwifery needs a different kind of ingenuity. It is important to standardize the delivery process. At 19In the 1930s, the medical "class" resorted to a strategy that was based on the standardization of medical practice. Standards have been developed for the training of birth attendants; hospitals have established strict regulations and requirements for birth attendants. In particular, professional requirements for obstetricians have been developed, taking into account their experience, ability to use obstetric forceps and other unsafe interventions. Standardization proved to be a turning point in obstetrics. By the early 1950s, thanks to the introduction of standards and, in part, the discovery of penicillin and other antibiotics, maternal mortality had declined to 90%.

Midwifery has come to be seen as both an art and a craft. As an art, midwifery provides for the improvement of the methods and techniques used in obstetric care. Special devices have been developed that allow you to control the fetal heartbeat. Epidural anesthesia has revolutionized many aspects of childbirth, greatly reducing the pain of childbirth. New synthetic drugs (pitocin instead of ergot) were invented that more effectively controlled uterine contractions during childbirth. nine0003

According to the World Health Organization, over the past 25 years, maternal mortality in the world has decreased by 44%. Nevertheless, despite the successful development of technology, about 1400 women die every day from various pathological conditions in the world before and during childbirth. And this happens not only in developing countries, but also in developed countries, such as the United States of America. Approximately one third of maternal deaths occur during the last weeks of pregnancy, another third during childbirth and within a week after childbirth, and another third during the year after childbirth. nine0003

There are many factors that lead to complications of pregnancy and childbirth, such as women's health problems, unfavorable environmental conditions, and sometimes insufficient medical qualifications. In developed countries, among the causes of maternal death, the most common are disorders of the heart and cerebral circulation, bleeding and embolism (blockage of blood vessels) with amniotic fluid. In the postpartum period, women are more likely to die from cardiomyopathy - insufficiency of the heart muscle. nine0003

Today, it is essential to focus on training obstetricians in the skills and abilities to apply traditional and new methods of childbirth. The craft provides for the constancy and continuous improvement of the acquired skills.

Last year, several cases of maternal deaths in the capital of Kazakhstan caused a great resonance. Then the invited foreign experts did not reveal unskilled actions on the part of doctors. Childbirth safety does not always depend on medical experience; much is determined by how the expectant mother prepares for the difficult process of having a baby. The body of a woman, exhausted by disease, malnutrition and exposure to bad habits, is ill-prepared to accept the hardships of pregnancy and childbirth. To this should be added the undesirability of short internatal intervals: a woman's body must rest and recover after childbirth and breastfeeding for at least one and a half to two years. In addition, it must be taken into account that with age, the compensatory capabilities necessary for physiological pregnancy and safe childbirth naturally fade in a woman's body. nine0003

Therefore, it is extremely important that the expectant mother deeply realizes the great responsibility for her own safety and the health of the expected baby. To do this, it is necessary to eat rationally, give up bad habits and a sedentary lifestyle, prevent and treat diseases in a timely manner, and regularly see a doctor in order to prevent potential health threats in time.

Pregnancy and childbirth in terms of physical sensations and experiences is perhaps the most amazing, emotionally intense period in a woman's life. It is important to make sure that you are ready for these most important events and phenomena so that the miracle of the birth of a baby is not overshadowed by the bitterness of ailments and losses. nine0003

What the stars faced during pregnancy and childbirth

Stars love to talk about how happy they are to become mothers, but few people talk about the other side of pregnancy and childbirth. Vomiting leading to a hospital bed, diabetes, the inability to stand up after a caesarean section - what difficulties the stars faced during pregnancy and childbirth and why they arise, Gazeta.Ru understood.

Infertility, IVF and surrogacy, intractable vomiting and diabetes, manual removal of the placenta and caesarean section - many women go through this when they decide to have children, and celebrities are no exception. Gazeta.Ru found out what difficulties the stars faced during pregnancy and childbirth. nine0003

Famous women often talk about how happy they were to become mothers, but only a few share the details of pregnancy and childbirth. Meanwhile, this information allows expectant mothers to prepare for possible difficulties and survive them without too much panic.

American actress Anne Hathaway at the end of July 2019 told subscribers in social networks that she was expecting her second child. Both during the first and during the second pregnancy, Hathaway had difficulty conceiving, but the actress prefers to keep their details a secret. However, she hopes that her victory over infertility will give hope to those of her fans who are unsuccessfully trying to get pregnant. nine0003

See this post on Instagram

It's not for a movie... #2 All kidding aside, for everyone going through infertility and conception hell, please know it was not a straight line to either of my pregnancies. Sending you extra love

Posted by Anne Hathaway (@annehathaway) 24 Jul 2019 at 11:34 PDT

“Pregnancy is usually presented as an unconditional happiness, and all negative aspects are left in the shade. But it's different for everyone. And for many women, everything happens not at all so easily and simply. I'm tired of this state of affairs, because it's not true, and I love the truth, ”said Hathaway in an interview with Daily Mail .

A couple is considered infertile if the woman does not become pregnant within a year of regular intercourse - at least two intercourse per week without the use of contraceptives.

According to the WHO, about 8% of married couples face the problem of infertility during the reproductive period of their lives.

Its causes are both developmental defects and traumas, as well as the consequences of infectious diseases or endocrine disorders. In men, infertility is often related to the quality of sperm. nine0003

Fighting infertility means eliminating the causes that led to it. Sometimes you have to resort to assisted reproductive technologies.

So, the singer Mariah Carey became pregnant for the first time with twins at the age of 39 with the help of IVF. The pregnancy was difficult, so after giving birth, the singer said that she no longer plans to have children.

"I had gestational diabetes, life-threatening high blood pressure, and all the things you don't even want to know about," she said. nine0003

During IVF, a woman, as a rule, first undergoes a course of hormonal injections to stimulate superovulation - the maturation of several eggs at once during one menstrual cycle. Then the ovarian follicles are punctured and the eggs are removed from the body. The male usually collects the sperm for fertilization on his own.

The embryologist then adds the suspension containing the spermatozoa to the oocytes in the culture medium, or injects the sperm into the oocyte manually using microsurgical instruments. The probability of successful fertilization is 60-70%. After 2-5 days, the embryos are transferred into the uterine cavity of the patient or a surrogate mother. Usually two embryos are transferred. nine0003

Pregnancy diabetes goes away after childbirth, but doctors see it as a precursor to type 2 diabetes—women who experience it have an increased risk of developing diabetes in the future.

Comedian Amy Schumer also faced the "charms" of pregnancy - she had to endure severe toxicosis. Because of him, she ended up in the hospital, all performances had to be canceled. Kate Middleton also complained about toxicosis - in all her three pregnancies in the initial stages, she had to miss some events that the royal protocol requires to attend. nine0003

See this post on Instagram

Texas I am so deeply sorry. I have been really looking forward to these shows. I have to reschedule. I am in the hospital. I'm fine. Baby's fine but everyone who says the 2nd trimester is better is not telling the full story. I've been even more ill this trimester. I have hyperemesis and it blows. Very lucky to be pregnant but this is some bullshit! Sending so much love to the doctors and nurses taking great care of me and Tati! They are cool as hell! And Texas I am really really sorry and I'll be out there as soon as I'm better. nine0003

Posted by @ amyschumer 15 Nov 2018 at 10:55 PST

Toxicosis in pregnant women in mild form is manifested by nausea and vomiting up to five times a day, in moderate form - up to 12 times. This is accompanied by weakness, tachycardia, irritability. This is due, in particular, to a change in the hormonal background so that the embryo can gain a foothold in the uterus. Also, toxicosis is considered as a reaction of a woman's immune system to an "invasion" into her body.

Hyperemesis, intractable vomiting of pregnancy, is a condition in which vomiting occurs up to 25 times a day. nine0003

Hyperemesis occurs in every 100 pregnant women. Frequent vomiting leads to dehydration and a sharp loss of body weight, lack of potassium and magnesium, anemia. In these cases, the woman is transferred to intravenous nutrition, given antiemetics. In the event of a threat to her life and health, the question of abortion is raised.

Reality TV star Kim Kardashian, having survived two difficult pregnancies and childbirth, hired a surrogate mother to carry her third child - doctors forbade her to get pregnant. Shortly before the second birth, Kardashian admitted that pregnancy is the worst stage in her life. nine0003

“New mothers usually don't talk about the unpleasant side of pregnancy. But do you know, for example, that we have to wear a diaper for two months after giving birth?” she said.

“After the baby is born, the placenta must come out. But mine is stuck. This causes severe bleeding and often leads to the death of a woman. In my case it was disgusting! - Remembered Kardashian after giving birth. - To get the placenta, the doctor had to stick his hand into me almost to the elbow and scrape it all out. It was unbearably painful." nine0003

Factors that increase the risk of uterine growth - a history of inflammation of the uterus, curettage, scars after cesarean section, chronic infections, toxicosis. However, their absence does not protect against uterine growth by 100%.

Placental accreta is divided into true, when the vessels of the placenta grow into the uterine tissue, and dense attachment, when it fuses only with the spongy layer located between the placental and muscular tissue of the uterus. In this case, if after childbirth the placenta did not come out by itself within about an hour, the doctor separates it manually by inserting a hand into the uterine cavity. nine0003

True augmentation often requires hysterectomy.

Singer Madonna gave birth to her second child at the age of 41. The birth began prematurely: Madonna's placenta was torn and bleeding began. In the hospital, the actress had an emergency caesarean section. Tennis player Serena Williams also had to go through the operation - her daughter's heartbeat suddenly slowed down. The caesarean section itself was easy for Williams, but the postoperative period was hell for her.

“I didn't even expect it to be so terrible - I couldn't walk. I couldn't even roll over in bed. I couldn't even go to the toilet on my own. My husband literally carried me in his arms. I didn’t expect that from one of the strongest athletes in the world I would turn into a person who can’t get out of bed without help.” — shared later in an interview with Harper's Bazaar.

Caesarean section was used even before our era, although until the 19th century it was deadly. After they began to remove during the operation, and after a few years - simply sew up the uterus, a quarter of women died as a result of caesarean section.

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