The phrase "to be born with chicken and wine, to be born with four pieces of plate" describes the risks that mothers go through during labor and delivery, and even with advances in medical care, there are still unpredictable conditions that can occur during pregnancy and delivery. While advances in medical care have significantly reduced maternal mortality rates, too much medical intervention has led many to question the necessity of medicalizing the birth of a child.
What is a full course meal?What is the full-course meal that scares mothers? According to the birth reform action alliance pointed out, the birth of the full meal refers to the "routine birth of the classic full meal", that is, the mother in the medical hospital birth of the common problems, including ***, shaving, cut open the perineum, artificial breaking water, drugs to promote the birth of the baby, non-essential injections, the whole bed to monitor the fetal heartbeat, to the only way to reduce the pain of the drug, the pressure on the stomach, the rate of non-essential cesarean section is too high, the limit of the spouse as the only accompaniment, to the The authorization of the mother's fear to cooperate with all the standard operations.
The Childbirth Reform Action Coalition (CRAC) argues that "the classic full course meal for routine labor is not entirely necessary" and that unnecessary medical interventions should be reduced so that women can have more labor-friendly environments and support. However, for the frontline clinicians, how do they view the medical practices they perform during the birth process and what is their purpose? It's worthwhile for expectant mothers to know more.
*** Because the sensation of exertion is similar to that of defecation in natural birth, the baby and feces are born together. Li Ruyue, an attending physician at the Department of Obstetrics and Gynecology at Kaohsiung Veterans General Hospital, pointed out that *** is no longer part of the production routine at Kaohsiung Veterans General Hospital, "I'm not in the ***, but if you find out that a woman has a lot of feces through internal diagnosis that may affect the birth of the fetus, you will be told that the woman needs to be ***, and you will also be asked to consider whether or not feces will contaminate the wound at the perineum."
Chen Chunmu, an attending gynecologist at Citizenship Hospital, said that the traditional practice of hospitals will be directly *** before the birth of a woman, but now will seek the consent of the mother, respect the rights of the mother, and the current guidelines of the world's birth of a woman *** is not an absolute necessity. What is the purpose of ***? Dr. Chen pointed out: "Because during the birth, the baby will follow the mom's stool together with the *** is to avoid the fetus and perineal wound infection, no matter in the public **** hygiene or fetal health point of view, as far as possible to avoid the mother's feces is better.
Shaving What is the connection between shaving and labor? Dr. Chunmu Chen explains that during labor, the mother's perineum *** usually suffers various degrees of lacerations, and the purpose of shaving is to facilitate post-partum suturing of the perineal wounds, for the same reason that surgical brain surgery requires shaving of the hair. Furthermore, shaving is now done only from the perineum *** to the ***, not all of the ***. However, in the current birth process, shaving is not a necessary behavior, and the mother's consent will be sought before proceeding. In this regard, Dr. Li Ruyue also said that shaving has long been one of the birth routines, and in her clinical experience, almost no shaving is being done.
Cutting the perineum The perineum is the part of the body between the mouth of the *** and the ***. Cutting the perineum is a way of expanding the birth canal to assist in the delivery of the baby, and it's usually done with local anesthesia in the vicinity of the perineum, and then cut along the direction of the mouth of the *** down to the ***. Cutting the perineum is not a routine step in labor. If the mother asks "not to cut the perineum", Drs. Li Ruyue and Chen Chunmu say, "Respect the mother's opinion. However, when there is a particular change in the labor process, the physician must evaluate the situation and take appropriate measures.
According to Dr. Ruyue Li's clinical experience, unless the second child is in labor (the labor process is relatively faster and better), there is no need to cut the perineum, most of the first-time mothers will have different degrees of lacerations, and the wounds are irregular, and the advantage of cutting the perineum is to reduce the chance of the wounds going forward to the urethra or *** (the wounds will be more painful if they go forward), and the wounds will be more painful. In addition, cutting the perineum makes the wound straight, which reduces the difficulty in suturing the wound. The first time I saw this, I thought it would be a good idea for me to go back to my old school and try to get a better understanding of what I was doing.
Artificial Breaking of Water The two doctors said that the purpose of artificial breaking of water is common in the labor process does not have any progress, for example, the cervix is open, but the water is delayed, this can be used to shorten the process of artificial breaking of water, or uterine contraction status is not good, but also by artificial breaking of water to promote the uterine contraction, and so on. Dr. Ruyue Li said, "Doctors usually think that the woman is already in labor, and if she can't regenerate, she must find a way to artificially break her water, and will not artificially break her water without any medical reasons. Dr. Chen Chunmu also said: "Generally speaking, now we have to do before the artificial breakthrough will be explained to the mother, artificial breakthrough is common in the labor process did not progress, or not clear whether the baby has to solve the special reasons, will not be taken to the artificial breakthrough observation.
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Non-essential injections Since the injection of an IV will affect the mother's freedom of movement, Dr. Chen Chunmu believes that because of the time it takes for the mother to go from labor to delivery, in the event of an emergency, the IV can be used to give medication immediately, and that there is a preventive need for the presence of the IV. Dr. Ruyue Li agreed, "In medical centers, we often come across emergencies in labor and delivery, and putting an IV in beforehand can save time for subsequent IV administration, which I think is necessary. I think this is necessary because we want to improve safety. The patient may get one shot, but the follow-up is very protected." In addition, different hospitals have different practices, to Kaohsiung Veterans General Hospital, if the mother wants to get out of bed to walk around, you can also ask the medical staff to pull out the drip, leaving the drip line can be.
Pressing the stomach Dr. Li Ruyue said that when the mother exerts herself for a longer period of time, she will press the mother's stomach a little bit, so that she can feel the head of the fetus down to the *** feeling, and help the mother to exert herself at the same time. Pressure on the stomach is not the obstetrics routine. Dr. Chen Chunmu pointed out that most of the time, when the baby is about to be born and the mother is no longer able to push herself, she will be able to press her stomach to make the baby's birth smoother.
Non-essential cesarean section rate is too high The rate of cesarean section can't be summarized by simple statistics, Dr. Li Ruyue said, mothers must meet the conditions of cesarean section to be able to cesarean section (for example: fetal distress, delayed labor, fetal position, multiple births, etc.). The reason for the high cesarean section rate in Taiwan has been criticized is because of the culture of Taiwan, or because of the mother's "fear of pain" and "many medical disputes".
Restricted to spouses Dr. Chen Chunmu said that the rules for spouses are different for each hospital, and that it is up to each hospital to decide whether or not to restrict spouses to spouses.
Compatibility with all standard operations due to fear of authority Dr. Ruyue Li understands that physicians do have authority, and that a single word spoken by a physician may cause a patient to worry and be afraid, but it is not fair to all physicians to say, "Compatibility with all standard operations due to fear of authority", for example, in the case of perineum cutting. For example, in the case of perineum cutting, when a physician says, "If you don't cut the perineum, you are responsible for it yourself," it may be scary for the mother to hear, but the physician must make all the circumstances clear. The first thing you need to do is to make sure that you have a clear picture of the situation beforehand, so that you don't have to worry about the consequences.
Why don't we just cancel the whole meal?
The birth of a child is an innate ability and gift of a woman, and civil society believes that we should do away with ***, perineal cutting, and other unnecessary "birth meals. The most important thing is to evaluate the current situation and make sure that the safety of the mother and the baby is the first priority, and to choose the necessary medical interventions according to the condition of the mother.
Dr. Li Ruyue said that no medical treatment can guarantee full safety, including childbirth, all treatments are not only risk, but there are many unpredictable unknowns, some of the production methods are still necessary. In fact, now most of the medical institutions will have the so-called "birth consent form" (each medical institution is different), compared to the past society, in the respect for maternity this piece is indeed much improved.
Dr. Chen Chunmu said, generally speaking, in the past more physician-centered, maternal will be ignored or must respect the authority of the physician, but now the patient consciousness rise, coupled with the Taiwan Obstetrics and Gynecology Medical Association is also to promote suitable for Taiwan's health care production plan book, hope to provide to the maternal friendly production of medical environment. However, the most controversial aspect of medical care in Taiwan is whether it is better to leave the decision to the patient or to the physician. In addition, can the patient take responsibility for making the decision? Dr. Chen further pointed out, "In Taiwan, the quality of maternal care is one of the top three in the world, and almost all births in Taiwan are attended by physicians, and there is a certain quality in the physician care system. Is it really better for the patient to make the decision while respecting the patient's idea? Is it possible for patients to be responsible for their decisions? Physicians do so much because they don't want anything to happen." In particular, there is a lack of mutual trust in the relationship between doctors and patients nowadays, and if any of the steps are missing, it often becomes a point of contention in the medical disputes, which is exactly what makes it difficult for obstetricians to respect the patients' opinions and the medical profession.
Fill up on the right knowledge and choose the right birth method for youDr. Ruyue Li pointed out, "The birth process has progressed from no medical intervention at all to too much medical intervention, and now some unnecessary medical interventions can be removed, for example, breastmilk used to be regarded as non-nutritious, but now it is advocated for the benefits of breastmilk. There are many views that are changing." Dr. Lee said, "I have met a mother who indicated that she wanted to have a natural birth at home during her checkups at my clinic. She thought that this was a very special and natural way to have a natural birth, and she was willing to take on all of the problems, which I thought was very good," she said. As long as every mother understands the risks involved in the birth process, she will know what to expect and will not panic during the birth, and will be more likely to accept and go through the birth process, and her tolerance will be strengthened, and she won't choose to have a C-section because of fear of pain.
Finally, Dr. Chen Chunmu said, "Taiwan's obstetricians and gynecologists respect the rights of pregnant women and women, and if there is good communication between the physician and the patient, there will be no misunderstanding, but the physician is willing to communicate with the patient, and the patient's level of knowledge, is there a way to make a decision? Theoretically, the patient must be responsible for the decision, but is the patient willing to be responsible? If it is only the obstetricians and gynecologists who have to pay the bill, I think it is not fair."
Civil society also emphasizes that the pursuit of friendly birth does not mean that obstetricians and gynecologists are on opposite sides of the fence, and should call on *** to promote the "Clinical Guidelines for Maternity Care" by *** to develop relevant policies to support the development of pregnant women, women in labor to get the right information, and also to allow healthcare professionals to be able to feel comfortable in keeping up with the international trend, and engage in the best evidence. The most important thing to remember is that it's not just a matter of time before you can get the job done. However, the reality is that Taiwan's medical personnel manpower, the hospital environment is set up to improve, and medical personnel worried about medical disputes, prefer to follow the obstetrics full meal to avoid lawsuits is also a major cause of public thought.