Vaginal Delivery or Caesarean Section?

Questions about pregnancy process?

The adventure of pregnancy which is an unforgettable period in a woman’s life brings along a lot of questions despite being a rather joyful process. Prospective mothers have various questions ranging from pregnancy follow-up to selection of delivery method. Gynecologist and Obstetrician Sedat Cömert, M.D., of Güven Hospital answered questions regarding the pregnancy process.

What should prospective mothers do before pregnancy? What kind of support they may get from gynecologists and obstetricians?
Some gynecologic infections may lead to several problems during pregnancy. We recommend all women to present for gynecologic examination before pregnancy to prevent these undesired situations. Screening and treatment of these problems prior to pregnancy is very critical for healthy pregnancy. In addition, functioning of several hormones, especially thyroid hormone, should be checked before the pregnancy. Identifying a hormonal dysfunction after the pregnancy may mean that we are late. Moreover, it is known that some vitamin levels matter during the pregnancy. Analyzing vitamin D and iron levels before pregnancy is beneficial for a healthy pregnancy period.

In addition, immunity of prospective mother to certain infections should be known before pregnancy. Women who plan pregnancy should be tested especially for rubella antibodies and vaccination is necessary, if the result is negative. We allow pregnancy at least 3 months after the vaccination. Therefore, necessary health check-ups should not be ignored before the pregnancy.

Is there an ideal age for pregnancy? Which age groups are at higher risk and what are those risks?
Being a mature adult is the primary condition for an ideal pregnancy. Individuals below the age of 20 still have characteristics of the adolescence. Early motherhood is wrong for a woman who is not physically or mentally ready to be a mother. Similarly, pregnancy at advanced age may also bring along various problems. Therefore, we consider that the appropriate age range for pregnancy is 25 to 35 years of age.

In which age range pregnancy proceeds healthier?
One has to be very fair when a view is expressed on ideal pregnancy age. Today, social and economic problems cause various women to postpone pregnancy. Many prospective parents desire to obtain financial security before pregnancy. At this point, we have a lot of pregnant patients over the age of 35. It is unfair to think all these pregnant patients will experience problems. They are also able to complete the pregnancy in a healthy way. Thanks to ever improving medical facilities, pregnancies over age of 40 also increased. However we still recommend to get pregnant before 35, if it is planned and if possible.

Which risks does advanced maternal age cause during pregnancy?  For example, what may women over age of 35 experience during pregnancy?
We should consider the age of 35 years as an advanced age pregnancy rather than a rigid age limit. First, incidence of chromosomal disease increases in babies of advanced age mothers. Of course, this risk can be measured to a certain degree. Therefore, we can express that it is generally considered as a secondary factor. Pregnancy-related problems, such as gestational hypertension, are more common in pregnancies at advanced age. Maternal age above 40 also brings along certain problems. We know that certain age-related diseases, such as vascular diseases, diabetes, hypertension or heart diseases, may worsen in the pregnancy. This does not mean that every woman at the age of 42 will face these problems. Particularly, some people marry in later stages of life. There are also people who do not get the opportunity due to certain reasons such as academic carrier. We, therefore, encourage prospective mothers in advanced age to try and lend our support during pregnancy.

How is pregnancy follow-up performed? Which tests and examinations are performed by months?
Pregnancies are monitored rather intensely and well in our country. When a woman gets pregnant, we scan ultrasound to verify the location of pregnancy as the first step. After it is confirmed that the fetus is living, we continue with regular monthly checks. Meanwhile the Ministry of Health also screens pregnant women. In other words, they ensure that pregnant women are reported by neighborhood units and they follow up those women to a degree via family physicians. We monitor pregnant women through regular monthly intervals. This interval generally shortens after the week 32 and we start conducting examinations at 2-week intervals. We repeat monitoring sessions on weekly basis for all pregnant women after the Week 36. Various tests are done in this period. A part of these tests allows us to manage the maternal health, while others help us to check the fetal health. Baby-related tests usually consist of chromosomal screening tests and ultrasonographic imaging methods to verify if anatomic structure of the baby is normal.  Generally, we perform a series of routine tests at the beginning of pregnancy to figure out if there are risks regarding the baby and the mother. There are also specific tests that are done at specific intervals. For example, all pregnant women are screened regarding gestational diabetes at Week 24-28 of the pregnancy. Moreover, we measure blood pressure regularly throughout the pregnancy to identify hypertension and assess the results in a personalized manner.

Mothers are very curious about glucose challenge test. Can we say this test is harmful?
There is no scientific data to suggest that glucose challenge test is harmful. This claim has actually been raised by a physician. There are no other scientists asserting this clam in the world. Drinking a certain amount of sugar for once for a screening test is not harmful. Here, we are not referring to continuous consumption of sugar, which should be the issue we emphasize. We just ask the mother to swallow a certain amount of sugar once for screening and I can clearly express that it is not harmful. There may be other modalities to screen gestational diabetes. In other words, we can understand whether postprandial blood glucose is high by measuring blood glucose level after various meals, but this is not very practical. The reason why this test is recommended for all pregnant women around the world by the World Health Organization is this test is very practical and performed only once.

What is the importance of pregnancy follow-up for maternal and fetal health?
There are two goals of pregnancy follow-up. The first one is to decrease infant mortality, while the second one is to decrease maternal mortality.  The practice of antenatal screening has become popular around the world generally after 1950s. Supervision of pregnancies can actually ensure early detection of some risks and sometimes prevention of them before they become dangerous. Pregnancy is a process that advances well in nature. To be honest, I think keeping the pregnant alert all the time through this modern antenatal follow-up programs is wrong. I mean, it is not true to make them feel like they are under a critical threat and those threats are being investigated with continuous follow-ups. Most of the pregnancies can progress and end without any problems. We try to detect the small group with problematic process and problematic end with these follow-ups.

Which method of delivery is more popular amongst prospective mothers?
Recently, naturalism is more dominant. Therefore, I can say that vaginal delivery is more popular. As I already mentioned, childbirth and pregnancy are not associated with problems or risks in most cases. Consequently, I also believe that if you really leave the delivery process in the hands of nature, you face fewer problems. Here, the problem is training and preparing the women in advance to make sure they can cope with the labor pain. To the extent we can ensure this, women prefer vaginal delivery and succeed in completing the natural processes in childbirth by bearing the problems they experience. But, of course, epidural anesthesia practices are very commonly used for the groups who cannot cope with the pain. We also use it. Everyone feels and experiences the pain differently; a woman may not be able to cope with the labor pain while another woman can. There is one group that does not prefer vaginal delivery. They prefer Caesarean section due to various anatomic reasons, their psychological status or personal preferences. To manipulate the potential changes in their body. I believe that we should not force the prospective mothers about this if they are still confident with their decision after we properly inform them. Because, in my opinion, every woman should be free to choose the method of delivery.

What are the factors that should be considered while choosing a method of delivery?
Unless a woman has a specific psychological condition, a special demand, in other words, any physical demand, we do not need to choose a method of delivery. When you leave the woman into the childbirth process, the nature guides her and the childbirth progresses naturally. In case of any problem during vaginal delivery, the physician performs Caesarean section as a medical indication; there is no problem in that. The problem emerges with people’s demands. I mean, if the woman wants to give birth with vaginal delivery but does not want any change in vaginal anatomy, the prospective mothers should be informed that this is not possible. If this is an important priority of the woman, she should have caesarean section or if she has requests such as “I want to give birth with vaginal delivery but the process should be painless”, or “I want to know the exact time of delivery, I do not like uncertainties”, those requests make the vaginal delivery process difficult. Otherwise, when you leave the process to the nature, the nature starts the childbirth whenever it wants and advances the process as it wants. When the process does not advance properly in a small group, intervention is made by the medical team.

What are the considerations in a healthy pregnancy period?
The considerations for a healthy life are valid for this process. In other words, healthy diet, sufficient sleep and healthy psychosocial environment are all necessary for a healthy pregnancy. When women get pregnant, they are always curious about how their diet should be. In fact, when we explain to them, they understand that what we tell is also necessary for the ones who are not pregnant. Maybe, pregnant women should be more careful about eating-drinking discipline. When there is no pregnancy, people can do something just because they want even if they know that it is unhealthy. Consuming desserts or alcohol are some examples. In pregnancy, they may need to be more careful. But a healthy diet is fundamentally the same for everyone. The rules of healthy eating are the same for the pregnant and there is nothing specific for this process, as is the case with other conditions. For example, air pollution is a very harmful factor for the pregnant, but it also applies to other people. Also is smoking. Therefore, we can say a healthy life is sufficient for a healthy pregnancy.