Giving birth from the perspective of doctors and midwives. Observing and listening to insiders. How does the clinical practice of giving birth work today?
I have a mother.
Two of my siblings are gynecologists and they often fight.
There were slightly more men speaking than women. However overall there were more women present, especially among the younger participants.
61. Congress of the German Association for Gynecology and Obstetrics.
Gynecologists seem to pay a lot of attention to their looks.
Parenthood is given just through the wish of giving life to a child.
When a child is procreated through sperm and egg donation and brought to term through a surrogate mother, then the initiators are still the parents because without them the process would have never taken place.
Who has the parenthood for children who were created unintentionally?
In Japan women only start to breastfeed 6-8 weeks after giving birth. But then the Japanese have breastfeeding rates of 80% because the women were able to recover first.
Incontinence is a big problem after pregnancy, but many women don’t talk about it. We send them to postnatal exercise and to the gym. They wet pants once and they will never go again because they are too embarrassed.
We have to look after the women for longer periods after they have given birth. For weak connective tissue postnatal exercises only have a minimal effect.
1. Do you feel physically able to breastfeed? 2. Do you have enough time? 3. What is your real motivation to breastfeed?
Not every woman can breastfeed and we should not force them to do it.
Breastfeeding is the best for mother and child, if it is the best for mother and child.
We should not allow the midwives to take away after-birth-care and acupuncture from us.
Many women tell me that under no circumstances they want a natural birth. We have to engage in a conversation with those women and supervise them psychologically.
How many times are mother and child saved although there was no need to save them?
I have a psychological after-birth-talk with all my patients.
One patient told me that she cannot get her second birth out of her mind although it was much faster than the first and without any complications. I asked her who was taking care of her during the process. She was looked after by an older midwife who only stopped by from time to time because the day was very busy. During her first birth a young midwife looked after her with whom she got along very well. The older midwife was also nice but due to the amount of births that day she did not have a lot of time for her. I asked her aobut her relationship with her mother. She said it was bad. That was the key – she was once more, during her second birth let down by an older woman. The woman was healed from her birth-trauma after we had figured that out.
With me no one gets a planned caesarian section. The child decides the day of birth. And I will not induce a section before the rupture of foetal membranes.
In Brazil, due to prevalence of the caesarian section, the government has to check the indication for a section now. When it is not confirmed, the doctor in charge has to cover the costs of the treatment.
Not all women who want children also want a birth.
The dissertations of midwives are often of much higher quality than those of the medicine students.
Midwifery vs. obstetrics / Geburtshilfe vs Geburtsmedizin
Through the transition of the midwife training into university education, responsibility will be transferred to the midwives in the clinics.
Young doctors learn from midwives.
Midwives give women a voice in medicine.
If midwives are allowed to take over more responsibility they will also earn more. There will be a shift in the distribution of salaries since there will not be more money overall.
Is there an overrated whish for children?
The German embryo protection law was written under the expectation that all embryos have full potential to grow.
In German we have the paradox that abortion is legal but every in-vitro fertilized embryo has the right to live.
We have to disenchant the artificiality. It is not that unnatural to fertilize in-vitro. It is a question of medical quality and not one of choosing blue eyes.
15% of all women have miscarriages. 5% have two and 3% have three or more. The risk for a miscarriage increases with every miscarriage.
Half of all pregnancies are aborted by nature as we know today. Most of the miscarriages are not even noticed because they already happen within the first few days of the pregnancy.
I wonder how often I have been pregnant without noticing it.
Miscarriages make women insecure in the relationship with their body and make natural births more difficult.
The fetus can be rejected by the immune system of the mother.
If the mother is stressed this influences the exchange of nutrition and oxygen with the fetus.
The culture of after birth talks helps to identify and treat peripatal psychological disruptions early.
Where are certain ideas about birth created?
During birth the woman is different to the person she thinks she is. This can cause traumata.
We gave a workshop in a primary school and noticed that there was an open conflict between the caesarian section kids and the ones born naturally.
I thought I wasn’t allowed to tell anybody that I was born by caesarian section.
Fathers can also have depressions after birth. One father I treated was for a while unable to be a pilot because he did not know how to deal with his child. It unsetteled his sense of responsibility.
Pregnancy as critical point in life.
If a woman is depressed during pregnancy she will pass it on to the child.
I should be happy now.
Approximately 15% of all mothers suffer from postpartal depressions. Half of them already fall ill during pregnancy.
71% of all pregnancies in Germany are categorized as risk pregnancies.
Are we all risks or only the women?
With 35 a woman is late parturient and therefore is put into the category of risk pregnancies.
In Germany we have the highest number of screenings during pregnancy.
Pregnant doctors are not allowed to conduct surgeries nor to venipuncture.
Pregnancy is not an illness.
We have to inform without generating fears. More is not necessarily better.
Although Germany has the highest density of doctors the people are not healthier in comparison.
But what are we supposed to do with the women if they come into our practice? – The personal attention and preoccupation is much more important for the pre-birth examination than the mechanical examination.
The house birth as well as the planned caesarian section use self-determination and fear from loss of control as arguments.
It is easier to be a good caesarian than a good obstetrician.
Caesarian section: most frequent abdominal surgery for women.
Is the planned caesarian section a smart medicalization or does it help to achieve female self-determination.
No patient has to be reasonable.
Doctors have no statutory duty to follow the wish for a caesarian section.
If I decline to accept the wish for a planned caesarian section the woman will go to another hospital where she will receive it.
During one work shift I have to deliver approximately 7 children. If I don’t reach that average the head of department will ask why.
We have to do everything so that the women want to deliver in our hospital.
The positive rights of a mother are limited under consideration of the child.
An intact perineum does not mean anything.
One has to know a lot to do little.
The reputation of clinics is that they solve every problem with a caesarian section.
Do the risks of vaginal births soon require a patient signature?
It is a misapprehension that the caesarian section is economically more profitable. For a section more staff and more medical effort has to be provided.
Caesarian section by wish or preventive section?
Why do women express the wish to have a caesarian section? – They are afraid of pain, that the child will be harmed during the birth and of a pelvic floor trauma.
The term caesarian-section-by-wish is discriminating. We are talking about serious fears the patients have.
The number of lawsuits by women who have experienced a trauma through a vaginal birth increases.
Older women are younger today.
When is the best moment to have a child?
Maybe the children receive better parenting when their parents are older.
The men are also older when they have their first child.
With 40-45 years the time has finally come to do something for yourself and to have a child.
With 34 years 10% are already sterile and with 44 years 55% are sterile.
Risky child delusion.
Lifestyle or medicine? Obstetrics in the 21st century.
Why do I talk about a vaginal insert to induce birth under the headline of lifystyle?
The higher the body-mass-index the higher the risk for deformities of the child.
The rate of discovery of anomalies is lower when the body-mass-index is higher.
You can proceed with the ultrasound scan on pregnant women with obesity more easily if you lift the flab.
We transplanted nine uteri. Five women have so far given birth to healthy children. One of them is expecting her second child. For two women we had to remove the uteri again shortly after the surgery. Two are still trying to become pregnant.
The women had to find their own uteri donors. The prerequisite was that the donor had given birth before to a healthy child. For most of the women the donor was their mother.
We recommend keeping the uterus for two pregnancies and then remove it because the women have to take immune repressors so the uterus is not rejected by their body.
Uterus transplantations will certainly also be used in ways in the future not everyone of us will like.
In Afghanistan the caesarian section rate is only at 4%. The women there try to give birth naturally under all circumstances – even with triplets.
Multiples lead to separations more often.
For planned singleton children the family situation is especially good.
It is most likely for single parent mothers over 40 to mention personal overload.
Children are rarely enlightened about sperm donations. It is dangerous. Children should know about the other genetic material involved as soon as possible, otherwise this can lead to traumata.
The gold standard of genetic motherhood.
There is no legal ban for lesbian couples and single women to receive gamete donations. But the medical associations in a lot of German states think of it as not reasonable.
A woman I know has wanted a child for a very long time but she is single. She went abroad to receive reproductive treatment. It was financially possible because her father is wealthy. He, however, never found out what she used the money for. Before she went abroad for the treatment she always had to take hormones so enough egg cells would ripe to then be fertilized. The hormones were always a struggle and to go abroad she had to call in sick but couldn’t tell anybody what she was really doing. For a very long time it did not work. But eventually she became pregnant only to then find out that the child was nonviable. She would have been also happy to adopt a child but this is very difficult for a single woman with a fulltime job. Just recently she received the chance to care for a foster child. She is very happy about this opportunity. However, the mother of the child can always ask to have it back.
The German government is working on the regulations of fatherhood. After they have renewed the regulations sperm donors can no longer become the legal fathers.
How is it as a father to tell your child that there was a sperm donor involved? Isn’t there a lot of fear that the child will tell everybody in kindergarten about it?
Sooner or later the children will find out that there was different genetical material involved. Most often it happens during puberty. When the child does something unpleasant the parents might say something like – that you certainly inherited from the donor.
What was the legislator thinking when the donation of female eggs was made illegal in contrast to sperm donation? Apparently it leads to difficulties within the identification process of the child when motherhood is fragmented. The well-being of the child is not ensured.
According to studies egg donors do not develop problems through their donation.
Reproductive freedom as fundamental right.
A woman who goes abroad to receive an egg donation will not receive any legal consequences.
The government is against surrogate motherhood because it is incompatible with human dignity. That is a very frivolous handling of human dignity.
In the UK the surrogate mother decides after birth if she really wants to give away the baby.
The mother-child relationship is valued differently to the father-child relationship. That is the reason why sperm donation is legal in Germany in contrast to egg donations.
The wish to have children and sex belong together.
There is not enough talking about sex. For many couples who want to have children sex is not related to desire anymore. It is only about meeting the fertile days. Sometimes the women cry after sex – after all it will not make me pregnant.
You have to talk more about sex with your patients.
He is also a doctor, a hygienist and he thinks sex is generally disgusting – no matter if he is involved or not. However, the couple has a child now. There is still the option with the cup.
The sexuality changes during fertility procedures. It loses spontaneity and intimacy because the doctor recommends when the probability to become pregnant is highest and therefore when to have sex.
Some couples are happy to have abandoned their sexuality because it wasn’t fun anyways.
Asthma and allergies are fostered through fear and domestic violence during pregnancy.
Long term effects of fear and stress during pregnancy: fetale programming, chronic-immunologic illnesses increase.
Young women breastfeed less than women over 35.
Women with lower education breastfeed less that women with higher education.
The child starts crying when it is taken away from the mother right after birth.
The skin contact after birth is the first bonding contact between mother and child.
Skin to skin right after birth for at least one hour.
Pelvic presentation is no reason for a caesarian section.
It is not only useful to advertise condoms but also breastfeeding.
The Germans on average breastfeed exclusively for 3.9 months.
The World Health Organization recommends to breastfeed exclusively for 6 months and partially up to two years or longer.
To encourage women to breastfeed, support has to be provided by her partner, her employer and the health system.
Three ministries are involved in the national breastfeeding commission. The responsibilities are blurred.
It is worth to breastfeed: cancer among mothers is reduced.
Is there research on the artificial production of breast milk? Or to reproduce it artificially from small samples?
What happens when I as a grown human being drink breast milk?
Breast milk stem cells make cancer cells commit suicide.
Is breast milk from a different person than the own mother problematic or enriching? It should not be a problem since the immune system of a newborn is not fully developed yet.
The problem was underestimated: 25% of the women who gave birth have sore nipples or mastitis. The psychological problems should not be overlooked.
We should not condescend our treatment into sales events.
The midwives want to take over the healthy pregnant women and earn more money.
Who should take care of the pregnant women in the future?
The majority of the women who make use of social freezing use it because they have not yet found the right partner to have children with.
The risk of deformation increases through in-vitro fertilization.
The younger the egg cell, the lower the risk for deformation.
There is a 1:22 risk of schizophrenia when the father is older than 45.
Which information am I allowed to give to a woman knowing that she will go abroad to receive an egg donation, without committing a crime?
Eventually children assume the family secret that there was other genetic material involved because in every family one talks about who the child looks alike.
Children with old parents are burdened with the fear of their parents’ death.
When women become pregnant later in their lives the medical care has to be different. For example a cardiologist should also be consulted.
Many women who received an egg donation abroad only mention this during the birth, often because there are complications.
Children become the victims of modern reproductive medicine and of their parents. – Then all children are victims of their parents. – Humans are never victims of medicine.
That humans want children is a physical need. We don’t have the right to say, it would be better this child hadn’t been born.
Overshooting reproductive medicine turns children into victims because it creates multiples and therefore also premature infants.
Medicine has to be more open so people come to get counseling.
Many women don’t know that with 45 their organs are not as fit as with 25.
The consultation abroad about egg donations is not lead with the honesty that is necessary.
My dear child you should have not been born because your mother only had a life expectation of two years left.
Concept and Text by Jasmin Schädler
Concept and Design by Christoph Knoth
Illustrations by Inga-Marie Ruxton
This website was inspired by a visit to the yearly conference of the German Association for Gynecology and Obstetrics. It is an attempt to question and confound the hierarchies of knowledge around the topic of birth and motherhood in the medical context. Please find a more elaborate discussion of the topic here.