Trial of Labor and Vaginal Birth after Three Previous Cesarean Sections: Report of Two Special Cases

Background Natural childbirth could represent a deeply rooted need for many women, even in exceptional situations such as after 3 previous caesarean sections. Case presentation The first patient, a 28-year-old 6th gravida and 3rd para, first presented in the 40+3 week of pregnancy desiring a vaginal birth, after all the other hospitals in the area had refused her request. A detailed explanation of potential risks was given and, when 2 days later contractions started, she gave birth to a newborn of 4450 g spontaneously, without complications. A month later, a second woman, 42 years old, 5th gravida, 3rd para, read about the above-mentioned case on social media and decided to attempt a natural delivery after 3 caesarean sections at our hospital as well. She presented herself for the first time in the 41+1 week of pregnancy in our delivery room with an onset of labor after rupture of the membranes and gave birth on the same day, spontaneously without complications, to a 4150 g heavy healthy newborn. Conclusions The wish to attempt a spontaneous birth after 3 previous caesarean sections can be deeply anchored and should be professionally approached by obstetricians, even if counseling and management can be challenging.

The Shift in the Childbirth Paradigm in Latin America and its Socio-Political Implications

The article tackles the issue of the shift in the model of childbirth taking place in Latin American countries. Based on the analysis of 2012 documentary film Nacer by Jorge Caballero, audiovisual material from organizations dedicated to maternity care, and selected documents and legislation it focuses on values, significances, normative principles and power relations in technological and natural childbirth models. I argue that a shift from the technological paradigm to the natural paradigm of childbirth may contribute to the abolition of patriarchal structures perpetuating violence, the women’s empowerment and the construction of a society supported by the values of respect and love for living beings.

An Innovative Approach to Studying the State of the Uterine Scar after Cesarean Section on the Basis of a Comparative Study

Background. Today we have not really highly informative methods for assessing the state of the uterine scar. This fact does not allow us to formulate clear selection criteria for spontaneous delivery for patients who had cesarean section (CS). The result of the formulated problem is not only an increase in the frequency of repeated abdominal delivery, but also a fivefold increase in the risks of intraoperative and postoperative complications for women of reproductive age. Aims explore the property, structure and morphological features of the myometrial scar tissue by developing a physical model based on morphological predictors. Materials and methods. The study included 49 women who ahead a second caesarean section in the maternity hospital at the S.S. Yudin state medical center. The patients had scar tissue excised in the lower uterine segment and the resulting biopsies were divided into 2 fragments. The first fragment of biopsies was necessary for performing a morphological study, based on the results of which randomization was carried out into groups. The main group included 24 fragments, where the scar tissue was well-established, and the comparison group included 25 fragments, where according to morphological research, signs of its insolvency were revealed. Further assessment of the scar state was performed using the second fragment of biopsies by creating a physical model of the study, on the basis of which the dependence of elongation on the applied force was estimated. The study was conducted in the laboratory of scientific research on the development of bioprostheses of the CSSC A.N. Bakuleva. Results. Based on a morphological study, it was confirmed that the failure of the scar is based on the disorganization of connective tissue, indicating the possible presence of undifferentiated connective tissue dysplasia for the patient. The physical model of the study demonstrated that the presence of such a difficult-to-diagnose pathology leads to a decrease in the elasticity, and therefore-the strength and elasticity of the scar on the uterus. Conclusions. For this period of time, we need to improve methods for assessing the condition of the uterine scar in order to resolve the issue of the possibility of conducting natural childbirth for patients after undergoing CS surgery. It is possible that the created physical model will be able to evaluate the predictive ability of ultrasonic elastography within the framework of this problem. It is important to remember that scar formation is the final stage of regeneration, therefore, the maximum number of answers to a detailed study of morphological and immunohistochemical features of the myometrium, as it is the primary matrix on which will be the formation of scar tissue.

Training Birth Attendants in India

This chapter documents the local and global processes of construction, legitimization and delegitimization, and the political uses of the knowledge of traditional birth attendants—TBAs. Based on four years’ ethnographical investigation in Tamil Nadu, this chapter discusses the issue from various points of view. It looks at the debates of actors involved in the national and international public health agendas, Indian movements promoting ‘Natural Childbirth’, and movements in favour of the preservation of traditional systems of medicine. TBAs are variously perceived as wicked mothers whose archaic practices must be controlled, the archetypal ambassadors of traditional knowledge, or as relevant actors bringing together ideal elements of any development activity—locality, community, and low cost. This careful reading of the contemporary social representations of TBAs and of their role reconfigurations offers a lens to examine authoritative knowledge’s social forms, practices, and paradoxes.

Analysis of the Clinical Effect of Music Combined with Hypnosis on Labor Analgesia Based on Data Mining

The objective of this paper is to study the curative effect of music combined with hypnosis on labor pains during childbirth. Based on the algorithm of data mining, we randomly selected 100 women who delivered babies in obstetric units from October 2020 to June 2021, set the control group and the observation group, obtained the relevant clinical data through comparison, and analyzed the value of music combined with hypnotic analgesia midwifery in obstetrics. The results showed that the number of spontaneous delivery cases in the observation group was higher than that in the control group ( P < 0.05 ) and the delivery time in the observation group was better than that in the control group ( P < 0.05 ). It is proved that music combined with hypnosis can effectively improve the rate of natural childbirth and shorten the overall labor time, so as to guarantee the health of mother and child.

Effect of the Iranian Health Sector Evolution Plan Implementation Focused on the Type of Delivery on Maternal and Neonatal Health Indicators in Selected Hospitals of East Azerbaijan Province

Background: Health systems are making reforms to ensure and promote public health. Measuring the effects of reform is one way to determine its effectiveness and consequences. Objectives: This study was aimed at investigating the effect of the Iranian Health Sector Evolution Plan (HSEP) implementation with a focus on the type of delivery on maternal and neonatal health indicators in East-Azerbaijan Province. Methods: This descriptive-analytical study was conducted in 2017. The data of 800 patients were randomly selected through the dataset of eight hospitals equally in the two time periods of before and after the HSEP implementation. A researcher-made checklist was used for data extraction. Data were analyzed by SPSS version 22 using descriptive statistics, t-test, and chi-square. Results: The mean age of the mothers in both periods was 27 years. Most of the participants did not have a previous delivery and had a diploma or a lower level of education. The rate of natural childbirth increased from 34.5% (before the HSEP) to 44.2% (after the HSEP) (P < 0.05). Maternal and neonatal mortality rates decreased from 0.3 and 0.8% to 0.0 and 0.5%, respectively. Maternal and neonatal mortality and stillbirth rates were not significantly different based on the study period and type of delivery (P > 0.05). Conclusions: The findings indicated a significant increase in the rate of natural childbirth after the HSEP implementation. Maternal and neonatal mortality rates had also decreased. These results can guide policymakers in deciding whether to continue or review the reform.

Investigating the Relationship between Childbirth Type and Breastfeeding Pattern Based on the LATCH Scoring System in Breastfeeding Mothers

Objective The role of breast milk in the physical and mental health of infants and in the prevention of infant death is widely known. The benefits of breastfeeding for mothers and infants have been proven, but several factors can affect breastfeeding. Childbirth is one of the most influential factors. The present study aimed to investigate the effect of the type of delivery (natural childbirth and cesarean section) on breastfeeding based on the latch, audible swallowing, type of nipple, comfort, hold (LATCH) scoring system. Methods The present cross-sectional observational study was performed using the census method among women who referred to Afzalipour Hospital for delivery in May 2020; the breastfeeding pattern was completed by observation and the in-case information, by LATCH checklist. Data were analyzed using the Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Armonk, NY, United States) software, version 19.0, analysis of variance (ANOVA), and the Chi-squared statistical test. Results Out of a total of 254 deliveries (127 natural childbirths and 127 cesarean deliveries), there was no statistically significant difference between the 2 study groups in terms of age, maternal employment status, and infant weight, but there was a statistically significant relationship between the type of delivery, the maternal level of schooling, and the appearance, pulse, grimace, activity, and respiration (Apgar) score in the first minute. The mean score of breastfeeding patterns among the natural childbirth group (9.33) was higher than that of the cesarean section group (7.21). Conclusion The type of delivery affects the mother's performance during breastfeeding, and mothers submitted to cesarean sections need more support and help in breastfeeding.

Uterine Epithelioid Trophoblastic Tumor in a 44-Year-Old Woman: A Diagnostic Dilemma

Background: Epithelioid trophoblastic tumor (ETT) is a rare and newly defined disease, which most commonly occurs in women of reproductive age and can be a sequela of any gestational event. ETT can be present in both intrauterine and extrauterine sites. Case report: A woman of reproductive age, without specific comorbidities and with a single pregnancy and natural childbirth eight years ago, was diagnosed initially with poorly differentiated pleomorphic leiomyosarcoma on the hemostatic uterine curettage. Conclusion: Our case highlights that ETT presents a diagnostic challenge due to its rarity and histologic resemblance to other pathologies. Misdiagnosis delays effective treatment and affects survival. To date, only 8 cases of ETT of the uterus without previous gestational event and normal human chorionic gonadotropin (β-HCG) levels in a 60-year literature survey have been reported.