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At the base of everything Ms Valeria in a calm but firm and documented complaint is an obstetric procedure called pharmacological induction of childbirth.
I obviously do not want to get into the technical as not only would it be boring to non-experts but above all because it has been a subject of scientific research and discussion for many years and subject to continuous adaptations and updates.
Basically, the problem concerns situations in which the continuation of pregnancy involves an increasing risk to the health of the mother and fetus and therefore being able to anticipate the birth contributes to improving the outcome of the pregnancy.
These are situations in which in the past it was not possible to do anything and which contributed to the appalling maternal and neonatal mortality.
Regardless of how much scientific research has made in this area, the induction of labor still presents critical issues and aspects that still need to be better defined.
This does not mean that this procedure, even with its limitations, has nevertheless proved effective in improving maternal-fetal outcomes.
In the case of Laura, Valeria’s daughter, the pregnancy had passed the term for several days and in these cases the placenta begins to age and is unable to support the metabolism of the now increasingly large fetus. Amniotic fluid is reduced and fetal distress can progressively develop up to intrauterine death.
All clinical studies done to date have shown that in these cases the artificial induction of labor is advantageous.
Since we are all different, from each other, we also respond differently to medical procedures and in Laura’s case, unlike her roommate who gave birth in 4 hours, things can go differently.
Why is it better to try everything possible for a vaginal birth rather than a caesarean section?
Also for these questions, medical research and epidemiological studies have given an answer based on hundreds of researches whose results are published daily in medical journals.
In recent years, researchers have finally managed to understand the microbiological basis that cause a difference in the development of the immune system in subjects born by vaginal birth compared to those born by cesarean, showing that passage through the vaginal canal favors the colonization of the newborn by of “good” bacteria and consequently a better production of antibodies. All the data from the world literature show that vaginal birth, when there are no particular situations, is certainly preferable to cesarean section for mothers and babies.
The WHO states that the percentage of Caesarean sections really necessary should not exceed 15%, while in Italy we are at 36%.
It is precisely in the interest of mother and child that the most responsible and prepared obstetrician staff try to contain the rate of caesarean sections, although this, as the letter I am reading shows, does not always correspond to the wishes of the relatives present at the birth scene. or those of the woman herself.
No doctor is humanly capable of keeping up to date in a world where scientific research produces material at a dizzying and sometimes contradictory or in any case not definitive pace. For this reason, government bodies and medical associations try to take stock of the state of the art by summarizing and schematizing the results of the research in the so-called Guidelines which then become protocols and algorithms of practical use that will guide the work of individual operators and medical teams. .
Even the recent Italian law on medical liability known as the Gelli law establishes that serious negligence in the event of a negative outcome of a medical intervention is attributable to the professional if he did not follow the guidelines and this resulted in damage to the patient.
However, the same law recalls that it is possible to derogate from the guidelines as long as there is a documented and proven reason that induces the doctor not to respect them in that specific and particular case.
And this is what Mrs. Valeria reproaches the colleagues who followed the birth of her daughter Laura. Being too tied to the guidelines as in fact has happened correctly.
There was therefore a conflict between correct professional procedure and the experience of the subjects concerned, that is, of mother and daughter in labor.
These are very difficult situations to manage that sometimes put a strain on the resilience of the assistance staff in tiring conflict between adherence to the rules of good medical practice on the one hand and respect for the will of the patient and his carers.
Although from a jurisprudential point of view no relative, not even at first degree, can decide on a medical procedure for a person capable of understanding and wanting and therefore the request of Laura’s mother to perform a caesarean section could not be accepted, it is evident that in situations with this particular load and emotional connotation everything is subverted.
On the one hand the doctor and the midwife want to behave in the most correct way from a technical point of view, on the other hand the mother of the woman and the woman herself, with full rights, may not be able for various reasons to accept validated medical procedures.
Let’s think of how many people are convinced in absolute good faith that vaccines are harmful despite the fact that the history of humanity, not just science, has demonstrated without a doubt their effectiveness in saving millions of lives. Our task is not to condemn or, worse still, despise them, but to understand their wrong motivations and try to change their opinion.
Probably better coverage of pain by anticipating more effective forms of analgesia and more structured communication would not have had this outcome.
What is certainly to be condemned is the comment of the nurse who brought the baby to Laura, with whom it is declared that the caesarean section was necessary because the baby had two turns of the rope around her neck.
As is known, the funicular turns are present in many births without causing problems and are certainly not the cause of induction failure.
For many years we have worked hard as an AOGOI association to raise the professional level of our staff to achieve and exceed the results in the field of maternal and neonatal mortality and morbidity obtained in countries such as Sweden and Japan but Ms Valeria reminded us that much we still have to do in the area of communication and pain management in labor.
A final reason for regret and surprise is that all this took place in an exclusively female environment, no male operator was present. It is therefore likely that the gender of the operators present in the delivery room is not as decisive as one would think.
The observations contained in Ms. Valeria’s letter are a valuable contribution and a stimulus to improve even more birth assistance in our country.