The delivery date is getting closer, looking at the increasingly “magnificent” belly, feeling the regular fetal movement, and looking at the vague but extremely cute little guy in the B-ultrasound list, my heart is getting more and more anxious:
How to welcome this new life? In what way to bring him/her to this new world? Will I be able to give birth naturally? Are there any risks to me and my baby during pregnancy?
This hospital has a high rate of natural births
Is natural birth also my best option?
As a 35-year-old quasi-advanced mother with the first child, neither I nor my teammates or elders have any experience in the choice of natural delivery or cesarean section. The understanding of the advantages of different delivery methods comes from the theoretical courses of the Maternal and Child Health Hospital. , the sharing of mothers in the APP, and the long-term memories of colleagues, friends and other “passers-by”.
The district-level maternity and child health care hospital where I work has almost the same reputation as the Red House Hospital in Shanghai. The hospital strictly controls the indications for cesarean section. Except for factors that are medically unsuitable for natural childbirth (such as malposition, fetal distress, placental abruption, etc.), all other natural childbirth methods are adopted, and the rate of natural childbirth ranks among the top. Mao, therefore, is dubbed by the mothers as a “natural birth cult”, and can be said to be a proper honest girl.
Naturally, the benefits of natural delivery need not be repeated, but every mother’s experience is completely different. Some gave birth to a baby with a perfect score, and some went to the “ghost gate” for a while. I want to give birth naturally, but is it the best choice for me? For the sake of demonstration, at the 36th week of pregnancy, I started to walk in different hospital departments to solve the problem.
I want to give birth
But there are three swords of Damocles hanging over his head
Compared with the various situations that some mothers-to-be have, my entire pregnancy was relatively stable, with no emergencies or serious pregnancy reactions, but there have always been three swords of Damocles hanging over my head, which made me I was trembling, not knowing what to do.
The first sword was multiple uterine fibroids, which were discovered during the pre-pregnancy physical examination, and the largest one was 3.5cm at that time. With the increase of estrogen and blood supply during pregnancy, uterine fibroids also grow wildly with the growth of the baby, reaching nearly 6cm at one time. I asked the doctor at the Maternal and Child Health Hospital whether they would compete with the baby for space, and whether it would affect the normal delivery. The doctor said that fortunately, the location of the uterine fibroids is relatively remote, not on the “birth route”, and the late B-ultrasound is also difficult. If the photo is not available, it will not have much impact on the baby’s development and production. I also got the same answer in another tertiary hospital, which is a factor that is not conducive to normal delivery.
The second sword is that the baby’s head circumference is too large. During my pregnancy, I always felt that the home-cooked meals were not tasty enough. I had a soft spot for “junk food” such as burgers and pizza. My weight control was poor. At the 36th week of pregnancy, the baby’s biparietal diameter reached 95mm, which belongs to the large head circumference. After that, I carefully controlled my food intake every day, secretly praying that the baby would grow up slowly. The doctor at the Maternal and Child Health Hospital asked me to strictly control my weight in the late pregnancy, and said that it is unknown how much the baby’s head circumference will increase during delivery. Comprehensive judgment, there are many precedents for natural delivery of babies with a biparietal diameter of 100mm, and you only need to trust the doctor at that time. This uncertainty factor passes.
The third sword is ultra-high myopia. For a long time, I have myopia and astigmatism of more than 1200 degrees. During the annual physical examination, the doctor will specifically instruct me not to exercise vigorously or lift heavy objects, because the risk of retinal detachment is several times higher for people with ultra-high myopia than for ordinary people . As for the first child and normal delivery, it is necessary to use the force of breastfeeding to help the baby deliver, can my eyes bear it? This time, the Maternal and Child Health Hospital could not give any advice, because as a specialized hospital, ophthalmology is not within the scope of business, and high myopia is not a strong indication for natural childbirth. The obstetrician suggested that I consult an ophthalmologist.
My ultra-thick lenses丨Photo courtesy of the author
The degree of myopia exceeds 1000 degrees丨Photo courtesy of the author
Chief Physician of 10 tertiary hospitals
Opinion is divided into three factions
At first, considering the distance, I called the deputy director of ophthalmology at a nearby general hospital that had just been promoted to the top three. After listening to my narrative and concerns, the doctor ordered a series of fundus examinations, one of which was written in an ultrasound report: a small amount of punctate echoes can be seen in the vitreous, accompanied by continuous thin band echoes, and the posterior movement is obvious, the vitreous body of both eyes Opacity with subsequent detachment possible.
Ultrasound examination results丨Photo courtesy of the author
Results of scanning laser fundus examination丨Photo courtesy of the author
Looking at the extremely awkward terminology on the report, I don’t feel very good. The female doctor took my report and said while typing the medical records, “ Ultra-high myopia and natural delivery are indeed very risky. I advise you to give birth by cesarean section . In fact, the method of delivery is not that important. Why do women make things difficult for themselves? You say right?”
Seeing “Natural childbirth is not recommended” written in black and white on the medical record, I felt mixed feelings in my heart. On the one hand, with this diagnosis, the Maternal and Child Health Hospital could not “persevere” in giving me a normal delivery. On the other hand, my myopia has become so severe! I was a little unwilling in my heart. Is it true that high myopia cannot give birth?
I still want to listen to the suggestions of several doctors and make a comprehensive judgment. I just heard from a colleague that she was consulting an online consultation APP, where doctors from all over the country gathered, and the reply was very fast. With a thought in my heart, I immediately downloaded and registered, and consulted 10 chief physicians from tertiary hospitals across the country through “Ask more questions about one disease”.
After describing the doubt of “whether ultra-high myopia can be delivered normally” and attaching my previous checklist, within an hour, my mobile phone beeped non-stop, and many chief physicians responded online own opinion.
The opinions are mainly divided into three factions: one is the agreeing faction . This faction analyzed the data in the report and believed that the report showed that the condition of the fundus was acceptable, there was no degeneration and hole around the retina, and the childbirth could be normal. The second is the faction with reservations. It is believed that cesarean section is safer , and natural delivery may induce retinal detachment or fundus hemorrhage due to force. The third is to let myself weigh the pie . I think it is still necessary to consider factors such as maternal condition and fetal size before making a decision.
A chief doctor also sent a “soul torture” in the reply: “Why ask the ophthalmologist? How to give birth to the obstetrician, right? And the patient’s own wishes.”
In general, in the results of the online consultation, 70% agree, and 30% have reservations and let me weigh. It will exist, but the fact that ultra-high myopia is not absolutely impossible to give birth gives me some comfort.
Responses from online consultation doctors丨Photo courtesy of the author
Midwives are waiting
I successfully brought the baby into this world
At the 38th week of pregnancy, it was the last moment to choose the mode of delivery. If I choose a cesarean section, I will make an appointment with the doctor and time immediately.
In order to make a final decision, I went to the most authoritative ENT hospital in ophthalmology. The doctor who received the consultation was also a female doctor. After listening to my statement, she ordered a series of examinations. After reading the results, she said: Judging from the inspection report, the condition of the fundus is acceptable, and no retinal breaks have been found. Although there are certain risks, the delivery can be done smoothly!
Every word that came out of her mouth was like music, and this good news means I can choose how I bring my baby into this world.
Before production丨Photo courtesy of the author
At 41 weeks of pregnancy, my stomach still hadn’t moved. The doctor immediately forced me to “unload the cargo” and help me to give birth by artificially breaking the water.
When I was pushed into the delivery room, I immediately informed the doctor of my high myopia, and the midwife stood by and instructed me step by step how to exert force accurately . After more than an hour of long delivery, the baby I had been looking forward to for 10 months was born, and I was finally officially promoted to an old mother!
The baby came to this world丨Photo courtesy of the author
I think there are doubts and unease during pregnancy, but in general, you have to trust the doctor, listen to different opinions, and then weigh your own decisions. No matter which way you use to bring your baby into the world, you don’t have to regret it.
doctor review
Yu Xin | Attending Physician of Shanxi Eye Hospital
According to literature reports, only 5% of pregnant women fully understand that high myopia can cause complications during natural childbirth [1] . I am very pleased that this mother knew the dangers of high myopia during pregnancy and consulted a regular professional ophthalmologist. Although she struggled for a long time before giving birth, she finally gave birth smoothly and got a happy ending with a safe mother and child.
High myopia is due to the elongation of the front and rear diameter of the eye (that is, the growth of the eye axis) so that the diopter of the eye reaches -6.00DS (myopia 600 degrees) or more, and ultra-high myopia refers to the diopter of the eye reaching -10.00DS (myopia 1000 degrees) or more. The author’s myopia is greater than 1000 degrees, which belongs to ultra-high myopia . If the degree of myopia exceeds 600 degrees, the axial length of the eye is greater than 26.5mm, and the degree of myopia increases year by year with age, pathological myopia should be considered.
Normal eye axis, myopic eye axis, pathological myopic eye axis丨Reference [5]
The retina plays an important role in imaging. If the eye is compared to a camera, the retina is equivalent to the film of an old-fashioned camera. If there is a problem with the film, the photos cannot be displayed clearly.
The Structure of the Eyeball丨Tencent Medical Dictionary
Under normal circumstances, the retina is tightly attached to the wall of the eyeball, allowing external images to be clearly presented on the retina, similar to a mobile phone screen film. When there are holes in the screen film and there is water under it, the film will slowly separate from the screen, and we will not be able to see the phone screen clearly. People with high myopia are prone to this condition, which is retinal detachment.
If the eyeball is compared to a balloon, the process of the excessive growth of the eye axis due to myopia is like the process of the balloon being blown up. The larger the balloon, the thinner and more fragile the balloon wall, and the retina, which is one of the “balloon wall” structures, will be prone to retinal tears due to thinning and degeneration.
People with high myopia often have obvious vitreous liquefaction, and the liquefied vitreous enters under the retina through the hole, resulting in rhegmatogenous retinal detachment, which is similar to the process of “water enters after the mobile phone membrane breaks”. The main symptoms of retinal detachment are flashes of light, floaters, visual field defects and decreased vision.
Retinal Detachment丨Tencent Medical Dictionary
With sudden force, intraocular pressure increases, and the already thin retina is more likely to rupture and squeeze the liquefied vitreous humor under the retina . Therefore, the author will be told by the doctor not to exercise strenuously or lift heavy objects during the annual physical examination.
Theoretically , during childbirth, mothers will adopt different positions and use different degrees of force, which will increase the intraocular pressure to varying degrees at different time points, which may cause retinal tears and retinal detachment. In addition, in patients with high myopia, the retina and choroid undergo degenerative changes, and new blood vessels are prone to appear. Increased intraocular pressure will also cause new blood vessels to rupture easily, causing fundus hemorrhage.
However, the current research does not have direct evidence to prove that fundus complications will occur in highly myopic mothers during natural childbirth [2-3]. Even if there are reports in the literature that fundus hemorrhage occurred immediately after natural childbirth in highly myopic women, it cannot be ruled out that this is the natural progression of high myopia [4] .
High myopia, especially the pathological changes of the fundus of pathological myopia, progresses with age. Therefore, highly myopic mothers-to-be should go to a professional ophthalmology institution for detailed fundus examinations before pregnancy. If there are problems, they should be dealt with in time before pregnancy, and regularly follow the doctor’s instructions to check the fundus during pregnancy , so that they can be prepared. Fundus examination before pregnancy is also suitable for expectant mothers who suffer from systemic diseases (diabetes, high blood pressure, etc.).
High myopia is not an absolute contraindication to natural childbirth . When the childbirth is approaching, if the doctor judges that the physical conditions permit and combine with your own wishes, you can actively prepare for natural childbirth, but before the natural childbirth, as the author said, you should inform the doctor and midwife that you have high myopia . In this way, during the delivery process, the puerpera can be timely and timely instructed to hold her breath correctly and exert force, so as to avoid excessive use of brute force, so as to end the delivery as soon as possible.
Of course, in the process of natural childbirth, if the mother has physical discomfort or eye discomfort, the natural childbirth can be terminated immediately and a cesarean section operation can be performed instead.
references
[1] Li Fang. Investigation of 120 cases of high myopia puerpera with natural childbirth and analysis of influencing factors [J]. Special Health, 2017, (23): 240.
[2] A Katsulov, M Iankov, Zh Koleva, I Grŭncharov; [Myopia and childbirth]. Akusherstvo i ginkologiia 2003;42 Suppl 2:7-9.
[3] M Prost; Severe myopia and delivery. Klinika oczna 1996 Feb;98(2):129-30.
[4] Karen Bitton, JL Bacquet, F Amoroso, S Mrejen, M Paques, EH Souied; Immediate post partum macular subretinal bleeding in a highly myopic patient: a case report. BMC ophthalmology 2021 Jan 21;21(1):54.
[5] Wei Wenbin. Controlling ocular axial extension is the key to reducing the risk of blindness in high myopia. Health World, 2022(2):3.
The sharing of personal experience does not constitute a diagnosis and treatment recommendation, and cannot replace the doctor’s individualized judgment on a specific patient. If you need to see a doctor, please go to a regular hospital.
Author: Niuniu Mama
Editor: Zi Yi, Doctor Dai Tian
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