Even if you've heard that you are nearsighted, you will have a caesarean section instead of a natural childbirth, today it is known that it is not true. We talk to Dr. Paweł Kubik about eye diseases that are an indication for a caesarean.
Should a pregnant woman with a visual impairment tell her gynecologist about it?
- Definitely yes. She should tell you about it at the very beginning ofpregnancy , as well as about any chronic disease. By the way, it is the doctor's duty to ask the patient about all illnesses.
Can visual impairment somehow affect my pregnancy or vice versa?
- Ophthalmic diseases do not affect the course of pregnancy. Also, the course of pregnancy does not affect the development of eye diseases. Although intraocular pressure disorders and choroidal hyperemia may occur during delivery, it does not lead to the progression of retinal changes. However, in the case of some eye diseases, the way of terminating the pregnancy is to be considered. Certain eye problems are an indication forcaesarean section .
According to an expertPaweł Kubik, MD, PhD, specialist in obstetrician gynecology, Institute of Mother and Child in WarsawExactly. This is perhaps the most controversial issue. Pregnant women hear contradictory opinions from doctors, e.g. one claims that myopia of minus 7 diopters is an indication for caesarean section, and another that even minus 12 does not exclude physiological delivery. Who is right?
- According to the recommendations of the Polish Gynecological Society, indications for cesarean section are only degenerative changes in the retina - advanced retinopathies and retinal detachment. The number of diopters has nothing to do with it, becausemyopia- regardless of the stage of advancement - is not an indication for an operative delivery at all. Childbirth does not worsen the sight defect, in this case myopia.
So why these contradictory opinions of doctors?
- The old way of thinking still lingers here and there. Several years ago, there was a belief that myopia was an indication for incision, because during partych contractions, the sight defect may worsen. However, nothis was confirmed by research. And doctors rely on research, not what you think it is. It was already explained about 10 years ago and it should not be controversial today.
Women sometimes hear that they can give birth normally but are told to avoid exertion. So they ask: visual delivery does not hurt, and much weaker effort - right?
- It is difficult for me to respond to specific recommendations without knowing the patient's situation. Lifting heavy objects is not recommended in every pregnancy. I can only repeat that neither myopia nor hyperopia is an indication for a caesarean section.
Who does the decision about the type of delivery belong to?
- The obstetrician always decides about the type of delivery. But when making a decision, it is obviously based on the opinion of an ophthalmologist.
Should this opinion be in writing?
- It would be best if it were. In such an ophthalmological consultation, the patient's situation should be described and the reasons for which a caesarean section is indicated should be listed. Some ophthalmologists actually suggest a cesarean section based on the fact that the patient has myopia. But there are fewer and fewer of them. Ophthalmologists usually already know what the indication can be and their opinions are substantive. It is worth mentioning that even if there is a risk of retinal detachment, childbirth is possible. If a woman wants to give birth to a child naturally, she can undergo a laser photocoagulation procedure, which effectively protects the retina against possible detachment. That is why it is very important that the patient informs the gynecologist about ophthalmic diseases early enough, that there is time for examinations and consultations, and possibly also a procedure that will enable a normal delivery.
So when should eye examinations be performed?
- It's best to do them once at the beginning of pregnancy and repeat them after the 30th week. Then they will be the most reliable.
It happens that a woman has the opinion of an ophthalmologist that physiological delivery is risky and surgery is indicated, and the obstetrician questions this. Then what?
- If the obstetrician clearly disagrees with the ophthalmologist's opinion, it is probably because the ophthalmologist does not provide actual indications. It is indeed an awkward and difficult situation. When deciding on the type of delivery, we must obtain the patient's approval. In such a situation, I always talk to the patient then, I present all the facts to convince her that insisting on the operation is unjustified and its performance would not result from medical indications. But the will cannot be ignoredpatient when she stays with her opinion. In addition, the obstetrician is sometimes afraid, to put it bluntly, about the consequences of possible lawsuits, because in the event of any deterioration of eyesight, the patient may accuse him of not performing the cesarean section, although there were ophthalmological indications. Therefore, she finally agrees to a cesarean section. Obstetricians tend to be distrustful because ophthalmic indications are overused to justify de facto on-demand cesarean sections. However, women with real retinal problems shouldn't be afraid of anything - no responsible obstetrician will act against the opinion of an ophthalmologist.
Sometimes the ophthalmologist recommends not a caesarean section, but a shortening of the second stage of labor. What can a woman with such an indication expect?
- Shortening the second phase of labor is to eliminate the pressure of the mother in labor. This is to reduce the risk of retinal congestion that can occur with prolonged stress. In practice, the termination of labor is then performed with the use of an obstetric vacuum pump or forceps.
And a procedure that involves mechanically pushing the baby out of the abdomen?
- You are talking about Kristeller's treatment. Currently, it is no longer used, or at least should not be used. Stuffing a baby by kneading or pressing on the mother's belly is a traumatic method abandoned by modern obstetrics. There are other, safer ways, so women advised to shorten the pressure phase shouldn't worry about anything.
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