Today we publish the first part of an extensive interview we have conducted with Dr. Emilio Santos, which we have previously announced. Although we have taken longer than desired to finish it, I am sure that the result, because it is thorough and explanatory, will make the wait worthwhile.
To the Doctor Emilio Santos I have known him for years, as we have met for various circumstances in meetings on issues of pregnancy and childbirth. For several years he has focused his practical and theoretical work towards respected labor and without necessary medicalization. He currently directs the Warp Center in Madrid and attends deliveries at home and at the Acuario Hospital. In addition to gynecologist is a psychiatrist and physicist.
I have always found a man of great intelligence and sensitivity, interested in the emotional part of the pregnancy and childbirth, but also a rigorous scientist who makes his decisions based on verifiable data. The interview I have done, of which we publish the first part today, has reinforced this previous impression.
What led you to Obstetrics after studying Physics and then Psychiatry? I always had obstetrics in mind because I have been convinced for many years of the idea that the birth of human beings must be close to how Nature has anticipated. This conviction was always at the base of my motivation to do Medicine, and what I learned those years reinforced my initial idea. I was always passionate about curiosity about the human body, but I began my training studying Physics, because I was convinced that the doctor and health are over-resorted, which nullifies the individual's confidence in his body and also interferes with many healing processes; I thought and I think that medicine is good in concrete situations, but not in most of the situations in which it is used; I didn't want to be one more piece of this system. The choice of physical sciences had to do with my enormous scientific curiosity. I wanted to know about the origin of things, big and small.
What are the risks of induction?
The first risk of induction is obvious, when labor is induced it ceases to be a natural process in which the body acts by its own mechanisms and its wisdom; When it is induced it intervenes in the natural process and childbirth is medicalized. In all inductions, the proximity of an operating room and special surveillance are required. The parturient becomes a patient.
When should it be induced? Scientific research will be the one that will show us more clearly in the coming years when it should be induced and when not. Today, scientists, we think there are cases in which it is necessary, but they are very clear and few. For example, a clear cause of induction is a baby who is taking little weight inside the uterus and that this circumstance is due to placental insufficiency. I must clarify that inducing simply by poor intrauterine growth is no reason to induce if placental insufficiency is not previously confirmed by an echodoppler. Well, when the baby is smaller than expected in the measurements it is usually due to two reasons, or an error in the dates of pregnancy or an erroneous ultrasound measurement, so the confirmation of placental insufficiency is essential to confirm that the induction is accurate. The most frequent cause is post-term induction, which must be done after 41 and a half weeks or 42 weeks. The evidence indicates that it is reasonable to induce in these cases, although if the mother, in good conditions, decides to wait for the delivery to be naturally triggered, it is also possible, offering all the safe and truthful information to the pregnant woman. The second most common cause is the bag break induction if labor is not triggered in a short time, since there is a risk of infection. But keep in mind that in these cases the most possible route of infection is vaginal examinations. Therefore, in case of a ruptured bag, I do not perform vaginal examinations to avoid infections and wait up to four days for the delivery to begin on its own before resorting to induction. I have copied this protocol from the one used at King's College Hospital in London.
What percentage of inductions did you program last year in the deliveries you attended?
7 percent.
Is there an excess of inductions in Spain? The highest percentage of avoidable inductions arise in private medicine for a time convenience of the professional or the mother
Can a woman be sure that an induction is necessary? Women should know that inductions should only be performed in case of real medical necessity and that these cases really are few. A woman must be informed and receive from the professional who attends to her all the certain information about the risks of waiting or the need to induce, so that she can make her decision. As I mentioned before, it is important that you take into account what I have said before about the greater frequency of inductions for non-medical convenience in private medicine.
What dangers and disadvantages does synthetic oxytocin have? In what cases may it be necessary?
The use of synthetic oxytocin in births has been routinely institutionalized in the second half of the twentieth century. This measure was adopted in obstetric practice in the belief that the artificial acceleration of childbirth would decrease the time in which the mother and the child would be in a risky trance. However, today, scientific evidence has shown many data that contradict this belief. First, routine oxytocin does not make the delivery shorter, since a free and natural posture usually tends to become shorter. Second, the synthetic oxytocin itself causes some complications in childbirth and that poses a risk that causes it to be used only when necessary. As I said, Synthetic oxytocin is associated with increased chances of fetal distress, tears in cases of previous caesarean sections or placental abruptions. And third and most important, at the scientific level, evidence begins to be collected that indicates that routine oxytocin could be related to personality alterations in the child or in the adult. Specifically there are strong indications that there is a relationship between the oxytocin epidemic and the autism epidemic. There are studies that have revealed this relationship and it is considered that it is possible that the oxytocin administered to the mother inhibits the baby's production of oxytocin, eventually causing her brain to develop less oxytocic receptors in her brain. The dangers of the use of synthetic oxytocin should be taken into account in all cases and value one by one if the risk assumed can be offset by the benefits of its use, and perform inductions when they are really necessary.
When should a caesarean section be scheduled? The truth is very rare cases in which you have to schedule a C-section. For example, a caesarean section is scheduled in many centers in case the baby comes from the buttocks, but I consider that you always have to wait for the woman to naturally give birth, and only then do the caesarean section if it has been decided this option, but it is not necessary to program them. For example, it is necessary to program when it is a monoamotic twin pregnancy, that is, twins who share a single aminotic bag. But that case is a minority. In many cases, cases in which a scheduled caesarean section is performed, in reality, one could wait for the woman to have labor contractions; It is more physiological; it means respecting the biological moment in which the baby has given is the starting gun; respect the rhythms of the baby's body and the mother's body; concreting more: it is to respect that the baby's hormonal system generates the cortisol that it needs to have the lungs ready, it is to respect that the mother's body is really prepared for breastfeeding. In short, it means moving away less from the normal birth process, transforming it less.
How many caesarean sections have you programmed in your career?
A. It is true that I play with advantage; In general, to my consultation, women who have a marked inclination towards minimal medical intervention usually attend. In this case it was a delivery after a previous caesarean section and the woman came to my office with the very clear idea: I wanted a caesarean section and I wanted it scheduled. I informed her, as is my obligation, about the possibility of vaginal delivery after caesarean section, and about the possibility of waiting to perform the caesarean section when she began labor contractions; but she was very clear about her choice. I should not overwhelm with arguments in favor of an option no matter how much I consider it better. The woman's decision is above that of the doctor.
We have talked about synthetic oxytocin, inductions and programmed caesarean sections. In the second part of the interview with doctor Emilio Santos, which we hope to offer shortly, we will address issues such as the effect of natural oxytocin on the baby and the mother, cephalopelvic disproportion, orgasmic delivery and other aspects of birth as a natural process as well as the complications that make medical intervention necessary.
