“Giving birth endlessly is wrong”: a gynecologist told how to defeat abortion without banning it

Our conversation with the Honored Doctor of Russia, obstetrician-gynecologist and gynecologist-surgeon of the City Clinical Hospital named after. Yudin, author of many scientific works, Ph.D. Natalya IVANOVA.

— Natalya Vladimirovna, I can’t help but start with a “hot” topic. Recently, Chairman of the Federation Council Valentina Matvienko spoke out on the topic of abortion. She said that if they were banned, criminal abortions would begin, from which young women would die.

— Valentina Matvienko is a wise woman. I am anti-abortion. But it is possible and necessary to reduce their number by creating conditions for increasing the birth rate (legislatively and financially supporting pregnant women and young mothers). Bans won’t solve anything. There are countries where abortion is prohibited, so what? Women from there travel to neighboring countries and have abortions there. This is the best case scenario. At worst, women mutilate themselves with the help of representatives of underground criminal medicine.

— Surely in your practice you have encountered the consequences of “underground” abortions?

— I came across it, alas. And one story from my practice still haunts me. This happened in one of the districts of the Tambov region, where I, working as a doctor, received expectant mothers. One day, a forensic expert approached me, and the following dialogue took place between us.

“Natalya Vladimirovna, do all pregnant women come to you? Has anyone gone missing? “Nobody. And what happened?”

“Criminal case. Body found.”

“Pregnant?”

“Yes”.

“What happened to her?!”

“Drowned woman. In general, please come. Suddenly you recognize her.”

I came and saw this unfortunate woman. It was summer. I remember noticing that she was wearing dirty underwear. It turned out that she was taken out of the river.

-Did she drown herself?

– No. The woman, as it turned out, had a drinking husband. And at the same time, either three or four children were already growing up. And then she became pregnant again. She didn’t want to give birth anymore, and so she agreed with a midwife who lived not far from the river that she would help her get rid of the child. I bought a bottle of vodka and went to see her in the evening. And then it was like this. Together with the midwife and her husband we shared a bottle. After this, the pregnant woman lay down on a regular kitchen table, and the midwife injected her with a soap solution using a syringe. And this woman’s cervix is ​​open (after so many births), the solution immediately entered the vascular bed. A thromboembolism occurred and she lost consciousness. The drunken couple tried to resuscitate her, but were unable to. Then they, frightened, loaded the poor fellow onto a wheelbarrow, took him to the river and drowned him.

– What a terrible story. How many women who come to you for an abortion can you dissuade?

— I don’t keep such statistics, but there are a lot. In general, in such cases I try to use all my eloquence, all my experience to convince. And I am so happy when I succeed! Every life saved is priceless.

– And how do you persuade?

— Gynecologists haven’t come up with anything new here. We talk about the consequences. During a woman’s first pregnancy, this may be easier to do because she may be afraid of possible subsequent infertility. And in any case, I say that he, the child, is alive, he has a soul. To do this, I show on an ultrasound how the fetus’s arms and legs move and the heart beats.

Even when a woman has made a decision and taken tests for surgery, the chances remain. And if you manage to dissuade it, then this is not only thanks to gynecologists, but also to psychologists. We now have a protocol that provides for a “week of silence” for women who come for an abortion (during this period they must go to a psychologist who works at antenatal clinics). I believe that every life saved will definitely count for all of us.

FROM THE MK DOSSIER:

According to the order of the Ministry of Health No. 216n, if the pregnancy is less than 11 weeks, then it is prohibited to have an abortion within seven days from the date of admission to a medical institution. If the pregnancy is more than 11 weeks, the woman will be given 48 hours to think it over. During this period, she visits a psychologist and undergoes an ultrasound, during which she is shown an image of the embryo and its heartbeat.

— Deputies now often call for modern women to give birth a lot and often. Still, how much does this affect women’s health today?

— In my opinion, initially every woman has her own resource. The functional characteristics of the ovaries or the genetic ability to reproduce are different for everyone. There are indirect possibilities to determine this – for example, by the level of the so-called anti-Mullerian hormone. And if it is less than one, then compulsory medical insurance specialists do not undertake to help the woman. That is, age is not an obstacle, but low hormone levels are.

Therefore, it is probably wrong to say that everyone should give birth endlessly. Someone gets pregnant quickly, carries it to term perfectly, and gives birth safely. For some people, everything is not at all easy. But it is clear that the sooner a woman gives birth, the better. Now many come at the age of 35-37, deciding to give birth. Before that, they received a specialty, made a career, and earned money for housing. And they didn’t think that there was a decrease in reproductive function and the ability to conceive. IVF is expensive and difficult. And of course, it is definitely easier for the state and society to create conditions for young people (subsidies, housing, scholarships) so that they can give birth.

— Some women are afraid of the consequences of childbirth for their bodies. How much can free medicine help them recover today?

“Pregnancy and childbirth don’t spoil a woman—they even make her beautiful.” But there must be some kind of reasonable limit in everything. If a woman has, say, a heart defect or cancer, then a special approach is required. Today, such patients become pregnant and give birth. Modern medicine allows us to help such women at any stage. And it also allows you to bring your body back to normal and recover after childbirth.

The vagina of a woman who has given birth and one who has not given birth is fundamentally different. Here (shows photo) it is from a woman who gave birth to two children. She gave birth to a large first fetus, which led to ruptures and prolapse of the vaginal walls and rectal wall. A woman, of course, is sexually active, but does not experience any pleasure from it. Her muscles were torn and her vagina became wide. That’s why she came to us so that we could make her a normal vagina.

— Now can this be done under compulsory medical insurance?

– Yes, free of charge, in a state hospital. And also operations to treat urinary incontinence, prolapse of the walls of the vagina and uterus… In total, only one doctor performs more than 100 such operations a year (how many such operators are there in the country?). Other cases, such as labiaplasty, are considered individually. If this is regarded as a disease (hypertrophy of the labia minora, for example), then also according to compulsory medical insurance.

Look at the pictures (shows). These are severe cases when the bladder, or the uterus in general, prolapses, when vaginal erosions form. And with this the poor woman walks. But doctors today are able to restore all this. It’s not always easy, there are relapses. A lot depends on the quality of the first operation performed and the correct choice of surgical approach and the qualifications of the surgeon. When they have operated once and everything falls out again, they come to the doctors. Then these women are offered another operation – mesh implants are installed, which make up for the lost fascial support of the woman’s genital organs.

The etiology of prolapse and prolapse is multifaceted. Childbirth comes first, especially with a large fetus, but at the heart of everything there is a certain genetic problem. We are all made up of muscles, fat, skin and fascia, which holds everything together, including the uterus. In some women, these fascial tissues have a certain weakness and sag because the fascial tissue has defective collagen.

—- Is it true that there are more Russian women with delicate problems? And what is the reason?

— There are more patients, that’s true. Previously, they simply did not apply because they thought no one would help them. When there were no operations to eliminate incontinence in women, there were few requests. Now this operation has been put on stream, special devices have appeared to eliminate this problem, and qualified surgeons have appeared. People undergo surgical treatment to improve their quality of life. Same thing with omission. As soon as a person appears who knows how to do this, who operates on it, a queue forms.

There are just a lot of operations, and in general, there are certain reserves in the compulsory medical insurance fund. But this is all done for free. Do you know what has increased? There are more patients who want to improve their sexual health. Women began to love themselves more, they began to pay more attention to themselves. The population is becoming more informed, women are becoming more socialized and aware of their sexual attractiveness. Aspects of sexual life, I can’t say that they come to the fore, but in any case, they become significant. In general, attitudes towards women’s health have improved in recent years.

And you see, you have to go through anesthesia, surgery, discomfort in the postoperative period, and all of this has certain risks. But nevertheless, people who have problems come and have surgery with pleasure. And families fall apart when problems are ignored. I noticed that in fact, a woman’s sexual health largely depends on her partner. There are times when a woman feels comfortable, but is ready to undergo surgery because her partner is not happy with something. “I don’t want my family to break up,” the women argue.

By the way, a lot of patients are operated on from the Lugansk and Donetsk regions. It’s not that it’s on purpose, they just have the opportunity to get medical care here, and they seek it. So this is all in great demand.

— Are there more women with initially congenital pathologies?

— Congenital pathology is a separate topic. Uterine malformations are not a common pathology, approximately 1-2 percent. There is a duplication of the uterus, or an intrauterine septum, there is a rudimentary horn, a whole list on two pages of these classifications. This is due to the fact that, in general, the female genital organs of the fetus initially develop in utero and at some stage a genetic failure occurs in the formation of the uterus and vagina. Sometimes it happens, rarely, but it happens, two vaginas, two cervixes, two uteruses are formed, completely separately located. Sometimes there is a vaginal septum, but there is only one cervix and one uterus – this also happens. There are a variety of options, but most often what we work with is the intrauterine septum. The uterus is the organ that is supposed to carry a pregnancy. But the septum located in the uterus does not allow a normal pregnancy to be carried out. In a woman, the pregnancy stops developing, the embryo dies in the early stages, or a miscarriage may occur before the fetus reaches viability. Removing the intrauterine septum avoids these complications and gives the woman the opportunity to carry the child to term.

There is a special tool – a hysteroresectoscope, with which you can remove this septum inside the uterus. After this operation, a woman can carry out a normal pregnancy and give birth to a healthy child.

In general, there are all the tools to help a woman. And it is important to treat her with love. Because if you don’t love your patients, you won’t be able to overcome the difficulties of the profession and become a good doctor.