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From unnecessary C-sections to poorly healed C-section scars and depression — many women face stressful interventions and emotional crises around childbirth. What can help
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00:06Before you can enjoy those first magical moments, your baby has to be born, and vaginal birth
00:13is often painful, exhausting, and long.
00:16So why not opt for a C-section?
00:19It's quick, predictable, and easy to schedule, right?
00:23C-section rates are rising worldwide, but when they're not medically necessary, they're
00:28not always best for mother or child.
00:31So what can help slow this trend?
00:33All this and more on In Good Shape.
00:51I always imagined I'd have children one day.
00:55And we've been very lucky.
00:58We've had two healthy kids who are fine, who are doing well.
01:01And they definitely made us think about having another one.
01:05I had a very pleasant early pregnancy, thank God, which has been uneventful up to now.
01:13And now the third birth is just around the corner.
01:16How do you imagine it?
01:19I imagine it will be a peaceful, complication-free birth, or at least that's what I hope.
01:28The current situation is that the baby is breech.
01:32And that is a birthing position that makes things a bit more complicated.
01:38Babies can get pretty acrobatic in the womb during pregnancy.
01:42Most end up with their heads pointed down, an ideal position for both mother and child.
01:47But in about 4% of cases, babies remain head up in what is known as the breech position.
01:54These days, most breech babies are delivered by caesarean section.
02:02The Charité in Berlin, one of the largest university hospitals in Europe.
02:08Jorinde has an appointment in the obstetrics department here today.
02:12She had her first child via c-section, then her second vaginally.
02:17Jorinde says the experiences differed dramatically.
02:20What scares you about having a c-section?
02:25I was open to it.
02:26But I have to say, I was surprised at how much it took out of me.
02:30Even as a young, healthy woman, I had some complications.
02:33And afterwards as well.
02:36So it's really not something I take lightly.
02:41In most cases, vaginal birth is still a possibility with breech babies like Jorinde's.
02:46But many doctors prefer performing a c-section.
02:50In an effort to curb this trend, the WHO has published some guidelines in 2018.
02:55It warned that unnecessary c-sections offer no significant benefit.
03:00On the contrary, there's evidence that due to the risk involved, it may even harm the
03:07woman, the child and future pregnancies.
03:10In the case of a breech baby like Jorinde's, the WHO recommends performing an external cephalic
03:16version, or ECV for short.
03:19It's a procedure in which the baby is manually turned so the head is facing down rather than up.
03:26I'm trying to exhaust all available options to avoid a c-section.
03:30Yeah, my name is Larry Hingsen.
03:33I'm one of the consultant obstetricians working at the Charity University Hospital here in Berlin.
03:39How many babies did you deliver?
03:42I don't keep an exact track of all the babies that I deliver.
03:47But it's quite a lot.
03:49Larry says that over the years, he's watched a rising rate of cesarean sections in Germany
03:54and around the world with concern.
03:57That's why he wanted to provide women who want to have a vaginal birth with another option.
04:01In almost 30 years as an obstetrician, he has performed more than 1,000 ECV procedures.
04:07The breech presentation is only a part of the reasons why there's a rising rate of cesarean sections worldwide.
04:18But it's also one of the areas that we can focus on to try and bring the rates down.
04:24So how do you help patients with breech babies like Jorinde Waide, for example?
04:29When I see them, we basically speak about three things.
04:33One is a natural delivery with breech, the option of having the baby turned,
04:39and then the third option is the cesarean section.
04:44Women from all over the world come to Larry specifically to have their babies turned.
04:48That's because he has developed a special ECV technique that takes advantage of the baby's natural reflexes.
05:05ECV is a process with a low level of risk and a high success rate.
05:10It could provide a safer alternative to C-sections,
05:13especially in countries where poor medical care during labor and delivery is the rule.
05:19The method has been in use for about 2,000 years.
05:22But in the past, women described the medial procedure as very painful and stressful.
05:28And that's not good for either mother or child.
05:33Larry encourages the baby to move without using aggressive force.
05:37He says his gentle approach works in around two out of three cases.
05:57Larry believes that his approach explains the rising success rates he sees.
06:02A gentle approach to ECV can prevent women from eventually having an unwanted cesarean section.
06:08But the likelihood that an emergency C-section, vacuum or forceps delivery might have to be performed
06:16is slightly higher than in deliveries where babies don't need turning.
06:21And Larry admits there are a few contraindications and rare risks associated with ECV as well.
06:27If you're going to do something like a manipulation on the baby, you want to be 100% sure that
06:33it's safe
06:34and that you've had a proper look at all the structures within the pregnancy.
06:39Not only the baby, its position and weight, but also the structures around.
06:44So how much fluid is around, where's the umbilical cord, it's very important.
06:48Because if it's wrapped around the neck several times, it could be difficult to turn
06:53and also be a high risk for stress during the ECV.
06:57Larry says that's exactly what he wants to avoid.
07:01We also met up with another obstetrician.
07:04One who's working to overcome not only the medical obstacles that lead to preventable C-sections.
07:09She also focuses on the structural and social reasons they happen so often.
07:18Not far from Cologne's famous cathedral is the Portsam Rhein Hospital.
07:26Patricia van der Waal has been working on her vision of good obstetrics here for the past 17 years.
07:33Unlike in most German hospitals, obstetrics is a separate department in the Portsam Rhein.
07:39Patricia made this change so that a team of doctors could be available just for the delivery room around the
07:46clock.
07:48She also introduced regular training sessions on how to handle complications.
07:56You can also practice what's called shoulder dystocio,
08:00which means that the baby's head is born but the shoulders are stuck.
08:03Then the baby can't get out.
08:07Patricia thinks many doctors choose to perform caesareans because they have too little experience with vaginal childbirth.
08:17The training helps young doctors in particular get past the fear of complicated births
08:22and keeps them from reaching for the scalpel too quickly.
08:27Everything went well, everything's fine. Then the child can go straight to mama.
08:32There are complications sometimes during labour. Of course you can't deny or negate that.
08:37But there are rarely factors where you say you have to have a caesarean section
08:42because otherwise the birth is too dangerous for the mother or the baby.
08:47Patricia says she's managed to reduce caesarean rates at her clinic by over 100 procedures every year.
08:57Does the way in which you've set up your clinic help solve the problem?
09:03I think it's the beginning of a possible solution.
09:06But ultimately there are a lot of factors, more structural, organisational things,
09:10which will prove much more important.
09:13Patricia admits there are other limitations too.
09:17She thinks the way the media portrays c-sections and how they are perceived in society also play roles.
09:24You're pushed into the OR and everyone is smiling and in a good mood.
09:27Then you're pushed back out with your baby in your arms. Unfortunately it's not like that.
09:33Providing a lot of information, putting perceived risks into perspective and taking the fear out of vaginal birth.
09:41That's how Patricia builds relationships with pregnant women.
09:45Through trust and clinical care but also by having faith in the women themselves.
09:51Even a beautiful birth is accompanied by pain and great physical effort.
09:56I don't want to trivialise it at all. That's how it is.
09:59But a woman can do it. However, women also have to be able to mentally accept that they can do
10:06it.
10:06And if there are complications, we're there to help.
10:11Jorinda's solution was accepting Larry's help.
10:19And it worked.
10:30Just a few weeks later, Jorinda gave birth vaginally without any complications.
10:36This is wonderful. You know, I feel great about it.
10:38But I would feel even more happier if more doctors would try and learn this technique.
10:45We need more staff. We need more specialised doctors so that we can provide adequate care for women.
10:51And I'm really certain that this would allow us to avoid more C-sections.
10:55And above all, women would be more satisfied than they are now.
11:00There's still work to do. But despite limitations, dedicated healthcare professionals like Larry and Patricia continue to look for solutions
11:09for women who want more childbirth options.
11:14A vaginal birth is generally better for babies. It helps clear their lungs and gives their immune systems an early
11:21boost.
11:22For mothers, though, it's not always complication-free.
11:26The pelvic floor is put under intense strain during a vaginal delivery, and that can lead to temporary or sometimes
11:33long-term issues like incontinence.
11:36It's different with a cesarean, but a C-section is major surgery, and recovery takes time.
11:43And even then, there can still be long-term consequences.
11:52Natalie Glaubetz is in pain. After the birth of her fourth child seven years ago, suddenly everything changed.
12:00My bleeding and spotting started to last about 16 days with pain before it started and after it ended.
12:08Pelvic pain with powerful urges to urinate. It just got worse and worse, really unbearable.
12:14Natalie often relied on painkillers just to cope.
12:18She began seeing her gynecologist every month, but the cause of her suffering remained a mystery.
12:26She gave me chasteberry, but everything got worse. I got even more yeast infections.
12:32Then she put me on the pill, and I bled for three weeks straight.
12:36Emotionally, I was very unwell. I cried a lot, and I never knew what was causing it. That scared me.
12:43Her doctors recommended a hysterectomy. Natalie didn't want that, so she started researching on her own.
12:51And she came across a possible diagnosis. Caesarean scar disorder.
12:59More than half of women heal poorly after a C-section, leaving niches and holes in the uterine wall.
13:09I'd never heard of this condition before. I didn't know that something like this could even happen.
13:14No one tells you about it.
13:18Natalie's children were born by C-section, just like 200,000 other babies in Germany every year.
13:25That's almost one in three babies, and that number is rising.
13:31Natalie eventually found a specialist who treats women with caesarean scar disorder.
13:36Gynecologist Angela Koeniger in Regensburg.
13:40Here we can see this very large notch, this niche.
13:43That's what's causing your symptoms and why you've had pain for so many years.
13:48Defective C-section scars were only officially recognized as a medical condition in 2023.
13:54They can cause a range of symptoms.
13:57The main symptoms are painful in prolonged periods.
14:01Sexual intercourse becomes painful.
14:04Women also report increased discharge.
14:07But the main problem is that the women can no longer become pregnant.
14:15Infertility after the first child is known as secondary infertility.
14:19That's what Sarah is experiencing.
14:22She's asked to remain anonymous.
14:24The topic is simply too personal.
14:27For more than two years, she's been trying to conceive again, hoping for another baby.
14:32She's had eight fertility treatments, all of them unsuccessful.
14:38After my C-section, it was hard to even get the catheter into my uterus for the embryo transfer.
14:46It was painful.
14:51For a long time, she blamed herself.
14:55Every time we tried, the pressure grew.
14:58I started wondering what was wrong.
15:00Why was my body not cooperating?
15:02Could it be my diet or maybe not getting enough exercise?
15:06Eventually, Sarah consulted Angela Koeninger.
15:09She quickly found the problem.
15:13The front of the uterus here should look the same as it does here.
15:16But what you see is a gap at the spot where the baby was taken out during the C-section.
15:22Sarah was stunned.
15:24By then, she'd already spent a great deal of money on fertility treatments,
15:28even though she could no longer become pregnant.
15:32That really upsets me.
15:34It's not hard to figure out what's wrong if you know what to look for.
15:38A gynecologist should be able to do that, especially in a fertility clinic.
15:42They're specialists, so why didn't they figure it out?
15:48Angela Koeninger saw her first patients with cesarean scar defects more than 13 years ago.
15:53But why did the problems suddenly start appearing more often?
15:56She began researching the cause.
16:00It's the suturing technique.
16:03Before 2006, surgeons in Germany usually stitched the three layers of the uterus separately during a C-section.
16:10After that, a simpler technique became more common, and all three layers were sutured at once.
16:16The problem is, if we don't suture the uterus in a way that restores it to how it was before,
16:24and instead stitch this highly active, hormone-sensitive tissue into the muscle,
16:29that active tissue becomes trapped.
16:32And with every menstrual cycle, the cells stuck in the uterine wall keep growing.
16:36Over time, they stretch the wall from the inside.
16:44That's why some specialists believe this shift contributes to scar defects,
16:49and say the suturing technique used in C-sections needs to change again.
16:55Today, Natalie Glaubetz is scheduled for surgery to repair her C-section scar.
17:02I'm very nervous, but glad it's happening.
17:04I think it will be better afterwards, no more symptoms or pain.
17:09Körninger has developed a technique to correct the problem.
17:13It begins with a hysteroscopy, using a tiny camera to look inside the uterus.
17:19The endometrium is trapped in the niche like a spot of red mold.
17:23Next comes laparoscopic surgery to detach the adhesions between the uterus and bladder.
17:30Right here, there's an open area in the uterus.
17:34Through another small incision, she removes the affected tissue.
17:41Here's the hole.
17:45The wound is then cleaned.
17:47Finally, the layers of the uterus are stitched back together with tight, even sutures.
17:53The surgery went well, with very little bleeding and no complications.
17:58So we hope the adhesions between the bladder and the uterus won't return.
18:06Natalie Glaubetz is relieved to have the surgery behind her.
18:11I hope it heals quickly, so that I can go home.
18:17I'm really happy, and I feel good.
18:20Sarah also hopes that her dream of a second child may still come true.
18:26Now I know it's not my fault, so I have hope that there's a solution to fix this.
18:33According to one study, about 60% of women who undergo niche surgery are able to become pregnant again.
18:43Many new mothers are under a lot of stress from the very start.
18:48Newborns need constant attention.
18:50They're hungry.
18:51Their pacifier has fallen out.
18:54Or they're too warm.
18:56Real rest for new mothers is hard to come by.
19:00On top of that, they're dealing with major hormonal shifts and sometimes a bout of the baby blues.
19:06And for some, those feelings can deepen into postpartum depression.
19:18I kept thinking I was doing something wrong.
19:21I can't do it.
19:23Can't cope.
19:24All the time.
19:25It became so ingrained that I thought, I'm a terrible mother.
19:29I'm just not cut out for this.
19:34That was several years ago.
19:36Julia Kriegsman had just given birth to her son Luis, right in the middle of the Covid-19 pandemic.
19:43She and her husband were thrilled about the baby.
19:46But suddenly, everything changed.
19:51I couldn't make sense of it.
19:53I'd be standing at the changing table and suddenly burst into tears, thinking, what am I even doing?
19:59It felt like I'd lost control.
20:01I couldn't even take a 10-minute shower without everything falling apart.
20:08Julia could barely sleep and was hardly eating.
20:12Before the baby, she'd worked full-time.
20:16Afterward, she felt completely overwhelmed.
20:19She didn't realize anything was wrong, but after weeks of this, her midwife and a friend urged her to get
20:26help.
20:27Julia was suffering from postpartum depression.
20:34Before the baby, I had big plans. I wanted to be a relaxed, happy mom.
20:39All the things you hoped for.
20:43Having a therapist to support me, that helped a lot, of course.
20:48I didn't feel so alone, so lost anymore.
20:55Sarah Stuckrat had a similar experience when her son was born.
20:59Instead of feeling joyful, she was overwhelmed by stress and anxiety.
21:04Within a few months, she was so distressed that she checked herself into a psychiatric clinic.
21:13Leaving my baby was incredibly hard.
21:18I never would have done it if I had another choice.
21:23But I had no strength left.
21:25I was stuck.
21:28And I couldn't see any way that things would get better.
21:34Postpartum depression affects nearly one in five mothers.
21:38It can be triggered by hormonal changes, the huge shift that comes with a newborn, or by perfectionism.
21:46Unlike the baby blues, which many mothers experience, postpartum depression can linger and often brings intense feelings of guilt and
21:55shame.
22:00It's very important to seek medical advice and get treatment.
22:05Depression, including postpartum depression, can improve on its own.
22:11But up to 30% of cases become chronic.
22:16Postpartum depression was once a taboo topic.
22:19Now, interdisciplinary support networks across Germany offer help to women, partners and families, from pregnancy through the baby's first year.
22:29At this Frankfurt day clinic, mothers and fathers receive specialized therapies.
22:34Treating the mother is crucial for the child's development.
22:38We know that if depression goes untreated, children are more likely to develop mental health conditions later in life.
22:49An eight-year-old, for example, may face a higher risk of anxiety or depression.
22:54Their social, emotional, cognitive and motor development can also be delayed.
23:05After leaving the clinic, Sarah found another lifeline, the Blue Sisters self-help group.
23:12It was founded 20 years ago by Melanie Weimar, who also went through postpartum depression.
23:19Here, mothers find understanding, practical support and a way out of what can feel like a vicious cycle.
23:27Women often don't believe things can get better.
23:31They think their old life is gone forever.
23:33But when they hear from others who are further along, who feel happy again and enjoy their babies,
23:39it gives them the courage to believe they can feel better too.
23:50Many women don't immediately recognize what's happening.
23:53And partners, friends and family may react with confusion, especially when a new mother isn't as happy as they expect.
24:04Families say things like, what's wrong? You should be happy.
24:08Pull yourself together, your grandmother had five kids and you're overwhelmed with one.
24:13Women still hear this, which makes it harder and creates shame.
24:17They try, but willing yourself through a mental illness is as impossible as willing a broken leg to heal.
24:26For Sarah, the clinic and the support group made all the difference.
24:31Her son is now six.
24:33She and her husband have separated, but they remain on good terms.
24:39Postpartum depression has become an issue very close to her heart.
24:45It's so important to talk openly about it and to improve the way we deal with it.
24:51I think, as a society, we're moving in the right direction.
24:56But I want to help push things forward in awareness and acceptance.
25:08Julia Kriegsman has also recovered.
25:12Talking to her therapist helped, and so did returning to work.
25:18Today, she and her family are doing well.
25:24I'm more relaxed now and not so hard on myself.
25:28It was a stressful, exhausting time.
25:31But looking back, it made me stronger.
25:34I learned so much about myself and my son.
25:42Today, Julia loves spending time with her son, and that means everything to her.
25:48Postpartum depression is common, but with the right support, mothers can find their way back.
25:56That's all for In Good Shape this time around.
25:59Thanks for watching, and see you soon.
26:02Bye-bye.
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