Today we share with our readers the second part of the interview with doctor Emilio Santos, psychiatrist and gynecologist, specializing in the care of natural and home birth, with which we already made a first conversation that we published last February.
On this occasion we have talked with him about some aspects that raise doubts for women, such as the possibility of orgasmic delivery, pain in childbirth, vaginal births after caesarean section or in podic and natural birth for a woman suffering from fibroids in The uterus.
You have written two books already, do you intend to continue publishing?
I want to write at least two more books, one about what patriarchy and machismo hides and another about normal birth in the human species.
Can you explain what an orgasmic birth is?
Childbirth is very similar to sexual intercourse, from the hormonal point of view, as the same substances, oxytocin and endorphins, and also from the postural point of view.
When the images of the postures, gestures and moans of a woman giving birth are witnessed, it is inevitable to think that there are great similarities with the postures, gestures and attitudes and moans of a sexually excited woman. So much so that it could be thought that the sexual act in women is a kind of trial for childbirth. Possibly the birth would be better framed from the biological point of view as a climax in the sexual life of women. Of course, this whole facet is canceled in a medicalized delivery.
But most people would tell you that the birth hurts and the sexual act does not.
Yes, but recently I read a statistic according to which one hundred years ago 60% of women felt pain during the sexual act, today we assume that it was due to cultural reasons or sexual repression. Couldn't the same be happening with the childbirth today? We know that there have been cultures in which childbirth did not hurt; and on the other hand, all of us who attend births at home are witnesses that a percentage, which is really low, of women, feels something very similar to orgasm during the last stages of labor. Shouldn't we think that the design that nature has planned for the birth process is quite similar to that of the sexual act as it seems to show the similarity of the hormonal cocktail that intervenes in both processes? Pain could simply be the result of the emotional and cultural context in our society. Who recounted the "Genesis" of the Bible describes that at one point the birth did not hurt and that something that changed made it start to hurt. I witness births in which the degree of pain has been zero. Sensations of a lot and in general the experience has always been joyful.
In addition to using a bathtub, are there other ways to relieve pain in a delivery without anesthesia?
The important thing in a birth is not to eliminate pain, but suffering. I give an example in which something comparable happens. To a mountaineer, when a winter Sunday is climbing the summits, hail hurts in the face, the cold hurts in the hands and face, the muscles and the heart hurts from the effort, but the mountaineer comes home , he showers, and is looking forward to his next Sunday to repeat his joyful experience. It would never occur to a mountaineer like this to try to find ways to diminish the sensations he experiences. Some of the sensations are painful, but their overall experience is joyful. In childbirth that happens too, although it hurts, natural childbirth is always an experience of joy. There is a percentage of moms who during the birth experience have felt without strength and have preferred to continue with epidural, some for pain and more for fatigue; but, among those who have finished their delivery at home, I don't know anyone who has told me: "for the next with epidural". Why?; because childbirth as a whole when it is with respect to physiology, is an experience of joy. Not only for the mother, it is also for the baby. 
What recommendations would you give to a woman who wants to try a vaginal birth after one or two C-sections?
Until a decade ago it was considered that after caesarean section, even after only one, childbirth would always be by caesarean section. Scientific evidence showed that trying a vaginal birth does not pose more risk. When there were two previous C-sections, it was still recommended that the third one be by C-section. Well, recently, scientific evidence has been published that demonstrates that after two C-sections the risk is similar to one and that the woman should also be offered the option if she wishes to have a vaginal delivery.
What risk is there then when doing a vaginal delivery after caesarean section?
The feared risk is a ruptured uterus, which can lead to the death of a baby and a major hemorrhage in need of transfusion and urgent surgery for the mother. What the scientific evidence shows again is that when the delivery is treated in a non-medicalized manner, without medication, and in free posture, this risk is almost non-existent.
Can a vaginal delivery be attended if the baby is breech?
It is true that in 2000 a multicentre study was carried out (in many countries of the world simultaneously) comparing the option of planning a vaginal delivery with planning a caesarean section in pregnant women with babies in breech presentation. It is known by the surname of its principal investigator: Hannah's study. This study showed there is an appreciable difference in risk and that, therefore, caesarean section is preferable. The mother is the one who, informed, must make the decision. In my opinion, a reasonable option to opt for caesarean section is not to schedule it, but to wait for it when labor contractions begin, respecting the moment chosen for the baby's physiology.
Would the data be different if podic births were not medicalized?
That is the crux of the matter. What happens with Hannah's study is that it was carried out in hospital centers of highly medicalized delivery, in almost all cases with the woman in horizontal, with continuous monitoring, with intravenous and epidural oxytocin; in many cases, even with labor induction. Therefore the scientific conclusion of this study is: "after a C-section, if the delivery is going to be medicalized, another C-section is better." From my point of view, a similar scientific study would be needed but that would include the possibility of a breech delivery in a free posture and without medicalization, with a protocol to perform a C-section before the slightest suspicion of complication. My experience makes me intuit that this study would be favorable for the vaginal option.
Have you attended vaginal births with the baby in podic or buttocks?
Yes. In my experience, in these deliveries, women tend to choose, by instinct, the four-legged posture, in which the need for those who attend the birth to perform special maneuvers is eliminated. My personal and professional experience is that breech deliveries are mostly faster and as safe as birth deliveries. Probably, and this is disseminated by scientist Michel Odent, in a breech birth it is a good criterion to use caesarean section in case the process takes place in a slow or non-fluid way.
Can a woman with a fibroid in the uterus assume pregnancy?
It depends on myoma, but in general yes. The majority of myomas are subserous, that is, they are located in the outermost layer of the uterine muscle and are also usually in the upper part of the uterus. The fibroids that may present an obstruction to the birth process are those located in the lower part of the uterus. Of course, during the birth the need for a C-section can be detected which, in this case, would not be a major emergency. Therefore, in a woman with uterine fibroids, a natural birth can be planned in the same way as in any woman without risk factors. In either case you should not perform any special attitude in pregnancy or childbirth beforehand, but you must know that fibroids often grow during pregnancy and, in this growth, they can be very painful. In addition there are fibroids that may represent an increased risk of abortion: they are those called submucous, located inside the uterine cavity, or near the neck.
We hope this interview with doctor Emilio Santos I find it as hopeful and revealing as for us and I encourage you to wait for an upcoming installment, well, I must confess that this conversation led me to new questions and topics to deepen from the hand of a man so knowledgeable about what the fact is of giving birth in the human species and endowed with such sensitivity to explain it.
