Giving birth to a child is a pivotal moment in the life of any woman. Sometimes it takes years and a long struggle with health issues to conceive. Professor Christian Breymann, one of Switzerland’s leading gynaecologists, can tell you thousands of stories of how long-awaited children have arrived in this world. He can also reassure you that it is never late to have a child. With Professor Breymann responsible for pregnancy management, any future mother can feel safe: all his decisions are bound to be the correct ones. His clinic, with the associated Zurich Obstetrics and Gynaecology Center, delivers over 1000 children each year. There is a joke among his ex-patients that Prof. Breymann’s care guarantees beautiful children.
— Professor Breymann, what is the right moment for a woman to go to your center — when the pregnancy has already begun or while it is being planned?
— It is best to start with prenatal consultations, meaning when the pregnancy is just being planned. We have to compile a complete medical history to understand whether it is safe for the future mother’s body to go through all of the steps from conception to childbirth. Women frequently appear to have chronic conditions or complications after abortions. Another factor is age. So, such mothers-to-be need special medical attention: a full physical examination, a hormonal balance check and the measuring of blood concentrations of vitamins and minerals are necessary.
Studies confirm that pregnancy goes more smoothly if the concentration of nutrients and hormones in the female body is balanced. In cooperation with the largest Swiss vitamin manufacturer, I have been able to develop a special formula. There are no equivalent products, as mine contains vitamins, minerals, berry extracts and many other valuable nutrients. If, say, a lack of D vitamin or iron is detected, we tailor the formula specifically for each patient.
— What stages are there in your work with a mother-to-be?
— The first is a conceptual examination and consultation, and an examination of the medical history. The second is the actual pregnancy management. There are three important points here: a genetics and ultrasound scan at about week 12, then, at week 20, an examination of the child’s morphology and diagnostics of its organs, especially the heart, and screening as well; and, finally, growth monitoring at week 30. By that time, the diagnostics of organs and genetics are completed. If that goes well, in most cases there will be no further problems.
Our Center cooperates closely with other clinics and specialists from many fields. If there is a sudden need for an additional test or another specialist consultation — for instance, if a consultation with a cardiologist in the case of heart arrhythmia is needed — it can all be organized very quickly. The most surprising thing is that sometimes it is not only women who need a consultation. We recently had a case where it appeared that our patient’s husband had problems with his lungs, so we contacted a specialist and the next day, the man was sent off to an appointment with a specialized clinic.
— Nowadays more and more women are tending to become mothers at quite a mature age. This is known to increase the risk of complications significantly.
— ‘Mature pregnant women’ are one of our major specializations. This group of patients includes women who become pregnant at around the age of 40 or later. We examine them most thoroughly and offer them a special program of pregnancy management.
In all cases, it is me personally who performs all the tests, like the ultrasound scan, organ diagnostics, and placental diagnostics. Besides this, genetic studies of the fetus are performed and additional consultations are given. In this way, we can minimize all the risks.
— Data on women of fifty and even sixty years old who have given birth to children are frequently published. How old was your oldest patient?
— 55. She was a famous photographer. It was her first child, so we went with a caesarian section. Our team managed her all the way through the pregnancy. Needless to say, she was very happy!
— What risks to a child’s health can a mature mother’s age pose?
— There was a study conducted in the Fertilization Center we collaborate closely with. They gathered statistics on the state of health of newborns whose mothers were over 40. Unfortunately, they are not as good as those of young obstetric patients. However, medicine is progressing and I keep saying that thorough examinations carried out by professionals before and during pregnancy are sure to minimize the risks. Every time a patient comes to me for an ultrasound scan, I personally examine the child’s organs, check the state of the placenta and blood vessels, and monitor all the parameters. And I do this regularly, starting from week 20, while many doctors do not do this.
— What overall evaluation can you give to modern, middle-aged expectant mothers?
— The majority of women who want to have a child at around 40 years of age are from large cities. They have been building their career, they have achieved a certain position, and they can afford high-quality medical service. Such women tend to be more aware of their health and healthy eating and exercise, so their physical condition is often quite enviable. But, on the whole, modern women in their 40s and 50s seem to treat their health with more respect that in the past. It means that the chances of producing a healthy child are very good.
— Doctors often recommend that mature women have surgery rather than a natural delivery.
I disagree with this. I do not oppose natural childbirth for mature pregnant women, even though many doctors consider it too risky.
If there are no medical contraindications, a woman is free to choose the way she wants to deliver. We discuss all of the benefits and drawbacks, but it is the patient who makes the decision. It is a different story if the expectant mother has diseases like heart defects, diabetes, or liver dysfunction, or the fetus is too big or is in a breech position. Then we operate. It can happen that a woman chooses a caesarian section without any indications. At the same time, there are patients who insist on natural delivery at the age of 45. I support any decision.
— It is said that the caesarian sections in your center are unique. Do you use special methods?
— We do. An example is the Misgav Ladach method, which allows the surgeon to cut through a smaller volume of tissue but which involves more manipulation. We introduced the method just several years ago, but we are now seeing the excellent results it brings.
The operation lasts 20–30 minutes and the blood loss is comparable with that of a natural delivery. It is even preferable from this point of view. The patient stays in hospital for 5–6 days. She can get out of bed on the first day.
We provide high-quality care for mother and child and the likelihood of infection is minimal. That is why famous women and celebrities’ wives come to us from England, Monaco and other countries, countries with their own luxury-class medical service.
Recently, our center has been the basis for the medical paper, «Patient satisfaction level in reduced-trauma caesarian section». According to the results of the study, over 90% of patients were satisfied with the outcome. We are planning a series of scientific publications based on this research.
— Caesarian section is usually offered in the case of complications. For instance, breech birth is a common problem. Some specialists recommend changing the position of the fetus mechanically, but others are categorically against it.
— Delivery with the breech position is always a risk, so I recommend caesarian section. One can deliver a child in the breech position, but it depends on many factors: the woman’s weight, the baby’s weight, and the details of its position. But even if all the conditions favor a natural delivery, we still operate in 90% of cases because a caesarian section allows a woman to deliver a healthy baby without birth trauma, vacuum or hypoxia.
As for changing the baby’s position, it is practiced in some hospitals but it is forbidden in ours: this process involves changing the position of the placenta along with the fetus. This can be extremely dangerous.
— How often do patients from abroad have to come for appointments with you during pregnancy?
— It depends on the woman’s health and the development of the fetus. Some visit us several times during the most significant periods for diagnostics — usually weeks 10, 20 and 30 — and, naturally, before the delivery. Others require more frequent visits. Sometimes we see the mother-to-be only once or twice shortly before the planned caesarian section. There are women who pay one visit after another, as they feel safe here. For example, I have a patient from Malta who has even come for an ultrasound scan.
— If a pregnancy is getting complicated, does it mean that the woman must spend all nine months in the proximity of the clinic?
— Each case is different. The higher the risk, the more often I need to see the patient. But if there is a good doctor in her country, there is no need to come to us all the time. I trust my colleagues.
— Even in the smoothest pregnancy, there is still a chance that the newborn will need specialized care.
— We are prepared for all unexpected situations. As the pregnancy progresses, I anticipate possible scenarios. Not long ago, one of our foreign patients had a baby with renal dysfunction. Because we knew about it in advance we contacted specialists from a child healthcare clinic right away, thanks to our network of contacts.
— What else does your clinic specialize in, apart from pregnancy and delivery management?
— Of course, perinatal care, obstetrics and delivery are our major specialization. We have over 30 years of experience in this sphere. But we also deal with general and operative gynaecology. Also, we give recommendations as to hormonal therapy and hormone replacement therapy in the post-menopausal period.
— In Russia, prejudices against hormonal medicines have persisted for years. While contraceptives are now widely used, hormonal replacement therapy for women at the start of menopause still raises quite a lot of questions and concerns.
— When a woman reaches menopause, the level of estrogen in her body falls in a short period of time and the first postmenopausal symptoms occur. The changes affect practically every organ. Some of them do not manifest themselves visually: for example, bone weight loss. I strongly believe that hormone replacement therapy is, along with a healthy lifestyle and good nutrition, the only way to age in a less traumatic way. If you put 20 women of the same age in front of me, I can definitely say who is receiving hormone therapy and who is not. It is visible without special tests.
I am not referring to anti-ageing measures: hormone replacement therapy is not about prolonging youth. It is about alleviating the effects of age-related changes, allowing them to happen in a less traumatic way. In addition to hormones, food supplements, antioxidants, mineral substances, calcium and much more is necessary. It goes without saying that constant monitoring and regular medical check-ups are important. Hormones must be taken in the right dosage and form, be it a patch, tablets or jelly, to avoid overloading the liver.
— At what age should hormone replacement therapy be started?
— The most important thing is not to start it before the menopause. The body must manifest symptoms of a deficiency in certain substances. It is necessary to measure hormone levels and assess them, and only then to make a decision. Many women come to us at the age of 42–45 — that is too early. While there is menstruation, no hormone replacement therapy is prescribed.
— It is thought that hormone replacement therapy increases the risk of breast cancer. Is this true?
— There is an ongoing discussion and it depends which preparations you are using. Surprisingly there are even situations where menopausal hormone replacement therapy (MHT) can lower the risk of breast cancer. According to the research, many women who develop cancer have coexisting risk factors such as smoking or being overweight, or there are other unfavorable factors like hereditary ones. Anyway, hormone replacement therapy must be supervised by a physician. It is necessary to monitor how the woman feels and perform regular breast check-ups. Besides, for those who have had their uterus removed there is no need to receive progesterone; just estrogen is sufficient.
There are certain rules to be followed. This method is very effective if used with expertise. It yields visible results: the skin becomes firmer, and the hair and nails get stronger and shinier and the bones less fragile. Nothing is better than hormone replacement therapy for stabilizing bone tissue and preventing osteoporosis and vaginal atrophy.
— Nonetheless, prolonging youth and preserving beauty is a highly popular field of medicine. Can you offer women anything in this area?
— Sure. Systematic hormone replacement therapy in combination with the right diet and food supplements provide comfort for the body. Meanwhile, one’s appearance can be preserved thank to hormonal dermatological products manufactured by our partners.
Professor of Medicine. Honorary professor of Gynaecology and Obstetrics in Zurich University, co-director of the Obstetrics and Gynaecology Center (Zentrum GGS), Seefeld, Zurich. Pfizer prize winner 2009 (as a co-author) for research in the field of cardiovascular diseases. Full member of the German Association of Perinatal Care, the Association of Gynaecological Endoscopy (AGE Germany), the International Society of Umbilical Cord Blood, and NESA (New European Surgical Academy).