Readers' questions

In Zusammenarbeit mit dem Magazin "wir eltern" beantworten Spezialisten von Hirslanden die Leserfragen rund um Schwangerschaft, Geburt, Baby und Stillen. Hier publizieren wir die gestellten Fragen.

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Headaches caused by an epidural?

I received an epidural anaesthesia while giving birth. Afterwards I had massive headaches for nearly two weeks. Is there a connection between the two? S.C.

Dr. med. Martin Fröhner, anaesthetist at Hirslanden Klinik Im Park in Zurich

There’s a good chance that your headaches are indeed related to the epidural. In around one percent of patients the protective casing around the spinal canal is perforated, which can cause spinal fluid to leak out.  That will cause very severe headaches, which are usually related to whether you are standing, sitting or lying down. If you are lying down you will probably experience virtually no pain, but the pain will increase when you standing. The headaches usually go away by themselves within a week. After that, it’s very rare for patients to experience further side-effects. Sometimes, as a therapeutic measure, the mother’s own blood will be injected into the site where the epidural took place, because headaches are particularly burdensome for the mother in the period just after giving birth.  


Problems with the internal scar?

We have three children – the youngest is one and a half – who were all born by caesarian. With my last child, a uterine dehiscence was discovered during the caesarian (a separation of the various layers of the uterus). Seeing as we’ve always wanted to have four children, I was recommended to have the internal caesarian scar checked out before becoming pregnant again. Unfortunately, the examination revealed that the uterine scar had healed, but that it is still very thin, around 3.5 millimetres. Could that be problematic if I were to become pregnant again? Also, I have had breast reduction surgery. Can I still breastfeed? V.P.

Dr. med. Bruno Jürg Studer, gynaecologist, affiliated doctor at Klinik Hirslanden & Klinik Im Park in Zurich

A fourth pregnancy is still possible after three caesarians. The thickness of the caesarian scar is irrelevant for a subsequent pregnancy, as is a uterine dehiscence. There’s nothing you can do to improve the internal scar or anything like that. For a subsequent pregnancy, there are other precautionary measures that are more important than measuring the thickness of the uterus wall, such as checking the position and functioning of the placenta, early and efficient suppression of premature labour, and planning a resection around 14 days before the biological due date. If you take these precautions, there’s nothing standing in the way of another pregnancy; however, the pregnancy should obviously be monitored by an experienced obstetrician. With regard to breastfeeding after you breast reduction, you need to ask the surgeon. Only they will know whether the milk ducts were retained all the way to the nipples.

Gazing at the stars

My unborn child is lying in the ‘stargazer position’. Is it still possible to give birth spontaneously and without a caesarian? How will the birth be different from a baby that is born in the normal position? Should I assume there will be complications? A.W.

Dr. med. Reto Stoffel, gynaecologist, affiliated doctor at Hirslanden Klinik Im Park in Zurich

The term stargazer is a buzzword and has no real medical meaning. During labour, the baby’s head rotates and usually positions itself so that the back of the head is facing to the mother’s front and the face is pointing towards her sacrum. This is known as the ‘proper position’. However, in five percent of all pregnancies, the baby is not in this position. If the mother has normal sized hips, the child is born normally. But the birth takes longer as a result of the increased resistance and occasionally external assistance is required (ventouse or forceps). If the mother has narrow hips, the birth may fail to progress and a caesarian might be necessary. If the child’s face is pointing forwards during the pregnancy – in other words, the baby is a stargazer – it’s not a problem because, as mentioned previously, this can only influence the birth after the head has moved down lower into the pelvis.


Afraid of tearing

I’m six months pregnant. I’ve just heard from an acquaintance that her perineum tore while she was giving birth. Perineal cuts are also supposed to be problematic. Now I’m a bit afraid. Can I do anything to prevent tearing? C.D.

Sandra Schmid, midwife at Hirslanden Klinik Stephanshorn

Yes, during the last few weeks of pregnancy there are some measures you can take to prevent a perineal tear. For instance, you can massage your perineum, do stretching exercises in a squatting position and drink raspberry leaf tea or other pregnancy teas. All of this will help to loosen the tissue in your pelvis. During the birth, the midwife will warm and massage the perineum to help prevent it from becoming damaged. When you are admitted to the hospital to give birth, let the staff know that it is very important to you that your perineum is properly prepared during labour. Whether or not your perineum will be damaged and how any damage may occur depends on a variety of factors: such as the elasticity of the tissue, the size of the child, the speed of the birth and how the protective measures are carried out. These days, a perineal tear is preferred to a perineal cut. Tears generally result in smaller injuries and often only affect the soft tissue – rarely the muscles – so they heal more easily than a deliberate cut. As a result, perineal cuts are now rarely carried out. They are mainly used when urgent action is required if the baby is at risk of not receiving sufficient nutrients and oxygen. A cut may also be done if there is a risk of a major perineal tear, or if the ventouse method or forceps are being used. But even then a cut is not standard procedure. So there’s nothing to be too worried about.


Could my history of anorexia harm my baby?

I was anorexic as a teenager. Now I’m 25 years old and pregnant. Could those years of malnourishment have any adverse affects on my baby? I’m afraid to tell my doctor that I used to have anorexia. T.F.

Dr. med. Reto Stoffel, gynaecologist, affiliated doctor at Hirslanden Klinik Im Park in Zurich

Your previous anorexia – or even bulimia – will not disadvantage your child during pregnancy if you are eating a balanced diet and are not suffering from excessive vomiting. However, your prior medical history is relevant for your own health, as your bones are presumably not as strong as they could be as a result of your anorexia, and while you are pregnant and later breastfeeding, your rate of bone calcification will be reduced by an additional 10 percent. For this reason, I think it would be a good idea to tell your doctor about your previous eating disorder, so that they will monitor your vitamin D level (which I do routinely with all my pregnant patients), because practically all pregnant women have a vitamin D deficiency. The doctor may discover that your bones are in an ‘osteoporotic’ condition, which means the pregnancy will put significant strain on your skeletal system.


Flat head

Our son is four months old and sleeps on his back, as is medically recommended. Although he lies on his stomach a lot when he is awake and we also carry him around a lot, the back of his head is still distinctly flattened. It doesn’t look great. Will it grow back into shape? F.L.

Dr. med. Katayun Hojat Wüthrich, specialist in paediatrics and adolescent medicine at Hirslanden Praxiszentrum in Bern

Since we started recommending that babies sleep on their backs, we have seen far fewer cases of sudden infant death syndrome. This sleeping position causes the back of the head to become somewhat flattened, because pressure is put on that part of the head for long periods at a time. Even if the child preferred to turn its head to one side, the back of the head would develop an asymmetrical flat spot, which can then also alter the facial bones.

You can continue to place your son on his stomach during the day (if he’s being watched), not just because of his head shape, but also to strengthen his muscles. At night you can also place him on his side, alternating between right and left, and support the lower half of his body with a U-shaped breastfeeding pillow. During the day, try to lie him down so that he will be interested to look in different directions. In many cases, prevention and treatment leads to a normalisation of the head shape. If this is not the case, physiotherapy, craniosacral therapy and osteopathy can help. Special helmets are also recommended for very severe cases.