Birth assistance in Spain is often criticised for being over-medicalised and over-standardised, with very little on offer for the woman who would prefer to have a less medical approach. Intervention rates are high: 85% of women receive episiotomies, oxytocin is used in over 80% of births and caesarean sections are performed in 22% of public sector births, and 36% of private sector births. Freedom of movement is often very restricted and there are generally no alternative forms of pain relief to the epidural (used in 95% of births in Catalunya).
Things are changing however. Demand for a more sensitive approach in which the woman’s wishes also count is rising. In Catalunya some interventions such as shaving of the pubic area and enema are becoming increasingly uncommon. From 2005-2006 just 1% of women in Catalunya had natural births (in a hospital environment but with no medical intervention). At present only one hospital in Barcelona, La Maternitat, offers natural birth with just one room dedicated to it. Within the next two years La Maternitat will have five natural birth rooms and the Hospital Sant Pau will also have a natural birth room. In May this year the Generalitat published a natural birth protocol with guidelines for attending natural births. In July 2007 SEGO (Spanish Society of Obstetrics and Gynecology) published new recommendations on attending normal births. The recommendations recognise that the intimacy of birth has been lost as it has become a more technical process and place emphasis on not intervening in the natural process unless necessary. Specific recommendations include, among others, letting the woman have freedom of movement, allowing intermittent rather than continuous fetal monitoring and ensuring that the woman is clearly informed at all times of her choices. These are of course only guidelines and as so will not be enforced, leaving their interpretation to the individual gynecologist, but they do at least show some movement in the right direction.