|
Birth, a natural process that gets "medicalised"
Mercedes Serraller
El Mundo 03/11/2006
- Associations and sectors of society ask that the wishes of the woman are respected and that the recommendations of the World Health Organisation about birth be followed.
Something is happening in the sphere of childbirth. It's no longer strange to consider giving birth naturally or at home or to use peculiar words such as oxytocin or episiotomy with confidence. The blame lies with articles published by writers Rosa Montero and Lucia Etxebarría - that brought a flood of letters to the editor - the documentary De parto (Giving birth), which TVE2 emitted last monday and the associations El Parto es Nuestro (www.elpartoesnuestro.es) and Nacer en Casa (www.nacerencasa.org).
These women denounce the birth process in Spain as unnecessarily medicalised and say that the woman is not taken into account. They also consider that in our country interventions that the World Health Organisation (WHO) advises against except in specific cases, are carried out as protocol. Mercedes Serrano, a midwife in Guadalajara, and treasurer of Nacer en Casa, considers that natural birth is that in which "the parents' decisions are respected. One must strive for the best conditions for the mother and the baby and wait to see what their needs are."
"Five years ago I had a 'normal' birth in Gijón which left me with a phobia of giving birth and of doctors" assures Cecilia Díaz, a member of El Parto es Nuestro in Toledo."They induced labour because they said that pregnancy can't last for more than 42 weeks. They broke my waters, gave me oxytocin - a hormone that accelerates contractions - they didn't let my husband in, they gave me an episiotomy - a cut in the perineum - and they used forceps" she tells. The perineum is made up of the muscles and skin between the anus and the vagina.
Cecilia Diaz remembers that she thought what they were doing was normal, but that the lack of information, the fear and the pain made her doubt. "With this onslaught of agressions the baby came down, but then I noticed how he moved up again". Cecilia was aware of everything. "They did the episiotomy before the baby's head came out, which produced a terrible pain, since they had lowered my epidural so that I would be able to push" she comments, adding, "Luckily, neither myself nor the baby suffered any lasting physical damage".
Rebeca Romero wasn't so lucky. A year and a half after giving birth, she still hasn't recovered from the episiotomy - even though she has since been operated on- which has made sexual relations impossible and physiological needs very difficult. This traumatic experience led her to join El Parto es Nuestro. Cecilia and Rebeca are looking for a place in Toledo where the group can meet.
The birth of Cecilia's daughter was the opposite of the birth she experienced with her first child in Gijón. Two years ago she gave birth at home in Toledo. She was attended by a midwife from Madrid - "as she was closest", she says. "Labour began in the early hours of the morning" Cecilia remembers. "At nine in the morning the baby was born. I felt pain but also some very pleasurable and moving sensations." I didn't want to be in hospital with an epidural. Two hours later I had already recovered" she remembers. Cecilia says she's not able to describe exactly the pain that she felt, which is in stark contrast to the bad memory she has of her first birth.
Cecilia explains how many people think she's mad when they find out that she gave birth at home. So far as safety goes, she insists that she was very informed and that all tests indicated that her pregnancy was low risk. And if there are complications? "They take you to hospital" she answers. "And she adds, "I thought about the length of time that the midwife took to come and see me during my first birth - while she was dealing with other births and consultations - and in the time it took me to decide whether to call the gynecologist, I would have got to hospital from my house."
Mercedes Serrano, who is midwife at the Sescam CAP and who has been attending homebirths in Guadalajara for 25 years, agrees. "In Castilla-La Mancha 6.7% of homebirths go to hospital, and 4.2% have a caesarean. Serrano adds "When it's necessary to go to hospital we do it gladly. But, it's to solve a problem that has come up. We don't create problems, as they do in hospital."
Studies show that homebirth is safer. Serrano attributes the complications that happen in hospital to iatrogenic causes - worsening of the patient's state as a result of medical treatment - which in the case of birth begins with the treatment of the natural process as though it were an illness.
Mercedes Serrano points out that Castilla-La Mancha is, proportionally, the region in which most homebirths are carried out. Serrano and other women ask that homebirth, which is private, be covered by the Social Security. In Holland, 40% of births are carried out at home.
"The WHO says that women have the right to be informed regarding which kind of birth is best for them", affirms midwife Mercedes Serrano. Isabel Fernández del Castillo of El Parto es Nuestro, believes that it's not a question of modifying the laws that already establish the patient's autonomy, but of applying them. In Spain a natural birth is possible in private clinics such as Acuario (Alicante) or Migjorn (Barcelona). Some public hospitals are beginning to respect the mother's wishes more, and the mother sometimes brings a birth plan, but generally this is not the case. Serrano says sadly, "Many women don't want to know. They make sure they get the right information when they go to buy a dress, but not when they're going to have a child." Serrano calls on women "not to be afraid of their bodies, to trust in the most natural process, birth" The WHO recommends that oxytocin is not used in more than 5-10% of cases - in Spain the figure is over 80%; that episiotomies should be 10-15% - in our country the figure is around 85%, and it advises against the number of caesareans rising over 10-15%. In Castilla-La Mancha there were 21.77% of caesareans in 2005, and this is the national average. In private clinics these figures shoot up. Gaspar González de Merlo, head of Obstetrics and Gynecology of the hospital of Albacete and president of SEGO (Spanish Society of Obstetrics and Gynecology) in Castilla-La Mancha assures that in the hospital of Albacete "consent is asked for everything and birth is dealt with very humanely" González de Merlo believes that those who criticise the protocol of the Spanish public health system "are exaggerating" and looking for anecdotes. This gynecologist believes that what is missing in hospitals is space, but, he says "it's a structural problem that's not beyond solving". González de Merlo considers that there are very few lawsuits for malpractice although he attributes the rise in caesareans to doctors' fears of being sued for not carrying one out. "There's a lot of social pressure. Women are not mentally prepared to wait as they are in Holland", he explains. He says "There are fashions. At the moment it's natural birth". The treasurer of the Association of Midwives of Castilla-La Mancha (Amacama), Inmaculada Garcia Serrano believes that birth is being demedicalised in small hospitals such as the one in Hellín. Maite Martin Rubio, head of patient care at Sescam explains that "hospitals can't meet the demands of natural births in an individualised way", but that "Sescam is trying to use the scientific evidence that favours more personal care in birth". With new patient care guidelines being introduces, protocols are being revised. Mercedes Serrano believes that these measures are "a change in strategy" but that, for the moment, things haven't changed.
|