The disaster of giving birth Rosa Montero El Pais 13/08/06 For many years now there's been one particularly painful issue that I've put off writing about: the almost universally bad medical practices applied during childbirth in Spain. During this time, dozens of women have told me about the different unpleasant situations that they've had to put up with to give birth. I suppose that since I don't have children, I've been waiting for another female writer that has gone through the process to write about it, with the benefit of her own experience. A couple of years ago Lucia Etxebarría explained to me, in exasperation, what she had suffered when her daughter was born and promised to write something about it. But, I don't think she has yet. And, in fact, I've just received an excellent and very informative book about the subject. It's by Isabel Fernández del Castillo and has just been published by Granica. Everything the book relates is overwhelmingly simple; and yet, Isabel, who I know only through a few emails, tells me that the media doesn't want to address the issue, and that the weight of the obstetrics profession makes it very difficult for other opinions to be heard. Isabel has "other opinions", and they appear to be well developed and documented. We can hear all the complaints, cries and tears of all those women who have told me their sad stories over the years. Because the problem, as Fernández del Castillo well points out, is that the system applied during labour is incorrect. Let me sum up the ideas in the book: birth, obviously, is an involuntary event directed by the most primitive part of our brain. Hence, you can't help it to happen (just as you can't help someone to sleep), all you can do is create the ideal conditions for it to happen. Yet, in Spain and in Latin America, the vision of childbirth that still prevails is pathological, interventionist and hierarchic. The woman is considered to be ill (which she isn't) and worse still, an ill person deprived of all rights, which she would be entitled to in any other medical speciality. Often, practices which have been advised against by the World Health Organisation are applied whether the woman needs them or not - for example, the episiotomy (vaginal cut), the oxytocin drip (which accelerates the birth, provoking greater suffering to the mother and baby) - and without providing the woman with information about their consequences or whether other alternatives exist. But, I prefer to dwell on the positive, the other side, because there are other ways that a woman can give birth and because birth does not have to be accompanied by the trauma, nightmare and sensation of ill treatment that is often experienced in Spain. (There are sensible doctors here too, but they're the minority and not too well looked upon by the medical establishment). And, the positive side is that in Europe (EU), giving birth is a very different affair. Still following Fernández del Castillo's book; in other countries, the woman doesn't have to give birth in the cold, surgical atmosphere of Spanish delivery rooms, but does it in the intimacy of her room. In Europe, the woman is not shaved, does not receive an enema, her waters are not broken and the least internal examinations possible are carried out. That archaic torture instrument called the obstetrical chair doesn't exist, and during dilation the mothers can move around as they wish and use natural means to reduce the pain; have a bath, receive a massage, sit on a birthing ball. And, they can adopt whatever position is most comfortable for them for the delivery; the birthing stool, crouching, on all fours... And, of course, unless it's absolutely necessary, they are not attached to the terrible accelerating drip that almost all women here get and which is so comfortable for doctors and nurses, as it's a way to ensure that the birth occurs when it's most convenient to them. Birth is naturally driven by the hormone oxytocin, the secretion of which is blocked by adrenalin. The enormous stress under which women in Spain have to give birth causes adrenalin levels to shoot up, thus starting a vicious circle that increases the need for caesarean and forceps and of course the epidural, supposedly a feminist conquest which often only serves to dull the disaster of the pain and trauma caused by an obsolete obstetric system.