The Department of Health wants to tackle the excessive number of cesareans
J. Albarrán Bugié Barcelona
ADN, 20/09/2007
In Spain, when a woman arrives in hospital to give birth, it's very common for her to be medicated to encourage dilation and medicated to alleviate the pain. Her pubic area is shaved and a cut is made in her vagina to facilitate the birth. Also, in the public sector, one is four births ends in a cesarean (about 40% in the private sector), a proportion much higher than the 15% recommended by the World Health Organisation and the average in the European Union (18%).
The Ministry of Health wants to tackle this excessive number of cesareans and at the same time encourage natural birth (with a midwife's assistance but without medical intervention) and return the emphasis to the woman in what is often an excessively medicalised process. For this, the Ministry is preparing a strategic plan that will be presented before the end of the parliamentary season.
"You feel like a baby container", says Patricia Sanz, whose first birth ended in a cesarean that she believes was not necessary. For her second birth she chose to go to a centre specialised in natural births and spent three days giving birth: no hurry, no pressure, experiencing the creation of a new life with intimacy and intensity.
She is now a member of the association El parto es nuestro, which fights for women's rights to a "respectful and humane birth", in which external intervention is reduced to the absolute minimum and is as unintrusive as possible. "Mothers have stopped being the protagonists and authors of the birth and have become passive spectators", says Evarista García-Peña, of the Catalan section of the association. Part of the problem according to Sanz is that the hospitals "are completely oversaturated and there's a rush to get things over quickly", with action being taken even before there are any complications.
The Health Minister, Bernat Soria, recognised a few days ago that it is necessary to put together a plan "to reduce unnecessary practices, such as routine episiotomies (a surgical cut in the vagina), and to reduce the number of cesareans to those that are clinically necessary". Soria has undertaken to have the plan ready by the end of the parliamentary season and meetings are now being held between the different parties to analyse the future Strategy to Improve Assistance in normal birth.
Last July the Spanish Society of Gynecology and Obstetrics (SEGO) its 2003 Protocol for Assistance in Normal Birth, adding a document of recommendations for assistace in birth where it states that a "change" is necessary that allows "the mother to be at the centre of the assistance received." It states that "birth with the minimal necessary intervention must be favoured" and that none of the practices mentioned earlier should be carried out in a routine manner and without informing the woman.
Although this document insists that in the birth "the health and safety of the mother and baby must take priority", the society representing gynecologists also recognises that in recent years there has been a "loss in intimacy" and that the "atmosphere" of birth is "totally improveable".
The gynecologist Neus Prat, vicepresident of the Catalan Society of Gynecology and Obstetrics, assures things "are advancing quickly" with respect to recuperating the woman's protagonism in the birth and that there are already many centres where the woman can choose her birth position and where it is the midwife who attends the woman, with the gynecologist only intervening if there is a complication.
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