Rachel – Maternitat

I gave birth to both of my children in the Hospital Clinica Casa Maternitat, under seguridad social as I don’t have private healthcare. The first time was in August 2005 when I was 29 and while this hospital was automatically allocated due to the CAP I was attending for my antenatal care, I was also very happy about this as this hospital has a protocol for natural birth. It is quite typical to have an epidural during labour here in Spain, but apart from the effects that this can have on mother and baby, the thought of having an injection in my spine also freaked me out. Of course no hospital will force you to have an epidural, but with having a protocol the Casa Maternitat supposedly offer more support for a natural birth. 

Antenatal care
I was perfectly happy with the antenatal care I received once I was referred to the hospital towards the end of each pregnancy.  First appointment ‘booking in’ with a midwife, then subsequent appointments with the obstetrician. Unless he/she is on holiday when you’re due an appointment, you’ll see the same doc each time, but they will not necessarily attend your labour as it depends on whether it’s their shift in the labour ward.
I was overdue with both babies, and at 40 weeks started foetal monitoring (where they measure any uterine contractions, baby’s heartbeat and movements), and ultrasounds to check baby is OK. They allow your partner or a companion to be with you if you choose. At 41 weeks they repeated the monitoring and ultrasound, then it became every 2 days. At 12 days overdue I went into labour with my first baby – my waters broke and within 2-3 hours I was having contractions – more about the actual birth in the next section.
With my second baby I reached 42 weeks and decided to be induced. I’d had absolutely no contractions and my cervix was still long and closed, so showing no signs. I was never pressured by the obstetrician to be induced at this point – I was fine, baby was fine, but she told me that the performance of the placenta can diminish after this point and that this can be gradual or more sudden, so I’d be required to go into hospital every day for foetal monitoring after 42 weeks. I’d already noticed less movement from baby for the last few days and had been in once ‘de urgencias’ to check baby was OK, and he was, but as it was Friday with the weekend ahead I decided I didn’t want to be worrying myself at home. So she sent us home for lunch and told us to come back in the afternoon to be induced – more about the birth further down.
First birth
I arrived at hospital around midnight, about 3 hours after my waters had broken.  I was taken to ‘urgencias’ for foetal monitoring.  Unfortunately your partner is not allowed to accompany you for this which is absurd, but it’s apparently because there are two women to a room with only a privacy curtain – as if your partner is going to be interested in what’s going on with the other woman anyway!  But there you go.
My contractions were quite infrequent at this point, so I was sent upstairs to the ward to wait until they became more regular and uncomfortable. My husband was there with me.  It was a shared room (most rooms are double, though if available you can pay for a private room). At about 4/5am they were 4 minutes apart and I called the nurse, who said she’d arrange for us to go down to the dilation suite for monitoring.
There are 4 dilation rooms at the Maternitat – two with windows, two without. We were put in one without, bad luck…  The rooms each have private toilet with sink, equipped with bed, birthing ball, stool, chair, and the four rooms share a shower that you’re free to use as desired.
Baby was doing fine but the contractions were becoming more uncomfortable so we decided to stay down in the dilation room rather than go back up to the ward. I had taken along a TENS machine (bought in the UK) which I was using to manage the discomfort. I had written this into my birth plan, and all the staff attending me had read my birth plan. The midwives basically leave you to it, checking you every so often. You are required to have foetal monitoring for 20 minutes every hour under the protocol, and they can see the readings from their central station outside the rooms.
The midwives encouraged me to drink juice and eat some biscuits around breakfast time, even though I really didn’t feel like it.  I was in a lot of discomfort as the morning went on. At no point did they push the epidural. It was me who initiated the idea, asking at which point it would be too late…  I wasn’t dilating very fast, and on top of feeling exhausted from not having slept all night (nor had I napped the day before, silly of me…), I was no longer managing the pain very well and losing control of my breathing techniques. Baby was also suffering – heartbeat dropping dramatically with each contraction, which were now coming with only 30 seconds rest between, and lasting about 1 minute each.  Around 2pm we decided to have an epidural.
I was scared, in pain, feeling almost delirious and wanted my husband to be with me while they administered it. They wouldn’t allow him in as they transferred me to the delivery suite. One midwife tried to persuade the doctor, but he wouldn’t budge. The midwife was very supportive though. Once done, my husband was allowed back through. I was now on my back with legs in stirrups, exactly what I hadn’t wanted, but I was too tired and too out of it to care by now. Apparently I dozed off a bit during the next hour or so. I’d actually asked for not too much epidural as I still wanted to be able to feel enough to push my baby out – I was still a bit uncomfortable, but no longer in pain.
About 4pm I really started getting the urge to push, so the midwife said to go ahead. But then baby was really distressed (of course foetal monitoring is continuous once you’ve had an epidural), and wouldn’t turn to be born, the umbilical cord was wrapped twice round baby’s neck, so before I knew it they were preparing to deliver my baby using forceps. My husband had to leave while they gave me an episiotomy and used the forceps, only allowed back in as our baby daughter was just being born at 4.30pm. The cord was cut immediately because of it being wrapped round her neck, she was put straight to my breast, but was very pale and exhausted so had to go in an incubator for 10 minutes, and I said to my husband to go with her. They delivered the placenta by hand and then stitched me up and I don’t remember much about it.  I just remember quite a lot of staff being present for the birth and afterwards – it’s a teaching hospital so that’s what you get…
While the birth wasn’t at all the experience I’d hoped for, I actually believe that in another hospital it might have ended in an emergency caesarean, so for that I’m grateful I was in a hospital where they are confident and skilled in using forceps. Actually when my daughter was a couple of months old I took her to see a cranial osteopath to check everything was OK, which is was with no damage done by the forceps, although there was some residual tension in her skull which the osteopath released in a couple of sessions.
So all in all I was happy with my experience at the Maternitat to want to go back there for my second baby, and this time I actually had to request the hospital as the automatic one from my local CAP is the Hospital del Mar.  

Second birth
I arrived at ‘urgencias’ about 4pm to be induced, where I had to have foetal monitoring – without husband present, as before…  After this they then did a vaginal ultrasound, even though I’d already had an external one that morning and everything was fine – just their protocol to do another when you go in to be induced.  It was about 6pm when they finally took us to a dilation room (I asked for a room with a window and got one this time!), and gave me the prostaglandin strip. This would be left in place for up to 24 hours, and if nothing happened then they’d put me on an oxytocin drip. I was required to lie in bed and be monitored for 2 hours, and then as still nothing was happening I was shown up to the ward. I had dinner and sent my husband home, figuring that if we were in for a long wait he might as well get some decent sleep in bed at home. At 10pm I felt my first period-pain like twinges, but nothing major and went to sleep. At midnight I woke up and quickly realised I was in ‘proper’ labour. I felt my waters break about 15 minutes later, called the nurse and she asked me to tell her when my contractions were 4-5 minutes apart.  10 minutes later I called her to tell her they were less than 2 minutes apart!  I’d called my husband to rush back!
By the time he arrived around 1am I’d been moved down to the dilation suite – I’d asked to walk rather than be pushed in a wheelchair as I could cope better with the contractions standing. I was 4cm dilated. Things progressed rather quickly. This time I’d brought with me a CD player to listen to relaxation music, a beanbag and extra pillows to get comfortable during and between contractions, and all of the midwives attending me were happy for me to get on with it as I wished – they’d all read my birth plan and respected what I wanted, especially not talking to me during my contractions so I could concentrate on my Hypnobirthing relaxation and visualisation techniques. I was allowed to be on my knees during foetal monitoring as I wanted to avoid being on my back, but when baby’s hearbeat seemed to be slowing during contractions they did ask me to try lying on my back to see if this helped him.
It actually didn’t, and as I approached transition the obstetrician came in and said they’d need to do a ph test (where they take blood from baby’s head) to check his oxygen levels. For this I’d need to go through to the delivery suite, but I was having such intense contractions that I kept saying hang on, wait a minute, I can’t move now, and before I knew it they were saying right, this baby has to be born now – PUSH! I was actually on my back on the bed, but at that point I didn’t feel I could move anyway and at least I was in control of where my feet were and not in stirrups. It all happened very quickly and with manual help from the midwife my son was born in 5-10 minutes at 3.25am. I tore where I’d had my episiotomy the first time round, but it was external only. As they hadn’t had time to do the ph test, they explained that they’d have to cut the cord straight away to test that for oxygen, and luckily the results were fine. Baby was put straight to my breast and left there for well over an hour while they stitched me up – it took a long time as I haemorrhaged badly after the birth and they had to give me syntocin to stop the bleeding. There were only three midwives present during this birth, and the obstetrician looking on but playing no part. So again this wasn’t quite the calm experience I’d hoped for, but perhaps the speed of my labour had something to do with that, and maybe that was down to being induced. Anyway, I managed a natural birth, and I honestly feel that I recovered from this birth much more quickly than the first one – both emotionally and physically. My son is generally more chilled than my daughter, but I don’t actually believe this has too much to do with the birth itself – I noticed he was different in utero compared to my lively daughter who used to kick me non-stop!  

Post-partum
Your baby stays with you in your room in the Maternitat, apart from a couple of times a day when they’re taken to the nursery for checking over.  But if the ‘queue’ is long you can ask them to come back and fetch baby from you when the wait will be shorter so they’ll be away from you less time.  The staff, in my experience, have been pro-breastfeeding.
However, my daughter showed up with jaundice after her 48 hour heel prick test, so we had to stay in hospital a couple more days while she had phototherapy. She was still with me the whole time. But the staff then encouraged me to top her up with formula saying she’d need the extra energy to reduce her billirubin count. I knew no better, but have since read that this isn’t true – breast milk is best to help with this.
I had problems breastfeeding my daughter and gave up after a few weeks, but I actually don’t believe it was to do with supplementing her at such an early stage. I experienced exactly the same difficulties with my son and this time got help and discovered he had a suction problem (not a latching on problem), and he’d never had a bottle before.  So I think it’s probably just something about my babies’ breastfeeding ‘style’ rather than bad advice at the hospital with my daughter.
With my son there were no post partum issues, and we went home after the standard couple of days.  They no longer do a 6 week post-partum check at the hospital, whereas two years ago you used to see a midwife at the end of your’ cuarentena’.  Now you only see your gynecologist at the CAP where you had your antenatal care.