Barcelona birth

Tereixa Constenla
El País Andalucia 30/12/2006

Women give birth, but the births are hardly theirs. Nearly all decisions depend on the professionals involved in the birth. From this year, all public maternity wards in Andalucia will offer women the choice of delivering their baby in a vertical or horizontal position, following the example of Huércal-Overa (Almería), where this became standard procedure six months ago. The Andalucia health authority is following the recommendation made by the Agencia de Evaluación de Tecnologías Sanitarias de Andalucía (AETSA) that the woman be given "the choice of position in which she delivers her baby", something the World Health Organisation (WHO) has been recommending since 1985. 

In Andalucían public hospitals in 2005, 76,624 births were registered, out of which, 16,848 (22%) were caesareans. The moment of giving birth is probably one of the most crucial in a woman's life, yet her capacity to intervene in the birth has been almost nonexistent since the 70s when hospital births became the norm and the lithomy position (semiseated) was imposed. 

According to the study carried out by the AETSA, the positions adopted by women in the past for delivery had been determined by "mobility" and "verticality". Birthing chairs were common in the Middle Ages, but from the XVII century "Western obstetrics took a significant change in direction, placing birthing women semi-seated on a bed". In general, women have to adopt a horizontal position "in part because it is the most comfortable for professionals to carry out their work". However, in 1985, the WHO clarified that during dilation and delivery "it is not recommended that the woman be placed in the lithomy position". On the contrary, it advises walking during dilation, and states that every woman "must be free to decide what position she adopts for delivery". 

This will be possible in 2007 in all public maternity wards in Andalucia, which will incorporate obstetric chairs so that women who prefer to give birth in a vertical position may do so. This is one of the recommendations in the report by the AETSA which, after comparing scientific literature about vertical and horizontal births concluded that there are no "important differences" for the safety of the mother and baby. Nor did it find any "significant" differences in studies that evaluated subjective aspects such as the woman's satisfaction, pain, ease or preference for the following birth. "Yet, the results, above all in the preference of position for the next birth, show a tendency to favour vertical positions" it states. 

The Agency also recommends that a study be carried out to compare "different types of epidural anaesthesia" in women who give birth in a vertical position in order to identify the best way for the anesthetist to accompany the birth in that position". In other studies by the Agency they found very different opinions about whether an epidural allows a vertical position to be maintained. The use of epidural is not universal in the rest of births: it was only used in a third of births in 2004. 

Offering delivery in a vertical position doesn't represent an excessive cost to the Health budget - an ordinary birthing chair costs about 600 euros, but another issue will be the professional change. "The economic costs are hardly worth mentioning, the main investment will be in training." says the Secretario General de Calidad y Modernisación, José Luis Rocha.

"What they're going to do in Andalucia is good, but it won't serve any purpose if everything that happens before and after doesn't change" clarifies Patricia Sanz, member of the association El Parto es Nuestro, that calls for the emphasis to be on the woman making choices based on correct information". Sanz proposes that more weight be passed from the gynecologist to the midwife and that there be a "mentality change" in line with other European countries. "Pregnancy is not an illmess" she sums up.