June 29, 2003

Maternity care in Spain - 1

I have been havng trouble accessing the Internet in Spain, so will include two Diary entries today to catch up...

Working in Spain is proving a fascinating experience. It’s been a steep learning curve - discovering the workings of the Spanish health care system, hearing about the way birth is conducted here and thinking, on the spot, of ways I could adapt the normal Active Birth workshop content to better fit local conditions.

Spain has a three tiered health system. The national health service is similar to those elsewhere - everyone pays through their taxes - and it is apparently fraught with the usual problems: lack of money, long waiting lists, under staffing. Many people take out health insurance as it is cheap and offers the alternative of faster care and a private room in the hospital. The third layer is for the rich - they by-pass the rest and just pay outright for the care they want.

Until around 30 years ago, all births were in the home. The Government then decided to move birth into the hospital (this will be familiar to my British readers as the same thing happened there) and homebirths became an things of the past. The hospitals were staffed with many doctors who then got involved in the births and because there were plenty to go around, more than were really needed, it was decided to cut back on the training of midwives. All of the schools of midwifery were closed and the nurses were given extra training when needed. The doctors took firm charge of the whole birth process.

However, as the midwives aged, and then retired it became apparent there was an acute shortage and there were none being trained. The few midwives left were allocated to the labour wards and nurses were left to undertake the prenatal and postnatal care. After eight years, the midwifery schools were opened again and now there si some new blood entering the scene.

Meanwhile, women, although they may have seen a nurse during their pregnancy for the routine tests etc, started seeing a doctor as well, as he could provide continuity of care. The first and only time a woman would see a midwife was during the labour and even then the doctor would arrive for the birth itself.

The initial breastfeeding rate is very high as Spanish women want to breastfeed their children. While it may be 95% plus after the birth, there is no support in the hospital and by two weeks the breastfeeding rate has dropped dramatically, and by 6 weeks is almost non-existent. Formula feeds are freely available in the hospital and samples are given are given out post partum.

There is no midwifery organisation in Spain and few nurses would consider themselves as “midwives”. Of course there are exceptions, and these will likely be women who have trained elsewhere, probably in Britain. There is an informal network of these people and I am fortunate that this workshop is being organised by one of them, Rachel MacLeod who works at the Acuario birth centre south of Valencia (more about Acuario later).

In the light of all this, birth in Spain is very medicalised. Midwives are firmly under the control of the doctors who dictate all the protocols and demand strict adherence to rigid routines. All women give birth on a narrow table with their legs in stirrups - they will have had a perineal shave and an enema and can expect an episiotomy. There is routine starvation of women during labour and most births as augmented. Needless to say the epidural rate is very high and so are the caesarean, forceps and vacuum rates.

It is all so antiquated, and a real reality check. Two days ago I was debating the finer points of physiological third stage with British midwives, and here I am being told that the doctors insist that if the cord is not cut immediately the baby’s blood will drain back to the mother! As a consequence, I have left out whole sections of my normal workshop program because they are not even at first base with physiological birth.

Tomorrow I have been asked to give them some practical pointers about how they improve birth for women who are on the beds as there is no way they can enable women to give birth on a floor mat. Although it goes against all my basic teachings (as many of you will know) I will be as creative as I can and give them some suggestions so that they can try putting some of the basics (such as upright birth) to the test with the women on the beds. It will be a challenge!

More on how this turns out tomorrow.

Posted by andrea at June 29, 2003 05:19 PM

Comments

Hi
Here I am training to be an antenatal teacher with the National Childbirth Trust trying to find birth statistics (epidural, cs, instrumental delivery rates etc) for Spain.

This is where I´ll be teaching - have pity please - but any idea where I can find good reliable stats?

Thanks
Cheryl

Posted by: Cheryl Kennell on September 5, 2003 10:40 PM

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Hi
I would like to ask if anyone has any information available regarding birthing pools, which may be available here in Spain.
Thanks
Kay O´Higgins

Posted by: kay ohiggins on October 20, 2003 12:44 AM

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Hello,I live in Puigcerda a town in northern Catalunya and I am looking for a midwife to attend my desired home birth. I greatly welcome any information on how I can go about finding a midwife. thanks Lise Pacioretty

Posted by: Lise on December 27, 2003 10:30 AM

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hello,
I was wondering what level of fluency is needed to work as a midwife in spain. Also what qualifications are needed
thank you Dom Brown

Posted by: Dominique Brown on January 13, 2004 07:11 AM

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Posted by: blackjack on January 19, 2004 09:46 AM

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be great to chat re midwifery in spain i work in orgiva nr granada as a spiritual midwife, be lovley to my web site is at www.da-a-luz.co .uk i run a preggy group every mon for people in my area look forward to more contact with you all blessed be vanessa

Posted by: vanessa brooks on February 23, 2004 09:45 PM

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Hi can you help? I have the opportunity to move to madrid in a few years time and wondered how easy it would be to work as a midwife there. I will qualify in july. If it is possible, how fluent would I need to be in spanish?
many thanks

Posted by: Michelle neal on March 23, 2004 05:33 AM

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I am due to give birth in july and would love to have a home birth. Does anyone know anything about having a midwife come to your home in Spain? Or would any midwives out there be willing to take me and my baby on? I live in Almeria, near Velez Rubio (on the A92N motorway) from Granada to Murcia (about 2 hours from Granada and 1 hour from Murcia)

Posted by: clara Mollett on April 15, 2004 10:24 PM

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Hi there,

I'm a journalist putting together a feature for British women planning to have their baby in Spain. I'd love to hear from any English speaking midwives that could help to put our reeaders' minds at rest, or any support groups that expats can contact for support.

Many thanks!

Emily Berryman

Posted by: Emily Berryman on April 19, 2004 11:55 PM