June 29, 2003

Maternity Care in Spain - 2

This was written at the end of the workshop in Spain, the day after my previous entry.

As I mentioned before in a Diary entry, Spain has a very medicalised approach to birth. In many ways this is not so different from other countries, but they have developed some unique routines that are amazing.

I was staggered by some of the things I have been told about by the midwives here. For example, every woman in Spain goes for a CTG each week, starting from 38 weeks (or even earlier if a problem is suspected). until the baby is born! They seem to have the idea that this is done in other countries, and the reason they offer for this service is that women want to know that the baby is OK and also in case the baby dies later - they can say that it was doing well before the birth. Since the rate of litigation is very low in Spain and women are not inclined to sue, even if there is a clear problem with her management, it is hard to justify this routine on legal grounds.

I think this practice is a prime example of setting women up for intervention. How easy to would be to say that there is a problem with the baby and that an induction is indicated! A caesarean could also be offered with ease, should the caregiver wish, and as most women are seeing an obstetrician, this seems a likely possibility. Given the varied interpretations of these traces, almost anything could be read into them. Women, of course, will take up the offer to the CTG because they see this as “care” and every woman craves attention for her pregnancy and baby, especially at the end of her pregnancy.

Imagine what this must be costing the Spanish health system! If every pregnant woman in England lined up for weekly routine CTG s from 38 weeks on , the whole health system would grind to a halt, as it would in other countries. They were surprised when I said that this doesn’t happen elsewhere.

We had a long discussion about unnecessary pregnancy testing and what is means in relation to creating the feeling that pregnancy and birth are normal physical events for a woman. Frequent ultrasound scans are another popular pastime, especially in the private sector, and lots of other tests abound. It is hard to change a culture a fear about birth when there is so much emphasis on testing and technology and it is no wonder that women want it all to carry over into the labour. The midwives in this group had very limited knowledge of many of the issues we explored, probably because they see themselves as servants of the doctors and they assumed that the doctors would know best. Some of the older, more experienced midwives however, who knew what birth was like before all this palaver became entrenched, were able to share some very valuable insights drawn from their own practice and this was enormously helpful for the group. We need ways to celebrate this expertise and to capture the skills for others to draw from, before they retire and it is too late. Spain certainly needs to learn from these wise women.

Posted by andrea at June 29, 2003 05:22 PM

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

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I am a 3rd year midwifery student and fluent spanish speaker. Are UK qualifications accepted in Spain and is there any alternative or more 'radical' midwifery in the region of Valencia. Any comments gratefully received.

Posted by: susie on April 29, 2004 07:14 AM