There are countless horror stories about giving birth here, as evidenced from many of your comments on the Expatica forum. But how much of it is true?

If pregnancy were a book, they would cut the last two chapters," says Meryl Streep's character Rachel Samstat in the film Heartburn.

Of course, childbirth can't be edited conveniently, but women rightly expect a central role in writing that story.

In Spain, though, many discover childbirth choices are limited.

"I asked my gynaecologist about a water birth," says Dominique White, a British-Argentine mother who had a son at a state hospital in Madrid a year ago.

"She said it wasn't possible. 'We don’t like to expose the baby to any unnecessary risk.' 

It is not just water births that are out of the question. The standard hospital delivery procedure is highly regulated, with doctors and midwives generally inflexible over delivery positions and pain relief.

Briton Sonya Dowsett considered going private, but found private obstetricians were not open to the kind of birthing positions recommended in top medical journals like The Lancet.

"I asked if I could adapt the birth position," she says.

"I had found one that worked well for me when I had my first son in England. It was a completely ordinary position, but you would have thought that I had asked the doctor if he could come into the woods with me and light joss-sticks from his reaction!"

Disappointed, Dowsett opted for a state hospital near her home in Madrid where she had an upsetting delivery.

"I was shocked at the backward birthing practices carried out in such modern surroundings in a major European city," she says.

"I was put on my back with my legs in stirrups."

When she didn't want to forcibly push because she didn't want to tear, the female doctor on duty told her: 'With the volume of deliveries that we have here we haven't got time to wait until you're ready to push."

"The doctor was so horribly unsympathetic and unprepared to allow any leeway, like just letting me not have my legs in stirrups. It really shocked and upset me."

Not everyone has had a traumatic experience.

Gemma Sims, who is half British and half Spanish, gave birth to a daughter in another state hospital in Madrid where she found the staff supportive.

She felt confident about giving birth here after learning of the country's low rate of infant and neonatal mortality.

According to Eurostat figures, in 2004, infant mortality in Spain was 0.35 percent of births, compared to an EU average of 0.45 and the UK's 0.51.

Its neonatal mortality rate was 0.28 percent compared to the UK's 0.35.

"There are a lot of horror stories about birth in Spain, but they're not horror stories about deaths," says Sills.

"I think too much choice can be dangerous if someone pigheadedly wants a type of birth which creates a difficulty where one didn't exist.

"I knew that my birth was not going to be very progressive but I was happy to go along with what the professionals were telling me. I felt confident if there was a problem they could fix it."

Sills would, however, have liked to have used gas and air - which is not available in most Spanish hospitals - and to have been allowed more mobility during labour.

In Dowsett's case, medical staff removed her TENS machine, a pain relief device which is regularly used in many countries.

They said it interfered with an internal monitor.

"At one point, when I shouted and cried a bit, they told me not to make so much noise. I heard one nurse say to another: 'This is what happens when they don't have an epidural'. "

In Spain, epidurals are often used.

Sleeping soundly: Baby is oblivious of mother's ordeal

"Here women are told they must be off their rockers not to want one," says Rachel Macleod, a British midwife who has worked in Spain for 13 years.

She is the head of midwifery at the maternity unit at Acuario (http://www.acuario.org/), a private clinic in Beniarbeig near Alicante.

She believes it is the only Spanish maternity ward to offer a natural birth - with gas and air available and facilities such as birthing pools – while also providing full medical backup to handle complications.

She is highly critical of the childbirth system here, describing it as over-'medicalised'.

"It is all defensive medicine with the idea being this is dangerous; let's get this baby out as fast as we can," she says.

"Natural birth is about being patient and waiting. Here almost everyone is induced. Almost everyone is given episiotomies and the drug oxytocin.

"Women can't eat and drink. A drip is stuck into her with glucose. The worst thing is a woman being on her back without being able to move which is the worst position to have a baby in."

Macleod adds: "What happens usually is a cascade of interventions - one leading to another. An epidural slows down contractions, so then oxytocin is given.

"The woman can't eat and drink or move and is in an environment in which she's scared. Her adrenalin goes through the roof and that leads to foetal distress and then it's off to theatre for a Caesarean."

A report in the newspaper 20 minutos puts the Caesarean rate in Spain between 23-40 percent and states it is higher in private clinics.

The EU average is about 17 percent, while the World Health Organisation stating a rate above 10-15 percent.

Spain's routine use of episiotomies and lack of choice of birthing position are among a number of aspects of Spanish procedure which go against WHO guidelines.

The evidence causes many non-Spanish women who want a natural birth to consider returning to their home countries to give birth or to consider Acuario.

However, for those who do not live near the Alicante area, travelling and staying there in the run-up to the birth is not always practical or affordable (a normal birth would cost around EUR 2,500 but if a Caesarean were needed the bill could rise to EUR 5,000).

One mother, who did not wish to be named, found an alternative solution after one less-than-satisfactory Spanish hospital birth.

She found there was a small body of midwives who do homebirths whose contact details are listed on the website Nacer en Casa (be born at home).

 A birth in her own home proved a reasonable way to have a proper say in the birth process for this fourth-time mother.

However, she says it is by no means an ideal solution for many expectant mothers.

"Really I would have liked to have been able to choose a natural birth with full medical backing," she says.

[Copyright Expatica]

[July 2006]

Subject: Spain; Childbirth