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Photo by Lee Woolcock
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Photo by Lee Woolcock
Pregnancy. A time when most women, especially those who are pregnant for the first time, can feel strong and vulnerable in equal measure (and quite probably sick, tired and moody as well). For those away from family and in a country where they may not speak the language or understand the system, knowing what to expect and the options available for giving birth can be a bit of a minefield.
In Spain, medical intervention during pregnancy and labour is high compared to other EU countries, which can be daunting for those new to the system and new to pregnancy. According to the Barcelona Birth website, 85 percent of women here receive episiotomies (a surgical incision on the perineum and the posterior vaginal wall during the second stage of labour), while Caesarean sections are performed in 22 percent of public sector births, and 36 percent of private sector births. The EU Caesarean average is 17 percent.
When information and options are key components of a stress-free pregnancy, it’s reassuring to know then, that in Barcelona there is a wealth of services available for pregnant women and their partners, with English-speaking practitioners on hand to guide them through the process and offer natural birth alternatives.
Uby Muñoz is a trained doula, with two-and-a-half-years’ experience in the UK, as well as an acupuncturist and in charge of a successful Well Woman Clinic in the centre of Barcelona. A doula is a woman, usually a mother herself, who offers emotional and physical support during the pregnancy and labour. “When women come to see me, they are usually nervous, even if they have had a baby in their own country,” said Uby. “They feel more insecure, so I help them relax, get in touch with their bodies and then offer support throughout the pregnancy.
“What women want at this time is information. If you don’t understand what is happening, you feel helpless. Here, it can be difficult to get answers to your questions, so, having seen it all before, I can help with that. I know of one woman who was under a private obstetrician and every time she had a question, he said: “Don’t you worry, the baby will come out.” She just felt she didn’t have the right to ask anything.”
Esther Jones, who set up the Barcelona Birth website, believes an informed mother, with choices, is a more relaxed mother, and that the “medicalisation” of giving birth here can go against the natural order of things and create more stress for the mother.
“In hospital, there is a sense of being on a timetable. You are much more likely to be induced and given synthetic oxytocin, the ‘love’ hormone that the body produces naturally to make the uterus contract and to help you bond with your child, to speed things up.
“This almost always leads to an epidural. Yet the body can usually do everything naturally if it is left to get on with it.”
Esther offers classes in hypnobirthing, a self-hypnosis process that aficionados claim gives them a joyful birth, rather than a horrific one. “Suffering does not have to be a natural part of labour,” said Esther, who used hypnobirthing for the birth of her second child. “The birth of my first child was long and hard work, but this method really helped me relax, feel good about the birth and, more importantly, feel in control. That is so often not the case and while a mother should be able to be direct and get what she wants, she often feels powerless.”
This is when a doula can be indispensable, as Viktoria Löwenthal, a doula from Sweden, notes. “The doctors are not trying to be mean when they are working,” she said. “They are professionals, and for them, [medical intervention] is the safe way, very fast and very clean, Monday to Friday, when everything is covered. When people have a doula at their side, however, they know they have somebody supporting them, giving them extra energy, someone speaking up for them, who knows what you want because you have spoken about it with her in advance.”
The husband or boyfriend also needs to feel relaxed, Viktoria says, which is why she offers classes for pregnant women and their partners to help them prepare, based on the Swedish ‘Annas Profylax’ concept.
“This teaches people what to expect in labour, breathing and relaxation exercises, massage techniques and also how coaching and visualisation can be used. It’s very focused and we always involve the partners as much as possible,” she said. “We go through the different phases of labour, looking at them in a calm way, and we look at the contractions as a positive force rather than something to be scared of. We all want to say “no, no, no” at first, but without them, you wouldn’t see your baby, so we focus on that! Labour is painful, there’s no getting away from that, but I try to separate the pain from suffering. When you get to the point where you want to quit, you know you are almost there!
“The men who come in are very positive. At first, they think they are coming to a hippy place and that we are all going to sit around pushing together, so I always make them feel safe and reassure them they won’t be made to feel stupid! I give them basic tools so that after the birth, the wife or girlfriend can say: “My husband was breathing with me, he was holding my hand.” Often, at the hospital, the midwife will sense the man is nervous and tell him to go to the bar! But you should never leave a woman in labour.
“The midwives may be angels, but they come and go, so a doula, or a well-prepared husband or boyfriend, can make all the difference.”
Amy Proszowski, a doula and yoga instructor from Canada, runs yoga classes for expectant mums. “Yoga is a very soothing way for women to commit to quality time with their baby. We also use meditation and visualisation to help them connect with their bodies at a time when they need to be intuitive and in touch with the sensations. Prenatal yoga also tones the pelvic floor, which helps during birth and also helps recovery.
“We seem to have lost that innate intuition about what is actually happening with our bodies. Pregnancy, labour and birth have become physiological processes: we are not even a part of it anymore. The people in my classes are worried before they go for ecos [ultrasonogram], and they are worried they are going to have to have an episiotomy. I just help them focus on a baby that is healthy and fully nurtured by the mother who has a healthy and positive attitude.”
Things are changing slowly within the Spanish system, however. At least three Barcelona hospitals are now open and prepared for natural births and more women, local and foreign, know what the options are. Home births are also on the rise.
Krishinda Powers is a British-trained American midwife who advocates home birthing from her clinic at the MareNostrum Centre de Salut Familiar. “Women in labour need time, peace, security and space, and home is the one place you can have privacy and feel safe. You won’t, for example, have a medic popping his head round the door asking a colleague if they want to go for lunch in a minute!” she said.
“As a midwife, I’m dealing with individual women, individual babies and individual births. I work with the mother and baby before it is born. I get to know it with my hands and it is always a very special moment when the baby comes out and I think: “So that’s what you look like!”
“During labour, we are fully trained to know when things are going wrong, and of course get that mum medical assistance if necessary. They are not failures if they need extra help. But most of the time, women are more than capable of doing the one thing they were put on this earth to do, without medical intervention.”
Uby Muñoz—Barcelona Well Woman Clinic, Bruc 38. Tel. 622 720 499. email@example.com; www.bcnwellwoman.com
Viktoria Löwenthal—Tel. 667 546 194, firstname.lastname@example.org, www.maremeva.net
Amy Proszowski—Prenatal yoga classes every Thursday at 6.30pm at Well Woman, as well as private classes at home or at Well Woman. Birth preparation workshops twice a month at La Mama Vaca or private workshops at home. email@example.com; www.yogadoulaspain.com
Marenostrum Centre de Salut Familiar—Fontanella 16 pral. Tel. 93 302 2915. www.marenostrumcsf.com
Monthly pregnant women get-together
To help English-speaking women navigate the available childbirth choices in Barcelona, several birth professionals have got together to offer an informal monthly meet-up for pregnant women. Meet-ups will take place on the last Thursday of each month at Mujer in the Born. Carders 28 (Metro: Jaume I). Tel. 93 315 1531 or firstname.lastname@example.org.
For more details about doulas: www.doulas.es