Homebirth
While most people accept that giving birth will mean going to hospital, a small, but growing number of families are opting for natural births at home. Giving birth naturally means having no medical interventions or anaesthesia. Some people feel they will not be provided with support for this choice in a hospital and so choose a home delivery. The homebirth rate is low in Spain, an estimated 0.05 percent compared with up to 20 percent in some regions of the UK. Catalunya has the highest homebirth rate in Spain, an estimated one per day.
“In the Sixties, after the Civil War, big hospitals were built and birth moved from home to hospital,” said Montse Catalan, an obstetrician who works at Migjorn Casa de Naixements birthing centre. “In the Seventies, the feminist movement in Spain had so much else to battle with after Franco that birth was overlooked, and by the Eighties the medical profession was using Oxytocin [a chemical to accelerate birth] and constant monitoring of foetal heart rate as standard. Because of the artificially stimulated contractions, and not being able to move from a bed, birth became more painful, and the epidural [a form of anaesthesia] rate peaked in the Nineties. Spain still has one of Europe’s highest epidural rates.”
In a hospital setting here there is not much scope for natural birth, according to Mireia Marcos, a UK-trained midwife who works at the Marenostrum Centre. “Many women [who want a natural birth] are frightened of what happens in the hospital, but there is not a wide range of choice,” she said. “There are only two hospitals here in Catalunya where you can guarantee that you can have a natural birth in vertical position. They are Santa Catarina in Girona, and Hospital de Vendrell in Tarragona. The Maternidad [in Barcelona] has a natural birth protocol, but in reality they have very few midwives who know how to deal with a birth without epidural.”
In a normal pregnancy, all that’s required to give birth naturally and safely is trained support and a comfortable setting, both of which can be provided at home. To prepare for a homebirth, the couple and midwife meet early on in the pregnancy and then every month, and it’s important that they build up a good relationship. At the same time, expectant mothers go either through the state Seguridad Social or a private health scheme for scans, checkups and blood tests.
Homebirth is not covered by the Seguridad Social, but is cheaper than birth in a private hospital. There are three main options: the first is going through a family health centre that offers homebirth and has its own team of midwives. Costs start at €1,300, with the actual expense depending on how many prenatal visits are made. Another option is finding an independent midwife either through websites, forums or by word of mouth. A third option is to go to a birthing centre. The nearest one to Barcelona is Migjorn Casa de Naixements. They offer a safe and comfortable space with a birthing pool; a good option if the home of the mother-to-be is not suitable or she simply wants a different environment.
After an initial free consultation, the couple will have a more detailed session where they can discuss any issues that come up. Mireia Marcos said that this is the point when the issue of safety usually arises. “It’s quite common that the woman wants a homebirth, but her partner has safety concerns. It would be terrible for the woman to be giving birth at home and the partner not to be happy with it, and we don’t allow this to happen. We are evidence based; we have research and the World Health Organization guidelines to back us up. We talk in a scientific way, we are not silly hippies; we are professionals. When the men talk to us, they realise we are professionals, and they accept us.”
One of the most common concerns is what happens if an unplanned caesarean is needed. “If this happens we phone the hospital and say we need the operating theatre,” said Marcos. “We get into the car and the husband drives on a route that he has practised during the pregnancy. We are never more than 30 minutes from a hospital. When we arrive the woman goes straight to the theatre.”
Other concerns are bleeding, or haemorrhage after the birth, or having to resuscitate the baby. “The good thing about these problems is that they can be sorted at home. We have drugs to stop haemorrhage, and the equipment to resuscitate babies. We go on regular training courses and are specialised in these kind of problems.”
Once a woman goes into labour she stays in contact with her midwife until she is in labour proper, when the midwife comes round to help. A family can also choose to have a doula present at the birth. A doula is a woman who has experienced and assisted births, and is there for emotional support. She can help a pregnant woman prepare for birth at home or hospital, support her during birth and offers post-natal support and help with breastfeeding. There are no home checkups by a health visitor here, so doulas are especially useful for those who have no family nearby.
Women often choose homebirth because they want to be in control of their experience, which is not always possible in hospital. “In hospital it is the institution that makes the protocol and it’s the medical team that decide everything from who can be with a woman during labour to all the medical practices applied,” said Montse Catalan.
Catherine Sherry gave birth at home. “Here, the ‘norm’ is a medicalised birth, but I knew that that could lead to other complications like forceps delivery, episiotomy [a cut made to ease the exit of the baby] and even a higher chance of having a caesarean, and I wanted to avoid this,” she said. “The birth was amazing. Afterwards I was so full of energy and almost high. The feeling of euphoria lasted a long time and I still get emotional when I talk about the experience. It was incredible.”
Although pain is a common issue surrounding birth, it is well known that the less stressed a woman is during labour, the less pain she will feel. Homebirth midwives offer the use of homeopathic medicine, aromatherapy and a birthing pool during labour to minimise stress and aid in a birth with little pain.
While homebirth rates are still low, it is fast establishing itself as a viable option for families who want a natural birth, especially while it’s still almost unavailable in Spanish hospitals. While it is not for everyone, for some there is nowhere quite like home.
Family health centres offering homebirth:
Doulas:
Birthing centres:
www.diwebtori.com/montse/index.html
(Migjorn. Sant Vicenç de Castellet)
www.acuario.org (Near Alicante)
Other useful links: