Reflections on midwifery in Spain

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Este es parte de otro articulo publicado en The practising midwife Volume 8 N 2 La autora es Elizabeth Arthur.
En todos lados nos ponen a bajar de un burro¡¡¡¡

Working independently in Spain.

In 2001 i held up my hands and admitted that I was addicted to the ever growing number of television shows encouraging the mass exodus of my fellow countrymen and women to warmer climes. I was also guilty of perusing homes in the sun style magazines depicting a more relaxed way of life where men still ride donkeys into town to buy their weekly shopping. With thoughts of working as an independent midwife and with basic knowledge of European and Spanish law I came to the conclusion that if living abroad appealed to me and mine then surely there would be scores of women contemplating family life abroad. So armed with a husband, three kids and a dog, we joined the exodus to Andalucia in search of a different way of life, better health and the desperate hope that we were doing the right thing.

Limited role.
After extensive research, it became very clear that working within the public sector was definitely not in my best interests. In Andalucia, the role of the midwife lies mainly within the labour ward, where they are assisted by Obstetric nurses. There is limited primary role in postnatal care and very little antenatal education. Althoung midwives do provide antenatal clinics in local health centres, postnatal care is restricted to performing the Guthrie test for baby on day seven and a postnatal check for mum at 30 days. There is no community based service. Midwives appear to be governed by strict protocols and procedures, which include continuous CTG monitoring, IV fluid therapy not eating or drinking in labour, routine use of episiotomy for primigravidas combined with fundal pressure for the second stage. Pubic hair shaving and enemas are still used frequently. Partners are not allowed to be present during admission into hospital for approximately half an hour and are asked to leave the room during vaginal assessments. In some hospitals, partners are not present during ultrasound scanning. Sadly, husbands or partners are not allowed to be present during assisted births or caesarean sections. Homebirth is not offered at all. If you are ill, then you will receive excellent medical care. However, for many women particularly those who already have children, the rigid policies and lack of choices for childbirth have caused many to return to their native countries for care. In publick hospitals caesarean section rates are low, being performed only when absolutely necessary. Unfortunately, this is not always the case in the private sector where the euro appears to be the deciding factor.
One thing became very clear, and it was being shouted from every clinic, private hospital and labour ward: Normal uncomplicated pregnancy and childbirth was actually a high risk situation that needed strict control and absolutely no adherence to the wishes of the mother, her partner or even sometimes the midwife who was caring for her.