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Birth in the 21st Century is a Spanish documentary produced by a Spanish television company with English subtitles. It has five episodes with an option to visualise detailed graphics on birthing statistics in Spain by clicking on a magnifying glass icon on the screen. There are prompts to help you to develop your own birth plan in English, which can also be downloaded. It is an informative documentary for anyone interested in birth and includes a separate section on birthing during the Covid-19 pandemic. It is easily accessible at http://lab.rtve.es/webdocs/parto-respetado/en/expectations.
By Rachel Boldero
Birth in the 21st Century is a Spanish documentary following five families from the antenatal period through labour and birth and also into the postnatal period. Two families are first-time births and all five mothers birth their babies vaginally in a hospital setting. One family experienced birthing during the Covid-19 pandemic. Whilst this film was primarily produced for a Spanish audience, it is also great to celebrate the range of birth resources available outside the UK, albeit with some important caveats.
The births shown are beautiful and the film strikes a fairly good balance, depicting a natural and gentle birth coupled with the discomfort that some women experience. The bond between mother and baby is also gorgeous throughout. I like how the film is split into clear sections with pop-ups about options for developing an individualised birth plan. There is also the option to look at flashy graphics on Spanish birth statistics for those interested in caesarean birth, induction and episiotomies. However, I believe there are some fundamentals missing, which I will expand upon below.
I love how calm the women are (particularly at the beginning of the film) and how well they are supported by their families. Despite research showing that birthing people in Spain report high levels of obstetric violence,1 it is clear that hospital is viewed as a safe place: the film mentions that some of the women wanted to go to hospital so that they could ‘safely’ have their baby. I view this as a positive, as we want to eradicate as much fear from birth as possible, ensuring that we are not inhibiting those fundamental hormones needed for the birthing process such as oxytocin. However, there is no mention of birthing at home or in other non-hospital-based settings as a safe option. Also, the mode of birth is one-dimensional, showing only spontaneous vaginal births.
Another positive aspect for me is seeing how the midwives interact with those giving birth, ensuring they are kept fully informed and obtaining consent before carrying out any examinations. I appreciate the midwives’ attitude and the language they use throughout the film, e.g., ‘we don’t need to know yet’ in terms of whether the woman could feel the head, ‘you know better than I,’ ‘you need to do what your body asks you to do,’ ‘you are in control.’ As a student midwife, I really embrace such phrases and strive to mirror them in practice. This theme also plays into the pop-up messages, prompting women to consider things like what position they want to be in when giving birth.
I enjoyed how delayed cord clamping, skin-to-skin and the administration of vitamin K feature, and whilst this is now generally commonplace, I think it is useful to draw the viewer’s attention to such aspects of the period immediately post birth so that they can consider their own wishes. It is also great that the third stage of labour is covered, which is sometimes missed from birthing information and again prompts the viewer to consider this for themselves. Breastfeeding is also depicted positively, and I found it refreshing that in one scenario the baby took some time to get used to this, highlighting that it can require patience on occasion and again preparing the viewer for what may be to come – it’s not always the easiest of rides!
However, there are some aspects of the film I’m not so keen on. It is always a challenge to make a resource that completely covers all aspects of birth, but this film concentrates only on spontaneous vaginal births and babies who breastfeed. It might be more realistic to actually see caesarean birth, induction and bottle-feeding and also to have same-sex couples represented.
In addition, I feel that some elements of the birthing and postnatal period are glossed over. In reality, some women are shocked by the birthing process or feel low in the days and weeks afterwards. Perineal tearing is also a common aspect of birth and is only mentioned very briefly, yet for some women this can be pivotal. As always, it’s a delicate balance of setting families up for a positive birth, but ensuring individuals are aware of possibilities and being encouraged to be open-minded about some things so they are better informed and more able to cope emotionally and physically.
The film is not set in the UK and it goes without saying that there are some elements that I wouldn’t be as comfortable witnessing in practice. For example, one of the women is hooked up to a CTG (cardiotocography medical assessment of baby’s heartbeat and the uterine contractions) immediately upon admission; there may be a reason, but it isn’t made clear. She had been coping well in an upright standing position but doesn’t look at all comfortable attached to a CTG in the chair, which is such a shame. Furthermore, one of the midwives appears to apply a considerable amount of pressure directly to the baby’s head during the birth. I believe this was probably a bid to prevent tearing; however, the evidence on whether or not ‘guarding the perineum’ is of benefit is still not clear.2
Overall, however, I really enjoyed this film. I love the format and the positive focus on birth, which can and should absolutely be an empowering process. The film reiterates the overwhelming joy that a baby brings to a family, prompts viewers to consider many useful aspects for their birth plan and includes some incredibly cute babies! I think it’s a positive resource to encourage those in the antenatal period to consider aspects for their birth plan, reiterating the incredible process of birth along the way.
Author Bio: Hi, a little about me! My name is Rachel and I’m an AIMS Volunteer who decided to pursue a pretty drastic career change last year to become a midwife. I’m now nearing the end of my first year of training in South Yorkshire and am absolutely loving it. I’m always keen to review resources aimed at pregnant women/people and their families and was really pleased to watch Birth in the 21st Century.
 Mena-Tudela D et al. (2020). Obstetric Violence in Spain (Part I): Women’s Perception and Interterritorial Differences. International Journal of Environmental Research and Public Health 17(21):7726. www.mdpi.com/1660-4601/17/21/7726.
 Aasheim V et al. (2017). Perineal techniques during the second stage of labour for reducing perineal trauma. Cochrane Database of Systematic Reviews, Issue 6. Art. No.: CD006672. www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006672.pub3/full.
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