Of Birth, Spanish Obstetricians, bad jokes and roses by Jesusa Ricoy-Olariaga
I am a Spanish woman who has been living in the UK for as long as I lived in my own country (18 years). I am a mother of three, a doula and childbirth educator. Occasionally I train doulas and other professionals in Spain and I founded a network modelled on Sheila Kitzinger’s Birth Crisis Network (I also volunteer for BCN). Over the years I have developed a social network of Spaniards who are either involved in birth or simply support a more progressive approach than the one which seems to be the norm.
When I talk to fellow Spaniards I sometimes feel as if I am in the movie 'Back To The Future', explaining to people in the 1950s how life will be thirty years later. I tell them that doulas are present at births in the UK, unlike in Spain where they can act only in a postnatal capacity, pretend to be a member of the family or wait outside the labour room entirely.
I tell them about my lovely team of midwives at my home births, paid for by the NHS.
In Spain home birth care is private. You have to pay for independent midwives or obstetricians, and they are not widely available. Even if you manage to find care, if you end up needing hospital assistance for any reason most likely the care given to you will include retaliation against you for having had such silly ideas in the first place. Like a runaway having to come home because they've run out of money only to be punished.
I know things in the UK are far from perfect – I disagree with offering sweeps at 40 weeks, for example – but in Spain, most of the time there is no choice; they just do a sweep without even telling you. I'm sure there must be competent professionals who do their job properly in the country of my birth, but recently I've really begun to wonder.
In Spain we have a 90% episiotomy rate, a caesarean section rate of around 22% in public hospitals and 32% in private ones, and we don’t even know the statistics for the use of forceps or ventouse because they're not recorded (the lack of data and transparency is a major problem). Women are often verbally and physically abused by their obstetricians and Kristeller’s manoeuvre (fundal pressure) is a common practice, yet never recorded in the notes. In Spain it's either epidural or nothing (epidural rates are currently around the 80% mark) and women are still systematically shaved and given an enema in most hospitals.
On top of all that, we've now discovered that instead of trying to improve birth and the care of women, obstetricians and gynaecologists are laughing at us.
Overleaf are four of a series of 21 cartoons that the Spanish organisation El Par to es Nuestro publicly complained about in the second week of September 2011. They were drawn by a gynaecologist member of SEGO (Spanish Society of Gynaecology and Obstetrics) and published in La Gaceta, the professional journal of SEGO, for everyone to see online.
The cartoons poke fun at prolapses, incontinence, STIs, non-medicalised birth, babies and it seems all women in general. They even joke about approaching attractive patients in a sexual manner. The cartoons portray women as largely illiterate and the doctors as men.
You think this is bad? Some of us thought so too. So I opened a Facebook group and started campaigning. Soon we had over a thousand people getting together, signing petitions and generating ideas.
I proposed using roses as a symbol to represent women, and with the wonderful creativity and talent of the people in the group we created a logo for our campaign. We called it The Roses Revolution: a movement against obstetric violence, and had quickly organised some actions and demonstrations in several Spanish cities.
From my point of view things were bad, but what was horrific, and still is as I write this piece, was the silence. The silence of midwives, of student midwives, of female gynaecologists and obstetricians, of women medical professionals in general who work with, or as part of, SEGO. Only a few have spoken out, so few I can literally count them on one hand. On top of that, in the few media outlets who touched on the story, the comments were shocking.
We received even nastier and more degrading insults from women unconnected with SEGO or the medical establishment in general, who insisted that the whole debate was based on a sense of humour. Even a well known author and paediatrician, who many women respect for his approach to breastfeeding, stated in an online interview that there was no need for all the fuss and that he wouldn’t want to live in a country where his freedom of speech was reduced in any way. We were, on many occasions, in various online publications, called 'Feminazis'.
Meanwhile, where were Dr Josep Lailla, President of SEGO, or Dr Server, gynaecologist and part-time cartoonist?
Well, the former stated in a radio interview that the whole thing was just a bit of a joke and that he was shocked and displeased with the reactions they'd received. When under pressure from the Ministry of Health, Gender Equity and Social Affairs, he stated that they were going to ‘analyse the comic strip’ to see what could have caused such upset. This analysis must be more in-depth than expected, because there still hasn't been any apology, and although the cartoons have been removed from SEGO’s website they have been frequently reprinted. As for the latter, Dr Server, he won't speak without his lawyer.
It really feels to me that many women in Spain are being systematically and institutionally abused and nobody cares. Yet more women inadvertently defend the abuse because they believe it's a necessary part of the process.
You think I'm exaggerating?
I created a page for women who could not actively participate in our various actions and demonstrations, in order to document the horror many of us go through at the hands of medical professionals in Spain. This quickly filled up with a litany of abuse.
One women stated that, ‘They immobilised my hands so that I couldn’t move during the placenta extraction.’
Another older woman, a widow, claimed that when going for a vaginal examination the doctor exclaimed, ‘Gracious me! You have cobwebs up here!’
And it gets worse. Yet another wrote:
‘I was told off for not coming earlier with the first contractions. They said that my waters were leaking so it would be my fault if the baby died of sepsis. I was forbidden to move from the bed for 10 hours. They insisted more than 15 times that I needed an enema. They did eight vaginal examinations without asking for permission. A plumber arrived to carry out some work without my consent. There were mistakes in the monitoring of my baby’s heartbeat. They were actually taking my pulse from my thigh. I had to insist and insist for them to double-check as one of the midwives was ready to go for caesarean section. They never answered any of my questions. The effect of the epidural (which I requested for the lack of mobility and resultant pain) wore off before they performed the episiotomy, so forceps and stitching was done without any anaesthetic. My baby was eventually passed over me for about two seconds before they took him away again. I even had to put up with comments such as, “We don’t do natural birth here, we do managed birth” and “How I wish they all birthed weekdays between 8am and 6pm” said within my presence as if I wasn't even there.’
It is an utterly devastating picture for me as a very passionate birth activist, as a mum, as a doula, and a Spaniard, one who feels very 'lucky' to have given birth at home in London.
I wish, hope and fight for the day where giving birth is not a matter of luck, but a matter of respect.
However, I know that this respect also has to come from the women in a society, where demanding an end to brutality against our bodies is perceived as 'feminazism'. Where even highly respected and intelligent professionals consider these horrendous attacks from the doctors who handle the most sensitive and emotional parts of our bodies to be simply freedom of expression.
It's not going to be an easy task and I think this issue is serious enough that it should be considered by EU regulatory bodies. We simply cannot tolerate, in a so-called civilised society, for women to continue suffering mutilation of their bodies and genitalia. In a country with a 90% per cent episiotomy rate this is institutionalised mutilation.
We cannot raise a healthy society if so many of the population are damaged by their birth or believe that birth means horrific torture and exposure to abuse.
There is nothing else to call it: it is violence and abuse.
So it is time to say 'No more!'
I just hope the message will travel far and the pressure on Spain will grow. I hope this for my friends, for their daughters, for the genuine professionals and for all women everywhere.
Quick ... call the pediatri... the geriatrics team! We have another prolonged pregnancy!!
Quick, put him back, she hasn’t signed the consent form!
A smear every three years? How strange!!…My gynecologist does it every three months…
Maybe it's me, but seeing this pessary, I'd have preferred surgery ...
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