About a month ago the debate about home birth in Argentina started when A doctor He published in his blog a post explaining the case of a home birth that ended with the death of the baby.
His writing began to be shared on the networks until he went viral and thanks to that he crossed the borders and arrived in Spain, where the reactions are of astonishment, in accordance with the words of the professional, but also of indignation.
Indignation for lack of self-criticism and the iron defense of childbirth care that has not just adapted to the new recommendations, which still does not take into account that childbirth is a physiological process and remains how respectful towards women it should be.
The doctor's letter that has gone viral
Then I leave you with the post of which I speak, which on the internet is already known as the letter of the desolate doctor for the death of a baby in a home birth:
Many times I wanted to cry, holding a patient's hand. But never before had he felt like crying with rage and helplessness in that situation.
Today a mother with her dead son came to my guard. He had decided to have the delivery at home, although he was his first baby and was in podic (tail). From a well-off and educated family, everyone had tried to dissuade her, without success.
The criminals who agreed to carry out labor at home, being overwhelmed by the situation, called SAME. And an ambulance went to look for her, when there was nothing more to do. They did not even give him the birth (exit of the placenta), which we carried out here, in the delivery room, in antiseptic conditions, with serum, medication and surgical instruments.
All of us who dedicate ourselves to the noble art of healing, want things to work out well. We study, train and specialize, we do refresher courses to guarantee our patients the best care. Although in the public system we do not always have all the resources.
If I give you a serum, I am not disrespecting you, I am preventing you from bleeding if you get into hypovolemic shock.
If I give you medication, it is because it is necessary.
If I break your bag, it is because it is important to know the color of the liquid. It gives us information on how the baby is having a tummy.
If I tell you that you need a caesarean section, it is not because "I want to get rid of you quickly." I have to be here 24 hours. It is because I try, at best, to avoid complications. At worst, save your life and that of your baby.
Pregnancy and childbirth are physiological facts, it is true. But quickly, from one moment to another, they can become pathological and life-threatening.
Having a hospital, with trained equipment, with anesthesia, with an operating room, is a privilege. Privilege that our predecessors of past centuries could not enjoy. For centuries women died of complications in pregnancy and childbirth. They did not have the chance to choose.
My body, my birth, my decision?
It's not about your body: your son is in the middle.
My birth? You are not the only protagonist, you are really just a secondary character, the protagonist is him.
Your decision? You don't have the training to know when your life or your baby's life is at risk.
Primum non nocere. First do not harm. We know. You also have to know.
A logical defense, although lacking self-criticism
I think it's great that a doctor talks about what happens in hospitals, gives her version of events and defends her profession. Of course. The problem is that we have been hearing, reading and suffering in the first person for many years (I am not, that I am a man, but many women are), practically unspeakable deliveries happened in hospitals. Stories of professionals who do more harm than good instrumentalizing childbirth, trying to accelerate meaningless, putting women lying when they ask to be otherwise and making them feel silly or incapable, not only to make decisions, but to give birth. And in the end women have done what anyone would do instead: run away from hospitals, tired of waiting for childbirth care to improve.
That is why I have decided to give my vision of the letter to ask that she and the other professionals make self-criticism and begin to take their share of guilt: many women give birth at home because they prefer to give birth in a familiar environment and with professionals they trust, but many women give birth at home because they don't want to give birth in the hospital. A hospital they would go to if things were different; And this is very serious.
Today a mother with her dead son came to my guard. He had decided to have the delivery at home, although he was his first baby and was in podic (tail). From a well-off and educated family, everyone had tried to dissuade her, without success.
The criminals who agreed to carry out labor at home, being overwhelmed by the situation, called SAME. And an ambulance went to look for her, when there was nothing more to do. They did not even give him the birth (exit of the placenta), which we carried out here, in the delivery room, in antiseptic conditions, with serum, medication and surgical instruments.
The more absurd the situation seems, the greater the certainty that things could be done much better in hospitals. If a first-time mother with a baby in podium decides to give birth at home and not in a hospital, why will it be? How many women will have talked about their births to decide something like that? What was he running from? Why didn't the health professionals get this woman to have confidence in them when giving birth in a hospital? Think about it, because what happened to this woman is not the problem, but the consequence.
I don't know if they are criminals. I understand that he calls them that because he must have proof that they are not health professionals, not even midwives. Because if they are, there are many gynecologists in hospitals that could also deserve the name of criminals, I'm afraid. Are there no unexplained deaths in hospital births?
On the other hand, do you know what happened? Did those "criminals" force the mother to give birth at home? Perhaps they explained to him that the delivery in podálica is more risky than a normal delivery and that why in the hospitals cesarean section is recommended. But perhaps he was told that a vaginal delivery is possible as indicated by the Society of Obstetricians and Gynecologists of Canada, provided that freedom of movement is given, preferably done in an upright position and hardly involved in the expulsion. Y maybe they gave him a choice, because the decision was yours.
Better caesarean section? Well, after seeing it, it's easy to say yes. However, caesarean section does not always end well. A few weeks ago a mother died here in Spain after she was made one; Four months ago, another. And knowing that in Argentina the alarm has already jumped because more and more unnecessary caesarean sections are being carried out (the barrier of 30% of deliveries attended by caesarean section, which is more than double what WHO recommends) has been exceeded, It seems obvious to think that a woman may have serious doubts when deciding where to give birth.
All of us who dedicate ourselves to the noble art of healing, want things to work out well. We study, train and specialize, we do refresher courses to guarantee our patients the best care. Although in the public system we do not always have all the resources.
And the mothers more. They they want things to go well even more than all the professionals who are so updated. And despite that (or perhaps because of that) they continue to run away from hospitals because they continue to see that their birth will be a lottery: they may have respectful and up-to-date professionals who inform them before acting, let them choose, be kind and not hurry to act. But maybe not, maybe that day the midwife who judges more than informs, the gynecologist who does not explain anything to you before making a painful maneuver or that professional who decides that she is caesarean because after knocking her against her will and taking away the confidence that He will be able to give birth with his continuous messages of "you are not dilating anything, so you will not achieve it", he considers that the delivery is stopping.
If I give you a serum, I am not disrespecting you, I am preventing you from bleeding if you get into hypovolemic shock.
If I give you medication, it is because it is necessary.
If I break your bag, it is because it is important to know the color of the liquid. It gives us information on how the baby is having a tummy.
If I tell you that you need a caesarean section, it is not because "I want to get rid of you quickly." I have to be here 24 hours. It is because I try, at best, to avoid complications. At worst, save your life and that of your baby.
No, a serum is not disrespectful. But yes it is to put it without explaining why it is necessary, and without waiting for consent. No, the medication given is not always necessary. How many births has oxytocin been given to speed up the process when it could have been expected? It is possible that you have patience and do not do it, and that you only do caesarean section in case you consider it really necessary. But there are already many deliveries in which the professional is looking at the time more than the account and accelerates the process to finish earlier (perhaps he knows that here in Spain there seems to be more deliveries during the week than in the weekend). And I wish it wasn't.
Sometimes it is enough to approach the woman, explain what you see, or what you think, offer the solutions and allow her to choose the option to follow. No, I do not talk about going and saying "we are going to do a C-section because ...", but "it seems that the baby may not be well, we have seen that ..., we think that the best option is to have a C-section. If we do not, we can to happen this, although if we do it, this can happen. "
Pregnancy and childbirth are physiological facts, it is true. But quickly, from one moment to another, they can become pathological and life-threatening.
Having a hospital, with trained equipment, with anesthesia, with an operating room, is a privilege. Privilege that our predecessors of past centuries could not enjoy. For centuries women died of complications in pregnancy and childbirth. They did not have the chance to choose.
A privilege to be used when necessary, and when the woman has the information and consents. To make use of all this when it is not necessary is to overdo its functions, it is to jeopardize the physiological process and, if it is done without the approval of women, it is obstetric violence. Thus, births are multiplied in which babies are well (thanks or despite the attention received) and women suffer and cry for weeks, months and years when they remember how they felt, how they made them feel, how they treated them ...
My body, my birth, my decision?
It's not about your body: your son is in the middle.
My birth? You are not the only protagonist, you are really just a secondary character, the protagonist is him.
Your decision? You don't have the training to know when your life or your baby's life is at risk.
Yes. It's your birth and the birth of your baby, so yes it's your decision. Of course his son is in the middle; precisely because of this, because they believe that she and he will be treated better, many women do not even want to hear about giving birth in a hospital. Again, I should think hard about this.
And of course a mother does not have the training to know when her life or that of her baby is at risk, but you do; The professionals do. For this they have to be able to inform women for them to decide. Doctors do not train and update to decide for them, but to help them make an informed decision.
As long as this is not understood, nothing will change.
Primum non nocere. First do not harm. We know. You also have to know.
Exactly, doctor. First do not harm. This is why some women believe that it is better to run away from hospitals. Why they have lost confidence in their ability to first not harm. Perhaps if they saw that there is a bit of self-criticism, they would think better. Perhaps if they saw that they are able to say that they have been doing it for many years, but that they are going to try to be more patient, respectful and close, they would think better.
Perhaps if they relied more on a woman's ability to give birth and managed to convey that confidence to themselves, the deliveries would go better and there would be no need to intervene so much. Because as a physiological process it is, the woman's mind influences the future of childbirth, and the most that she may need is accompaniment; Accompaniment of someone to tell you that he is doing well and help her move forward when in doubt. And not of those professionals who doubt everything and make her feel incapable without her help ... as if they were there to take care of her birth because they are essential.
While everything remains the same, or worse (given the trend with caesarean sections ...), we will continue and will continue, there in Argentina, watching deliveries of women in their homes. Most will go well, and these mothers will make them think it was the best decision they could make. But others do not, and doctors will go out publicly to say better in the hospital, when we all know that today, it's not always true.
Photos | iStock
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