Resignation of the President of the Spanish Society of Gynaecology and Obstetrics
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Considering the statements made by the President of the Sociedad Española de Ginecología y Obstetricia (SEGO), Dr Martínez-Astorquiza, in the El Correo (1) newspaper on 25th November, regarding a baby’s death after being transferred to a hospital from home, where the baby was born:
“Giving birth at home is putting yourself at stake. Nowadays, it is a complete nonsense”.
“If 35 % of deliveries need help, that means that in case all these women gave birth at home, it would be difficult for us to solve complications in one out of three cases”.
“I do not dare to state that home deliveries should be prohibited as we live in a free country. But I don’t like them because we are not ready to assist the potential health contingencies which may occur during a delivery at home. Whether they are in Euskadi, Spain nor in most of the European countries”.
The undersigned join in urging for the retraction of such statements in public media. Nevertheless, we also request his immediate resignation due to the following reasons:
It is the women’s decision to choose where to give birth in the exercise of their sexual and reproductive rights, and according to the own Spanish Law of Patient Autonomy. When making such decision, they have the right to have access to the updated scientific information and evidence, as well as to be assisted by health providers who meet those requirements.
It is embarrassing to remind Dr Martínez-Astorquiza the wide scientific literature regarding the safety of planned home deliveries with the assistance of midwives around the world. For instance, in Europe, the English system consider them part of their public national health system. The studies made by the Royal College of Obstetricians and Gynaecologists and Royal College of Midwives from the UK, as well as by The Society of Obstetricians and Gynaecologists of Canada are an example of this. Besides the wide literature summary published by the University of British Columbia in 2009 (2). This practice is not only possible and safe but also desirable and defended by numerous institutions in our country, especially by the Colegio Oficial de Enfermeras y Enfermeros de Barcelona [The Official College of Nurses of Barcelona] with its Guía de Atención al Parto en Casa [Homebirth Assistance Guide] (3).
SEGO’s president states that in 35 % of the cases at the hospital, the deliveries “need help” from health providers, ignoring the report from the proper Health Ministry (4) published only five years ago in which the Estrategia de Atención al Parto Normal [Strategy of natural childbirth care] is evaluated. This report outlines that:
“The use of oxytocin during dilatation in 53.3% of the deliveries of spontaneous onset seems to be higher than it is desirable. A figure that is way too far from the expected standard (i.e., 5 to 10 %, considered a good health care practice)”.
“Episiotomies are performed in 41.9 % of the eutocic births, which is way too far from the recommendable practice (<15 %)”.
“While inductions are performed in 19.4 % of deliveries. This figure is higher than the reference standard recommended by the WHO (less than 10 %). Such excessive number of inductions shows the need to figure out the causes, in order to be able to evaluate these data as a whole, to think about the induction indications and the fulfilment of the EAPN recommendations for the obstetrics personnel”.
“The use of epidural analgesia is too high with a percentage of 72.2 %, and it’s not only due to clinical indications but also to the demands created by the health care services and its reflection on the demands of pregnant women. This high percentage of the use of epidural analgesia, too far from the EAPN recommendations, suggests that the primary care providers are not making enough emphasis on the information for the users, as well as that the hospital care providers are not offering enough alternative methods to deal with the pain”.
“In 87.4 % of the vaginal deliveries, the lithotomy position during the whole second stage has been maintained. Therefore, it might be considered that nowadays the standard position during the second stage is still in lithotomy or supine positions, which is more favourable for the health providers than for the mother. The desirable standard is not reached and, probably, it may suggest that changing acquired routines is difficult”.
“The kristeller maneuver is still used in 26.1 % of vaginal deliveries. Although it seems to be a disused technique taken apart from the conventional practice, it can be observed that this maneuver has not disappeared, but it is still used in a high ratio of births. Hence the need to keep on monitoring its use in deliveries in every hospital”:
And, despite the shy progress put into practice, despite all the difficulties, despite the health providers committed with the goods practices who disagree with the above-mentioned statements, a great disservice is made to these health providers by making such statements while holding a position in that institution.
The right to decide and access to such scientific evidence is breached when from a powerful position and with media coverage such as that of the president of the Sociedad Española de Obstetricia y Ginecología, these statements are made, without scientific basis, with the aim of frightening and blaming women in their free choice.
A baby’s death is individually, socially and professionally devastating. We could understand (not justify) that a person, or the personnel who have participated in a case like this, vents his/her frustration or his/her personal opinion -individually- in his/her immediate circle, regarding what happened.
But, in a modern society and among the top countries in many fields, there is no room for the President of an institution which represents most of the collegiate members in the fields of obstetrics and gynaecology to blame an informed woman of her baby’s death as she chose a home delivery. By disregarding or ignoring the scientific evidence about it; breaching her right to privacy and confidentiality during the most awful and increased vulnerability moment of her life, with a media coverage provided by the fact of speaking on behalf of such institution (we can easily assume how difficult will be for the mother to overcome this grief under these circumstances), and in a presumably conflict of interest as he is, besides, the chief of the obstetrics and gynaecology services of the hospital where the decease of the baby took place.
It entails, under our understanding, a case of institutional violence against women, precisely amid the month we fight against and request the end of all kind of violence against women just for being women.
For all these reasons, we request the public retraction of such statements and the resignation of the President of the Sociedad Española de Ginecología y Obstetricia.
(2) Society of Obstetricians and Gynaecologists of Canada. Midwifery. J Obstet Gynaecol Can.2003;25:239. [PubMed]
Cresswell JL, Stephens E. Home births. London (UK): Royal College of Obstetrics and Gynaecologists and Royal College of Midwives; 2007. [(accessed 2009 July 31)]. Available:www.rcog.org.uk/womens-health/clinical-guidance/home-births
Lindgren H, Radestad I, Christensson K, et al. Outcome of planned home births compared to hospital births in Sweden between 1992 and 2004. A population-based register study. [(accessed 2009 June 26)]; Acta Obstet Gynecol Scand. 2008 87:751–9. Available: www.informa-world.com/smpp/content~content=a794025460~db=all~order=pubdate [PubMed]
Outcomes associated with planned home and planned hospital births in low-risk women attended by midwives in Ontario, Canada, 2003-2006: a retrospective cohort study. Hutton EK1, Reitsma AH, Kaufman K. Birth. 2009 Sep;36(3):180-9. doi: 10.1111/j.1523-536X.2009.00322.x.
Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician. Patricia A. Janssen, PhD, Lee Saxell, MA, Lesley A. Page, PhD, Michael C. Klein, MD, Robert M. Liston, MD, and Shoo K. Lee, MBBS PhD CMAJ. 2009 Sep; 181(6-7): 377–383. doi: 10.1503/cmaj.081869 PMCID: PMC2742137
Olsen O, Jewell MD. El nacimiento en casa frente al nacimiento en el hospital [Revisión Cochrane traducida].En: La Biblioteca Cochrane Plus, Número 4. Oxford: Update Software Ltd.; 2008. Disponible en: http://www.update-software.com/BCP/BCPGetDocument.asp?DocumentID=CD000352 (Traducida de The Cochrane Library, 2008 Issue 3. Chichester, UK: John Wiley & Sons, Ltd.).
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