Childbirth Choices

By the time this column is published, our family size will have increased by one. Since, as I write, the big event is drawing nearer every day, I find myself reflecting on my previous birth experience here in Spain and wondering about what this next one will be like.

The first time around, I diligently signed up for the childbirth preparation course that was covered by our private health insurance policy. Run by two women doctors, I figured it would promote a progressive, feminist approach. Early on, one of the instructors lamented the fact that so many women who came to her practice used euphemisms to refer to their “private parts” or “down there.” “We need to call things by the proper names!” she thundered. “Sing it, sister!” I wanted to cheer. Bring on the vagina power!

After awhile, however, I began to suspect that her issue wasn’t so much about reclaiming our bodies as it was a penchant for correct medical terminology. After all, she was similarly upset that people here refer to lower back pain as dolor de riñones or “kidney pain.” And some of the other things she said didn’t quite gel with my imagined enclave of sisterhood. On the subject of enemas, still the norm here, she said: “Don’t worry, you’ll be glad you had it. Just imagine if you accidentally pooped on the delivery table — wouldn’t that be horrible?”

In another session, the instructor discussed proper birthing decorum. Apparently, despite the pain, one shouldn’t make a lot of noise: “Remember, you are ladies, not animals!” Oh, I thought. I guess she’s not going to encourage us to find our own personal birthing sound.

We did have a class early on about different breathing techniques for labor, though it was mostly theoretical. With so many people packed into a small, un-air conditioned room in the heat of summer, we were only allowed to practice each type of breath once, lest we collectively use up all the oxygen in the room. She told us to practice at home, but since we were all giving birth in private clinics, perhaps it wasn’t that important — “you’re all having epidurals anyway, right?” When we began our eighth month, we could attend weekly 30-minute sessions with actual breathing practice, exercises, and relaxation; but since Pedro was born two weeks early, the few I attended didn’t exactly make me feel prepared when the moment arrived. As fate would have it, my labor and delivery happened so quickly that I arrived at the clinic and had Pedro an hour later, with no time for an enema, epidural, or much of anything else.

This time around, I have the same doctor and clinic, but I attended a preparation class given through the local public health system. The midwife who was to teach it seemed more of the extended breastfeeding/family bed type, quite unusual for Spain, but she was out on medical leave for most of the classes, so we had a hodge-podge of substitutes. The classes were supposed to be weekly two-hour sessions, with the first hour devoted to lectures and the second breathing, prenatal exercises, and relaxation. However, due to a severe midwife shortage in the public health system, ours was really two groups combined into one, again, crammed into a small room, so once again the practical side was given short shrift.

Not to be daunted, I turned to the internet to fill in the gaps. I frequented message boards with names like “Childbirth Choices” and read about the numerous options available to women in the US. Unfortunately, none of that seemed to transfer here. Doulas? Nope. Water birth? Nope. Birthing ball? Nope. Classes on Hypnobirthing, the Bradley Method, or other natural childbirth techniques? Not unless you count ordering books and tapes from Amazon.com. Birth plan? Just go to the hospital when labor begins and let the doctors take over from there.

Here in Spain, labor and delivery is a fairly intensely-medicalized, intervention-prone procedure. In both public and private hospitals, most women still give birth on their backs, on a delivery table, legs spread and braced under the knees. This may partially account for why episiotomies are almost universally performed in first-time deliveries. Both external and internal fetal monitoring is routine, and procedures and drugs to keep things moving along at a speedy pace are common. One recent study (2000) lists a combined Cesarean/instrument-assisted delivery rate of 40%. The same study cites an epidural rate of 89%, and that includes births in the public system where epidurals are not always available to women who request them.

As my second labor and delivery experience approaches, I feel a pang of wistfulness reading through the message boards. While most women in the US probably still do have hospital births that are likely not terribly different from the ones common here, at least there are different options to consider. But then again, more choices lead to more pressure, and potentially, more guilt. Here I have never heard women compete over whose birth experience was more authentic, empowering, or personally fulfilling. I know that some women are happy and some are upset about how their particular experiences go, but in the end most agree that the outcome — a healthy baby — is the most important part.

I don’t know what is in store for me this time around. Sure, I would have liked to have had more options, but considering that a nap-less Pedro has meant that I haven’t even had the time or energy for a simple daily prenatal exercise routine, I doubt I would have been able to master any more complicated pain-management techniques. While homebirth sounds like a great choice for some, I don’t picture myself going that route, either, and I also don’t imagine I will be in the frame of mind to challenge a set of strict hospital policies while dealing with labor. So, I’m just going to hope that it all goes as quickly and smoothly as last time (well, maybe not quite as quickly, as we now live a good deal farther away from the clinic!). If things get complicated, I will probably opt for the epidural and hope for the best. Whatever happens, I will focus on the outcome — hopefully, a healthy baby — without dwelling so much on how he gets here.

And that, dear readers, is my “birth plan.”