Many pregnant women do not feel well informed by their gynaecologist

Jul 17 2008

A survey carried out among 250 pregnant women showed that 24% of them do not feel adequately informed by their gynaecologist, and almost half do not take part in any prenatal course. The study, prepared by the Head of the Obstetrics Department at the Hospital Clinico San Carlos in Madrid, Miguel Angel Herraiz, also showed that 80% of those surveyed prefer a "medicalised" birth, with epidural anaesthesia, to a natural birth.

The Head of the Obstetrics and Gynaecology Department at the Hospital Clinico San Carlos, Miguel Angel Herraiz, who presented the results of the survey this week at the summer course, Natural Birth -organised by Madrid's Complutense University (UCM) in San Lorenzo de El Escorial-, explained that the aim of the study is to find out pregnant women's preferences during birth, with there currently being a tendency in administrations and the media in favour of a more natural birth. With regard to the high number of women who believe their gynaecologist does not inform them properly, the expert recognises that "we need to provide a birth plan and explain well and at all times how the process is going to be".

The midwife at the Hospital General Universitario Gregorio Marañón, Mercedes Martin, pointed out during the course that information "is essential", and has explained the research project carried out at this centre with the objective of "women becoming the central figures in the birth of their own child". This involved the preparation of hospital visits, primary health care sessions, birth plans, satisfaction questionnaires and a birth chart showing measurements of cervical dilation over time, the foetus's heart rate and the mother's vital signs. Experts are currently entering the results into a database.

A prenatal course was essential for participating in this project "because the woman must be informed" said Martin, who explained that when many pregnant women are explained for example the benefits of moving about, the use of epidural can be reduced.

"Both the pregnant woman and all of society need to be informed", added the Head of the Obstetrics and Gynaecology Department at the Gregorio Marañón Hospital, Angel Aguarón de la Cruz, who believes that the results of the survey will be different in a few years time, after better explaining the different alternatives and improving the population's sex education.

The study consisted in a questionnaire of 34 questions put to 250 pregnant women of different nationalities and educational levels, between 16 and 45 years old, with an average age of 31 years and 1.89 children, with 52.8% using public health care and the rest private.

The results showed that "the ideal form of giving birth for pregnant women" is "medicalised" for 80%, natural for 16% and 4% with caesarean as their choice. "The higher the level of studies, the fewer the women wanting a natural birth", said Herraiz, with 12.5% of university students preferring this, 14% of those with professional training opting for it and 26% with just a basic level of education stating it as their choice. With regard to the place of birth, over 99% agreed that this should be in a hospital, rather than at home.

Some of the measures proposed by defenders of natural birth are the preparation of birth plans, walking and choosing the required postures (especially the vertical posture), use of baths and special salts, presence of person chosen by pregnant woman, alternative methods to epidural anaesthesia, not using oxytocin or serum, not carrying out episiotomy (a surgical incision in the vulva practised in certain births to assist childbirth and prevent tears in the perineum), and allowing the skin on skin contact of the newborn child with its mother, without immediate paediatric revision.

Herraiz recognises that the pressure of groups in favour of a more human birth has favoured the advance in recent years of aspects such as allowing partners into the delivery room or reducing the number of episiotomies from the 100% which used to be performed up until a few years ago, to the 40% carried out today.

The department head proposes that, for the small percentage of women who want a natural birth, instead of preparing all the hospitals, "a specific centre in each autonomous region can be provided, with the necessary equipment and resources, as well as health personnel sensitised to these types of births", in line with the recommendations of the World Health Organisation.

For his part, Angel Aguarón explained to SINC that a natural birth, or birth with minimum intervention requires three principles: greater participation from the partner (not only the woman), greater warmth and intimacy, and the cancelling or reducing of routines not backed by medical evidence (such as drips, episiotomies, inductions or caesarean births, if they are not necessary).

Aguarón advises, however, about the reality, because as the survey data shows, "most women want to continue with epidural", although those who are against claim it is due to the lack of information on alternative methods, such as balls or massages.

In any case, he believes that things are changing on this matter, and there is no need to look for guilty parties: "Sometimes people say it is the Ministry who is to blame, but they have now realised what is happening and are making a concerted effort; or the traditionalist, taliban doctor is at fault, but they have also realised what is going on and are changing; or it is down to society's ignorance, but they now have more Internet access and ask more. In short, actions are being taken, and the most positive aspect is that everybody is making an effort of moving towards a more human birth".