Cada día nacen niños en varios puntos del planeta. Sin embargo, no todos nacen de la misma manera o bajo las mismas condiciones. Algunos vienen al mundo en un hospital público y otros lo hacen en uno privado. Algunos en una casa y otros en una bañera. ¿Cuál es el caso de Sevilla?
Es como cuando vas a tener una relación sexual: con seguridad y sin interrupciones. De esta manera se consigue un nacimiento orgásmico. ¿Qué querrá decir? La idea que nos da la doctora Marsden Wagner, directora de la organización de la salud de mujeres y niños del mundo, no es muy convencional. Pero todo cobra sentido tras escuchar a Luz Viudes Middelman, una doula (o matrona sustituta) procedente de Tarifa, que nos comenta esta revolucionaria idea, al punto de parecernos hasta lógica.
En su labor como doula, Luz se dedica a dar apoyo emocional y psicológico a las mujeres durante el embarazo, el parto y el posparto. Sus ojos brillan cuando nos habla sobre lo que ahora se conoce como un nacimiento orgásmico: ‘las personas involucradas deberían respetar, tanto como sea posible, la intimidad y la conexión que se crea en ese momento’.
Aunque es difícil conseguir esa intimidad en un sistema sanitario público. Basta con imaginar esas horas previas al parto (el sudor comienza a brotar, las obscenidades salen a gritos, el dolor se intensifica). Y en ese mismo momento una mujer mantiene una conversación con su marido sobre los planes que tiene para cenar con los abuelos el próximo fin de semana. Este no es precisamente el entorno tranquilo e íntimo al que Luz se refería. Por tanto, ¿es ésta la única opción para las mujeres en España?
En Andalucía, las opciones para las mujeres que van a dar a luz se reducen a los sistemas sanitarios públicos o privados. Según Antonio Jiménez, jefe del departamento de ginecología del Hospital Universitario Virgen de Macarena de Sevilla, el 80% escoge la vía pública. Si el 20% restante escoge un centro privado para poder disfrutar de una mejor comida, una habitación individual antes y después del parto (sin la mujer charlatana) y una atención más personalizada, por qué escoger cualquier otra opción?
El dinero es un factor importante. El doctor Carlos Jiménez, quien ha seguido los pasos de su padre en el campo de la ginecología, dice que se debe esperar un importe de más de 4450€ ($6700) para dar a luz en un hospital privado. Este precio sería considerado ‘una estafa’ en los Estados Unidos, en donde el paquete completo de felicidad roza los 5850€ ($8800) según un reportaje del March of Dimes en 2007. El caso es que en Estados Unidos no hay otra elección y en Sevilla las mujeres pueden elegir no pagar una fortuna.
Antonio enumera otro factor crítico que afecta a la decisión que son los recursos disponibles en el sistema público (una ventaja de la que hacen eco Olga Merino y Morgan Reiss, dos madres en Sevilla). La asistencia médica, las salas de parto, el personal y la tecnología que se ofrece son de mejor calidad. De hecho, si hubiese alguna complicación durante el parto en una institución privada, la afectada sería inmediatamente trasladada al hospital público más cercano.
El doctor Jiménez nos explica que esta ha sido la situación desde 1975, momento en el que la tecnología mejoró notablemente el desarrollo de los embarazos, partos y nacimientos en Sevilla. De acuerdo con las estadísticas, la tasa de mortalidad infantil descendió en picado de 22 muertes de cada 1000 nacimientos a sólo 6 o menos en 1998. La tasa de mortalidad materna también descendió de los 46 casos en 1975 a 2 en 1996.
En el pasado, los bebes prematuros que cabían en la palma de la mano no tenían ninguna esperanza de sobrevivir. Con la incorporación de las ‘máquinas milagrosas’, como los ventiladores y las incubadoras, los 4000 primerizos que nacen cada año en España tienen ahora la oportunidad de sobrevivir. Luz Viudes añade que el método conocido como ‘el cuidado canguro’ ha mejorado el panorama. Este método enfatiza la importancia del contacto entre el bebé y la madre, que ayuda a estabilizar el ritmo cardiaco, la temperatura corporal y la respiración del bebé. Amamantar al bebé es también una parte esencial de este método para desarrollar la fuerza del recién nacido. Un bebé prematuro que recibió la ayuda de Luz debía permanecer en la incubadora durante dos meses; combinando la tecnología y el método, el tiempo se redujo a tres semanas.
Otro desarrollos tecnológicos incluyen esa maravillosa inyección que la mayoría de las mujeres exige, cuyo efecto adormece la zona abdominal: la epidural. Este salvavidas no estaba disponible hasta mediados del siglo XX. La epidural da ahora a las mujeres la opción de sentir dolor o...menos dolor. Para Olga Merino, la epidural es ‘estar en la gloria’ después de horas de dolorosas y fatigosas contracciones. Antonio Jiménez señala que un 80% de las mujeres utilizan la epidural durante el parto. Y el 20% que no la utiliza caen en esta categoría simplemente porque no tienen tiempo para nada más. Un ínfimo 1% de las pacientes desean un parto natural, evitando el uso de la epidural.
A pesar de este pequeño porcentaje, muchos doctores, entre ellos Carlos Jiménez, están a favor de los partos naturales y se esfuerzan por hacer de éstos lo ‘más naturales que sea posible’. Y es que hay opciones para las mujeres: Morgan Reiss quiso dar a luz voluntariamente sin el uso de medicamentos. En principio había pensado en un parto en el agua, pero ya que en Sevilla no hay centros especializados tendría que desplazarse unos 350 kilómetros hasta Madrid. En lugar de eso, se le asignó la tarea un partero Belga (conocido como ‘la persona indicada para el trabajo’) de ayudar a Morgan con su embarazo y parto ya que él estaba bien informado, capacitado y dispuesto a realizar acciones revolucionarias. El partero resultó ser la opción indicada para Morgan: su parto ocurrió de forma rápida y simple que no hubiese tenido tiempo para pedir la epidural. Aunque admite que durante el momento más duro del parto la quiso desesperadamente, también nos cuenta con una sonrisa: ‘justamente cuando crees que no puedes aguantar más...es ése el momento en el que nace el bebé’.
Mientras que da la sensación de que todo funciona correctamente en el sistema sanitario público español, ¿habrá que pensar en posibles problemas que necesiten alguna solución? Antonio Jiménez suspira: ‘hay una montaña de cosas por hacer’. Tanto él como su hijo están de acuerdo en que la frustración es algo frecuente entre los profesionales médicos. Nos explican que son especialmente las doctoras de entre 35 y 45 años las que muestran las actitudes más negativas.
Y mientras que la tecnología ha proporcionado una sensación de seguridad a las mujeres, de que todo saldrá bien cuando las cosas se compliquen durante el embarazo, también se ha llevado consigo el contacto humano. ‘Más seguridad pero menos humanidad...’ afirma Antonio Jiménez. Carlos añade que tantas exigencias hacen imposible que se dedique más tiempo y la atención que requieren los partos. Luz hace hincapié también en esta idea: ‘es imposible ofrecer una atención más especializada ya que puede haber un doctor respaldado por uno o dos parteros/as atendiendo a ocho mujeres que están dando a luz a la vez en una noche’.
Olga Merino nos cuenta una experiencia similar cuando recuerda el momento del parto. Nos describe como una matrona entraba bruscamente a revisar como estaba ella y el bebé durante las contracciones antes de dejarla a ella y a su marido solos, sin decir ni una palabra o sin preocuparse por saber como se encontraba. Morgan Reiss se encontró con el mismo problema de atención personal y decidió complementar sus citas en el hospital público con las consultas de un ginecólogo privado.
Visto así, ¿quedan hoy en día momentos personales o íntimos en los hospitales públicos?
Quizás en los momentos justo después del nacimiento. Para Luz, que ha participado en 14 partos como doula, ese es el momento más preciado. ‘Ver a la madre tener el primer contacto con su bebé crea una situación hermosa. Te encuentras muy cerca de la forma más pura de vida, llena de amor. Estar ahí junto a los padres es el mejor regalo. Es como una inyección de vida que deseas cada vez más y más.’
Thursday, December 17, 2009
7 Pounds of Life
Babies are born every day in every part of the globe. However, they are not born in the same way or under the same conditions. Some enter this world in a public hospital, others in a private. Some in a house and others in a bath tub. How does it happen in Seville?
It’s got to be like it is when you make love with someone. It’s got to be safe and secure and uninterrupted. And that is how you have an orgasmic birth.” An orgasmic birth? The idea of Marsden Wagner, M.D., Director of Women and Children’s Health in the World Health Organization doesn’t exactly sound conventional. But when Luz Viudes Middelmann, a doula, or alternative midwife, in Tarifa, Spain, talks about this revolutionary idea, it doesn’t seem so “out there”… it just seems logical.
As a doula, Luz dedicates her life to providing emotional and psychological support to women during their pregnancy, labor, and post-labor experiences. Her eyes light up while talking about what has come to be known as an orgasmic birth: “The people that are involved should respect, as much as possible, the intimacy and connection that’s created.”
Intimacy is a little hard in the public health care system, though. Imagine the hours before going into labor – sweat starts streaming, profanities start flying, pain starts intensifying – and the woman next to you is casually chatting with her husband about dinner plans with the grandparents next weekend. Not really the setting for intimacy and tranquility Luz refers to. So, is this the only option for women in Spain?
In Andalusia, a woman’s options for giving birth can really be boiled down to the public or the private health care system. According to Antonio Jiménez, head of the Gynecology Department at the University Hospital Virgen Macarena in Seville, a majority 80 percent choose public. If the 20 percent that choose a private center get to enjoy better food, an individual room before and after delivery (without the chattering wife), and more personalized attention, why choose anything else?
Money is one factor. Doctor Carlos Jiménez, who has followed his father’s footsteps into the field of gynecology, says one should expect to pay upwards of $6,700 to give birth in a private hospital. Such a price could be considered a “steal” in the United States, which rakes in $8,800 for every bundle of joy according to the 2007 March of Dimes report. But the U.S. doesn’t have a choice. In Seville, women can choose to opt out of paying a fortune.
Doctor Antonio Jiménez continues that another critical factor affecting the decision is the superior resources available in the public system – an advantage echoed by Olga Merino and Morgan Reiss, two mothers in Seville. The medical assistance, the delivery rooms, the personnel, and the technology that is offered are of a higher quality. In fact, if a labor were to suddenly go wrong in a private hospital, the woman would be whisked away to the nearest public one.
Dr. Jiménez goes on to explain that it has been that way since 1975, when technology dramatically improved pregnancies, labors, and births in Seville. According to medical statistics, the rate of infant mortality plummeted from 22 deaths for every 1,000 births in 1975 to just under six in 1998. The rate of maternal death also dropped from 43 cases in 1975 to a mere two in 1996.
Also in the past, premature babies able to fit in the palm of a hand had little to no hope of survival. But with the introduction of miracle machines, such as ventilators and incubators, the 4,000 preemies born every year in Spain now have the chance to live. Luz Viudes adds that a revolutionary method known as “kangaroo care” has also improved their outlook. This method stresses the importance of skin-to-skin contact between mother and baby, helping to stabilize the baby’s heartbeat, temperature and breathing. Breastfeeding is also a key part of this technique to develop the newborn’s strength. A premature baby Luz helped to deliver was expected to be in an incubator for two months, but a combination of technology and kangaroo care quickly turned two months into three weeks.
Other technological developments include that wonderful little injection that practically numbs from the waist down: the highly sought-after epidural. This lifesaver wasn’t even an option until midway through the 20th century. Epidurals now give women the option of pain or… less pain. For Olga Merino, the epidural was “the glory” after hours of tiring, merciless contractions. Antonio Jiménez claims that 80 percent of women use epidurals during labor. And the 20 percent that don’t use them fall into that category simply because they don’t have time for anything else. A tiny, less than one percent of the population of the patients actually desire a natural birth, epidural-free.
Despite this small percentage, many doctors, including Carlos Jiménez, defend natural births and constantly strive to make labors “the most natural as possible.” And there are options for women, like Morgan Reiss, who voluntarily choose to give birth without drugs. Originally, Morgan had wanted to do a water birth, but since there are no specialized centers like this in Seville, she would have had to have made the 330-mile trek to Madrid. Instead, a Belgian midwife, known as “the one to go to” for natural births, was assigned to help Morgan with her pregnancy and labor because he is “informed and more ready and willing to do revolutionary things.” The midwife ended up being a perfect fit for Morgan and her labor was so quick and simple that she wouldn’t have had time for an epidural anyway. Although she admits that during the most intense moment of labor she had wanted it, she adds with a smile that “just when you think ‘I can’t do anymore’… that is when the baby arrives.”
While everything seems to be running smoothly in the Spanish health care system, are there any glitches to be fixed? Antonio Jiménez sighs, “there are a mountain of things.” Both he and his son agree that “burn out” is a frequent problem amongst medical professionals. They explain that female doctors 35-45 years old are especially affected and display the most negative attitudes.
And while technology has provided reassurance to women that all will go well in the critical moments of their pregnancy, it has also taken away from any personalization. “More security… less humanization,” states Antonio Jiménez. Carlos adds that so many demands make it impossible to dedicate the time and attention that labors require. Luz reiterates this idea: “It’s impossible to give more specialized attention because there might be one doctor with one or two midwives for eight women who are giving birth in one night.”
Olga Merino expresses a similar experience when recounting her labor. She describes a midwife briskly entering to monitor her and the baby during contractions before leaving her and her husband alone just as quickly, without another word or a “how are you feeling?” Morgan Reiss noticed the same personalization problem and turned to consults with a private gynecologist to supplement her appointments with the public hospital. “I wanted people to explain things more. In the consult, I could be with her an hour… it was much more personalized.”
Are there any intimate, personal, humane moments left in public hospitals today?
Perhaps in the moments right after birth. For Luz, who has been part of 14 births as a doula, that moment is the most precious. “To see the mom having her first contact with her baby creates such a beautiful situation. You are very close to life in the most pure form and one full of love. To be there with the parents is the best gift. It’s like an injection of life and you keep wanting more and more.”
It’s got to be like it is when you make love with someone. It’s got to be safe and secure and uninterrupted. And that is how you have an orgasmic birth.” An orgasmic birth? The idea of Marsden Wagner, M.D., Director of Women and Children’s Health in the World Health Organization doesn’t exactly sound conventional. But when Luz Viudes Middelmann, a doula, or alternative midwife, in Tarifa, Spain, talks about this revolutionary idea, it doesn’t seem so “out there”… it just seems logical.
As a doula, Luz dedicates her life to providing emotional and psychological support to women during their pregnancy, labor, and post-labor experiences. Her eyes light up while talking about what has come to be known as an orgasmic birth: “The people that are involved should respect, as much as possible, the intimacy and connection that’s created.”
Intimacy is a little hard in the public health care system, though. Imagine the hours before going into labor – sweat starts streaming, profanities start flying, pain starts intensifying – and the woman next to you is casually chatting with her husband about dinner plans with the grandparents next weekend. Not really the setting for intimacy and tranquility Luz refers to. So, is this the only option for women in Spain?
In Andalusia, a woman’s options for giving birth can really be boiled down to the public or the private health care system. According to Antonio Jiménez, head of the Gynecology Department at the University Hospital Virgen Macarena in Seville, a majority 80 percent choose public. If the 20 percent that choose a private center get to enjoy better food, an individual room before and after delivery (without the chattering wife), and more personalized attention, why choose anything else?
Money is one factor. Doctor Carlos Jiménez, who has followed his father’s footsteps into the field of gynecology, says one should expect to pay upwards of $6,700 to give birth in a private hospital. Such a price could be considered a “steal” in the United States, which rakes in $8,800 for every bundle of joy according to the 2007 March of Dimes report. But the U.S. doesn’t have a choice. In Seville, women can choose to opt out of paying a fortune.
Doctor Antonio Jiménez continues that another critical factor affecting the decision is the superior resources available in the public system – an advantage echoed by Olga Merino and Morgan Reiss, two mothers in Seville. The medical assistance, the delivery rooms, the personnel, and the technology that is offered are of a higher quality. In fact, if a labor were to suddenly go wrong in a private hospital, the woman would be whisked away to the nearest public one.
Dr. Jiménez goes on to explain that it has been that way since 1975, when technology dramatically improved pregnancies, labors, and births in Seville. According to medical statistics, the rate of infant mortality plummeted from 22 deaths for every 1,000 births in 1975 to just under six in 1998. The rate of maternal death also dropped from 43 cases in 1975 to a mere two in 1996.
Also in the past, premature babies able to fit in the palm of a hand had little to no hope of survival. But with the introduction of miracle machines, such as ventilators and incubators, the 4,000 preemies born every year in Spain now have the chance to live. Luz Viudes adds that a revolutionary method known as “kangaroo care” has also improved their outlook. This method stresses the importance of skin-to-skin contact between mother and baby, helping to stabilize the baby’s heartbeat, temperature and breathing. Breastfeeding is also a key part of this technique to develop the newborn’s strength. A premature baby Luz helped to deliver was expected to be in an incubator for two months, but a combination of technology and kangaroo care quickly turned two months into three weeks.
Other technological developments include that wonderful little injection that practically numbs from the waist down: the highly sought-after epidural. This lifesaver wasn’t even an option until midway through the 20th century. Epidurals now give women the option of pain or… less pain. For Olga Merino, the epidural was “the glory” after hours of tiring, merciless contractions. Antonio Jiménez claims that 80 percent of women use epidurals during labor. And the 20 percent that don’t use them fall into that category simply because they don’t have time for anything else. A tiny, less than one percent of the population of the patients actually desire a natural birth, epidural-free.
Despite this small percentage, many doctors, including Carlos Jiménez, defend natural births and constantly strive to make labors “the most natural as possible.” And there are options for women, like Morgan Reiss, who voluntarily choose to give birth without drugs. Originally, Morgan had wanted to do a water birth, but since there are no specialized centers like this in Seville, she would have had to have made the 330-mile trek to Madrid. Instead, a Belgian midwife, known as “the one to go to” for natural births, was assigned to help Morgan with her pregnancy and labor because he is “informed and more ready and willing to do revolutionary things.” The midwife ended up being a perfect fit for Morgan and her labor was so quick and simple that she wouldn’t have had time for an epidural anyway. Although she admits that during the most intense moment of labor she had wanted it, she adds with a smile that “just when you think ‘I can’t do anymore’… that is when the baby arrives.”
While everything seems to be running smoothly in the Spanish health care system, are there any glitches to be fixed? Antonio Jiménez sighs, “there are a mountain of things.” Both he and his son agree that “burn out” is a frequent problem amongst medical professionals. They explain that female doctors 35-45 years old are especially affected and display the most negative attitudes.
And while technology has provided reassurance to women that all will go well in the critical moments of their pregnancy, it has also taken away from any personalization. “More security… less humanization,” states Antonio Jiménez. Carlos adds that so many demands make it impossible to dedicate the time and attention that labors require. Luz reiterates this idea: “It’s impossible to give more specialized attention because there might be one doctor with one or two midwives for eight women who are giving birth in one night.”
Olga Merino expresses a similar experience when recounting her labor. She describes a midwife briskly entering to monitor her and the baby during contractions before leaving her and her husband alone just as quickly, without another word or a “how are you feeling?” Morgan Reiss noticed the same personalization problem and turned to consults with a private gynecologist to supplement her appointments with the public hospital. “I wanted people to explain things more. In the consult, I could be with her an hour… it was much more personalized.”
Are there any intimate, personal, humane moments left in public hospitals today?
Perhaps in the moments right after birth. For Luz, who has been part of 14 births as a doula, that moment is the most precious. “To see the mom having her first contact with her baby creates such a beautiful situation. You are very close to life in the most pure form and one full of love. To be there with the parents is the best gift. It’s like an injection of life and you keep wanting more and more.”
Monday, December 14, 2009
Saturday, December 12, 2009
Instantánea de Sevilla
Siempre recordaré Sevilla como esta foto: tranquila, preciosa, una mezcla de historia rica y la vida moderna. Cada día, yo veo esta vista en mi camino de mi casa en Triana hacia el centro de la ciudad y cada día, estoy anonadada. Echaré de menos las palmeras contra el cielo, la cumbre de La Giralda, y el rio tranquilo, pero espero que yo pueda volver en el futuro para ver la misma vista hermosa.
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