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.”