This article was first published in 2006 in the Association of Radical Midwives journal.
A TASTE OF FREEDOM
Homebirth in Spain
I qualified as midwife in 2002 with the sole intention of practising independently…in Spain! I worked briefly in the UK; very nearly left the profession, and then travelled with three children, a small dog and wonderful husband to the Murcia region of Spain in September 2003.
During our time there I worked in both hospitals and in health centres, although community midwifery is far removed from that offered in the UK. Care in Spain is highly medicalised, and does not follow WHO recommendations for care in normal birth. It can be soul destroying to see women lined up in beds on their back, alone, with epidurals and syntocinon as routine care. Episiotomy for all; shave and enema, and CTG without question. Homebirth is not offered within the health service in Spain and is generally considered dangerous by both professionals and lay people. Midwifery-led care does not exist in Spain. Obtetric care is the only care on offer. I was fortunate to attend the Paramanadoula workshop, taught by Michel Odent and Lilliana Lammers, which was a wonderful inspiration. Then following this, whilst working within the Spanish NHS system, I also gave talks to the public, in collaboration with a local breastfeeding support group, on choices in birth and the WHO recommendations.
Whilst attending the doula workshop in Malaga, I met a woman who would affirm my deeply held beliefs about birth in an amazing way. Noemi, a Spanish prenatal yoga teacher planning her first pregnancy, asked me to be her independent midwife at her homebirth. There are a handful of independent midwives offering homebirth, but no-one was offering this care in Murcia. I had attended an IMA workshop prior to leaving the UK, and also spent a weekend in Barcelona at their annual independent midwives meeting so was getting prepared to make this leap.
Noemi quickly became pregnant with her first baby. She was a healthy young woman with an uncomplicated medical history. During the pregnancy I visited her at home, each visit lasting one hour, providing antenatal care, health education, minor discomforts and choices of screening. Her back pain in pregnancy was treated by her own acupuncturist. Noemi practised yoga daily, attended counselling for personal issues and was very self- aware. During the course she attended a course for professionals about the use of creativity in pregnancy and birth. Noemi used these skills to prepare herself both mentally and emotionally for the journey ahead. She declined the routine screening for group B strep and glucose intolerance that is offered in Spain, following discussion regarding the evidence we learnt together at the Michel Odent workshop.
Following discussion Noemi requested a stretch and sweep at term. She did not want to risk the possibility of induction in an obstetric unit. On examination I was unable to reach her cervix, and she found the experience unbearable. At this point she became upset and disclosed to me for the first time that she was being counselled for issues relating to sexual taboos that she had encountered as she was growing up. Taboos that had affected her sexuality, and experience of intimacy. She was very anxious about her ability to give birth vaginally. Following reassurance from both myself, and her close friend and birth partner, I left; to remain in contact by phone.
The following morning I received a call saying she was experiencing mild contractions and had noticed a pink mucousy discharge. She told me that she had spent the previous afternoon talking and crying; releasing feelings contained for years. I had often heard of the power of emotions and its’ effect on birth but this was my first experience. We stayed in touch during the day until she rang in the evening with a definite change in pace, and lots of heavy show! My forty-five minute journey down to the coast was filled with excitement and a pounding heart. I would be attending my first homebirth, alone with only my faith in the physiological process and Michel Odent’s words ringing in my ears. Her husband would be with her, as well as her close friend – a neonatal nurse. This would be, as far as we were aware, the first planned homebirth in Murcia since the 70’s. Even my Spanish midwifery colleagues, who in theory wanted to take midwifery forward, were not comfortable in taking the step of becoming my back-up.
On arrival at the house at 8.30pm it was clear by her body language that she was in strong labour; releasing oxytocin and endorphins; breathing controlled; concentrating yet distant. The room was dark, gentle music playing, with just the glow of a halogen heater, Noemi sat on the floor supported in the arms of her husband. All observations were normal, including the fetal heart. I chose not to examine Noemi as such an interruption would only disturb the birthing process. I withdrew from the birth environment, waiting and watching at a distance. I also took my knitting which Michel Odent swears is a fabulous adrenalin reducer for the midwife. At around 10.30pm she appeared to be pushing involuntarily. The atmosphere remained calm. Noemi said she felt she needed to push but felt embarrassed so I suggested moving to the toilet. I expected it would be sometime before the baby was near, and continued to listen in to baby’s heart rate unobtrusively, and then withdrew to the lounge. Ten minutes later the waters broke releasing clear liquor. At 11pm she said she touched the baby’s head so I started to prepare for the birth. I left the bathroom briefly and in the moment I had gone her partner cried out “Ya esta!”, “He’s here!” I dashed in to the sight of Noemi on all fours with her husband sat behind holding his new baby.
Their baby cried at birth then in the glow of the heater, he became so calm and suckled immediately at the breast. Knowing the both mother and baby were both well and very warm, believing the hormones of love would continue to flow, I watched at a discreet distance for the arrival of the placenta. She birthed the placenta with minimal blood loss. Suturing was I felt was required; however looking back I’m not sure I would even do this now, having gained more experience. I feel this really was a taste of freedom to practice intuitively, unrestricted by protocols and time limits. Watching and observing when you have developed a close relationship with someone; having complete faith in each other to safely birth; and realising someone is putting their complete trust in you at this moment in their life, is an unforgettable experience. One that has molded me into the woman and midwife I am today.
This amazing experience has remained with throughout my subsequent time working in an obstetric unit and now at a birth centre. It feels to me to be the culmination and affirmation of everything I have believed since first embarking on a career in midwifery. I now look back and know that my more recent hospital experience has tainted my unshakable faith in women’s’ bodies, but never eroded it. I still endeavor to practice in the same way and to share my beliefs with others. One day I hope to take the step again to being independent.