By Teresa Rubio Asensio BSc, MSc (embryologist).
Last Update: 07/11/2014

In 2008, the New Directive for Birth Attendance was approved by the Spanish Health Ministry. The Spanish Health Agency amis to humanise the birth attendance and give more room for decision to the pregnant.

Due to the technological advancements and increased medicalisation in the field, some practices carried out during delivery might seem unnecessary. Birth does not flow spontaneously. The objective is to provide more intimacy and warmness to the moment of delivery, in order to make it as natural as possible without compromising the safety of the mother and the newborn.

In some European countries, like the Netherlands for instance, birth it is not as institutionalised as it is in Spain. In that country autonomous midwifes attend the birth in a more intimate way. Within other countries like the United Kingdom, Norway, or Germany, the Public Health System offers more options, such as water birth or delivering in the most comfortable position for women, like doing it crouched, at their knees, or sideways.

The new models aim to consider birth more a physiological and natural process and less an illness. It is a once-in-a-lifetime moment, where the pregnant, the woman, has an unique role.

New guidelines for birth attendance

  • Regarding perineum shaving, a widespread practice conducted in hospitals, from now on it will be optional in case of tears, because there is no evidence of the shaving preventing perineal infections, quite the opposite actually, as some studies suggest that removing hair makes the pubis more exposed to microorganisms.
  • The routine administration of edema will be optional too. During pregnancy the anal area is isolated in case there are evacuations.
  • Episiotomies, surgical incision en the perineum, will be selective and not a routine procedure anymore. Besides, the posterior suture will be made with resorbable materials. The episiotomy is counter-indicated with the World Health Organisation (WHO), given that it does not prevent neither anal nor vaginal tears.
  • Amniotomies, to artificially break the amniotic sac in order to increase the frequency and intensity of contractions, should not be performed. This procedure alters the natural evolution of the delivery.
  • To duly inform and instruct the pregnant women on the dilation period. A proper information on dilation signs identification and onset of birth will decrease the number of visits to the hospital due to false alarms. Pelvic exams only when necessary.
  • To let the pregnant women choose the position she may prefer, when dilating and when entering into the delivery room. To create a warm and intimate atmosphere so that the pregnant feels more confident.
  • To give the pregnant the opportunity to ear or drink if she wishes to. Any anesthesia will de administered. According to some studies, having the mother drinking or eating does not carry any risk at all.
  • To limit the use of oxytocin, hormone used to induce pregnancy and stimulate contractions, to be used only in cases where is completely prescriptive. If it’s not, it’s better to let the pregnancy flow naturally.
  • To inform the pregnant woman on the alternatives and options she has regarding pain relief, the advantages, disadvantages and risks of each one of them. To explain the types of drugs, anesthetics, epidural and alternative choices, such as acupuncture. Also to inform that during a natural birth, the organism secretes endorphines, substances that aid pain relief.
  • No to clamp the umbilical cord by routine if it is still beating. It would be better to let the cord collapse on its own, it takes 3 to 20 minutes. The premature clamping may cause problems in the newborn due to cerebral anoxia.
  • To let the pregnant to be escorted in every moment, since the onset of the first signs, like dilation, until they gave birth in the delivery room. To be accompanied decreases the stress and creates a more trustworthy context. Pregnant women who receive support are less likely to need anesthesias, C sections,…

To implement this strategy requires that the medical professionals, specially those that have a direct implication in the delivery, must reorientate their formation and receive specialised and ongoing training on the new models and protocols.

Research will be promoted, in order to improve the field of birth attendance as a whole, evaluating the cutting-edge practices and its impact on the psychophysical wellbeing of the parents.

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Authors and contributors

 Teresa Rubio Asensio
BSc, MSc
Embryologist
Master's Degree in Medicine and Reproductive Genetics from the Miguel Hernández University of Elche (UHM). Teacher of different Clinical Embryology courses at the UHM. Member and writer of scientific contents at ASEBIR and ASPROIN. Embryologist specializing in Assisted Procreation at UR Virgen de la Vega. More information
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