Today we reach the sixth and last part of the extensive conversation we have had with the psychiatrist and gynecologist Emilio Santos, which has resulted in six Babies interviews and more in which we have thoroughly discussed issues such as the consequences of the separation of the baby, the feelings of the women who give birth, the possibilities offered by the health systems for respected childbirth and many other issues that we hope will have served so that our readers know more about what a birth is and what a natural birth means for women and babies.
How did you come to want to attend natural births and at home?
For me, nature is too perfect to pretend to improve it. I have always thought that medicine is useful for the disease, but not for health. In the case of childbirth, I also had the memory and teaching of my mother from a very young age, to which I often heard my uncles and my father recriminate with the phrase “you pushed me to have my other deliveries in hospitals when my best birth It was the first one, which was at home. ”I became a gynecologist with the clear idea of attending births at home. He had the conviction that, without bad intention, medicine hurts when it has the arrogance to believe that it can annul the mechanisms that nature has planned to replace them with other mechanisms that are believed to be more perfect.
So this was, in a way, your destiny.
It is also biographically significant to say that my mother's first birth, the one that was at home, was where I was born, that I am the oldest of seven siblings.
How did they teach you in the school that you should attend the delivery? When I decided to dedicate myself professionally to contributing to change the way of birth I had to start two formations simultaneously and in parallel. On the one hand I passed the MIR exam and began my training in a public hospital in Madrid. On the other hand I stuck to an elderly midwife, Doña Consuelo Ruiz, and so I could begin to attend home births with her. So, when I started attending the Hospital, I already knew, because I had seen it with my own eyes, what a woman was giving birth free. That phrase reflected the concern of who thought to teach me what to do in childbirth. That phrase shouted at me in the belief that I should be guiding the woman to push and that, in addition, I should be putting my hands in her vagina to widen the soft birth canal, which should be with the scissors in a hand prepared to make a great episiotomy, which should be willing to pull the head and quickly remove the shoulders. But I knew that all that was not necessary because I had seen with my eyes that the woman stopped alone and by herself if allowed to do so.A phrase that screamed at me in the public hospital where I received my official training still rumbles: "But do something, Emilio, do you still not know how to attend a delivery?"
Will there be changes in obstetrics in the coming years?
Well, for me, in the case of Spain, it's very easy to know. We need only look at the countries that were in our situation a few years ago, such as Norway or the United Kingdom.
What will these changes translate to? In view of what is happening in these countries, my prediction is that there will be a greater fork in two types of care. When I was in the United Kingdom continuing with my training at King College Hospital, I was surprised at how well births were treated and how well the natural process and wishes of women were treated. But it was an almost greater surprise when I asked about the rate of caesarean section of that hospital and I found that it was exactly the same as in the highly interventionist public hospital where I had been training in Madrid: 26 percent.On the one hand, I am sure that there will be an increase in women who want a home birth and the offer of professionals who attend it, and even greater acceptance of the option of home birth and natural childbirth in general. But on the other hand I believe that there will also be an increase in the total number of caesarean sections and an increase in caesarean sections by choice of women.
What were these figures due to?
While there were many respected deliveries, on the other hand, the caesarean threshold or decision bar was much lower. After discovering that data I went to look at the perinatal mortality rates in Spain and the United Kingdom to compare them and I found that according to the WHO they are very similar.
If the WHO recommendations regarding birth care were really followed, how would the care and outcome of births in Spain change?
Of course, the number of episiotomies, which is already doing so, would decrease tremendously. I also believe that the percentage of deliveries with synthetic oxytocin will decrease dramatically. In general, the number of cases of genital and pelvic sequelae of women who have given birth would decrease in the medium term. And, in the long term, we would necessarily see the percentage of certain pathologies that science is showing us more and more firmly that are related to the type of birth: autism, diabetes, obesity, hypertension; all of them pathologies in which it is being seen that aggressive birth is a risk factor. However, as I said before, from what I see happening in other countries, I do not believe that it decreases and could even slightly increase the percentage of caesarean sections. Although the WHO says that when the delivery is attended according to scientific criteria the percentage of caesarean sections should not exceed 10 or 15 percent of births, the reality is that there are factors that lead to this percentage necessarily increase, factors such as fear from the professional to medical complaints or the cultural fear of women to hypothetical consequences of a vaginal delivery.
Would they increase problems such as cerebral palsies, anoxies or complications from fetal distress?
As for cerebral palsy and mental retardation, it was previously thought that most cases were due to an alleged fetal distress during childbirth. But there is scientific evidence currently showing that the vast majority are due to inevitable factors that occur during pregnancy such as viral infections or genetic and metabolic disorders that cannot be avoided in childbirth care.
But would there be a risk that maternal and infant mortality would increase?
I do not think so. My mentor, Doña Consuelo Ruiz, had attended during her life about 3,000 deliveries at home and never had a baby died. Perinatal mortality in any hospital in the western world is around 8 per 1000.Perinatal and maternal mortality have decreased thanks to advances in hygiene, diet and living conditions, not so much thanks to hospitalization.
In short, the trend in the opinion of Dr. Santos is that childbirth care in Spain will increase the percentages of natural and respected births, with a clear decrease in episiotomies and sequelae for the mother and child related to the intervention, but that the caesarean sections will remain or increase slightly, no having these changes, in general, as a consequence of the feared increase in infant mortality that is usually adduced against natural births, at home or without unnecessary interventions.
We finish this series of interviews with doctor Emilio Santos with the latter, hoping that they have been of as much interest to our readers as they have been for us to enjoy performing them.
