Birth in the 21st Century

caesarean sections in Spain

What is the rate of cesarean sections in Spanish hospitals? How has this rate evolved in the latest years? Does Spain follow WHO recommendations regarding cesarean sections? Are there differences between the cesarean section rates between state and private hospitals?

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My birth plan

PREFERENCES UPON ARRIVAL IN THE HOSPITAL

The staff attending me should read my birth plan, ask me and respect my preferences and needs. I would like to be informed regarding my options and be involved in decision-making. Any procedure will require my informed consent.

Accompaniment

I would like to be accompanied at all times by the person of my choice, even in case of c-section.

Physical space

I request intimacy is favored during all stages of labor. I would like a quiet, low-light and comfortable temperature environment.

Intimacy

I would like the minimum amount of staff possible in the delivery room. If, besides the midwife, it is necessary the presence of another professional, I would like to be informed as to this requirement beforehand.

In case staff in-training would like to be present, they will have to request for my permission before coming in.

PREFERENCES DURING DILATION

Assistance, care, diet

I do not authorize to be put on routine IV. It should be done only in case of necessity.

I request being able to drink or ingest light foods.

Treatment and management of pain

I request being offered epidural anesthesia.

I request being offered non-invasive and non-pharmacological options for pain during dilation. I do not discard asking for epidural anesthesia if I need it.

I would like to be able to get up during dilation and to choose the posture most comfortable for me at any given moment.

I would like to undergo dilation in a hot tub in order to alleviate pain.

I would like freedom to use support elements and aids for walking, either available at the hospital or brought in by myself.

Procedures

I request intermittent auscultation in order to control the fetus’ well-being, for my comfort and in order to have freedom of movement. If there is a clinical need for continuous monitoring, I would like to be informed of the cause.

Vaginal examination

If necessary, I accept undergoing vaginal palpation every 4 hours, being notified beforehand and, if possible, by the same person every time. In case additional palpation was necessary, I would be informed of the cause.

In case the midwife would like to perform a palpation for training purposes, they will have to ask for my written permission.

Procedures to hasten labor

I would like for the physiological duration of labor to be respected. I do not authorize routine procedures to induce or hasten labor.

I do not wish for routine vesical probing.

PREFERENCES DURING DELIVERY

I wish to be able to be in any position I choose.

I wish to push freely, without anyone directing me. Should I need directing, I will ask the midwife for it myself.

I wish to be able to deliver in a hot tub, if I so choose.

I do not authorize any episiotomy, except in case of urgency and risk to the fetus’ well-being, with previous verbal authorization on my part.

Instrumental delivery or caesarean section

In case there was no other alternative and there arose a need to perform a c-section:

I request information and consent previous to an emergency caesarean section.

I wish my companion to be present in the surgery.

I wish the staff to be silent during the extraction of the baby.

I wish the baby to be placed on my chest from the very first moment, allowing its adaptation to the external world and the start of lactation in the operating room.

I wish for the umbilical cord to stop beating before having it cut.

I do not authorize the baby be separated from me at any moment. I wish to bring it into the room with me.

During surgery, I wish for a respectful, silent atmosphere, in which I’m to be informed of the progress of the procedure, if I so choose.

I wish the curtain to be put down in order to see the baby come out. If I use glasses, I wish to wear them.

I do not authorize my arms to be tied.

PREFERENCES IMMEDIATELY FOLLOWING BIRTH

Immediate skin contact after birth

I wish that immediately following birth, the baby be placed against my skin on my abdomen. I wish the first necessary procedures to be performed, such as ocular prophylaxis or vitamin K administration, without interrupting skin on skin contact.

In case I was not in a condition suitable for the baby to be with me, it will be with my companion, skin on skin.

Cutting of the umbilical cord

I wish for the umbilical cord to stop beating before it is cut.

I wish my companion to be able to cut the cord.

Placenta

I wish to be handed the placenta.

Newborn care

I do not wish to be separated from my baby, at least during the first two hours, without interruptions and in a quiet environment. The baby will always be with me or my companion.

I wish exploratory procedures such as weighting and measuring to be postponed for the first two hours and then be performed in my presence.

Start of lactation

I wish the first feeding to be facilitated during the baby’s first hour of life.

I do not authorize any serum or milk bottles to be given, nor pacifiers or nipples, without my consent.

Suction of secretions and probing after birth

I do not wish any routine insertion of gastric or rectal probes be done on the baby.

Baby hygiene

I do not wish my baby to be washed. I wish for it to retain its vernix until I decide.

I wish to clean and care for my baby myself. I will decide if I do so with the help of my companion. If I cannot do it, I wish a person I choose to do so.

PREFERENCES IN CASE OF COMPLICATIONS

In case of complications in the baby’s health I wish to be informed of the existing alternatives and have the chosen accompaniment, the professional support and the necessary time to take the necessary decisions. I wish to be in a quiet and intimacy-respecting place. If it is necessary that I am hospitalized, I do not wish to be admitted into the maternity ward.

“All women have the right to receive the highest level of health care, which includes the right to receive dignified and respectful care during pregnancy and childbirth, and the right not to suffer violence or discrimination”

– WHO statement

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