ARGENTINA: The Right to Give Birth Naturally

By Marcela Valente Reprint | | Print |

Marcela Valente

BUENOS AIRES, Jun 7 2005 (IPS) - An original media campaign in Argentina is aimed at raising women’s awareness on their right to be accompanied in the delivery room, and to give birth in whatever position is most comfortable for them and without unnecessary medical interventions.

With financial support from the Dutch foundation Mama Cash, the Argentine non-governmental organisation Dando a Luz (Giving Birth) produced a series of television spots in which famous actors and models urge women to demand respect for their right to give birth the way they want.

"Don’t let them lie you down," advises Leticia Brédice, a popular actress who is currently pregnant.

The phrase has a double meaning, literally referring to the right to give birth in an upright position, but also alluding to not allowing one’s rights to be trampled.

In another ad, model Dolores Barreiro asks "Would you hurry the rising of the sun?" while pointing out that women and their babies "take their own time to give birth and to be born."

"The oxytocin drip (to speed up labour) or the artificial rupture of membranes (of the amniotic sac) should only be used in cases of extreme necessity," she adds.

And a third actress, who appears alone with a bouquet of flowers in the civil registry office, asks "Can you imagine getting married alone, without a groom, and without any family members? Why do we accept being unaccompanied by a loved one at such an important moment as the birth of our children?"

Men also take part in the campaign. Popular television host Julián Weich recommends that the umbilical cord not be cut until it stops pulsating, to boost the infant’s iron intake. But not all obstetricians are willing to lose the few minutes needed for delayed cord clamping.

The ads refer to the rights of mothers and infants in delivery, which are recognised in a national law in effect since November 2004.

But the failure to disseminate information on the new law has facilitated the persistence in both public and private hospitals of traditional practices that run counter to the new legislation.

In an interview with IPS, Sonia Cavia, a member of Dando a Luz, said the nationwide campaign, which was launched in late May, has had a strong impact.

"The number of women contacting us to ask questions has doubled, and some ask how they can report mistreatment they received in private clinics," she said.

Many of these women complain that they had previously agreed with their doctors that certain unnecessary procedures would be avoided, but that their wishes were not respected.

The World Health Organisation (WHO) recommends reducing the use of a number of traditional procedures and avoiding the excessive "medicalisation" of birth. But in Argentina many unnecessary medical interventions remain standard practice.

In private clinics in Argentina, half of all births are by cesarean section, a practice that according to the WHO is necessary in just 15 percent of all deliveries, but is frequently used to fit births more conveniently into the busy schedules of doctors, or to make sure a hospital bed is available when the woman has her baby.

C-sections are also frequently requested in Argentina by mothers-to-be, especially women from the middle and upper-income sectors.

Cavia, however, said that "concluding that the rate of c-sections is high because many women prefer them is like justifying the existence of bad programmes on television because many people watch them."

According to the activist, it is a cultural question. After so many years of habitual medical interventions, women are fearful and leave the decisions up to the health professionals who attend their labour and delivery.

Many of these fears arise from bad experiences in natural births that were not attended to properly, Cavia maintained.

In public hospitals in Argentina, women are not accompanied during delivery by any family member, are routinely hooked up to an oxytocin (pitocin) drip, are required to lie down and have their amniotic sac ruptured, and are given drugs to accelerate the dilation of the cervix.

In many cases, women are also routinely given pre-birth enemas, have their pubic hair shaved, and have their legs strapped down to keep them still.

These interventions have become standard practice based on arguments that they are good for both the mother and the baby, but they mainly cater to the convenience, comfort and preferences of health professionals, according to Dando a Luz.

Doctors also routinely make an episiotomy – an incision in the skin between the vagina and the anus to enlarge the vaginal opening and facilitate childbirth – even though it has been demonstrated that this intervention does not prevent tears, while it does condemn women to a painful birth.

According to the Latin American Perinatology Centre, episiotomies are practised in 85 percent of all first-time births in Argentina, even though no scientific study justifies such widespread use. In addition, healing is painful, and the return to sexual relations is delayed.

"After a ‘normal’ delivery, where the woman is alone and has been given oxytocin drip and an episiotomy, it is understandable why many prefer a c-section" the next time they give birth, said Cavia.

The new law on childbirth rights states that any woman giving birth in a public or private health centre has the right to be treated with respect and to be previously informed of any medical interventions to be carried out during labour and delivery, in order to give her the chance to choose available alternatives.

The legislation says pregnant women have the right to be considered healthy and to have a natural birth, respectful of their biological and psychological rhythms, and to avoid invasive practices and medications that are not justified by the state of health of the mother-to-be or the infant.

The law also underlines that women can be accompanied during childbirth, and can have their baby with them after delivery, as long as neither the mother nor the infant need special emergency care.

Violations of the law can supposedly lead to penalties for the institutions or health professionals in question. But, Cavia said, "the law is not enforced anywhere."

So far this year, Dando a Luz has brought several cases before the office of the people’s defender (ombudsperson) for incompliance with the law, which forced hospital directors to provide explanations and to correct practices in their institutions.

In some hospitals, fathers are required to attend a course in order to be present at the birth, while in others they are not allowed to accompany their partners during ultrasound procedures, even though these restrictions are now illegal.

In their defence, hospitals cite a lack of infrastructure and the right to privacy of other mothers-to-be as arguments to bar the entrance of fathers or other family members.

Cavia, however, argued that the real reason behind these restrictions is that health professionals and institutions prefer to work "without witnesses" who could verify whether or not the laws are respected.

Dando a Luz recommends that women present a "letter of informed consent" to hospital authorities and the heads of obstetrics and neonatology services prior to the birth.

In the letter, which can be printed out from the group’s web site, the pregnant woman outlines the conditions in which she would like to give birth.

The organisation also recommends that she carry five copies of the letter, in order to distribute four and keep the last one, sealed to certify that it was received.

Each of the copies of the letter should be accompanied by additional information, such as the text of the new law and WHO recommendations on childbirth, says Dando a Luz.

"We know it’s not easy, but there is no other way to do it. We want to help empower women, and to see them demand respect for their rights to a safe, healthy delivery," said Cavia.