This week has occurred a war of competitions between midwives and gynecologists at the Maternal and Child Hospital of Malaga. Recently, and following the recommendations of the World Health Organization and the Strategy for normal delivery care, it was decided, by the management of this hospital, that normal deliveries, in which there was no no complication, were attended exclusively by midwives and only ask the intervention of gynecologists if special circumstances occurred that made their attention necessary. So far, everything is correct.
However, the reaction of the gynecologists did not wait. Despite being known that childbirth is not a disease and that, if everything is normal, the right professionals to care for women are midwives, they were unwilling to give up what until then was their competence.
The guide who had proposed the direction of the center and signed the gynecology director seemed inadequate. In his opinion, a delivery can be a vital risk at any time and only a gynecologist should have the ultimate control of decisions. While this could be true with many nuances, supposing that a midwife, who has the appropriate legislative qualification and complete training to detect these risks, could not determine that the gynecologist's attention is necessary, is a great mistrust, in my opinion in the competence of these professionals.
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Can a normal birth become a risky birth? Of course, it can happen, but precisely the midwife determines when this happens and is able to go, then it is a gynecologist who takes the reins.
In the end, I believe that two issues underlie the conflict. One is simply competitive, in which coorporativism makes it difficult for a professional sector to resign itself to leaving a plot of decision and work. On the other hand, the second, which is the training that gynecologists receive, which I think makes them see childbirth as a trance of serious vital risk, in which the parturient automatically becomes ill, and in which they, and Only they will save your life with medical interventions.
All this has led us to the excessive medicalization of births, to provocations, inductions, fixed dates, scheduled caesarean sections, instrumental deliveries and caesarean sections at very high rates. Ultimately, the medical intervention of labor detracts it, makes it a disease, at the same time it is accelerated, conditioned and medically intervened in excess.
The competition war It had been unleashed but, nevertheless, the reaction of the center was rapid, returning to the gynecologists the attention to the normal childbirth, denying the previously decided by the pressures received.
I want to highlight that the Maternal and Child of Malaga has a cesarean section rate of 25%, which far exceeds what the World Health Organization recommends, which is between 10 and 15%. And it is known that medicalization and birth scheduling is one of the main causes of these high rates of non-vaginal or normal births.
At Malaga Hospital is again the gynecologists who will have control of decisions and attention in normal deliveries.
The guide that had been proposed in the Maternal and Child Hospital of Malaga indicated that attention and decisions in normal deliveries would be the responsibility of midwives. The enormous dissatisfaction of gynecologists, citing reasons of organization and danger to women and babies has resulted in its application being delayed to a new wording.
Everything indicates that it is very clear that it will include a double competition of gynecologists and midwives in normal deliveries, which, in fact, I fear that it will end up materializing in that doctors will be the ones who decide even if everything seems to be going well in the opinion of the midwife .
It has reversed and the guide has become invalid. The manager of the Hospital de Málaga will meet this week with the medical director, the gynecology director and the doctors, and it is expected that the midwives also, so that the new wording collects that the specialists in obstetrics and gynecology are jointly responsible for the deliveries without complications.
The Association of Andalusian Midwives have made public their discomfort, requesting that the professional competencies be clarified perfectly.
The Andalusian Association of Midwives has requested a meeting with the Minister of Health, Mª Jesús Montero in order to intervene and demonstrate regarding the latest statements in the press that will be positioned on the right professional to attend a normal low-risk delivery . The Andalusian Association of Midwives wants to express the discomfort perceived by this group in the face of the denigrating attitude of some hospital centers that call into question the ability of midwives to attend low-risk delivery.
The network has mobilized in support of midwives and to defend, which in the opinion of many, is a form of care that benefits the possibility of having non-medicalized deliveries without need. There is even a group in FaceBoock and the Association Breed with Attachment, based in Malaga, has initiated a campaign to request that normal birth be returned to the midwifery competition.
The Association Breed with Attachment wants to express its concern about the situation of midwives in the Maternal and Child Hospital of Malaga. This hospital has developed a clinical guide on normal birth in which, at the beginning and as recommended by WHO, the midwife was granted full autonomy in the care of this type of birth. But due to the pressures of gynecologists, who believe that this means taking away competencies, the hospital has backed down and will state in said guide that the responsibility for such care is shared by midwives and gynecologists.
Also the association El Parto es Nuestro has echoed what happened, calling it a step back.
For this reason, from the association “El Parto es Nuestro” we want to extend our support to the midwives of the Maternal and Child Hospital of Malaga in their proposal to be the professionals in charge of normal delivery care and show our disagreement to the Board of Directors of the aforementioned hospital for giving in to the criticisms originated with the first version of the guide. We are convinced that these setbacks not only return the midwife, once again, to the position of “gynecology nurse”, but that they manifestly harm the users of Malaga maternity services.
I believe that the time has come for gynecologists to assume their role in childbirth care and leave normal delivery in the hands of those who should assist them, without further ado. competition wars like the one in Malaga. Really, I do not think they lose power or jobs because of it, nor that accessing this change will pose any danger to women and babies, but quite the opposite, because giving birth normally is not being sick.
