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ARGENTINA:
The Right to Give
Birth Naturally
Marcela
Valente
BUENOS AIRES, (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.
Another actress says: ”Don't let
them take your baby from your
side.”
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.
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