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Spanish doctors criticised for high tech births

Xavier Bosch, Barcelona

Spanish obstetricians are facing criticism for ignoring World Health Organisation (WHO) guidelines on the care of women in labour. Most of the nearly 350000 women who have babies every year in Spain's public and private hospitals undergo routine procedures that the WHO considers justifiable only in certain circumstances. The high rate of caesarean sections and the failure to allow women to participate in decisions about their obstetric care have also been criticised

According to Jose Antonio Gomez Yanez, a sociologist who has reviewed obstetric practice in Spain, many of the obstetric procedures carried out in Spanish centres contravene the 1995 WHO Resolution on the Rights of the Pregnant Woman and the Newborn. In particular, just before delivery most women undergo a complete pelvic shave, an enema, and an episiotomy, all of which are not justified according to the WHO's recommendations.

Enrique Lebrero, an obstetrician from Valencia, says that both pelvic shaving and enemas are perceived by most women as aggressive interventions. But most obstetricians favour routine enemas, and they believe that they have the support of most women. The problem, according to Dr Lebrero, is that women are not given the opportunity to say no.

 Routine episiotomy is also performed in many centres despite the WHO's guidelines. Obstetricians argue that routine episiotomy avoids tears. Episiotomies are performed in 90% of first labours and in 60% of women having subsequent children. Yanez is also concerned about Spain's high rate of caesarean sections. The current rate in Catalonia is 26.4%, and the number of caesarean sections has increased by 40% in the past five years.

The rate of caesarean sections is highest on Fridays and Saturday mornings. Epidemiologists argue that this high rate may be related to medicolegal considerations or may simply be for the convenience of obstetricians.
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Rapid Responses:

Read all Rapid Responses

WHO's recommendations have an uncertain future in Spain

José J Santonja-Lucas
bmj.com, 23 Nov 1998 [Full text]