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Hospital Reflections — 2 of 2. Post was not sent - check your email addresses! No importance is placed on the birth environment and its subsequent effects. Epidural anaesthesia is promoted by medical staff as being beneficial for both mother and baby. When fully dilated, the woman is moved to a delivery room to give birth in the lithotomy position. Birth partners are allowed during labour at the discretion of the midwife for a brief period, and then during the actual birth.

They are fully gowned as is the midwife. An episiotomy is routinely performed and fundal pressure applied by another member of staff to assist descent if necessary. Following suturing, mother and baby pass to the immediate recovery area where they will be observed and assisted with breastfeeding before being admitted to the postnatal ward.


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This ward is staffed by nurses, and babies are removed to the nursery routinely to be bathed and changed. Discharge to home occurs around four days following a vaginal birth and all women are advised to attend the midwife at the local health centre for a postnatal examination. The newborns are registered with a health centre based paediatrician. My first impressions of care given in labour were of shock and disbelief. I had not realised that in a European country so close to our own, there could be such vast differences.

The absence of recognition of the World Health Organization recommendations for normal birth is the most obvious difference.

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However, when I realised that the autonomy of midwives has been eroded to such an extent that they have no voice, nor seemed to seek a change in the balance of power held by obstetricians, it is understandable that the care of normal childbearing women is such that it is today.

These midwives, or more appropriately named, obstetric nurses have been trained in a culture where birth is a medical process and obstetricians are in control. This midwife was reprimanded for the incident and told that this was not modern practice and would not be tolerated.

Midwives were then instructed by the obstetric team to ensure that all women remained on the bed at all times.

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Reflections of a hospital

She received no support from her manager. The Midwives rules and standards NMC, lays out our sphere of practice and defines the midwife as being responsible for normal childbearing. The RCM has itself published guidelines for care in normal labour , however Spain has no such publications.


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  • In some hospitals, midwives with vision and leadership are collaborating to introduce new working practices such as reducing episiotomy rates or facilitating choice of position for birth. But this is very sporadic and depends entirely on the determination of the individuals involved. Unfortunately, all units are understaffed and with high induction rates, added pressure is placed on staff. The labour ward becomes a conveyor belt of clients to be processed.

    Midwives work or hour shifts caring for up to four women at a time. Professionals and women, via internet forums and meetings in Madrid, Seville and Valencia, discuss, advise and inform, to enable more individuals to access evidencebased information and seek out alternative birth choices.

    One method proposed is via a birth plan.

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    However this is a new concept in Spain and unfortunately many units are resistant to women challenging practice or merely suggesting a preference about their care. One of my clients received a written reply about her birth plan stating that individualised care was out of the question due to the infrastructure of the unit.

    How does the infrastructure affect performing an episiotomy or refraining from routinely augmenting with syntocinon? Issues such as choice and consent are only discussed in terms of surgical procedures such as epidural administration or caesarean section. From vaginal examinations to vitamin K, women are rarely consulted or their wishes documented.

    However before the practice of midwifery is recognised as being a distinct profession, able to set its own agenda, obstetric care in Spain will have to undergo a fundamental shift in its view of pregnancy and birth as a purely medical process that requires only doctors and nurses. Comunicacion y Servicio, Madrid. Student midwife wins top Leaders award. Air pollution link to miscarriage risk.

    13 Days: Hospital Reflections – 1 of 2 – The Seekers' Portal

    The Royal College of Midwives, a company limited by guarantee, registration number The Royal College of Midwives Trust, a company limited by guarantee, registration number Our membership is a united front of midwives, maternity support workers and student midwives. We offer membership both in the UK and internationally. You can join us here or by calling If you are already a member, you can update your membership details here. We provide workplace advice and support, professional and clinical guidance and information, and learning opportunities with our broad range of events, conferences and online resources.

    Contact the RCM by email, telephone, and post 24 hours a day. Find the latest RCM and professional midwifery news here. Read blogs, watch video blogs and read in-depth articles, briefings and reports on clinical midwifery practice, development and professional issues. Our members know that should the worst happen they have got the best support in their corner.

    You can turn to the RCM should you need support with disciplinary hearings or clinical negligence, and many other issues. The RCM has a vital role in disseminating information about professional midwifery practice, and in ensuring that there is a recognised UK-wide platform for sharing good practice. Sign in here to view evidence-based guidelines and positions statements. We have three types of WPRs; stewards, learning reps and health and safety reps.

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    Our networks spread further with workplace branches, student forums and societies. Joining us at our UK-wide events, supporting our campaigns or sharing your opinions in our consultations enables our members to voice their concerns and ensure we are representing all their opinions. Looking to advertise your event or have your event accredited? There are many different ways to continue your personal and professional development with our online study tools and resources.

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