“Unaccompanied deliveries have more complications”

Just a few days after the Zaragoza Clinical Hospital and the Sociedad Marcé Española de Salud Mental Perinatal organized the V Symposium on Perinatal Mental Health, this same hospital announced that it was no longer allowing women to be accompanied during the dilation period prior to delivery. . The person in charge of opening the Symposium had been the pediatrician María Teresa Hernández Aguilar (Zaragoza), who is part of the Initiative for the humanization of care at birth and breastfeeding (INAH). Finally, the Clinical Hospital has backtracked.

How is the pandemic affecting births and breastfeeding? What are you most concerned about?

We must bear in mind that, within the general population, the group of young women is not one of the most affected by the pandemic, nor is that of pregnant women. It is true that the period close to delivery is the most worrying moment for a pregnant woman to become ill, because at that moment the woman’s body is in a situation in which a respiratory infection is not exactly desirable. On the other hand, the blood clotting disorders that this virus is also prone to produce can also be important complications for a woman in the perinatal period: before, during childbirth and postpartum. In any case, if women or infants pass the coronavirus, most of the time it has gone unnoticed. So from my point of view, what is mainly affecting pregnant women are changes in health care. In the first moments of the pandemic, when we were in a situation comparable to an unexpected natural disaster, to a situation almost of war, as has been said in some environments, when there was no material, it was not known how the disease could affect it. You can understand some of the measures that were taken in some places. But, little by little, it has immediately been seen that this measure of separation from the woman during dilation, of not allowing her to have a companion, of not allowing it even during childbirth … there is no justification from a scientific point of view for separate mothers from their newborns, their partners or companions. This is proven to be detrimental to the physical and mental health of women, families and newborns.

What harm does not being accompanied during childbirth cause for women?

On the one hand, it affects your stress situation, which has consequences on your mental health that may, in the future, especially if you are more susceptible, lead to anxiety problems or even post-traumatic stress. On the other hand, what is clear is that the births are worse. A woman who is unaccompanied may have a longer, more complicated delivery, she may need instrumentalization, even end up in a cesarean section … Unaccompanied deliveries have more complications; that is proven in studies.

And what damages does the separation of the mother from the baby cause?

It can cause serious damage to the mother’s mental health and, of course, to the mental and physical health of the newborn. Starting with the physical, which seems easier to understand, when the baby is born and is with its mother, skin to skin, it is impregnated with the bacterial flora of its mother. This flora protects you from other germs that may be in the environment, so there is less risk of infectious diseases. In the case of coronavirus, very few cases of mother-to-newborn transmission have been described and, of course, very few serious cases. Furthermore, in the few cases that have been described, it is not clear that it was through maternal transmission. But there is a study as it shows how babies who were separated from their mothers at birth were infected with coronavirus by the professionals who were caring for them. It’s a study published in China. On the other hand, for the mental health of the mother and the baby, skin-to-skin contact is closely related to the mother-child bond and this bond has repercussions on their immediate mental health and in future stages, in that it favors the maternal care: the mother is more comfortable, more at ease, more eager to take care of her baby, to recognize it as her own … Then, we would find the difficulties of breastfeeding: in recent studies it has been shown that up to 60% of the women who were separated from their babies failed to breastfeed, even though they wanted to. Others had much more difficulty breastfeeding than those who had not been separated and who had been allowed the first breastfeeding to occur in the first hour of the baby’s life, which is what is recommended as a quality standard after the birth.

So there is no justification for these decisions not to allow contact between the mother and her companion or her baby?

I suppose the justification is that due to the high number of cases of coronavirus disease, an attempt is made to decrease the number of people in the hospital. However, there are scientific and health authorities at the European level and at the World Health Organization that say that all women have the right to have a companion during labor and delivery, to do skin-to-skin with their baby, to offer them the breast in the first hour of life and to have support for the establishment of breastfeeding, be it negative or positive covid. What is recommended at this time is to put in place the measures and resources that are necessary to, trying to prevent contagion to professionals and patients who are in the hospital, to maintain these rights. If necessary, they can perform PCR on the companions or require that the precautionary measures be kept. The necessary precautionary measures must be put in place, but not at the cost of separating the families. The damages are proven, and yet there is nothing to support separating families at such an important time for physical and mental health.

Are you also worried that the coronavirus complicates support for mothers who want to bet on breastfeeding?

Throughout the Spanish geography, breastfeeding support groups are being organized in different ways. In general, at this time, in many places virtual meetings are being held, of four or six people, with a lactation consultant or a more expert person and they share their experiences, their problems and give each other the support they need. There should be no problem for medical care, a nurse or a midwife or a lactation consultant, who should be figures to be incorporated into the Spanish health system. In any case, if a person needs personalized attention, with due precautionary measures, it must be given. What must be understood is that support for breastfeeding is also necessary in times of crisis, because it is health for the newborn and for the woman herself. The number of months that a woman breastfeeds in her life is related to the decreased risk of breast or uterine cancer; against breast cancer, it is one of the most effective protective factors, recognized by oncology authorities. Therefore, we should begin to understand that we are indeed in a situation of alarm, in which we must take precautions against contagion with a disease that can have very serious consequences, but breastfeeding must be protected because a woman cannot breastfeed, If that is her wish, it is to steal health opportunities from her and her son. On the other hand, we know that the virus is not transmitted by breastfeeding. Cases of transmission due to skin-to-skin contact or being in the same room are extremely rare. Families need adequate information and, with this information, to be able to decide. But the advice today of the world health authorities is not to separate women from their companions during childbirth. In this sense, the INAH of Spain, the Initiative for the humanization of care at birth and breastfeeding, following the recommendations of the WHO and Unicef, recommends not separating, maintaining skin-to-skin contact and the first feeding in the first time. It cannot be said that we are humanizing when we give women Ipads to see the babies in the nest. The point is that mothers have the right to be with their children and children with their mothers. And mothers and fathers cannot be considered visits in hospitals: they are not visitors, they must be the main caregivers in the perinatal period.

Are you afraid that this situation will cause a setback in the number of women who choose to breastfeed their babies naturally?

We imagine that it will be seen in years because, unfortunately, in Spain the health authorities have so little interest in breastfeeding that the statistics are rather scanty. The truth is that, on the one hand, we find that many women, after the first weeks of uncertainty, are very informed and know that breastfeeding their children can prevent infections and reduce the risk of becoming ill. It is true that breastfeeding has not been shown to reduce the risk of getting sick from coronavirus, but it is known that breast milk has antibodies against other previously known coronaviruses and it is clear that it reduces the risk of getting sick or being hospitalized for many other things. In these moments, being healthy is very important. When hospitals are saturated, getting sick is a problem, even if it’s not from coronavirus. Many women know this and we are seeing that many more women want to fight for their breastfeeding, they demand help when they have difficulties, they do not want to give up and many want to breastfeed. But there is no doubt that when many barriers are put in place at the time of birth, women have it more complicated. Many times the abandonment of breastfeeding is against the mother’s will because she cannot cope with difficulties, because she is not able to breastfeed. Those women who have been separated from their children at birth are going to be subjected to more pressure from themselves, because when women want to breastfeed they feel bad, they feel bad mothers for not having been able to do so. She is not, of course, a bad mother. A mother who breastfeeds is not better than one who does not, but women have the right to have their wishes respected and supported if, on top of that, they are going to benefit their health, that of their children, and indeed that of the whole of society.

How about the decision to separate the mother from her companions in other stages of pregnancy, for example, ultrasound scans?

When people are vulnerable, the ideal is to be accompanied, but I want to think that in the hospitals where ultrasounds are done, I imagine that, if they have the possibility, they will allow the woman to be accompanied. I believe that it is not as delicate a situation as at the time of delivery and it is important to assess the appropriate protection measures. This is the same as when a person with cancer goes to a check-up: they probably feel more protected if they are accompanied by their family or the person they want. Humanization measures should not be lost, even though we are in a pandemic stage. We must also ask that we all be responsible and that we understand the situation of overload, saturation, and the very high pressure to which the entire health system is subjected. It is a complex situation, we all have to do our part.


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