More investment in personnel, updating protocols and improving information about what a cesarean section entails. These are some of the key aspects pointed out by the experts consulted that would serve to reduce the rate of caesarean sections in Spain. An investigation published this Monday by elDiario.es, which collects data from hospitals throughout our country, has revealed that 28 hospitals triple the recommended rate of these interventions, which the World Health Organization (WHO) places at 15%.
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In Spain, the average rate of caesarean sections in public hospitals is 21.9%, while it reaches 37% in private centers. There are big differences between autonomous communities. The highest rates are found in the Valencian Community, Extremadura, Catalonia, Castilla y León and Andalusia. The lowest are recorded in Euskadi, whose rate is below the limit indicated by the WHO.
The director of the Women’s Institute, Antonia Morillas, has related these data to the concept of obstetric violence with which the Ministry of Equality has been working for some time and one of whose fundamental elements is respect for childbirth.
The situation worries public health associations, who believe that greater investment in midwives, for example, would greatly reduce the number of instrumental deliveries. On the one hand, there is the general situation, acknowledges Pilar Serrano, vice president of the Madrid Association of Public Health (AMASAP) and professor at the Autonomous University of Madrid; and on the other the causes that can occur between communities and provinces. The data shows, in any case, that “public institutions are working better because there are fewer caesarean sections,” Serrano points out.
The growing tendency to caesarean sections has been in the sights of the association El Parto es Nuestro since its birth. The organization, a pioneer in raising awareness and denouncing obstetric violence, calls for greater transparency as a first step and regrets that the elDiario.es investigation is “the only complete database” in which caesarean section rates can be consulted by center, something that it considers “unacceptable”.
Given this, it asks that the data be “published and accessible” on a mandatory and regular basis, in order to know how the rates evolve in each hospital and have all the information, as well as extend transparency to other interventions. Among them, the inductions, on which there is no public data, or the Kristeller maneuvers, a practice discouraged by the WHO that consists of exerting pressure on the abdomen to try to make the baby go down towards the birth canal.
The data revealed by elDiario.es this Monday show that there is an enormous variability in the number of cesarean deliveries depending on the center. “What it puts on the table is that performing a caesarean section on a woman in Spain does not depend so much on her health or that of her baby, but on the hospital she goes to. And that is terrifying”, denounces Francisca Fernández Guillén, a lawyer who has brought several cases of obstetric violence to the UN. “Major surgeries are being done on women without a valid medical reason,” she adds.
Protocols, inspections and information
“For some time we have been pointing out that the rate of caesarean sections is above that indicated by the WHO,” says Marciano Sánchez Bayle, a doctor and spokesman for the Federation of Associations for the Defense of Public Health. For Sánchez Bayle, this is because even though there are protocols that indicate when a cesarean section should be performed, “they are not executed carefully.”
“What should be done is to establish professional criteria, which are already established by the Ministry of Health, and an inspection of those centers that deviate a lot from what is reasonable to know what circumstances and causes are occurring,” recommends the health worker. “In some cases it may be justified because there has been more pathology, but in other cases it is not.”
Serrano also asks that there be an improvement in the information received by women who are about to give birth because there may be a sense of “false security” around caesarean sections in the private sphere. “C-section is a very important risk in terms of hemorrhage, facing a second birth, recovery or delayed skin-to-skin contact,” she warns. “There are many side effects that may not be explained in detail and that is why many women choose it. Something like a false security ”, ditch she.
In Serrano’s opinion, the fact that Euskadi, Navarra and Asturias are the only communities with an average of less than 20% is due to the fact that “with all precautions, there are health services that are healthier than others”. “There is evidence that the number of midwives determines that fewer caesarean sections are performed because they are not interventionists and can give the woman that time to do the dilation.”