Nearly two decades ago the International Conference on Population and Development recognized reproductive health as a human right. Its program of actions defined that to guarantee antenatal care, safe delivery, postpartum care, and mothers and children quality of life, populations had to receive health services and basic information which would permit them to freely decide and actively participate when it comes to their welfare.
While some regions have made progress in the availability of maternity and neonatal care, preparation for pregnant women, expectant parents and other family members on how to react -cooperate during the stages of labor is still poor and insufficient, and this natural physiological process undergoes an interventionism global epidemic, according to the World Health Organization (WHO).
Experts of that body, from various disciplines and countries, argued the situation and issued, in 1985, the Declaration of Fortaleza, which text analyzes and informs the appropriate technologies for delivery, while it also urges administrators and health personnel to review protocols and continuously investigate the relevance of certain practices, as it is estimated that between 70 and 80% of pregnancies classify as “low risk” to the onset of labor.
Beyond technicalities, the Declaration promotes respect for autonomy and the prominence of women as a basic element in judging the quality of care in these cases , because, although certain procedures, equipments or invasive instruments allow mothers and children to survive adverse events, should routinely be used in any context.
Thus, WHO does not justify annual cesarean rates above 15% in every nation, due to the evidence of its impact on perinatal mortality rates, reserves delivery inductions to specific medical indications (below 10%) and insists on previous consultation with the patient and family, and inform them of the existing consequences and alternatives.
It also urges to protect the perineum, as the systematic use of episiotomy (cut extending the opening of the vagina) is among the leading causes of deep anal tears, sexual dysfunction, postpartum hemorrhage and infection, in addition to the wound causes discomfort to the mom and limits her development with the newborn, especially when standing up or sitting to breastfeed him.
This is not a crusade against surgery nor denies its benefits at specific times. Rather, it calls to evaluate its relevance taking alternatives such as encouraging the mother to walk or move around during dilation and expulsion, rather than laying face up-for changes in posture to relieve pain, gravity to contribute to the descent of the unborn and not to reduce his oxygenation.
It was decided then that the future mother could choose a person she trusts to support her emotionally during labor, along the medical team. In fact, that possibility exists in Cuba from the 90s and the Mother-Child Program comprises the prior preparation of the pregnant woman and her companion through meetings with professional nurses in primary or secondary health institutions where they learn what happens when knowing this process. However, OnCuba developed some surveys in the street that show that few Cubans under 35 know these opportunities and even fewer outside Havana .
María del Carmen, Jani and Ivette, from Havana, Mirelis, from Matanzas and Santa Clara’s Nayvi suffered episiotomies without consulting them or prior warning, although they confessed to believe that the “little cut” was always a necessary evil when bringing a baby into the world through natural childbirth. Three of them were delicate and had to receive transfusions because, with enervated vaginas, the seams did not stop the bleeding.
Gloria, meanwhile, after her experience as first-time mother, suspected that episiotomy worked for medical equipment, not for her. “They ended quickly with me, but because of the wound, it cost me a lot to take care of myself and the girl. So the second time I had contractions during maternity, I remained silent, I walked, I stood up leaning over the bed until reaching sufficient dilation. I remember when the nurse came to check on me, 6 or 7 hours later, my daughter was crowned and she reproached me: ‘bitch, you’re giving birth over’. I was moved to the living room and pushed, but there were no cuts that time. I had saved them time … “
In Maternidad Obrera Hospital, in Havana’s Marianao municipality, doctors argue, when asked about episiotomy, that it is practiced only if “necessary”, but they barely specify under what criteria. By pointing out that it is not indicated to shave pubic hair or administer an enema (empty the large intestine) as preventive hygienic measures-except when the woman asks it, ‘the Declaration of Fortaleza sharpens its defense to not even the slightest detail to circumvents the right to a gentle birth.