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Aser García Rada: The value of one minute and delivery practices in Spain

31 Dec, 10 | by BMJ Group

Aser Garcia RadaIt is a common Spanish tradition to play the “Christmas lottery” on December 22 — it is the most important draw of the year.  Those that don’t win still keep some hope for the second lottery — the “kid’s lottery” on January 6th. But this year, as the front page headline of the Spanish journal La Razón says, there is still one more chance to be a lucky winner if you happen to be pregnant. The “baby cheque” is the other kid’s lottery. And it is indeed a lottery, the one showing, like rarely before, the true value of a single minute. To be precise, a value of 2.500 Euros.

In July 2007, the Spanish president Jose Luís Rodríguez Zapatero approved a bill to give 2.500 euros to every mother having a new baby. Since then, more than 1.5 million mothers have received a so called “baby cheque.” At first glance, it doesn’t seem a bad idea for a country that has for many years had the lowest birth rate in the world. But the distribution of the aid has been far from ideal. For example, this is a conversation someone overheard between a couple whilst doing their shopping: “I think I am going to spend the 2.500 euros on a flat screen plasma TV,” said the very well dressed woman.

Seems unfair? Yes, because it actually is. And it is also unfair to cancel this measure for 2011, or at least for those people who really need it. Let’s remember that Spain has around 20% unemployment, the highest rate among developed countries, so the Government’s decision will make a great difference for some of those born between midnight and 0:01 tonight.

Still, this would be merely something to fill the front pages on days of low political activity, if it didn’t unveil questionable practice in private Spanish clinics.

This is what a midwife from a large hospital in Seville said to El País a few days ago: “In the public system it won’t work, but I have colleagues that are seeing this in private clinics in Andalucía.” She is referring to pregnant women who are due to deliver in the first fortnight of January that are coming to visit the doctor early and suggesting they have gone into labour. “They don’t dare ask openly, but we know they wish to bring forward their delivery date,” she said.

And the midwife continues: “Bringing forward the delivery date is relatively common in the private sector. They usually do it when there is a holy day for example Easter or the Feria. It carries certain health risks, though not usually serious ones.” Astonished? Well, I am not, as I see this for myself whilst working as a neonatologist in a couple of private clinics in Madrid.

This may be one of the reasons why Spain has such a high rate of caesarean deliveries. The current rate is between 20 and 26% of total deliveries, while WHO says the recommended number is around 15%. Though the rate is still high in the public sector it is closer to the WHO recommendations. It is in the private sector where the rate of caesarean sections gets up to 35%, and this really increases the average.

A mother’s decision on how and when to have her baby should be based on scientific evidence, and doctors have a professional and ethical duty to advise them correctly. But it seems in some places the limits are wider. This is just one aspect of perinatal care in Spain that is still very linked to old customs that have more to do with professional convenience than with delivering a baby in a healthy and proper way.

Fortunately we have a new national strategy for improving labour care and some hospitals are beginning to improve their procedures substantially, though we still have a long way ahead.

Mahatma Gandhi said that “one can measure the greatness of a nation and its moral progress by the way it treats its animals.” We could add, “…and the way they deliver their babies.” Though we won the soccer World Cup, considering what we still do to bulls, we may have to deal with a few more details yet before we can consider ourselves a great nation.

Aser García Rada is a paediatrician at the Hospital Infantil Universitario Niño Jesús in Madrid, Spain, and a freelance journalist.

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