Interview with British trained midwife Laura Peña Ortega in Madrid

After completing her nursing training in Spain in 2000 Laura moved to the UK where she lived and worked for over 14 years. She trained as a midwife in central London and worked as a community midwife there, specialising in home births. Laura talks to MumAbroad Life about supporting women during pregnancy, birth and through the postnatal period, hypnobirthing, and returning to Madrid.

What made you decide to become a midwife?
It was when I was doing my nursing training that I became interested in midwifery and women’s health. After several years of nursing in the UK I went travelling to South America. During some time spent in a remote area of the Amazon, I was lucky to witness a natural birth and met with a group of women who were traditional birth attendants. They taught me about their perspective on childbearing and birth. I was hooked from then on and a couple of years later I moved to London to get my qualifications.

Why did you decide to qualify in the UK and not in Spain?
I was reluctant to study midwifery in Spain having heard how medicalised it had become here. Whilst I was back in the UK after my travels I had the opportunity to accompany a very good friend through her journey into motherhood. I was pleasantly surprised by the care my friend received. It felt familiar and respectful, putting women and children at the centre of care, listening and facilitating information and choices. I liked the fact that midwives in the UK work as autonomous professionals, being the main care providers for pregnant women and their families.

Considering the difference in attitude towards pregnancy and childbirth in Spain compared to the UK, how difficult was it for you to work in the way that you wanted to when you returned to Madrid in 2015?
My Spanish colleagues in the UK warned me how hard I was going to find working as a midwife in Spain, having been in the UK for so long. So I tried to come with an open mind. Initially I got a job in a hospital in northern Madrid just to accustom myself with the policies and services offered. I have to say the team and the facilities were impressive, however the care was extremely different.

As a midwife I had lost my autonomy, but it was even harder to see that women too often lose their autonomy once they walk onto the hospital premises. Pregnancy and childbirth were treated as health issues, medical intervention was routine and many protocols and practices seemed out of date. Luckily, I know some health professionals working in hospitals in Madrid who are eager to change this. Some hospitals are making huge changes towards providing better care for women and their families, facilitating options and choices and changing their practice based on updated evidence.

As an independent midwife what is your work philosophy?
I aim to be ‘with women’ and their families on their journey through pregnancy, birth and parenthood. I believe that pregnancy and birth are natural, physiological processes. I support and encourage women to give birth in an environment of their choice, helping them to trust their instincts and feelings about their own bodies and their births. I feel that communication is key to establish a relationship of trust and confidence and to understand each individual’s needs. I strive for women to have a complete and unique experience, whilst providing the most up-to-date information to empower and enable them to make informed choices.

How do your midwifery services differ from the Spanish health system?
The Spanish health system does not offer a large range of options to pregnant women. Care is mainly lead by an obstetrician and the public care option for giving birth is confined to hospitals. Thankfully, many hospitals are changing as I said, offering women a friendlier environment and more respectful service. Nevertheless, those women who want a more familiar, less medical environment to birth in, are having to look outside of the public health system.

We offer women individualised care, each visit requires its own time. Appointments are never rushed, it is important to build a relationship of trust and confidence with women and their families in order to support their wishes and believes. We respect women’s decisions and empower them to birth in an environment of their choice, adapting ourselves according to their needs. A great deal of emphasis is put on care during the postnatal period, as this is a time that is often overlooked and where close support can make a big difference to the health of women and babies.

Do you think midwifery services are underdeveloped in Spain?
I wouldn’t say midwifery services are underdeveloped, I think there are a lot of very good health professionals here, offering the best care they can. However, in my opinion, Spain should rethink the way these services are delivered and opt for a model of care that puts women and their families at it’s centre, whilst encouraging a better dialog between clients and professionals.

Midwives in health centres have a huge workload and they are often unable to provide women with the care and support they would like to. Hospitals themselves are usually understaffed and professionals in the postnatal wards are not always specialised in women’s health. Therefore, continuity of care might not be possible and in many cases key information is not delivered.

How important is antenatal preparation?
Women are designed to give birth and any woman can give birth without antenatal preparation. However, I believe we have been given lots of contradictory and negative messages about pregnancy and childbirth. A large number of women unfortunately go into labour with lots of fears that can hinder their experience. Antenatal preparation offers the chance to resolve doubts and questions, remove myths, understand physiology and facts, enabling women to experience childbirth feeling confident and in control, knowing what’s happening and feeling empowered to make their own decisions.

You are an advocate for home births. What are people’s main concerns about home births?
The main concern and argument against home birth is the lack of access to the resources available in a hospital. However, different studies have shown that home births are not dangerous as long as they are low risk pregnancies, without complications and attended by qualified professionals. Home births have a similar perinatal mortality rate as hospital births, but the rate of interventions such as c-sections, episiotomies and instrumental deliveries are significantly less when births happen at home.

I believe women should feel supported and encouraged to make choices. When people choose to have a home birth they often come to us having done a fair amount of research into the subject beforehand, therefore they feel pretty confident once they have a lot of the facts. We then help to reinforce their confidence by explaining our safety procedures so that families enter into the process fully aware of the risks and benefits of a homebirth.

Midwives are trained to diagnose any problems that may arise, make clinical decisions, transfer care for obstetric support and are qualified to respond to emergency situations. The National Institute for Health and Care Excellence has concluded that it is safer for healthy women with uncomplicated pregnancies to give birth under the supervision of midwives as it reduces the risk of medical intervention.

Are there any circumstances where you would not advise a home birth?
Yes, we cannot offer a homebirth to any women with a high risk pregnancy that requires obstetric care, for example women who are expecting twins or those with a medical pathology such as insulin dependent diabetes. Unfortunately we are unable to offer the necessary equipment and expertise in these situations, a hospital birth is the safer option. Nevertheless, if these women ask us for support, we can provide antenatal and postnatal visits and accompany them through birth in the hospital, having gained permission from the hospital beforehand.

How popular are home births in Spain?
Unfortunately Spain seems to be behind the UK and many other countries when it comes to maternity services and women’s choices. In the UK home births are an option offered within the National Health System, which means, it is an option available to anyone who can access public healthcare. In Spain, home births are still a private option that you need to finance yourself and therefore not available to all. Home births are not yet supported by most of the medical establishment.

Thanks to the increased access to information more and more people are aware of home birthing and able to find health professionals who can support their choice. Although still unknown by many, home births are becoming increasingly popular in Spain.

From your experience, what are the main concerns of foreign mums-to-be preparing to have a baby in Spain?
I think, for many mums-to-be who have recently arrived in Spain, the main concern is the language and even if you do have a good level of Spanish, medical terminology can be difficult to understand. Pregnant woman can be made to feel very vulnerable in a situation when communication is not clear. Another big concern is the different model of care offered over here. Women feel that it is more medicalised and they are worried about the amount of tests and scans they are given.

You are also a hypnobirthing practitioner. Can you explain what hypnobirthing is exactly?
Hypnobirthing is a complete antenatal course that uses deep relaxation, breathing techniques and birth education to help bring calmness and confidence to the birth. It gives women the tools to allow their minds to relax and their body to let go of tension, so that the birth will be more comfortable. A technique widely used in countries such UK and USA but still not very well known here in Spain. Hypnobirthing has been shown to decrease the use pharmacological pain relief during childbirth and often helps women to achieve a positive birth experience.

While pregnant many women focus on the pregnancy and giving birth without giving much thought to once the baby is born. How important is the postnatal period?
I am an advocate of postnatal care. This is a very important time, good support will have an effect on the physical and mental well being of the mother, baby and the family. Here in Spain, women have to access care in the community if they need any support during the postnatal period. Once discharged from hospital, they have to arrange their own appointments to see their GP and have to organise all the paperwork so their newborn can get an appointment with the paediatrician in the Health Centre. This can be a difficult time for the mother having to adjust to the many changes, leaving the house can be challenging. Lack of organised support can lead to women giving up breastfeeding, increased anxiety and worries that can create unnecessary stress on families. I think a lot of this could be avoided by offering health visits at home.

Are there any changes you would like to see in attitudes towards childbirth in Spain?
I would like to see women and their families treated with more respect and given access to more information regarding their choices. Some health professionals in this area can have an outdated view on childbirth and the ability of women to give birth naturally.

Luckily, many aspects in the Spanish system are starting to change. More people are aware of their rights and are better informed about the different practices available these days. With more demand for a more progressive childbirth service I feel attitudes are changing and the options available to families will increase.

What antenatal and postnatal services do you offer?
Within my antenatal services I offer personal midwifery support and advice throughout the pregnancy. I can be contacted at any point through the antenatal period. These appointments are an opportunity to ask questions, explain any recommended tests and their results and provide women with updated information and advice. I also offer antenatal classes tailored to individual needs in the comfort of their home; hypnobirthing preparation both, in groups or one-to-one; and group antenatal classes that involve learning the theory behind childbirth plus water-based exercise classes.

The support received after birth can make a big difference in the adjustment to parenthood. It can be quite daunting being at home with a new baby. Postnatal midwifery care involves checking on both, the mother and baby’s well-being for up to a month after the birth, providing the family with support regarding new parenting skills, breastfeeding and understanding new needs, as well as the physical and emotional changes.

I feel midwifery is more than being with women at birth. By providing care both before and after childbirth women and their families can often enjoy a more wholesome experience.

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www.lauraindependentmidwife.com




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