Gynecologists, against the controversial Canarian sentence: "The decision on whether it is cesarean section or natural childbirth must be taken following a strictly medical criterion"

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The decision to deliver vaginally or caesarean section should be made by the mother, not the doctor. This has been ruled by a contentious court in Las Palmas de Gran Canaria arguing that, by imposing natural childbirth, the woman's right to decide has been violated.

The sentence, a pioneer in Spain, recognizes it as a fundamental right of pregnant women and has condemned the Canarian health to compensate a mother with one million euros for prolonging a twin birth for 17 hours in the Maternal and Child Hospital of this municipality. As a result of this delay, one of the newborns suffered irreversible brain injuries.

Predictably, the verdict has reopened a debate on the treatment of women during childbirth care and the positions are absolutely opposed. The focus is mainly on the term obstetric violence. The World Health Organization understands as such the violence that women suffer during pregnancy or childbirth when receiving physical abuse, humiliation and verbal abuse, or coercive or non-consensual medical procedures.

In the case of the Canary Islands, the sentence considers it an act of obstetric violence because it violates the fundamental right of the mother to decide if she wanted her twins to be born vaginally or by cesarean section. The investigating judge has ruled that the doctors violated "the right to information of which the parturient woman was the exclusive holder and the inalienable faculty to opt for cesarean section as a surgical alternative to give birth to her two babies."

"The doctor does not have the last word"

Apart from this specific case, should the mother's desire prevail over medical criteria? Should professionals refrain from acting in accordance with what their knowledge dictates? If Francisca Fernández, lawyer and member of the Observatory of Obstetric Violence, takes the floor, the answer is that medical knowledge is not enough or competent to decide whether the birth should be done vaginally or by cesarean section: "We are talking about a physiological process in which the doctor does not have the last word. She cannot be allowed to usurp a right that belongs exclusively to women. It is an absolute right. Once informed of the circumstances in which the birth takes place and the dangers or risks of each option, she decides under her responsibility. The mother knows what is right for herself and the team caring for her must respect her when she is about to give birth."

He assures that the opposite is obstetric violence. "Not acknowledging it means continuing to allow doctors to pursue their own interests. Their criterion for the welfare of the child or mother is false. They decide according to their interest. Who says they have to set themselves up as spokespeople for the well-being of the child, as rescuers of babies? It is simply a question of power and we should not fall into the trap of posing, as they do, obstetric violence from a lexical point of view. It is a serious problem, of malpractice, of imposition of power by doctors. It's always been that way and, once again, the consequences have been terrible."

"The criteria must be exclusively medical"

The gynecologists and obstetricians consulted do not share his thinking. Federico Galera, gynecologist and director of the Madrid Fertility Institute (IMF), defends the right of the mother to be informed of the alternatives that exist, of the benefits or difficulties that each one may have. "Communication - he says - is important throughout the process. Both in gestation and at the time of giving birth. However, the final decision must be made following strictly medical criteria. The mother will not refuse to respect an assessment that she knows is the one that benefits both her and her child. In medicine, everything that can be improved is improved and, if there is malpractice in a specific case, it should be pursued, but without taking it as a pretext to condemn themedical profession. "

The Spanish Society of Gynecology and Obstetrics has already described as "inappropriate and unfair" the use of the term obstetric violence as a form of gender violence because it does not conform at all to the current model of maternity birth assistance, focused on women. This is also the opinion of gynecologist Eduardo Cubillo, who, after many years in the profession, refuses to think that medical criteria can be thrown overboard.

"In the first place," he says, "we cannot allow this concept to criminalize the work of gynecologists and obstetricians who take care of the quality of care and the health of women and their children. Contrary to the opinion that wants to impose now, taking advantage of the concept of obstetric violence, scientific evidence shows that things are being done well." Cubillo points out that the advances applied to maternal and fetal medicine have allowed a great reduction in morbidity and mortality in recent decades. Hospital care allows both the baby and the mother to benefit from all this.

Also in terms of humane treatment can speak, in his opinion, of quality, information, respect and participation in decision-making. "It is unacceptable to speak of obstetric violence or lack of empathy towards patients when there is an absolute commitment to ensure their well-being and that of the child. It is our vocation and we exercise with absolute scientific and ethical rigor."

Fear of the judicialization of obstetrics

Cubillo is concerned that the abuse of these terms – obstetric violence or patriarchal conception of women – results in doctors acting under pressure and avoiding cesarean sections when appropriate for fear of being judged and later convicted.

He reiterates that the mother is informed if there is a need for a caesarean section or an episiotomy and the reasons are explained. "Caesarean sections have saved and save the lives of many women and children. It cannot be said cheerfully that they are done in a disproportionate way. Work has been done in recent years to ensure that there is a medical justification. In any case, there is no imposition by anyone here. The logical thing is that there is good communication between the mother and the doctor so that he keeps the mother informed of the medical conditions and, based on a strictly medical judgment, chooses what is best for the parturient and the baby. "

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