Amid COVID-induced rights curb Spanish women fight for control of childbirth

Madrid: As she struggled through painful labour contractions, Spanish nurse Teresa pleaded with doctors not to perform a caesarean section on her. But offering no explanation, they did it anyway.

Teresa, 40, who asked not to give her real name, found out later they had operated because she had COVID-19 - triggering a hospital protocol that said most women who had tested positive for the disease should have caesareans.

Traumatised and suffering nightmares, Teresa has sought psychological help and feels unable to return to her job at the public hospital in northern Spain where she gave birth seven months ago.

"I only realised what was happening when they put up a blue sheet to block my view and gave me an anaesthetic," she said.

"I begged them not to cut me open and said I wanted to push, but no one spoke to me or even looked me in the eye. It was like I was nothing."

There has been a spike in complaints about medical interventions and violations of patient rights since the pandemic hit Spain, one of Europe's worst-affected countries, said lawyer Francisca Fernandez Guillen.

Fernandez specialises in obstetric violence cases - in which mothers are mistreated during or around childbirth - and is preparing legal action on Teresa's behalf.

Every week, she said she gets calls from women who had been separated from their babies or forced to give birth unaccompanied due to hospital protocols, as well as from concerned midwives.

The health crisis has exacerbated long-standing problems with the treatment of women during childbirth in Spain, Fernandez said, describing a culture of excessive procedures, poor communication and a lack of accountability.

"In general, women aren't being given explanations or options that relate to their situation. They're simply told what's going to happen and it happens," she said.

Because Teresa was in the pushing stage of labour, she should have been spared a caesarean under the terms of the protocol issued by her particular hospital, which was seen by the Thomson Reuters Foundation.

The document describes caesarean delivery as the best way to protect staff safety.

But Fernandez said such edicts rode roughshod over patients' rights: "A professional can protect themselves, but never at the cost of doing damage to a woman or baby."

'What I lost'

A study of more than 17,000 Spanish women conducted in 2018 and 2019, published in the International Journal of Environmental Research and Public Health in October this year, found 38% "perceived having suffered obstetric violence".

"Offering information to women and requesting their informed consent are barely practised in the healthcare system," the study said.

It is an issue that goes far beyond Spain.

The United Nations and the Council of Europe recognised last year that gynaecological and obstetric violence was widespread, attributing the problem to institutionalised factors, from under-resourced health services to patriarchal attitudes.

As the pandemic puts further strain on healthcare services, the World Health Organisation (WHO) has emphasised that, whether or not they have the coronavirus, women are entitled to "a positive birth experience".

According to the WHO, C-sections are not necessary for COVID-19-infected women and should only be performed "when medically justified".

Teresa had quarantined at home for two weeks before going into labour with her third child in April and was asymptomatic for COVID-19, though still testing positive.

She expected to give birth in an isolation room but was taken into surgery, despite being at an advanced stage of labour and experiencing no complications.

After the birth, she was separated from her newborn daughter for seven days and her requests for skin-to-skin contact and breastfeeding were denied. Instead, the baby was entrusted to her husband, who was also positive for COVID-19.

She said she has struggled to bond with and breastfeed her daughter following their separation, and feels shattered by the disregard for her wishes and wellbeing.

"I hardly recognise myself physically or mentally," she said. "I want to show the hospital what I lost and stop it happening to others."

'Basic human rights'

Other Spanish women are fighting back too.

Sara, also using a pseudonym for privacy reasons, spent 11 years seeking justice over a litany of interventions carried out without explanation or her consent during her labour at a northwestern Spanish hospital.

The ordeal left her with post-traumatic stress disorder and her baby with an infection.

"They had breached such basic human rights that I couldn't just do nothing," she said.

After failing in Spain's courts, Fernandez and a wider legal team took Sara's case to the U.N. Committee on the Elimination of Discrimination Against Women (CEDAW), which recommended in February that Sara should be awarded compensation.

It also urged Spain to safeguard women's autonomy and capacity to make informed decisions about their reproductive health.

The ruling "made visible" an often-ignored global problem, said Fernandez, who has two more cases pending with CEDAW.

But advocates in a number of countries fear maternal rights are going backwards in the pandemic.

Pregnant women and midwives in France have protested against women being forced to wear face masks during labour. In Britain, restrictions on partners being present at antenatal appointments and throughout labour have sparked anger.

Franka Cadee, president of the International Confederation of Midwives, based in The Hague, said many midwives and obstetricians were trying to fight for women's rights but were often hampered by institutionalised approaches to childbirth.

Safety measures should ensure all midwives are supplied with proper protective equipment, which was lacking in the first wave of the virus, and prioritise mothers' wellbeing, she said.

"The best birth is a birth where the woman can say: 'I understood what happened, it was with my consent and the people with me were skilled and loving'," Cadee said.

"We have to invest in our future, especially in this time of COVID, by making sure that women are able to give birth healthily so they can nurture their families."