«I had a cesarean section with my upper limbs tied up»

The doctors diagnosed him polyhydramnios (excess amniotic fluid) and suspected an excessive percentile of the creature. Therefore, they scheduled the delivery in week 41. However, “after 11 hours and multiple pH of the fetal skull (a small drop of blood is extracted from the baby’s scalp to check the parameters of the acid-base balance), the delivery did not progress – he continues – so a non-humanized cesarean section was resorted to” which involved, as indicated by the center’s protocol, “the upper limb support and the absence of a support person in the operating room, as well as skin-to-skin contact with the baby.” As soon as her son was born, without any health problems, he was separated from his mother because she was taken to intensive care. “My little one was taken to the infirmary units intended for skin-to-skin contact for non-pregnant relatives.”

That night, Maria suffered a hemorrhage and a drop in saturation. “I was given oxygen, serum and plasma, and my abdomen was drained. They also applied weights to it to help with the process,” she says.

The next morning, she was taken to the ward and minutes later her baby was brought to her. «More than 15 hours had passed»she recalls. “During that time, the nursing team decided to feed him with formula milk and a bottle without prior consultation.” In addition, the child “was diagnosed with colic from the first 24 hours and we forced to use a pacifier “to control crying and not disturb other patients.”

Fifteen months after giving birth, after the State of Alarm and confinement were declared, she ended up “in a Private emergency psychiatric consultation» The diagnosis was clear: post-traumatic stress disorderwhich she had to overcome with therapy and pills. “There was no follow-up after the intervened birth. Nor was there any humanization in the process or mental health protocol,” she says today, aware of what she suffered. “I also had to endure Comments on my physicality» by the medical team. Although she admits that other professionals were kind to her, «the impact of the birth experience increased as the exterogestation progressed».

Everyone, including her, They normalized what happened. No one “meaningfully addressed the mental state I was in because I answered questions naturally. I was not aware of the level of obstetric violence that I suffered».

Mothers and babies, without resources

The experience of Maria, and of many other women, shows the importance of Caring for perinatal mental health in our countryHowever, as the study reveals, ‘The map of the desert’prepared by the European Institute of Perinatal Mental Health (IESMP), specialized public resources for perinatal mental health care shows the absence of these programs and the neglect of the mental health of mothers and babies.

This research has revealed the need to improve this situation, as well as the importance of recognizing and supporting pioneering programs and professionals in this field. “We have been able to collect Data from 46 initiatives throughout Spain and many of them are dependent on the individual effort committed professionals, which makes them vulnerable to disappearing in the event of any eventuality,” he says. Blue Forti Burattichild and adolescent psychiatrist and lead author of this research.

This lack of resources contrasts with the situation in other European countries, such as the United Kingdom or France, which “have highly complex resources for the most serious cases, as well as outpatient care for prevention, early detection and intervention,” the expert explains to this newspaper.

“Perinatal Mental Health – continues Forti – encompasses everything related to the Mental health of women and their partners in the perinatal stagewhich includes pregnancy, childbirth, and postpartum until the baby is one year old. It also includes the Search for pregnancyas well as the gestational or infant lossesWhen we talk about mental health, we refer to the treatment of mental health problems or disorders, but also to all those practices that promote mental health and prevent the development of subsequent pathology.

Types of pathologies

Perinatal mental health disorders affect approximately 20-25% of mother-infant dyads during the perinatal period, according to the IESMP. But other problems such as anxiety, stress, mild depression or trauma resulting from childbirthmake this figure increase considerably.

“There are more serious and less serious pathologies,” explains the researcher. “Within the first, we can include postpartum psychosis, major depression, bipolar disorder, obsessive-compulsive disorderany serious mental disorder that already existed before pregnancy, but the perinatal period may be a time of greater vulnerability and requires closer monitoring. Among the less serious ones, we can find depression or mild anxiety.

The problem of not to treat “minor pathologies in time” is that they can reach become chronic or worsen“, the expert stresses, “in addition to having medium- or long-term consequences on the health of the mother, the dyad and the family in general.” This is what happened to Maria: if she had been diagnosed in time, everything would have been different.

We must not forget that the World Health Organization (WHO) and the Human Reproductive Program (HRP) have been warning for some time about mistreatment of women and their newborns during childbirthIn fact, the UN has already called Spain’s attention to poor practices in childbirth and birth.

‘The map of the desert’ It also reveals that the few initiatives that exist are, in addition, distributed very unevenlywith areas that completely lack programs in the public network. In addition, many professionals point out institutional obstacles which hinder the effective functioning of these programs. In fact, the few that exist They depend too much on individual effort of specialists and are affected by the absence of qualified personnel.

“Sometimes they are professionals who have experienced situations close to home and have realized the shortcomings of the system or who have experienced motherhood first hand and have become more sensitive,” says Forti. Thus, “the Administrative, management and organizational obstacles can greatly hinder work. And when those professionals leave their posts, the program disappears.

The study also highlights the low availability of specialists in this area. One of the relevant findings of the 46 initiatives is the Disparity in the availability of specialistswith a considerable number of programs lacking psychiatrists, although in almost 80% of cases they do have at least one psychologist.

While Catalan families have extensive coverage thanks to the services of hospitals such as the Germans Trias i Pujolthe most complete, or the Barcelona Sant Boi de Llobregat Health Parkthose of Galicia and Estremadura They do not have any kind of attention.

Practices that should not be carried out

«We must promote training for specialists, but also Including perinatal mental health in the curriculum of future health professionalsboth in the residency (in professions that have residency) and in basic studies,” says the expert regarding the measures that must be taken to improve the situation because the reality is that today certain practices in hospitals that should have already been eliminated.

“The list can be very long,” laments Forti. “Some examples may be that in the care of a woman with a gestational lossdo not allow accompaniment by your partner or administer benzodiazepines to a woman who is distressed by the news of the intrauterine death of her baby, since the current recommendation is Avoid administering them as much as possible because they interfere with the elaboration of grief.».

Not taking care of perinatal mental health It is also “not exploring symptoms of emotional distress, anxiety, depression in routine pregnancy check-ups, minimizing the discomfort reported by the woman by attributing it to hormonal changes, say ‘don’t cry’ When communicating bad news or separate mother and baby “without a justified medical indication,” continues the expert, who continues to give examples of practices that continue to occur today by many professionals, such as “not supporting breastfeeding or indicating the suspension of a medication after pregnancy or breastfeeding when it is compatible but the specialist does not know it.”

Finally, the study reveals how patient care varies in format and scope: 34 of 46 programs are carried out in hospital settingswhile 21 are developed in specialized outpatient settings, such as mental health centers or outpatient clinics. Two programs that operate in an intensive outpatient format stand out: one specifically as a mother-baby day hospital, Cataloniaand another, a children’s day hospital, in Castilla la Manchawhich serves children up to 36 months of age and their families, and which addresses relationship difficulties.

A plan for the future: the approval of the Ministry of Health

«We often receive desperate requests from mothers or families who need urgent and specialized care for problems such as depression during pregnancy, postpartum psychosis or gestational loss. It is It is vital that they receive prompt support and, if necessary, at home, since lack of attention at this critical moment can make the situation worse,” he says. Ibone Olzaperinatal psychiatrist and director of the IESMP, who also participated in the research.

For all these reasons, the IESMP has prepared a formal request to ask the Ministry of Health for Development of a National Perinatal Mental Health Plan that integrates multidisciplinary approaches, promotes specialized training for health professionals who care for maternity, guarantees equitable access to quality and trauma-sensitive services, and addresses gender-based violence during pregnancy and the postpartum period as a priority.

«We have met with Belen Gonzalezdirector of the Mental Health Commission of the Ministry of Health, and her team,” says Forti, who acknowledges that the meeting was very positive. “My perception is that the Ministry’s team recognizes the need to implement a plan that includes attention to perinatal mental health at a transversal level.” Now, all that remains is to make it a reality.