Reírse o ponerse a llorar.

La Sociedad Panameña de Obstetricia y Ginecología, SPOG, no “entiende” cuál es el clamor de las familias acerca del parto respetado y humanizado en Panamá!No logra entender que realizar múltiples  exámenes vaginales, romper las membranas ovulares en etapas incialee del trabajo de parto, poner Oxitocina artificial para “apurar” el parto, obligar a las mujeres a parir acostadas, no permitirles comer e ingerir líquidos durante la labor , estar sola sin el acompañamiento de ningún familiar , tener un porcentaje elevadísimo e inaceptable de cesáreas , mantener a las mujeres atadas a aparatos electrónicos, tracciónar la placenta durante el alumbramiento, separar a veces durante horas a los bebés sanos de sus madres y mucho más constituye ni más ni menos un IRRESPETO a sus más elementales derechos !

Es el mundo al revés: las mujeres saben de embarazo, parto y lactancia más que los médicos especialistas!

La llegada de Adrian Ignacio…Mi parto en agua


Luego de 10 días de la llegada de  Adrián, aprovecho para escribir la maravillosa experiencia de recibir a nuestro hijo en un parto en agua, en casa de mis padres.

Mucho antes de quedar embarazada, leí un post en el blog Verdades Embarazosas que me marcó. Me dije que cuando me tocara el momento, quería algo así.

Ya se acercaba el gran día y  desde las 6:30 a.m. del 1 de agosto empecé a sentir dolorcitos en las contracciones que antes eran solo incómodas.  Bajé una aplicación de contador de contracciones para ir revisando, ya que la enfermera estrella: “mi madre”  estaba conmigo y quería saber si iban aumentando. Se mantuvieron erráticas y variaban en tiempo. Fui al área social a eso de las 6 p.m. a caminar como lo hice los últimos días para ayudar a que el bebé bajara y se encajara.

Las contracciones siguieron leves durante el…

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Tessie’s Testimony

We had the most amazing experience in our lives, thanks to the wonderful people and great OBGYNs, Dr. Rodrigo Aybar and Dra. Graciela Anhel-Aybar 
The Doctors here in Canada, at least most of them; they see and treat you like a file number. It’s not a nice feeling at all. When I found out that I was pregnant, I started thinking about what my husband had always said about the medical system here in Canada and how nice it would be to have an intimate home birth. A home birth felt instinctively natural to us. 
Sounded like a very nice idea but we didn’t know anyone who had done a home birth. 
WHEN I WAS 4 MONTHS PREGNANT, we decided to embark on an adventure and to take off for a month to travel through Costa Rica and Panama… our last trip as a couple before we had a child. As Fortune would have it, during the tail end of our trip we met Sara Zomer, a prenatal Yoga instructor and doula. While I was checking her website, I saw articles about Water Births. I got all exited. This is a sign I told my Husband. Last day of our trip, Sara made sure that we had an appointment with Dr.Aybar. 
He was great; he took the time to know us and had a genuine interest in how my pregnancy was progressing (actually, I had a very good pregnancy from the beginning until the end). He took time to answer all our questions with much patience. Everything he said resonated with me!!! 
After our experience with Dr. Aybar, deep down we knew that we were coming back to Panama for the birth of our child, but we nonetheless took a wait-and-see approach when we returned to Canada. In Canada, the Doctor’s appointments became less and less pleasant. DURING MY 31st WEEK appointment, the Dr. told us: “We should do a C-Section at 38 weeks because the baby is too small and in breech position”. I almost cried, maybe I did. 
As soon as we returned home, I sent an email to Dr. Aybar in Panama for a second opinion! The answer came in less than an hour: “It’s too soon to make decisions about C-sections or about the baby’s size. The baby will grow. You are a small person and you don’t need a big baby. It may yet turn, and even if it doesn’t, a birth from breech position is possible and natural.” 
That was it: my husband and I decided to go to Panama! I know some people thought we were crazy to go to a foreign country where we know no one to have a home water birth with a doctor that we had met only met once? And this, to have our first child? Of course, these people wanted what’s best for us but their reactions were coming from fear (victims of the system) and from unawareness about natural births, home births or water births. 
We were glad that both our moms believed in us and supported our decision!  We knew that we are doing the right thing! We felt it! We are people who trust our instincts and our instincts told us to go to Panama and Dr. Aybar. 
AT 35 WEEKS, ON MAY 1st, slightly more than a month before my due date (which was June 9), we flew to Panama, rented a nice apartment in Casco Viejo (Old City) and made sure we had time enough to make it feel like home before our baby arrived. And very soon felt like home. 
Marie –Andre and her husband Ricardo, who both live and work in Casco Viejo and who also helped me to find our apartment, made us feel very welcome in Panama. They shared with us their water birth experience with their 3rd child, Manolito, and had nothing but the nicest things to say about Drs. Graciela and Rodrigo. I was amazed from their story and I told her that I wish to have such a wonderful experience as hers. Then we met our lovely friends Michelle Toose and her husband James and little Alex, they were there for us from the beginning. 
WE HAD REGULAR DOCTOR APPOINMENTS at Dr. Aybar’s office but some of the appointments were in our home. We were looking to see if the baby would turn. My husband wanted to try a version . Deep down, I didn’t feel that the baby needed to turn for me to have a natural birth.  
Drs. Aybar and Graciella managed to turned the baby but only for a few seconds, because it turned back to its original breech position. “Terca”, Dr Aybar exclaimed! Terca, I found out meant “stubborn” in Spanish. My husband was worried when the baby turned back to breech, but Dr. Aybar told us that “we need to trust our baby. If she returned to breech position, it is because that is what she wants and that there is a reason for it. WHEN THE TIME COMES, MUM AND BABY KNOW THE WAY. IT’s NATURAL, IT’S HUMAN NATURE.” and he was right. 
My husband made sure that I have a Doula… my mom! My mom Despina came all the way from Kastoria, Greece to Panama city on June 1st! A great supporter and a huge help! I was so happy to have her with us and to share our life experience with her. 
THE DUE DATE PASSED. Days were going by with no sign of contractions. I was feeling fine, going to the pool upstairs, walking almost 7 km every day, having nice dinners; we even went dancing, but nothing, I wasn’t feeling ready to give birth. All our friends and family waiting on Skype. No news 🙂  We asked Dr. Aybar how long we would wait? I was a week late but everything in the examination seemed perfect (we could wait). Baby was so comfy in my big belly that she didn’t want to come out.  
Almost 42 weeks and still no signs that baby was ready to come out. It was Thursday morning when the Dr. examined her last and said that we could wait a little bit longer, but that if she didn’t come out by the weekend, we should do a C-Section.  I cried. 
But that night, something amazing happened. I knew that I would be having a natural birth on Saturday night with the full moon and that it was going to be a girl, just like that Kuna lady predicted. There were still no signs, but I just knew. In the meantime, everyone around me was trying to help induce the baby naturally. 
I don’t know what helped: Maria’s special tee (boil oregano in hot water)? Some lubricating concoction my husband went and bought? Positive thinking? Baby understanding when I was rubbing my belly and telling her that she is Safe and it’s time to come out because we didn’t came all the way to Panama to have a C-Section? 
MY CONTRACTIONS STARTED EARLY SATURDAY MORNING. I called my Doctors and they told me when I have contractions 5min. apart, they will come. We went for a walk, came back home and waiting…waiting… During this time, Vasili and my mum were trying to make everything comfortable for me…My husband  prepare the house, the lighting, put some relaxing music and my mum massage my feet. 
The Doctors arrived around 8pm. They checked on me and told me that I needed another 5 to 6 hours. They were very respectful, sat in the living room, reading books and they were there for me only if I ask them to be. We also joked and laughed at some point. I remember Graciela holding my hand. I mostly stayed in the bedroom with my husband, very supportive from the beginning till the end. He was giving massages and bringing me anything I asked for. 
The Dr’s encouraged me to eat and drink water…. to move and do whatever I felt like.  I even took a shower… which relaxed me for a bit.  I meditated and made sure that my baby feels safe.  Around midnight (00:10am), the Doctor told me to get inside the birthing pool. Finally the time was coming. 
When I entered the pool, the warm water was a relief. It relaxed me and my muscles; Vasili was holding my hand and bringing me tea with honey. The doctors guided me: How to breath, how to push and how to keep my energy for the end when it is really needed. While I was pushing suddenly I felt it, I put my hands down and I felt my baby. . her butt 🙂 and then she went right back inside. 
But now I was happy; there it was! The reason I was labouring in pain for so many hours. _
 I got my energy back! I knew the baby is coming!
Graciela offered to hold a mirror so I can see the baby coming out. I told her no. I just wanted to concentrate and just feel everything that was happening. Also my mum was there going back and forth, praying for a healthy and safe birth. At that moment my husband got into the pool for support. 
On June 23rd, around 1:45am Sunday morning, under the big full moon which I could see from the living room balcony, another push and here she is, half way out! Legs and back were dangling out but the rest of her body was still inside. My next contraction took longer than expected. My baby was just floating there, very calm and relaxed. Me too the same, we knew that everything was ok. She didn’t even move, just floated there. I trust her and she trust me. It was after a minute when I hear the Doctor say: NOW, PUSH HARD and I did. and there she is!!!! All out.  She did it! she just knew her way out __
Rodrigo place her on my chest. OMG what a moment !!! She had eyes wide open and was so alert. She looked at us. She knew. She was the most beautiful baby ever 🙂  
We couldn’t believe what just happened. It was a miracle!Me and Vasili kissed each other, amazed and bewildered. I remember Graciela telling me to talk to the baby , and I did… and I kissed her, we were all so happy !!! 
I started breastfeeding her right away…she just knew how. After a while sitting in the pool, Vasili cut the umbilical cord. 
After a little while in the pool, he gave Aliana(my  to Graciella for tests. She was 3.200 kilos (around 7 pounds) and 9/10 on the Apgar score. Dr. Aybar check on me, everything good! No tears, no stiches.  
I took a quick shower, laid down in my bed and they brought my beautiful baby girl Aliana to me. My mum made sure to bring me plenty of water and Graciela showed me how to breastfeed. I just stay there with Aliana skin to skin, I think all night long, while everybody else, Drs included, were having a late dinner at 3am in our dining room! Next day, Doctor Aybar and Graciella came by to check up on us. Everything was perfect! _
Coming to Panama was the best decision we ever made!!!! The journey was wonderful thanks to all the nice people who met and gave us so much  help and support!  
I encourage all the women out there to trust their feelings, to believe in themselves and to nature!!! _

Tessie Kalafatidou 








The most important pause in the life

The Birth Pause: Unhurrying the Moment of Meeting
The birth pause, very simply, is a slowing of the moment when a mother and baby first meet. This can occur in many ways, but we are loving what happens when a midwife or doctor simply guides the baby down where he is born, allowing the mother the extraordinary moment of discovery where she can really see and explore her baby before she gathers her just-born child into her arms.

The Birth Pause

If a ‘pregnant pause’ is a breath held in a story, a moment’s stillness where we linger between what has been told and what is yet to be told, then what we are calling a ‘birth pause’ might be thought of as a breath at the moment of birth: a place to linger, suspended briefly between what has just happened – the mighty work of birth, and what is to come – the unfolding of the new human life that has been placed in your care. When you pause at birth you are in a sense stopping to catch the moment of arrival, yours as much as your baby’s.

What is this “birth pause?” you ask your midwife.

A baby is guided down at birth

Well, practically speaking, instead of delivering your baby directly to your chest, she will simply guide your baby down where he is born. He will land gently on soft pads in a warm pool of amniotic fluid. He will stretch out his arms and expand his lungs for those first sweet gulps of air. You will likely take a breath yourself and gather yourself together after the huge effort of birth. You will then probably turn your full attention to this newly-born child lying in front of you. You will be the one to welcome your child as you touch his hands, arms, legs, belly. When you are ready, you will be the one to wrap your hands around his torso and bring him up to your chest. The moment of birth itself will be held by this pause, a pause in which you and your child first find each other on the other side of birth.

A mother sees and touches her baby for the first time

The first touch

Perhaps it makes sense to you that you will be able to see your baby much more clearly at the moment of birth if he is below you than if he is delivered straight to your chest. But won’t you be sort of overwhelmed at the moment of birth for all this looking and studying, you wonder? Maybe you’ll need a moment to collect yourself?

A mother who has just birthed
her baby takes a moment
Very true. You may need just such a moment. And that is one of the beauties of a baby guided down at birth. When a baby is birthed down, and no one hurries your baby onto your chest, you will very naturally have your moment for the stunned relief of delivering your baby. This part of the birth process will be accorded its own respect. A woman will exhale from the work of birth before she begins to inhale the presence of her child and her new identity as a mother.

Now ready, they turn their full
attention to the extraordinary
moment in which they
meet their baby
Indeed, your midwife knows that when a baby is delivered directly to a woman’s chest, many women are in fact somewhat overwhelmed when they finish the work of birth and attempt to take in their baby in the very same moment. As a witness to the birth process and perhaps a mother herself, your midwife knows that the words and phrases that describe many mothers’ very first moment after giving birth include a stunned kind of relief, bewilderment, and shock. Of course you are eager to see your baby at long last, but you are still very right brain. The tears your midwife most often sees at the time of birth are the father’s. You are not there yet. But then, like a cruise ship changing course, coming now into port, your attention shifts. There is a coming back, a return, a shifting of focus to this new child who is also experiencing his own coming into port. This changing of course will happen at more of a clip for some women than for others. But it is with this turn of attention that the high begins to swell, and it will continue to swell over hours and days, weeks and months, parenting effort after parenting effort, until one day it is the tidal wave of love that you have for your child.

Meeting their daughter just after she is born

Meeting their son moments after he is born

Seeing her daughter for the first time
When a baby is delivered immediately onto a woman’s chest there will be plenty of time to study your child’s face and body, absorb his presence and digest your new state of being in the hours and days to come. But perhaps with a simple shift in business as usual, we can pause at the moment of birth … slow this first trip that your baby makes to your body … and allow what midwife Karen Strange calls the “natural sequence of birth” to unfold.

Picking up her daughter for the first time

Picking up her daughter for the first time
Karen describes the sequence of birth as a sort of blueprint for what happens when we do not disturb birth. She speaks of it as one of Connection—mother and baby connected in pregnancy; Rupture—the moment of separation at birth; Rest—the pause as the baby lies before its mother, the mother seeing and touching her baby for the first time; and Repair—the trip the baby makes to the breast, thus completing the sequence of birth. Karen says, “We all carry this blueprint within us. When we follow it, it turns on the brain in a certain way. It is amazing!”

With the Rest, or ‘pause,’ there is no rush to get the baby onto your chest. “This pause,” says Karen Strange, “allows the mother to integrate this moment of transition”. You sigh with the completion of your labor and turn your now-ready attention to the next deliberate moment, the moment in which you discover your baby. With your baby below you, not yet on your chest, you can really see your child. You study him. You touch him and then finally gather him in your arms.

A baby crawls to the breast

When this sequence is uninterrupted, neither is there a rush to get the baby to latch on the part of eager helpers. There is a tender, gentle time as you rest from your own hard work of birth where your baby, when ready, begins his search, as all mammals will do, for the breast. You help him as needed, but give him the time and opportunity to exercise this age-old, instinct-driven ability to find your breast. In fact, your midwife has seen how beneficial it is for a baby to be allowed to take the lead in breastfeeding in the special hours after birth (and beyond!), something that is dramatically shifting many parents’ experience of breastfeeding.

A cuddle completes the sequence
But just as your midwife is now appreciating what occurs when we respect a baby’s ability to find its mother at birth, she and others are learning a respect for and understanding of our own abilities as women to find our babies at birth. When we do not rush through the moment of birth, but honor the pause that marks the center of this sequence, what happens seems to be nothing less than a paradigm shift of equal significance. For you are not only finding your baby, you are finding yourself as a mother, finding your way into a new state of being.

For more on this, see “Waiting to Inhale: How to Unhurry the Moment of Birth,” Journal of Perinatal Education.
Mary Esther Malloy

Priscilla teaching Biology

TeachingPriscilla’s Biology class

During the month of January, we received an amazing guest: Priscilla Kramer.

Priscilla is a young North-American Midwife who studied and who is currently working in the State of Florida (USA).

She is levelheaded, intelligent, capable and well prepared. She has been involved in a lot of Natural Water births, home births and births at birthing centers in the USA.

With her at our side, we were able to perform a few deliveries at the Caja de Seguro Social (Panama’s Public Health System’s Hospital) and they were wonderful and caused huge impact in the Labor and Delivery Unit’s personnel, doctors, nurses and aides. The happier ones were the mothers that had the privilege of being assisted by Priscilla and experienced a gentler birth.

In future blog’s entries we’ll continue sharing the enriching experience we lived together.

Today, for example, I’m going to share with you one of these experiences.

Mason was born a few days ago, Sheila’s third son. Graciela and I have assisted her in all her children’s births: José, Ria and now Mason.

This last child was also born in water and at home, as did Ria.

It was a beautiful and gentle birth like the previous ones.

The children stayed with their father Joe during labor and arrived a few minutes after Mason’s birth.

As if it were the most natural thing in this world, they walked to their mother’s and brother’s side. There was only peace and happiness in the room.

After the placenta was expelled, Priscilla was able to answer all of Jose’s (the older brother) questions regarding how the placenta, this human and mammal organ, works.

Priscilla showed them every detail. Vessels, umbilical cord, cotyledon and placental membranes…

It was an unforgettable biology class for Sheila’s and Joe’s children.

When I live these kinds of experiences I realize that Panama’s has a long road ahead to learn about things so simple and life changing as the birth of a child into this world.

We would like to say: Thank you Priscilla for your sensitivity and lessons that we will never forget.

Dr. Rodrigo Aybar
Dra. Graciela A de Aybar

The most important organ

The most important organ

The placenta and the umbilical Cord

The most important organ

The most important organ

The placenta and the umbilical Cord.

When we talk to a future mom, we try to answer all her concerns, which is a continual process throughout her entire pregnancy. We do not limit the questions she can ask. The purpose is for the expectant mom to know we are there for her and we will always answer any concerns she may have.

One of the aspects that are generally hard for the future mother to understand is the placenta and umbilical cord. What they are made of, how they work and their role during the pregnancy and during labor and delivery.

We recognize how difficult it can be for a future mother to understand the role of the placenta and the umbilical cord. Once the placenta is expelled (afterbirth) along with the umbilical cord, we show it to the mother. At that point she is surprised, and with her eyes wide open and great satisfaction, she then understands what this very important organ is made of.

During ultrasounds, we often take advantage of the visuals to talk with expectant moms about the importance of the placenta, umbilical cord and membranes. During the entire pregnancy a woman shouldn’t have more than 3 ultrasounds (1 each trimester).
It is a perfect opportunity to clear any doubts.

Future moms are particularly concerned about the umbilical cord. Often scared that “something could happen” with it during the pregnancy or during childbirth. With great fear and quite insistently they ask about the possibility of a nuchal cord, known as the umbilical cord wrapped around the child’s neck.

We will try to explain some important factors:

The placenta is an extraordinary vascular organ. It is everything for the baby meaning that it supports hormonal, metabolic, respiratory, protective and immunological functions, and many more.
We want to point out two important elements that reach the baby via the mother through the placenta and the umbilical cord. Those are the Glucose (energy and food) and Oxygen (breathing) molecules.
Without these two elements human life is basically impossible.
The blood that comes from the placenta to the baby comes from two umbilical arteries along the cord. The blood that returns from the baby to the mother travels through a single umbilical vein.
The umbilical cord is soft and elastic and very resistant. It floats in the amniotic fluid and surrounds the baby.
When the baby moves and as he grows, often he will press against it often.

What does it feel like, what happens to the fetus/baby when the umbilical cord is pressed or squeezed?
The answer is quite simple: He is left without air/ oxygen to breathe, without food (glucose). The same happens with an adult if you cover their mouths and nose and isn’t allowed to breathe.

How does the fetus/baby react when this happens?

The answer is also simple, he tries to get out, to move and “escape” from that dangerous and uncomfortable situation.
This is a vital exercise: compressing the umbilical cord, moving, getting out of danger. The baby does this thousands of times prior to birth. Really, permanently! In other terms, the baby isn’t dumb; he knows he has to do this. This vital exercise while in the womb will help him/her for life.

The baby’s Fetal Heart Rate (FHR), meaning the amount of heartbeats from the baby’s heart is quite stable. It fluctuates between 120 to 160 beats per minute. It is easy to find and listen to with a Doppler placed directly on the mother’s womb.

If the umbilical cord is pressed, what happens to the FHR? That answer is also obvious: The Fetal Heart rate drops drastically and a bradycardia occurs (slow heart rate), meaning the amount of beats per minute of the heart diminishes. It can drop to 60 – 80 bpm (beats per minute).

If the baby is uncomfortable it moves, changes position, moves a limb and rotates a little. They are perfectly prepared and programmed to face constant adversity during the pregnancy and during labor so they permanently prepare for it.

During the third and last trimester, slowly, another event interferes periodically with the process of a body delivering blood to the placenta and the umbilical cord. During the last trimester the mother will start feeling Braxton Hicks until eventually she feels real contractions.

A true breathing exercise that prepares the child for birth.
What happens?

The answer isn’t complicated: the uterus is a powerful muscle. When it contracts, it tightens and blood vessels close (the lumen the blood vessel collapses) and blood doesn’t reach the baby.

As the pregnancy progresses, the length and frequency of the contractions changes and during labor they happen every 3 minutes and can last up to 40 to 50 seconds and they are more intense.

Something similar to what happens to an adult when their heads are submerged under water for 40 to 50 seconds and only give them two seconds to breathe before plunging them again happens to the baby.
How does the baby react to this experience?

Logically this situations causes the baby stress which releases huge amounts of adrenaline and noradrenaline which alerts it and activates mechanisms that allow him to adapt which then allows him to face adversity.
In other words, uterine contractions are nature’s mechanism that prepares the baby for life outside of the uterus.

It is an extraordinary breathing exercise prior to birth.
Then, what should the birthing partner do during the pregnancy and birth?
What we do when a natural birth happens, we motivate the mother to move.

We allow her to change positions as many times as she desires. She can move freely and should avoid laying down all the time.
Offer her soft foods and liquids during labor and delivery.

Avoid binding the mother or any type things that could restrict her movements such as IV’s and fetal monitors.
The child tells the mother when they are uncomfortable with a position and asks the mom to move. Meaning, when the child feels asphyxiated briefly, it does things such as kick, move the head, rotates for the mother to change and be allowed to move out of that uncomfortable feeling that comes from lack of breathe.

Avoid the use of synthetic Oxytocin that produces intense and frequent contractions of the uterus and do not allow the mother or child to rest during delivery.
Allow the mother’s oxytocin to do the job. It enters the mother’s bloodstream naturally and not continuously how it happens when administered via an IV.

Avoid rupturing amniotic sac as much as possible or completely avoid it. That way the amniotic fluid cushions the pressure that the uterus could have on the umbilical cord.

When the baby is born: do not cut the umbilical cord immediately and do it when it stops beating or pulsating spontaneously a few minutes after birth.

If any degree of pressure had been placed on the umbilical cord in the last few minutes of birth, delaying clipping the umbilical cord until it has stopped pulsating allows for the compensatory tachycardia (fetal heart rate speeds up – FHR) compensate for “lost time” and send the child the Oxygen and Glucose molecules the child direly requires at birth (FHR increases to 180 BPM).
The placenta revives the baby after birth.
Finally, allow the placenta, the umbilical cord and related membranes to be expelled softly, by itself without any unnecessary maneuvers which ensure that it remains intact and we avoid further discomforts for the mother who just completed such an incredible task and we avoid interrupting both mother and child that spiritual moment of their lives.

To show it (the placenta) so that the mom can better understand and see this very important organ that managed to nourish her child during the course of the pregnancy.

Dr. Rodrigo Aybar
Dra. Graciela de Aybar




Rocio Atencio



Rodrigo and Graciela are amazing OB’s. I was extremely fortunate to have found them (thanks to my hubby).
We have a beautiful baby boy thanks to their support when sorely needed. I recommend them to anyone who is looking for a second opinion, personal and humanized healthcare. Best wishes to all pregnant ladies and mommies out there!

Here is my story:

Panama City, Republic of Panama.

My story starts in 2008 in Houston, Texas USA, when after years of trying to conceive (1 failed IVF attempt), I finally got pregnant (naturally after a laparoscopy to remove some endometriosis). My daughter was born premature. My membranes ruptured at 25 weeks and Danielle Victoria was born at 26 weeks, weighing 2 pounds 7 ounces. She was a trooper from birth, a real fighter. To this date, she continues to be a feisty 5-year old (beautiful and healthy). We were lucky to be living in a city and country were prematures have a chance to survive and to be absolutely healthy.

I really never thought I would or could get pregnant again, but fortunately, God/destiny blessed my body once again. 

At 20 or 21 weeks, my first OBGYN indicated that my cervix was thinning and based on my past history (pre-term labor); he wanted to conduct a cervical stitch (cerclage). Since my husband and I were already looking into natural birthing options (due to my very dramatic first pregnancy), we immediately contacted Rodrigo and Graciela Aybar.

Dr. Graciela was very kind to make room to see me after I told her the story… A cerclage at around 22 weeks…. I was afraid that would conflict with our natural birthing plan. Both she and Rodrigo were there on the first appointment. They listened carefully and did a thorough examination… Both concluded that I needed to be on bed rest until I reached at least week 37 to ensure the baby wasn’t born pre-term like my first daughter. They also prescribed progesterone suppositories through the course of my pregnancy (until week 37).

My husband, who is an acupuncturist, took care of me the entire pregnancy. At any sign of contractions, he would immediately tell me he had to perform acupuncture to ease the contractions and to relax me. Acupuncture worked wonderfully!

Dr. Graciela and Rodrigo closely monitored my evolution and the health of my baby in-uterus.

I read a lot about natural births and water births. I decided I wanted something less stressful than my first experience. I wanted to be at home. My husband doesn’t like hospitals so he was totally happy that I would opt for a home, water and totally natural birth.

Since my first child was via C-Section, the doctors checked my scar and made sure I would be OK if I opted for a vaginal birth. They went to our home to make sure it was in good conditions for a water/home birth. We were ready for the day, my belly was huge and I was ready for my baby to decide when he wanted to come out into this world.

September 28, I started contractions at around 10PM. At around midnight, my water broke. I had called the doctors to let them know my evolution. As soon as I informed them that my contractions were 5 minutes in between, they headed our way, reaching our home at around 1AM with all their equipment (pool included).

It was 12 hours of labor. At 10:15 AM (9/29/2013), our son Fabian Corpas, was born! Absolutely and positively PERFECT!

I gave birth squatting and nobody told me I couldn’t eat or drink… I was free to move, to walk around my house, to be naked if I wanted to… hehehe…. Zero beeping from hospital machines and zero nurses monitoring every single movement. I didn’t tense up from that hospital smell… You know the one that gives you hibby jibbies….

The doctors were supportive and were constantly joking! They are a SUPER TEAM!!!! They were relaxed at all times! Their calm attitude gave me additional confidence that everything was going to be fine.

If I were to get pregnant again (I am 37), I would immediately approach our doctors Rodrigo and Graciela and plan for another home birth. It was an amazing experience….

A lot of people have approached me after giving birth and cannot believe that I had a vaginal birth after C-Section and cannot believe that I opted for a natural birth; when I explain the reasons behind my choice, they totally understand. A lot of women have said that nobody ever told them that a vaginal birth after a C-section was even an option. So I am always happy to share my story and talk about the wonderful couple that helped us during our pregnancy and during childbirth.

Rocio Atencio

Birthing Room

Free birth

Free birth

Expulsion Unit/ Expulsion Ward

It is incredibly interesting to see how many mothers and expectant moms have become more and more interested in defending their rights; in particular the right to give birth in the manner they prefer and feel more comfortable with.

Each day they contact us and motivate us! They always give us useful and interesting ideas.
One of them, Eliana, told us that we should suggest to the hospital that has named their labor and delivery unit the “Expulsion Unit” to change that name to the “Birthing Unit”. We thought her suggestion was fantastic.

Unfortunately, the problem in our country is that the attention to child birth is more serious than just a simple name that you could give the Labor and Delivery Unit.
All maternity areas in panama’s public and private hospitals are cold, full of medical gadgets and artificial lighting, with the same background music that has been used for the past 40 years y managed by personnel who in most cases are cold, distant and authoritarian.

For example, none of the public hospitals in Panama allows a mother giving birth to have a birthing partner during labor and delivery.

In private hospitals a birthing partner is allowed, but with tons of rules and limitations. In most cases, those birthing partners feel stressed because they know hospital personnel doesn’t really want them there.

The scenario itself is always the same, the pregnant woman about to give birth on a bed and when she is about to give birth, they apply an enema to clean her bowels!
She is connected to an IV so she can receive an infusion of synthetic Oxytocin.

A fetal monitor is permanently strapped to her belly with two belts that keep the monitor in place so that the nurse or doctor can monitor the baby’s heart rate from a distance (in essence losing any human contact).

The expectant mother cannot stand up. She cannot eat nor drink anything.

If the woman wishes to urine or have a bowel movement, they place a cold metal or plastic bedpan under her hips …

Vaginal exams are conducted with excessive frequency, without even consulting with the woman in labor or discussing with her the need (or not) to conduct this exam at any given moment.

In private clinics, they suggest with enormous insistence that the mother accept an epidural, which immobilizes her even more and once the epidural is administered, they connect even more monitors to her, for example, the electrocardiograph sensors and the blood pressure meter remain permanently in place on her other “free” arm.

The epidural is a “cocktail” of drugs that adds to the synthetic oxytocin already in her bloodstream.

To pressure the mother to “request” the epidural, in each bedroom of the labor and delivery unit of some private hospital, they have a huge pain scale. The nurse will walk in the bedroom frequently, without even knocking, to ask the mother to point to the face that best describe the pain she is feeling. If the pain is “Severe to Worst Possible”, the nurse then calls the doctor so they can suggest the epidural.

Quite frequently the doctor helps the mother rupture membranes…

And in the middle of all this madness, if she is lucky to escape a C-Section, she is rolled into the “Expulsion Unit” on a wheelchair!!!

There, she is examined frequently. And they continue to press down on her belly to “accelerate” the birthing process.

Almost always they will perform an episiotomy. As soon as the baby is born, they cut the umbilical cord take the newborn away from the mother to conduct an Apgar assessment (which can be performed on her belly) on what they like to call a reanimation crib (recovery crib).

They speed up the process of placenta expulsion, which causes intense pain and increased bleeding.

Currently, in any part of the civilized world, the reality is completely different. I saw this personally, for example, in Germany in the city of Heidelberg.
Things are completely different there.

During the pregnancy, every woman visits the place where she will give birth with her entire family.
She is given birthing options such as a water birth or a big cozy bedroom that doesn’t feel like she is in the hospital.

She will be in this big bedroom during labor, delivery and post-delivery. She is released after two days. The new mother is given support with nursing and bonding in the first hours of the newborns life.

Mother and newborn stay together all the time, without any interruptions.

During active labor a mother is allowed to walk, sit and lean on ropes that were especially installed to help her during the last moments of delivery. She can eat, drink, take a shower and go to the bathroom.

When she is ready to give birth, the bed where she has been during labor becomes the delivery bed.
Then they bring in the medical equipment that will be needed to give the mother and the newborn the care required… The reality is that the medical equipment was always there but placed discreetly and not entirely visible in order to keep the mother focused in labor and not causing her any unnecessary stress.

The rooms have adjustable lighting and the mother can opt to have background music or not. Hospital personnel cannot come and go in her bedroom as they please. They have limited access to ensure the mother isn’t distracted nor interrupted.

They even worry about the tone of voice used when they are walking inside the labor and birthing area or bedroom.

In the moment of giving birth, the mother can choose whatever position she desires. For example, squatting if she feels safer and more comfortable.

The midwife or doula must adapt to the birthing the position the mother chooses.

So we reach the following conclusion:

We do not even need the Labor and Delivery Unit!
Of course, in the meantime, changing the name from Expulsion Unit to the Labor and Delivery is more appropriate!

Dr.Rodrigo Aybar
Dra. Graciela A. de Aybar



Maru is Panamanian, her husband Felipe is Colombian.
They have a life project that is hallucinating
They live in a house that is part of the history of Panama in Casco Antiguo

Maru is joyful, sweet and intelligent. Felipe is restless, intelligent and with desires of changing the world.

Lukas arrival kept us waiting, but when he took the decision of coming to meet us, he did it so fast that Graciela almost didn’t make it. I was in the United States in a workshop that I went in The Farm, together with Ina May Gaskin.

Graciela got to tell Felipe, when she was on her way to Casco Antiguo, that Maru should get in the bathroom tub of their house. When we visited their residence before the birth, we saw the tub and it was an excellent alternative instead of the birth pool… and so it was!!

Maru has a fantastic Blog and this was what they wrote telling the story of the arrival of Lukas to the World.

June 6
Week 41: Lukas Arrival.
As I was running up the stairs I heard Maru scream “!Felipe! !Come look!”. Not even two minutes had passed since I left her with Graciela (her gynecologist), to go down and open the door to Jimena (her doula).
Submerged in the tub where I left her just a few minutes ago (if not seconds) I saw Lukas for the first time. Just born he rests in his mommy’s lap, he passes his hands through his face and try’s to open his eyes. It’s 2:10 a.m. of the 24th of May 2013.
The storm that for hours lashed with clamorous strength the doors and windows of our house (in Casco Viejo and the same one that for over a year we worked to restore and remodel for his arrival), passes…. The rest of the dawn goes on with calm.
We let the water from the bathtub drain a little meanwhile the placenta got out; I cut the umbilical cord and take Lukas in my arms so that Maru can take a shower, she dries up: Graciela and Jimena help her to the bed that we had prepared we put Lukas in her shest again. Easily but without a pause he “crawls” all the way to her breast and he sticks to it; Jimena looks for fruit and water so that Maru eats and drinks; we wait a little longer and we pass Maru and Lukas to our bed.
Graciela goes out first and then Jimena…It’s about 4:30 a.m. Everything had happen as we wanted it, yet we never imagined.
Always, when Maru and I thought about having kids, we expressed our desire that when we did it was going to be a natural birth. When we were pregnant we told the gynecologist that we went first. But for some reason, the assurance that we receive from him in that and other appointments didn’t satisfy us.
And because it wasn’t enough we decided to know about the miracles of medicine, about how medical intervention safes mothers and babies when they need to be saved, about the benefits of such intervention in situations of high and very high risks for one or the other. We also found out how miracles of modern medicine had been converted into a “menu” of options so that the mother and father “get to choose” how their babies come into the world.
We also found out the little importance that hospitals pay to natural births. Yes, in the “menu” that today exists for giving birth, natural birth is seen as the “bread” that in the restaurants is “for free”. Seriously now a day’s natural births seen from the optics of health managers, doctors, nurses and support staff, it’s like that besides the resources that demands and costs it has to be “for free” and worst than anything it “takes away the hunger of the dinner guests”
Hospitals and doctors are taking the place of managers of “fast food chains” and in a clear conflict of interest they are stopping to offer “bread” so that they can increase their incomes and lessen the marginal costs per “client”. The saddest part of all is the process of dehumanization that turns out of their commercial strategies so that the miracles of medicine those that save lives and prevent risks, today are sold like the only way to prevent the normal risks of healthy births that require very little or any medical intervention.
The worst is that they are telling the women that they can’t give birth by their own means. And to make sure of that they put in practice very stretch ranges for what it turns out “acceptable” concerning the number of weeks and estimated weight of the babies so that they can be given birth “naturally”. So that for the moment of labor very strict protocols of medical and hospital intervention where they apply enemas, intravenous leaking, fetal monitoring and hormones to induce contractions and so on. This without counting with the “manage” protocols of newborns that means the least interaction possible between the mom and her baby and between this and that instead of offering options they silence the parents voices in saying how their babies are going to be birthed and what the conditions of their first days between us should be.
I don’t know about you but as we knew these things we were terrified, to say the least. So much, that Maru and I had to do a deep reflection about what it meant to her as a woman to be pregnant and giving birth, about what it would mean to Lukas the way he was going to arrive to the world but most of all if been responsible like we were been, to raise our child that for that moment we had conceived, we also had to be responsible of the way he was going to arrive to the world without delegating such responsibility in an inverted system without even caring because of their own conflict of interests. We investigated and then discovered the option of giving birth home and in water.
We knew Jimena first from the PANAMAMÁ foundation and she referred us to Rodrigo and Graciela. With the company of the three we started building the strength to give birth just as humanity had been doing for millenniums. I’m not going to tell you that it was easy..It wasn’t. Not only because of our own doubts but if it was the right thing to do. Also because of the fears of others were passed to us because of the boldness of our decision.
For months we threw away all the reasons of “certainty” the system has and built enormous reserves of confidence in our own humanity. Of that self confidence that allows you to open doors to the unknown and the humanity that allows you the strength to go through the threshold and go throughout the roads that are revealed for one to travel. Reserves that we almost used entirely between the weeks 38 and 41 to the point that we almost got weakened because of our impatience and the ones around us, of wanting to have in our womb our baby that didn’t arrived…until it came !AND IN WHAT WAY!
To be fair those last week’s felt like how the escalators must feel when they see that the zenith the more it shows the more elusive it turns in their try to conquer her. We felt that it made us confer more times that we had in months in our “sherpas”; felling that demanded from them (they actually) a profound intervention in the last days of our pregnancy.
So much that the afternoon that preceded the dawn that Lukas arrived we were in the phone with Jimena and in the check up that Graciela did to Maru. At 6:30 p.m. on Thursday we attained the peace that we hadn’t had in days, we knew it would last little but it worked to give space to Lukas to be born in the next seventy two to ninety six hours without altering our birth plans. Calm that let us help the locksmith that came to change the locks and then having dinner and going to sleep. (At least me that by 10:15 p.m. was in deep sleep)
Calm that was with us during the time Maru felt contractions but didn’t wake me up, she was doing her own monitoring and they were every 4 to 5 minutes when she woke me up pass 11p.m. When we called Graciela she told us that because of the check up she did that afternoon it wasn’t probable that she was in labor she told us to rest and that most probably were practice contractions of the body,that we needed energy for what it was coming. We called Jimena to tell her the contractions were deeper in frequency and intensity, so we went into the shower to see if the hot water would help to calm them. When I went down to fill the bathtub I heard Maru´s exclamations than more than pain it were enormous releases of energy, we called Graciela and Jimena again who decided to come, We went downstairs to the bathtub Maru got in, we lighted the candles and put on the meditations that we had prepared for the birth. All in between the exclamations that announced that the contractions had increased in frequency and intensity and that would get lost in the tropical thunderstorm outside that would hit the windows and doors.
The calm started to vanish when Maru got worried because of the intensity of the pain she was feeling and that if this was the beginning of the birth to please give instructions for when it got real to give her medicines for the pain so she could tolerate it, for when the exclamations were louder than the storm outside and all the neighbors from the block heard her I called Graciela that told me that the storm couldn’t let her get there faster but that she was at 5 minutes from our house by that time I felt powerless of seeing how Maru would twist and changed position and would shout..
And just then when I felt that all the brightness was been consumed by the confusion of the moment the cell phone ranged and it was Graciela that she was downstairs. I went downstairs like a lightning I opened and rushed upstairs running. Maru looked at me scared ¡LOVE IM BLEEDING! To what Graciela answered with the calm of her experience “WHAT YOU ARE IS GIVING BIRTH, WHAT A BEAUTY MARU, ¡LUKAS IS COMING!” She checked her and said…¡WAO! You have 8 centimeters of dilation. The phone ranged and it was Jimena downstairs. I went down again as a lightning.
Between me going down and upstairs again, something extraordinary happened. Maru tells me that when she heard Graciela tell her how much she was dilated, she told her that she wanted to push to what she answered “then push”. She got on her knees in the bathtub laying her arms in the edge and she pushed…BLUB “What was that” “the head Maru, push again”…BLUB, and Lukas was out. For when they put him in her lap Maru screamed ¡Felipe! ¡Come look!
It was 4:30 a.m. and everything had happen as we wanted it to be, yet we never imagined.
They say that the name Lukas derives from the Latin Greek Loukas which means “the one that brings light”. Our son brought it in the middle of the storm. Son we love you.
Dr. Rodrigo Aybar