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