Marijke once again.

Marijke once again.

A little over two years ago, her daughter Jiske was born. It was an unforgettable experience.

Now Marijke had an impact on us once again, with her sweet personality extremely sensitive and secure.

This second birth of Marijke in water was calm.

Graciela and I were with Marijke and Joris that day. Truthfully it was wonderful to see them together throughout all the labor that we didn’t wanted to interrupt them. They would relax, listen to music and caress each other. Later on she asked to get into the pool and there they continued in the intimacy of her maternity.

It was an easy and sweet birth. Janne was born as beautiful as her sister and parents.

A couple of days later Marijke wrote to us:

Dear Rodrigo & Graciela,

I’m sitting on my bed feeding Janne. Her name is Janne, I believe we forgot to tell you at the night she was born. And I’m so grateful that our beautiful girl is healthy and happy. You must know that I’m even so grateful to you. What a beautiful day it was, as soon as Graciela walked through our door my first contractions diminished and got a rhythm, both Janne and I knew that now everything was going to be just fine. I was alert during the whole birthing process, knowing each second from start to finish, so different than from Jiske’s birth. But again a very quiet, peaceful experience. Thank you for making this possible! Thank you for being here in Panama, for your warmth, your guts, expertise and common sense and just being you.

I will keep on spreading the word of your good work here, where I can I would love to help you gain more and more recognition of your practices. And when we ever leave Panama, I will never forget you! I want you to know how grateful I am to you both!

I wish you a beautiful Christmas and so many more beautiful births.

Lots of love

Marijke, Joris, Jiske and Janne!

Episiotomy Always?

Is Episiotomy necessary?

When a future mother goes to the beginning of her prenatal control, she always asks about the episiotomy.  In Panama it is known as “stinging” or “cutting”.  It is a real torment.  To feel that it’s obligatory in order to have a natural birth, the doctor has to cut the vulva and the perineum!

The answer is NO!

Medicine based on evidence, which means that after multiple studies with large groups of populations, recommends clearly not performing a routine episiotomy in any birth.

Every woman knows what they have to do for her not to get hurt.  The only thing we do is discuss during pregnancy how does she have to let the head and the body of the baby out, slowly so that she doesn’t have any lacerations.  Surprisingly they all make it. And it’s not even hard.

 The last time I did an episiotomy was 12 years ago and personally I attend births every day.

If a tearing or laceration is produced, it is always going to be less than a cut with a scissor that is very anti natural and painful.  Little lacerations in the vaginal membrane may be produced, that most of the times doesn’t require any stitching, because the vaginal tissue it’s extremely noble and heals wonderfully.  The pain after birth it is enormously greater if an episiotomy was performed in comparison with the lacerations that may occur.  Also the risk of an infection it is significantly smaller and the sexual life doesn’t suffer any changes of any kind to the women who hadn’t had and episiotomy performed.

So the answer is NO. It isn’t necessary to perform a routine episiotomy and it’s scarcely the situations when it’s necessary to do it, independently of the existence of previous births or not.

Dr. Rodrigo Aybar

Barbara Harper Part II





Discussing all the pointsDiscussing all the points



As part of the visit of Barbara Harper to our country and in coordination with the United Nations World Fund Population, we traveled to the Chiriquí Province located to the west of the Republic.

We visited the Ngäbe Buglé region. This indigenous region is the biggest and has the most population of the country, it also covers a territory that involves three provinces in Panama: Chiriquí, Veraguas and Bocas del Toro.
The so called “lagoons” of poverty the biggest in Panama are precisely located there. There are foreigner enterprises that are developing big scale hydroelectric projects, using the innumerable rivers, exporting electricity to neighbor countries, and the indigenous from the region, meaning the owners of those lands, do not count with electric light.

There in the high lands of the region we went with Barbara and we held encounters with the Ngäbes empiric midwifes and health staff assigned to those areas. We were in the Health Center of Hato Chamí the District of Nole Duima of the Nedriní Region.

We shared experiences and talked for hours with them, we saw videos of water births and natural births. We had to translate from English to Spanish and from Spanish to Ngäbe and vice versa.

We have to point out emphatically: that the traditions, the way of performing the deliveries, the bond between mother and child, childbirth and maternal breastfeeding of our Ngäbe Buglé population are perfect.

It’s extraordinary how the husband keeps her company and supports her during birth, the wisdom and peace of the midwife that accompanies the mothers.
The exchange was truthfully productive and exciting. Like Barbara Harper used to say, it is the language of infinite love that has no boundaries nor obstacles of any kind.

It profoundly caught our attention the support of the nurse assigned and all of the staff at the center.

It was an extraordinary experience.

The day after in David, Barbara Harper performed a magisterial conference in the Infirmary Faculty of the National University of Chiriquí.
In the conference participated approximately 80 students of obstetrician infirmary, were there´s a group of about 25 of them that are preparing to give support in the care of pregnant women in the Ngäbe Buglé region.
Literally it was a two hour presentation and exchange without anyone even blinking.

All of these show that we are moving forward. That the women in our country every day are more active in the defense of their rights to a natural and soft maternity, free of unnecessary interventions and respectful of the intimacy of the woman and her family.

We must thank the invaluable support of all the staff at the United Nations World Fund Population assigned to the Ngäbe Buglé region that performs an irreplaceable job.

Dr. Rodrigo Aybar

Barbara Harper Part I



Barbara Harper

Barbara Harper



Thanks to the invaluable support and effort of Elizabeth Noble, author and educator all of her life for pregnant women, Barbara Harper contacted us and we had the wonderful opportunity to have her between us.

Without a doubt it was an unforgettable visit in which we all learned plenty. It was a unique and wonderful week in our lives.

The first two to three days she was with us in Panama city and then we traveled to the Chiriqui Province located to the west of our country.

On Tuesday April 23rd it was our meeting with the pregnant women, mothers and familiars. To the event assisted university students, doctors, representatives of the birth inscription service of our country, journalists and many more.

Briana and Lidia, two of our wonderful mothers, narrated their water birth experience.  It was exciting!!

Then Barbara marveled us with her exposure of almost three hours.  Nobody moved from their seat.  It was the mothers and fathers in their world showing their infinite human and maternal spirit, proudly.

Graciela and I were privileged witnesses of the event.

Next day Barbara was interviewed by the magazine Ellas. Then we shared in the Miraflores restaurant beside our Panama Canal and then we visited Misty’s house whose family just had a water birth.

The teachings and wisdom of Barbara, her deep love is going to be kept engraved forever in our minds and hearts.

 Thanks Barbara!!

Dra. Graciela Anhel de Aybar

Dr. Rodrigo Aybar

Brianna and her husband John Hanna

Brianna and her husband John Hanna

Our dear Lidia!

Our dear Lidia!

Thank you!

Thank you!

Barbara Harper, Misty, Matt, Graciela and the King!

Barbara Harper, Misty, Matt, Graciela and the King!



The first look

The first look

All together

All together

In a beautiful house from the reverted area on Panama City we lived un unforgettable experience.

It’s the house of Misty and Matt. They are a very special couple. They perform a generous and extraordinary effort in Panama, protecting abandoned children.

Misty was awaiting the arrival of her first baby. She is simple, intelligent and infinitely motherly.

Matt is joyful, secure and immensely tender. They both prepared cautiously for the arrival of their son.

We arrived at Clayton at night. Misty was already in the transition stage, meaning an advanced dilation. In this stage the energetic cost of the mother is huge and comes with the sensation of “I can’t” or “I’m not going to make it”.

Graciela prepared the pool quickly and a few minutes later Misty was in it and was relaxing.

Parting from here everything changed. Graciela and I went to another room to rest and read. Matt stayed beside Misty without moving from her side, giving her all the possible love of this world and watchful of everything.

After 2 hours we got close to Misty and little time was missing. She had reached the complete dilation and it started to appear the common sounds of her body of an imminent birth.

Isaac was born! Beautiful! Strong! Healthy!

We step aside a little and did nothing else but watch this infinite enchanted moment of reunion between both mother and baby.

We can’t say much more but: Thank you Misty and Matt for letting us feel the warmth and love of your home and the marvelous arrival of Isaac.

A few days later we visited Misty and her family in the company of Barbara Harper and Elizabeth Noble.

We couldn’t keep from sharing with our lustrous visitors this unique and wonderful experience.

An unforgetable day

An unforgettable day

Barbara Harper, Misty, Matt, Graciela and the King!

Barbara Harper, Misty, Matt, Graciela and the King!

Dra. Graciela A. de Aybar
Dr. Rodrigo Aybar

The umbilical cord: Part II

The Umbilical Cord II

What happens when we have a birth with the umbilical cord around the baby’s neck? How does the baby manage to get free from this challenge without any harm?

Let’s remember that between 30-40% of the births are produced with some kind of compression of the cord forming a circle or a loop around the neck. It could be a circle or one loop, as it can be two or three loops. It can be loose or tighten. Those of us who accompany the mother during labor can see the loop in the moment of child birth or in the moment the head of the baby girl or baby boy appears. We can easily tell how many are there? and if they are tighten or not.

Normally if it’s only one loop and it’s not tight the birth of the shoulders will continue and the cord will slip slowly around the body as a “bandoleer”. If it’s more than one loop or only one loop is tight, we ask the mother to breathe with her mouth opened, to gasp so that she can give us time to cut the cord, unwind it and then let the shoulders and the rest of the body out. With a couple of simple instructions the mother can easily understand what she has to do and they always do it very well!!

At the moment of showing his head for the first time if the child comes in contact with the air around, he immediately starts with his first breathings. They aren’t deep because the thorax is still in the birth canal but it’s immediate as a reflex answer. If the loop of the cord is tight we have an extra difficulty. Frequently he turns a little pale and loses some body tone. The opportune maneuvers of drying that we perform and in occasions providing some oxygen throughout a mask, helps the baby overcome the difficulty quickly.

When the birth is performed in the water the situation is different. If it’s more than one loop of the cord around the neck we cut it and take the baby out of the water so that we can dry him up and help him. If it’s only one loop then we slide the cord through his body. When the body is completely out, we observe the newborn under water without putting him yet in direct contact with the air. This way we can avoid for a few seconds that he makes this effort and also give time for the cord, that is no longer compressed and its loosen to allow the baby to receive all the oxygen the mother is sending him through it.

Let’s remember that immediately after the compression of the cord when it ends a compensatory tachycardia is produced allowing the girl or boy to restore the oxygen he or she needs by increasing its cardiac frequency. We see how they brighten up underneath the water and recover their body tone their color and movements. Then we take them out of the water and give them to their mother.

The cord remains intact until slowly its pulsations start decreasing and are almost imperceptible mean while the breathing of the baby replaces completely its function and then and only then we cut it. This process generally lasts a few minutes.

Usually during the controls the mother has during her pregnancy we talk to the future mother about this and other situations that are normal in any birth. We analyze every aspect in detail and that makes it easy to solve any surprise that any childbirth has.

It is wonderful to confirm every day how the mother does everything so naturally and efficiently.

Dr. Rodrigo Aybar
Dra. Graciela A. de Aybar

The umbilical cord: Part I

The Umbilical Cord I

A frequent question of the woman during her pregnancy is: Can my baby get tangle up with the umbilical cord? What happens if it gets tangled around my baby’s neck? How can I know if during labor it isn’t going to tighten even more and suffocate my baby?

The umbilical cord is a fundamental structure of mammals. It is through it that the fetus is going to receive all the nutrients in the form of the glucose molecule, the air that the mother breaths in the form of the oxygen molecule and an innumerous of indispensable components for its intrauterine life. Throughout the umbilical cord, it passes from the fetus to the mother all of the fundamental waste products from the respiration and the fetal metabolism.

The cord varies in length and in diameter sometimes being very long or very short, thick or very thin. It’s elastic and very resistant. The baby’s play around during their intrauterine life with the umbilical cord and I even dare to say that it is the baby’s first toy! This is well seen in the ultrasounds when we see them tighten it and loosen it frequently.

When the cord tightens or compresses the fetus receives less blood. Immediately he feels a sensation of suffocation because it’s receiving a lot less oxygen. It’s like if someone covers the mouth and the nose of a child all the sudden. What does the fetus do then? He releases immediately so that he can get out of the urgency and receive again the air that the mother is sending, which is the oxygen that goes throughout the umbilical cord.

Sometimes the fetus tightens the cord with an extremity or with their own body. What do they do then? They move and change position. It is frequent that the future mother tells us about “abrupt movements” of his daughter or son that sometimes wakes her up during the night. It is more of the same: the baby waking up the mother so that she changes position and he can get out of the hurry.

Said in other words, the compression of the umbilical cord during the fetal life it’s a magnificent respiratory exercise that trains the future infant to deal with critical situations when a lack of air exists. This ability accompanies the human being during its lifetime. These intrauterine compressions occur as many times as the occasions when the fetus sucks on his thumb. It occurs frequently and during the whole pregnancy.

How can we know if during labor there is a dangerous compression of the cord?
Actually it isn’t difficult or complicated. It’s listening and auscultating the fetus heart frequently during the labor.

When the cord compresses is makes a drop of the Fetal Cardiac Frequency. Meaning that if the heart of the fetus was beating for example at 130-140 beats per minute it produces a descent or a drop in the Fetal Cardiac Frequency of 70-80 beats per minute. This drop is sudden and brief and it goes away quickly.

What happens after the drop or descent of the FCF?
Immediately after the compression of the cord meaning after the drop of the FCF, a compensatory tachycardia occurs. To make it even clearer during the minutes after the drop, the fetus heart accelerates leading the hearts frequency to 170-180 beats per minute. Then it goes back to its usual rate of 130-140 beats per minute. This way the fetus receives the oxygen that he stopped receiving during the compression. It’s what a child does for example, after holding its breath when he submerges in a pool. When he gets out, he takes a deep breath several times.

We can listen to the cardiac frequency in several ways:
Putting an ear on the mother’s abdomen, auscultating with the stethoscope or a Pinard horn or with a Doppler or a Fetal Monitor.

The auscultation mustn’t be continuous or permanent. It is very uncomfortable for the mother and it doesn’t have any advantage. The auscultation or monitoring of the Fetal Cardiac Frequency it’s intermittent. It’s performed frequently during the labor job in brief periods trying to make the mother the least uncomfortable.

Next time we will make an explanation in relation to the enormous benefits that the water birth has when an umbilical cord compression happens in the moment of childbirth.

To conclude I must add that the odds of the umbilical cord around the neck can be present in 30-40% of all childbirths around the world, so it is an usual and normal event during any birth. The real accident of the cord, meaning a real tighten nod of the cord or a real and mortal compression of the cord, it is produced in a rate of 1 to 40.000 childbirths!! In other words it is extremely rare. In Panama there are born 50.000 infants per year which means that the real cord accident happens once a year.

Dr. Rodrigo Aybar
Dra. Graciela A. devAybar


Barbara Harper visit us !

Dear mothers, dear fathers, dear babies!

As a result of a huge effort, patience and almost a three years work in which you have been the main protagonists we can see the “fruits”.

Each day, more and more mothers live the delivery experience in a soft and free way.

It has been more than seventy women who had a childbirth at home and in a pool. Half of them, Panamanians.

We received a wonderful news: Barbara Harper an American , nurse, midwife, educator , author will visit us and will make a workshop to families, nurses, physicians… During the activity some of our marvelous mothers will tell their experience .

We would like to invite you to be present during the activity. The workshop is without cost, with a coffee brake and are invited all of you with your children . The idea is to motivate other future mothers in the way to a gentle, free and natural delivery.

After the workshop we will be in Chiriqui and will give support to the nurse students of the Gnäbe Bougle Comarca who are receiving a training in indigenous way in pregnancy and delivery care , with respect to their wise traditions .

We attach to you the activity poster and are very grateful for your attendance to the activity. You can confirm your participation in :

Kind regards,

Dra. Graciela A. de Aybar
Dr. Rodrigo Aybar

Panama, April 2013

WaterBirth english

Benefits of Waterbirth



Water seems to relax the body muscles and the relaxation reduces the pain.

Birth positions:

The water helps the future mother to be in a pressing position for longer time than she could normally endure.

A gentle start for the child:

To be born in water is a gentle start for the child who is given a little more time before it will start breathing. Waterbabies cry less after birth.

Stay and birth in water:

Many pregnant women choose to stay in water during the birth because it feels good. The warm water seems relaxing and pain relieving and it also provides more freedom of movement. Often labours tend to be shorter and the contractions become more efficient. Also it can influence whether the woman has less tearings.

The water helps to a better birthing positions:

The water in the pools helps the woman to find more ergonomically correct birthing position, and at the same time the warm water is powerfully relaxing the muscles and thus pain relieving. This relaxation and pain relief often result in a shorter and easier labour.

Dra. Graciela A. de Aybar

Dr. Rodrigo Aybar