Horror stories push Cuba toward gentler approach to childbirth

By Laura Becquer

Havana, Feb 2 (EFE).- An unprecedented study of giving birth in Cuba revealed numerous cases of “obstetric violence” and urged the island’s public health system to embrace the concept of Respectful Maternity Care.

Put together by five independent journalists, “Broken Births” recounts the stories of 514 women who had should have been an occasion for joy transformed into a nightmare.

“Get pregnant again? No way in hell!,” Osiris Gonzalez replies when EFE asks about her experience.

“I spent 24 hours with the worst pain of my life left in a bed unattended,” the 33-year-old Havana resident says.

A woman calling herself Alina says that only the effort and tenacity of her female doctor allowed her to avoid undergoing a cesarean.

Her advice to pregnant women is to establish a relationship with their physicians before giving birth.

Cesareans accounted for 40 percent of the deliveries covered in “Broken Births,” one of the Global Investigative Journalism Network’s Best Investigative Stories from Latin America in 2022.

That is double the rate globally and well beyond the 10 percent to 15 percent deemed appropriate by the World Health Organization (WHO).

And more than 75 percent of the women interviewed said that doctors subjected them to an episiotomy – making a surgical cut at the opening of the vagina to ease the delivery – even though the WHO insists the procedure should be used only when absolutely necessary.

The doctors asked for the women’s consent in a mere 21 percent of those cases and in all but 27 percent of the instances, the cut was made without administering anesthesia.

Forty-one percent of the 514 women reported suffering verbal or psychological abuse during the delivery.

Accounts similar to those in “Broken Births” have even begun to appear in Cuba’s state-controlled media.

The official daily in Las Tunas province published comments from Yunier Egnodio, an obstetrician/gynecologist who acknowledged the validity of the points made in the independent study.

“Sometimes we abuse the episiotomy, we don’t consult the patient and we don’t always ask their approval to administer drugs such as oxytocin,” the physician said.

“While in Chile and Germany women give birth in pools, as it is the ideal medium for the baby, we remain attached to old routines. An example is the obligation that pregnant women in labor remain in bed,” Egnodio told the newspaper.

Cuba has one of the Western Hemisphere’s lowest rates of infant mortality, five per every 1,000 live births, less than one-third the median rate for the region, according to figures from the World Bank.

The United Nations Population Fund attributes Cuba’s success on that front in part to the medicalization of childbirth.

Even so, the UN agency and the Cuban Ministry of Public Health note in a 2022 guide to Respectful Maternity Care that medicalization is associated “at the global level with complications due to interventionism.”

Three Cuban hospitals have begun to apply the principles of Respectful Maternal Care, but EFE’s inquiry to the health ministry regarding details of the program went unanswered. EFE lbp/dr