“Fear is common in mothers after giving birth, and it is related to loneliness and excessively medicalized care during pregnancy and childbirth,” explains Ibone Olza (Louvain, Belgium, 52 years old), a doctor of medicine and a specialist in child and perinatal psychiatry. and director and teacher of the European Institute of Perinatal Health. She is the author of several books, among them, Give birth. the power of childbirth (Vergara, 2017) or mother’s word (Vergara, 2022), currently collaborates with the World Health Organization as an expert advisor on maternal and child health issues.

ASK. Why do you think there is so much taboo and stigmatization regarding intrauterine gestational or fetal death (between conception and birth) and perinatal (from 28 weeks of pregnancy to the first 7 days of life) and mourning? What should be the role of families regarding these mothers whose baby dies?

ANSWER. As a society we live with our backs to death, as if we could avoid it that way. In the case of perinatal grief, there is a tendency to think that because life is shorter it must hurt less, when we already know that it is not true. The best thing families can do for these mothers and fathers is to respect their pain and ask them what they need, understanding that they will remember and probably miss that child for the rest of their lives.

Q. According to Unicef, nearly two million babies are stillborn each year.. Do you think that many of these deaths could be prevented?

R. It is known that most of these deaths are preventable with quality care (many are due to preventable or treatable diseases) and with greater listening to pregnant women, especially if at the end of the pregnancy they perceive changes in the baby’s movements or sense that something is wrong. not going well. It must also be made visible that some of these deaths occur in contexts of gender violence or other violence and malpractice.

Q. What psychological consequences can these deaths have on mothers and their relatives and what professional care would they need?

R. In the initial moment there is usually anger, grief, perplexity or shame. With accompaniment, affection and care, these duels are not so terrible and, although they are very sad, they can bring growth, as professionals such as Pilar Gómez Ulla of the El hollow of my belly network, dedicated to perinatal bereavement care, point out to us. If there is a lack of care, malpractice or violence, trauma is generated, which is something very different from mourning and which hinders it. It is very important to offer time and sensitive accompaniment, which is why we are now talking about trauma-sensitive care, and this is especially relevant when death occurs during pregnancy or childbirth.

Q. Is it possible to speak of underdiagnosis in fetal deaths? Because?

R. Researcher Paul Cassidy demonstrated a few years ago that in Spain fetal deaths are underdiagnosed, partly due to the diversity of criteria and records. It is essential to continue advancing in the recording of all perinatal care indicators, also to make visible the possible iatrogenic causes (alterations in the patient’s condition caused by the doctor or by the treatment) of some of these deaths and to be able to prevent them.

P. You have wanted to help other women from your knowledge as a professional and mother. There is a lot of talk about loneliness after childbirth, fear, insecurity as a mother, especially when you are a new mother. Is it easy to raise in this society today?

R. I have the impression that raising children is especially difficult for many reasons: the labor market, social conditions, the enormous loss of the social network and fabric, added to the pressure that accentuates the idea that raising children is an individual task or at most two. . It is urgent to implement social protection and support policies for upbringing and care: paid leave for pregnancy, caesarean section leave, recovery of public spaces for children and, of course, the development of perinatal mental health care programs and improvement of working conditions of maternity care professionals.

Q. Childbirth, pregnancy and idealized lactation, what happens when women go through them suffering, crying?

R. The postpartum period is especially hard and sometimes there is a deep disappointment with oneself. Desiring and loving your baby does not mean that it will not take you months to get to know him well and to adapt to your new life as a mother. Perhaps the greatest learning in many cases is to reduce self-demand and, above all, learn to ask for and receive help.

Q. Many women experience unnecessary practices and without consent in childbirth. Do you know professionals who have had a hard time and have been aware of these situations?

R.. Yes, and it is especially painful for those professionals who, even knowing the hospital environment well, have felt mistreated, judged or abandoned during their own deliveries and postpartums. These are traumatic experiences that in many cases motivate these same professionals to become very actively involved in initiatives so that other mothers do not go through experiences like theirs.

Q. What is missing so that the woman can have a respected birth and it is not a mere extraction of the baby?

R.. It is necessary to review the training of obstetricians and midwives and respect the neurological, psychological and hormonal process in deliveries. Accompaniment, free movement and understanding the role that fear plays are important keys. This fear can lead to panic in the face of any symptoms or crying of the baby and can make it impossible to enjoy parenting.

Q. Do you think more should be said about the physical and emotional damage caused by unnecessary cesarean sections? What consequences can derive in the mother?

R. The issue of caesarean sections is very serious. We cannot forget that a cesarean section is major abdominal surgery. They have normalized and most are preventable. “Unnecessary” sections can even be the cause of maternal or neonatal death. On a psychic level, not having gone through the neurohormonal process of childbirth, it may take longer to feel like a mother or to bond. There must be the right cesarean sections, promoting skin-to-skin, non-separation from the baby and breastfeeding from birth.

Q. With such an intense debate that has been opened in recent days, surrogates: yes or no?

R.. When the practice is analyzed in the light of perinatal neuroscience, it must be said that it is a very dangerous practice for the physical and mental health, both in the short and long term of mothers and babies. If we add to this the information we have from the social sciences on the contexts of violence and exploitation where it occurs, it would confirm that in no way. I think it is unethical and unhealthy to decide to separate a newborn from her mother from birth.

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