Birth at home with medical attention (Spain)
Among the wealthy classes, home delivery with medical attention was widespread from the beginning of the 20th century. During the last three decades, however, most births took place in maternity wards with professionals in attendance, with a very interventionist protocol. Among the more educated, a return to home delivery with a professional midwife occurred.
Spain has excellent results for maternal-infant health indicators: 100% of deliveries are attended by qualified staff, maternal deaths are 5/100,000 and neonatal deaths are 2.8%. But in 2011, 22% of attended deliveries in the Spanish public healthcare system were by caesarean section, with big differences by autonomous community (12.6 in Euskadi and 27.4 in Extremadura). In private healthcare the figure was already 37% in 2009.
Following the development of the Strategy for Attending Normal Delivery in the National Welfare system (2009), a variable decline in the number ofcommon interventions can be seen. The fall in unnecessary interventions is an indicator of good healthcare practices. For caesarean sections the drop has been discreet, and for episiotomies considerable; nevertheless, instrumental interventions are on the rise, and Spain has the second highest rate in Europe.