Barcelona Mum

Interview with Dra Leila Onbargi

Dra Leila Onbargi is a highly recommended English, French and Spanish speaking Gynaecologist working at the Teknon Hospital in Barcelona. She is certified by the American Board of Obstetrics and Gynecology (ABOG), is a fellow of the American College of Obstetrics and Gynecology (ACOG), and is a member of several other prestigious American medical associations. These qualifications are continually maintained, and have been homologated by the Spanish Board of Ob/Gyn. She has been in private practice at Centro Medico Teknon in Barcelona since 1994. She is a member of the Spanish Society of Obstetrics and Gynecology. If you would like to contact Dra Onbargi please call her office for further information: ( 34) 933933161

What (if any) changes have you seen in the last few years with regards to giving birth in Catalunya (e.g. age of women giving birth, number of children women are having etc.)?
There has been an increase in the birth rate over the last decade in Catalunya by 50%. Spain still has one of the lowest natality rates in all of Europe, currently close to 1.4 children per couple, up from 1.2 children per couple 10 years ago. This is, in part, due to immigration. In addition for the past decade the number of women having their first baby after age 35 has risen steadily, contributing to this increase.

What advice would you give to women from the International Community who are preparing to have a baby in Catalunya.
Women have access to excellent medical care in Catalunya, both through the public health system or in private medicine. Although historically in Spain the birthing process has been quite surgical, there is a move away from that with completely natural births, and at a minimum a more personalized approach gaining territory. The key is finding a good obstetrician who is trained in natural births, and is willing to personalize the patient’s delivery experience, as well as a medical centre where the personal needs of each patient can be met as well as good neonatal and high risk services that are available in case of emergencies.

Do you promote the idea of natural birth?
Yes, as previously mentioned, in many centres the birthing process remains quite surgical i.e. everyone gets the epidural, oxytocin stimulation, enema, shaving and women partake little in the experience. However this is all changing and more women are demanding natural births.
I agree in a natural approach to childbirth whenever possible, if the conditions are good and there is no risk to mother or child. However I am not against the use of the epidural anaesthetic when used appropriately. Not too soon (i.e. minimum of 4cm. dilatation if possible), as well as not too strong so that the patient does not lose complete sensation, and feels the contractions so she can help push the baby out. It is a great tool in modern obstetrics, and is without risk to the foetus.
I support a patient’s decision for a completely natural birth when desired. I do not routinely use episiotomies, only when necessary, and of course shaving and enemas are completely unnecessary. I think a patient should understand that she can start off this process thinking of a natural approach, and she needs to be prepared for it, but if the process becomes complicated or prolonged, she must remember that ultimately what we all want is a healthy safe delivery and hopefully a positive and rewarding experience, and that can also happen with the help of a light epidural, if necessary. She does not need to feel like a failure if she requests one.

There has been concern about the number of Caesareans performed in Catalunya – do you think the concern is justified.
The caesarean section rate has increased in the developed world and not just in Catalunya. Currently the C-section rate is about 22% in Spain and up to 30% in private clinics. This is due to several factors, including advanced maternal age of patients having their first child which are associated with greater risk factors, recommendations against the practice of breech vaginal deliveries, twin pregnancies (on the rise because of assisted reproductive technology in patients with infertility) which are more likely to present suboptimal foetal position at birth, and of course previous caesareans which make a second caesarean more likely. We also need to mention the practice of “defensive” medicine as patients are intolerant to complications during labour and doctors want to avoid malpractice suits.

Some mothers from the International Community have commented that the level of post-natal care is very poor in Catalunya, would you agree with that?
Post natal care is provided by the doctors, nurses and paediatricians in medical centres. Depending on the area, this care in general is very good, even though the patient has to seek it out. There is no tradition of visiting nurses and midwives to the home (as in Holland, for example) in the post natal period.

Do you think there is enough ante natal (non-medical) advice for expectant mothers in Catalunya?
Yes, the patient just has to find the right doctor and his/her team to find it.

Many mothers in other countries are told to prepare a birth plan – do you think that is necessary?
I always offer my patients the possibility of writing up a birth plan, but it is not absolutely necessary. A birth plan allows me to see what a patient’s expectations are, and to advise her whether her requests are feasible or not. Most patients put forward a birth plan that are straightforward and do not differ significantly from my approach to the labour process in the first place.

In what areas do you think Catalunya could improve when it comes to maternity care?
As mentioned before there is room for improvement in Catalunya by more doctors and hospitals allowing a more personalized and natural approach to  the birthing process, with more involvement and explanations on behalf of patients, as well as their husbands. 

How often are women required to go for a smear test?
A patient’s first Pap should occur within 3 years of first episode of sexual relations. Thereafter it should be done annually. However these protocols are beginning to change with the new HPV testing and vaccine. (HPV is a virus that causes cervix cancer). In healthy women in stable relationships with 3 consecutive normal Pap tests or negative HPV, the screening process can be spaced out. However yearly exams are still important for other aspects of gynaecological and general health care, including breast exams, contraception, STD screening, etc.

Where should women go to get a smear test?
Paps are available through the local CAP (Public Health) or in private medical centres.

How common is cervical cancer in Catalunya?
Fortunately the incidence of cervix cancer is low in Catalunya, being the 5th most common female cancer here. This risk is approximately 8,5/100.000 women, one of the lowest rates in the world, and certainly in Europe.

Are you in favour of the vaccine for teenage girls against the HPV virus to protect against cervical cancer?
Yes, I am recommending the HPV vaccine for all teenage girls, which prevents both cervix cancer and genital warts from the age of 9 to 26, and ideally before the onset of sexual relations.

How common is breast cancer in Catalunya?
The incidence of breast cancer in Catalunya is on the rise, increasing by about 2% per year and representing 30% of all cancers diagnosed in women here. 1/11 women in Catalunya will develop breast cancer, slightly lower than the risk in the U.S., which is 1/9.

What steps can women take to prevent it?
Unfortunately many cases of breast cancer are genetic in origin, and therefore can not be “avoided”. Environmental risk factors include the use of estrogens, high alcohol intake, nulliparity. Breast feeding is protective. Whereas breast cancer can not usually be “prevented” regardless of a healthy lifestyle, the goal should be to detect it as early as possible by breast self exam, and screening mammographies and seeing a specialist immediately if something does not feel right when you examine your breast. For women with positive BRCA 1 and BRCA 2 gene testing, the possibility of a prophylactic mastectomy as well as removal of ovaries when finished with childbearing can also prevent breast cancer. This is usually recommended at around the age of 40 and when patients no longer desire pregnancy.

At what age do you advise women to start having mammograms?
I routinely order a baseline at age 35 (earlier if there is a strong history of breast cancer in the family) and yearly after the age of 40. If I have a patient in a very high risk group, I will do one mammogram and one ultrasound yearly ( 6 months apart) as well as breast exams every 6 months.