Birth in Ukraine, part I
For years I’ve had this blog named “birthinukraine” but I’ve posted very little about actual births in Ukraine. Now that I’ve seen a few more “Ukrainian” births, I’m in a stage where I can come up with some general observations about cultural differences in birth that I’d like to share in a series of posts.
This post will address the medical personnel involved in birth. This is the same in all births I’ve seen for any couple.
The system I’m familiar with (American/European), either an obstetrician or midwife attends a birth. Nurses do things like monitoring fetal heart tones, checking vaginal dilation, etc. And the doctor or midwife enters usually at the end to catch the baby, get the placenta, and suture. (This is very simplistic, I know.)
Here it’s a little different. During the labor, the obstetrician comes in periodically to check the fetal heart tones and check cervical dilation. He/She is also the one who breaks the water.
(Note: I’m not saying any of these interventions are healthy or normal; but in institutional birth here, it is regular practice.)
Once the mom is pushing, a second careprovider enters the scene–this woman (I’ve never seen a man in this role) is generally translated as “midwife,” though it’s not really an accurate translation. Her job is to get the baby and the placenta out. (I will talk about this process in a separate post.) Usually the doctor is in charge still, ultimately, so he and the midwife communicate about what’s going on at various points of the birth.
If there are tears, the obstetrician sutures. If a piece of placenta or membrane is retained, the obstetrician deals with it.
The midwife later helps to initiate breastfeeding.
Also, there is a woman who comes in whose job it is to clean up the mess. After the ob and mw are done with the mom and baby part, she cleans up, wipes the mom’s legs, and fixes the bed back to normal.
Usually a pediatricians also comes in along with the midwife to observe the birth of the baby. She (He?) checks the baby soon after birth. Some do this just glancing over the baby and not taking baby from the mom. Others take the baby to the exam table for a while to do all this.
Sometimes what I suppose are students are also present. Student midwives, student pediatricians, etc. I’ve seen up to about 7 people come into the room for the birth.
So these are the main personnel involved in birth in a Ukrainian birth house, from my observations.
There is one element of Ukrainian obstetric birthing style that just really shocks me. Sometimes I feel like I’m living the movie “Anna and the King”–You know, the clash of East and West cultures. Each one is shocking to the other.
I will try to be *sensitive* as I write this, but I think even most Ukrainians will agree with me that it is a shocking practice.
(Is this my trauma talkingtalkingtalking???)
Let me stop on that trauma point. Doulas see traumatic things during birth. It’s hard for me to go to births sometimes. I used to cry after births. I used to be haunted for days. I used to go around for days after a birth feeling cruddy. … Now … Now I am more used to it … more “professional.” What I witness doesn’t intrude so much into my own life. It’s still there, but somehow I’m more used to it now.
Gah. Is it right that I should be used to these things?
I described how the midwife (not an exact translation of the western word) is responsible for handling the baby and placenta coming out. The thing that shocks me the most is how they use their hands/fingers while the baby’s head is still in the mom’s v~gina.
I’ve seen their fingers in the v~agina while the mom is pushing and they use their first two fingers along the sides of the babies’ heads, working it out in a sweeping motion from deeper in to out, deeper in to out.
I’ve also seen, if I am recalling this one correctly, kind of using the outside edges of her hands all around the outside of the perineum, kind of kneading it back around the baby’s head.
Anyway, I don’t like talking about it even, it gives me the creeps. But it happens a lot.
You know, American OBs and midwives are taught “hand maneuvers” to do on babies once the head is out, to get the body and shoulders out. It’s also creepy. And scary. And dangerous. But western maneuvers start when the head is out. I want to find a textbook of Ukrainian obstetrics and know if they are taught these things formally. Or do they just pass it on during clinical experience?
So is it cultural that Im shocked by the midwives here doing maneuvers on the baby while s/he’s still in the mom’s birth canal? Maybe. As an American, I see it kind of as a physical attack of a mom. I know some stuff goes on in U.S. hospitals, too, during birth that are made to sound really aggressive. Maybe I’m just more used to those issues because it’s from my culture. I don’t know. I’m not used to this, though.
I haven’t seen a Ukrainian really shocked about it yet. It happens kind of fast; they expect birth to hurt; they don’t know any better; and what does the mom herself really see? Is it not more the dads seeing this and not thinking it something unusual?
Anyway . . . . shiver.
I am a witness.
One thing I really like about birth here is the lack of machines and tubes and constantly beeping/wave-making machines. In the average birth house, women don’t have IVs hooked up during birth, they don’t have electronic fetal monitoring, they don’t have …. anything, usually.
It’s really nice.
Doctors still often use Pinard horns to listen to the baby’s heart beat, prenatally and during birth. That is way cool.
Here’s a wikipedia entry on Pinard horns.
Pinard horns are the most common fetal stethoscopes in much of Europe, even today, which surprises some doctors from the United States, where a Doppler ultrasound is standard.
So most births here are low-tech, and I like that.
Interestingly, epidurals are now generally available and probably more common than they were previously, but they are also *generally* looked upon with suspicion because of their health risks to mom and baby. So that also makes birth here a more natural event.
Those are some things I like about birth in Ukraine.
One aspect of Ukrainian culture and birth that I really like is the normalcy of un-pain-relieved birth. I mean birth without pain relief drugs (like epidurals, etc). Women here, while yes, they do consider birth painful generally, they don’t view it as impossibly so.
I say this based on my own culture in the U.S. I think that quite a few American women have the assumption that birth is impossibly painful, that there is no way for one to live through the experience of un-pain-relieved birth. I don’t say this in a judgmental way; just as observation. I think many American women sincerely think it’s impossible for herself to birth without pain relief. That is the cultural message passed along.
Ukrainian women generally start with the assumption that they can/will birth without pain relief, for various reasons (money, desire, etc). When I was pregnant with my first child, I was over at my friend’s house (we lived in a village at that time), and she had two kids. We were chatting about birth, and I mentioned the pain of labor, and she just smiled and said I would do just fine. … I like that women in a culture can pass that normalcy on to each other.
And I would like to insert a thought from Carla Hartley, the director of my midwifery school. Basically, if you’ve had a natural birth, “you’re nothing special.” In the sense that most of the world’s women birth without pain relief. It is the norm; it’s not heroic or a special achievement.
♥ ♥ ♥ ♥
Next, I would like to comment about finances and the economy of birth here.
Birth houses are government facilities. Opening a private birth house would be next to impossible without enormous sums of money and a lot of uncertainty about if, even then, the government would allow/approve it. It’s been done once so far.
So, being an ob/gyn is a government job, not a private one. Just like being a policeman or working in the local government buildings. And in Ukraine, probably in all post-Communist countries, the pay is laughable. In Kiev, this site says the average monthly cost of living is $1,728. That’s a really thrifty budget for Kiev, especially if you rent an apartment for $1000 or more.
Doctors in Kiev (like other govt workers) are paid a salary of $100/month. In order to actually live, they have to be “paid” by average citizens for their services.
I used to have a bad view of doctors and other govt workers who angled for personal money gifts. I don’t really anymore. The government is unjust. I dislike that treatment is based on this, and as a Christian, I hope I would be able to treat everyone well and without discrimination. But what means “well”?
When our daughter had her appendix out a few months back, the anesthesiologist took Vitaliy aside and said that it would be nice if Vitaliy would pay him $100 for doing the operation anesthesia, but it wasn’t necessary–just what we could afford would be OK. So Vitaliy paid him and also thanked the surgeon/doctor for $100. And we noticed that the entire stay, Vitaliy (who had to live in the hospital to take care of daughter) was given his own bed to sleep in, for example, when other parents had to sleep on the same bed as their child.
So, what is considered normal? What is a doable normal for the conditions in which these medical personnel work?
Personally, I see the advantages of this system. When people want to arrange ahead of time for their births and pay a particular doctor to attend them, they can bargain with one person who can be pretty flexible. They don’t have to bargain with an entire institution, for example, that pays the doctor. You have bargaining power because you are paying the doctor personally from your pocket to his.
So, economically, you can have a “free” birth, although you are expected to buy and bring with you a list of birthing supplies (kind of like home birthers do). Or you can opt to pay a pre-arranged sum to the doctor of your choice, or you can “thank” the doctors/medical personnel that are on shift when you arrive (or afterwards) to leverage some nicer treatment, etc.
Continuity of Care: This is a major minus here in Ukraine.
A pregnant woman goes to see OB/GYNs in her local clinic for prenatal care.
The doctors in the birth houses she usually sees for the first/only time during her birth.
One exception I know of is if she arranges/pays a particular doctor to be at her birth, she might go to see him/her the last 3-4 weeks of pregnancy, depending on how that particular doctor makes arrangements.
Basically all the birth doctors know is what’s written in the woman’s prenatal care booklet which they hopefully look over when she comes to the birth house for her birth.
Speaking of prenatal care, it’s nothing like a one-stop shop/private doctor’s office. It requires going to all different offices, etc., in the local clinic to get all the various tests done at various hours of operation.
And if you do a urine test, it’s BYOC (Bring/Buy Your Own Container). Most of the supplies the woman needs to supply herself.
Out in our village, I saw a doctor there one time in order to register the birth and get the prenatal care form we needed (in order to get the forms after the birth to then get the birth certificate after a home birth). It was a very interesting experience. I had my pelvis measured, an already antiquated practice in most places. They used this tool below. It was very simply done as I lay on my back. I have never heard or seen this done in Kiev, however. So maybe it was just a village thing?
well, this is a little graphic, sorry.
The first birth i was at as a doula in Ukraine was … well, no one really left with happy memories.
I won’t tell the whole story here. But I want to comment on two things I saw, that are/were common practices.
One is “checking the cervix” after birth. They way the doctor checked the cervix at this birth was by pulling it out of the woman’s body with ring forceps. (edited to add: she was not medicated in any way.)
Just sit on that for a while.
The other thing is fundal pressure. I’ve seen/heard of it different ways. At this birth was a fast jab on the fundus to pop the baby out. I’ve also seen, woman lying on her back and the doctor applying constant pressure during a contraction.
My ob friend told me that when she worked, she remember getting up on the birth table, straddling the mom, and pushing.
Oh, a dad said he saw it with the doctor (standing on side of mom) using his elbow to bear down on the fundus.
I want to say, too, maybe once in a blue moon this might be a helpful thing. But we’re talking what is/was standard treatment.
The Dark Side
There is/was a lot of bullying and cruelty during birth in post-Communist countries.
I have friends here, my age, from another city, and in their birth house, one form of bullying was throwing water in the woman’s face (yes, during labor). This was done, for example, if she stared pushing before they saw the baby’s head at the introitus.
Denise Thompson, a deceased American midwife, a friend and mentor to me, came here and sometimes worked in a birth house here and she observed many cruel things. She wrote a brief article about it in Midwifery Today magazine, Autumn 2009, Number 91, p. 39 “What I Have Seen.”
I do not know the young woman strapped to the table. .. She cries out in pain. The nurse throws water in her face. … The doctor then climbs onto the delivery table and straddles the woman’s chest. He begins pushing on her fundus with all his might. The nurses are yelling at the girl. … [The baby is born.] … The nurses whisk the baby away…. The woman is screaming in agony. I can’t see what the doctor is doing, but he is standing between her legs now. He has large instruments in his hand. [And she is stitched with no anesthetic.]
[Another birth, after the baby has been born.] The doctors and nurses take over and bring in what look like long shoe horns and barbecue tongs. They take the “shoe horns” and insert them into the woman’s vagina. Stretching her open, they grab her cervix with the tongs and pull it out of her body to inspect it. Although the woman is heavily drugged she is screaming and flailing…. Then they take the “shoe horns” and scrape out her uterus thoroughly. …
I found more information in Barbara Harper‘s book, Gentle Birth Choices. In this section she is talking about waterbirth around the world, and she comes to Russia. They visited birth houses in Russia, Ukraine, and Georgia. Here is what she says:
They displayed the most terrifying conditions for childbirth that I had ever witnessed. Almost all women were drugged or unconscious, and physical brutality was common, with women being beaten or struck while in labor. p. 166
She goes on to mention the forced separation of mothers/babies for several days, and that husbands were not even allowed in the birth house the entire duration of the mother’s stay.
. . .
I don’t know what to say now.
I think I’m winding down on this series, but who knows?
I’d like to mention perineal massage, specifically during pushing stage, done with the intent to help mom not have a vaginal tear.
In the States, this means that the midwife or OB applies downward pressure of some form on the lower edge of the vagina. On the edge of the inside of the vagina downward.
Here, I’ve seen the opposite thing done to protect the perineum. Instead of downward pressure, the midwife (not totally accurate translation) will place her hand/fingers in a “U” and use her fingertips to cup the perineum/lower edge of vagina upwards. Not exactly at moment baby is emerging, but slightly before and around crowning.
This is just yet another interesting detail of difference 🙂