My concerns about birth in Ukraine
I will start by talking about the stressful conditions under which Ukrainian birth professionals are sometimes/often required to work. Underpaid and overworked are great descriptives.
1. Salaries are paid by the government and are very low. The anesthtologist we met is paid $150/month for his job. And to give you an idea of how ridiculous that is, we pay $550/month just to rent a 2-room apartment, and that is a low rent! Hopefully this man owns his own apartment, which may mean living with parents and other relatives as is usual here. How does this affect a birthing woman? Well, she’s expected to personally pay the birth team that helps her (for her “free” health care), and often nice treatment is based on this. In order to survive, ob’s and other birth house workers are “forced” to angle their jobs so that the patients will pay them personally for their services. If you as a laboring woman don’t pay the staff personally–maybe you don’t have the money–you could be treated terribly, which often happened with our elder pastor’s wife.
2. Overworked: I once talked with a Christian labor/delivery nurse here, and she was in tears describing how she would be left alone to care for nine women in labor. Nine women who have no other care but what she gives them–no family members, no doula, no other staff.
So, in citing my concerns about birth houses in Ukraine, I include my sympathy for the injustices that birth workers themselves face. It does not excuse their sometimes cruel behavior, but I do have compassion for their often unfair situations.
My concerns for Ukrainian women in birth:
1. The illegal use of cytotech to induce labor. I don’t know if this is widespread, but I know that at least in one birth house in Kiev, cytotech is used to induce labor. It is bought from Russia and used illegally–it is not legal to use during labor here–and not charted. To my knowledge, the laboring women themselves do not even know it is being inserted into them during a vag exam. Here is an article about cytotech and labor.
2. Cruel and demeaning treatment during labor. I know this is subjective and depends on the worker and his/her character, but I’ve heard enough stories to make me think this type of treatment is fairly widespread, however changing somewhat as Ukraine becomes more modern. I will simply tell some of the stories women have told me:
- Being yelled at during labor: “Shut up!” “Can’t you hurry up?! My son has a school program soon!”
- Not being consulted about or informed of what interventions are used during labor. Being strong-armed into doing/agreeing to whatever the birth house workers want.
- In one birth house (again, I’m not sure if this practice is widespread), the women were not allowed to push until the staff saw the baby’s head crowning. One nurse threw cold water on a woman’s face because she was pushing before this time. Throwing water on birthing women is not uncommon in this particular birth house.
3. Non-family-friendly atmosphere. Husbands are not encouraged to be with their wives during birth, usally not allowed. It’s changing somewhat now, but most women still birth alone. And the baby is often separated from her and kept in a nursery.
4. Poor medical practices.
A. Routine use of fundal pressure during delivery. Sometimes this involves someone standing to the side of the bed. Other times, it can be a person standing on the bed straddling her and pushing.
B. Routine vaginal and fetal manipulations during delivery.
C. Routine procedure of pulling out the mother’s cervix after birth to check it’s integrity.
D. Other: For example, I don’t know what an episiotomy is in this country, but if a woman is cut here, she literally cannot sit for a month or so. She must stand or lie down. Also, catgut is routinely used to suture uterine incisions. Catgut dissolves so quickly, it may not be sufficient time for a good scar to form. This is detrimental to women desiring VBAC. If a woman here even finds a dr who will let her try a VBAC, s/he requires an ultrasound at 38 weeks. If the scar measures greater than 3 cm, it is considered acceptable to try VBAC.
5. Ukraine has a serious past of harvesting newborn organs and selling babies (telling moms their babies had died, when in reality they hadn’t, or the drs had killed them for organs). This was/is done in birth houses by the doctors to get money.
There is much more. This is an excellent article.
The World Health Organization reports that birth outcomes for moms and babies are improving. I (and not only I) am very leary of reported statisitcs from Ukraine. A Ukrainian woman who works with the government told me that when she reads a statistic like this, she multiplies it 4 or 5 times. But . . . according to the statistics: From 2004 statistics, maternal mortality ratio per 100,000 live births was 13.34. That’s down from 24.67 in the year 2000. Perinatal mortality rates per 1000 live births was 7.82 in 2004 (down from 9.56 in 2000). Read the entire report on Ukraine for yourself. Wouldn’t it be wonderful to see those statistics improved even more?
Finding out about birth issues in almost any culture is not easy, but these are some of the things I’ve learned about Ukraine so far. And as my mother always said, when you see a problem, instead of just criticizing, see how you can be part of the solution.