Open Letter to the Minister of Health of Ukraine

February 19, 2015

For the purpose of our initiative to implement alternative obstetrics in Ukraine (you can find more details here), Olha Vereshchak and Olha Gorbenko, doulas and professionals of the ‘Semitsvet Family Development Center’, have written an open letter to our Minister of Health of Ukraine inviting his attention to a very important problem – the inadequacy of obstetric aid system in Ukraine, which jeopardizes the reproductive functions of a woman and the health of our children!

Dear Mr. Kvitashvili,

We, the women and mothers of Ukraine, are writing to you to ask for your assistance in solving a very important problem, which is alarming for many mothers and specialists. No matter who we are: obstetricians-gynecologists, neonatology physicians, midwives, doulas*, psychologists or other specialists, who work with pregnant women and newborns – first of all, we are women and mothers, who are concerned about the inadequacy of the present system of obstetrics aid in Ukraine and the health of our children.

It is fair to say that current legislative framework for obstetric aid in our country is one of the most advanced in the world. Officially, a woman is entitled to many significant rights and freedoms, such as the right of informed choice, freedom from medical procedures, right of free choice of positions during delivery and many others. According to our reckoning, the main achievement of new medical orders was reflected in the Order of the Ministry of Health of Ukraine No. 620 back in 2003, which ordains to treat a woman, a birthing mother, not as an object of medical practice to execute delivery, but as an individual and the main participant in the important moment in her life – childbirth. [1]

Some of the maternity hospitals in Ukraine, which participated in the New Perinatal Technologies Project and bear the title of the hospitals with “benevolence to a child”, are committed to the principles, stated in the new orders, and indeed there was the improvement of the health level of mothers and children and more women were satisfied with their delivery experience. However, in the past few years, we, mothers and the specialists of caring professions, faced with the groundless return to obsolete, rigid, aggressive and medicalized technologies of obstetric aid. Mothers and children became the victims of traumatic, disrespectful obstetrics, which is typical for many post-soviet countries with authoritarian regimes.

In the Addendum to this letter, you will find numerous facts that concretize the current situation.Each of them speaks volumes about the infringement of the rights of mother and child, disrespect of women’s needs, when they are in the most vulnerable condition during the birth-giving, as well as about numerous hazards to the health of mothers and children in the majority of Ukrainian maternity hospitals these days.

The past experience of obstetric aid system reformation has shown that the absence of safe alternative to the delivery in maternity hospitals for a woman and inadequate load for physicians, who have to be on duty day at night and supplement their salaries by accompanying deliveries outside regular hours, lead to the return of a routine medicalized approach. Many physicians wish to accompany deliveries at a time, which is convenient to them, so they apply labour induction which can be dangerous for the lives and health of mothers and children.Moreover, a woman at birth does not know about the medical intrusion most of the time. Obviously, it is impossible to change such state of things without altering the whole system.

According to the modern researches of different models of obstetric aid systems in the world, it may be concluded that the most optimal model that allows preserving the health of the nation to the greatest possible extent, is the system that harmoniously combines the following three variants of obstetric aid:

1. Hospital delivery for women at high and medium risk;
2. Delivery in birth centres under hospitals or not far from them, accompanied by midwives ONLY; in case of emergency, a woman at birth and a newborn can be transported to the hospital;
3. Home birth, accompanied by highly professional certified midwives for women at low risk (mostly subsequent childbirth) [4].

As of today, Ukraine has succeeded only with the first clause, creating large-scale, high technology perinatal centres, designed for women at birth at high risk. However, modern Ukrainian system of obstetric aid cannot provide the majority of women that have no contraindications, especially women with subsequent pregnancy, with proper conditions for their deliveries. Indeed, the majority of maternity hospitals have individual comfortable family-type delivery rooms. Nevertheless, normal deliveries are still accompanied by physicians-gynecologists, initially trained to deal with pathological processes, and that often causes iatrogenic effect and leads to groundless medical intrusions.

With the development of scientific and technological progress, midwives have lost their important role – to specialize in the physiology of birth, so the medical treatment of a woman at birth is now performed exclusively by obstetricians-gynecologists.The researchers of the World HealthOrganization threw discredit on such an approach. The comparative analysis has shown that midwives, as opposed to obstetrician-gynecologists, accompany deliveries in a more conservative way. As a result, they have to apply labour induction, operative vaginal obstetric aid (forceps and vacuum extraction) and episiotomy(perineum section) less often, and the fewer percentage of babies need reanimation and hospitalization in the departments of intensive therapy [3]. Apparently, it is pointless, and, probably, unsafe for women with physiologically normal pregnancy to be under the control of an obstetrician-gynecologist, even if there is a possibility for this. [3, p. 8].

It is no wonder that the number of planned home births is growing in modern Ukraine. It is mainly conditioned by the unwillingness of women to interact with the present monopolized, rigid system of obstetric aid that disrespects the dignity of a woman at birth, her right of choice, regulating the interaction of mother and child during the period of they stay in the maternity hospital, but first of all, it endangers the health of mothers and children.

However, Ukrainian women have no safe alternative. In case of any complications during homebirth, a woman either cannot count on medical aid at all or faces with the utterly negative reaction of medical staff at the healthcare institution, where she seeks assistance. Such situation infringes the right of women to choose the place of her delivery, and one of the fundamental rights of a person – the right of women and children to receive emergency medical aid. And afterwards, when applying for the certificate of birth after the homebirth, a woman has to spend the most precious time for being with her child and establishing child and parent relationships, on gathering the enormous number of bureaucratic documents and undergoing humiliating medical examinations up to DNA testing. All this can be changed for the better if women have access to comfortable childbirth centres, where deliveries would be accompanied by midwives, as well as to homebirths, accompanied by highly professional certified midwives and supported by the state.

Relying on the all stated above, we ask you to approach the problem of reforming the system of obstetric aid in Ukraine within the framework of the general reformation of health care in the country. Such reforming could be based on the recommendations of the World Health Organization. The Netherlands system of obstetric aid organization can be taken as a basis, as nowadays for about 20% of births are carried at home in this country. In comparison: in the USA, where women also have the opportunity to choose safe homebirth, the number of such births does not exceed 1 %.However, this quite minor part of women has a right to make their choice.

The similar system, where women can choose between maternity hospital, birth centre with a midwife and safe home birth, was implemented in the Netherlands, New Zealand, Great Britain, Denmark, Canada, Israel and other developed countries with high-level of mother and child healthcare. Among the countries of the post-Soviet area, the described model of obstetric aid exists in Latvia and Poland, and we believe, it can be successfully adapted and implemented in Ukraine.

With deepest respect and hope for understanding and cooperation,

Women and specialists of Ukraine

OlhaVereshchak and OlhaGorbenko,

doulas of the ‘Semitsvet Family Development Center’of Dnipropetrovsk city,

Olga Vyshkina,

mother of 3 homebirth children, Kharkiv city,

co-organizer of the First International Festival on Natural Childbirth “Miracle in the Heart” proestro.com

Svetlana Demianova-Ponomarenko,

mother of 2 children (1 homeborn) and the head of ‘Indigo LIGHT’ International Development Center, co-organizer of the First International Festival on Natural Childbirth “Miracle in the Heart” proestro.com

Supplement

Today Ukrainian obstetrics system disrespect to mother personality and child rights are compounded by uncontrolled, unreasonable use of large amounts of drugs, during pregnancy as well as during delivery. Recently pregnant women, childbirth and the puerperium even more often faced with the inability to realize their legitimate right for safe childbirth.

Today, fewer women can say that they had a free choice of birthing positions. Most of the obstetrics staff could not abandon the practice of receiving deliveries in lithotomy position (on the back). This position is the most dangerous for a child and uncomfortable and complicates the bearing-down period for women. Evidence of this is the statistics of independent centres working with pregnant women. Women imposed dangerous and traumatic position, leading to an increase in birth defects in the child and increase the percentage of unjustified episiotomies and other medical interventions for mother.

Despite the fact that the medical protocols clearly state that physician should obtain informed consent from the woman for all of the procedures (except for cases relating to life-saving) [1], this and other women's rights are often ignored. So, for example, artificial rupture of membranes (amniotomy) often occurs without the prior consent of the parturient woman.

Increasingly, we are faced with the inability to abandon the active management of the third stage of labour even in cases of normal and uncomplicated delivery (a written refusal is perceived by a staff as a formality, which can be ignored).

The right of mother and child on a continuous and unbroken skin-to-skin contact during the first 2 hours after birth is realized no less formally. However, the importance of the contact is difficult to overestimate. It is to establish the necessary conditions for safe delivery of the placenta, postpartum haemorrhage prevention for mother, parent insemination microflora for the child and successful breastfeeding initiation. The first contact is also very important to establish a close relationship between mother and child.

It should be noted that only recently began to appear the first study on the global implications of such active intervention in the birth process, which was marked the twentieth century. And although it may seem that "always like this taking birth ", – it is dangerous misconception length of a few decades.

Due to the development of such sciences as molecular microbiology, epigenetics and ethology modern scientists introduced the concept of "critical period": biologically defined time period within which a body is optimally prepared for absorption of certain reactions, and interference in this process can have irreversible consequences.

The period before, during and immediately after birth is one of these critical periods in human life. Some possible consequences of intervention in this period we can find in the database Research Center of primary health www.primalhealthresearch.com and websites www.wombecology.com. These databases are constantly updated and collected thanks to the efforts of the world-famous obstetrician-gynaecologist Dr Michel Odent.

Thus, the databases represented one of the works of Swedish scientists. The scientists have been able to establish that the perinatal period is a critical period for the development of autism by analyzing the birth histories all of Swedes born during 20 years, and having the medical records of all children (408 people), who were diagnosed with autism which according to strict criteria. In other countries, further studies have shown that children with autism are characterized by disruptions in oxytocin synthesis [2, p.136].

All this indicates that we need to carefully relate to the use of oxytocin during labour and epidural anaesthesia often runs in tandem with it. Widespread use of oxytocin during childbirth is a sign of the past decades, and perhaps no coincidence that in these years we have seen an unprecedented increase in the number of children with autistic disorders.

We also have the ability to model the effects of active intervention in humans oxytocin system on the example of other mammals. Michel Odent gives the example purebred dogs who for decades born with health benefits and now almost always give birth by caesarean section. Today, English Bulldogs born by caesarean section in 90% of cases, and artificial insemination has become common practice for representatives of this breed. After a few generations, which in human terms corresponds to several centuries, "life Bulldogs, especially their reproductive life, almost entirely in the hands of veterinarians. Directs at reflexions ... " [2, p.28].

Also, thanks to the hard work of researchers, we can suggest that awaits us, as a species Homo Sapiens, in the near future, unless we carefully concern to basic needs of women and children in labour and the postpartum period.

It is important to understand that any active intervention and the failure mechanisms inherent nature reproduction our species has far-reaching consequences. Today development level of medicine allows us to save the life of women and children those need it. In this context, it is especially important to create the necessary conditions for those women who can give birth to their children without medical intervention.

Some women find described situation in the Ukrainian birth attendance is also a discrimination form based on gender. According to statistics men less likely to seek by several times the services of medical institutions, they also are not imposed mandatory hospitalization for childbirth.

Today we are at that borderline where it keenly feels the necessity to change existing system obstetric aid. This necessity is dictated by our mother's concern for children health, desire to keep our women's health, the necessity of greater respect for human dignity, the rights of women and children, as well as the necessity of more efficient resources use allocated for health care.

Bibliography

1. Order of Ministry of Health№620 «Organization and inpatient obstetric and neonatal care in Ukraine" dated 29.12.2003.
2. Childbirth and the evolution of Homo Sapiens / М. Odent. – М.: Nazarov publishing house, 2014. – 216 p.
3. The modern aspects of physiological birth running (abridged translation from English «Care in Normal Birth» WHO-1996) / Ed. T. Asatiani - Tbilisi: Association of Obstetricians and Gynecologists and the reproductologists of Georgia, 1998. – 27 p.
4. Birth models that work / Robbie E. Davis-Floyd, Lesley Barclay, Betty-Anne Daviss. — University of California Press, 2009. – 496 с.