Giving birth at home in Ukraine: Pros and cons

Author : Natalia Lebed

Source : 112 Ukraine

On January 23, a 34-year-old woman died in Rivne. She gave birth to her second child at home - in the presence of her husband, sister and friend, who played the role of a "spiritual midwife". The woman's healthy son was born, according to relatives, at 15:15. And at 18:20 an ambulance took her to the hospital in agony
19:37, 3 February 2021

child birth
Open source

In the three hours that passed after the birth, the woman in labor bled to death. Now the police are investigating the role of every adult who was present at the tragedy, and is studying the problems of home birth.

Everything you need to know about home birth from a legal perspective

It is not forbidden for Ukrainian women to give birth at home. It is forbidden for professional doctors to help them in this process. That is, if a woman decides to give birth at home, she should understand that she can only rely on herself. Or only for relatives and for underground obstetricians. But if something goes wrong, the actions of doctors who have come to take delivery at home are subject to the sanction of Art. 140 of the Criminal Code - improper performance by medical or pharmaceutical workers of their professional duties.

As for the actions of other people who witnessed a home birth and, in case of complications, did not call an ambulance in time, they can be punished under Part 3 of Art. 136 of the Criminal Code - failure to provide assistance to a person who requires it, which entailed grave consequences.

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That is, even if we ignore the physiological aspects of home births, all participants should remember the legal consequences. And this is not intimidation, but the actualization of an important problem. After all, doctors with whom spoke, saying that it would be useful to legally allow home births under the patronage of maternity hospitals. That is, to legalize the call of an obstetrician at home.

This practice takes place in a number of countries. In the United States, you can call a licensed midwife. In Germany, in addition to an obstetrician, gynecologists and general practitioners can also attend childbirth. At the same time, home births are covered by health insurance. Homebirth is also allowed in France, UK, and Poland. And in the Netherlands, they account for 40% of births.

In Ukraine, there is only one type of medical care during childbirth - exclusively in a hospital. Perhaps, legislators should revise this rule, in particular, taking into account the Rivne incident.

And how many home births occur in Ukraine during the year? As found out, no one keeps such statistics. Because home births fall into the same category as births that took place outside the hospital. That is, premature and unexpected - in a taxi, on the street, on the road, in fact, anywhere. In such cases, the baby's parents might not want to give birth at home, but they got into a situation where the child "asked" to be born, despite the adults' plans.

In such a situation, by the way, it will not be easy to register it. You need to write two applications - to the children's clinic at the place of residence and to the Department of Health. A pediatrician will come from the polyclinic and a whole commission from the Department. Together they must pass a resolution that this child belongs to this particular mother. And in case of doubt, they will send the baby and the woman for a DNA test. In a word, there will be plenty of bureaucratic troubles.

And yet women, in particular Ukrainian women, decide to give birth at home. Why?

The first “pros” from such women in labor is that they strive for natural childbirth (without stimulation, etc.) in a relaxed home atmosphere. Well, this is possible, says the American College of Obstetrics and Gynecology, but provided that the woman in labor is clearly informed about all the possible risks and consequences. At the same time, we recall that in the United States it is allowed to invite a professional obstetrician to home birth. The conclusions of American doctors say that improper placement of the fetus, multiple pregnancies, or previous cesarean sections is an absolute contraindication to home birth. Information about such factors should be known to the woman in labor in advance. Therefore, obviously, in developed countries the situation when a woman does not even consult a doctor about home birth is impossible by definition. Meanwhile, the Rivne woman in labor did not just consult with specialists and was not registered in the antenatal clinic.

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Americans note the woman's right to independently choose the option that is acceptable to her, but emphasizes that the advantages of home birth have not yet been studied. And not only in the United States, where 35 000 home births took place in 2020, which is only 0.9% of the total but also in European countries. "In countries where home births are more common than in the United States, attempts to conduct such trials have been unsuccessful, mainly because pregnant women were reluctant to participate in clinical trials that randomized home or hospital births," the report says.

Another American source notes: an analysis of 680 000 cases of home births revealed that healthy women who do not have complications of pregnancy are as safe as giving birth in a hospital. But here an important nuance is added: even if the process of childbirth itself went well, the percentage of sudden deaths of babies who were born and were at home exceeded the deaths in the hospital by 20%. The second argument is the ability to avoid obstetric violence. This problem has existed for a long time and is common for countries with any standard of living. However, in states like Ukraine, it is especially acute. Ukrainian women in childbirth even founded the Enough to be silent movement, in which they talked about their experiences of inhuman treatment by obstetricians.

And in 2019, this problem was considered at the UN level. The rapporteur Dubravka Šimonović from Croatia recommended that member countries of the organization, in particular, ensure the de jure and de facto right of women to invite any person they choose to give birth and consider allowing home births and decriminalizing such births. On the whole, the UN has recognized "childbirth" violence as a violation of human rights. And this is the correct position.

The third argument is the unwillingness to face corruption in Ukrainian hospitals. Nominally, childbirth in Ukraine is free - and not only according to the Constitution, but also with the foundations of the medical reform that Ulyana Suprun's team began during the presidency of Poroshenko. The National Health Service of Ukraine compensates the funds for each delivery to hospitals.

However, almost every woman in childbirth in Ukraine was faced with insistent advice to pay this or that amount to the "hospital charity fund". So this is corruption. And attempts to fight it on their own sometimes end in a traumatic experience for women in labor.

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And yet, home birth is, first of all, the risk of losing a child. Due to the inability of unskilled adults to handle an infant, which can serve as the first and main argument against home birth.

Obstetrician from Kyiv maternity hospital No. 6 Natalia Yaremchuk in a commentary to Life.Pravda notes that women in labor who first decided to give birth at home, but then felt that they could not cope on their own, are brought to the hospital twice a month. “Fortunately, we have not lost women yet, but there were different things with children - both death and injury,” she states.

And here is a picture from America. In 2020, Reuters Health wrote about this. Researchers studied mortality rates within 30 days of the birth of children who were born at home and in a hospital (...). It was found that almost 14 newborns per 10 000 live births die after planned home births, which is four times more than babies born in hospitals. The same publication talks about infant mortality in the context of the professionalism of medical personnel. If the birth was attended by a certified midwife in a hospital setting, the loss was 3.27 children per 10,000 live births.

At the same time, American experts say, if you start giving birth at home, and then - already in the process - move to the hospital, the threat to the child's life increases even more.

The second argument against home birth is, in fact, the mother's life. A woman is lucky to have a home birth more often than a child, but powerful uterine bleeding is a phenomenon that kills in a matter of hours. And there is no way to replenish lost blood reserves by transfusion at home.

Doctors say that just like soldiers in the army are trained to follow orders in a strictly regulated time, they only have 15 minutes to minimize the threat in the event of a difficult birth. These 15 minutes include the removal of the child through a cesarean section, as well as preparing the woman in labor for anesthesia and surgery.

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The UK's National Health Service notes that 45 out of 100 women who had a baby at home ended up being hospitalized anyway. And the above-cited American College of Obstetrics and Gynecology writes that in the United States, the percentage of women who, after home birth, still go to doctors, ranges from 23 to 37%. The third argument "against" is directly related to the first two: even if a woman has all her dearest ones at home (father of the child, older children, close relatives), as well as a qualified midwife; even if the whole entourage matches the tastes of the woman in labor and creates a certain positive attitude (candles are burning or music is playing), this does not at all compensate for the absence of other important people or things.

Because a woman in childbirth may need not only obstetricians and gynecologists, she may also need resuscitators and neonatologists, as well as blood transfusion systems, epidural anesthesia, plus an operating room with all its instruments.

Finally, we note that the lowest infant and maternal mortality was recorded in the Netherlands (where, accordingly, is the highest percentage of home births). However, in this country, they study for 4 years as an obstetrician, and the ambulance is guaranteed to arrive at the call in 10 minutes.

In Ukrainian cities (including Kyiv), there is also a 10-minute time limit for an ambulance to arrive in the city and a 20-minute timetable outside the city. But there is no need to say that reality is different. As recently as January 30, in the Odesa region, a newborn baby died in the snow-covered village of Novi Shompoly. The ambulance, which was called to the woman in labor, got stuck in the snowdrifts, and the child choked with amniotic fluid.

So in the event of force majeure, doctors simply may not be in time. Although, of course, everyone chooses the degree of risk himself.

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