Talking Point Czech mothers want greater say when it comes to childbirth

11-11-2008 16:42 | Ruth Fraňková

The Czech Republic boasts one of the lowest rates of prenatal and natal mortalities in the world, yet paradoxically, criticism of Czech maternity hospitals is growing. Mothers complain that doctors regard childbirth as a strictly medical procedure, forgetting that it is first and foremost a natural process and as such should be directed by the mothers themselves. Some mothers who have previously given birth at maternity hospitals are so dissatisfied with the experience that they opt to bring their second child into the world at home with the help of a certified midwife.

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Zuzana Štromerová, photo: www.pdcap.czZuzana Štromerová, photo: www.pdcap.cz Zuzana Štromerová, a certified midwife and advocate of home births, explains why:

“The problem is that mothers in the Czech Republic don’t have a free choice of the type of care they would like to have. And I am speaking about healthy mothers, because the Czech system is designed for ill people, for mothers who don’t experience physiological pregnancy and birth. But they are in the minority. The majority of women are healthy women who can give birth without any intervention. The problem is that hospitals are designed for treatment, they intervene a lot and don’t listen to mothers who regard birth as a natural experience, as a family experience.”

What exactly do mothers, who are not happy with the current hospital care, demand?

Michal HalaškaMichal Halaška “They want the hospital staff to explain everything that is going to happen to them in simple terms that any mother would understand. They want to be regarded as a partner and not as a person who is manipulated. They wish to experience the birth without unnecessary medical interventions. The also want to choose their birthing position but their strongest wish is: don’t take the baby away from me. That is quite a common practice in Czech hospitals that the paediatrician will check the baby immediately after the birth, interrupting the birthing process.”

Czech obstetricians admit that some interventions may be unnecessary, but argue that they are taken in order to reduce the risks during delivery. Michal Halaška is the head obstetrician at the Bulovka hospital in Prague.

“I started my career in the 1970s at the oldest and biggest department of obstetrics and gynaecology in central Europe, which was the first on the continent to introduce a continuous observation of the foetus in almost a hundred percent of cases. We were used to saving the baby and the mother. I admit it was connected with a lot of monitoring which may not be necessary but on the other hand we have significantly lowered the rate of prenatal and maternal mortality.”

Czech mothers do have a choice: giving birth at home is not illegal. However, the Czech association of obstetricians and gynaecologists remains extremely critical towards home births, arguing that the risks involved are far too great to be undertaken.

“The delivery is a natural process but it could change into a major complication threatening the lives of both the mother and the child. The time reserve is in some cases a matter of seconds and we cannot bring the woman from her home to the hospital in time.”

According to Mr. Halaška, doctors can never say beforehand how the delivery will proceed and unexpected complications can arise even in the case of healthy mothers. Can midwives cope with such an emergency? Zuzana Štromerová says they can:

“The majority of complications that arise during natural childbirth announce themselves well in advance. Only seldom does it happen from one minute to the next. Transportation to the hospital is the usual solution in such cases. For instance, if the baby is not doing well, its heartbeat has slowed, I evaluate how far in the birthing process we are. If it isn’t possible to deliver the baby in let us say five minutes, I wouldn’t wait and I would transport the mother to the hospital.”

Despite the ongoing debate, Mrs Štromerová admits that Czech hospitals have changed for the better over the years, allowing the mothers more freedom of choice. But, she says, these changes are not happening fast enough. One solution to the problem could be a compromise between home and hospital birth, an alternative birth centre in the hospital led by midwifes - something Mrs Štromerová has been striving for for many years.

“This would be the best solution. If it was in the hospital, not attended by doctors, the midwives would provide certified care but at the same time there would be no transportation necessary in the event of an emergency because the hospital would be at hand. But the Czech system is somehow not able to incorporate this type of care into the system.”

The country is currently going through a baby boom, with the 1970s generation in their 30s. This generation of women is much better informed and they are ready to assert their rights. Karolína Vančurová, a mother of three, says she started thinking about “an alternative delivery” because of the way doctors treated her when she even mentioned the idea of home birth. That’s when she started to look for information:

“Until then I was under the impression that giving birth was something scary or dangerous and something I am in the deepest sense afraid of. I started to work on that fear to get over it. I started believing that delivery was not something to be afraid of and I decided this was the way I wanted to go. I didn’t want to arrive at the hospital and let the doctors direct me how to give birth. I wanted to observe myself and my body and, with the help of the birth assistant or the midwife, give birth to my child myself.”

Have you though about the risks?

“I came to the conclusion that the risks presented to mothers who want to give birth by themselves, are often exaggerated and I believe the birth assistants or midwives who say there would be enough time to get to the hospital in case there was a problem during the delivery.”

Incidentally, the midwife who assisted Karolina at her first delivery was Zuzana Štromerová. The birth did not proceed fast enough and they chose to go to the hospital in the end, where a healthy boy was born. With her next two kids, she decided to give birth in hospital. Does it mean that delivering her first child at home was not a good decision?

“I think that my decision to give birth at home in that kind of atmosphere, in that kind of war between the doctors and the midwives, was not a good idea. But I am sure now that there are things that have to change in the hospitals so that mothers who want to give birth naturally and have their own demands on how to give birth are given the possibility.”

This is something that many doctors and midwives agree on but bringing it about may take years. For the present time mothers-to-be have to do some investigative work and use the local grapevine to find out what sort of care is provided at what facility, in order to make an optimal choice. However with maternity wards currently bursting at the seams they are often forced to compromise. Despite their feelings, only a tiny percentage of pregnant women opt for a home birth.

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