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The battle over birthing

The EC intervenes in a dispute pitting doctors against midwives

By Hilda Hoy
Staff Writer, The Prague Post
June 20th, 2007 issue

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Midwives are locking horns with the medical establishment over a law that bars them from working freely to deliver babies, and the European Commission (EC) is taking notice.
In developed countries, midwives are medical professionals, usually women, trained to provide prenatal care and assist women in childbirth. But a leading Czech midwife says she and her colleagues are being discriminated against, relegated to being mere doctors’ assistants and barred from operating birthing centers where they can provide autonomous care.
The EC issues directives regulating professions throughout the European Union, and the Czech Republic is breaching those rules, says Zuzana Štromerová, vice president of the Czech Confederation of Midwives.
“[The EC] says midwives are autonomous care providers,” she says. “Every country in the EU should ensure that midwives can work according to this directive.” In 2005, the confederation contacted the EC with its complaint. The two parties met this past April, and the EC has since sent a letter to the government asking for an explanation.
There are some 5,500 licensed midwives in the Czech Republic.
Štromerová opened the country’s first and only birthing center in 2005 and named it U Čápa, or At the Stork. Set in a quiet, residential area in Prague 4, the house boasts clean, cozy rooms for checkups and prenatal classes, and walls decorated with pictures of newborns delivered by the center’s three midwives.
Ironically, however, actual birthing is not allowed at the birthing center. Unless there’s an on-staff doctor and expensive equipment comparable to that in a hospital, the center won’t be licensed to perform births, the Health Ministry says.
“The term ‘safe birth’ entails adequate technical and personnel conditions,” says Health Ministry spokesman Tomáš Cikrt.
This leaves pregnant women with only two options: Give birth at home, either alone or with a midwife, or give birth in a hospital where midwives are secondary players.
Cold hospitals
Many of Štromerová’s clients complain of unpleasant experiences in hospitals. “They say it was a horrible experience. … They say, ‘Why should I have to go to a hospital, I’m not an ill person,’ ” she says. “Hospitals should not be factories for babies.”
The problem is manifold: harried and unfriendly staff, lack of support for drug-free birth and cold, clinical hospital policies that favor efficiency over family time.
Michal Halaška, an obstetrician at Prague’s Motol Hospital, acknowledges this. “Hospitals aren’t very nice sometimes. But I think we’re trying to improve this,” he says.
Still, safety should be the first concern, he insists. This means having equipment, facilities, obstetricians and anesthesiologists immediately on hand to account for any health complications.
“You can have a normal delivery and within three minutes the mother is dying, or the baby is dying. … You need to have a powerful hospital behind you,” he says. Choosing to do otherwise is “absolute nonsense.”
Clearly the Czech Republic has been doing something right, he says. National infant mortality rates are tied with Finland, Iceland and Norway as the second-lowest in the world.
But Štromerová says 80 percent to 85 percent of pregnant women could safely give birth outside of a hospital setting. The remaining women either have risky pregnancies or pre-existing health conditions, which, in the past, would likely have resulted in the death of either mother or baby, she says. In the worst-case scenario, U Čápa is within seven minutes of a hospital.
Parents should have the right to choose the birthing experience they want, says Václav Krpec, an expectant father who’s been attending prenatal classes at U Čápa with his wife, Ilona. They’re expecting their second child, a boy, in late June.
When their daughter was born two years ago, the hospital birth was less than ideal. They’d been hoping for a home birth this time, but when they were told their son has grown large, they decided they’d be more comfortable having doctors close by.
If there was an option in the middle, a birthing center that’s more comfortable than a hospital but better-equipped than home, they gladly would have taken it, Krpec says.   
“The typical birth at a hospital is not really a normal birth,” he says. “When you consider the issue of safety, most women don’t need any medication or special care. They’re able to deliver naturally.”
“It’s just bureaucracy” that’s kept medical policies here from keeping up with other parts of Europe, he says.
— Naďa Černá contributed to this report.

Hilda Hoy can be reached at hhoy@praguepost.com


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