The quality of maternity care services must be radically changed because the present hospital environment is inadequate, corruption in various forms is no secret, incompetence and culture of communication may affect further physical and mental health of mother and child. This was stated by participants of a discussion held at Ukraine Crisis Media Center, devoted to the problems highlighted in Olena Solodovnikova’s documentary “Give birth in proper conditions”.
Olena made the film when she herself got to a maternity hospital and faced all the problems. “The purpose of the film is to take the opportunity to see the inside of Ukrainian medical system. It is not only about maternity hospitals, but about our entire medical system,” she said. Olena does not consider the film to be investigative journalism, because, according to her, everything she was able to capture is no secret to anyone, she only disclosed the problem. “By the way, this was not a hidden camera. If people behave this way, knowing that they are videotaped, they are likely to believe that this is normal. There must be even worse cases because this film is about what takes place in central maternity hospitals in Kyiv,” she said. The response from the public was different: some people commented that they had gone through the same thing; some said that the author deliberately exaggerates. There were even those who considered this situation quite normal.
Often a woman is not explained what and why they are going to do to her, and is not asked for consent to certain medical actions such as oxytocin treatment or amniotomy, said Hanna Petrovska, activist of the NGO “Natural rights”. According to a survey conducted by this and partner organizations, 40% of patients were not asked for consent to amniotomy.
“When I saw this film, I was very happy, because finally we began to talk about it openly, that Olena dared to do what I wanted to do long ago – tell everyone,” says Larysa Kolodiazhna, obstetrician, doctor of the first category. She has been working in this area for 43 years. According to her, Ukraine has an excessively high number of consultations for expectant mothers and analyses you have to take, although under the protocol it is not necessarily. In Spain, a woman undergoes a medical examination only 4 times, performs analyses several times less, and has the rest of analyses made, only when indicated. The reason is simple – in Ukraine, analyses are usually made in private laboratories. The analyses are paid, and doctors cash in on this. According to her, there are people who wish to change the system, but there are also many of those who are quite satisfied with this situation. The worst result of excessive control and interference, says Larysa Kolodiazhna, is that a woman loses her faith in her ability to give birth easily and safely with little medical intervention.
Impressions of such communication with doctors may leave their marks on further psychological health of a mother and child, warns Daria Pohylevych, perinatal psychologist. “This is a period when both a mother and a child are the most vulnerable. Though this fact is known to everybody, the medical system demonstrates quite the opposite attitude. And then we have a large percentage of postpartum depression, which is not even diagnosed. (…) A mother who is going through many traumatic events, then is unable to be emotionally sensitive to her child,” she stressed. According to Iryna Sitkarova, child and family psychologist, psychotherapist, often the problems that people complain of are correlated with a childbirth history. Because of the childbirth problems the child will possibly suffer from hyperprotection by relatives that will harm his normal development in the future. Microtraumas received during labor may partly affect his attention and thinking in the early school age.
The first-priority task is to raise awareness of women about what and how they should do so that they are on firm ground and consciously refuse analyses and procedures that go beyond the protocols. It is important that doctors should also change their attitude. “Show respect for women by shutting the door during the examination does not require any money… There should be a dialogue with the Ministry of Healthcare and those doctors who want to change the situation and by joint efforts to change the very psychology of obstetricians,” emphasized Hanna Petrovska. According to the activists, the main thing is that women should not to believe the myths, should read protocols, and by no means perceive their condition as a “disease”.
According to the panelists, the medical reform, in particular, even if the principle “money follows the patient” improves the situation, will be a difficult and long process. But, according to Larysa Kolodiazhna, competition between hospitals will become the best incentive for them to make changes.