Birth policy in Romania

Whys and wherefores of childbirth in today's Romania

Luiza Moldovan, 21.10.2020, 14:00

We got
used to Romania being included in EU classifications compiled according to all
sorts of negative records. A recent Eurostat statistics has revealed that since
late 2019, Romania has hit yet another dismal record: at the level of the EU,
our country is second only to Cyprus in terms of reported births by caesarian
section. 60% of the children who are born in Romania are being born by caesarian section. We recall that during Ceausescu’s regime, the percentage of births by caesarian section was insignificant, yet the percentage began to increase gradually after
1990s. The big private clinics encourage the procedure, since it is expensive
and brings in a lot of money to the medical establishment. Also, births by
caesarian section are extensively performed in state-run hospitals. Do mothers
run away from natural birth, demanding that they give birth by caesarian section, or is the procedure medically imposed?

Qualified midwife Irina
Mateescu attempts an answer to this question:

I do not think they avoid giving birth naturally, I
think they run away from today’s image of natural birth, which is slightly
traumatic. There are all sorts of stories, speaking about accelerating the
labor pains, of women who had a fallout with the medical staff or who are being
addressed in a rude manner by part of the medical staff, the birth-giving pose is atypical,
it is antigravitational, what with the fact that it is so difficult to give
birth in that pose. In quite a few hospitals, the general anesthesia is not
available, it is not administered free of charge, and then, perhaps, women find
a reason for themselves to avoid being treated disrespectfully, to run away
from pain, to escape the lack of empathy. In our country, there is a phony
medical reason, to a great extent, for which we have so high a percentage of
caesarian births, which has nothing to do with women’s demand of that. Let me stress that
once again, there is a tremendous percentage of caesarian births imposed by the
physician, and nor asked for by women.

Obstetrician
Brandusa Mitroi also emphasized the mother’s fear of the unknown as well as her
age:

For their most part, the reasons are predominantly medical, since women
tend to give birth later in life, and with that, all sorts of complications
occur, among which gestational diabetes or high blood pressure. Also, there are
cases when complications occur during the labor pains. At this point, we need
to act under emergency conditions. Reasons of a maternal nature pertain to her
choice, which stem from the fear of the unknown, and, oftentimes, from the lack
of information. As for the medical reasons
they could stem from malpractice, which has been growing, and yet, what
we need to pay heed to is the fact that, for the medical doctor, opting for a caesarian surgical operation is not the easiest procedure, since the medical community
unanimously has admitted to a higher rate of complications in this case.

There
were times when midwives used to play a key role in the process of giving
birth, but things are not the same these days, at least with us. Midwifery
faculties have been dismantled, and midwives have been in short supply ever
since. Unfortunately, Romania does not use its midwives to the best of their
abilities, although they are in short supply in medical institutions. Who
stands to lose because of that ?

Irina Mateescu:

The role midwives have to play remains crucial, while
the prevention and the monitoring we can have at national level regarding
midwives can give a boost to some of the healthcare indicators, at once
bringing other such indicators to a low level of risk, but there’s not enough
of us to that end either. All told, there is less than 1,000 of us who practice
their profession and who are members of the Order of Trained Nurses and
Midwives, while the rest of us, needed to complete the required number of
12,000 midwives, still needs to do their training. If faculties do not open
once again, practically, this lever is denied altogether. At the moment,
midwives play a very small part in the whole prenatal process because we are
not wanted, we are not active according to our skills, they dismantled the
faculties (as we speak, training as a midwife is almost impossible, if you want
to set about going to the university you have nowhere to go to any more,
because, of the nine university centers, barely one has remained operational),
we’re speaking about a market, which at the moment is oversupplied by
physicians specializing as obstetricians, neonatologists who grabbed this
field, that of midwives, for themselves, for which they are not trained at all.
85% of the pregnancies could be attended to by midwives.

In
Romania, giving birth by caesarian section has been gaining ground to such an extent
that a handful of people are doomed to failure in their bid to change this
mentality. We tend to forget that birth is part of life, we forgot that nature
supports us, it is not our enemy.

Brandusa Mitroi:

How can we change that? Bearing in mind that birth is part of life. In
most of the cases, nature does not fail, enabling each and every woman to give
birth to that one child she can safely bring to this world. How can we improve
that? Attending prenatal courses, demanding, if possible, the presence of the
father for the birth process, or the epidural analgesia.

Irina Mateescu:

As a solution, from my point of view, we need to separate ourselves from
the Order of Trained Nurses, so that our profession can be properly represented
among the medical staff on call. The fact that there is someone who assists us
while we’re giving birth, that is a typically Romanian abnormality, as for the
women, they gave loads of credit to the physician regarding emotional security.
A physician who is exhausted after his on-call shift or who has recently
descended from a birthday party, they are in no way efficient as they intend to
assist you while you’re giving birth. The most efficient one is the one who is
on call, the one who is sufficiently rested, the one who is available. And at
this point, there is a recommendation to operate according to a set of
protocols. There are guides that must be turned into protocols and practices
based on evidence in every hospital, meaning that specialist care for the
well-being of the mother and child needs to be based on uniformity, it must be
standardized, so that it can be implemented all over the country.

There
is one more problem, a major one, in maternities all over Romania, that of
separating the infant from the mother immediately after she or he were born. For
the newborn, such a treatment is brutal, and for the mother, emotionally
devastating. When will a solution to that problem be found, from a midwife’s
point of view?

Irina Mateescu:

When midwives become active
and when the number of pregnancies we can supervise is growing, when we’re
allowed to support women during labor and childbirth, when we can take care of
the mother and child together, afterwards, without separating newborns from
their mothers. Healthy mothers and newborns are allowed to be together, they
are quickly discharged from hospital, and then are monitored while at home. As
for the midwives, they have no problem doing that. The thing is for us to be
allowed to work in our country as well.

(Translation by Eugen Nasta)