Charis Around the World

Life In Ukraine
Anne Sokol

Baby Maria's Birth

As a doula, I just accompanied my first couple to a Ukrainian birth house for the birth of their second child. In some ways, it was beyond words, but I will try to write it out there.

First, I am so thankful to God for giving me the privilege, knowledge, desire, and ability to serve families in this niche of life. A birth that could’ve been a wretched, debilitating experience was turned into a special memory, though colored with a bit of horror.

Vitaliy and Natasha are the pastor and wife of our small church. They have been attending my birth preparation classes, and they asked me to be a doula for their birth. Doulas don’t really exist in Ukraine yet, but I hope that changes. I desire that even more earnestly after what I witnessed.

I first talked to Natasha about 7pm Tuesday night. I called her to tell her not to go into labor yet because I didn’t have my nasal streptococcus test results back yet (birth houses require a chest x-ray (checking for active TB) and a nasal swab test checking for streptococcus). Natasha told me that she had just been about to call me because she thinks she’s starting labor. I asked her to try a warm bath and see if things speed up or slow down.

At 9 pm, she calls me to say that contractions are about 15 seconds long but spacing farther and farther apart. Don’t come. . . She calls me back a little after 11pm that I need to come and we should go to the birth house.

Their birth is planned to take place in birth house #3 where, as a birth class, we had visited and asked lots of questions of the midwife. We felt fairly comfortable about what we were getting into.

When I get to Natasha’s house, I just spend about an hour or so with her, just watching, drinking tea, did some massage, a lot of talking about this and that. She’s having small contractions but they aren’t really too noticeable on the outside. I was hoping secretly that we do quite a bit of the labor at home, but after an hour, Natasha thought we should go. I doubted that we should go, but we talked about it, and she wanted to go because they needed to stop at a store and she wanted to get settled in. I decided to trust mom’s instincts, let her be in control, and I saw that she was set on this plan, so we needed to do it so she would be comfortable. But mentally, I prepare myself for a 12-hour labor in a Ukrainian birth house. It’s about 1am.

However, while we were walking down the stairs out to the car, she stopped during her contraction. We waited, then continued. Hmmmm. We went to a large store and walked around buying food for her birth house stay and lots of chocolate to give the birth house workers. She’s contracting, but still not too noticeable.

We drive to the birth house. It’s the dead of night, about 2:30 am. We go to one door with a light on beside it. Vitaliy talks to the lady thru the speaker---no, we need to go to the door on the right. There are two more doors to the right; Vitaliy tries them all, but we are always sent away saying we are at the wrong entrance. I’m with Natasha contracting in the parking lot. He goes back to the first door. Go to the RIGHT. We then understand that it’s the speaker’s right and our left. We go to the main, darkened entrance. Vitaliy knocks loudly repeatedly. Finally a lady comes and tells him to go around to the other side of the building (even farther “right.”)

We do and finally get in the right place. Two personnel meet us, check Natasha’s blood pressure, and we start hauling all our many bags up to the fifth floor where the birth rooms are. This birth house, like several here, are remodeled so that couples can labor and birth in one room by themselves. Each room has a birth ball, wide ladder, and a few other accoutrements.  Fifth floor. Yikes. We are greeted with unhappiness. Every birth room is full, they are running around, maxed out. They put us in an empty room with five beds in it and a sink. We start making ourselves at home a little. The building in general is very Soviet.  Concrete, dirty tiles, metal beds.

Natasha and I go to the bathroom—there is one toilet for all the birthing women and their partners. None of the toilets I saw there had seats on them. You squat on the rim or just hunch over without sitting. A small trash can is beside the nasty toilet where we throw out toilet paper (that we ourselves bring) and there are bloody things in there.

The doctor, a tight-lipped lady, checks Natasha. “We’ll have a baby soon,” is all she says. I ask how open she is. “6 centimeters. . . . We need to break your water.” Natasha isn’t sure she wants her water broken. But the doctor takes us all into another room with a small exam table with stirrups. Natasha puts down her chux pad—you buy your own and bring them all with you, also sterile gloves and any other medical supplies.

Natasha is still questioning the water breaking, and I see we don’t have much choice, so I say at 6 cm, it should be OK. She actually only breaks the outer bag, so only a tiny bit of water and blood came onto the chux pad. “We economize with these so take it back to the room with you,” the doctor says.

I’m starting to get the idea about sanitation. She’s on a metal bed with a mattress with some sheet thrown over it, and she lays on the chux pad, too.

The doctor gets out her paperwork and starts asking Natasha questions. Natasha is lying on the bed on her left side. I’m on my knees beside her talking to her and massaging her back when she wants it. She’s having harder contractions. The doctor asks her questions. Natasha tries to answer. “How much weight have you gained?” “17 kilograms.” (37 pounds) “Why did you gain so much weight?” . . . . And on it goes. We have music playing, aromatherapy scent, I’m talking/massaging Natasha through contractions (she liked hard pressure on the sacrum), and Vitaliy is sitting by her on the other side of the bed talking to the doctor. She asks about our religion and how we differ from Orthodox (the main religion here). They have a long conversation about that. I pray and talk and massage and contract with Natasha. Things were going so fast.

Natasha wants a drink. We had been told before that eating and drinking in labor was fine here. “No!” the doctor says immediately. “If she has to have general anesthesia, she might throw up.” When she leaves the room, we give Natasha a drink. Also, two things I had with me were very important to her. One, I had bought her clear lipstick for dry lips. She was ecstatic to have that. Second, she asked for something cold. I had brought a purse-sized cooler with me with two frozen water bottles in it. She loved holding that then drinking the water.

At some point the doctor checks Natasha again. She’s having hard, hard contractions, although not many—it all happens so quickly. Vitaliy and I stroke her face and talk to her during the checks. No information offered so I ask. “9 centimeters.” Soon Natasha tells me she felt like pushing a little. I say to wait another contraction or so to make sure. Two more contractions. “I’m pushing.”

I send Vitaliy to call the doctor who had just left. I tell her Natasha wants to push. They have a birth room cleared out, so we quickly move Natasha and all our stuff over there.

This next part is very hard for me to write about. I am crying.

Natasha is about to get on the bed and she asks a question about position. The midwife says—side or back. She wants someone behind her so I sit at the head of the bed. A crowd of about seven women circle the bed.

All of what I’m about to describe takes place in about six contractions—it’s fuzzy to me now. They tell her to push like she’s pooping. I’m holding her head and shoulders trying to help her breathe, telling her she’s great. During the contraction, the midwife is attacking her vagina, pushing it back and open and sort of digging out the baby’s head. It was so painful. Natasha was instinctively pushing away from her, so she was on my lap kind of falling off the bed.

The women around are all making horrible comments about what a bad job she is doing, that they’ve never seen anything like this, and how she needs to listen to them.

I get a clue. During contractions, I’m trying to help her breathe, but when I see that they don’t want me interfering with their “method,” I understand that trying to actually help Natasha birth normally is not the thing to do. They will just intentionally hurt her more and more if she tries to do anything other than what they say. Vitaliy is standing on the other side of the bed comforting her, too. I just stay in her ear, start telling her to push and breathe (it actually wasn’t really hard pushing), and I am just in shock at what I’m seeing. They mention her moving, that’s she’s getting off the bed. I think if we should position her differently. She says she’s fine and doesn’t want to move. I stay put.

The midwife keeps digging into her vagina at each contraction, and when the head comes out, she’s pulling on it up and down and all around and another lady next to me (who had deliberately stationed herself there at Natasha’s fundus) does fundal pressure at some point to get the baby out.

Sweet baby comes out and is put on Natasha’s chest (how modern) with a blanket over her. They start messing with the placenta, digging into Natasha’s uterus, tugging the cord, she’s crying out over and over at the pain. Placenta finally out.  Then comes the vaginal check with the doctor. Two silver shoe-horn-shaped things are put in either side of the vagina.

Natasha is in agony. I’m not positive, but I think the doctor pulls out the cervix to check it. Then she digs around the vagina. A tear has gone into the vagina (because she was behaving so badly, they say). I am in shock, but just stick with comforting Natasha, telling her she’s great, stroking her face, describing to her what the doctor is doing exactly so she feels better.

She needs stitches. She asks for a shot of numbing stuff. They give her Novocain because she didn’t think to buy her own anesthetic---they don’t normally use that anymore they explain.

The doctor intends to stitch right away after the shot. Natasha asks her to wait a bit so the place will numb. She waits a few minutes. Natasha feels the stitching. Four stitches. I talk her thru each one because she feels all the pain but doesn’t see what it’s from. ‘She’s putting another stitch in. . . Now she’s tying it . . . Now she’s cutting the thread.” I keep telling her how great she is. We are enjoying the baby.  Vitaliy is being a rock.

After they all left, Natasha was still in her bloody chux, fluid soaked night gown laying on the bed. The baby, Maria, had been born at 4:30 am. We had arrived on the fifth floor at 3:00.

I start talking some. I explained that I don’t want the workers to make her feel guilty for her birth, that they themselves behaved very badly, emotionally and medically. I talked a little about how dangerous it was what they did and that is was not normal or good. Ukraine is a culture of control and shame-motivation. I didn’t want them hurting my little family. I felt very protective of them. Once when the midwife came back in, she mentioned again how Natasha had torn because she’s behaved badly during the birth. They both looked at me. The midwife’s back was to me. I rolled my eyes and shook my head.

Vitaliy holding Maria in the birth room

The newborn table in the birth room.

When we’d visited before, the midwife we interviewed said we would be moved downstairs to the room where Natasha and the baby would stay two hours after the birth. We were together a long time in that birth room. About four hours. We talked. We talked a lot. We got through the shock of what they had done, we praised and thanked God for giving us such a fast birth. They both were so grateful for my presence. And you know, I made a difference. Having positive, on-your-side support during that experience made a world of difference for them, especially for Natasha. We made it into a happy memory. That 30 minutes of the 2nd and 3rd stages is hard to think about. But we talked about how great she had birthed, how fast, how beautiful and cute Maria is (and she is!!!). We made pictures. And they were together. Natasha breastfed a little and Vitaliy held his daughter a long time. They had an edifying experience together because a doula was there. I can imagine how horrible it could’ve been, and usually is, without any other trained support.

The family in the birth room.

About 8:30 (four hours after birth) we were moved downstairs, Natasha on a gurney. We settled her into a room with another lady/baby there. We took off her nasty nightgown, and I washed her bloody bra and socks. Things were much more peaceful here and everyone so much more pleasant. A nurse came and a pediatrician and explained certain things to do or not do. When I discovered no warm water in the nasty shower, I washed her off with a cool washcloth and she loved that. We stayed a long time, until noon or so. Made her comfortable, ate, helped her get up to the bathroom. She wanted to pee before we left, so she stood in the shower, and hot water had come by that time so we washed off her lower body.

We made more photos. We held the baby. Changed meconium diapers, rehashed more good and bad about the birth, but in this new place and with the baby there, bad things faded more. She breastfed more.

The family in the new room where Natasha and the baby will stay for a few days.

I drove home with Vitaliy and another couple who came to pick us up. We were analyzing the birth in the car, and the guy asked Vitaliy how he felt about it. He said he was just so sorry for his wife, to see her like that, knowing that if you try to intervene and protect her, they will just hurt her more. That about summed up the horrible part for me, too. But we made happy memories, too, and I think the happy memories combined with a precious baby outshine the evil.

After getting a little distance from this experience, I realize more and more things as I ponder what happened. The experience in the birth house reminds me of the movie, Anna and the King. I’ve watched and analyzed that movie several times, and it resonates deeply with me as a foreigner. It’s a story of culture clash. In small details and overarching philosophies, two opposing cultures mix and both edify and combust simultaneously.

I remember sitting on the bed holding Natahsa while she was pushing and the birth house workers were all yelling at her. I see now that we were trying to stand in two cultures, one was my culture of support and comfort during birth. The other was a system of shame and control and uncaring towards the mother. And in the clash of cultures there was both edification and combustion.

Sometimes I question if I was guilty. (Is it something like survivor’s guilt?) I ask myself, Did my presence somehow make her birth worse? Would it have been easier for her to endure this if I hadn’t been there? Would they not have treated her that way? Would she more easily have “pleased” them somehow?

It gives me greater understanding of home birth midwives and home birth advocates here. My friend Nadya is a dogmatic home birth advocate. But I’ve doubted her. She lives in a smaller town with few birth choices. Surely, I thought, in Kiev there are more modern ideas now. Several birth houses have been praised to me as being so great and changed and modern. This very birth house was praised to me over and over about how wonderful and modern it is, about how you can birth “in any position you want.” A man who works there told me I could birth “like in America” there. What are they thinking? . . . Now I understand Nadya.

I’m leaving soon to go talk to my next doula couple, also members of our church, who also went with us to visit this birth house before Natasha’s birth. The husband, Sergei, has already talked to Vitaliy. I have some things I want to say while it’s fresh, too. I know they won’t choose this birth house now, but another one? Will it be any different? Will we hear about how great it is, then have the same type of experience? Do they want to more seriously consider homebirth? What is my role in all of this?

I feel like this trauma, too, was worse for me than for Vitaliy or Natasha in some ways. Her pain was excruciating and the treatment terrible. But now Natasha has a beautiful baby to hold and friends and flowers. I feel like I’m left just with this terrible shock of what I saw and experienced and no new baby to distract me. Vitaliy witnessed it as I did, but even during the birth, I could tell he didn’t understand how dangerously and horribly they were conducting the birth. He didn’t know until later (when we processed the birth together) how bad it was. I’ve read a few times about terrible births like this but now I’ve seen and experienced it.

I spoke with a friend, (and former birth house doctor), about all I witnessed.  She validated that they were indeed pulling her cervix out to check it after the birth. She explained that all the vaginal and fetal manipulations, fundal pressure, cervix checking, etc., that I witnessed were normal for birth here in Ukraine and mandatory for the doctors to perform, even at the birth house.  It’s what they always do all over the country—it’s the written protocol from the Minister of Health.

In the end, I’m glad I’m a doula. I love it. I don’t enjoy seeing these things or being a part of them. But as a doula I made a huge difference in a family’s health and happiness. I can’t wait ‘til I’m a midwife and can help even more.

 Love, Anne Sokol

Victoria, Anne, Vitaliy and Skyla Sokol

Our International Charis Family
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