Charis Around The World

Birth Houses in Ukraine
Shared by Charis student Anne Sokol who lives in Ukraine with her husband, Vitaliy
and their two precious little girls, Victoria and Skyla.

In Ukraine, women give birth in a “birthhouse.” These are located regionally, and unless she makes other plans, she will birth in the birthhouse in her region. Only births are in this building. For prenatal care, she visits her local clinic. The staff are also separate, so whereas in the States, we have an ob/gyn,  in Ukraine the prenatal/women’s health care doctor is called a gynecologist, not an obstetrician.

Birthhouses in Ukraine are run by the government. They are not private and do not have insurance programs. While we may think this is great initially, it’s actually not better as a system. Women have very little to no say about how they are treated and what is done to them. Informed consent is not an issue here. The staff mostly just does as they like.

Some women make private arrangements with an ob before her birth. She pays him to have a good experience and care, perhaps to have her husband present (very rare here), and maybe for some other agreements. Paying the staff, too, is also helpful to how she will be treated. Sometimes the nurses and other staff will withhold things unless they are paid.

Aside from other birthing women and the staff, women usually birth alone. Family members aren’t allowed. Husbands are if they pay and make arrangements beforehand. Outside the birthhouses in some places you will see lots of graffiti on surrounding walls where husbands have spray-painted messages for their wives to see through the windows. By law (passed in 1996), a woman is allowed to birth how she wants, with whomever she wants, etc. But this law has no influence in birthhouses. If a woman tries to site this law, she is just told that she can then birth somewhere else if she doesn’t want to comply.

One of the effects of Communism is control issues. Very often here, in various settings, the issue is control. An official gives you problems because he wants to show you who is in control. It happens the same in birthhouses. The staff is in control. There are no niceness regulations. Good births happen. But they don’t happen because of the system, rather in spite of it. I have heard stories of demeaning and even cruel treatment.

Accountability is a problem. In America, insurance is a means of accountability, though it’s not perfect. Here, if there is a bad outcome, the birthhouse staff will find a way to cover it. For example, the baby of an acquaintance died in a birthhouse. The staff destroyed her hospital records and wrote that she had birthed at home.

These days there seem to be many c-sections. There are also regulations regarding them. For example, a woman is allowed to only have three c-sections. During the third one, her tubes are tied. Also, while there is a slim chance she can find a doctor who will help her have a VBAC, by regulation, VBAC’s are not allowed.

There are two birthhouses in Ukraine who have conformed themselves to WHO’s Baby-Friendly standards and hold that title. They are in Zhytomyr and Lvov. (I have personally sent several friends there; they allow VBACs, which is rare, don’t separate mom and baby, encourage dad’s presence, and don’t even have birthing tables.)

I am, however, sympathetic with birthhouse staff in some regards. They are horribly underpaid. So the fact that they take money from their patients in a country where health care is supposedly free is understandable. But it’s sad that money can be the deciding factor on how they treat a woman. It isn’t always so, but often.

Another way I sympathize with birthhouse staff is that they are often understaffed. One or two people may be left to care for a room of birthing women. Attentive care is almost impossible to give in these circumstances.

Some practices that concern me are the use of catgut to suture a c-section; routine enemas; also, I don’t know what an episiotomy is here. If a woman has one, she literally cannot sit for at least a month. She has to lie or stand. Some also perpetuate the idea that a woman needs to pump her breasts after she feeds to get all the milk out so it won’t spoil and the baby drink spoiled milk the next feeding. There are many other such nuances. I don’t know how prevalent this is, but one main birthhouse in Kiev routinely uses Cytotec to induce labor without the women even knowing. They do this illegally and don’t chart it.

One thing I do like about Ukraine is their liberal use of herbs. Their pharmacies are full of herbs. They also have “alternative” ideas about health and medicine. In other ways, they are very medical and invasive. And the more influence they have from Western countries, the more they become technological and drug-medicine oriented. On the one hand, ultrasound is common. On the other hand, they use wooden Pinard Horns to listen to the baby’s heartbeat.

Homebirth midwifery does exist in Ukraine. These midwives mostly just conduct childbirth preparation classes then attend the birth. They do not offer prenatal care. Their skill level and equipment vary. This profession is basically illegal. Usually, a homebirth midwife has a secret arrangement with a doctor, so if there is trouble she can call the doctor to come to the house. Or if she sees a problem coming, she can send the couple to the birthhouse during labor, and they just say that they were trying to birth by themselves at home.

Childbirth in Ukraine is ripe for change. Freedom, openness to new ideas, and learning about birth in other cultures are key ways that Ukraine is being affected. On many fronts there is much to do. I want to be a leader in this, Lord willing, so changes are positive and God gets glory. Pray that God will use me in this respect.

These are photos of a big birth house in Kiev, the capitol city.


There is one large room with lots of beds where women labor.

When the woman is ready to push the baby out, she’s brought into this delivery room.
This hospital had two birthing rooms.

This particular birth house had one “family” room where the husband and wife could birth together and note the bassinet for the baby included in the room. The labor/delivery table was in this room, too, the now-somewhat-old-fashioned kind with stirrups. This lady is the head of the nursing staff at this birth house. It was she and the  anesthesiologist who gave us the tour and had tea with us.

I believe this is the c-section room.
 

Two pictures of the Neonatal Intensive Care Unit (NICU)

Victoria, Anne, Vitaliy and Skyla  Sokol