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Changing childbirth in Croatia

I have received the following email from Vedrana Valcic of “RODA” a group of parents and midwives who have banded together to try and bring about reform of maternity services in Croatia. She had agreed to her email being included in this Diary, and I will reproduce it in two parts, as t is very long. This first section describes the current scene in Croation maternity hospitals and the next installment will cover the actions that RODA are taking to encourage some changes.

"I am a keen reader of your diary and the Birth International web pages. I am writing to you from Croatia, a country where birth is very medicalised, run by obstetricians, midwives only have secondary education, patients' rights are ignored in most cases when it comes to birth, breastfeeding rates are pretty low (around 30% of exclusively breastfed children at 6 months), a situation which is pretty close to the one in Italy, which is our neighbouring country. I should also mention that the International Code of Marketing Breastfeeding Substitutes is being violated in the whole country. I am also a member of an NGO called "RODA", which is short for "Parents in Action" ("RODitelji u Akciji" in Croatian), which has been fighting (among other things) for a possibility of birth without interventions, as well as lobbying for higher education for midwives. RODA is also a member of IBFAN. We have a good cooperation with the organization of midwives, whose web site we helped to build (www.udrugaprimalja.hr). You might also want to check our web site at www.roda.hr. Both sites are mostly in Croatian, I’m afraid.

This is the situation today in the majority of Croatian maternity hospitals. Women are still routinely shaved in normal births and given enema. In the first stage of normal labour, there is constant electronic fetal monitoring and women spend this time bedridden in most hospitals. Delivery is mostly in the supine position. It is practically impossible for a woman in labour to refuse these and other procedures. Non-pharmacological methods of pain relief, such as showering, massage, relaxation and breathing methods are rarely used. In addition, early amniotomy and oxytocin infusion are a common routine. Episiotomy rate is slightly reduced, but only in few of the hospitals, and overall it is still between 50% and 60%. There is usually an attempt to accelerate the normal birth process using all of these procedures, including fundal pressure during the second stage of labour. It is extremely hard for women giving normal birth in Croatia to make decisions about their labour because they are being denied their right to an informed choice. Even when women have presented a birth plan, their decisions and wishes are neglected or it is hard to get the medical personnel to comply with them, even when the labour is progressing normally.

This negative atmosphere for women who wish to have expectant management of their labour is even more emphasized with the fact that in 17 of total 36 maternity hospitals the women are still not allowed to be accompanied by a close person. Out of the 19 maternity hospitals which allow the attendance of a close person, in five there is a prerequisite of attending an educational course while in another four an approval of a physician in charge is required. Furthermore, it is an exception, more than a rule, that a baby is with her mother in the critical period after birth – they are usually separated for at least two hours after birth and bonding is rarely encouraged".

In my next entry I will include the actions that RODA are undertaking. Vedrana is looking for ideas and input from other around the world and is keen to network with other groups and midwives who might have ideas for her. I have already given her some ideas and we are talking about various possibilities for improving education and networking. I have suggested that she join the ozmidwifery email list and read what other midwives/women are doing not only for ideas but also to gain some support.

Posted by andrea at May 25, 2005 09:05 PM