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More on birth in Croatia

Continuing the story from Croatia, as emailed to me by Vedrana:

Concerning birth, in more detail, we organized the petition entitled “My Childbirth, My Body, My Choice” in 2002, with which we tried to improve conditions in Croatian maternity hospitals and to bring the standard procedures performed in normal birth closer to the WHO recommendations.

This petition demanded from the Croatian Ministry of Health that:

* All women in Croatian maternity hospitals be allowed to be accompanied by a close person during normal labour.

* Routine shaving and enema be abandoned and be performed only at the woman’s request.

* Guidelines for normal birth be made, which would accept the WHO recommendations stated in "Care in normal birth: a practical guide".

* Statistical reports about medical interventions and conditions in different maternity hospitals be publicly available, so that pregnant women can choose the hospital in which they want to give birth.

These requirements were made according to the WHO document “Care in Normal Birth: a practical guide”. A total of 8931 people have signed the petition. There was some correspondence with WHO and FIGO, and FIGO recommended that Parents in Action (RODA) go into a discussion with our local health authorities, i.e. HDPM (Croatian Association for Perinatal Medicine). We did so, and in May 2003 a working group was formed, including members of HDPM, Ministry of Health and RODA. We were very happy with what promised to be a fruitful co-operation. The goals of this working group, agreed by all parties, were:

* to prepare a questionnaire for women, which they would fill in after the birth. The intent of this questionnaire was to gather information about childbirth conditions in Croatia, including the quality of preparing for birth, the support during and after birth, and the satisfaction with the medical staff and conditions in the maternity hospital. Information was to be used as the basis for various activities for humanizing birth in Croatia,

* to prepare a standardized birth plan, customized to conditions in Croatia. The recommendation was that women fill it in during their last trimester, with help from their gynaecologists, if needed, and

* to create guidelines for normal birth.

Six meetings of the working group were held in over one year and, by March 2004, the working group had prepared a birth plan and the questionnaire. The birth plan takes into consideration the specifics of the Croatian health system, encourages women to seek information and encourages co-operation with the gynaecologist. The questionnaire that the working group prepared was taken for an analysis to an agency for market research, which confirmed that it is professionally made and that it assures qualitative research on this segment. Concerning guidelines for normal birth, it was agreed that they will be based on the WHO document “Care in Normal Birth: A Practical Guide” and adapted to conditions in Croatia.

The working group reported about its work to the managing board of HDPM in March 2004, in order to get an approval on the work accomplished, before going on to creating guidelines for normal birth. The only agreement made after the report was filed was that the managing board would discuss the birth plan and the questionnaire at their next meeting. All official correspondence ceased after that. We have officially requested information on the status of the matter, but have received no response. We have been waiting for more than nine months now for HDPM's official statement about those documents.

We have tried to change this completely inadequate routine treatment and create a freedom-of-choice atmosphere with our petition and, later, with our co-operation with HDPM, but very few changes have taken place since 2002. Those changes that did take place were mostly because of individual initiatives of a few gynaecologists and neonatologists in hospitals in which they work. The co-operation with HDPM is now stalled and practically non-existent. The co-operation with the organization of midwives is great, but they do not have much influence and are, in many cases, afraid to speak up because they are afraid that they might lose their jobs. The perinatal mortality rate of 6.3 per thousand births in Croatia (for 2003) proves that care in complicated births is of high quality, given the circumstances, but the problem of care in normal birth remains and it has proved to be extremely hard to accomplish improvements in that area.

Much of what Vedrana has written will be familiar to readers - her struggle is similar to many that are going on around the world. If anyone would like to contact Vedrana, please email me and I will pass on you message. I can be reached at: andrea@birthinternational.com.

Posted by andrea at May 27, 2005 08:34 AM