Pregnancy and childbirth are excessively medicalized in Romania
“Pregnancy is not a disease” – is the message of the Association of Independent Midwives of Romania, which initiated the project in Constanța and aims to improve services to pregnant women in Romania, the country with the highest maternal and infant mortality rate in the EU, where they die at birth 10 times more mothers than in Poland or Austria and 3 times more than in Bulgaria or Slovenia. Pregnancy and childbirth are excessively medicalized, even when there is no health problem. The breastfeeding rate is extremely low, routine cesarean sections are very high, and 25% of pregnant women never go to the doctor.
All this time, authorized midwives are marginalized by the medical system. In order to do their job and be present in individual hospitals and medical offices, offering free consultations and counseling, they need the settlement of services, an aspect still postponed by CNAS and the Ministry of Health. About birth myths, widespread in Romania, here.
About the operation of the Birth Center and its objectives, I talked to Irina Popescu, vice president of the Association of Independent Midwives in Romania and initiator of the project in Constanța.
Premiere in Romania: the midwife takes care of the normal pregnancy, and the doctor of emergencies and associated diseases
Irina Popescu: The birth center is a medical establishment where we find only midwives. The birth center can be inside or outside a hospital, ie an independent birth center. For Romania, we chose to start with a midwife center inside a maternity hospital. We take care of everything that means physiology, natural, prevention, surveillance, birth assistance. Midwives are also the ones who take care of the babies. This has not happened in any hospital in Romania so far, although it is within our competence. We no longer spoil, in any way, the holistic experience of the mother, so much labor, birth and meeting the baby, breastfeeding, attachment from the first period and the first days in the hospital.
Reporter: Maybe it would be good to mention that we are talking about authorized midwives who graduated from the Faculty of Medicine.
I.P: Exact. It is strictly about licensed midwives, medical graduates, specialists in the physiology of birth, pregnancy and the period after. We are neither competitors of doctors, nor of obstetric nurses or other specialties, but we want to do our part of maternal and child care, just to let the other specialists deal with the pathology and the necessary interventions. There is a collaboration between us. In principle, pregnancy is a period of health in a woman’s life. Exceptionally, in less than 15% of cases complications can occur, which we detect and solve together with the team of doctors. This means collaboration between midwives and doctors. Each one deals best with the piece on which he specializes, on the professional branch for which he was trained.
A midwife’s consultation takes an hour. Emotional issues are also addressed
Rep: So I stay on the team and work together. The doctor solves the emergencies, the complications, intervenes where necessary, and the midwife takes care of everything else, of all the natural, physiological part.
I.P: Yes. And prevention and counseling, education, emotional support in addition. A consultation with a pregnant midwife takes between 40 minutes and an hour. The consultations with the doctor are shorter because they cover all the levels that we deal with, but they solve some complications. When you have a low-risk pregnancy, as most do, you can have a pregnant woman to see for five minutes and have nothing to do with it.
Midwifery care decreases risk indicators in pregnancy
Rep: The model is not invented in Romania, but is taken from countries where assistance is provided by midwives.
I.P: Yes, and this model has shown a decrease in all risk indicators. Women have fewer interventions and a much higher degree of satisfaction. The success of breastfeeding is much greater. The risk of postnatal depression also decreases, through such a physiological and psychological approach of support and encouragement. It is complete medical safety. This type of midwifery care leads us to a third of our risk indicators. I mean, it’s down to two-thirds. It is a bit difficult to understand why there is no national directive to adopt this type of care, but this is exactly what we want to prove. We want to demonstrate what results are achieved in such a birthplace and why everyone civilized in Europe, all partner countries with us in the European Union, adopt or already rely on such facilities in hospitals or independently, next to them .
Marginalization of midwives in Romania: In order to do our job, we need contracts with CNAS
Rep: Can it be considered a kind of pilot project that will serve in other working groups? At the Ministry of Health there is a working group set up since the last term for the involvement of midwives. Then, the normative regulations to which Romania should align to clarify the status of the midwife.
I.P: To clarify the status of the midwife and to have this type of care settled by the National Insurance House. It is not normal. What we are doing now is an atypical thing. It doesn’t have to be the rule. It is a private space. We want midwives to be able to work in offices, in state outpatient clinics, in delivery rooms, according to our skills. The protocols for the healthy, physiological part, related to pregnancy and postpartum are something new for Romania. We have several types of protocols focused on interventions and problems, but no one has the coordination on the natural, on the healthy pregnancy. It is as if it does not even exist at this moment in Romania. We want to change the mentality of our mothers, of our colleagues, as if pregnancy and childbirth were pathological processes. Most of the time, I’m not.
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