In the hospital, you are guaranteed privacy, you are accompanied by your husband, brother or friend. You don’t pay for it. You also get free anesthesia, so you give birth to your baby with a smile on your face. And right after birth, it goes to your belly and spends two hours on it. It’s a theory. The truth is different. It was just revealed by the Supreme Audit Office’s report on Polish delivery rooms.
A few years ago, we introduced modern standards of perinatal care in Poland. They guarantee women giving birth in intimate conditions, in a convenient position, in the presence of a designated person. Puncture of the fetal bladder or episiotomy should not be used routinely, but only when necessary. And immediately after birth, the baby must be placed on its mother’s stomach for at least 2 hours. That’s what the rules say. Unfortunately, women still give birth separated by screens and the staff will not allow them to change positions. There are delivery wards where doctors are on duty for up to six days without interruption, and you have to pay for the presence of the closest person.
Intimacy behind the screen
In 21 out of 29 maternity wards inspected by the Supreme Audit Office (NIK), giving birth and newborns were not provided with the possibility of using rooms that meet all the requirements specified in the regulations. There are still many rooms in hospitals, where the delivery beds are separated only by screens. In 12 inspected departments, the postnatal rooms were not even equipped with toilets and the patients had to use the generally accessible ones. In 1/3 of the controlled delivery facilities, delivery centers were organized in such a way that when the door was opened, outsiders could see the patient in an intimate situation. For example, in the Polish Mother’s Memorial Hospital – Research Institute in Łódź, women in delivery rooms could be seen from the corridor, through the windows of both maternity clinics.
The standard enabling the delivery of a delivery woman to be convenient for the delivery position was also not respected. While the patients in the first phase were able to move and change position, 90% of the delivery itself took place in the delivery bed, and in 93% – in the supine position. NIK also pointed out that family childbirth is one of the benefits provided for in the Act on Patients’ Rights. According to these regulations, a close person may be present when healthcare services are provided. However, there were hospitals where fees for family childbirth were collected contrary to the regulations.
All under the knife
An episiotomy in labor is still a routine activity in many wards, but should only be performed when absolutely necessary. The NIK audit shows that they are done in about 60% of patients, while, for example, in Sweden in 9,7%, in New Zealand in 11%, in Great Britain and Denmark in 12%, and in the USA in 33%.
NIK also stated that nearly half of the patients were given oxytocin to stimulate labor, and that the fetal bladder was punctured in 17% of the patients. Only in three departments all activities required by the Regulation on the standards of perinatal care were performed and documented. Most often, there was no confirmation of the child’s position on the mother’s belly, the so-called the newborn’s first skin-to-skin contact, which should begin immediately after birth and last continuously for at least two hours.
According to the questionnaires carried out among the giving birth, although 90% of them had skin-to-skin contact with the baby immediately after birth, only 11% admitted that it lasted as long as the regulations provided for, ie two hours. As many as 63% said it was less than 30 minutes.
151 hours without rest
Obstetrics departments inspected by the Supreme Audit Office did not provide patients and newborns with the quality of healthcare required by law. Doctors working in maternity wards were overworked, some were on duty continuously for up to 6 days. It is difficult to expect such a tired employee to make the right decisions quickly, especially at four in the morning. In 17 hospitals, the continuous working time of individual doctors ranged from 31,5 to 151 hours. For example, in the Obstetrics and Gynecology Department of the Bytów County Hospital, the Supreme Audit Office found that during the controlled period as many as seven doctors worked from 31 to 151 hours without rest. According to the explanations of the director of the facility, the main reason was the long distances that gynecologists traveled to get to work and therefore they did not want to commute single shifts for economic and logistical reasons.
Having only one anaesthesiologist on duty in many wards, sometimes even absent from the hospital, but only on call, made it impossible to perform an immediate caesarean section. Also, due to the lack of an appropriate number of anaesthesiologists in obstetric wards, mainly due to the small number of deliveries, especially in “district” hospitals, in 20 inspected maternity wards, epidural anesthesia was not used for vaginal deliveries.
Empress on demand
Still a problem in our delivery rooms is too many cesarean sections compared to other countries. In the audited hospitals their percentage increased from 40% in 2010 to almost 50% in 2015. There are even hospitals where it is 78%. According to WHO data, the cesarean section rate in Poland was one of the highest in Europe, with an average of 25%. Heads of wards explain that this is primarily due to the pressure of women and accompanying persons, as well as doctors’ fear of the unsuccessful natural delivery process. Doubts of the Supreme Audit Office are raised by the reliability of instructions, which are read to the patient before giving “informed” consent to this procedure. There is a lack of information about its harmfulness to the health of the child. Meanwhile, studies show that Caesarean delivery increases the risk of asthma twice as compared to the natural risk. Babies born through cesarean are also more likely to be overweight and obese in the future. During natural childbirth, there is also a very important contact of the baby with the mother’s bacterial flora, which is the first natural vaccine in his life. Specialists also believe that a caesarean section can change the structure of the baby’s DNA, which will result in more frequent immune diseases such as diabetes, cancer, asthma, and allergies. One factor that causes changes to the genetic code is the stress level at birth. In physiological delivery, stress increases gradually, and during cesarean delivery, the newborn experiences a tremendous shock, possibly “reprogramming” the DNA. According to the World Federation of Gynecologists and Obstetricians, natural delivery is safer in the short and long term for both mother and baby.