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On Polish internet forums you can find chilling stories from delivery rooms. It is enough to talk to one of the friends who already have a child to find out that something was a special trauma for her. The birth plan thrown away, no anesthesia despite the explicit request, rudeness of the staff … Why do births in Poland often look bad? A gynecologist from one of the Polish cities anonymously reveals why this is the case. She also tells what was wrong with her childbirth in Poland.
- Some childbirth practices in Poland are not due to the malice of the staff. Often it is also a lack of appropriate competences or opportunities
- The staff attitude towards patients is a separate issue. And this, as our interlocutor admits, is not always right
- The gynecologist we are talking with is forced to give birth after two births. It was not a pleasant memory for her either. Due to the subject matter of the text, the doctor wants to remain anonymous
- More information can be found on the Onet homepage.
What is usually not said about pregnancy?
Agnieszka Mazur-Puchała, Medonet: Perhaps the most common complaint that I hear from women about pregnancy and childbirth in Poland is: “nobody told me about it”, “nobody talks about it”. What, in the eye of a gynecologist, is actually not talked about enough or not at all?
Well, there are really some of these things. I agree with that. In order not to look far, it is about pelvic (urogenital diaphragm) exercises before and after childbirth. So these muscles, connective tissue and ligaments through which (if the delivery was traumatic or difficult, and we didn’t exercise before and after) later we have problems with urinary incontinence. In fact, a pregnant woman should go to a pelvic therapist as a standard, who will examine her and show her how and when to exercise. Even then, because it will protect the pelvis to some extent. These exercises absolutely CANNOT be learned from the Internet. And after the delivery, a visit to a physiotherapist should be a standard, as well as visits by community nurses. Which, by the way, are weak. Not trained in current standards, based on knowledge acquired during studies, practice, and outdated. What they sometimes tell their patients is drama. Out of 100 postpartum patients who ran to my office with panic in their eyes, because the environmental midwife says something is wrong, maybe in 10 it was justified.
It is very unusual for a gynecologist, but I gave birth to the forces of nature. Twice. In our specialty, however, we usually do a cesarean section on request. I started rehabilitation immediately after the first and second birth. Here it is important that such a therapist has the right to examine through the vagina – you do not have to be afraid of it. On the contrary. She checks for muscle tone and any abnormalities. You go to two or three meetings, learn how to do exercises properly, and then do them yourself at home. And that will be crucial in 10 years. Urinary incontinence problems begin after 40 and childbirth without rehabilitation definitely worsens it.
The best test for urinary incontinence to be performed at least six months after childbirth is a springboard. If you feel like peeing while jumping, it’s a sign that your muscles are weak and need rehabilitation. And at this stage there is a good chance that a more advanced degree of this ailment will be avoided.
Pregnant women are not told that rehabilitation at this stage can reduce the hernia, i.e. the white line break. They are also not told that it is completely normal that the perineum is paralyzed after delivery. You don’t feel much then when it comes to urinating, stools. Even urinary incontinence may occur. They are terrified of it, and that’s perfectly normal. It will pass in a while.
And another very important issue these days – physical exercise. Women want to get back into their pre-pregnancy figure as soon as possible, they start exercising too quickly. And let’s work out how it should be – six weeks (both after natural delivery and cesarean section) none physical exertion. Just carrying a baby but baby and the carrier no longer. Pelvic rehabilitation, on the other hand, can already be started. What’s next? After six weeks, you can start gentle exercises: stabilization (so-called plank), stretching, slowly cardio. But exercises with higher loads are eliminated. And the most important: jogging at the earliest six months, and some physiotherapists recommend it only after a year. Unfortunately, running is exactly the activity that can have a very bad effect on the statics of the reproductive organ. However, walking up the stairs or the cross trainer is OK.
Childbirth – why does it look the way it looks? Why is it so hard to get anesthesia?
Since the vast majority of gynecologists decide to have a cesarean on request, is such a delivery better?
Honestly, there’s no good way to get your baby out of your belly. There isn’t. Both cutting and natural childbirth have their downsides. In the case of CC, I make my patients think about this solution, because if they want to have more than one child, it may be a problem. I read on forums that it is a kind of “zipper” making. Well, not really. In the case of cesarean section, apart from the fact that it is a surgical procedure with all possible surgical complications, we must also remember about the so-called long-term complications, e.g. about pregnancy in a caesarean scar. In the past, such situations were sporadic. And now, due to widespread CC births, the average has jumped up significantly. Unfortunately, such pregnancies have to be terminated. They have no chance to develop. Moreover, after CC, long-term complications may arise in future pregnancies. The placenta may misalign (ingrown, overgrown), adhesions may develop. A caesarean section scar may come loose during the next pregnancy, and may – fortunately very rarely – rupture the uterus in systolic activity. The uterine wall will never be there again as it was before the procedure. Let’s remember this.
There are women who are lucky and will not be affected by this problem. But for others, one cut is enough to make them walk bent in half for six months, and then have lower abdominal pain for 10 years. You can use anti-growth agents right away, but this is not popular in Poland at all. In addition, most hospitals do not agree to the use of these preparations, even if the patient brings them. It is understandable, but really such funds should simply be reimbursed (they are very expensive) and in stock in every hospital. To use them as a preventive measure after each cesarean section. But this is not the case in our country and it is a scandal. Women are simply supposed to bear children, and that is the ultimate goal.
There is also often no anesthesia during childbirth. In the West, the standard, and in our case, you have to ask, and it doesn’t always work.
And I will tell you what it means that there is often no chance of anesthesia in childbirth. Well, because of the lack of anesthesiologists. Although there must always be an anesthesiologist in stock, he is usually alone, which means that he is the one who takes care of all departments or procedures and simply cannot approach the woman in labor at the right moment. Because anesthesia can only be given up to a certain period of labor. Later, it is either impossible to physically, because the patient will not survive in the crouched position long enough, or the second stage of labor has begun and there is no point in administering anesthesia. Unless for crotch sewing. This is the problem, not the reluctance of the staff. Such a delivery actually takes a little longer, but midwives usually avoid anesthesia because of these staff shortages.
Sometimes they do it in such an ugly way: first they tell the patient asking for anesthesia that it is too early. The girl’s neck opens, opens … and we are 6 cm open. What does the midwife say then? “Too late!”. Few will say that there is no chance of anesthesia for staffing reasons. Instead, they use just such a maneuver.
I am reminded of my birth plan. It was supposed to be in the water, the midwives said it was clear, no problem. And then they said there was no time.
I thought that I would give birth in the knee-elbow position, but when it came to what happened, when I started to contract, I was not able to assume this position. But if I could, there is still the problem of training midwives. Some of them simply do not know how to give birth in positions or conditions other than the “standard” ones.
There are generally a lot of problems with this birth plan. There was once such a scandal that the patients refused everything: puncture, oxytocin, perineal incision. I understand and accept it all, but if my patient refused to insert the needle during childbirth, I would tell her to go to another hospital. And not because I have such a whim. In childbirth, the situation can collapse in a second. So much so that both the patient and the child will leave the room with their legs forward. If we do not have access to a vein and the patient is shocked, she will die before we can puncture.
There is this reluctance of women to take enemas. I used to think it was evil, too, but now I will say it is quite the opposite. Enema is a fantastic boost to labor. I’ve seen it many times. What else? Crotch shaving. I am not an advocate of perineal shaving at all, but in labor, if you have to incise the perineum and then sew it together, it becomes a problem. The hair falls into the field, and when we pull these threads, we also pull the hair. AND the women begin to screech in painbecause it’s really not cool. However, I would advise you to at least trim the hair before giving birth. For your own good.
And the perineal incision? I am definitely an advocate of its protection, but if it does not stand up to us, it really is it is better to cut it than to have it burst itself. Because then it’s a massacre. And the patients are not aware of it, because they have read on the forum and think that the cut is a drama. And sometimes you really have to do it.
On the other hand, of the things that I completely disagree with during childbirth, and are standard in Poland, I will mention cervical massage. It is a drama and a scandal that it is being done at all. It is such an artificial dilation of the neck that hurts mercilessly, and at the same time does not bring much. It is enough to upright the patient – let her walk a little, jump on the ball. And finally the neck will let go by itself. And if he does not let go, it would be appropriate to ask the patient if she agrees to such a procedure. This may be the last chance before making a cut with an indication of the so-called cervical dystocia (i.e. the neck does not want to shorten and expand).
Many Polish women have traumatic memories of their birth. When you read them, it is hard to believe that it is possible to give birth to human beings …
Right. The comfort of giving birth and the quality of the Polish health care system are what they are. And it won’t be better, because if you don’t pay people, then there is no one to work. If there were more doctors and midwives, it would be a bit different. You wouldn’t have to fly from one patient to the next with your tongue lowered on every shift. You could talk to her, do more. But there is no time for that.
In fact, our care is not bad at all. Most of the complaints of patients are about the staff. They say he’s rude, no empathy. And I agree with that. Quite a few doctors, nurses and midwives behave this way. If you don’t get out of the community center, studies won’t help you. But in fact, care during childbirth in Poland is not bad. I would even say that it is very good. I myself know many fantastic doctors, midwives and nurses. As in any profession, they are better and worse. Matters where a child or a mother died are publicized. You know, bad news clicks. Let us note, however, that there are very few such situations for the total number of births in Poland. Poland is second in the world when it comes to low infant mortality. We have very good obstetrics. Contrary to popular belief. Only the caesarean section is at a terrifying level, and I think something should work here.
Postpartum care in Poland “practically does not exist”
The childbirth is already behind us. What he was, he was. What happens next? From my experience: a woman is left to herself. Perhaps she shouldn’t.
Postnatal care is practically non-existent with us. The women in the room are left to themselves, they help each other. I did too. This is not due to the bad will of the staff, but the lack of nurses. There is one or two girls out of 20 on call. So when is she going to go to them?
And there is also lactation counseling with this kind of terror. I had a fantastic lactation nurse. But she also introduced such terror to me. «Just you know, don’t give her artificial milk. Don’t give artificial milk! » – as if it were some kind of poison that would kill my baby. She was beating it terribly to my head. And it works the worst for women who do not have food. I have a friend who still feels guilty about it, because she heard from lactation nurses how bad this formula is. When he comes to me and I’m feeding, he looks so sad and says that she couldn’t. Three years after giving birth, and she continues to live it.
And that brings us down to another important issue, which is postpartum depression, and even postpartum depression. This is a big problem that everyone has, to put it bluntly, fired. In fact, a psychologist should come to every woman after childbirth. Instead, a community nurse comes, who is usually less concerned with a woman’s psyche, because it is known – this is how it should be. If I had to change something in the perinatal care in Poland, I would start with the so-called the fourth stage of labor, i.e. puerperium. And she created such maternity care centers, open 12 hours a day, where a patient with a child could come, see a psychologist, talk to a qualified lactation nurse. It is very difficult for a woman after childbirth. And then she needs the best possible psychological and substantive help. Only there is no place to get it. This is a drama.
Also read:
- Being a mom is great, but it starts with a hard 40 weeks [COLUMN]
- The doctor joked that “a child gives birth”. Then he jabbed his elbow in the stomach
- Postpartum depression after IVF. Stress and hormones are an explosive mix
- The worst texts of gynecologists
- Louise Joy Brown – the first IVF child. How does it look today?