Every Polish woman deserves free anesthesia for childbirth. On request. Unfortunately, this is often just wishful thinking. Hospitals have a shortage of anesthesiologists, there are no full-time jobs for them, or they are on duty, but for example only until 14. Meanwhile, most births take place at night.
– The pain of labor is so strong that only epidural anesthesia can relieve it – says prof. Krzysztof Czajkowski, a national consultant in the field of obstetrics and gynecology. Meanwhile, many women in labor do not receive such anesthesia.
Only 60 percent of women use anesthesia for childbirth in the best clinical hospitals. However, there are places where it is hardly available. Meanwhile, everyone has the right to pain treatment, which is guaranteed by the Patient Rights Act amended this year.
The price of anesthesia
– Since the implementation of additional financing by the National Health Fund of the costs of epidural anesthesia by the National Health Fund, hospitals perform three times more of them – says Sylwia Wądrzyk, the press spokesman of the National Health Fund. However, there are hospitals where such anesthesia is not available. It was loud recently about the hospital in Płock, where those in labor could not use it.
The National Health Fund does not limit the anesthesia procedure and pays for each one performed. – Its valuation, however, is underestimated – says prof. Radosław Owczuk, national consultant in the field of anesthesiology and intensive care.
The Agency for Health Technology Assessment and Tariffs valued it at about PLN 400. The actual costs are higher. In order to guarantee anesthesia for every woman in labor at any time of the day or night, 24-hour duty of anaesthesiologists in the delivery ward is needed. In addition, according to the regulations, in addition to the doctor, you need a nurse or a properly trained midwife to perform anesthesia. And they, like anesthesiologists, are missing. Before the National Health Fund started to finance this procedure, in some institutions it was possible to purchase it additionally. It cost about PLN 800. However, when the new regulations came into force, hospitals stopped charging additional fees. And this in smaller centers means even more difficult access to anesthesia.
Why do they give birth in pain?
When the National Health Fund started financing epidural anesthesia in childbirth, the media announced that every woman has the right to request this procedure. Meanwhile, as the NFZ spokeswoman emphasizes, the decision to administer anesthesia is always made by the doctor taking into account all medical aspects. – Due to the safety of the mother and child, it is he who decides about the appropriate method of treatment based on the identified indications and contraindications, as well as the possible consequences of the method used – he says. National consultant in the field of anesthesiology and intensive care prof. Owczuk admits that there is no such thing in the standards of pain relief as analgesia, i.e. the abolition of pain on demand. He also emphasizes that it is the obstetrician’s gynecologist who orders the consultation preceding the analgesia of labor. “But gynecologists don’t always do this,” he says.
Happy childbirth
National consultant in the field of obstetrics and gynecology prof. Czajkowski claims that he has never encountered any signs of reluctance of his colleagues to anesthesia during childbirth. However, many women in labor have different feelings. They say that the doctor suggested to them that this could affect the baby badly or make the mother-offspring bond not as strong as after a painful delivery. – Unless there are contraindications, an epidural is a good choice. The doctor is also pleased to see smiling women in the delivery rooms, instead of suffering from pain – says prof. Tchaikovsky. When asked if such anesthesia is safe for a child, she replies that with actively conducted labor – yes. Since the anesthetized woman does not feel any contractions, the midwife must tell her when to push. If he does, the baby is not at risk. Prof. Czajkowski believes that the Polish regulations on the anesthesia procedure are more restrictive than in other European countries. – In Scandinavia, a pregnant woman declares that she wants anesthesia before giving birth. Then it is easier to plan the work of anesthesiologists.
Little complaints
In the clinical hospital of the Medical University of Warsaw Fr. Anna Mazowiecka, about 60% of patients use anesthesia. Among the remaining 40% – some resign from it or have contraindications to perform it, some give birth by caesarean section, and some cannot receive it due to a lack of staff. – When there are a lot of unscheduled cesarean sections, anesthesiologists are missing, because they have to assist with cesareans and cannot anesthetize physiological deliveries – says Prof. Tchaikovsky. The National Health Fund informs that since the beginning of this year, more than 11 jobs have been performed in hospitals. anesthesia. Most in the Mazowieckie – 3, Małopolskie – 983 and Łódzkie – 1 wards. – This means a threefold increase compared to the monthly average of anesthesia performed in the period before the introduction of additional funding, ie before July 928, 1 – emphasizes the spokeswoman for the National Health Fund. The Fund reminds that in the event of any difficulties with obtaining the guaranteed service, each patient has the right to refer to the Provincial Department of the National Health Fund. Each report of this type is explained in detail. He adds that no such complaint was filed with the Fund’s Head Office either this year or last year. – For the ten months that I have been serving as a national consultant, the patient ombudsman has provided me with only one complaint regarding difficulties in accessing this service – adds prof. Owczuk. This, however, does not prove that the problem does not exist, but is rather the result of a lack of time for new moms to write complaints.