In February, Anna Starobinets’ book «Look at him» was published. We publish an interview with Anna, in which she talks not only about her loss, but also about the problem that exists in Russia.
Psychologies: Why did Russian doctors react in such a way to questions about abortion? Do not all clinics do this in our country? Or are late-term abortions illegal? What is the reason for such a strange relationship?
Anna Starobinets: In Russia, only specialized clinics are engaged in terminating pregnancy for medical reasons in the late term. Of course, this is legal, but only in strictly designated places. For example, in the same infectious diseases hospital on Sokolina Gora, which is so loved to scare pregnant women in antenatal clinics.
Saying goodbye to a child: the story of Anna Starobinets
A woman faced with the need to terminate a pregnancy at a later date does not have the opportunity to choose a medical institution that suits her. Rather, the choice is usually no more than two specialized places.
As for the reaction of doctors: it is connected with the fact that in Russia there is absolutely no moral and ethical protocol for working with such women. That is, roughly speaking, subconsciously any doctor — whether ours or German — feels a desire to distance himself from such a situation. None of the doctors want to take delivery of a dead fetus. And none of the women do not want to give birth to a dead child.
It’s just that women have such a need. And for doctors who are lucky enough to work in facilities that do not deal with interruptions (that is, the vast majority of doctors), there is no such need. What they tell women with relief and a certain amount of disgust, without filtering words and intonations at all. Because there is no ethical protocol.
Here it should also be noted that sometimes, as it turned out, doctors are not even aware that in their clinic there is still the possibility of such an interruption. For example, in the Moscow center. Kulakov, I was told that “they don’t deal with such things.” Just yesterday, I was contacted by the administration of this center and informed that in 2012 they were still doing such things.
However, unlike Germany, where a system is built to help a patient in a crisis situation and each employee has a clear protocol of actions in such a case, we do not have such a system. Therefore, an ultrasound doctor specializing in pregnancy pathologies may well be unaware that his clinic is engaged in the termination of these pathological pregnancies, and his superiors are convinced that he does not have to know about it, because his professional field is ultrasound.
Maybe there are tacit guidelines to dissuade women from terminating a pregnancy in order to increase the birth rate?
Oh no. Against. In this situation, a Russian woman experiences incredible psychological pressure from doctors, she is actually forced to have an abortion. Many women told me about this, and one of them shares this experience in my book — in its second, journalistic, part. She tried to insist on her right to report a pregnancy with a lethal pathology of the fetus, give birth to a child in the presence of her husband, say goodbye and bury. As a result, she gave birth at home, with a huge risk to her life and, as it were, outside the law.
Even in the case of non-lethal, but severe pathologies, the model of behavior of doctors is usually the same: “Urgently go for an interruption, then you will give birth to a healthy one”
In Germany, even in a situation with a non-viable child, not to mention a child with the same Down syndrome, a woman is always given the choice of whether to report such a pregnancy or terminate it. In the case of Down, she is also offered to visit families in which children with such a syndrome grow up, and they are also informed that there are those who wish to adopt such a child.
And in case of defects incompatible with life, the German woman is told that her pregnancy will be carried out like any other pregnancy, and after giving birth, she and her family will be given a separate ward and the opportunity to say goodbye to the baby there. And also, at her request, a priest is called.
In Russia, a woman does not have a choice. Nobody wants a pregnancy like this. She is invited to go through «one step at a time» for an abortion. Without family and priests. Moreover, even in the case of non-lethal, but severe pathologies, the model of behavior of doctors is usually the same: «Urgently go for an interruption, then you will give birth to a healthy one.»
Why did you decide to go to Germany?
I wanted to go to any country where late-term terminations are done in a humane and civilized way. Plus, it was important for me that I had friends or relatives in this country. Therefore, the choice was in the end from four countries: France, Hungary, Germany and Israel.
In France and Hungary they refused me, because. according to their laws, late-term abortions cannot be performed on tourists without a residence permit or citizenship. In Israel, they were ready to accept me, but they warned that the bureaucratic red tape would last at least a month. In the Berlin Charité clinic they said that they have no restrictions for foreigners, and that everything will be done quickly and humanely. So we went there.
Don’t you think that for some women it is much easier to survive the loss of a «fetus» and not a «baby»? And that parting, funerals, talking about a dead child, correspond to a certain mentality and are not suitable for everyone here. Do you think this practice will take root in our country? And does it really help women relieve themselves of guilt after such an experience?
Now it doesn’t seem to. After the experience I had in Germany. Initially, I proceeded from exactly the same social attitudes that practically everything in our country comes from: that in no case should you look at a dead baby, otherwise he will then appear in nightmares all his life. That you should not bury him, because «why do you need such a young, children’s grave.»
But about the terminological, let’s say, acute angle — «fetus» or «baby» — I stumbled immediately. Not even a sharp corner, but rather a sharp spike or nail. It is very painful to hear when your child, although unborn, but absolutely real for you, moving in you, is called a fetus. Like he’s some kind of pumpkin or lemon. It doesn’t comfort, it hurts.
It is very painful to hear when your child, although unborn, but absolutely real for you, moving in you, is called a fetus. Like he’s some kind of pumpkin or lemon
As for the rest — for example, the answer to the question, whether to look at it after the birth or not — my position changed from minus to plus after the birth itself. And I am very grateful to the German doctors for the fact that throughout the day they gently but persistently offered me to “look at him”, reminded me that I still have such an opportunity. There is no mentality. There are universal human reactions. In Germany, they were studied by professionals — psychologists, doctors — and made part of statistics. But we have not studied them and proceed from antediluvian grandmother’s conjectures.
Yes, it is easier for a woman if she said goodbye to the child, thus expressing respect and love for the person who was and who is gone. To a very small — but human. Not for pumpkin. Yes, it’s worse for a woman if she turned away, didn’t look, didn’t say goodbye, left “as soon as possible to forget.” She feels guilty. She does not find peace. That’s when she gets nightmares. In Germany, I talked a lot about this topic with specialists who work with women who have lost a pregnancy or a newborn baby. Please note that these losses are not divided into pumpkins and non-pumpkins. The approach is the same.
For what reason can a woman in Russia be denied an abortion? If this is according to indications, then the operation is included in the insurance or not?
They can refuse only if there are no medical or social indications, but only a desire. But usually women who do not have such indications are in the second trimester and do not have the desire to do so. They either want a baby, or if they don’t, they’ve already had an abortion before 12 weeks. And yes, the interrupt procedure is free. But only in specialized places. And, of course, without a farewell room.
What struck you the most about those creepy comments on forums and social media that you wrote about (you compared them to rats in the basement)?
I was struck by the total absence of a culture of empathy, a culture of sympathy. That is, in fact, there is no «ethical protocol» at all levels. Neither doctors nor patients have it. It simply does not exist in society.
Are there psychologists in Russia who help women who are faced with a similar loss? Have you asked for help yourself?
I tried to seek help from psychologists, and even a separate — and, in my opinion, quite funny — chapter in the book is devoted to this. In short: no. I haven’t found an adequate loss specialist. Surely they are somewhere, but the very fact that I, a former journalist, that is, a person who knows how to do “research”, did not find a professional who could provide this service to me, but found those who sought to provide me some completely different service, says that by and large it does not exist. Systemically.
For comparison: in Germany, such psychologists and support groups for women who have lost children simply exist at maternity hospitals. You don’t have to look for them. A woman is referred to them immediately after the diagnosis is made.
Do you think it is possible to change our culture of patient-doctor communication? And how, in your opinion, to introduce new ethical standards in the field of medicine? Is it possible to do this?
Of course, it is possible to introduce ethical standards. And it is possible to change the culture of communication. In the West, I was told, medical students practice with patient actors for several hours a week. The issue here is more one of purpose.
In order to train physicians in ethics, it is necessary that in the medical environment the need to observe this very ethics with the patient by default is considered something natural and correct. In Russia, if something is understood by “medical ethics”, then, rather, the “mutual responsibility” of doctors who do not give up their own.
Each of us has heard stories about violence in childbirth and about some kind of concentration camp attitude towards women in maternity hospitals and antenatal clinics. Starting with the first examination by a gynecologist in my life. Where does this come from, are they really echoes of our prison-camp past?
Camp — not camp, but definitely echoes of the Soviet past, in which society was both puritanical and spartan. Everything that is connected with copulation and childbearing logically arising from it, in state medicine since Soviet times, has been considered the sphere of obscene, dirty, sinful, at best, forced.
In Russia, if something is understood by “medical ethics”, then, rather, the “mutual responsibility” of doctors who do not hand over their own
Since we are Puritans, for the sin of copulation, a dirty woman is entitled to suffering — from sexual infections to childbirth. And since we are Sparta, we must go through these sufferings without even uttering a word. Hence the classic remark of a midwife at childbirth: “I liked it under a peasant — now don’t yell.” Screams and tears are for the weak. And there are more genetic mutations.
An embryo with a mutation is a culling, a spoiled fetus. The woman who wears it is of poor quality. Spartans don’t like them. She is not supposed to have sympathy, but a harsh rebuke and an abortion. Because we are strict, but fair: do not whine, shame on you, wipe your snot, lead the right way of life — and you will give birth to another, healthy one.
What advice would you give to women who had to terminate a pregnancy or experienced a miscarriage? How to survive it? So as not to blame yourself and not fall into a deep depression?
Here, of course, it is most logical to advise you to seek help from a professional psychologist. But, as I said a little higher, it is very difficult to find it. Not to mention that this pleasure is expensive. In the second part of the book “Look at him”, I talk exactly on this topic — how to survive — with Christine Klapp, MD, head physician of the Charité-Virchow obstetrics clinic in Berlin, which specializes in late pregnancy terminations, and performs not only gynecological, but and psychological counseling for their patients and their partners. Dr. Klapp gives a lot of interesting advice.
For example, she is convinced that a man needs to be included in the “mourning process”, but it should be borne in mind that he recovers faster after the loss of a child, and also has difficulty enduring round-the-clock mourning. However, you can easily arrange with him to devote to a lost child, say, a couple of hours a week. A man is capable of talking during these two hours only on this topic — and he will do it honestly and sincerely. Thus, the couple will not be separated.
A man must be included in the “mourning process”, however, it should be borne in mind that he recovers faster after the loss of a child, and also has difficulty enduring round-the-clock mourning
But this is all for us, of course, a piece of a completely alien social and family way of life. In our way, I advise women to listen first of all to their heart: if the heart is not yet ready to “forget and live on”, then it’s not necessary. You have the right to grief, no matter what others think about it.
Unfortunately, we do not have professional psychological support groups at maternity hospitals, however, in my opinion, it is better to share experiences with non-professional groups than not to share at all. For example, on Facebook (an extremist organization banned in Russia) for some time now, sorry for the tautology, there is a closed group “Heart is open”. There is quite adequate moderation, which screens out trolls and boors (which is rare for our social networks), and there are many women who have experienced or are experiencing loss.
Do you think that the decision to keep a child is only a woman’s decision? And not two partners? After all, girls often terminate their pregnancy at the request of their friend, husband. Do you think men have a right to this? How is this treated in other countries?
Of course, a man does not have the legal right to demand that a woman have an abortion. A woman can resist the pressure and refuse. And can succumb — and agree. It is clear that a man in any country is capable of exerting psychological pressure on a woman. The difference between conditional Germany and Russia in this regard is two things.
First, it is the difference in upbringing and cultural codes. Western Europeans are taught from childhood to protect their personal boundaries and respect others. They are very wary of any manipulations and psychological pressure.
Secondly, the difference in social guarantees. Roughly speaking, a Western woman, even if she does not work, but is entirely dependent on her man (which is extremely rare), has a kind of “safety cushion” in case she is left alone with a child. She can be sure that she will receive social benefits, on which one can really live, albeit not very luxuriously, deductions from the salary of the father of the child, as well as other bonuses for a person in a crisis situation — from a psychologist to a social worker.
There is such a thing as «empty hands». When you are expecting a child, but for some reason you lose him, you feel with your soul and body around the clock that your hands are empty, that they do not have what should be there.
Unfortunately, a Russian woman is much more vulnerable in a situation where the partner does not want a child, but she does.
The final decision, of course, remains with the woman. However, in the case of a “pro-life” choice, she must be aware that she is taking on much more responsibility than a conditional German woman, that she will have practically no social cushion, and alimony, if any, is rather ridiculous.
As for the legal aspect: German doctors told me that if it comes to terminating a pregnancy, say, because of Down syndrome, they have instructions to carefully monitor the couple. And, if there is a suspicion that a woman decides to have an abortion under pressure from her partner, they immediately respond, take action, invite a psychologist, explain to the woman what social benefits she and her unborn child are entitled to if he is born. In a word, they do everything possible to get her out of this pressure and give her the opportunity to make an independent decision.
Where did you give birth to children? In Russia? And did their birth help them cope with the trauma?
The eldest daughter Sasha was already there when I lost the child. I gave birth to her in Russia, in the Lyubertsy maternity hospital, in 2004. She gave birth for a fee, «under the contract.» My girlfriend and my ex-partner were present at the birth (Sasha Sr., the father of Sasha Jr., could not be present, he then lived in Latvia and everything was, as they say now, “difficult”), during the contractions we were provided with a special ward with shower and a big rubber ball.
All this was very nice and liberal, the only greeting from the Soviet past was an old cleaning lady with a bucket and a mop, who twice broke into this idyll of ours, fiercely washed the floor under us and quietly muttered to herself under her breath: “Look what they invented! Normal people give birth lying down.
I didn’t have epidural anesthesia during childbirth, because, supposedly, it’s bad for the heart (later, a doctor I knew told me that just at that time in the Lyubertsy house something was wrong with anesthesia — what exactly was “not right”, I do not know). When my daughter was born, the doctor tried to slip a pair of scissors into my ex-boyfriend and said, «Daddy’s supposed to cut the umbilical cord.» He fell into a stupor, but my friend saved the situation — she took the scissors from him and cut something there herself. After that, we were given a family room, where all four of us — including a newborn — and spent the night. In general, the impression was good.
I gave birth to my youngest son, Leva, in Latvia, in the beautiful Jurmala maternity hospital, with an epidural, with my beloved husband. These births are described at the end of the book Look at Him. And, of course, the birth of a son helped me a lot.
There is such a thing as «empty hands». When you are expecting a child, but for some reason you lose it, you feel with your soul and body around the clock that your hands are empty, that they do not have what should be there — your baby. The son filled this void with himself, purely physically. But the one before him, I will never forget. And I don’t want to forget.