Years of fighting for the rights of women to a dignified childbirth have borne fruit – they can be accompanied by their partner in the hospital, choose the position in which they give birth, and finally – from this year on, they have been guaranteed free anesthesia. Only the year is not over. And right now, quietly, ignoring Polish women and obstetrics consultants, the Ministry of Health introduced new regulations. The woman in labor will be guaranteed that she will be at the grace and disfavor of the doctor. It is he who will decide whether someone will give her a glass of water and whether a newborn baby will be placed on her stomach.
It seemed that Polish women did not need to be afraid of childbirth anymore. We have one of the lowest maternal mortality rates, Euro-Peristat data say 4,4 per 100 births. This is not enough, because there are countries in Europe, such as Estonia, where 000 women die for the same number of deliveries.
The Polish Gynecological Society regularly publishes guidelines on the standards of pregnancy, childbirth and puerperium. Four years ago, the Ministry of Health issued an ordinance in which it wrote down these rules. It was there, among others a provision on the woman’s rights to choose the place of childbirth and the doctor, position during childbirth, the possibility of drinking water and to respect intimacy.
After family births were introduced, and this year also anesthesia on request, it seemed that the times of childbirth under humiliating conditions were gone forever. And yet the recent inspection by the Supreme Audit Office, about which we wrote in Medonet in the article entitled “Childbirth behind a screen”, showed that it is not so good. In any case, not everywhere, because there are still hospitals where it is difficult to ask for anesthesia, women give birth in scandalous conditions, and perinatal procedures are performed in front of outsiders. And those in labor listen to vulgar comments from doctors and midwives concerning, for example, their personal situation.
The Supreme Audit Office noted that the conditions offending the dignity of patients are partly the result of provisions that can be freely interpreted, which some hospitals use.
Willing to improve the situation, the Ministry of Health, quietly, without consulting obstetricians, introduced changes to the act. In the entry “standards of medical procedure” were replaced with “organizational standards of health care”.
What’s behind it? The doctor will decide whether a woman can change position during childbirth, take a shower, drink water, or whether she will have continuous contact with the baby after the birth, not the doctor. Because it won’t be guaranteed anymore.
The Ministry of Health defends itself and explains that it resigns from strict adherence to standards, because although «(…) they are created in accordance with the principles of Evidence Based Medicine, they constitute important guidelines in everyday medical practice, but they should not constitute mandatory provisions of law ».
What do the doctors think about the MZ’s decision? – By introducing changes to the act, the Ministry deprived women of the certainty that she would be treated in accordance with the global guidelines created by the Polish Gynecological Society, international organizations setting the rules of medical procedure in providing health services in the field of obstetrics – says Dr. Grzegorz Południewski, MD, a well-known gynecologist, for MedTvoiLokony – a midwife from the Society for Family Development.
“All this takes us back to the gloomy years of oppressive obstetrics in the second half of the XNUMXth century. of the century »- this is the opinion of the foundation« To give birth to people ». Maybe she does not withdraw, but she can actually withdraw, if a woman, relying on a clearly defined law, but on the whim of the hospital staff, finds a doctor without empathy, who will not take into account the patient’s feelings, but only his comfort. In any case, this creates a field for abuse in the name of the “organizational standards” of a given hospital or head of department.
– I am not surprised that the Foundation “To give birth to human” has doubts about the future of obstetrics and the safety of women who will give birth in Polish hospitals – admits Dr. Grzegorz Południewski. – There is a danger that obstetric regimens based on evidence-based medicine, i.e. medicine based on facts, will cease to apply in our country. And what is standard today will not be followed. The amendment to the act exempts hospitals and other medical facilities from complying with the rules which, according to medical knowledge, are optimal for the health and safety of a pregnant woman. And doctors and midwives gained the opportunity to develop rules “on their own, according to what is good and convenient for them. Probably every hospital will be able to develop its own standards, which will not always be in line with the position of PTG and other scientific communities – adds the obstetrician-gynecologist.
He also calls the new regulations “a great loss for women who have fought for many years to make obstetrics in our country more friendly”. He also points out that “Someone might say that the standards were not respected by all hospitals anyway. And he will be right. But our goal should be to create mechanisms that will persuade non-conforming hospitals to catch up with the best facilities where care for the pregnant woman is carried out in an exemplary manner. The Ministry of Health has released all medical facilities from this obligation ”.
“The abolition of the standard will deprive women of the opportunity to file a complaint, as they will have nothing to appeal to. The quality of care that the woman in labor will receive will depend on the decision of the head or doctor, customs and routines in a given facility ”- this is another complaint of the foundation.
What is the Ministry of Health responding to it? – The amendment to the provisions of the act on medical activity will not limit the lodging of complaints by women who believe that their rights have not been properly implemented. Such a right is guaranteed to patients by the Act of November 6, 2008 on the rights of patients and the Patient’s Rights Ombudsman (Journal of Laws of 2016, item 186), says Danuta Jastrzębska, head of the Media Service Department.
Of course, you can always accuse a doctor or hospital, in a free country every citizen has the right to do so. First of all: many women will fear court skirmishes, knowing that the regulations are not precise (- When there is no standard, and the rules in the gynecology and obstetrics ward depend only on the doctor’s decision, it will be practically impossible to pursue your rights. – admits Dr. Południewski.) And secondly: such a complaint will be the so-called with mustard after lunch, or rather after childbirth.