Joanna Pietrusiewicz: Many women experience rights violations, but in the case of violence defined by scientists as childbirth violence, this indicator is approximately 20% . It sounds better than 50%, but it is still a very large percentage of women who experience mistreatment. How can this be avoided? Sometimes there is no way. If someone allows others to push their boundaries, then this happens. For your part, you should first take care of the selection of the place , read about hospitals and facilities with positive opinions, visit the website www.gdzierodzic.info , where women create the ranking themselves by completing a survey. Many thousands of women complete the survey every year, for which I am extremely grateful. Thanks to these answers and the algorithms we have developed, we create a ranking in 10 areas, e.g.: assistance in breastfeeding, freedom of giving birth, care during cesarean section, postpartum care, respect for patient rights.
Another thing we can also influence is knowledge . Awareness about patient rights, the use of these rights and, above all, awareness that knowing one's rights is not demanding . I come across this word very often in the Foundation - when women take care of their rights, they feel entitlement. And I encourage you to seek your rights, so that you know what the right to information means and what this information is. This knowledge should be taught in childbirth classes. The person conducting the preparatory classes should highlight all matters regarding consent to procedures and what this consent entails. The hospital staff knows our rights perfectly well, but our personal awareness puts us in a completely different position.
Another issue is the so-called mental work . Our state of mind and awareness that the white coat of a doctor or midwife means partnership and willingness to help us. The hospital staff is not "higher" than us, despite their knowledge. Lack of fear and openness to this help is the first step that we must take ourselves. We must be aware that in the hands of a doctor we are not an object, we have the right to vote and we do not have to agree to everything. It is worth using this right, and our psyche will surely reward us for it.
My experience shows that this is not a good strategy. First of all, it doesn't help because it shows that we are weaker in this relationship and you can do whatever you want with us. I strongly encourage you to be assertive and speak clearly about your needs: "I really want you to do...", "I do not agree to this, please respect my opinion." Such clear messages and emphasis on personal manners are the best way to refute the strategy of a person behaving rudely, rudely and unpleasantly. What else can we reach for? These are legal aspects regarding our consent and expectations. We can always ask for an entry in the medical records - such a sentence always signals "I see what is happening here, I do not agree to it."
I have this feeling that the silent mouse strategy is not a good strategy. It has consequences in the form of a deep psychological wound/trauma, and if the situation was exceptionally difficult, it may lead to the emergence of postpartum depression. Therefore, when we feel that our boundaries are being violated, it is worth simply informing them. Sometimes the things that happen are because we are very different. For one of us, the diminutive forms of our name will be pleasant and warm, for others, it will be a trigger that will only lower our mental well-being during childbirth. This does not result from the person's bad will, but from experience in which such phrases were often met with positive reception.
In Poland we have something called a " birth plan ". This is a document attached to the hospital's medical records - I strongly encourage you to complete it. Such a plan is available on the website www.gdzierodzic.info . By answering the questions included, we generate our own, private birth plan and go with it to the facility where the birth is to take place.
Therefore, it is worth choosing a hospital where the birth plan is implemented and respected . You can also find a list of such places at www.gdzierodzic.info . The situation of hospitals in Poland is very diverse and it is not true that it is the same everywhere. The only influence we have is to make sure about the place we choose. However, the very fact that a birth plan will be generated will provide the future mother with knowledge and will allow her to see what is most important to her . Then you will be able to check individual elements in a given hospital and abandon the one that does not provide the most important issues. A birth plan is only a list of expectations , it does not oblige us to anything. If we indicate that we consent to an episiotomy, nevertheless - before the procedure - the person performing the incision must ask us for consent.
While working at a antenatal school, I realized that all women believe that they want the same thing, that it is obvious what a woman giving birth needs. Of course, each of us wants to give birth to a healthy child, but everything else is a very individual matter. From the presence of a partner, through the type of delivery - it all changes with each new patient. It's nice if we manage to find a hospital that will meet all our most important needs.
Most often, women do not know about the existence of a document called the Organizational Standard of Perinatal Care, which is a regulation of the Minister of Health, and therefore these are our inalienable, basic rights regarding pregnancy, childbirth and postpartum. Further issues are: the right to information and the right to consent and refuse . These are very important patient rights that we not only should know about, but we must be sure of them. We are free people, we have free will that no one can take away from us. In the case of childbirth, the hospital is listed as a place of service, we want to give birth to our child there, but we are still human. The role of doctors and midwives is to present the situation as it is, dispel doubts and determine possible consequences. The consequences are ultimately borne by the patient, not the doctor, so it is the patient who decides for himself.
The most important rights are:
I would like to refer once again to the Organizational Standard of Perinatal Care: we have a catalog of services and types of visits that are guaranteed to us by law. What women often do not know is that from the 21st week of pregnancy they can benefit from the care of their community midwife . It is worth taking advantage of this and making sure to find a midwife in your area. A community midwife can help with preparations for childbirth, very often they are people who run antenatal classes themselves.
What's more, the Standard of Perinatal Care says that our pregnancy can be 100% managed by a midwife . Polish law stipulates that completing midwifery studies qualifies you to conduct pregnancy. A midwife has been training for several years at the Medical University to support our health during such a demanding time as pregnancy. Let's not be afraid to say it - a midwife's knowledge about natural childbirth and its physiology often exceeds the knowledge of a doctor, who in turn is trained to treat. The midwife's task is to spot moments when the situation deviates from the norm and alert the doctor about her doubts. This is, in my opinion, an ideal system and the Foundation is fighting hard to maintain this system. The midwife has more time and physical capabilities to carry out childbirth in the most natural way possible , without threatening the health of the baby and mother. Unfortunately, a doctor does not have time to spend 10 hours in one room and provide comprehensive care for a woman giving birth. This is also how young doctors are prepared for work - they have to act as quickly as possible. Such haste does not always work in the case of childbirth, when, for example, we are more nervous and agitated by the current situation. Analyzing our condition, the midwife will encourage us to drink tea, cool down or talk and give us time to calm down our hormonal system.
The most characteristic difference in childbirth is the so-called emergency room effect . When the first, regular contractions begin, we rush to the hospital. As soon as you walk through its door, the contractions suddenly stop. This is due to the high level of adrenaline in the blood, and the midwife's task is to prepare and allow us to get organized in a new place (the delivery room) and calm our body as much as possible before the effort. Doctors, however, act. The assumption both in Poland and around the world is the same - the midwife deals with physiology, while the doctor deals with the treatment of abnormalities. This does not mean that a midwife has lower competences - her competences are completely different, but equal to those of a doctor.
If you decide to have your pregnancy managed by a midwife, you will see the doctor at least three times during the entire pregnancy.
It is our right to have access to pain relief methods – pharmacological and non-pharmacological. Unfortunately, Polish law is a complete failure here. We do not have legally guaranteed epidural anesthesia and I think we will not have it for now. This is very sad news, and it results from the fact that we have too few anesthesiologists and if it were to be a legal provision, a huge number of hospitals would disappear from the map of Poland. There are entire provinces where women do not have access to epidural anesthesia. It is true that the National Health Fund reimburses the amount of anesthesia, but anesthesia on request is often not carried out due to lack of staff . This does not change the fact that the hospital should have a pain relief procedure developed. At the beginning of labor, the patient should be informed about the available options.
What influences the feeling of pain during childbirth is the atmosphere . Do we feel safe? Do we need company? Does loneliness increase our pain? I really hope that after the pandemic, most hospitals will reopen the possibility of giving birth with loved ones . I say "close ones" because it doesn't have to be our partner. It may be a friend, mother - simply someone with whom we feel safe and comfortable. When giving birth with a partner, women very often feel the need to take care of him so that he also feels comfortable. There is no room for this during labor. Childbirth is the moment when a woman takes care of herself and everyone else is there to help her.
The presence of a loved one gives you a sense of security and the opportunity to focus on giving birth . This is when real magic happens in our body, hormones go crazy and influence each other. This is also the moment when physiology is heavily dependent on external events . The friendliness of the staff, the possibility of complete physical comfort, moving freely around the room, entering the water, as well as the intimacy of the situation - all these external factors influence the feeling of pain and pharmacological help is not always necessary. This is also knowledge that we should familiarize ourselves with and take into account - anesthesia is not always the best solution.
This is a difficult question. I do not encourage this to be the case. Rather, I encourage you to remind the woman giving birth what is most important to her, what she cared about before the start of labor and what was agreed earlier. So that we can take actions ourselves during childbirth and emerge from the entire event with a sense of agency , with the thought "I did it, I did it." We need the feeling of victory so that when we hug our baby after birth, we will have the strength to take care of him. Women who have experienced childbirth admit that in the rush of love and postpartum emotions, all their fatigue disappeared. This is the feeling of strength that comes from this event.
Childbirth is an experience in which we cannot be deprived of our sense of agency. When preparing men for family births, I always emphasize the need to put their masculinity in their pockets. Men often feel responsible for their family/partner, and in the face of childbirth they should not get carried away with their actions. A woman giving birth should be questioned and given wise support in order to build her potential, not suppress it.
Napisała: Hanna Borowska
Editor, journalist, science writer, certified nutrition consultant. Motherhood made her interest in health issues change the direction of her professional path. She has completed several trainings and courses in Poland and abroad in the field of dietetics, functional medicine and aromatherapy. She is passionate about the unexplored power of the human microbiome. She graduated with honors from the Faculty of Journalism and Political Science at the University of Warsaw. For many years associated with Euroradio.fm.
Gość: Joanna Pietrusiewicz
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