Radio România Internațional

Tag: newborn

  • Birth policy in Romania

    Birth policy in Romania

    We got
    used to Romania being included in EU classifications compiled according to all
    sorts of negative records. A recent Eurostat statistics has revealed that since
    late 2019, Romania has hit yet another dismal record: at the level of the EU,
    our country is second only to Cyprus in terms of reported births by caesarian
    section. 60% of the children who are born in Romania are being born by caesarian section. We recall that during Ceausescu’s regime, the percentage of births by caesarian section was insignificant, yet the percentage began to increase gradually after
    1990s. The big private clinics encourage the procedure, since it is expensive
    and brings in a lot of money to the medical establishment. Also, births by
    caesarian section are extensively performed in state-run hospitals. Do mothers
    run away from natural birth, demanding that they give birth by caesarian section, or is the procedure medically imposed?

    Qualified midwife Irina
    Mateescu attempts an answer to this question:


    I do not think they avoid giving birth naturally, I
    think they run away from today’s image of natural birth, which is slightly
    traumatic. There are all sorts of stories, speaking about accelerating the
    labor pains, of women who had a fallout with the medical staff or who are being
    addressed in a rude manner by part of the medical staff, the birth-giving pose is atypical,
    it is antigravitational, what with the fact that it is so difficult to give
    birth in that pose. In quite a few hospitals, the general anesthesia is not
    available, it is not administered free of charge, and then, perhaps, women find
    a reason for themselves to avoid being treated disrespectfully, to run away
    from pain, to escape the lack of empathy. In our country, there is a phony
    medical reason, to a great extent, for which we have so high a percentage of
    caesarian births, which has nothing to do with women’s demand of that. Let me stress that
    once again, there is a tremendous percentage of caesarian births imposed by the
    physician, and nor asked for by women.


    Obstetrician
    Brandusa Mitroi also emphasized the mother’s fear of the unknown as well as her
    age:

    For their most part, the reasons are predominantly medical, since women
    tend to give birth later in life, and with that, all sorts of complications
    occur, among which gestational diabetes or high blood pressure. Also, there are
    cases when complications occur during the labor pains. At this point, we need
    to act under emergency conditions. Reasons of a maternal nature pertain to her
    choice, which stem from the fear of the unknown, and, oftentimes, from the lack
    of information. As for the medical reasons
    they could stem from malpractice, which has been growing, and yet, what
    we need to pay heed to is the fact that, for the medical doctor, opting for a caesarian surgical operation is not the easiest procedure, since the medical community
    unanimously has admitted to a higher rate of complications in this case.


    There
    were times when midwives used to play a key role in the process of giving
    birth, but things are not the same these days, at least with us. Midwifery
    faculties have been dismantled, and midwives have been in short supply ever
    since. Unfortunately, Romania does not use its midwives to the best of their
    abilities, although they are in short supply in medical institutions. Who
    stands to lose because of that ?

    Irina Mateescu:


    The role midwives have to play remains crucial, while
    the prevention and the monitoring we can have at national level regarding
    midwives can give a boost to some of the healthcare indicators, at once
    bringing other such indicators to a low level of risk, but there’s not enough
    of us to that end either. All told, there is less than 1,000 of us who practice
    their profession and who are members of the Order of Trained Nurses and
    Midwives, while the rest of us, needed to complete the required number of
    12,000 midwives, still needs to do their training. If faculties do not open
    once again, practically, this lever is denied altogether. At the moment,
    midwives play a very small part in the whole prenatal process because we are
    not wanted, we are not active according to our skills, they dismantled the
    faculties (as we speak, training as a midwife is almost impossible, if you want
    to set about going to the university you have nowhere to go to any more,
    because, of the nine university centers, barely one has remained operational),
    we’re speaking about a market, which at the moment is oversupplied by
    physicians specializing as obstetricians, neonatologists who grabbed this
    field, that of midwives, for themselves, for which they are not trained at all.
    85% of the pregnancies could be attended to by midwives.


    In
    Romania, giving birth by caesarian section has been gaining ground to such an extent
    that a handful of people are doomed to failure in their bid to change this
    mentality. We tend to forget that birth is part of life, we forgot that nature
    supports us, it is not our enemy.

    Brandusa Mitroi:


    How can we change that? Bearing in mind that birth is part of life. In
    most of the cases, nature does not fail, enabling each and every woman to give
    birth to that one child she can safely bring to this world. How can we improve
    that? Attending prenatal courses, demanding, if possible, the presence of the
    father for the birth process, or the epidural analgesia.


    Irina Mateescu:


    As a solution, from my point of view, we need to separate ourselves from
    the Order of Trained Nurses, so that our profession can be properly represented
    among the medical staff on call. The fact that there is someone who assists us
    while we’re giving birth, that is a typically Romanian abnormality, as for the
    women, they gave loads of credit to the physician regarding emotional security.
    A physician who is exhausted after his on-call shift or who has recently
    descended from a birthday party, they are in no way efficient as they intend to
    assist you while you’re giving birth. The most efficient one is the one who is
    on call, the one who is sufficiently rested, the one who is available. And at
    this point, there is a recommendation to operate according to a set of
    protocols. There are guides that must be turned into protocols and practices
    based on evidence in every hospital, meaning that specialist care for the
    well-being of the mother and child needs to be based on uniformity, it must be
    standardized, so that it can be implemented all over the country.


    There
    is one more problem, a major one, in maternities all over Romania, that of
    separating the infant from the mother immediately after she or he were born. For
    the newborn, such a treatment is brutal, and for the mother, emotionally
    devastating. When will a solution to that problem be found, from a midwife’s
    point of view?

    Irina Mateescu:


    When midwives become active
    and when the number of pregnancies we can supervise is growing, when we’re
    allowed to support women during labor and childbirth, when we can take care of
    the mother and child together, afterwards, without separating newborns from
    their mothers. Healthy mothers and newborns are allowed to be together, they
    are quickly discharged from hospital, and then are monitored while at home. As
    for the midwives, they have no problem doing that. The thing is for us to be
    allowed to work in our country as well.


    (Translation by Eugen Nasta)







  • Newborn Health in Romania

    Newborn Health in Romania

    The proper equipping of neonatal clinics is essential for the good management of premature birth cases. In Romania, the neonatal mortality rate is twice the European average. This rate is a good indicator of the gap between Romania and the more developed European countries. In Romanias poor counties, the neonatal mortality rate is double the one in the big cities, where neonatal clinics have modern medical equipment, according to a report by Salvati Copiii Association. Gabriela Alexandrescu, executive president of Salvati Copiii, tells us more about it:



    Gabriela Alexandrescu: “A national equipping program has not been implemented in Romania since 2007. Given the high number of premature birth cases, the equipment was intensely used. Moreover, the number of beds in neonatal ICUs is half the one needed. Consequently, many departments received more newborns than they were able to accommodate. The lack of equipment able to provide vital support was one of the causes. Another cause is the education of mothers, the number of visits to general practitioners and scarce pregnancy monitoring. Almost half of the pregnancies in Romania are not monitored by a physician. A lot of women give birth in maternity hospitals that do not have the equipment, the expertise and the legal right to care for newborns weighing less than one and a half kilos.



    As for the causes of child mortality in Romania, Gabriela Alexandrescu says they are social and cultural, but are also related to the lack of medical services in the less developed regions of Romania.



    Gabriela Alexandrescu: “It is a cluster of factors: education, the lack of basic services at the level of communities, especially in rural communities, where there is a major shortage of family physicians, a shortage of check-up procedures for pregnant women, many womens impossibility to travel to town to have their pregnancy tests. This has created a pretty difficult situation for families in Romania. The reported infant mortality rate has doubled, we also have discrepancies across the country, between various counties. We have more than 23 counties where the reported mortality rate lies above the rate at national level, with the counties of Botosani and Calarasi sadly being at the top of the list. Mortality rates for these counties are 3 times higher than in Cluj or Bucharest.



    In 2017, the child mortality rate stood at 7.2 per one thousand live births, with premature birth being the main cause of death. Salvati Copiii Association got actively involved in the efforts to properly supply medical units with the required equipment.



    Gabriela Alexandrescu: “We at Salvatii Copiii Association have been trying to make up for that kind of shortage. In recent years, since 2012, we have donated more than 515 pieces of equipment to 88 maternity hospitals, for 42,000 newborns. We have invested more than 4 million Euros, which we have received from corporate and individual donors. Everything was done with the support of people from Romania. Because we have seen and understood that, rather than waiting for the ministry and the authorities to earmark the sums needed, it was in our power to save our children. If we are unable to ensure our childrens right to live, what else is there worth talking about?



    In Romania, there are many cases of congenital heart defects among newborns. Many children are born with such problems and the only hospital where they can have treatment immediately after they were born is the Institute of Cardiovascular Diseases and Transplant in Targu Mures. The medical staff there works on a 24/7 basis, yet their effort is not enough. Out of the around 1,000 heart surgeries per year that are necessary, the hospital in Targu Mures only conducts around 230. Meanwhile, other doctors face equipment shortages. Here is the head of Neonatal Clinic of the University Emergency Hospital in Bucharest, Adriana Dan, with details:



    Adriana Dan: “Neonatal hospitals in Romania are rated according to levels of competence and facilities. There are relatively few 3rd-degree maternities, the best-equipped and best-prepared in terms of human resources. There are around twenty such units in Romania. They are capable of providing care in the premature births with the greatest needs. We run with limited, obsolete and overused equipment. In order for premature babies to survive, it is essential that we have incubators, ventilators, vital functions monitoring equipment, high-quality single-use consumables to prevent the multiple complications that infants with weak immune systems may have.



    We also asked Adriana Dan what neonatologists feel when they succeed in their profession in spite of the shortcomings in the healthcare system:



    Adriana Dan: “On one hand, we are happy that we can help a frail soul and a family that has so much wanted and expected this child. On the other hand, it is a matter of professional pride, when we see that what we do is important. At our annual meetings on November 17, when World Prematurity Day is celebrated, we get to meet the children we have saved and who are two, five years old or have even reached school age. It is such a joy to be able to know that part of what a child is has been possible thanks to you. It is something special.



    This kind of satisfaction will most likely be only felt by a physician who saves the life of a newborn. But for more such performances, Romania needs state-of-the art neonatal hospitals. In 2019, “Salvati Copiii Romania is purchasing equipment for 49 maternity hospitals.



    (translated by: Elena Enache, Eugen Nasta)