After a woman in labor from Sremska Mitrovica lost her baby due to obstetric violence in mid-January of this year, more and more women in Serbia are witnessing some kind of violence during childbirth. The autopsy confirmed that the death of the newborn occurred as a result of a violent birth, so the doctor in question was arrested and faces up to 12 years in prison. Meanwhile, another mother accused the same doctor of her baby's death a year ago.
The Minister of Health, Danica Grujičić, initially said that women in labor who were exposed to obstetric violence should contact the director of the institution, who is obliged to order an internal professional check, but also to the Ministry of Health via email in order to activate the health inspection, after which an external inspection is carried out. expert control.
"We have to agree that not everyone will die now, because if the witch hunt starts now, in five years no one will want to be a gynecologist, nor an obstetrician," said Minister Grujicic.
Petition submitted to maternity hospitals
Today, a month later, the topic is still hot: in the maternity hospital in Sremska Mitrovica, in the meantime, the presence of an escort during childbirth is allowed, and the "Kreni-promeni" organization submitted a petition about free escorts for women in labor at the addresses of 20 out of a total of 70 maternity hospitals in Serbia. . Among these maternity hospitals are private ones, the Ministry of Health notes. A petition with more than 195.000 signatures was also handed over to them.
"The Ministry of Health gave an affirmative answer to that petition and promised to send a proposal to all maternity hospitals in Serbia to make it happen," says Petar Petković from the Niš team of the "Kreni-promeni" organization.
"Our goal is that, as it is everywhere in the world, it will come to life in cities in Serbia. First of all, the escort should be free, so that the woman in labor can choose who she wants to be with her that day. If (the birth mother from Sremska Mitrovica) had an escort, we think that everything would have looked different, in terms of preventing obstetric violence. We believe that it could help," says Petkovic.
Zoran Pešić, a lawyer from Niš, also believes in this, whose wife died after giving birth last year, but not because of obstetric violence, but because she was an oncology patient who needed special care. Now that "obstetric violence" is being talked about again in the media, he has decided to provide free legal aid to all mothers who feel they have been harmed.
"Talking about the problem publicly to encourage women"
"Most of the women who contacted me complain about open violence." But there is also verbal violence, there is also failure to provide adequate medical assistance, ignoring the patient and his needs, a disrespect unworthy of any human being, let alone women who are in a sensitive period and need increased attention," says Pešić. He also points out that some doctors are able to be encouraged by the fact that women are vulnerable, and he emphasizes that "there is a need to stand in their way, to stop the practice of violence in that area."
According to Pešić, the solution is in several aspects, and the first, he says, is to talk about the problem publicly in order to encourage women. Another thing, he adds, is to start with criminal reports and reports to health inspections.
"One, two or three reports will not give results, doctors will continue to protect themselves." But ten, twenty, thirty, a hundred reports - then doctors will no longer be able to protect each other. And what is most important, I think that it will encourage those good doctors to continue with good practice and that they are the first to fight against such doctors", the lawyer believes.
Define the term "obstetric violence"
Since obstetric violence as a term does not exist in law, lawyer Pešić explains that there is a whole series of defined criminal acts, among which is the criminal offense against people's health for which the obstetrician from Sremska Mitrovica is suspected and arrested. Or the criminal offense of not providing medical assistance. Pešić believes that a large number of reports, even if they do not lead to the initiation of proceedings, would have to change the awareness of doctors about their behavior towards female patients.
"I think the term 'obstetrical violence' should be defined, separated from obstetrical procedures and active management of childbirth, which means that not every opening of the amniotic fluid is violence against the woman in labor," says Dr. Marija Tasić, head of the maternity ward of the Gynecology and Obstetrics Clinic in Nis. She believes that responsibility should be determined in the accident from Sremska Mitrovica, but also that such a case "should not cast such a negative light on an entire branch of medicine."
Her maternity ward also received a petition for birth attendants. But this practice has existed in Niš since 2015, when the Clinical Center there received accreditation according to the standards of the Agency for the Accreditation of Healthcare Institutions, Dr. Tasić told DW.
"The point is that fathers who want to attend"
"One of the procedures that we had to come up with at the time is the procedure for the presence of a chosen person during childbirth - a close person, whether it is a husband, partner, mother, sister, someone the pregnant woman names... As for interest, it took a little time to came to life, and it started more intensively in 2017. At that time, we had 63 people who attended births, which is 2,5 percent of natural births," says Dr. Tasić.
In the following years, 2018 and 2019, before the corona, those numbers did not change significantly, and the only condition was to attend the school of parenting, which is still held today in health centers. Outside that school, when the time comes for childbirth, interested fathers with documentation come to the maternity hospital for additional explanations from the doctor, where the details of the birth are explained to them.
"The point is that those fathers attend, whose wish is not the wish of the pregnant woman, because then it is not a positive experience, then we have a negative effect." Let's explain to them the stages of childbirth, when he will enter to be with the woman in labor, we allowed them to be present until the very end of childbirth, and there were situations when we allowed them to cut the umbilical cord," says Dr. Tasić. He adds that in this way it is much easier for doctors, midwives and nurses.
However, he emphasizes that for the small number of those interested in attending the birth, it depends not only on the partner, but also on the pregnant woman herself. Many, namely, do not want their spouses to be present, because they are afraid that their partners will look at them differently, says the head of the maternity hospital.
The Ministry is preparing instructions
And Petar Petković from the "Kreni-promeni" organization became a father a year and a half ago. He did not attend the birth of his wife, because he found out about it too late. He was further discouraged when he heard that parenting school lasts seven weeks.
"I think that it is too long and that the school of parenting that exists in Niš is not oriented so much on the birthing procedure itself, and I think that is the only important thing for the companion." "Eventually, a course for attendants could be devised that would briefly, probably in one day, explain the procedure itself and what is expected of the attendant," Petković believes.
We learn from the Ministry of Health that they will make exactly such written instructions in the coming period - about everything that mothers should know immediately before and during childbirth. But also that it will improve and specify the guidelines for the actions of doctors during childbirth.
At the moment, "about half of the maternity hospitals that are in the plan of the network of health institutions of the Ministry of Health have the conditions and offer the possibility of attending births." However, the Ministry emphasizes that in some of the maternity hospitals in Serbia, this service may be limited if several women give birth simultaneously in a common space.
