Maternity wards pay little attention to human rights

The Slovak Spectator, 16. 6. 2015

“So I stayed there those two hours alone, without my baby, without my husband, two hours I was lying there on my own, incredibly thirsty, terribly pained, full of negative emotions about what I’d allowed to happen, […] it wasn’t supposed to be like this.” This is how a woman describes the immediate moments after she gave birth to her child in one of the Slovak hospitals in an interview which was part of the monitoring by human rights watchdog Citizen, Democracy, Accountability (ODZ) and Women’s Circles. The findings of their two-year-long monitoring were published in late April 2015 and show that even though most Slovak hospitals now label themselves baby-friendly and have introduced practices that were unheard of some years ago, from the perspective of human rights, most deliveries in Slovakia are well below standards observed in advanced democracies.

On one hand, a woman can now be accompanied by the child’s father or another person of her choice all through labour and can opt-out of some medical practices. On the other hand, there are many cases when medical intervention is performed during labour and birth without the informed consent of the labouring woman, and many hospitals are unable to secure sufficient privacy for mothers and their babies in the intimate moments of birth, the monitoring authors suggest.

The vast majority of Slovak women give birth to their children in hospitals. Home birth is an option that only exists in a grey area not covered by legislation (and thus the woman who gives birth to her child at home does not have the necessary medical care guaranteed in case of need), and other facilities simply do not exist.

The lax approach to the human rights in maternity wards is for the most part the legacy of the communist regime “and the ubiquity of totality in the maternity wards”, said Janka Debréceniová, one of the authors of the monitoring, in an interview with The Slovak Spectator. Since hospitals are the only places where the state guarantees health care to women in labour, this creates conditions where women are in the power of health-care facilities. “Once they get in, the institutions are hard to penetrate from outside, and public control is very difficult,” Debrecéniová added.

Before 1989, the focus was on the safety of the mother in labour and her child, and the delivery room was turned into a workplace with intensive care and monitoring, said Jozef Záhumenský, head of the gynaecological and obstetric clinic of the Faculty Hospital in Trnava. In result, Slovakia and the Czech Republic had been high in the rankings of quality of obstetric care, with relatively low financial inputs. All women have fully paid and accessible prenatal care, including all screenings. “The comfort and privacy of the women in labour have been slightly forgotten in the process,” Záhumenský told The Slovak Spectator.

In this respect, Slovakia lags behind some western countries, such as the UK, where movements that have pointed out inappropriate methods used in childbirth have been active since the 1970s, Debrecéniová noted. “When we look at birth care in some western European countries, in Canada, Australia, and elsewhere, we see that many of the things that we are pointing out now have already been tackled there,” Debrecéniová said. “And it is no coincidence that the places that have tackled these, are countries with well-established democracies.”

The report noted that it was a common complaint of women who gave birth to their children in Slovak hospitals that they lacked information about what was happening with them, and about their condition as well as the condition of their children. The women described some of the operations, such as incision of perineum, being performed on them without their actual consent. The authors claim that hospital staff have disregarded informed consent by the mothers and deem this one of the major problem of maternity wards in Slovakia.

“The hospital staff, instead of communicating with the woman, let her sign the form when she arrives to the hospital, she is in contractions, and this is a moment when it is hard to negotiate about anything,” Debrecéniová told The Slovak Spectator, labelling this formal approach to informed consent very unfortunate. She noted that the women do not have to sign the form if they do not want to, but admits that this hardly ever happens because “it is hard to stand up against the system in such a moment”. Debrecéniová advises that women sign the consent with the note that is only valid with their birth plan, which they should bring with themselves or send to the hospital in advance by registered mail.