My previous post looked at birth in Bosnia from the perspective of episiotomy. I think this example demonstrates how the system is bogged down with bureaucracy which is perpetuating outdated and non-evidence based care. Nevertheless, I realize that there are probably many caregivers who long for change but are too overworked and underpaid to be able to do so. It's also not surprising that women are put "on the clock" and subjected to restrictive policies due to financial and time constraints.
Nevertheless, I think there are some positive aspects to the current situation that deserve a mention, especially if you're looking to have a natural birth. Here are some things I have gathered about the system, which seem quite positive for someone hoping for a natural birth, and there are probably more I've missed. I hope to learn more about the situation in the coming months. By the way, most of them apply to the Bosnian national hospital, Abdulah Nakas.
Baby Friendly Initiative
Abdulah Nakas hospital is a "baby friendly" hospital. It is an initiative of UNICEF and the WHO designed to promote breastfeeding. It includes allowing the mother to have skin to skin contact with the baby immediately after birth and to keep the baby with her afterwards, "rooming-in", rather than have the baby kept in a nursury. Also, the baby is not fed anything a part from breast milk and is not offered a pacifier. I'm not sure how it works at the other hospital in terms of promoting and actively supporting breastfeeding.
Episiotomy
My previous post looked at this issue. I mentionned there, but perhaps it's worth emphasizing that it is only routinely done for first time mothers. I've read a couple of birth stories where the midwife massaged the perineum during a subsequent birth to prevent the need for an episiotomy. Still, the post gave the impression that episiotomy is the norm and it's something special if it is not used, and that is rather disturbing...
More flexible timelines
According to a second-hand account, Abdulah Nakas is a bit more generous in how long they will allow a woman to labour before trying to speed things along somehow. Perhaps this is because it is a bit less busy than the other one in Jazero? Just a guess.
No epidural
When I first heard this hospital didn't even offer epidural, I thought that must be a sign that they were more supportive of natural birth than other hospitals in Bosnia and maybe than others around the world. That may be the case, but it's also possible that they simply haven't evolved since the time when epidural wasn't invented or they don't have the financial resources to pay an anesthesiologist. I guess that would have implications for how many c-sections are done, and if they are done, how they are performed. The other hospital in Sarajevo does offer epidural.
No continuous monitoring
According to the Dr. I spoke to, they don't usually do continuous fetal heart rate monitoring, which is a good thing, because continuous monitoring is known to falsely show signs of distress, increasing the likelihood of unnecessary interventions. Instead, they take the heart rate intermittently.
Water Birth
Abdulah Nakas is the only hospital in Sarajevo that offers water birth. This does seem like a great way to have a comfortable, natural birth. However, my impression is that the staff are not in general comfortable with this kind of birth, as evidenced by the fact that they only allow you to use the pool for two hours and also that they still think an episiotomy should be performed in the water. That is very strange, as the water itself helps soften and stretch the perineum. So, I'm not convinced this is really as good as it sounds. I'm happy to be proven wrong, though!
Skills for handling complicated cases more naturally
A friend of mine had a vaginal breech birth at this hospital about 10 years ago, so it was possible then and may still be. This seems to show that the Drs there have skills that valuable. In many places around the world, Drs are not taught how to handle vaginal breech birth; they are simply instructed to recommend a C-section when a breech presentation is discovered. If it is taught, they are still afraid to do it, as the safety of vaginal breech birth is under debate. However, it is very important to have care givers who are skilled in this area, as a baby can turn breech during labor and this can go undetected until it's too late. Furthermore, breech birth doesn't have to be an emergency if the care giver is calm and experienced.
It does appear that vaginal birth after C-section is allowed, though perhaps there are restrictions I'm not aware of, such as perhaps how close the previous birth was.
Also, it seems that many Drs will support vaginal birth of twins, something that is also not always supported in other parts of the world, such as some hospitals in USA.
Nevertheless, I think there are some positive aspects to the current situation that deserve a mention, especially if you're looking to have a natural birth. Here are some things I have gathered about the system, which seem quite positive for someone hoping for a natural birth, and there are probably more I've missed. I hope to learn more about the situation in the coming months. By the way, most of them apply to the Bosnian national hospital, Abdulah Nakas.
Baby Friendly Initiative
Abdulah Nakas hospital is a "baby friendly" hospital. It is an initiative of UNICEF and the WHO designed to promote breastfeeding. It includes allowing the mother to have skin to skin contact with the baby immediately after birth and to keep the baby with her afterwards, "rooming-in", rather than have the baby kept in a nursury. Also, the baby is not fed anything a part from breast milk and is not offered a pacifier. I'm not sure how it works at the other hospital in terms of promoting and actively supporting breastfeeding.
Episiotomy
My previous post looked at this issue. I mentionned there, but perhaps it's worth emphasizing that it is only routinely done for first time mothers. I've read a couple of birth stories where the midwife massaged the perineum during a subsequent birth to prevent the need for an episiotomy. Still, the post gave the impression that episiotomy is the norm and it's something special if it is not used, and that is rather disturbing...
More flexible timelines
According to a second-hand account, Abdulah Nakas is a bit more generous in how long they will allow a woman to labour before trying to speed things along somehow. Perhaps this is because it is a bit less busy than the other one in Jazero? Just a guess.
No epidural
When I first heard this hospital didn't even offer epidural, I thought that must be a sign that they were more supportive of natural birth than other hospitals in Bosnia and maybe than others around the world. That may be the case, but it's also possible that they simply haven't evolved since the time when epidural wasn't invented or they don't have the financial resources to pay an anesthesiologist. I guess that would have implications for how many c-sections are done, and if they are done, how they are performed. The other hospital in Sarajevo does offer epidural.
No continuous monitoring
According to the Dr. I spoke to, they don't usually do continuous fetal heart rate monitoring, which is a good thing, because continuous monitoring is known to falsely show signs of distress, increasing the likelihood of unnecessary interventions. Instead, they take the heart rate intermittently.
Water Birth
Abdulah Nakas is the only hospital in Sarajevo that offers water birth. This does seem like a great way to have a comfortable, natural birth. However, my impression is that the staff are not in general comfortable with this kind of birth, as evidenced by the fact that they only allow you to use the pool for two hours and also that they still think an episiotomy should be performed in the water. That is very strange, as the water itself helps soften and stretch the perineum. So, I'm not convinced this is really as good as it sounds. I'm happy to be proven wrong, though!
Skills for handling complicated cases more naturally
A friend of mine had a vaginal breech birth at this hospital about 10 years ago, so it was possible then and may still be. This seems to show that the Drs there have skills that valuable. In many places around the world, Drs are not taught how to handle vaginal breech birth; they are simply instructed to recommend a C-section when a breech presentation is discovered. If it is taught, they are still afraid to do it, as the safety of vaginal breech birth is under debate. However, it is very important to have care givers who are skilled in this area, as a baby can turn breech during labor and this can go undetected until it's too late. Furthermore, breech birth doesn't have to be an emergency if the care giver is calm and experienced.
It does appear that vaginal birth after C-section is allowed, though perhaps there are restrictions I'm not aware of, such as perhaps how close the previous birth was.
Also, it seems that many Drs will support vaginal birth of twins, something that is also not always supported in other parts of the world, such as some hospitals in USA.
No comments:
Post a Comment