A woman's right to choose

There are different motives for women who decide to give birth at home. Among other things, some of them are frightened by the news about obstetric violence in maternity hospitals and are more afraid of giving birth in hospital conditions than at home. In the middle of the summer of this year, two documents appeared in Belgrade hospitals that are given to women in labor for inspection and signature - Consent on caesarean section and Consent on vaginal birth - which list all possible complications and what can go wrong. At the end of those documents, a signature and ID card number are requested, that the signatory-birther agrees that, if something goes wrong, the hospital staff is not responsible.

Is home birth a trend, a movement or a response to obstetric violence? The interlocutors in the following text - birth mothers, midwives and doulas - emphasize that they have nothing against giving birth in hospital conditions, but that they advocate for women's right to choose,

CULTURAL AND TECHNOLOGICAL VIOLENCE

Dr. Vuk Stambolović, retired associate professor of the Faculty of Medicine and former manager of the Institute for Social Medicine of the Faculty of Medicine of the University of Belgrade believes that home birth is much more than a trend. "It could be said that this is a kind of birth guerrilla, and like every other guerrilla, this birth guerrilla was created as a response to mass oppression. Namely, a woman who gives birth in the local hospital conditions is exposed to double violence. One violence is cultural, and the other is technological. Regarding the first, obstetric hospitals are not isolated islands in relation to the cultural context typical of the community in which they are located. And this means that in the maternity hospital, the attitude towards the woman in labor is the image of the dominant attitude towards women in the environment in which the hospital is located. And according to the scale constructed by the American psychologist Claire Graves, which has eight levels of psychosocial existence, Serbia is at a rather low, third level - that is, egocentric - with a strong tendency to regress to the second, tribal level of psychosocial existence. There is a lot of data and research that indicates what this practically means for the relationship with women."

According to the professor, secondly, technological violence refers to the violence of medical technology.

"Essentially, it is about the obstetric institution appropriating the woman's body and her ability to give birth through a medicalizing procedure that dehumanizes the woman. A woman is, in fact, reduced to a group of tissues and bodily fluids, that is, to an object of manipulation. Practically, this dehumanizing procedure is more important than the woman giving birth, and this can be seen from the fact that it is part of her and elements that can disrupt the course of childbirth and even harm either the mother or her child to a certain extent. There are more examples of that, from the lying position of the mother in labor to the Kristeler procedure (when the baby is pushed out of the womb by strong pressure on the mother's stomach) which, for example, has been abandoned and virtually banned in Germany and France."

HOSPITAL OR NATURAL BIRTH

I give birth at home supervised by midwives and doulas/family members/friends, who follow the course of the birth, with the consent of the mother and with health precautions.

Doctor Milica Tubić Gačić (25) says that she gave birth the first time in a hospital, and the second time at home.

"As a doctor, the concept of home birth was really miles away from me," says Dr. Tubić Gačić. "I thought that giving birth at home was just another hipster trend in which I could not see any biological and medical basis and justification. My first birth was in a hospital and for my clinical knowledge and experience at the time, it went exactly as I imagined. I did not experience any obstetric violence, unkindness of the staff, but on the contrary, as their colleague I had really special care and attention."

Dr. Tubić Gačić cites the awareness and presence of a woman, without induction or episiotomy, as the main difference between a hospital medical birth and a natural home birth: "When you give birth to a child at home, you continue to live your everyday life with your family, in your bed and in the bathroom as if an ordinary day. Women who give birth freely and undisturbed in their home are women who take absolute responsibility for themselves and their child and as such are the armature of a society".

Marta (33) gave birth at home with her first and so far only baby.

"The situation in our maternity wards is the only thing that made me decide to give birth at home. Regardless of the fact that I believe that childbirth as such is not necessarily an event that requires hospitalization and that it would be very good if women (and their partners) were encouraged to give birth at home, I still counted on giving birth in a maternity hospital. The problem is that every birth tends to look more or less the same: induction, epidural, episiotomy. In particular, at KBC "Zvezdara" I received a written promise that they would give birth to me in 15 to 60 minutes. In the same document, it is necessary that you and your partner sign that, in case anything goes wrong, even if it leads to the death of the mother and/or the child, you release the hospital and all hospital staff from any responsibility. In addition, the sources I consulted emphasize the importance of cutting the umbilical cord only when all the blood has passed from it to the baby. It is the baby's blood, it contains stem cells, antibodies and nutrients necessary for the baby. In our country, the umbilical cord is cut immediately. During the first 24 hours, the baby is given two vaccines, regardless of the fact that the little being has just seen the light of day. To most of my questions about whether the aforementioned formalities can be performed at a slower pace, I received a universal answer: 'So, do you want your child to die?' All the publicized cases of obstetric violence and babies killed during childbirth certainly did not contribute to my choosing to give birth in a maternity ward. On the contrary. My fear of the maternity ward was greater than my fear of giving birth.”

Marta says that during the birth they drank coffee and had breakfast: "I walked as much as I wanted, filled the bathtub, took a nap, I behaved in accordance with the needs of the body at that moment. The midwife performed several examinations that day and monitored the baby's heartbeat, and the umbilical cord was cut by the child's father after half an hour. We all recognize that feeling of security that comes with own home: its smell, the way the parquet floor creaks, the road catches the draft, the softness of a clean towel. It's all soothing and safe. It makes you relaxed, this security gives the body space to focus on the serious task of bringing a new life into the world".

Marta registered the child by calling the municipality, told that she gave birth at home and made an appointment with the registrar, and with the child and two witnesses, a Birth Certificate was issued.

The motive of Hadži Aleksandra Jevtić (36) was not so much fear of the maternity hospital as favoring alternative methods of treatment, hence the decision to have a natural birth outside a hospital.

"I don't think it's a modern trend, since my four great-grandmothers gave birth to a total of thirty children in home conditions, without running water, electricity and the Internet. If my great-grandmothers were able to give birth to so many children in much less favorable conditions compared to today's times, why can't I be able to now, even easier and more beautiful than them? And the trend is increasing and a lot has changed in the last ten years that I have been actively following this topic, precisely because of the increasing number of women in Serbia who decide to give birth at home", says Aleksandra Jevtić.

Her birth experience was similar to Martina and Milično and, as she states, wonderful: "Towards the end, I no longer had any fear of anything. And the baby came out in the most gentle way possible, in an undamaged amniotic fluid. When I was pregnant, I was delighted by the birth video on YouTube during which the baby was born in the entire amniotic sac, but I never dreamed that it could happen to us too! I don't remember exactly how my research into the topic of natural, unmedicated, home birth began, but my attention was directed to natural healing methods from my earliest childhood, due to a grandfather who made herbal salves and was interested in bioenergy and Chinese medicine, and then and the topic of natural home birth just added to my existing interests”.

A WOMAN'S RIGHT TO CHOOSE

The representatives of the Association of Midwives of Serbia and the Doula of Serbia note that they are not advocating the home birth movement, but the right of women to choose. Divna Miljković is the president of the Association of Midwives, a person who has given birth to countless women in maternity hospitals and at home. He tells "Vreme" that home births take place legally all over the world, and that the most famous example is the Netherlands, where this practice is regulated by the health system, which directs them to home births. It is similar in other European countries such as Slovenia, Hungary, France, Germany, Austria, Italy, Sweden, Denmark, as well as on other continents in America or Canada... In Serbia, it is not regulated by the Law on Health Care and the system does not support this health care service. According to her, for quite a few women, the corona virus pandemic was the trigger for making the decision to give birth at home.

"Many professionals from this field advocate for better cooperation with the healthcare system," says Divna Miljković. "With joint forces, we can support women in an even better way in their needs to bring their child into the world the way they want it. Every woman in Serbia has the right to give birth at home by her choice. Home birth is legal and therefore there is a procedure that defines how a woman and their families can register a child after a home birth. The procedure for registering a child varies from city to city and from municipality to municipality, but this information can be obtained by contacting the relevant institutions directly."

In order to give birth at home, it is necessary that the woman in labor be healthy and that she does not have any accompanying diseases that imply childbirth in hospital conditions, and if some unforeseen circumstances occur, the emergency service takes the woman in labor to the nearest maternity hospital.

"Professional training and experience give midwives the legitimacy to be able to support a woman in childbirth wherever it takes place, and also to anticipate possible irregularities," continues Divna Miljković. "When it comes to giving birth at home, it is the pregnant woman who decides who will support her during the birth besides the midwife. It can be a doula, partner, mother, friend or relatives. I notice that lately doctors are also respecting women's decision to give birth at home more and more."

Midwife Miljković explains that throughout history, women have given birth under a veil of shame, alone and secretly, sometimes outside the house in the woods, in groves, or in the best case, in barns with the help of a relative or a nanny. The first midwives were mentioned in 1724 during the Austrian occupation of the Belgrade Pashaluk, and most of them were foreigners. The year 1886 is considered the year of true development of obstetrics and gynecology in Serbia, because women's hospitals and the first royal school for midwives were opened then. In the 99th century, giving birth in institutions was unpopular - the percentage of women who gave birth in hospitals was only one percent, while today we have the opposite situation - only one percent give birth at home, and XNUMX percent in hospitals.

"Women decide to give birth at home for various reasons. Some choose to give birth at home because they think it's the safest place, some will follow their intuition, some will take a scientific approach and make a decision after reading and getting detailed information about the physiology of pregnancy and childbirth. Also, some women feel that childbirth is deeply spiritual and that they can only achieve that deep spirituality at home, while some others do not want to interact with the system and want to keep their freedom by giving birth at home," says Divna Miljković. .

Birth at home is not covered by health care and there is no reimbursement from the RFZO as in other countries. It is not a dizzying amount and is significantly less than giving birth in a private clinic, and approximately the same as a monetary thank you to obstetricians and hospital staff for "watching" the woman in labor.

photo: pexels / duda oliveira

Dule of Serbia

Jovana Filipović, the president of the Association of Doulas of Serbia, explains that doulas do not give advice and do not perform any medical examinations and evaluations, and therefore it does not matter which profession they are primary. Doulas provide support on four levels: informational, emotional, physical and advocacy.

"It is important that they adhere to the code of ethics that we, as a formal association and soon members of the European Doula Network, have harmonized with world and European standards of doula practice," says Jovana Filipović. From 2012 to 2021, we had DONA International training for doulas in Serbia, one of the oldest and most famous North American organizations whose educator came to us from Hungary. Since 2024, we have formed an official association and, continuing our cooperation with the same educator, we are developing more thorough and comprehensive training for birth doulas, in which we also include our experienced doulas, master psychologists and psychotherapists under supervision, midwives, massage teachers for pregnant women and massage therapists, birth educator, instructor and teacher of yoga for pregnant women, practitioner of Bryrh Art and expressive art therapy, colleagues from the environment (Croatian doula association) and the president of the Center for Mothers. With live lectures and workshops, recorded material and a manual in Serbian, recommended literature, our 45-hour training is spread over several months for integration and acquisition of knowledge."