The biggest enemy of a healthy pregnancy is fear, experts say. Unfortunately, when thinking about starting a family in Serbia, that fear is justified because the healthcare system is often not only unsupportive, but cruel. From the moment the test shows a positive result, pregnant women fear whether everything will go well during childbirth. It is common for them, in addition to psychophysical preparations for childbirth, to prepare "envelopes" for doctors and look for "connections".
Midwife Dušica Kovačević, who through the program "Fit and healthy mom" empowers and supports women to self-consciously and confidently fight for their rights in maternity wards, tells "Vreme" that pregnant women often come to preparations with prejudices and with advice from those closest to them. they must have "someone of their own" during childbirth.
Numerous testimonies of exasperated mothers in labor who shared their experiences publicly say that they honored the doctor before giving birth, even though he did not ask for it, but they were told that it should be so. These amounts, according to the aforementioned testimonies on social networks, range from 300, 400 euros and upwards. There are also surcharges for the midwife and the epidural (which is covered by the health insurance), which amount to around 150 euros. The tariff for a caesarean section on request is around 500 euros, and some doctors in smaller areas charge it differently, depending on the gender of the child. Thus, according to some women in labor, 500 euros are set aside for a girl, and 800 for a boy.
And before that, only the costs of the "birthing bag", which every pregnant woman should bring to the maternity hospital, amount to 100 to 200 euros. In addition to towels, nightgowns, slippers, accessories for personal hygiene and mesh panties and pads, it contains the necessary balms, suppositories, creams...
PAYMENT BOTH ON THE BRIDGE AND AT ĆUPRIJA
According to the Law on Health Care, adopted on April 3, 2019, doctors may receive non-monetary gifts whose total value does not exceed the average salary, which is around 700 euros.
"It goes against everything that is happening in the world. In developed countries, there are different models of the health system, but the one we have is definitely the worst - you pay for health insurance, and in the end you are forced to manage the pregnancy privately, and to 'honor' doctors in state institutions", says Dušica Kovačević.
The average price of a gynecological examination in a private clinic is from 7000 to 8000 dinars.
As an entrepreneur, Dušica Kovačević also points out that employees often do not have a clear picture of how much of their money is allocated for health insurance.
"If you were to invest that money in some private health insurance, you could secure the most expensive policies," says our interlocutor. However, the different experiences of pregnant women from state and private hospitals in Serbia show that money does not guarantee anything but kindness. When someone has the money to afford "different treatment", it is not clear what exactly he means when it comes to the act of giving birth to a new human being.
VISION OF PRIVATE MATERNITY
The price of childbirth in private hospitals ranges between 320.000 and 470.000 dinars, depending on the method of delivery and the chosen doctor.
There, among other things, every woman in labor has at her disposal a personal gynecologist, anesthesiologist, neonatologist and several nurses and midwives who take care of her 24 hours a day, throughout her stay in the maternity hospital. For that money, an air-conditioned apartment with a bathroom, TV and Internet, a restaurant, as well as things needed for the maternity ward, such as nightgowns and mesh pads, are provided.
"We end up paying for hotel accommodation. Conditions are certainly better, some things in state institutions have not changed for 15 years. For example, the menu is definitely better, you can also get clean bed linen...", explains Dušica Kovačević.
From her perspective, the vision of a private maternity hospital is different. "Mama needs to be met. If she wants to give birth in water, let her do it, if she wants, she can have acupuncture during childbirth, and apply all the alternative methods that women might otherwise use. Why can't homeopathy be practiced during childbirth? Such a thing is recognized in the world", believes midwife Kovačević.
As he says, it would be best to find a middle ground between medicine and a holistic approach. "Even in a private maternity hospital, you cannot drink water during childbirth and you have to give birth on your back," she adds.
Childbirth in water is only possible at KBC Zvezdara, but, as told to "Vreme", only from spring, when it is not this cold.
Examples of good practice exist all over the world, but also in the countries of the region. The approach is mostly adaptable, adapted to the woman. Serbia could emulate the environment and change something, but there is a lack of interest and will for changes among healthcare workers as well.
"For example, I organized an education for midwives where I brought a midwife from Germany to share her experience. I was afraid that no one would apply, but eight of them applied. I was happy that young midwives came forward, but I would have liked more older, experienced ones who want to change something", says Dušica Kovačević. The key problems, he says, are the feeling of dissatisfaction among them. Also, the cooperation of doctors is lacking. Pediatricians often condemn speeding up childbirth and indicate how harmful it is for the baby, while some gynecologists will say that in the 21st century it is normal to "organize" childbirth.
COME, WE WILL FINISH
"There are gynecologists who openly work according to the principle I'm on call, come, we will finish, expecting compensation afterwards. We should not be silent and pretend that it does not exist. When everyone decides not to participate in this corruption, things will change", Dušica Kovačević points out. That is why, she adds, she fights to empower women and to convey to them what it means to give birth to a child.
"It does not depend on the doctors on duty, nor on the midwives. I teach them which tools to use, how to breathe, how to recognize contractions and what the breaking of the water means... Through it all, the woman relaxes slightly, listens to her body and finally knows how to make a decision and say loudly and clearly what she feels and what she would like she loved."
As our interlocutor points out, the essence is to humanize the attitude towards childbirth and women. "I would start with education from high school to college. We are witnessing different statements in the media, which some doctors, professors from the university, the minister of health, and all that does not seem like anything will change. We cannot welcome the fact that someone will invest in the renovation of the maternity hospital with enthusiasm, because it follows us", he concludes.
Let us remind you that the President of Serbia, Aleksandar Vučić, announced that maternity hospitals in several capital cities in Serbia will be reconstructed in the next four years. At the presentation of the "Leap into the future - Serbia 2027" program, he described the maternity hospital in Nis as "terrible". Three days later, these claims were confirmed by the Minister of Health, Danica Grujičić, saying that the maternity hospital was "in a miserable state".
However, given that the quality of the maternity hospital does not depend only on the inventory, but also on the people who work there, maternity support in Serbia will require larger and more complex investments.
As the interlocutor of "Vremena" says, it is necessary to penetrate the system in order for people in it to connect, educate and progress. "But without systemic resistance. Because now, in the midst of the obstetric violence, the Popular Front has decided not to visit. They cited covid and flu as the reason, but it seems that such decisions are sending a message to pregnant women and future parents", says Dušica Kovačević.
PILATES, JACUZZI, ESSENTIAL OILS, KEVAPI
Conditions in maternity hospitals in the countries of the region sound like science fiction for Serbian pregnant women - from pilates and relaxing in a bathtub with the scent of essential oils, the "golden hour" with the baby, to kebabs for lunch after giving birth.
Maternity hospitals in Germany organize "open doors", when women who are a month or two away from giving birth come to see the delivery box and the rooms themselves. Then they bring their medical documentation and declare whether they want accompaniment during childbirth, childbirth in a tub, epidural anesthesia... And all of that is covered by health insurance.
It is also allowed to give birth in different positions, i.e. in the position that suits the pregnant woman the most.
Both in Slovenia and Croatia, the father's presence is unquestionable, with visits to the mother and baby after childbirth; in the United States of America, up to three people can attend the birth; in Sweden, various pain relievers, such as so-called laughing gas, are provided in the room for mom, dad and baby. The birth is led by a midwife, and the doctor appears only in case of complications.
SUPPORT I/OR PROTECTION
The issue of accompanying during childbirth has not yet been resolved in all maternity hospitals in Serbia. In some cases, the presence of a partner or a close person at the birth is possible free of charge. All private hospitals also offer this service at a price of around 15.000 dinars.
Mothers in labor can count on support at GAK Višegradska, GAK Narodni front, Zvezdara, KBC Zemun, at the General Hospital in Pancevo, Vrbas, Subotica, Zrenjanin, Senta, Valjevo, Zaječar, Niš and Bačka Topola. After a reported case of obstetric violence in the hospital in Sremska Mitrovica, during which a baby died during childbirth, this institution also approved accompaniment during childbirth.
The presence of a father, family member or friend during childbirth has a positive effect on the child's development and the mother's recovery, according to the World Health Organization. And accompaniment during childbirth in Serbia is viewed from a different angle - more as a desirable and necessary measure to prevent or alleviate obstetric violence, that is, psychological and physical abuse of women during childbirth.
