STSM Report: Women’s rights and decisions around childbirth in the Czech Republic by Ema Hrešanová

Here is Ema Hrešanová STSM report on Women’s rights and decisions around childbirth in the Czech Republic.

Action number: IS1405
STSM title: Women’s rights and decisions around childbirth in the Czech Republic
STSM start and end date: 03/09/2018

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PURPOSE OF THE STSM
Women’s rights violations and violence against women in maternity care have recently received an increasing public and media attention, especially in Central and Eastern European countries in the EU.

Similarly, my recent research on Czech birthing women‘s experience with hospital birth care revealed numerous women’s rights violations and disrespect to women’s wishes and decisions around birth care in Czech maternity hospitals such as: medical interventions performed without a woman’s informed approval, a mother-newborn separation, Kristeller’s manoeuvre, psychic manipulation and coercion to comply healthcare providers’ demands, etc (e.g. Hrešanová 2010, 2014).

This STSM’s focused on women’s rights violations in Czech birth care and on women’s rights and decisions around childbirth in the Czech Republic more generally. Taking the above mentioned long-term research on these issues as a point of departure, this STSM aimed to elaborate a cross-cultural comparative perspective on these issues in close cooperation with Dr Sarah Church from the London South Bank University, UK. Its more general purpose was to contribute to a recent debate on human rights in childbirth in both the UK and the Czech Republic and internationally.

Yet another purpose of this STSM was to finalise work which has been carried out as part of the working group three (with a focus on socio-cultural aspects of maternity care); in particular this included: 1) moving a collectively drafted paper on “Values in maternity care” towards its submission (co-authors are: Sarah Church, Ema Hresanova, Serap Ejder, Ayse Parlak Gürol); 2) consulting a draft of a paper on Czech women’s birth care experiences; 3) acquainting the British midwifery audience with the Czech maternity
and birth care system and women’s birthing experiences while pointing to cases of women’s rights violations; 4) preparing a follow-up comparative research

DESCRIPTION OF WORK CARRIED OUT DURING THE STSMS
This seven-day visit started with a meeting with Dr Sarah Church at the LSBU during which we specified our work plan and discussed the main theme “human rights in childbirth” with respect to particular steps to be taken during my visit and beyond.

In order to get acquainted with birth care services available in London, day 2 (September 4th) was fully dedicated to a detailed visit to maternity units of the Royal London Hospital, Whitechapel. We were guided by Deputy Director of Maternity Services and Head of Midwifery Alison Herron who acquainted us in detail with the organisation of work and all the available services in this London’s biggest maternity hospital, ranging from specialised services for high risk women with a variety of health conditions (such as heart disease) to services for women with uncomplicated pregnancies and labour. These also include services of the midwife led Lotus Birth Centre placed on a different floor than “regular” delivery rooms are located, and services of community midwives. All the maternity services available in this facility and all the health care providers, including obstetricians (whom I also had an opportunity to meet), put a great emphasis on the normalcy of a birthing process, which is in sharp contrast to a dominant approach in Czech maternity hospitals.

On the day 3 (September 5th), Dr Church and I worked on the development of a future research proposal that relates to women’s rights and decisions in maternity care in the Czech Republic and UK and follows up our previous collaborative work.

On the day 4 (September 6th), Dr Sarah Church and the Women’ Health Research Group at the LSBU under her leadership organised a workshop on “Human Rights in Childbirth”. My key note lecture was followed by a presentation delivered by a Human rights officer from the British Institute of Human Rights who talked about particular legal obligations related to human rights around childbirth that are specific to English context and steps to be taken in cases of human rights violations. There was a specific emphasis on the publication Midwifery and Human Rights: A Practitioner’s guide. This was follow-up by a discussion of how midwives could enhance women’s rights in maternity and birth care, as it pointed to frequent women’s right violations not just in Central and Eastern European countries but across the globe.

On the day 5 (September 7th) Dr Church arranged a visit to the Barkantine free-standing birth centre run by the Royal London Hospital in Tower Hamlets. A midwife on duty showed us around and answered our questions about available services, the booking process and working of the centre. (For instance, I learned that midwives working in a birth centre regularly rotate across different wards within the larger Royal Hospital, which is an effective way how to keep midwifery skills up-to-date while keeping birth as normal as possible even in wards for high risk women). In the birth centre I also received a set of maternity notes used across Barts Health NHS Trust. Unlike in the Czech Republic, these are national maternity records developed by the Perinatal Institute and continue to be used in about 60% of all pregnancies in England.

In time remaining, we consulted drafts of papers to be completed for a submission in the upcoming weeks.

DESCRIPTION OF THE MAIN RESULTS OBTAINED
My visit to LSBU and work with Dr Sarah Church was a deeply enriching and illuminating experience. My visits to Royal London Hospital’s maternity units turned to be crucial points of reference for comparisons with the Czech context. They allowed me to get a sense of associated maternity care philosophies and learn about a wide range of options available to women of different backgrounds and of physiological and psychological needs. I was truly fascinated by an overall effort of the lead midwife and the staff (including midwives and obstetricians) to accommodate needs and wishes of all the women and by a genuine endeavour to make childbirths as “normal” as possible even for women with health complications. This stands in a striking contrast to most Czech maternity hospitals, especially those of comparable size and specialisation, which manifest a prevailing tendency to highlight an inherent pathology of childbirth. This is
evident not just on a system level in the overall organisation of maternity care services but in the actual provision of care in situ as well.

This can be well illustrated by a case of a Czech maternity hospital with a large number of childbirths whose management preferred to install a camera system in delivery rooms in order to monitor the progress of labour while cutting the number of midwives on duty (cf. Church 2016). In comparison, the Royal London Hospital has made amendments to provide one-to-one midwife care to as many women as possible in all units; it also provides community midwifery services available to women who choose to give
birth at home in addition to birth centres it runs.

Maternity notes may serve as yet another ethnographic example. I was amazed how informative these were in comparison to similar kind of document called “a maternity pass” in Czech. While the Barts maternity notes include a wide range of information about pregnancy and childbirth and provided care for women, including explanations of medical terms that are easy to understand, the Czech “maternity passes” are very brief, and include only basic information about provided care. There are charts and tables with signs not understandable to women without medical education, yet, they contain numerous adverts for nutrient supplements in pregnancy.

These examples speak of a fundamentally different approach to and position of pregnant/ birthing women in maternity/birth care. In summary, while the Royal London’s maternity hospital strives to accommodate various women’s wishes and needs, the main decision about care is up to the woman; Czech hospitals I have come to know through my ethnographic research, accommodate only some women’s preferences and only sometimes (Hrešanová 2008; 2014). My research even gives evidence of wide-spread women’s rights violations and disrespect to some women’s needs and wishes in Czech maternity units. This partly translates into free-birthing and a high number of certain obstetric interventions (Hrešanová, in preparation).

My visit in London’s unit, the workshop on human rights and discussions with Dr Church also pointed to the importance of regular quality of care checks by maternity care regulators at a national level.

Full document is available to download as a pdf here.IMG_20180904_152409.jpg

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