Doctor who deliver babies is called

What Is an Obstetrician?

Written by Judith Hurley, RD, MS

An obstetrician is a doctor who specializes in pregnancy, childbirth, and a woman's reproductive system. Although other doctors can deliver babies, many women see an obstetrician, also called an OB/GYN. Your obstetrician can take care of you throughout your pregnancy, and give you follow-up care such as annual Pap tests for years to come.

OB/GYNs have graduated from medical school and completed a four-year residency program in obstetrics and gynecology. The residency trains them in pre-pregnancy health, pregnancy, labor and childbirth, health problems after childbirth, genetics, and genetic counseling. A board-certified OB has completed the residency training and passed rigorous written and oral exams.

What Your OB Does

During your pregnancy, your OB will:

Monitor your health and your developing babies' health, including doing routine ultrasounds, measurements, and tests
Check for health conditions that could cause problems during your pregnancy or affect your babies' health, such as high blood pressure, diabetes, infections, and genetic disorders
Advise you about diet, exercise, medications, and staying healthy
Help you cope with morning sickness, back and leg pain, heartburn, and other common pregnancy complaints
Answer your questions about pregnancy and your growing baby
Explain what will happen during labor and delivery

Your OB will also:

Deliver your babies
Monitor your health while you recuperate

How Your OB Works With Your Pregnancy Team

Your OB will play a central role before, during, and after your pregnancy.

OBs work together with nurses, nurse-midwives, physician assistants, and other health professionals to provide your care. You may see these team members during your routine prenatal visits.
Your OB may recommend that you and the dad-to-be attend pregnancy education or childbirth classes led by nurses or childbirth educators.
When the big day arrives, nurses or labor coaches will help you through the hard work of labor, but your OB will monitor your progress and, when the time comes, deliver your babies.
If your OB is in a group practice where the doctors share "on call" duties, another doctor in the group may deliver your babies. Be sure to ask about this when choosing your OB.

Why You Might Need an OB

Family doctors and midwives can also coordinate your pregnancy care, but there are certain situations where it may be important to seek care from an OB:

If you are over 35 years old or have a high-risk pregnancy, you might want to get your prenatal care from an OB.
Some women with high-risk pregnancies benefit from seeing a maternal-fetal medicine specialist, an OB with advanced training in complicated pregnancies.
If a family practice doctor or midwife is providing your pregnancy care, and you develop complications, they will probably consult with or refer you to an OB.

If you are healthy and anticipate a healthy, normal pregnancy, you still may prefer to get your care from an OB.

How to Choose Your OB

When you start your search, ask your doctor for recommendations. You can also ask friends or family if there’s someone they might recommend. The questions below can help you choose the right OB for you.

Does this doctor have a good reputation?
What is this doctor's training and experience?
What is the OB's general approach to pregnancy care and delivery?
Will the OB support the type of delivery I want (elective induction, natural birth, water birth, no pain meds)?
Am I comfortable with the OB's views about when to induce labor or perform a C-section?
What percentage of the OB's patients have C-sections?
What percentage of the OB's patients have episiotomies, and under what circumstances are they performed?
If I want to work with a doula, will the OB support that choice?
How does the OB manage pain during delivery?
Who covers for the OB when they are not available?
If another OB might handle the delivery, can I meet them beforehand?
Does the doctor listen to me and explain things clearly?
Is my spouse or partner comfortable with this doctor?
Is the office staff pleasant and helpful?
Is the office location convenient?
How are emergencies and after-hour calls handled?
What hospital is the OB affiliated with?
Does my insurance cover this doctor's services?

Midwife vs OB-GYN: What’s the difference?

You’ve gone through all the test sticks in the box, and those little lines keep staring back at you. It’s confirmed: you’re pregnant! First come a mix of emotions ranging from completely thrilled to terrified. Then come the questions:

“How will I tell my family and friends?”

“Am I having a boy or a girl?”

“What do I do next?”

One of the most important next steps is deciding who will care for you throughout your pregnancy and during your labor and delivery. So the next question is: Should you choose an OB-GYN or a midwife?

“You want a trusted, reliable partner who can help you navigate your pregnancy with care and compassion,” says Dr. Katie Krumwiede, medical director for HealthPartners’ OB-GYN. “This is a very personal decision to make. It’s important to know your options.”

To help you learn more about your options, let’s dive into the similarities and differences between midwives and OB-GYNs, where doulas and family medicine doctors factor in, and what you should consider when choosing who to trust with your care.

What’s the difference between a midwife and OB-GYN? Let’s talk about similarities first.

You probably know that both an OB-GYN and a midwife can deliver babies. But they share far more in common.

Midwives and OB-GYNs are both highly trained and certified

Midwives and OB-GYNs are experts in women’s health and pregnancy care who have extensive specialty training and experience in their field. In addition, each has received a relevant certification, which means they have demonstrated knowledge and skill within their area of expertise.

Midwives and OB-GYNs are committed to your safety and comfort

Midwives and OB-GYNs are extremely passionate about what they do. And they want to make sure you and your baby are happy, healthy and safe throughout your pregnancy experience. So, they’ll work with you to honor your pregnancy goals and birth plan, while also offering their expertise and information on all your care options as your pregnancy progresses, including pain management during labor and delivery.

Midwives and OB-GYNs strive to give you the best experience

You probably have a vision or plan for how you want your prenatal care, and labor and delivery to go. However, you might think you need to trade experience for expertise (or vice versa) depending on the type of care provider you choose. But that’s not true.

At HealthPartners, our OB-GYNs, midwives and pregnancy care teams strive to deliver your baby, your way. That means we all want to help you have the care and child birthing experience you’re hoping for, regardless of who you choose as your primary specialist.

Now, let’s talk about the differences between a midwife and an OB-GYN

OB-GYNs and midwives both provide great pregnancy care and safely deliver babies. But there are some fundamental differences.

OB-GYNs and midwives have different credentials and educational backgrounds

While OB-GYNs and midwives are part of the same specialty area, the training, education requirements and credentials they hold are different.

OB-GYNs are medical doctors

An OB-GYN – which is short for obstetrician-gynecologist – is a medical doctor who specializes in women’s reproductive health, as well as pregnancy care and delivering babies. They’re also surgically trained and can perform Cesarean sections (C-sections) when necessary. You may already visit an OB-GYN for your annual well-woman’s visit.

When it comes to training and education, OB-GYNs complete four years of medical school, a four-year residency program and a three-year fellowship.

Board-eligible vs. Board-certified OB-GYNs

OB-GYNs – like other medical doctors – can also pursue certification from the American Board of Obstetrics and Gynecology (ABOG) after they’ve completed their residency and gotten their license to practice. Board-certification is optional but a mark of distinction, implying that a doctor has gone above and beyond the minimum standard of education in their field.

The path to certification requires passing a qualifying exam, preparing an extensive case list demonstrating expertise in multiple categories, and then passing a certification exam. At HealthPartners, all our OB-GYNs are board-certified.

Midwives are trained and experienced health professionals

Like OB-GYNs, many midwives can provide a broad range of women’s health services such as annual checkups, birth control and menopause care. But pregnancy, birth and postpartum care is what they’re most widely known for.

They work closely with the rest of your health care team (e.g. OB-GYN or family doctor) to meet your needs during your pregnancy. Many women continue to use their midwives for care after their delivery, too.

There are three levels of midwifery credentials:

Certified professional midwife (CPM) – Certified professional midwives are specialists who have demonstrated their knowledge and skills in providing midwifery services, and been certified by the North American Registry of Midwives.
Certified midwife (CM) – Certified midwives are non-nurses who have earned a post-graduate degree in midwifery, and have also been certified by the American Midwifery Certification Board.
Certified nurse-midwife (CNM) – Certified nurse midwives are registered nurses (RNs) who have master’s or doctorate degrees in nursing. They have also received their American Midwifery Certification Board certification.

In the United States, the vast majority of midwives have completed graduate degrees. At HealthPartners, all of our midwives are CNMs.

OB-GYNs and midwives have different birthing specialties

Birthing specialties are one of the most important differences between midwives and OB-GYNs. Why? Depending on your needs, certain specialized care may be required for you and your baby’s health and safety. And depending on your preferences, you may be looking for someone who has specific experience. Here are a few examples:

High-risk vs. low-risk pregnancies – OB-GYNs can manage high-risk or complicated pregnancies such as women who are expecting twins or have preexisting medical conditions. Midwives, on the other hand, can manage low-risk pregnancies and births.
Water births – While water births (or tub births) are becoming increasingly common in hospital settings where OB-GYNs are the primary care provider, they are very common within the midwifery specialty. So, if you are leaning toward a midwife, chances are high that water births are among their top specialties.
C-sections – Midwives can’t perform C-sections, whether they’re planned in advance or become needed to safely deliver your baby. OB-GYNs have the surgical training to perform scheduled, unplanned and emergency C-sections, which is one of the reasons they can handle high-risk or complicated pregnancies.

Midwives sometimes deliver babies outside a hospital setting

OB-GYNs almost always deliver babies inside a hospital-based birth center. But midwives can deliver babies in a few different ways:

Home births – When women with low-risk pregnancies plan home births, midwives are the professionals who support the labor and delivery process.
Freestanding birth centers – Freestanding birth centers are not part of a hospital and they’re designed to provide a home-like, non-medical environment for birth. While some freestanding birth centers may have OB-GYNs on their care team, midwives are usually the main care providers.
Hospital-based birth center – Midwives – like our certified nurse-midwives – can also be part of a larger care team at a hospital. A hospital setting is the safest place for giving birth. There, midwives can offer more pain management options and connect you with other specialized care if need be. All our midwives deliver at hospital-based birth centers.

Midwife vs. OB-GYN: A side-by-side comparison

Want to see the differences between a certified nurse-midwife and an OB-GYN at a glance? Here’s a quick overview of OB-GYNs versus midwives:

Doula vs. midwife: Another part of the pregnancy care equation

As you’re considering your options, midwives and doulas may come up in your research and conversations with friends. And it’s important to know what sets them apart.

So, what is a doula?

Doulas are trained professionals who provide physical, emotional and informational support throughout the pregnancy, birth and postpartum experience.

What’s the difference between a doula and a midwife?

While doulas are trained professionals, they’re not trained health professionals like midwives. Doulas do not deliver babies, rather they provide support through the process. Midwives (and OB-GYNs) deliver babies and are responsible for the health and well-being of their patients. At HealthPartners, we can help connect expectant mothers with doulas and welcome them in our hospitals.

What about family doctors? Can they provide pregnancy care?

Yes. Family medicine doctors can provide care during pregnancy, delivery and postpartum. But not all family doctors practice pregnancy care. And for those that do, not all have trained to perform C-sections.

So, if you already have a family doctor and think you may want to continue to see them, check with them to see if they can provide you the right care.

Choosing between an OB-GYN and midwife for pregnancy care: What to consider

Choosing who to trust with your pregnancy care and child’s birth is a very personal decision. Your goals, preferences, and health and safety should all be top of mind. Here are some things to consider as you weigh your options.

Is your pregnancy considered high risk?

If your pregnancy is deemed high risk or complicated, you’ll work with an OB-GYN who may also coordinate care with a maternal-fetal medicine doctor, who specialize in high-risk pregnancies. Remember, midwives focus only on low-risk pregnancies and births.

What is a high-risk pregnancy? If you have a preexisting medical condition like diabetes or high blood pressure, you may be considered high risk. If you’re expecting twins, triplets or other multiples, your pregnancy may be considered both high risk and complicated.

Where do you want to deliver your baby?

If you’re low risk and are considering a home birth or a freestanding birth center, a midwife is likely at the top of your list of potential care providers.

But the vast majority of births happen at hospitals or their attached birth centers, where both OB-GYNs and midwives can deliver babies. Hospitals are always the safest place to deliver your baby.

However, most OB-GYNs and midwives only deliver at one or two select hospitals. So, when you’re choosing between a midwife and OB-GYN, you may also be choosing a hospital to give birth at.

How do you want to deliver your baby?

If you’re low risk and leaning toward a water birth or hypnobirthing, an experienced midwife is who you’ll want to look into. But regardless of risk, if you think you’d be more comfortable with a medical doctor providing your care, then an OB-GYN might be the best fit.

If you want a wide range of birthing and pain management options so you can have flexibility when birth day arrives, finding a midwife or an OB-GYN who delivers at a hospital is key.

How do you want to manage pain during labor and delivery?

Whether you’re planning to forgo pain medication or you know you want an epidural, both midwives and OB-GYNs can provide you with a range of options.

That said, midwives often specialize in natural or little-to-no pain medication births. So, make sure to ask any midwives you’re considering about their experience in this area.

Your pain management options will also be limited if you choose a home birth or a freestanding birth center. So, if there’s any chance that you may want more options or you just want some peace of mind, make sure you choose a hospital to deliver at.

What kind of team do they work with?

The person you choose will likely be part of a larger team. Some teams are multi-disciplinary, meaning they work alongside a lot of different specialists. Other teams may be more focused within their specialty area.

It’s important to understand what kind of team your midwife or OB-GYN works with for a few reasons:

If you choose a midwife for care, you’ll want to make sure they have the ability to coordinate care with an OB-GYN and other specialists if complications arise.
Depending on the appointment type, you may not see your OB-GYN or midwife for every prenatal appointment. So, it’s good to find out who you may be getting care from on a regular basis.
The midwife or OB-GYN you choose for prenatal care may or may not be the one to deliver your baby. Every clinic is different but OB-GYNs and midwives usually share hospital on-call duties with a group of others in their field. That means “your” doctor may not be on-call when baby decides to make their entrance. So, for peace of mind, it’s good to know who’s on their team.

What kind of ongoing care do you want?

OB-GYNs and midwives can provide ongoing care for your reproductive health. So, as you’re looking at your options, think about whether you want someone you can see for years (and maybe even pregnancies) to come. Think about the qualities and areas of expertise that are important to you, from preventive care to fertility.

What kind of coverage does your insurance plan offer?

Many women wonder if there is a cost difference for an OB-GYN versus a midwife. But the cost of delivering a baby primarily varies based on where you deliver and what type of delivery you have, not who delivers your baby.

It all depends on your health insurance plan. The one exception here may be home births. Home births are usually not covered by most insurance plans.

Also, it’s quite possible that not every hospital or birthing center is included in your specific insurance plan. Likewise, there are different insurance coverage levels associated with C-sections and vaginal deliveries.

So, before you make any appointments, it’s best to check with your health plan to understand your coverage. There’s no such thing as a silly question. Member services representatives are there to answer exactly these types of calls.

If you have HealthPartners insurance, you can log into your HealthPartners online account. Or, call Member Services at the number on the back of your member ID card.

Ready to find your pregnancy person? We can help.

We try to make it as simple as possible for you to find the right specialist for your pregnancy care.

Through our doctor match tool, you’ll answer a few simple questions and we'll match you with doctors and certified nurse midwives who fit your preferences. From there you can make an appointment with the person of your choice, or you can explore their individual profiles and reviews to help you choose.

Another way we make it easy for you to get great care is by offering a range of appointment options, which includes in-person and video visits for prenatal care.

how will it be? What do the doctor and midwife of the maternity hospital do. Childbirth in the hospital. Who will help the mother in labor?

Many different specialists work in the maternity hospital, but most of all, a pregnant woman is interested in who exactly from the medical staff will be with her in the maternity unit. Let's talk about the medical specialists who will be there at the crucial moment of childbirth.

Obstetrician-gynecologist: head and assistant

The chief medical specialist in the maternity block is an obstetrician-gynecologist. His job is to make strategic decisions. This means that it is the obstetrician-gynecologist who decides how a woman can give birth, monitors the course of childbirth and the condition of the woman in labor and the child at this time. Without a doctor's instruction, none of the staff of the maternity unit can make any appointments or manipulations that may affect the course of childbirth. And this is justified: after all, it is he who is responsible for everything that the obstetrician-gynecologist prescribes and does in the rodblok. Looking ahead, let's say that the doctor does not directly accept the child during childbirth - this is the work of a midwife. Then what does this specialist do in practice?

First, the doctor examines the woman in labor, finds out how the pregnancy went, and draws up a plan for the delivery. Then the obstetrician observes the state of the woman in childbirth, although he is not constantly present with her in the maternity ward. In the first stage of labor, the doctor examines the woman in labor every hour, conducts a vaginal examination in order to assess the birth process, to determine how the baby moves through the birth canal. In addition, the obstetrician-gynecologist evaluates the results of tests, cardiotocography (CTG), monitors the dilatation of the cervix, the nature of labor, and so on.

Another doctor conducting labor performs manipulations such as amniotomy (puncture of the amniotic sac) or episiotomy (perineal incision). He decides at what point an anesthesiologist is needed, and also prescribes the necessary medications. During the birth of a baby, the doctor is next to the midwife and monitors how she provides obstetric benefits. After the baby is born, the obstetrician-gynecologist records the time of his birth, examines the puerperal and evaluates her condition. In addition, the doctor must observe the signs of placental separation, and after her birth, examines and evaluates her condition and integrity.

A woman has the right to know what medical procedures she is undergoing. She can always ask a doctor or a midwife what this or that appointment is for and whether it can be replaced with something.

If, during the passage of the baby through the birth canal, tears have formed in the soft tissues of the mother or incisions have been made, the obstetrician-gynecologist applies stitches. He also has to perform more serious operations: for example, with incomplete separation of the placenta. Even after childbirth, the doctor does not leave the mother unattended. He will definitely appear in the ward on the same day or the next to see how his patient is feeling, to find out if anything bothers her, and to give recommendations for the future.

It is now possible to conclude a contract for the management of childbirth with a personal obstetrician-gynecologist. This means that as early as the 36th week of pregnancy, the expectant mother meets the doctor, discusses the plan of her birth with him, and the doctor, in turn, talks about what and in what sequence will happen during childbirth. This is convenient for both the doctor and the expectant mother, because psychological contact is established between them by the time of childbirth, and this always has a positive effect on the course of childbirth.

Midwife: right hand

A midwife is a nurse in a maternity hospital. Each department of the maternity hospital has its own midwives, and their tasks are different - for example, the midwife of the admission department meets the expectant mother and fills out her documents, conducts an initial examination and helps to perform hygiene procedures (puts an enema, helps with shaving the perineum). Midwives in the pathology or postpartum department also have a lot to do: they usually perform normal nursing duties. But the midwife of the maternity ward has the most important task - to help the woman in childbirth, accept the child and carry out his primary toilet. What is her job?

The word "midwife" comes from the French accoucheur, which literally translates as "one who stands at the bed", and its modern meaning is an assistant in childbirth.

During childbirth, the midwife, like the doctor, regularly examines the woman in labor, determines how much the cervix has dilated, where the baby's head is. As prescribed by the doctor, the midwife measures blood pressure and pulse, installs a CTG machine. And she can also tell you how to breathe properly or restrain attempts if the cervix is not yet sufficiently open or the fetus's head has not sunk to the pelvic floor.

During the second stage of labour, after the baby's head has erupted (that is, when the head does not disappear back into the vagina between pushes), the help of a midwife is especially needed. In order to prevent the head from moving forward too quickly and strongly, the midwife helps the woman, thereby protecting her perineum from damage. During the birth of the baby, the midwife gently guides the baby's head, and then, after her birth, helps the baby turn around and release the shoulders.

As soon as the pulsation of the umbilical cord stops, the midwife clamps it and cuts it (if the father of the child is present at the birth, they can entrust him with cutting the umbilical cord). According to tradition, the midwife shows the baby to the mother, asking: "Who was born?". After this, the baby is applied to the mother's breast for some time, and then transferred to the changing table for processing.

The midwife washes the baby with warm water, removing blood, mucus, meconium, and wipes the baby with a warm sterile diaper. Then he processes the umbilical cord: puts a clamp on it, and then a staple. The rest of the umbilical cord is cut off and treated with an antiseptic, then a sterile bandage is applied. While the neonatologist is assessing the condition of the newborn, the midwife, together with the obstetrician-gynecologist, monitors the birth of the placenta, then, if necessary, empties the bladder of the puerperal using a catheter.

As you can see, the midwife of the maternity ward is really an extra-class professional - she manages to help both mother and baby.

Anesthesiologist: pain control

Each team on duty must include an anesthesiologist and a nurse from the anesthesiology-resuscitation department. They come to the maternity ward if a woman wants to give birth with pain relief. First, the doctor asks the woman about her state of health, examines her, examines the results of examinations, and finds out if she is allergic to any medications. All this is necessary in order to choose the right type of anesthesia and prevent unwanted reactions.

The anesthesiologist then decides which type of birth control is best to use (in each case individually). An anesthetist nurse helps the doctor: she draws medicine into a syringe, injects it into a vein, and measures blood pressure. Having anesthetized childbirth (most often, epidural anesthesia is done), the anesthesiologist is constantly next to the woman. He monitors how the anesthesia affects the woman in labor (whether the contractions are sufficiently anesthetized), decides when to add the medicine, and when it is already possible to stop the anesthesia.

Neonatologist: the first children's doctor

Shortly before the birth of a baby, a new character appears in the maternity block - a neonatologist (a pediatrician for newborn children). Immediately after birth, he must listen to the child's heart, breathing, check muscle tone, reflexes and skin color. Based on these observations, the baby is given Apgar scores (for example, 8/9). If necessary, medical procedures are immediately carried out (clearing the upper respiratory tract from mucus, restoring the normal rhythm of breathing and heartbeat).

The neonatologist then decides which department to transfer the baby to. In old-style maternity hospitals, this is the children's department. In modern maternity hospitals there are “mother-child” departments in which mother and child can always be together; in such maternity hospitals, a baby and a healthy mother are not separated from the first minutes.

In agony: how people give birth in Ukrainian maternity hospitals

"The midwife beat me on the legs because I was twitching in pain when I was being 'cleaned'.

"When I was giving birth, the doctor who took delivery put pressure on my stomach so that my ribs were broken."

"Oxytocin was injected with the words "we all do this." Doctors were in a hurry - to give birth, sew up, send to the ward."

There are many such stories. And they trace a similar plot: a woman is likened to an incubator, and the success of childbirth depends on the mood and loyalty of medical personnel. In Ukraine, the assembly line approach to assisting with childbirth, which was so widely used in the Soviet Union, is still practiced. Added to this is the problem of insufficient professional qualifications of medical staff, as well as the monopoly of the state on the provision of obstetric care. Officially, the concept of "home birth" does not exist in Ukraine. As a result, a woman has no choice but to play by the rules that the system offers.

Obstetric aggression in Ukrainian

According to the World Health Organization, obstetric aggression is a global problem and occurs to varying degrees in different countries of the world. However, in the post-Soviet space, the situation looks even worse - as evidenced by both scientific research (for example, the project of the European University in St. Petersburg, publications of Prof. Radzinsky), and the data of surveys of human rights organizations in the field of motherhood.

Over the 27 years of Ukraine's independence, the training program for specialists in assisting with childbirth in matters of the psychology of a pregnant woman, deontology (medical ethics) and the culture of communication with a woman in labor has not changed. According to the experts of the human rights organization in the field of motherhood "Natural Rights Ukraine", such training programs are mainly focused on pathology in childbirth and do not include modern world studies, and also pay little attention to understanding the boundaries of physiological (natural) childbirth, which do not need interfere. The consequences are a low level of obstetric culture and medical care during childbirth.

When Maria (name changed – ed.) started having contractions, she and her husband called an ambulance to get to the hospital. Since the birth turned out to be rapid, the ambulance doctors honestly admitted that they did not know how to take birth and did not know what to do with a woman giving birth. The low level of medical competence of the medical staff is not the only problem. Ethical norms are also often neglected: obstetrician-gynecologists invite a group of students to examine a pregnant woman or directly give birth to a group of students without asking permission. - When I was transferred to the delivery room and the doctor checked the dilatation - without my consent, he began to manually open the cervix - this happened four times during the entire birth. After that, they injected me with sleeping pills so that I would fall asleep and not fool anyone - since it was night. In the morning, students came and were sent to my delivery room - despite the fact that I was against it, - recalls Larisa (name changed - ed.).

Medical violence occurs both physically and psychologically. In the situation of childbirth, a woman often feels like an incubator, that is, an object, or as an infantile incapacitated, "naughty" person that the medical staff can punish or ignore for "harmful" behavior - says Anastasia Salnikova, a doula (a birth assistant who provides physical, informational and emotional and psychological support for a woman in labor), an employee of the Center for the Development of Public Health at the Ukrainian Catholic University.

The most common types of obstetric aggression in Ukraine, according to a study by the organization "Natural Rights Ukraine", are: medical intervention without warning or consent of the woman (opening the amniotic sac, incision of the perineum, restricting the woman's movement during the opening of the cervix, etc. ), the introduction of synthetic oxytocin (sometimes under the guise of "vitamins" and glucose), a ban on the presence of a partner chosen by a woman during childbirth. According to Ukrainian legislation, a woman has the right to choose her own position during childbirth, but in practice, no one asks a woman in labor about this and she has to give birth in a position that is convenient for the doctor and unsafe for her and her child - on her back. Doctors' refusal to apply the baby to the mother's skin immediately after birth, supplementing the baby with formula and water without parental consent, the lack of training for the woman in labor how to breastfeed properly - all this is also a manifestation of obstetric aggression.

"Medical violence occurs both physically and psychologically."

Ksenia (name changed - ed.) gave birth last spring, says that in general her birth went well, but without her knowledge, the amniotic sac was opened. "The man who did this was most likely a doctor. He was very rude and physically - also when examined on a chair," the woman says. According to gynecologist Lyudmila Kirichenko, the amniotic sac is opened with weak labor activity, that is, there are clear indications for this, and in some cases it is really necessary. But in Ukrainian maternity hospitals, this is often done without sufficient reason to speed up the natural process of childbirth, even if it proceeds normally, then oxytocin is administered for the same purpose. “They pierced my amniotic sac so that the birth would go faster. The doctor thought that I would give birth in an hour and a half. When this did not happen, they injected me with oxytocin. In a word, they speeded it up as best they could,” says Alina (name changed - ed.) who gave birth to a son a month ago.

According to Yevheniya Kubakh, an expert from the organization "Natural Rights Ukraine", a simple step can significantly change the situation - compliance by medical personnel with the existing protocols of the Ministry of Health of Ukraine, which are very progressive, but rarely implemented in practice. According to these protocols, which have been in force since 2003, a pregnant and giving birth woman "should not be perceived by the staff of obstetric institutions as an object of certain medical manipulations for the purpose of her delivery, but, first of all, as a person and a main participant in an important moment in her life - childbirth." In reality, a different picture is “non-observance of the rights of pregnant and giving birth women and lack of respect for their needs and dignity in Ukrainian maternity hospitals,” says psychologist and doula Olga Gorbenko.

If you don't pay, you won't give birth

In Ukraine, there is no system of universal insurance medicine, which is typical, for example, for most Western European countries. According to Ukrainian legislation, medical care, as well as assistance during childbirth, is provided by medical institutions and personnel free of charge, and the healthcare sector is financed from budgetary funds, that is, from citizens' taxes. However, this rule only works on paper. In addition to taxes on health care, Ukrainians also have to pay "in their pocket" to doctors. Childbirth is no exception and is quite an expensive pleasure.

The working conditions of medical staff determine the quality of care for women in labor. Photo CC BY 2.0: 40weeks_ua/Flickr. Some rights reserved.

According to Natalia (not her real name – ed.), the doctor delivered her well, everything went quickly and without complications: “He asked for $1,000 for his services. were given in the hospital. No one returned the funds and medicines that were not needed during childbirth. "

Marina (name changed - ed.) prepared for childbirth with all responsibility. I agreed with the doctor in advance, because I knew that I would have to do a caesarean section: “I also paid a charitable contribution to the maternity hospital - this is 2000 UAH (about 60 euros - ed.) And in the hands of the doctor. The doctor did not say the price until the last, and after the birth "He said it was at our discretion. We paid $1,000. He told others the price right away. It would have been easier if it had been agreed in advance what and how much."

"Charitable contribution" is only called charitable, that is, voluntary. Since in Ukraine medical care must be provided free of charge by law, and the maternity hospital has no right to issue an official invoice, medical institutions resort to tricks and ask women in labor to pay so-called charitable contributions. But in practice, they are not voluntary in any way - this is a mandatory payment: without paying it, you will have to give birth in the corridor.

In addition to taxes on health care, Ukrainians also have to pay doctors "in the pocket." Childbirth is no exception and is quite an expensive pleasure.

Despite the fact that future parents have to pay for medical services, the conditions of stay and the atmosphere in the wards are not the most rosy.

– I have chosen a paid ward. There were two of us, a terrible scoop. And those that are free - 10 people in the ward and every night someone has contractions, groans, screams. Scoop in prenatal - repair, or rather lack of it, terrible furniture, full of people. And there is very little space, the passage between the beds is 40 cm. I also paid for the postpartum ward, only because it was allowed for my husband or mother to be with me. In the free wards there were those women who were saved for a very long time or had no money at all, - says Yulia.

Medical staff are not distinguished by politeness and tactful attitude, especially junior medical staff, who often see in a woman in labor not a woman preparing for childbirth, but a purse with money: "The staff at the reception is mostly rude. And they were divided into two types. The first - evil and rude, until you put it in your pocket, they don’t answer questions normally. The second one is kind, they tell everything and show that it is also better to thank them, "says Natalya.

In general, childbirth costs young parents about a thousand euros and they will have to pay them out of their own pocket and unofficially. For many families, this is quite a large amount - the minimum monthly salary in Ukraine is only about 100 euros.

System to be changed

Medical professionals refuse to openly comment on obstetric aggression. But in a private conversation, they confirm that they often stimulate childbirth without real need, only because then they will have time to take them on their shift, and therefore it is they, and not their colleagues, who will receive an unofficial monetary reward from the parents of the newborn. "Why do doctors agree to a contractual birth? Because it's the only way to make money," says the OB/GYN, who asked not to be named.

The other side of the problem is the low level of pay for gynecologists, obstetricians and neonatologists. The medical profession in Ukraine is one of the lowest paid, despite the fact that it takes eight years to study and the level of responsibility in obstetrics is the highest of all medical specialties. So the minimum monthly salary of a doctor who graduated from medical school and internship is only about 100-150 euros per month. The consequence is that physicians take unofficial remuneration for their work with patients. The result is a vicious circle.

Another important factor is fatigue and heavy workload:

– A tired doctor is interested in completing the birth faster, rather than waiting for its physiological completion. For example, a woman agreed that the head doctor of the maternity hospital would take her birth. The night before, he was urgently called to assist in a difficult birth. He arrived at work by 7:30. The whole day I was engaged in solving stressful administrative issues, performed the operation. He returned home, just sat down to dinner and a woman in labor called him, saying that she had started contractions. Will he be ready to wait, for example, until 7.00 in the morning for the birth of a baby, if he had a difficult birth at night and a busy working day before that? And such a load from day to day, says the obstetrician-gynecologist anonymously.

Caring is the most important thing in childbirth. Photo CC BY 2.0: 40weeks_ua/Flickr. Some rights reserved.

Many OB/GYNs carry fear and negative experiences from one delivery with an unfavorable outcome to another. Instead of a clinical analysis, which in the future will help other colleagues to avoid medical errors, such a doctor is psychologically “destroyed” by the higher management, the obstetrician-gynecologist claims in a private conversation.

Added to this are the problems of lack of medical staff, lack of prevention of professional burnout, as well as limited access to information on new research in the medical field, materials of evidence-based medicine.

– Doctors responsible for the life of mother and child receive very low pay for such a responsible job, which reduces the desire and opportunity for professional development. Participation in the European Congress of Obstetricians and Gynecologists costs about 3,000 euros (2,000 participation plus accommodation and travel), which is incommensurable with a doctor's salary. Unfortunately, few of my colleagues know English, - says Alina Dunaevskaya, obstetrician-gynecologist, neonatologist of the first category, candidate of medical sciences. – Often, the only source of information for doctors is medical representatives who are interested in selling drugs, and many speeches at Ukrainian professional conferences are paid for by pharmaceutical companies whose goal is sales. As a result, the prescription of drugs is outside of evidence-based medicine.

The low level of professionalism of gynecologists is observed by women themselves. After the birth of the child, the local gynecologist diagnosed Maria with cervical erosion (which does not need to be treated, according to new research) and suggested treatment with methods gleaned from the Internet. “When I heard the phrase from the doctor, “Have you already decided how you will be treated? Did you look in Google?" I thanked him and left, realizing that I would not come to such a specialist again, "says Maria.

Until now, the situations of childbirth in women with injuries of the musculoskeletal system cause great difficulties, since most antenatal clinics do not know how to accompany the pregnancy, and then take delivery of such a woman. Elena uses a wheelchair and is one of the few disabled Ukrainian women who decided to have a baby with her husband. The decision was conscious and the couple went to it for a long time.

– At first, the doctors tried to dissuade me, – says Elena, – because they did not know what the consequences might be in my case, they honestly admitted that they had no experience in managing a pregnancy for a woman with a disability. One of the doctors told me that my case is a "state of emergency" for the whole city. I myself was scared, and when I saw such a reaction from the doctors, it became even scarier, since there was no one to support me. The same incompetence on the part of obstetricians and gynecologists was during childbirth. There were also moments of humiliation - somehow the gynecologist told me: "Sit down on the operating table." It's just that I don't understand how I could do it myself?!

The lack of special equipment and gynecological chairs for such patients in most antenatal clinics has led to the fact that women with spinal injuries are examined right on the wheelchair. Partially, the solution to this problem is taken up by perinatal centers specializing in providing assistance to pregnant women with disabilities. However, most antenatal clinics are not ready and do not know how to work with such pregnant women.

"Doctors often make a woman feel guilty if the pregnancy proceeds with complications, convince her that she herself is to blame for everything."

Doctors often make a woman feel guilty if the pregnancy is complicated, they convince her that she herself is to blame for everything and does not care about her unborn child. Miscarriage turns into multiple reproaches from some gynecologists who are not trained to provide psychological assistance to a woman in such cases. Until now, for the Ukrainian system of maternity hospitals, the birth of a dead child or a child who died shortly after birth is a taboo topic (as it was in Soviet times). With a woman whose newborn child dies or is born dead, psychologists who specialize in this issue do not work properly, since they are only in a few maternity hospitals. In addition, late termination of pregnancy for medical reasons is an area that is not sufficiently regulated at the legislative level. The decision to terminate the right to take only the regional expert commission.

In Ukraine, there is also no publicly available statistics on how many births (successful and with complications, caesarean section) per specific doctor, midwife, and maternity hospital (as is done in European countries), so that a woman can independently choose a maternity hospital in which would like to give birth. Ukrainian women mainly use the so-called word of mouth and watch information on various Internet forums created by women themselves.

All these problems are a real challenge for the healthcare reform that has recently started in Ukraine. This reform offers truly progressive and positive changes in the provision of medical care and models of its payment. However, the problem of obstetric aggression has not yet become the focus of the reform, says expert Evgenia Kubakh.

According to experts, a significant solution to the problem can be the introduction in Ukraine of a 3-stage model of childbirth assistance, which is successfully implemented in the Netherlands, Great Britain, Germany, Israel, Canada, New Zealand, the USA and other countries. A distinctive feature of such a delivery system is the ability to choose an obstetric rather than a medical model of care in the case of childbirth in women from a low risk group. However, midwives who are qualified enough to independently attend normal births are not trained in Ukraine. At the moment, a volunteer working group, which includes lawyers, medical practitioners, activists and representatives of civil society, is working on the development of such legislative changes.

In addition to legislative changes, changes are also needed in the professional development of medical personnel: access to modern world research in the field of evidence-based medicine, monitoring compliance with existing protocols, improving the quality of communication between women and medical personnel, as well as changing the approach to financing. No less necessary is a significant revision of the working conditions of medical personnel, the widespread introduction of a system for the prevention of emotional burnout, the introduction of the position of a psychologist in the staff of maternity hospitals and the high-quality training of such specialists, the introduction of progressive analysis of medical errors instead of punitive ones. Otherwise, you will still have to rely only on the conscientiousness of the doctor and on a lucky break.

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