Dear Henci Goer,
in Slovenia we are in the middle of public discussion about reorganization of the whole maternity care system with gynecological care for healthy women included. Group of different health care professional produce problematic document, Ministry of Health praise it, and in six weeks anybody can comment it.
As the representative of only non-governmental organization dedicated to improve conditions of becoming mother I’m kindly asking for clarification.
They insist that maternity unit with less than 1000 births per year is potentially dangerous because doctors and midwives don’t have enough experiences to recognize rare complications and are not skilled enough to help when CS, vaginal breech delivery is needed. So they say that the criteria for maternity unit is: more than 1000 birth per year (and something like 3-4 CS per week, 1-2 vacuum extraction per week, 1-2 breech and twins per fourteen days) – in such circumstances, they say, health professionals would have enough skills and experiences. And maternity units with less than 1000 births per year should be closed.
They say that with fewer procedures per year per hospital we put future mothers and their babies into danger – in small maternity units health professionals slowly lose their ability to recognize complication and to answer properly.
I think the first problem is to take procedures of maternity unit and not procedures of individual doctors. In the same hospital some of them are having more CS then others, the same for breech babies.
(In Slovenia we have some doctors and midwives who suggest vaginal birth if everything else is OK with mother and baby ... and some who suggest CS in advance – I know about scientific data about breech birth.)
What is the proper solution to enable the particular doctor in the maternity unit to be ready as a professional to recognized complication and to react on it in the best way? Is there really any scientific data about how many procedures per year (CS, vacuum extractions) doctor need to stay in excellent form? What about sending them on regular training (once per year ... or something like that) into the tertiary hospital where there are women with high/er risk to practice ... or?
This is very important for our goal: we would like to help with establishing first freestanding midwifery birth center in Slovenia and we are working towards circumstances for home births, too. And of course we would like to have good maternity units/hospitals with doctors to help with CS and other procedures when needed ... in reasonable radium. If the small maternity units are closed, there will be a problem with finding good location for birth center(s); and this would be also problem of background for home births. With centralization of maternity units - on the grounds of safety – we will lose an opportunity to broaden the choices of women to deliver at home, in birth center(s) or in hospital; we’ll be limited to the proximity of big centers.
So, maybe you can help me with your opinion.
And thank you in advance.
Society Natural Beginnings www.mamazofa.org
Here are some basic data about Slovenian maternity system:
Slovenia: 21.856 babies born in the year 2009
Perinatal mortality for 2004 was 7,4/1000 births (for babies with birth weight over 1000 g 4,6/1000 births
maternal mortality (0-4 women per year):
1998-2001 12,5 /100.000 live babies
2000-2002 15,1/100.000 live babies
fourteen maternity hospitals, no birth centres, no official professional help available for home births, no autonomous midwifery practice
CS around 18-20%, very medicalized birth in general (enema and shaving still in use, active birth management with inductions and augmentation, women mostly lying in bed during labour and birth, episiotomy – half of vaginal births … etc) with some attempts to humanise it (13 of 14 maternity hospitals are Baby Friendly).