The rebirth of "home delivery"
For many decades Czech women have been used to giving birth in maternity hospitals, in an environment they have often perceived as cold, impersonal and unfriendly. In recent years more and more women have been choosing to travel many kilometres in order to deliver their babies in small hospitals known for their friendly and individual approach to mothers and babies, or to give birth at home with the assistance of a midwife.
Soon Czech women will have a third option - a birth centre where they will be able to give birth safely in an atmosphere as pleasant as in their own home. One of the people behind the project is Zuzana Stromerova, a private midwife.
"It's a place where the women will have a chance to give birth like at home but accompanied by midwives. There will also be some technical equipment which will not be used in case it is not necessary. We will support natural birth as much as possible and the women will be the 'directors' of their birth. They will arrange what they want and how they want it during the birth, they should feel fine and they should find an intimate place here."
During the first half of the 20th century in many developed countries, labour changed from a natural process to a controlled procedure and the place of birth changed from home to hospital. At the same time much of the human touch was taken out. Towards the end of the century, the call for a return to the natural process of giving birth in many parts of the developed world opened up delivery rooms to fathers and to other family members, but the location stayed the same: the hospital. I asked Zuzana Stromerova what exactly Czech women preferred.
"What they prefer is not what they get, you know. So they mostly give birth in a hospital in an unintimate setting, surrounded with all the technology and doctors, and there is intervention into the birth even though it is not necessary."
The setting and interventions into the natural process can result in trauma in some women, encouraging them to seek a different setting for their next birth. Mrs Stickova, a mother of two, has told me her story.
"The first experience was horrible and it was a big surprise for me because I chose the hospital which was said to be the safest for babies in the Czech Republic, with the best neonatal unit. But this was a very bad choice in the end because the doctors there are trained very well for cases that are not normal and therefore I had to undergo many procedures even during a normal birth. I was made to undergo all the procedures as if she [my daughter] was an ill baby. Therefore I decided to deliver the second baby at home even though I wanted the baby to be very safe during the birth. So I found two midwives and they decided to help me even though it's not usual in this country."
The unwanted interventions into the course of her delivery made Mrs Stickova decide to deliver her second child at home despite knowing he was going to be quite a chubby baby.
"The birth might have been rather complicated because we knew the baby was over 4,000 grams, but in the end it was 5,000 grams. So it was a big surprise, but everything went well. I think the atmosphere, the setting of your own home where you feel safe and where you know that no doctor will do anything bad to you that you don't want, is good. In the hospital you simply cannot refuse all these procedures."
Good maternity hospital care has always been believed to be behind the very low rate of infant mortality in Czechoslovakia and the Czech Republic. Some people may wonder whether trying to move expectant mothers back home from the hospitals is not a step back in this respect. Midwife Zuzana Stromerova again.
"We have a good postnatal result but it's only about postnatal mortality, not morbidity, and that is another question. Also, nobody counts how many children are placed in institutions which care for disabled children and very often they are placed there because of improper birth. No statistics speak of the happiness of women with this system of care in the Czech Republic. So these are other criteria for quality care, not only postnatal mortality."
The official report of the World Health Organisation (WHO) on reproductive health says that the practice of home birth is unevenly spread across the world and in many developing countries it is the only choice. With the widespread institutionalisation of childbirth since the 1930s, the option of a home birth in most developed countries disappeared, even where it was not banned. The WHO report mentions the Netherlands as an exceptional example of a developed country where still more than 30 percent of pregnant women deliver at home. Mary Zwart works as a midwife in the Netherlands.
"I think you have to give credit to the Dutch women. Dutch women like to give birth and they like it to be normal, which means they are in charge and they have a choice wherever they want to be. The last survey said that still most Dutch women are fairly satisfied with giving birth at home and only five percent want medication for pain relief because then they are not in charge, I mean, you are not able to make your own decisions any more."
Mary Zwart points out something that modern medicine sometimes seems to forget about - that giving birth is not only a physiological but a spiritual process which women should be allowed to live through if they wish and their health condition allows it.
"As sex is fairly important to people, I think the outcome, the ultimate outcome of sex is birth. And women who are in charge of giving birth, they get a kind of self-esteem, they are proud, they can cope with difficulties in their life so I think it is cruel to take that away from women. It would be the same if you went to Mt Everest and you found out that at the back there was a staircase coming up instead of climbing Mt Everest. I think if women have this good experience with birth it's a fairly big event in a women's life and that's what really makes them a woman, so I think this rite de passage should not be taken from them but guided so that it doesn't harm them or break them but let them grow to be a woman."
This year the civic association "Active Birth Centre" is going to open a birth centre in Prague, a facility where healthy women can come to give birth in a home-like setting and with the assistance of professional midwives. At the moment the association is renovating a building in the Prague district of Roztyly which could soon welcome its first expectant mothers. As Zuzana Stromerova says, financial matters seem to occupy its founders most at the moment.
"As to finances we have been promised some machines, technical background from abroad and, as for money for reconstruction, we have to ask some foundations and also big companies and we are searching for investors. So anybody who could give us a tip where to ask for help or who could be an investor is really welcome."
It is an interesting coincidence that the future birth centre once used to be a kindergarten. With the birth rate constantly falling in the Czech Republic, it was no longer needed for its original purpose. But who knows, maybe the different experience of giving birth there at the birth centre will encourage Czech women to want to come back for more.
