Zuzana Stromerova - a champion of natural childbirth

Radio Prague's guest this week is Zuzana Stromerova, one of the country's few private midwives. A champion of natural childbirths, Zuzana Stromerova has been trying to convince the authorities for years that women should be given a choice as to where and how they want to give birth to their children. She is also behind the project of the Czech Republic's first birth centre which is meant to provide a home-like alternative to maternity hospitals. But although the Prague birth centre is ready to welcome women who are about to give birth, the establishment is actually not allowed to perform deliveries.

"The mothers are not officially allowed to give birth here. I say 'officially', that means we cannot advertise 'All mothers who wish an un-intervened birth, do come here!' This is what we can't do at the moment. But in case there is a mother who is in labour and she is not exactly sure that it really is labour, she can come here and ask for a check. And if the check proves she is really far in labour, close to delivery, of course, we will not send her away. And this way, three baby girls have been born here already and I think more will come. But we are still waiting for an official permission, an official registration of this facility which we need to, in business words, to make business here."

What is the legal problem?

"In fact there is a gap in the legislation. No law in the Czech Republic prohibits home birth, no law in the Czech Republic prohibits birth houses or an informed choice of mothers. But the legislative system does not know the term 'birth house' and does not know the term 'home birth'. And everything is focused on hospitals, so we have plenty of descriptions and regulations as to what a hospital must have and how it must be equipped and what it needs to provide to mothers, but no comment, no item, no issue about a birth house, how it should be equipped, what type of care or services it provides. The people who are authorised to make decisions have no support for their decisions. They have to use the current legislation in force and then they find out that we are not sufficiently equipped to provide care during birth."

What led you to the establishment of this facility?

"The feeling of discomfort of mothers, in other words they were not satisfied with the care provided in hospitals. Although our medical doctors would say that we have got one of the best health systems in the world, but that's not absolutely true. They say it because our infant mortality rate is very low, I think we are second or third in the world. And this number only they conclude that we have perfect, high quality care for mothers and babies. The problem is that they do not consider healthy mothers and healthy babies who need in fact no medical care. For these mother and babies, our country does not have any possibility or choice. All mothers, including the healthy ones, can only come to hospitals and they have to undergo all the routines and protocols that hospitals must have to be able to provide care for thousands of people. And there had been no place for births which need no interventions. And this led me to start this project years ago and also to overcome all the obstacles that we have and still will have."

Pregnancy and giving birth is not just a "medical" event. But, I suppose, we can say it is an important emotional and even spiritual experience in a woman's life. Do you think that these aspects are being neglected in this country?

"Absolutely. And it is also neglected that it is a social event. In fact the baby is a new member in the family. The pregnancy and birth are 80 percent psychological events and 20 percent physical events. I don't mean that we should neglect the baby in the mother's belly, of course, there is a physical body, a hundred percent physical body. But the birthing process as such is influenced from eighty percent by the mental condition of the mother and twenty percent by the physical condition of the mother. And it is very important. Fear as such is a major factor. If the mother is afraid she can be blocked to give birth smoothly and then the interventions are needed. And then a normal birth can turn into an absolutely pathological one."

Can you compare the situation in the Czech Republic and other countries, both developed and developing, as far as giving birth in hospitals, at home or in birth centres is concerned?

"We can divide the world into three categories, I would say. Poor-resourced countries, where there are very rich people on one side and very, very poor people on the other side. And very often the poor people in those countries do not even have a midwife at hand. Because they cannot afford a midwife or the country in general is not willing to put money in education of a sufficient number of midwives.

Illustrative photo

"Then we have another part of the world, which is well industrialised and well-resourced but has no options for the mothers and, finally, if it comes to the term, the mother who does not want hospital care would not have a midwife, either. And would be in the same situation as the mother in that poor-resourced country: staying at home with her friend or even without anybody because she does not want to undergo the risk of hospital procedures.

"Then there is the third group of countries which do provide freedom for mothers. It is mostly Western Europe where there are birth houses, home birth midwives, departments led by midwives in the hospitals where midwifery care is implemented but it is in the hospital so if a doctor is needed he is really at hand but not intervening uselessly.

Tomáš Julínek, photo: CTK

"So these are the three groups of countries and the Czech Republic is the middle one. I mean the one that is well-resourced with medical care accessible but with no choice and consequently no midwives for home birthing mothers. No midwives would be too strong - maybe five for the whole country. Five for ten million people which is not that many. So the comparison is that, of course, in the poor-resourced countries the infant mortality rate is very high. But it is not only the lack of professional care, it is also lack of hygiene, nourishment, poor social conditions. So we cannot compare these countries to the developed countries, to the well-resourced countries. And the Czech Republic belongs to the well-resourced countries.

"Now the problem is that our medical doctors say that if they would approve home birth care in general that we will get on the same level as the poor-resourced countries are. They absolutely do not take into consideration the hygienic aspect, the nourishment, the social conditions and such. So I think this is the mistake. Because we have all the conditions in the world to provide mothers with wonderful care wherever the mothers would decide to give birth. But the minds of people are quite closed."