An “Obstetrics situation”

Preamble

An “Obstetrics situation”

 “Obstetrical situation” In clinical midwifery are the range of objective symptoms, indicators, conditions, possible developments etc enabling one to draw up and carry through a plan for ensuring the safe delivery of the baby, i.e. ensuring successful outcome of labour.

The problem of successful deliveries has become critical in our city.

Everybody knows that in summer medical establishments, including maternity hospitals, are closed for regular repair. During this period the functions of the clinics out of service are temporarily fulfilled by the other such establishments. And it is desirable to make this process as efficient as possible, at least without lowering the accessibility and quality of medical aid. To achieve this, a special order is issued in advance every year. This order regulates in details, who and when (on what day of the week) is on duty in different districts, and is brought to the attention of all related organizations, including hospitalizing units of the city and regional ambulance service.

However, this year something went wrong, which is illustrated by the following monologues.

Account from a woman who recently gave birth

The maternity hospital was overcrowded with patients lying even in the corridor. The staff were ready to drop,. No point in thinking of an examination, just give birth and that’s it. I was discharged from hospital on the third day (!), without any advice. Well, it was my second childbirth, so I already knew something, but what about a young woman with her first child? It was even recommended that stitches be removed “according to your place of residence”.

Account from a pregnant woman

I was sent to the hospital two weeks before the expected time of delivery. The doctor of the antenatal clinic said that I had to be treated and prepared for childbirth. At first I didn’t want to go but then I decided that my health was worth more than the temporary inconvenience. However, nobody in the maternity hospital wanted even to talk with me. “We have no places. When the contractions start, call the ambulance and come”…

Opinion of an antenatal clinic doctor

The management demand that we doctors do not concentrate on out-patient care, but send pregnant women for treatment of various pathologies and refer them for pre-natal prophylactic hospitalization. Even the mandatory tests for doctors and midwife-gynaecologists to gain the appropriate qualifications stipulate specific prepares of pre-natal hospitalization where there are various problems in the normal course of pregnancy. In reality, it is very difficult to convince a woman and her relatives of the need for hospitalization (virtually nobody wants this), and finally we get the refusal of a clinic explained because “there are no places” and the standard recommendation “to continue out-patient treatment”. Yet what should we do such treatment is not efficient? There are far more possibilities in a maternity hospital. And if, God forbid, something goes wrong, then the blame is always on the antenatal clinics. That’s the usual Kharkiv stereotype.

Opinion of a maternity hospital doctor

It has become very hard to work: the wards are overcrowded with too many complicated cases and there are often several deliveries at the same time. It’s particularly difficult when we’re on duty:- the usual number of medical staff isn’t able to cope with such a load. It’s difficult not only physically, but also psychologically: you have to refuse to hospitalize a patient because there are no places or to discharge a woman with child in the third day after birth for the same reason. After such actions I feel uneasy: what if something happens? You see, in such case it will be my fault not my bosses’.

Excerpt from a speech by H. Seroshtan, Head of the central department of health of the regional state administration (“Medychna gazeta”, 10 September 2006, p.2)

 “During the reporting period beds for 24-hour patients were not made good use of in medical establishments. This is confirmed by the figures for the use of beds, these being 168 days instead of the recommended 170. In Kharkiv beds for pregnant women and those who have recently given birth were efficiently used only for 101 day, gynaecologic – 139 days”.

Short summary

Are you not, respected reader, tormented with the thought that “Something’s rotten in the State of Denmark”?

The author of these lines is and has been, very seriously, for a long time. I even know the address of this “Danish kingdom”: the Department of health of the Kharkiv city council.