Hard Labor : In the Commonwealth of Independent States, says Dr. Vera Matdeyenko, giving birth is a nightmare. The Moscow obstetrician is touring hospitals and birthing centers here as part of an effort to implement kinder and safer methods back home.

Having a baby in Russia is like going to jail. At least that is how the experience is described by Dr. Vera Matdeyenko, an obstetrician and gynecologist from Moscow who toured Southern California hospitals and birthing centers last week.

Matdeyenko’s visit was part of an international health group’s efforts to help doctors and midwives implement better birthing methods in the Commonwealth of Independent States, the former Soviet Union.

“If I dreamed about something, I would dream I worked at St. John’s Hospital,” said Matdeyenko, who toured five hospitals, including St. John’s in Santa Monica. “It was the most beautiful hospital I saw in the U.S. Pregnant women dancing with their arms around their bellies. It’s a happy experience, and everybody laughs. Americans are prepared for childbirth.

“I cannot create a St. John’s, but I want to create a little hospital so that women don’t see the difference between home and the hospital. So that women are not prisoners.”

Matdeyenko’s nine-day trip was sponsored by the International Center For Better Health, or ICBH, a Los Angeles- and New York-based nonprofit organization dedicated to improving health care in the Commonwealth of Independent States through health education programs.

The 2-year-old group, funded by Soros Foundation, Merck Laboratory and private donors, has sent three teams of certified-nurse midwives to Moscow to teach Western birthing techniques such as labor massage, emotional support during labor, and general aseptic measures often neglected by physicians due to a lack of supplies and education. The organization will send AIDS educators to Moscow in a week to address what many say will be an imminent explosion there of acquired immune deficiency syndrome.

Playing hostess to Matdeyenko at her Santa Monica apartment was Judy Chapman, a certified-nurse midwife from St. John’s Hospital who was part of the first group of ICBH nurse-midwives that traveled to Moscow last September. Two more teams followed in November and January.

“At birthing house No. 5, one of the best three birthing houses in Moscow, there were two midwives to 14 rooms with one woman in each room,” Chapman said. “They were overworked; one usually cleaned while the other attended the women. They didn’t believe it was necessary to support a woman in labor, like offering words of encouragement, getting her up to walk around and comforting her until they saw us doing it. By the end, we had some midwives massaging pregnant women’s feet. So we made some inroads.”

For Matdeyenko, 53, the humanitarian approach to childbirth in Southern California hospitals was nothing short of revolutionary. To women in her country, she explained through an interpreter, childbirth is a nightmare that begins with the onset of labor.

When the contractions begin, she said, the woman is rushed to an arbitrarily selected birthing center by ambulance. There she remains until she delivers, even if the labor pains are premature and the birth is yet three weeks away. The centers are cold, impersonal structures, and poorly heated. With no curtains on the windows, birth is not a private affair.

Worst of all, family members cannot visit, as infection in maternity wards is a grave problem, she said. During delivery, anesthesia is often unavailable. Once the infant is born, it is rushed away from the mother and isolated for two hours to prevent infections. The mother yells out the infant’s sex to her family standing outside.

“She is a prisoner,” Matdeyenko said. “Each time a woman is hospitalized, it scares her. The first time a woman has a baby, it is so traumatic that she doesn’t want to have a second baby. Women are afraid to sit on a hospital bed. In Russia, she spends about five days in the hospital after a vaginal delivery (the norm in the United States is one or two nights), and 10 days after a Cesarean section; they spend 10 days. . . .

“Infection is a big problem. Nobody explains anything to them. There is no information, no education, no psychological preparation. Adult women don’t know anything about their own health care, child care, prenatal care. Not a lot of women go to doctors. They only go in an emergency.”

Now, despite the dire state of her country’s economy, Matdeyenko’s dream is to open a model birthing center that replicates the coziness of the labor and delivery rooms she observed at Southern California hospitals. She also hopes to implement Lamaze Childbirth Education classes.

The goal for Matdeyenko is not simply to make childbirth more agreeable but also to make it safer. The Commonwealth has a Third World infant-mortality rate--in 1991, it was 23 deaths per 1,000 live births, compared to 10 infant deaths per 1,000 live births in the United States. And two years ago, Soviet television reported that more than three times as many women die in childbirth in the Soviet Union as in the United States. Poor prenatal and postnatal care, high rates of infection and inadequate sanitation are attributed as causes, according to Matdeyenko.

What women do go to the doctor for is abortions. The Commonwealth lacks any dependable, affordable, readily available birth control, and as a result it has the highest abortion rate in the world, Matdeyenko said. The average Russian woman has six to eight abortions in a lifetime--most performed without anesthesia, she adds. Sex education is only slowly making inroads into the educational curricula.

“It’s not normal for people to use condoms, pills or birth control right now,” Matdeyenko said. “Women are afraid to use pills. . . . It’s like a mentality (prevalent among them).” Condoms, she said, are poor in quality and cost the equivalent of $5 or more.

“People would rather buy food,” Matdeyenko said. “There are no ingredients to make spermicide. And the average woman has many abortions--some 20 times. Sometimes a woman cannot count how many times they’ve had abortions.”

Poor sterilization and sanitation are probably the greatest causes of the high infection rates. An estimated 65% of hospitals nationwide lack hot-water systems. Matdeyenko said that gloves and needles are often reused because disposables are in short supply. And when surgical gloves run out, it’s business as usual but without gloves. For instance, it is not uncommon for doctors to conduct vaginal exams with bare hands, she said.

Matdeyenko’s descriptions of health care conditions in the Commonwealth shocked many in the Southern California medical community and prompted an outpouring of support and supplies from the hospitals she toured--St. John’s, County-USC, UCLA, California Medical Center and UC Irvine. Matdeyenko headed home laden with donated disposable gloves, disposable needles and syringes.

Matdeyenko said she realizes that revolutionizing women’s health care and creating an ideal birthing house while her country adjusts to wrenching political and economic change will be no simple task. She acknowledges her country’s problems but is steady in her vision.

“Right now, no one wants more kids when the economy is down,” Matdeyenko said. “Still, I want to make the hospital like a little home so that baby can bond with the mother, so women won’t be afraid--so that it is not like jail when the doors close behind your back. Where they can call their children without having to stand in line for a pay phone in the cold air on the stairs. Not a gray, cold and unfriendly place.”