Childbirth in Russia Is Miserable

It’s one of those sodden, snow-crusted days when the sky looks like dishwater, the office temperature won’t budge above chilly and Dr. Vladimir N. Serov dreams of Santa Barbara.

Not the town. The soap opera. The television melodrama has set Russians swooning for years, and it has inspired Serov to dream as well. He marvels aloud at the medical care on the show. He wishes he could lift it from the TV and graft it onto Russian society. Starting with his own obstetrics practice.

For as Serov sadly acknowledges, Russia’s maternity wards are scruffy, ill equipped, harried. They follow rules from Soviet days. Husbands cannot help their wives through contractions or cuddle their newborns. Women in labor cannot see family or friends, or even the obstetricians who handled their pregnancies. The Health Ministry regulations are so detailed that they control nursing posture as well: Mothers must lie on their sides to breast-feed their babies.

Compared with “Santa Barbara”--or even real-life America--Russia’s “birth houses” are stern, stifling, scary. And dangerous.

Hundreds of mothers die each year from uncontrolled bleeding or raging infections after giving birth in the specialized state hospitals that handle all abortions and deliveries here. Hundreds more die from the lingering effects of bungled abortions, which wreck their reproductive organs and complicate future pregnancies.

True, Russia’s maternal mortality rate is nowhere close to the abysmal tolls in China, India or impoverished Africa. But Russians do not like to compare themselves to Third World countries. They look at nations they consider equals--and cringe.

Russians are six times more likely than Americans to die in childbirth. For every 100,000 live births, 53 Russians die. The United States and Britain each report eight deaths; Japan records 11.

“Our system is bad,” Serov said. “It’s not in the least bit modern.”

Indeed, little about Russian obstetrics is modern, at least by American standards.

In the birth houses, babies are treated almost as a commodity, to be churned out assembly-line style. Decrees from the Communist era regulate every aspect, from mandatory enemas during labor to postpartum attire.

In the United States, “we’ve made efforts to humanize the birthing process and make it more of a family experience,” said Dr. Brian Koos, chief of obstetrics at the UCLA Medical Center.

In Russia, however, personal choice and individual relationships remain a low priority.

As Serov put it: “They’re like factories.”

He serves as deputy director of one such factory--the Center for Obstetrics and Gynecology, a cinder-block clinic with chipped floors. The cheeriest poster is an ad for Tampax.

This is supposed to be a showcase birth house, reserved for women with high-risk pregnancies or a lot of clout.

But it has communal delivery rooms, built when privacy was considered a bourgeois decadence. Each floor has just two pay phones, so proud mothers must wait in line to announce their deliveries. The grimy windows are marked with numbers so that husbands--banned from the clinic--can find their wives’ rooms and shout greetings from the sidewalk below.

“Our maternity homes,” Serov said, “look a little like jails.”

Ironically, the few reforms that have swept through the birth homes may end up increasing the maternal mortality rate.

The new capitalist spirit, for example, has spawned a dangerous medical market. All women are entitled to free medical care--from ultrasounds to abortions--at their local maternity hospitals. But nowadays, many birth houses have opened “commercial departments” that offer better treatment to the rich. Bribes can secure top-notch service as well.

“The women who can’t afford payments really get the minimum in care, which is not sufficient,” said Rudolf Hoffmann, a UNICEF project director who oversaw a recent study of Russian obstetrics.

In some maternity hospitals, wealthy women can snag more than private rooms and attentive nurses. They can pay the equivalent of $800 to order a caesarean section. The operation is free when medically necessary. But some doctors now are willing to perform it at a woman’s request and in exchange for cash--a practice that would “absolutely not” be accepted in the United States, Koos said.

Caesareans have been relatively rare in Russia, used in 10% of births, compared to about 25% in America. The percentage may well rise, however, as rich women try to avoid the pain of labor. And more operations mean more risks of infection.

Russia’s heavy reliance on abortions--more than two-thirds of pregnancies are terminated--also drives up the maternal death rate.

Although sidewalk kiosks now carry condoms and pills, Russians still consider abortion a convenient, and free, form of birth control.

The average woman will terminate nine pregnancies. When she finally decides to carry a baby to term, she runs a much higher risk of premature labor, weak contractions and hemorrhaging, says the Russian Family Planning Assn.

“Abortion accounts for a quarter of all cases of maternal mortality,” the association said, “and it shows no signs of decreasing.”

Cutting the abortion rate will take major public education. Some physicians believe that an even broader propaganda campaign is called for as well.

They would like to teach a new--and, they hope, safer--attitude toward pregnancy. And they would start by introducing the Western view that pregnancy should be a joyful partnership for couples, rather than a scary medical emergency for women to endure alone.

Few doctors allow husbands in the delivery rooms--and then only after they’ve undergone medical tests to prove themselves healthy. Those men who do manage to attend births are booted immediately after, without getting a chance to greet their infants.

Fearful that germs might creep in even if visitors stay out, the Health Ministry also demands that obstetricians scrutinize each woman’s belongings.

In decades past, women complained that gatekeepers took even their eyeglasses as possible infectious agents. The list of taboos has been modified, but women still cannot wear fuzzy slippers or read old books in maternity wards, lest they scatter contaminated dust. Flowers are forbidden in recovery rooms, where up to half a dozen women wait out the mandatory five-day convalescence.

Russia’s quarantine of new mothers is certainly a nuisance for patients such as Natasha Kozlovskaya, who had to keep in touch with her husband through notes ferried by a kind nurse.

But worse than the inconvenience, segregating pregnant women chips away at patient health, Dr. Olga G. Frolova said.

A woman’s isolation starts way before the first contractions. She generally attends childbirth and parenting classes on her own. Uneducated about pregnancy’s physical and psychological demands, men often expect their wives to continue cooking, cleaning and working through their due dates.

“We need to change the attitude of society, especially men,” said Frolova, who heads the obstetrics division of the Russian Academy of Medical Sciences. “Pregnant women should be treated with special care and respect.”

At first glance, the Soviet-style welfare system would seem to coddle women.

Pregnant Russians are entitled to free checkups every two weeks. They are expected to take paid maternity leave starting eight weeks before their due dates and can remain home with their babies, collecting regular benefit checks, for 18 months. Employers must hold jobs for three years.

And while American mothers complain of being rousted from the hospital too early, Russians stay under observation for at least five days.

Once discharged, a mother and infant can expect a follow-up from a nurse.

Yet while the benefits look comforting on paper, they actually may contribute to the mortality rate.

Russia’s medical system works on a tag-team basis. Women get their regular checkups at local outpatient clinics that handle only gynecology. When contractions start, they must rush to a birth house, where an unfamiliar obstetrician takes over.

Many of the clinic gynecologists are trained to focus on reproductive health and the fetus’ well-being. Thus, Serov said, they may overlook other medical problems that can affect pregnancy.

“Women are dying during childbirth from illnesses that we fail to catch in the women’s clinics,” he said.

Russia’s chronic shortages of medical equipment and drugs also plague the clinics.

“The defense line for really safe motherhood is at the [larger, regional] hospitals,” UNICEF’s Hoffmann said.

But instead of referring their patients to specialists, he added, poorly trained clinicians either fail to see--or simply ignore--potential complications.

Once a patient in labor arrives, the on-duty physician has little chance to probe her medical history. At best, he can glance at a note card from the clinic doctor as he dashes from bed to bed in the communal delivery room.

During a single shift, a doctor may deliver a dozen or more babies--as many as an American obstetrician might in a month. One recent newspaper article claimed that a physician at Birth House No. 4 set a record by delivering 37 babies in 24 hours.

As for the monthly benefit payments, the money doesn’t go far. New mothers receive about $27 a month--which buys enough disposable diapers to last maybe 10 days. A one-time bonus for the birth of a child, equal to about $170, covers the cost of a good stroller or, perhaps, a secondhand crib.

Sky-high prices, piled atop political uncertainty and social unrest, have driven Russia’s birthrate to record lows in recent years. In fact, the country’s population is actually shrinking. For births to keep pace with deaths, the average woman would have to bear 2.2 children in her lifetime. Instead, the birthrate fell to a record low of 1.4 babies per woman in 1994.

“They’re surprised that no one’s giving birth these days, but what are we supposed to live on?” asked Oksana Kunayeva, who is expecting her first baby in March.

Young women’s cash woes start well before their babies are born and may contribute to the mortality rate. With prices for fresh produce and quality meats soaring, women increasingly have trouble nourishing a healthy pregnancy. Anemia cases have nearly tripled in six years, and vitamin deficiencies are common.

Plagued by poor nutrition, stress and a high rate of circulatory disorders and heart trouble, women enter childbirth with a distressing risk of complications. A government study conducted two years ago concluded that only 40% of pregnancies ended with “normal” labor and childbirth.

The same study urged a nationwide push to cut the maternal mortality rate in half by the turn of the century. But so far, rates have remained stagnant.

Hoping to spur progress by introducing Western medical techniques, the Magee-Womens Hospital of Pittsburgh has set up health clinics and childbirth classes throughout Russia.

Irina Stepanova, 26, makes a three-hour round-trip subway trek to learn more about her pregnancy in a Magee class. “It was all like a dark forest to me before,” she said.

Her teacher, Olga Ojarenkova, signed up for Magee’s training program after years of helping obstetricians in a traditional birth house. Women in labor would be terrified, unsure what to expect. With no education except rumor, they would scream extra loudly, hoping that their babies would hear their voices and come easily into the world.

Ojarenkova now teaches more modern methods of dealing with labor, like Lamaze. Although she pushes Western ideas, she still must heed Russian rules. Thus, she kept interjecting caveats as she showed an American video on childbirth.

When it depicted a woman walking down a hall in early labor, Ojarenkova broke in with a sigh: “We only allow that here if your partner’s with you.” The video showed the woman in bed, cooling herself with ice. “Unfortunately, they don’t allow that here,” she said apologetically.

Listening to the video’s triumphant soundtrack, a student asked if she could bring a tape player to help her through early contractions. Ojarenkova had to repeat her mantra once more: “They don’t allow that here.”

She added ruefully: “You know our system.”