- \n
- Life expectancy<\/u> in Slovenia has exceeded 80 years and is one year above the EU-28 average, with highly educated residents living longer and in better health than residents with the lowest level of education.<\/li>\n
- Infant mortality<\/u> is an indicator that reflects the accessibility and quality of healthcare in general. In Slovenia, it is among the lowest in OECD countries, at 1.6 infant deaths per thousand live births. Slovenia also ranks among the more successful countries in terms of maternal mortality<\/u> for the period from 2009 to 2011 (the three-year average rate is 1.5 maternal deaths per 100,000 live births). <\/li>\n
- Population vaccination coverage<\/u> for childhood diseases is an indicator of population inclusion in preventive programs and in Slovenia equals the EU average, with 96 percent of the population vaccinated against diphtheria, tetanus, and whooping cough (same as in the EU), and 95 percent against measles (94 percent in the EU).<\/li>\n
- Indicators showing regional health disparities<\/u>, along with other health determinants, also reflect accessibility to preventive and treatment programs. According to OECD data, Slovenia has the lowest proportion of people among all EU countries who could not afford healthcare due to financial or other reasons. We are among 17 European countries that provide healthcare to all their residents. However, due to the crisis and resulting unemployment, health inequalities between different population groups and regions have begun to deepen in Slovenia as well. At least in part, these differences can be attributed to reduced accessibility to healthcare (Ministry of Health of the Republic of Slovenia [MZ RS], 2015a). <\/li>\n<\/ul>\n
Nevertheless, we lack research in Slovenia on the satisfaction of women who give birth with a chosen midwife at home, in a maternity hospital, or in a birth center compared to the existing care provided in the Slovenian healthcare system. The practice in most Slovenian maternity hospitals is that a woman gives birth with the midwife who is currently on shift. Only Kranj Maternity Hospital offers the option of giving birth with a chosen midwife who has a contract with the Hospital for Gynecology and Obstetrics Kranj. Women contact this midwife themselves and she comes to give birth with them at BGP Kranj (Hospital for Gynecology and Obstetrics Kranj [BGP], ND). Trbovlje General Hospital has also listened to women in labor who want their birth to be led by a midwife they trust and choose themselves. Thus, they offer a self-pay service where the woman chooses her own midwife (Trbovlje General Hospital [SB Trbovlje], 2015). There are also women who decide to give birth at home with a chosen Slovenian or foreign midwife. Slovenia lacks separate statistics on labor augmentation, labor induction, perineal injuries, and preterm birth in physiological pregnancies compared to pathological pregnancies. If we wanted relevant statistics, tertiary centers would have to keep separate statistics, as only then would they be competitive with smaller maternity hospitals, which generally only deal with physiology and refer all pathological pregnancies to tertiary centers (e.g., to Ljubljana or Maribor). <\/p>\n
- \n
- Increase access to healthcare that most reliably supports the physiology of childbirth<\/em><\/strong>, i.e., to midwives, birth centers, and birth companions. Pregnant women in Slovenia have very good opportunities for access to healthcare. Their pregnancies are managed by gynecologists, and if necessary, they are referred to tertiary centers. Thus, they receive dual care, which makes gynecologist visits more frequent and the management of their pregnancy more thorough and detailed. However, we can see that gynecologists and obstetricians are those who deal with pathological pregnancy and participate in childbirth. Midwives, who are responsible healthcare professionals for managing physiological births and also support births that are as physiological as possible, are somewhat pushed to the margins in Slovenia. In Slovenia, every pregnant woman has the right to 10 systematic examinations and two ultrasound scans, as well as individual consultations. The purpose of preventive examinations is active health monitoring of the pregnant woman and fetus. If the pregnancy is not progressing normally, the gynecologist decides on additional examinations. The first examination is performed by a gynecologist up to the 12th week of pregnancy. Subsequent systematic examinations are approximately in the 24th, 28th, 35th, and 40th weeks of pregnancy. The remaining five systematic examinations in the 16th, 32nd, 37th, 38th, and 39th weeks of pregnancy are performed by a graduate midwife or a graduate nurse trained for independent work<\/u>. If a graduate midwife or a graduate nurse trained for independent work is not employed in the gynecological team, these examinations are performed by a gynecologist (MZ RS, 2015b). Since Slovenian gynecological clinics (within maternity hospitals, health centers, or independent gynecological clinics) do not employ a midwife\/graduate nurse trained for independent work who could perform these examinations (nursing staff is mostly only for administration), all examinations are performed by gynecologists. According to the Regulation on the Implementation of Preventive Healthcare at the Primary Level from 1998, last amended in 2015, we should work in Slovenia to ensure that women have greater access to midwives during pregnancy and receive midwifery care. Research below shows that contact with a midwife during pregnancy positively affects pregnancy and birth outcomes, even in cases of pathological pregnancy. At last year’s fourth birth conference in Maribor titled Ancient Wisdom and Modern Science of Childbirth, Jesenice Maternity Hospital also presented. Among other things, they said that every first Monday of the month they have a discussion about physiological birth with a gynecologist, pediatrician, and midwife. Since the beginning of 2015, midwives have also been running a clinic where they perform 5 midwifery examinations as prescribed by the Regulation on the Implementation of Preventive Healthcare at the Primary Level, for healthy pregnant women in the 16th, 28th, 35th, 37th, and 38th weeks of pregnancy. They also check urine and if they detect changes, they refer the pregnant woman to a gynecologist. Otherwise, they talk to her and give her further instructions. After physiological births, they also perform rounds themselves. Such a way of working requires the goodwill of system leaders, employees, and users of healthcare services. This requires more staff with appropriate knowledge and experience and additional spaces where this midwifery activity could be carried out. As healthcare workers with easy access to knowledge, we must ensure that we (re)design our existing systems so that we positively influence birth culture and thus change practices that will be demonstrably better and safer choices for pregnant women, women in labor, newborns, and others involved in the birthing process. However, staffing shortages must first be addressed. <\/li>\n
- Support the quality of work of all those involved in the birth process, support initiatives to improve the quality of maternal and child care and for physiological processes in healthy women and newborns and, when safe, in those with special needs. <\/em><\/strong>The following section of the master’s thesis will explain why it is important to routinely enable skin-to-skin contact even during cesarean sections or, if the mother is unable, to enable this for the father. <\/li>\n
- Develop and implement experiences with care, birth outcomes, and women’s opinions on the quality of care. <\/em><\/strong>It would be necessary to prepare surveys on women’s satisfaction with care during pregnancy, childbirth, and the postpartum period.<\/li>\n
- Develop and publish options for using safe websites that allow pregnant women access to relevant information<\/em><\/strong>. The author of the master’s thesis also strives for this, collecting and organizing relevant articles on pregnancy, childbirth, the postpartum period, and midwifery through the Facebook network under the name Moja babica and on the website mojababica.si<\/a>. <\/li>\n
- Promoting breastfeeding and maintaining the Baby-Friendly Hospital designation.<\/em><\/strong> Through the Baby-Friendly Hospital<\/em> initiative, the National Committee for the Promotion of Breastfeeding encourages breastfeeding for the good health of mothers and children (UNICEF, ND).<\/li>\n
- Support public education and information<\/em><\/strong> for women, the public, journalists, and others about the value of physiological birth processes for the health of women and newborns.<\/em><\/strong><\/li>\n<\/ol>\n
Zadok (2016) in her preparations of couples for childbirth uses a board where participants write down associations related to childbirth. Positive words appear on the board, such as: child, anticipation, blessing. But more typical are words like: pain, fear, loss of control, death. These associations stem from childhood, as childbirth is always presented to us as suffering and the media portrays it that way. Awareness, humility, patience, and dedication are four interconnected elements that help women in childbirth preparation to begin trusting their bodies, gain appropriate knowledge and confidence. A woman who does not feel safe or perceives danger will likely have a long and painful labor. We healthcare workers are the ones who must enable women in the delivery room to feel safe and trust us. Support and a sense of security make labor faster. Fear and anxiety slow it down and make it more painful. During labor, emotions and environment affect the secretion of hormones that have a major impact on labor. A woman who does not feel safe will secrete a lot of adrenaline, so labor will be slow and painful. Muscles contract under the influence of adrenaline, all energy goes to our limbs. The body is also more sensitive to pain. Adrenaline secretion helps us avoid danger, and we must ensure that as little as possible is secreted during labor. A woman who feels safe in the environment where she is giving birth will secrete oxytocin and endorphins, with the help of which her labor will progress well. Muscles are relaxed under the influence of these hormones, and energy is sent to the uterus, which further increases oxytocin secretion (Durham, 2016). To prevent adrenaline secretion in the delivery room, we must ensure that the woman feels safe, loved, and protected, that she has a sense of control and people around her who provide support. We must also provide her with privacy. <\/p>\n
Until approximately the 16th century, events related to childbirth did not differ greatly among nations and cultures. We can infer about childbirth far back in history mainly from preserved statues, paintings, and traditions. Most commonly depicted are women in labor giving birth in any of the upright positions and being supported. The hieroglyph meaning to give birth represents a squatting woman. Until the mid-18th century, the use of the birthing stool was very widespread. Women most often gave birth in a familiar home environment, surrounded by other experienced women. One of them had the role of midwife. Midwifery knowledge passed from generation to generation, most often by oral tradition. Unfortunately, midwives at that time, despite having more experience than other women, often did not have enough knowledge to ensure the survival of mother and child, especially when a birth complication occurred. They were completely helpless when the child got stuck due to incorrect position and the mother could not push it out herself (Hrovat-Kuhar, 1995). Mortality of both women in labor and newborns was very high. Mothers died en masse also from the consequences of preeclampsia, severe bleeding, and puerperal fever. Conditions for childbirth improved rapidly with the development of medical science, but they also brought a changed birth position (Wagner, 2008). So that those helping with the birth could have a better view, women in labor had to lie on the bed. This was also necessary due to the use of a new invention\u2014forceps, with which many infants were helped into the world. The lying, passive position became firmly anchored in the 19th century. Since then, all women in labor have been lying down, not just those who would need some intervention (Hrovat-Kuhar, 1995). <\/p>\n
![\"givingbirth-ancient-egypt\"](\"data:image\/svg+xml;base64,PHN2ZyB3aWR0aD0iMSIgaGVpZ2h0PSIxIiB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciPjwvc3ZnPg==\")
<\/p>\nPhoto 1<\/a> and Photo 2<\/a> <\/p>\n
Michel Odent is an obstetrician who dares to speak out loud about the importance of skin-to-skin contact after birth, breastfeeding in the first hour after birth, who talks about how important it is for birth to be as natural as possible. Many consider him controversial because of this. It is hard to agree that he is controversial in midwifery eyes. In his book Do we need midwives? he talks about how increased medicalization of childbirth means that women are losing the ability to give birth, which has potential harm for humanity. This is a rhetorical question. What is the role of the midwife in the world of medicalized childbirth? In an interview for The Telegraph, he says that the ideal scenario for childbirth is a calm, dark, warm space, with a companion and a midwife who understands the physiology of childbirth and the woman’s needs. Melatonin or the sleep hormone has an important role in the birthing process, which was discovered in July 2014, so all light in the delivery room is disruptive. This is the complete antithesis of most births in maternity hospitals, where there are too often overly bright, overcrowded delivery rooms, too little staff, and chaos. All this threatens the natural birthing process, so births too often end operatively (with the help of vacuum or cesarean section) (Woods, 2015). <\/p>\n
To globally change birth practice, we must approach the matter systematically:<\/strong><\/p>\n
– the more people are exposed to relevant information about midwifery and gentle birth, the more will take it as the norm;<\/em><\/p>\n
– attitudes are formed in childhood, so we must ensure that children are exposed to these ideas;<\/em><\/p>\n
– experiences influence change: if we encourage people to try something themselves, it is much more effective than just talking to them about it;<\/em><\/p>\n
– when providing information, we must be unbiased, which will make us more credible;<\/em><\/p>\n
– it is necessary to talk about childbirth also with the partner, parents, grandparents, and everyone involved in the birthing process, not just with the woman, as these people influence her decisions;<\/em><\/p>\n
– reflection on past decisions and their outcomes helps us think more logically about why something happened and reduces the possibility of false assumptions (Wickham, 2000).<\/em><\/p>\n
If we want to provide quality midwifery care, we must develop protocols rationally, reasonably, based on findings and research, so that we will do what is best for mothers and newborns. We must develop them together with the users of our care. <\/p>\n
Read more:<\/p>\n
The Wisdom of Birth – Michel Odent<\/a><\/strong><\/p>\n
- Support the quality of work of all those involved in the birth process, support initiatives to improve the quality of maternal and child care and for physiological processes in healthy women and newborns and, when safe, in those with special needs. <\/em><\/strong>The following section of the master’s thesis will explain why it is important to routinely enable skin-to-skin contact even during cesarean sections or, if the mother is unable, to enable this for the father. <\/li>\n
- Infant mortality<\/u> is an indicator that reflects the accessibility and quality of healthcare in general. In Slovenia, it is among the lowest in OECD countries, at 1.6 infant deaths per thousand live births. Slovenia also ranks among the more successful countries in terms of maternal mortality<\/u> for the period from 2009 to 2011 (the three-year average rate is 1.5 maternal deaths per 100,000 live births). <\/li>\n
![\"givingbirth-ancient-egypt\"](\"https:\/\/mojababica.si\/noviteta\/wp-content\/uploads\/2016\/09\/givingbirth-ancient-egypt.jpg\")
![\"9c4036d7b19078cd244d61d255609c85\"](\"https:\/\/mojababica.si\/noviteta\/wp-content\/uploads\/2016\/09\/9c4036d7b19078cd244d61d255609c85.jpg\")
<\/p>\n![Photo 1<\/a> and](\"https:\/\/s-media-cache-ak0.pinimg.com\/564x\/d4\/1e\/0a\/d41e0a466eb14ed0ddcf11695ab38c97.jpg\"){kind=link}
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