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Birthing – ‘Skin to skin’ disdained in Bulgaria

08/01/2012

I’ve very recently had contact with the budget end of the Bulgarian health system viz a viz childbirth.  Not me personally of course, but I had a very close interest in the proceedings.  The birth was by c-section at the ‘Maichin Dom’ (Mother’s House) – the main maternity hospital in the capital, Sofia (it’s also a teaching hospital).  As it happens, the delivery unit for ‘at risk’ mothers is brand-spanking new, with donations from several major companies.  They even play music during the procedure!

But in other ways, and in pretty much the rest of the hospital, it’s still old-school – the way things were done during the ‘former’ – ie, communist – times.  Including the entrenched policy, at least within the state hospitals, of separating mother and new-born for at least the first 24 hours of the latter’s life.  In the case in question, after extraction, the baby was first taken away from the operating table, to be checked and cleaned, and then displayed briefly – like, for a number of seconds – to the mother, who of course was a bit beaten up from the c-section but conscious, lucid and – probably – dying to hold the little life she’d been carrying for 37 weeks.  But no, baby then whisked off, mother next to see her after what proved in this instance to be 28 hours, four floors up in the neonatal ward.

In New Zealand these years, and many other countries, ‘skin to skin’ is official policy – putting the mother and newborn in physical contact from the time of birth.  It’s described thus in the website of the New Zealand Women’s Health Action Trust, a state-sponsored NGO:

Placing a newborn baby directly on the mother’s bare chest immediately after birth and leaving it there for at least an hour allows the baby to find her way naturally to the breast and start breastfeeding.

Not being in any way an expert on the topic, it nevertheless seems to me that ‘skin to skin’ is in the category of ‘bleeding obvious, really’ when it comes to supervised or assisted childbirth, whether it be in a maternity hospital or in the home.  Assuming no emergency, where else to put a newborn than at her mother’s breast?  But not here in Bulgaria, not for 24 hours.  What do they feed the baby in that time?  I have no idea, some kind of formula, certainly not from the mother, whose milk of course may or may not have started though nature undoubtedly intends that the process should start from minute 1 of the new life.

And it doesn’t do to ask such questions.  Seemingly, the last thing a new mother in the Maichin Dom or other state maternity hospital needs to be concerned about is being bombarded with information.  Indeed, there appears to operate a policy of ‘don’t ask because we don’t tell’, whether it relates to the question posed above, to immunisation – which as I understand is for hepatitis B and tuberculosis but you’d never know – in the first 24 hours, to likely discharge date, to correct latching technique, stuff like that.

And when mother and newborn are eventually reunited, it is only for the scheduled, three-hourly feeds.  Newborn babies apparently become hungry once every three hours, except during the night when – seemingly – they can go six or more hours.   At any rate, at feeding time the mothers troop dutifully from their rooms to the nursery part of the ward and wait while their babies are wheeled out into the corridor, each there to be claimed.  Sometimes the babies are put in the corridor before the mothers arrive and just sit – lie actually, of course – there until claimed.  Feeding – I hesitate in this soul-less environment to use the term ‘nursing’ – is performed in a bleak, sparsely furnished, pooly lit and heated (we’re talking mid-winter) room given over to the purpose, with mothers and infants left to their own devices, the assumption of the ‘nursing’ staff presumably being that all duly attended their antenatal classes.   Feeding done, the mothers are despatched back to their rooms, babies wheeled back to theirs.

As for visitors, whether father, sibling, grandparents or whoever, they are strictly forbidden access to the ward or to the newborn for the duration of the latter’s stay.  There are just two benches in the ‘public’ part of the floor, outside the lifts, otherwise it’s a case of standing around.

Where the new mother - sans the newborn - can spend time with visitors at Maichin Dom maternity hospital in Sofia.

The newborn may be viewed only through a glass panel.  It is not a welcoming place, indeed the whole message is that childbirth in Bulgaria is the business of the state and that private citizens – the mother necessarily excepted – have no role to play and are barely tolerated.

Close-up of the sign at the entrance to the neonatal unit. In part it reads "Влизането на цивилни лица забранено" - admission to civilians prohibited.

Of course, the main thing with any birth is that both mother and child survive the process and move forward, healthily, into their new life together.  One can assume that is the objective also in Bulgaria.  I don’t profess to know why ‘skin to skin’ is so disdained here, though I do know of a strong focus on avoidance of infection, of a belief that the mother needs to rest and recover after the birth, whether natural or by c-section, and – I suspect critically – of a deeply entrenched belief that the state knows best.  It was certainly how they did it back in the communist times and, at least as regards ‘skin to skin’, new-fangled ideas are not welcomed.

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