Problems in perinatal care - RPO's address to the Ministry of Health

According to Article 68 of the Polish Constitution, public authorities have an obligation to provide pregnant women with special health care. The standard of maternity care guarantees, among other things, the right to informed participation in decisions about pregnancy and childbirth, free choice of birthing positions or uninterrupted skin-to-skin contact with the child after delivery. However, practice shows numerous violations of these rights.

Key issues

1. Patients' lack of consent
   Pregnant women are not always asked for consent for medical procedures such as inducing labor or administering oxytocin. This violates the provisions of the Law on Patients' and Physicians' Rights.
2. Freedom of movement in childbirth
   According to the standard, a woman in labor has the right to choose a free position in childbirth, and in the second period of labor she should be allowed to assume the positions she finds most comfortable. The data shows that in many cases these decisions were made by medical personnel instead of patients.
3. Intermittent skin-to-skin contact
   Mother-baby contact after delivery is sometimes interrupted for reasons other than a health or life threat, such as weighing the baby.
4. Obstetric and gynecological violence
   Extremely disturbing are the signals received by the Foundation indicating that parturients experienced very difficult and traumatic situations, i.e. ridicule (1,611), blackmailing with the health of the child or the parturient (791), spreading legs by force during pushing (414), threats (167), tying legs to the bed (81), poking (59), slapping (10) and other unpleasant situations (1,922).
5. Inadequate lactation support
   Lactation care is not widely available, making it difficult for women to breastfeed.
6. Low availability of perinatal anesthesia
   In 2022, not a single epidural was performed in more than half of the delivery rooms, which significantly reduces the comfort of births. The current rules of anesthesiologists are questionable. In the UK, for example, the anesthesiologist performs the anesthesia, and if it goes smoothly, it is further administered by a properly trained midwife or nurse.

The ombudsman made recommendations, including:

• Increasing valuations of perinatal procedures,
• Providing access to epidural anesthesia,
• Introducing mandatory training for medical personnel,
• Strengthening the role of midwives,
• Monitoring perinatal care standards and imposing sanctions for non-compliance.

The RPO expects the Ministry to address the problems presented in detail and take steps to improve the situation. In particular, it is crucial to ensure the effectiveness of perinatal care standards and improve the availability of epidurals.

Source: RPO