New standard of perinatal care: better access to anesthesia, greater role for midwives, end of traumatic situations

The Ministry of Health has announced an amendment to the annex to the August 16, 2018 regulation on the organizational standard of perinatal care. This is in response to the demands of women, medical experts and social organizations, who have long called for a modern, consistent and patient-sensitive approach to childbirth and puerperium.

The proposed solutions were developed as part of the work of the Team for Improving Women's Health Security, established by the Minister of Health in May 2024. The team, made up of experts in obstetrics, gynecology, neonatology, anesthesiology and obstetric nursing, analyzed key issues and developed a series of changes to improve the quality of care in hospitals and in the home environment.

- The goal is to create a unified, safe and compassionate system of care for a woman and her child, in which medical personnel are guided by respect for the rights of the patient, cooperation and understanding, the project's explanatory statement emphasized.

Key changes in perinatal care

The new regulations include a wide range of modifications - from preventive care and examinations during pregnancy to the organization of childbirth, postpartum and patronage visits by midwives.

1. Greater role for midwives and fewer unnecessary consultations
   Midwives will gain the ability to manage physiological pregnancies on their own, without the obligation to consult a gynecologist three times. As the health ministry stresses, midwives have the necessary education and experience to monitor the proper course of pregnancy, refer for necessary examinations and, if necessary, consult the patient with a specialist.
2. Increasing access to anesthesia and anesthesia consultations
   Every woman giving birth is to have access to at least one method of pharmacological pain relief. Hospitals will be required to publish information about available anesthesia methods on their websites and update them regularly. Women planning to give birth with regional analgesia will be referred in advance for anesthesiology consultation.
3. Changes to testing and prevention during pregnancy
   The draft expands the list of mandatory tests to include, among others, HBV testing, ferritin determination and toxoplasmosis at certain weeks of pregnancy. It also changes the rules for cytology and rubella testing - in accordance with current epidemiological and clinical knowledge.
4. More empathy in difficult situations
   One of the most important changes is an absolute ban on placing women after a miscarriage or stillbirth in the same rooms as women with newborns. Women in this situation will be housed in single rooms or in conditions that do not exacerbate the trauma. They will also gain the opportunity for professional midwifery care at their place of residence.
5. Better education and emotional support
   The draft removes time restrictions on the start of prenatal education, strengthens the obligation for doctors to refer women to PCP midwives, and emphasizes education on immunizations during pregnancy, healthy lifestyles and substance abuse prevention.
6. Safe delivery and contact with the baby
   The new regulations emphasize the importance of uninterrupted, at least two-hour "skin-to-skin" contact between mother and newborn - including after a cesarean section. Women in labor will be able to eat easily digestible meals and take clear liquids without the need for staff approval.
7. Postpartum support and care for premature babies
   Midwives will also be able to make patronage visits to babies born prematurely or who have been hospitalized for a long time. Women whose baby has died or requires hospital care will also receive professional support from a midwife at home.

Source: RCL