Raising the voices of pregnant women in Poland

August 2015

A mother holds her newborn, Boyarka, Ukraine.
WHO/I. Chernichkin

When Milena, a gynaecologist and obstetrician, began delivering babies more than 30 years ago in Poland, pregnant women did not have the right to choose how they gave birth, how to be supported by her partner in the delivery ward or share a room with her newborn.

Although Milena was a doctor, the birth of her own child lacked respect and dignity.

“When I was a birthing mum the ward closely resembled prison,” says Milena. “Being devoid of human support is a hugely stressful experience. I’m happy that now my memories are exactly that – memories.”

A campaign for change

Twenty years ago, as a response to a nationwide campaign entitled "Childbirth with dignity", Polish women began sharing their childbirth stories and advocating for respectful maternal care.

Lack of privacy, loneliness and inadequate support during birth were common themes. Most women experienced mandatory episiotomies, felt humiliated and had no choice in the administration of pain reliefs. Since babies were not rooming with their mothers after birth, breastfeeding rates were low.

“Women had so much trauma after childbirth that the Foundation needed to share their stories and help them and other women become more comfortable with birth,” says Daria Omulecka, spokesperson at Childbirth with Dignity Foundation.

The campaign changed the health system and won international recognition. Bans on partners not being allowed in the delivery room were lifted. Mothers were allowed visitors and babies were placed in their mother’s arms after birth. Childbirth became a more pleasant experience.

“Today more women are now enjoying their labour, they don’t feel so lonely anymore, labour is treated more as a family and intimate event. We believe it has influence on their first month at home making it easier and gentler for woman,” explains Omulecka.

Preventing mistreatment of women during childbirth

Globally, many women experience disrespectful, abusive or neglectful treatment during childbirth. In 2014, WHO issued a statement calling on health systems to commit to promoting the rights of women in childbirth. To date, more than 80 organizations around the world have endorsed the statement.

The statement calls for the generation of data related to respectful and disrespectful care practices, systems of accountability and meaningful professional support – all actions being implemented in Poland.

First national standards

In 2011, as a result of the “Childbirth with Dignity” campaign and many years of advocacy, the Polish Ministry of Health issued the first national Perinatal and Postnatal Care Standards, in line with WHO guidelines. The standards outline a woman’s right to choose the place and method of birth, to decide who is in the delivery room, and to be with her newborn at least 2 hours after the birth, among others.

WHO, Childbirth with Dignity Foundation, the Polish Ministry of Health and other organizations are now monitoring improvements in quality of care for women and newborns. WHO and the Ministry of Health will soon launch a Hospital Assessment Tool to assess the implementation of these national standards.

“Through the WHO Hospital Assessment Tool, we hope to ensure adherence to proven standards of care in the country’s health facilities so that the quality of care for mothers and children can be improved,” says Paulina Miskiewicz, WHO Representative in Poland.

The Childbirth with Dignity Foundation has also launched a website: www.GdzieRodzic.info (WhereToGiveBirth.info).

The site publishes data from hospitals in order to help expectant parents identify where they would like to deliver their child. This year, the Foundation won the Sasakawa Health Prize at the World Health Assembly for its work in improving maternal care in the country.

Infant mortality has improved

Perinatal and maternal health in Poland has significantly improved since women began advocating for respectful care. Infant mortality has dropped from 1 in 66 in 1990, to 1 in 222 in 2013.

Although women are receiving more breastfeeding support after birth, national rates still remain low.

“Breastfeeding rates in Poland are very high in hospitals just after the birth but drop very quickly after discharge. Less them 10% of women exclusively breastfeed for 6 months,” says Miskiewicz.

WHO continues work with the Polish Ministry of Health to implement the Baby-friendly Hospital Initiative – a global effort, to implement practices that promote and support breastfeeding. Currently, 90 hospitals in the country have been certified as a baby-friendly, but more research needs to be done on why rates remain low.

A friendly maternity ward

Now, when Milena delivers a baby in Poland, the maternity ward is nothing like when she first started practicing.

“It’s Thursday, 12 o’clock and I just came back from working a 24-hour shift. The day concluded with 8 births,” Milena recalls. “I’m tired but actually feeling more content than exhausted. It’s really rewarding to see how suffering turns into happiness on a birthing mum’s face.”

* Not her real name.