Early in the morning on Feb. 25, Oleksiy Yushkov listened to a doctor at Cherkasy’s regional hospital maternity ward tell him his wife didn’t make it.
Yushkov and his wife Lena exchanged texts and calls throughout the day before, after she checked in to give birth. But around midday, Lena stopped answering.
The doctors informed Yushkov and his mother-in-law that Lena had given birth at 3:35 p.m. on Feb. 24, but died from blood loss at 4:10 a.m. the morning after.
COVID-19 protocols kept Yushkov from joining Lena in the delivery room. He wondered why no one called to tell the family their son had been delivered, or that the mother wasn’t well. He suspects the doctors hadn’t even noticed until it was too late.
Since COVID-19 arrived, women in Ukraine have consistently faced bans on having their partners in the delivery room. They were forced to give birth alone, in maternity hospitals notorious for mistreating patients.
Not only is this contrary to World Health Organization recommendations, it is illegal in Ukraine.
According to the law, a woman has the right to have up to two partners in the delivery room. The Health Ministry never officially banned the practice, but some local and regional health departments did it anyway, ostensibly to reduce the risk of COVID-19 infections.
Yevhenia Kubakh, co-founder of motherhood advocacy nonprofit Natural Rights Ukraine, says that local and regional hospitals don’t have the right to defy the ministry, and that placing restrictions on women giving birth “is a human rights violation.”
The Health Ministry responded by saying it “never banned partners at the ministry level.” But it also never demanded that hospitals allow partners, stating that restrictions “minimize the risk of infection and protect the health and lives of Ukrainians, including in childbirth.”
Oleksiy Yushkov, along with his mother-in-law, father-in-law, and brother, pick up his newborn son at the Cherkasy Oblast Regional Hospital on March 8. Lena, Oleksiy’s wife, died of blood loss after delivery in this hospital on Feb. 25.
Bureaucracy meets COVID-19
A partner’s presence can mean the difference between life and death. At a meeting organized by Natural Rights Ukraine last year, one woman said that when she started to hemorrhage after labor, her husband had to run around the hospital to find a doctor to help, ultimately saving her life.
Earlier this year, couple Gregory and Nataliya Fedosenko requested permission several times from the Ivano Frankivsk city maternity hospital to be together when she gave birth. In the end their requests were denied, apparently because “they didn’t include the correct documents.”
Fedosenko’s wife had to give birth without her partner, but the family is still suing the city for a violation of their rights.
“For us it’s important to prove this was a violation of rights and for those responsible to be held accountable,” said Fedosenko. “If you don’t defend this right, there’s a good chance it will be violated again and again.”
It’s difficult to pinpoint why some local health departments ban partners in delivery rooms and others don’t.
To Fedosenko it is a matter of bureaucratic dysfunction. Ivano Frankivsk’s Health Department refused orders from the city council to allow partners, instead taking direction from the State Emergency Service of Ukraine.
Kateryna Bulavinova, a health expert at UNICEF Ukraine, doesn’t believe health departments’ intentions were malicious, but also notes that partners in the delivery room were not to blame for the high COVID-19 rates in hospitals.
“I think it was misguided to exclusively ban partners in delivery without even improving general practices of infectious virus control (in hospitals),” she said.
According to Fedosenko, his wife was never even tested for COVID-19 before going into labor.
Part of a pattern
But Anastasiya Salnykova, a doula and co-founder of Natural Rights Ukraine, says these restrictions represent a broader disregard for women’s feelings during pregnancy and childbirth that has existed long before the pandemic.
According to a report by the organization, the most widespread mistreatment women experience during pregnancy and childbirth is the violation of informed consent.
Often, women are not informed of upcoming medical interventions, such as artificially breaking their water, surgical cutting to facilitate delivery, and administering medications.
In a 2019 survey of 7,100 women across Ukraine, out of a third of women on whom doctors performed episiotomies (surgical cuts), 65% said that doctors did so without their consent.
Women also report poor medical conditions, a lack of privacy, abusive or outdated treatments, and demands for payments, despite the fact that health care services in state hospitals for pregnancy and childbirth are free in Ukraine.
Kubakh believes that medical personnel treat informed consent as a bureaucratic formality, believing that patients are ill-equipped to make medical decisions about their bodies.
Mothers-to-be who test positive for coronavirus may be forced to give birth in dangerous conditions.
This was one of the reasons why Kateryna Babkina, a Kyiv-based writer, decided to give birth in Vienna.
“If I tested positive for covid before delivery, I would not be able to give birth in my chosen maternity hospital and with my doctor, but in a special “covid” maternity hospital with the doctor on duty,” she said. “It’s a lottery that can cost a life.”
Babkina wrote in her blog about how she also feared she could be mistreated or verbally abused by the medical staff even if she chose to give birth at a private hospital.
The price of giving birth at a private maternity hospital starts at $2,000. In some cases, when there are health complications, a woman can be directed to a state hospital, where doctors have more experience in treating these specific issues.
Giving birth abroad can cost anywhere from $10,000 to $30,000, depending on the country. In Ukraine, where the average monthly salary is around $375, that is not an option for most families.
A woman lays with her newborn daughter on April 1 after giving birth in Kyiv’s maternity hospital No. 5 “home birth center”. The hospital has overseen almost three times as many “home birth” deliveries in the last three months than all of last year. (Oleg Petrasiuk)
Home births
As women seek alternatives, home births have been increasing in recent years, says Salnykova.
While it is legal for a woman to give birth at home, it is illegal for doctors to provide medical assistance during a home birth.
So home births are usually assisted by midwives who are self-taught and use whatever resources they can find to assist childbirth. At the moment, the Health Ministry isn’t ready to give midwives legal status, says Salnykova.
If women face complications during a home delivery and have to be rushed to the hospital, they sometimes report mistreatment by hospital staff for attempting a home birth. Sometimes they’re refused immediate treatment.
Kyiv’s maternity hospital No. 5 wants to be different. It created an entire “home birth center” in its maternity ward, with rooms that are meant to resemble a home.
Vladislav Berestoviy, an obstetrician at the maternity hospital, says that last year around fifty women had “home births” in its maternity ward. In the first three months of the year, the hospital has performed over a hundred.
Providing this alternative is part of the maternity hospital’s “My Personal Birth Plan,” developed with women and their partners to ensure women have the delivery they want.
“We began listening to women, not telling them what to do, but asking them what they want,” says Dmytro Govseev, the director of maternity hospital No. 5.
While doctors’ attitudes in maternity hospitals in the capital may be improving, “they are the exception in Ukraine,” Salnykova says.
