The Moscow Times
Saturday, July 25, 1998
Young, Russian And Pregnant
By Anna Badkhen
Gynecologist Tamara Rudenko glanced absently through her gold-rimmed glasses at
my name written on top of a medical file while I rested my belly on a
corner of her table. I had just told her my last menstrual period was six months
"Did you come to see me about the delay?" Rudenko asked with a
bored look. I told her I had come to register. In Russia, all pregnant
women are required to register their pregnancy with a zhenskaya konsultatsiya --
a city gynecological office that provides pre-natal care and the papers
necessary for acceptance to a maternity hospital. Rudenko was a doctor at St.
Konsultatsiya No. 30.
"What are you, pregnant?" she asked, finally looking at me.
And so went my introduction to free prenatal care in Russia.
Elsewhere in St. Petersburg during the months I was visibly pregnant, it was an
entirely different story. I was the object of great care and concern from almost
everybody I met. People allowed me to go to the head of the line in department
stores and at currency exchange windows. Cab drivers gave me free rides.
Soviet-bred waitresses became paragons of
politeness. Crippled, 90-year-old babushki, who ordinarily seem to derive
unspeakable pleasure from scolding everyone in sight, eagerly yielded their
seats in trams and buses. One elderly woman who insisted that I take her seat
explained to the other babushki: "We have totake care of pregnant women.
There are so few of them nowadays."
Pregnancy would have felt like an extended bubble bath had it not been for my
sobering encounters with the medical personnel who were in charge of my prenatal
When I first learned that I was pregnant at the age of 21, I panicked. Having a
baby would put an end to my youth and to my career as a journalist, I thought.
After a brief discussion with my boyfriend of two years, Andrei, I decided to
have an abortion -- the most popular form of birth control in Russia.
In St. Petersburg alone, doctors performed last year over 60,700 abortions --
versus 32,900 births, according to the city health committee.
Compared with other industrialized countries, Russia has an
extraordinarily high abortion rate, according to the most recent figures from
the nonprofit, New York-based Alan Guttmacher Institute, which researches
reproductive health. In 1994, for example, there were 80.8 abortions per 1,000
Russian women between ages 15 and 44. In the United
States, by comparison, the number of abortions in 1992 was 25.9 per 1,000 women
in that age group, and in Finland, 9.4 in 1994.
At the time, I knew nothing of this. My expectations of what the abortion would
be like were colored by an experience I had in 1994, when I volunteered to
assist as a translator at an abortion in a Planned Parenthood clinic in the
small city of Utica, New York. Larissa, a Russian woman in her 30s who was
getting an abortion, arrived at the clinic and was taken to a private room.
There she was asked to sign documents saying that she was making the decision of
her own free will.
A counselor duly gave Larissa a detailed -- and terrifying --
description of the negative consequences of an abortion: the
possibility she might never get pregnant again, the increased likelihood of
Larissa was then taken to an operating room, where a doctor, a nurse, and two
volunteers explained to her what the procedure would be like. I held Larissa's
hand during the operation -- to keep her from feeling "alone," the
nurse explained. When the abortion was over, nurses brought
her cookies and tea in a private room. She ended up spending about two hours at
the clinic before returning home.
Two years later in St. Petersburg, I learned that abortions in Russia are a much
different affair. When I told the doctor at Konsultatsiya No. 26 that I wanted
to have an abortion, she told me to have a blood test for AIDS and syphilis, and
set the operation date as soon as possible.
"In a week, it won't be safe for you to have an
abortion," she said.
So much for the warnings.
When I returned two days later for the procedure, I found seven other women who
had also come to terminate their pregnancies. We sat together in the main
hallway near the door that led to the operating room, watching other women
visiting their gynecologists come and go. When I returned from a brief visit to
the toilet, my seatmates had all disappeared. I sat in the hallway for about 90
minutes before they started to emerge from the operating room one by one. I
knocked at the door. A doctor came out and asked me why I didn't come to the
operating room when everybody else did. I said I thought they were assisting one
woman at a time.
"We have eight beds in here," the doctor replied. "We operate on
you all simultaneously."
She then told me that I could not have an abortion that day because her shift
was over. The konsultatsiya, indeed, seemed abandoned. When I told her about my
deadline, she took me to an examination room, where I saw a row of washed
one-time-use-only medical rubber gloves drying on a
radiator, so they could be used again the next day. She examined me and told me
that the period of time when it was safe for me to have an abortion had passed
three weeks ago.
"The doctor who examined you must have been mistaken," she said in a
matter-of-fact tone. "It's a good thing you didn't have an abortion. It
could have only done you harm."
I took the metro home, and over the next day, Andrei and I wrestled with the
prospect of bringing the baby to term. Although I knew that having a baby would
complicate my life a lot, I also had a confusing feeling that to terminate a
pregnancy means to murder a living being. While I was
getting ready to have an abortion, I had a sense that I was doing something
wrong, and I was surprised to feel a relief when I learned that I had no other
choice but to have the baby.
The attempt at abortion behind me, I began to prepare for motherhood.
The first step was to visit the konsultatsiya in the neighborhood for which I
have a residence permit, or propiska. Other options were limited. With a monthly
salary of $500, the $210 charged by one Western clinic for each prenatal care
visit was certainly out of the question, as was even the $20 per visit charged
by a private Russian clinic. I had to be especially frugal since I was spending
more and more on necessities like food. I remember eating seven cans of canned
peaches and then immediately consuming a kilogram of smoked sausage. I could eat
two kilograms of blue cheese in 20 minutes. It was easy to spend $20 a day on
So I turned to Tamara Rudenko, the stout, middle-aged -- and above all,
free -- doctor at the district konsultatsiya who was to register my pregnancy
and, in theory, take care of me. Rudenko -- just like any other doctor at any
other konsultatsiya in St. Petersburg -- earned a monthly salary of 300
Having timed my first appointment with her at the end of her shift at 7:30 p.m.,
I might well have been her 30th visitor that day. As soon as I entered Rudenko's
office, I was introduced to the trademark of the konsultatsiya: The client is
"Leave your dirty bag there! No, there!" Rudenko's nurse ordered as
soon as I stepped inside the office with a backpack slung over my shoulder.
Later, after I had dismounted from the gynecological chair and accidentally
stumbled over a couch, Rudenko said, "I see 90-year-old women here, and yet
they are not as clumsy as you!"
During another visit, I had trouble understanding something Rudenko was saying,
and she commented, "All pregnant women have something wrong with their
heads." Whenever I came to see Rudenko, she addressed me as "beremennaya,"
or "the pregnant one"; her nurse, who never introduced
herself, did not address me at all.
But even more humiliating than Rudenko's rudeness was the lack of intimacy that
her konsultatsiya provided. Although she and her nurse shared a separate office,
Rudenko shared the examination room with another doctor. The examination room
had two examination chairs and one short sofa where the clients of both doctors
were to leave their pants, socks and underwear. Sometimes, both Rudenko and the
doctor from the adjacent office examined their clients at the same time: an
intimidating striptease, if you will. As if to underscore the fact that there is
no privacy in her office, Rudenko often saw two patients at a time, and the
women had to share their intimate problems not only with their doctor, but also
with other women who happened to be in the room. During one of
my visits, Rudenko scolded a pregnant 19-year-old patient in front of me.
"Are you serious about keeping the baby? But you are too immature to take
good care of him! Are you married?" Rudenko screamed at the crying girl.
I endured all this for months, never once having Rudenko ask how I felt or if I
had any questions. I needed medical advice badly, so I called a friend who knew
someone at Snegiryovsky Maternity hospital, popularly known as
Ida Vanovskaya, a doctor at Snegiryovka's intensive care ward, examined me three
times. I called her for advice four times more. She took me to have ultrasound
tests. She was not authorized to fill out the papers that would get me into a
maternity hospital -- and, therefore, could not substitute for Rudenko -- but
she gave me advice on what to eat, what to
drink, what vitamins to take and even what kind of washing machine to buy when
the baby is born. She never charged me a kopeck.
Once Icomplained to Vanovskaya about my humiliating visits to the konsultatsiya.
"I know, dear," she said. "All konsultatsii have the same
terrible way of treating people. It is free health care. Deal with it."
Free health care means a St. Petersburg woman in labor is entitled to one of
four to six beds in a delivery room. It also provides her with one of up to 12
beds in the postnatal ward. It pays for the nurses to take care of the infant
for the first three days after birth: The hospital staff only brings the
newborns to their mothers for short periods of time to nurse, five to seven
times a day. One of the best indicators of the quality of prenatal care
and maternity wards is a country's infant mortality rate. According to the World
Organization, the rise in Russian infant mortality rates following the breakup
of the Soviet Union stopped in recent years. Still, the figures from WHO's
division of health statistics in Geneva are telling. In Russia, there were 18
infant deaths for every 1,000 live births in 1995, the most recent year for
which statistics are available. In the U.S. in 1994 there were eight infant
deaths for every 1,000 births, and in
Finland the figure was four per 1,000 in 1995.
Free health care in St. Petersburg comes at a definite price. Mida Samarskaya,
an inspector at the city's health committee, said that in 1997, four women died
from infections contracted while giving birth in maternity wards with unsterile
conditions. Another woman died last year
because of an infection that was contracted during an abortion. In some cases,
Samarskaya said, doctors and midwives are to blame, but she cannot
remember an instance of someone losing their job over a death.
By the time I was ready to have a baby, I had had enough of free health
Four hundred dollars bought me a separate room at a special "family
confinement" ward in Maternity Hospital No. 16. When I arrived at the
hospital in June 1997, the private ward was a local innovation. It allowed my
boyfriend to be present at the childbirth. It provided a separate room and
private bath for my baby, my boyfriend and me. Our room was furnished with two
beds, a crib, a refrigerator and a
television. ("Wow! A fridge! A shower!" my mother exclaimed when she
came to see me at the hospital. She said that when she was in labor before
giving birth to me in 1975, she was offered a bed in the hallway, because there
was no free space in the hospital.)
Later, the ward's personnel told us that we were the fourth couple to ever use
the new facilities since they opened a month earlier. In the four days we stayed
at the hospital, two more women arrived to give birth there. The
ward had a doctor, a midwife, a pediatrician and a pediatric nurse. Galina, the
midwife, told my boyfriend that in the regular maternity ward downstairs, there
were 32 women, 4 to a room, all served by three nurses and one doctor.
On June 5 last year at about 10 a.m., the contractions started. Some nine hours
later, Andrei and I took a cab across town to the hospital. We arrived at 8
p.m., after the private ward's doctor was gone. By the time we had come, I was
in labor, and Galina had to call a doctor from the maternity ward downstairs.
"What a stupid novelty," the doctor said, regarding the private
department. "Why not have a baby the way everyone else does?" There
was something about her that immediately reminded me of my experience with
The doctor, who failed to introduce herself, examined me and said my
cervix was not adequately dilated. She gave me shots. Then more shots. The
cervix still wouldn't dilate. At 8 a.m. the next day, the doctor told my
teary-eyed boyfriend that she would have to perform a Caesarean section. She
kept coming and going from our room, shaking her head at
my stubborn uterus.
At 9 a.m., Olga Kordunskaya, the head doctor of the ward, arrived on duty.
"Why have a C-section?" she asked. "In order to open the neck,
just turn it to the side, like this."
Two and a half hours later, my boyfriend rushed across the delivery room to
count the wrinkled toes of our newborn son, Fyodor.
After Fyodor was born, my boyfriend met the doctor who had advised a C-section
in the hallway.
"So, did Anna have the baby?" the doctor asked.
My boyfriend said, "Yes."
"And she had no ruptures?"
"No," he said.
"And is the baby O.K.?" she asked."Yes," he said.
"Very strange," she said with a puzzled look.
(The next day, when my mother came to meet her grandson, the same doctor stopped
by. She looked at Fyodor and said to my mother with surprise:
"Bizarre. I thought they would both die.")
Four days later, we left the hospital. Rudenkos, Caesarean sections and washed
one-time-use-only medical gloves drying on a radiator were left behind.
(Letter from Tracy who sent me the article above. Tracy wrote me to ask if I
could somehow help her find a midwife in Russia. I had no luck in my search)
Thanks for your reply and for trying.
There isn't a whole lot of
"underground" these days in Russia and I don't think that is the
problem in finding a midwife. They don't even have this word in the sense
of it's meaning. The word they have for midwife is the lady who
delivers the baby with the doctor in the hospital. As I called
around they all thought I was crazy. It is even new here in the past few
years that a woman would have her own room in the hospital and that her husband
would even be let in the doors, let a lone in the delivery room.
One must pay much more money to have these
"luxuries" now. Men, in the past, and unfortunately probably
about 98% now as well, just get their wife pregnant and that's all he has to do
with her in her pregnancy. They, men and women alike, are very ignorant
about the whole process of being pregnant and birthing. It
definitely is not a shared special time of their lives.
Giving birth is like any other "illness", you
go to the doctor and do what he says without asking any questions or knowing why
or what's wrong. This is very sad. Also, the patient - doctor
relations is like man to dog. It even makes me angry.
I'll tack on
at the end an article that appeared in the local English paper here. I'm
sure you'll find it shocking and sad. The author sent it to me by e-mail
when I was trying to find information via the newspaper.
Thank you again for trying to help.
If you have any ideas, please share them with me. I really don't know what
I will do.
here's the story. i should warn you that despite all
the terrors discussed below, my son, who is now 2 years old, is perfectly fine
(touch wood). after all, most russians give birth in russia.
Dear Mother Dear
here for the Home Sweet Homebirth (Video)