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 ago.

  "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. Petersburg's Zhenskaya
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 care.

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 future miscarriages.

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 french fries.

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 rubles ($49).

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 always humiliated.

"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 Snegiryovka.

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 Health
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 care.

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 Rudenko.

  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)

Hi Greg! 
        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.
     ~   Tracy

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.

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