Interregional Public Organization “Motherhood, Childhood and Family Protection” was founded on April 16, 2009 to cooperate with the state authorities in protection of the rights and interests of mothers, children and families. The Constitution guarantees the state protection of motherhood, childhood and family, but, unfortunately, nowadays the declarations stand apart from the real life.
PUBLIC INVESTIGATION
Elena Ermakova is an obstetrician, a midwife and a well known supporter of the home birth movement.
Elena, 41, has six children (the three youngest are 4 months, 2 and 5 years old).
Elena was accused of illegal medical practices when unfortunately one of her last deliveries ended in the death of the child in 2006, and she was imprisoned when she herself was 30 weeks pregnant, in St. Petersburg on March 30, 2009.
She is in jail where her son, her 6th child, was born in July. The expert reports all conclude that she was not guilty of malpractice and that all the problematic deliveries of her 17 year career were the results of pathological pregnancies. The additional forensic medical examination ordered following the victims’ petition gave the same conclusion. If the accused are guilty they have to be punished. But the court, when passing sentence, didn’t take into consideration the expert reports. Elena was sentenced to 5 ½ years prison and is appealing the decision while in jail.
GROSS ABUSE OF HUMAN RIGHTS
A PREGNANT OBSTETRICIAN AND A KNOWN PROPONENT OF HOME BIRTH WAS IMPRISONED AND TORTURED WITHOUT ANY CRIMINAL CONVICTION.
Elena Ermakova was accused of illegal medical practice and taken into custody following a judicial order while she was at a doctor’s office. The court hearings were ongoing and no legal verdict had been passed yet. Elena’s complaints about persistent abdominal cramps, increased blood pressure, and deteriorating health were considered as malingering and completely ignored.
A written statement from Elena saying that she was unwell and had to seek medical help was presented to the Judge by Elena’s husband and her attorney, but did not influence the court’s decision. Although Ermakova’s doctor insisted on her urgent hospitalization, the court’s order was not changed. She was accused of reluctance to attend the court hearings. Russian officials and state-controlled mass media supported the judge’s decision.
Elena was in a critical condition, in a prison, where proper prenatal care and diagnostic tests were unavailable. She was deprived of food and basic hygiene and had to share a dirty freezing cell with eight inmates, mostly drug-addicts infected with hepatitis or tuberculosis, who were continuously smoking. She was forcefully treated with obsolete medications and was threatened with being subjected to X-rays. In addition, Elena was verbally and physically abused by the prison’s staff and deprived of any communication with her family.
On May 13th, 2009 the court announced that there will be no sessions till the 3rd of July, 2009. Meanwhile, an additional forensic medical examination was ordered following the victims’ petition. Ermakova’s appeal to change her preventive punishment from imprisonment to a written undertaking not to leave the city was dismissed. As a matter of fact, Ermakova was doomed to give birth to her baby in prison, although she hadn’t yet been convicted, and her unborn child was innocent.
An imprisonment of a mother of many children, who is in her last month of pregnancy, is a direct threat not only to her life but also to the life of an unborn child. Such violation of human rights is taking place these days not only in Ermakova’s case, but in case of hundreds of other pregnant women awaiting courts’ decisions.
Elena and her brother were brought up by their grandmother. Despite all the hardships of her childhood and teenage years, Elena grew up strong and confident that she could change her life and help other people. Elena’s first profession was as a school teacher with a graduate degree with honors in Russian literature and language. Subsequently, she became a certified midwife graduating from a medical college with honors. Pursuing her passion for helping and educating pregnant women, she then entered medical school, again graduating with honors as a medical doctor, finished residency and was board certified in obstetrics.
Elena and her husband Alex Ermakov established a cultural center for parenthood, named Cradle (Kolybelka; www.kolybelka.ru) in St. Petersburg in 1992. The center has been a success for all these years. At the Cradle, they have developed a unique program to fully prepare couples for parenthood. They provided specific education for women during pregnancy, training them emotionally and physically for natural childbirth. The program was designed to provide an extensive knowledge about the human reproduction system, breast feeding, the hygiene of the mother and newborn, and the basics of early childhood education. It also incorporated physical exercises, including yoga, aerobics, aqua fitness, and swimming. Special psychological training, creative work, drawing, and acting classes helped pregnant women and their partners to establish a close emotional bond with the unborn child. During these classes, women’s psychological and physical conditions improved significantly, and, likewise, their partners realized the importance of their role in the pregnancy and delivery.
Since the Cradle was founded, over 2,500 families have been prepared for delivery. Elena informed women and their partners about all available options, and discussed these options in a way that the future parents could make an informed choice.
Is Home Birth that Dangerous?
More than 1,500 families have made a choice to deliver at home, and requested Elena to assist them during the labor and birth in water. Many of these women were at risk of obstetric complications due to previous caesarean section deliveries, twin pregnancies, or breech presentation. Only 12 mothers were transferred to a hospital during labor, and 7 of them subsequently had caesarean section delivery. Fewer than 10 babies were admitted to a hospital for special care within 48 hours of delivery, including babies with complications of intrauterine infections. The rate of perinatal mortality through home birth observed by Elena was 3 per 1,000 births as calculated according to the criteria of the World Health Organization. No maternal death occurred. In comparison, the perinatal mortality in Russia is estimated to be much higher, at 14-18 per 1,000 births.
Home Birth is Illegal
The evolution of midwifery services in Russia has been shaped by the legacy of the Soviet era. In communist Russia, planned home birth was never offered as an option to women. After the disintegration of the Soviet Union, the first priority was to introduce new techniques for instrumental deliveries. As a result, specialist obstetricians have become the primary providers for child birth services, and the autonomy of midwives has been undermined. At the present time, neither state-run nor private medical services in Russia officially conduct planned home births.
Our law does not forbid to give birth at home, but does not allow to provide women wishing to do so with adequate medical assistance, since a license to perform midwifery services at home cannot be obtained, and practicing without a license is illegal.
Who is Interested in Illegal Midwifery?
Health care functionaries, including chief obstetricians in Moscow and St. Petersburg, have repeatedly expressed very negative opinions about home birth, and have encouraged all pregnant women to deliver in hospitals. At the same time, the health care system in Russia has not incorporated modern advances in knowledge of perinatal health and its life-long effects. Maternity clinics excessively prescribe pregnant women with numerous drugs and frequently recommend bed rest and hospitalizations without ample justification. The psychological environment at delivery units is very stressful and unfriendly. In addition, Russian obstetricians commonly use traumatic delivery interventions including forceps, episiotomy, vacuum extractions and manual maneuvering of the baby during the delivery. Moreover, the caesarean section delivery rate is constantly increasing, especially at private hospitals and at some places reaches 50-60%.
State authorities have used every chance to strike a blow on the homebirth movement to further their political agendas. In Elena’s case, the Russian authorities have utilized all means including the use of state-controlled media to prey on the fears of the public, and even influencing the opinions of forensic medical experts.
International Home Birth Experience
Numerous European and American studies have indicated that planned home deliveries are safe and result in an excellent outcome. However, no such studies have been conducted in Russia in spite of the fact that women have had this option for over 20 years. Scores of qualified individuals currently assist women during home birth. However, the state is reluctant to officially register their private practices. Midwives do not have professional organizations to establish their credibility or provide legal advice in cases where they are accused of malpractice.
