An expectant mother's journey through the modern Moscow medical system.
MOSCOW — "Russia needs babies" may as well be the unofficial slogan of Prime Minister Vladimir Putin's ruling United Russia Party. The country is in a demographic crisis, shedding 2.2 million people (or 1.6 percent of the population) since 2002, and the government is trying to encourage more women to bring Russian citizens into the world. This year, when I unexpectedly got pregnant soon after receiving my visa to work in Moscow, I became a test case.
Since the Soviet days, having a baby in Russia has been commonly understood as a nightmare of understaffed state hospitals and forbidding bureaucratic mazes. Feminist author Maria Arbatova's My Name Is Woman, an alternatively harrowing and hilarious account of childbirth in the 1970s, was the grim reality for many. Arbatova described being left completely unattended during the final stages of labor, which nearly resulted in her death and the death of her twin sons.
The fall of the Soviet Union did not improve matters. A 1996 Los Angeles Times article, titled appropriately "Childbirth in Russia Is Miserable," attested to Russia's "scruffy, ill equipped, and harried" maternity wards. The article described a health system caught in a straitjacket of leftover communist-era regulations, which even dictated the posture mothers must lie in to nurse their newborns.
These days, thankfully, maternal mortality is decreasing in Russia, according to the World Health Organization, but this doesn't mean that most women have renewed faith in the medical establishment -- horror stories still pop up in the press and the blogosphere.
It's only natural for the truly scary cases to make their way into the press, while the stories of regular birthing experiences remain generally untold. However, there are enough Russian bloggers out there recounting tales of being bullied and mistreated by medical staff to give a pregnant woman cause for concern.
Shortly before I gave birth, I was struck by a blog post by a recent mother, detailing a personal experience at a Moscow hospital not far from where I live -- yelling midwives, a doctor who was mostly busy somewhere else, and, for dessert, getting stitched up with no anesthetic by a staff member who threatened to walk away should she continue to squirm. According to the midwives, "it was my fault that I overshot my due date and was now screaming (and here I thought I was only moaning softly)," the author wrote.
That's not exactly good press if you're trying to get more women to give birth. This is why Putin is seen on the television news these days touring newfangled perinatal centers and holding high-profile meetings on maternal care -- to assure the childbearing public that the government is now watching out for them. The prime minister has also pledged to spend 1.5 trillion rubles (about $54 billion) over the next four years on demographics-related projects such as raising life expectancy and increasing the birth rate by 30 percent.
I hadn't planned on serving as a canary for Russia's new advances in state maternal care, but after my husband and I ran out of money, throwing ourselves on the mercy of free health care was our only choice. Last November, when I made my first appointment with an OB/GYN at the Norovkov Clinic, a private establishment in Moscow that came highly recommended by friends, my new doctor, Natalia Bovina, explained my options to me.
"You can pay for a special 'birthing contract' at a hospital that provides commercial services -- or you can call an ambulance once labor kicks in, but then it will all depend on luck," Bovina said. "Unless a nearby hospital is full, they won't legally be able to refuse to admit a woman in labor, but who knows what kind of doctors you will end up with?"
I sat across from her, still recovering from the shock of discovering I was pregnant a mere six months after coming to Moscow to work as a journalist, and said that I'd "definitely" be paying for a contract.
But by the time I was at 36 weeks, the stage at which most commercial birth plans are set up, my husband and I were struggling just to keep our apartment. A standard birthing contract costs $2,500 to $3,500, but we could not spare even this relatively modest amount.
I spent a lot of time bemoaning my fate. Marooned in Moscow! Pregnant and broke! Russia was supposed to be an adventure, like it is for most expat journalists -- not a dose of cold reality.
"It will work out," Alexey, my Russian husband, reassured me in his typical, carefree manner. "The gods are on our side."
Although I'm originally from Kiev, Ukraine, I spent most of my life living in the United States. My middle-class, private-school-educated, American self demanded order, not a reliance upon nebulous "gods" -- but I was too exhausted to argue. We decided to put our faith in the heavens, planning to forgo a birthing contract and give birth at City Hospital #70, which was directly across the street from our apartment.
We were hopeful: Not long before, Moscow Mayor Sergei Sobyanin had taken a well-publicized stroll through the hospital's modernized perinatal center at the maternity ward, or "birth house," as they are commonly known in Russia, handing out flowers to new mothers. I had been hospitalized there for a day and a half when my baby threatened to come early. The experience was decent -- the ward was renovated and clean, and the doctors were curt but professional, and appeared genuinely concerned for my welfare and the welfare of the baby.
As the weeks passed, however, and our baby overstayed his due date, I grew antsy. Thankfully, I still had Natalia Bovina, my doctor from the private clinic. According to Russian health-care tradition, she had shepherded me through the pregnancy process, but would not be there for the actual birth. Such practice is fairly common in Russia: One doctor guides you for nine months; another takes over once you are in labor, or close to it.
A week after my due date, I got in touch with Bovina, who arranged the paperwork so that I could check into the hospital before contractions actually began. This was supposed to be my ticket straight to Hospital #70.
But the hospital served up a surprise of its own. "I don't care about your hospitalization papers, woman!" screamed the receptionist in the maternity ward there when I called to inquire about a place on the wards while waiting for my hospitalization papers to come through later in the day. "You need to be seen by your doctor -- you can't just show up here!" She proceeded to hang up.
Although turning down a pregnant woman without an explanation is against the law, admittance procedure can sometimes depend on the mood of whoever is on duty at the reception desk, and some hospital workers still bank on the fact that many pregnant women don't know their rights. I could have argued with this charming receptionist, but my desire to give birth at Hospital #70 had quickly evaporated. I was emotional, scared, and desperate for help.
Dr. Bovina quickly proceeded to Plan B: booking me a room in Hospital #15, famous for being one of the best in Moscow -- modern, well-renovated, and the sort of place that promotes mother-and-child bonding and breastfeeding. Neither Dr. Bovina nor myself had originally thought I'd be able to give birth there, since the ward was closed near my due date. (Local rules demand that all maternity hospitals are closed for a month each year to be disinfected and spruced up -- why it takes a month, however, is beyond me.) But the hospital had just reopened and was filling up quickly.
Natalia Akhsyamova, a friend of Dr. Bovina's, was the anesthesiologist on duty at the prenatal ward in Hospital #15 when I showed up, a week late and feeling like my head was about to explode from terror and confusion. Friendly, polite, and more than a little amused by my terrified expression, she took me to see the head of the prenatal ward, Olga Glotova.
Glotova, a kindly blonde clearly used to seeing all sorts of hysterical women, examined me in her office, highly amused by the whole situation. "You wanted to give birth at Hospital #70?" she laughed. "That's ridiculous; their postnatal ward has four women to one room.… And oh, look, blood!"
"Here!" Glotova waved her bloodied glove at me. "You're in labor! Go grab your husband and head to the reception area. I'll get you admitted."
After Glotova rushed me through admission, Akhsyamova was called in to give me an epidural so that I could rest. Epidurals on demand are also relatively new for Russia.
"We never had such options," Glotova told me. "Nowadays, it's standard practice in any decent hospital, of course."
The labor was prolonged and difficult, even with the epidural. At one point, Glotova went away for a few minutes and came back brandishing a surprisingly pretty and colorful vacuum device. "A journalist writing an article about childbirth in Russia should know the latest in vacuum technology!" she said, beaming. "None of the old stuff! This is all shiny and brand new!"
I was immediately inspired to push properly.
Our son, Lev, was born not long after. Glotova placed him on my belly to share a few seconds of skin-on-skin contact -- still a comparatively rare practice in Russia. Lev sneezed. My husband cried.
"See? The gods are on our side," he said. This time, arguing with him didn't cross my mind.
In our case, the gods had acted through sympathetic medical professionals -- those who had the power to cut through the bureaucracy. However, other women who wind up in my situation are not always as lucky. While pumping money into maternal care is well and good, what these women most need is a change in the mainstream medical attitudes toward pregnancy and childbirth in Russia.
A hospital with modern technology is still only as good as the people who work there -- a lesson I learned the hard way through my experience with Hospital #70. If the staff is not motivated to treat pregnant women like regular human beings, as opposed to mere prisoners to their condition, all the money in the world won't improve Russia's maternal care system.
For now, Lev -- a positive statistic for the agencies that keep tabs on Russia's population and determine official policy on demographics -- has no idea as to the drama surrounding his coming into the world. He was born into a country that is both rapidly modernizing and, in some major ways, still clinging to the past. As I watch my Russian son sleep, I can only do what every new mother does -- stock up on hope.
VLADIMIR RODIONOV/AFP/Getty Images