After women started the Croatian version of the #MeToo movement, not over sexual harassment, but for dignified medical treatment, the Ministry of Health decided to "clean up" gynecology departments as it did four years ago.
That is when women complained about treatment during childbirth, but the focus this time is on curettage without anesthesia or, in their view, inadequate use of anesthesia during such procedures. The health inspection examined the issue then and the expert commission put forward recommendations aimed at improving the situation in maternity hospitals.
Terrifying stories
"I thought I was dying. The physician forcefully opened my cervix with his hands while the nurse held down my legs. She yelled I would suffocate the baby… They stitched me up before the anesthesia kicked in…"
"She said I was old for having my first baby and that I could not have a natural delivery. She said the pain I felt was nothing compared to what was coming. When I felt like I was dying, it would soon be over…"
"The physician who performed the C-section kept nagging that I came to give birth just when he was taking a nap."
"My water broke and amniotic fluid was green. I was all broken. My cervix and uterus ruptured because they forced me to push even though I was only partly dilated. A girl who said it was her first time stitched me up and it took three hours and 40 minutes. In the end I fell ill with sepsis."
These are some of the terrifying stories from Croatian maternity hospitals released to the public in 2014, when RODA NGO started the campaign dubbed Prekinimo šutnju [End the Silence]. Then Health Minister Siniša Varga sent inspectors to maternity hospitals, but no results were released as the Government claimed for some reason it was an "official secret!?!"
After the inspection was completed, the expert commission presented recommendations for improving the situation in maternity hospitals. JUTARNJI LIST has a part of the findings from inspections in 2014, which were performed in seven hospitals including clinical hospitals and clinical hospital centers.
Supervision revealed that only three maternity hospitals - the Zagreb Clinical Hospital, the Sisters of Charity Clinical Hospital and the Rijeka Clinical Hospital - had anesthesiologists available around the clock. That could mean that the remaining four hospitals might not provide anesthesia if women came at night, for instance. However, the hospitals pointed out that other departments have anesthesiologists available around the clock and can call them in case of emergencies, which is why better organization of work could solve that problem. In the last days, as the public reacted to the case of MP Ivana Ninčević Lesandrić, hospitals warned about lack of anesthesiologists for emergencies, which reveals that the problem from four years ago still has not been addressed.
Load
It was determined then that variation in application of epidural anesthesia, as an option for minimizing pain at childbirth, was significant. For instance, in Osijek Clinical Hospital, only 2.2% of women received this kind of anesthesia, while the figure stood at 34.8% in Holy Spirit Clinical Hospital, significantly higher.
Significant variation in application of epidural anesthesia for C-section was noted as well. Only 27.6% of women received this kind of anesthesia in Osijek Clinical Hospital, while others were under general anesthesia. In Holy Spirit Clinical Hospital, this form of anesthesia was applied in 86.8% of cases. Also, the inspection confirmed that Merkur Clinical Hospital, Sisters of Charity Clinical Hospital and Holy Spirit Clinical Hospital do not have maternity wards in line with standards as they are in areas that were converted, rather than constructed with that purpose. In addition, the problem of uneven workload among physicians and nurses is pronounced, which is why the conclusion from 2014 called for establishing norms.
Four years later, one of the members of the expert commission from 2014, physician Ratko Matijević, head of the gynecology and obstetrics ward at the Merkur Clinical Hospital, said that changes were implemented since, stressing that the only question is whether changes could have been implemented sooner. Number of women who are suffering less pain when giving birth, with the help of epidural anesthesia that numbs the lower part of the body, has increased.
C-section
We know that back then some 20% of women gave birth at Merkur Clinical Hospital under epidural anesthesia, with the figure certainly doubled today. Besides that, more women opting for C-sections are put under partial, rather than general, anesthesia, which presents a step forward with regard to quality of treatment - noted Matijević. He added that women can choose the type of anesthesia in majority of cases. -Some want epidural, while some are still asking for general anesthesia for C-section. However, in order to make the patients content, it is important for physicians to know what they want and to give their best to minimize physical and emotional pain in case of miscarriage. Errors in communication sometimes prevent this, which makes women discontent, even when they were provided the best possible healthcare - pointed out Matijević.
-We are consistently working to improve quality and functioning of the gynecology and obstetrics ward has been improved in the last four year - said Assistant Health Minister Vili Beroš, commenting on the 2014 report. He added that inspectors will visit the Split Clinical Hospital today in the wake of events from the last days, noting that inspections will continue after some 400 reports from women are sorted into regions and hospitals.
-We have to investigate this thoroughly and improve the system, for the sake of patients and physicians, most of whom are doing their jobs responsibly and fairly - said Beroš.