Τρίτη, 12 Νοεμβρίου 2013

The Maternity system and the Birth Choices of women in Greece 2013 -as seen by Irene Avramidou, Independent Certified Midwife - Submissions for Human Rights in Childbirth Congress

The Maternity system and the Birth Choices of women in Greece 2013
by Irene Athina Avramidou – Independent Certified Midwife

Thessaloniki – November 2013

About me
I'm Irene-Athina Avramidou, and I live in Thessaloniki, Northern Greece. I'm an Independent
Licensed Midwife since 2006. I was honored to be the midwife for over 250 mothers and babies
born at home, and over 500 babies born at clinics and hospitals. The reason I chose to work
independently is because I wanted to help and support women to their maternity period, with
respect and compassion. I promote natural birth and mother's choices in their childbirth, according
to the international guidelines.

The role of the Midwife in Greece
In Greece most midwives work in private clinics and public hospitals. A small number of them are
working in doctor's offices, and an even smaller percentage are working independently. For
example in Thessaloniki, a city of over a million people, we are only three independent midwives.
The role of the midwife is degraded. Most midwives, are doing the job of a nurse, following
doctor's instructions. They don't attend the mother for her pregnancy and they don't deliver the
babies. Independent midwives are working with mothers who give birth at private clinics and at
home but they are not allowed in public hospitals.

The current Greek Maternity care
Greece is the first country in the world that has the highest percentage in Cesarean Sections, with
65% in private clinics and 45% in public hospitals. Greece is the only European country that failed
to submit data for the EU 2010 Peristat Report on its rates of medical intervention in childbirth and
mode of delivery. On March 2013 the United Nations Convention on the Elimination of Discrimination Against Women (CEDAW) urged Greek government to reduce the rate of caesarean
sections performed without medical necessity. Most of the childbirths are induced and interventions
such as: shaving, having enema, breaking the waters, use of drugs to speed up labour, epidural
anesthesia, routine use of episiotomy, as well as a lack of informed consent for scientifically
discredited medical interventions during labor, are the common practice.

Homebirth
Homebirth in Greece is legal, but it isn’t acknowledged or supported. Homebirths have very low
percentage, about 0.2 - 0.5 % of all births yearly. The national health system doesn't provide
midwives for this option of childbirth. Also there are no official guidelines for homebirths.

My case
Practicing independently all these years by doing homebirths, I ended up having two lawsuits and
disciplinary actions against me.
On February of 2008, I had a homebirth with a new couple. In this birth a physiotherapist was also
there. Her labour was progressing normally and quickly enough for first time mother. She gave birth
a baby with 4.300 kg weight! She had a second degree lateral tear. The baby started breastfeeding
and I sutured the mother with the use of local anesthesia. Her obstetrician came at the morning to
check the mother, after father's request and a pediatrician came also for the baby. The doctors had
nothing to mention, their condition was perfect. The couple never complaint to me for anything
after the birth. Everything seems that was fine.
After two months of her birth, they went to a new Obstetrician because she claims that she was
aching during sexual intercourse. There was an involvement between the couple, the doctor and the
Midwifery Association of Thessaloniki, and four months later they sued me (and also the
physiotherapist who was at her birth) for simple injuries through negligence. On February of 2013
the court sentenced me at first degree for six months imprisonment with three years suspended, for
malpractice, and for 12 months with three years suspended the physiotherapist who was with me,
for the same accusation. On 8th of November 2013, the secondary trial for the appeal, acquitted me
and the physiotherapist, and at last the case is closed for us!

The disciplinary actions
While the criminal negligence charges proceeded against me, the Midwives Association pursued
disciplinary action regarding my provision of home birth services. On 20th of December 2012, the
Midwives Association of Thessaloniki gave me the highest punishment a midwife can get, which is
one year without working license. I'm the first and only midwife who had disciplinary control in
Greece until today (since 1955). The accusations were:
- For the perineal tear as I described before.
- For improper management of medical waste (placenta, gloves and other) for the above homebirth.
- For cooperating with someone who is not a midwife in the homebirth.
- For working independently without having two years of service in a hospital or clinic, but this
condition has been removed for midwives since 2005!
On July 2013, the disciplinary charges were dismissed from the secondary disciplinary board of
Athens, and now I can practice again four months earlier from the first punishment.

The “environmental pollution” issue
On February 2013 me and other 78 people received a new lawsuit! Local birth records were
trawled, and those indicating a home birth were separated out and transferred to public authorities,
without notice to the families that they were “under investigation.” The Midwifery Association
once again, brought legal action in Thessaloniki’s High Court against 69 parents most of them were
my clients, 9 doctors, and me as their midwife, regarding two allegations: For the parents and the
doctors for “forged birth certificates” that doctors had signed for home births at which no doctor
was, in fact, present, but there was a midwife. Some of these homebirths weren't even planed. And
the second allegation for which I'm accused is for “environmental pollution” from placentas. They
allege, using a law which is for hospitals and clinics, that a placenta is ‘highly dangerous human
waste’ and it has to be disposed of by the local toxic waste systems. Most of these people, believe
that placenta is the other part of their children and according to their religion and tradition, buried it
to their garden putting a tree on it or burned it in the fireplace. These parents never been asked what
they did their placenta but they received the lawsuit. The trial was on 11th of June 2013 but it was
postponed until 10th of January 2014.

Ternovszky in Greece: Offense
Some of the home birth families targeted for environmental pollution and forged birth certificates,
gave a lawsuit to the Midwifery Association of Thessaloniki for defamation of character and other
allegations. Also seventeen home birth families of Thessaloniki filed suit before the European Court
of Human Rights, to claim that Greece is failing to respect their rights under Ternovszky v. Hungary.
The suit observed that, although home birth per se is not illegal in Greece, administrative practices
and the treatment of home birth in the Greek legal system operate to effectively cut off the choice
for home birth.

Conclusion
As a midwife I feel that the rights of women to use their powers of birth however and whenever
they see fit is being blatantly attacked all over the Greek maternity system, and that is something
that have to change immediately. There is a luck of information to women for their birth choices,
and the medical system is using the fear to manipulate them.
Unfortunately homebirth in my country is not a free choice for women. There is a lot of fear to
couples who want to choose homebirth, and also to midwives who don't want to be in my position.
The Ternovszky Court, MUST become active in Greece, and all midwives who choose to work out
of hospitals, must be protected in order to give the women the choice of a natural birth, wherever
she feels safe.
It's our obligation to transfer the message that childbirth is the most physiological event taking place
to our body. We should listen to our bodies and respect the newborn child. This is what I will
continue to do. This is the real role of a Midwife for me. To be with the woman!