How MOST unites professionals: a Belarusian doctor learns how the Dutch manage the pregnancy process

09-05-2019

Yekaterina Shilkina, a gynaecologist from Minsk, was immersed in the practice of obstetrics – the branch of medicine covering childbirth and midwifery – when she went to the Netherlands for an internship in the framework of the EU-funded MOST programme.

She spent several days in the hospital of the University of Amsterdam, while most of the internship took place in the Central District Hospital of Dirksland in the south of the Netherlands, where she was involved in the Cura Vita obstetrics service.

Speaking the right language can get you anywhere, including to the Netherlands

Yekaterina found out about the MOST programme when she was looking for German courses on the Goethe Institute website. The doctor already spoke English. She believes that not knowing English automatically closes doors for professionals, so she opened them for herself:

“When it comes to medicine, the results of the strongest studies are presented only in English. If in the Middle Ages doctors used Latin as their second language, then now, of course, we use English. Speaking from my own experience I can say that English is not difficult to learn; it is enough to devote one year to the language to be able to use it for work.”

It did however take a while for Yekaterina to choose a country to move to, and she also asked for the project coordinators' advice on the subject:

“I really wanted to choose an interesting and modern internship. And according to the Euro Health Consumer Index, the Dutch health care system has been considered the best in Europe for several years in a row. In total, 91% of the population is satisfied with the quality of medical care; 10.7% of the GDP is allocated to health care (by comparison, in Belarus it is no more than 7%, and the country's GDP is 16 times lower). At the same time, the main success of the Dutch is not in financing, because there are countries which have even more funding but as healthcare functions differently there it is not as effective,” she says.

When Yekaterina made her choice, it took her no more than an hour and a half to fill out all the forms and she waited for a response for about five months.

“The internship was in English and I know it well,” says Yekaterina. “I studied English at school and at specialised courses. They start learning the English language in kindergarten in the Netherlands, so everyone there speaks English at a decent level. Since the Dutch language is similar to German, which I speak a little, I partially understood the conversations of doctors and midwives with their patients.”

A different kind of birth

Yekaterina says that the Netherlands was somewhat similar to Belarus:

“When we went on visits with midwives and drove through the neighbourhoods of Dirksland, I had a kind of déjà vu – the nature is similar to ours, the roads also resemble ours. They have district hospitals like we do as well. Once, a wonderful Dutch family invited me over for dinner, and we discussed various topics and looked at a map of Europe. The Dutch were surprised by how big Belarus was. I had honestly never thought about it. Belarus is five times bigger than the Netherlands, despite the fact that its population is 17 million, and ours is 10 million. They were interested in Belarus, I showed them photos, told them about the difficult history, about the heyday of the Grand Duchy of Lithuania, about life in the Polish–Lithuanian Commonwealth, and then as part of Russia and the USSR. I invited them to visit us and told them about the wonderful visa-free travel to Belarus.”

But the differences are colossal as well. For example, Yekaterina says the model for helping women in the Netherlands is obstetric – in other words, it focuses on the entire pregnancy and childbirth process – rather than purely medical.

“The Dutch are proud of their system, which is economically very profitable and efficient in terms of performance. And they are not going to change their historically established obstetric model. This is where all the differences between our systems come from. Virtually all obstetric work, with the exception of complicated situations, is assigned to well-trained midwives.”

In the Netherlands, each district has its own obstetrics team. During the shift there is always a doctor, a clinical midwife and midwives who travel around the district in their service cars. Every woman in labour knows the team members, and at the time of childbirth there is no stress caused by meeting with strangers.

There are districts where independent midwives work. They observe pregnancy, deliver babies and provide support during the postnatal period.

This is a model of so-called continuous obstetric care, in which the same specialist (or a team of specialists) works with a woman practically from the moment of conception until the end of the postnatal period.

The model of continuous obstetric care is actively supported by the World Health Organization. It is thought that with this form of interaction between women and the medical system, excellent results can be obtained at minimal cost.

“Pregnancy and childbirth are not necessarily considered as pathology. They do not intervene in pregnancy up to 12 weeks at all. Midwives speak with the women, tell them how to behave during their pregnancy, calculate the time for delivery, do the ultrasound. There is almost never any treatment during the pregnancy. There are only recommendations for a healthy lifestyle and nutrition. There are few check-ups – only the most important, the economically viable ones,” says Yekaterina.

Also, provided there are no contraindications, every Dutch woman has the right and opportunity to give birth at home. However, the doctor notes, the number of such births is getting lower; now, only around 12% of Dutch women give birth at home.

“In cases when the midwife detects a problem, she immediately contacts the doctor by phone and decides what to do with the woman in question. Sometimes she will be sent to a large clinic for a consultation, and in special cases she may be taken to the intensive care unit of a large clinic (in our case, there was the Rotterdam clinic). Incidentally, I was taken aback by the number of such wards; for example, there are six of them for the entire Amsterdam clinic.”

Innovative experience

Recently, the Dutch have decided to present their delivery system to colleagues from around the world, inviting specialists from different countries. Yekaterina believes that this idea was given to them by branding specialists, as branding is something that is taken seriously in the Netherlands, in order to keep the country recognisable and unique.

Yekaterina says that if she had evaluated the obstetric care in the Netherlands objectively, rather than from her perspective as a doctor, she would say that its most evident characteristics are accessibility, openness, and the lowest possible level of interference in the childbirth process.

She also notes the availability of high-quality care for women, both before and after childbirth, the individual approach, the early discharge from hospital after giving birth, the well-developed nursing service, and the low percentage of caesarean sections (about 16%).

The Belarusian doctor was surprised by the low number of examinations:

“When I asked why they did not take a cheap and simple urine test, they said that it was not necessary. They explained that it was proven that it was not necessary to do this at every check-up. Patients understand this and welcome the decision. And I immediately imagined our typical woman [in Belarus], who in this case would say that she was not being examined, not being treated, and that nobody was paying any attention to her.

“Why are they not afraid to do this [refrain from taking such tests] and why do we [in Belarus] never send a woman away from the doctor's office without checking her basic indicators? I found the answer to this in the much closer cooperation between midwives and women, who often call them and ask many questions based on how they feel. The midwives kindly answer all questions, including some unusual ones. They make it simple to speak with them and they are always in a good mood.

“Another important point I have noticed there is that the Dutch women seem to be healthier than ours; they are more active, ride bikes even while pregnant, they are interested in proper nutrition.”

What can be applied in Belarus?

Yekaterina believes that practically everything that is used in obstetrics in the Netherlands can be applied in Belarus. After all, we also want a comfortable system for patients and doctors, which puts respect for the dignity of both first.

“In addition to the basic model, it is possible to introduce a new one if the women and clinic’s management need it. The most important thing is the personnel, because it is very difficult to develop the proper model without them. […] Different pilot projects can be created and then their effectiveness can be evaluated, taking into account the specifics of our population, because our women are not as healthy.

“For example, in the Netherlands, every fifth woman suffers from obesity, while in our country it is every fourth. However, with the growth of economic well-being, the situation of women's health in Belarus will change for the better. Therefore, we should not be afraid, because our neighbours (Russia, Ukraine, the Baltic states) have been engaged in the creation and implementation of various options to help women for more than 20 years.”

When Yekaterina came back home, she had trouble analysing everything she saw:

“Everything is so different there, and I am not speaking about material things. Belarus and the Netherlands are both aiming for a high level of performance in obstetric services using different methods and styles. At the same time, in the Netherlands, women's satisfaction with obstetric services is higher.

“I started thinking about what I could do for our women, because many people would like to receive such support during pregnancy, as in the Netherlands. And I decided to conduct online consultations, answer questions about the physiological course of pregnancy, breastfeeding, issues of infertility and much more. When a medical situation arises, I immediately send a woman to her doctor in the city where she lives, or invite her for an appointment.”

Yekaterina not only offers consultations, but also courses on preparing for childbirth and women's health, which she has been doing for nine years already:

“Of course, my worldview was shaped over the course of many years; I went through a lot of different training programmes and conferences, finished graduate school, during which I studied a lot of foreign literature. And my views and attitudes towards women's health were confirmed by my Dutch colleagues.

“This internship gave me the confidence of knowing that I am going in the right direction and I perceive everything correctly. The main task of my activity is to provide the necessary information for women on how to conceive a child; how to stay healthy during pregnancy, childbirth and breastfeeding; how not to do things that can lead to complications, including serious ones that affect the rest of your life.”

Yekaterina believes that to further develop obstetric care, it is important to understand why our women are not always satisfied with the experience of pregnancy and childbirth, because there are opportunities for providing quality care:

“We can do absolutely everything in Belarus, since we have a strong obstetric school. How can we bring the majority of births for women as close to physiology as possible? It is worth working on this task, and not only at the stage of the maternity hospital, when it is often too late to change anything. The results of our medicine are impressive. They need to be reinforced and the quality should be improved.” 

Author: Elena Spasyuk

Article published by Naviny.by in Russian.