How Polish midwives help Ukrainian women fleeing their homes

Amid the daily work of bringing newborns safely into this world, a group of Polish midwives collect necessities for Ukrainian women who arrive alone at the hospital to give birth. “It’s a small gesture that can hopefully bring sun for a moment,” says Martyna Grygiel-Kaczmarek, midwife at the St. Sophia Hospital in the Polish capital Warsaw.

Marking the International Day of the Midwife on 5 May this year, WHO/Europe is shining a spotlight on the midwives across Ukraine and in neighbouring countries who continue to provide life-saving care to mothers fleeing war. Over the last century and indeed throughout history, midwives have stood by women at the vulnerable moment of childbirth, helping bring new lives into the world.

At the St. Sophia Hospital, Martyna helps women deliver babies in what she calls an ideal place for giving birth. Increasingly now, because of the war in Ukraine, midwives here have started caring for Ukrainian mothers and their newborns.

Outside her work in the midwifery unit, Martyna is also involved with a local volunteer association, as they package and send birth kits to women in Ukraine, who may have to deliver their babies in a shelter or in a basement. The birth kits contain instructions for people with no medical experience on how to help a woman in childbirth.

The St. Sophia Hospital “Żelazna” Medical Centre opened as the first hospital-based midwife-led birth centre in Poland in 2012. Here, Martyna experiences a large degree of autonomy: “My work in the midwifery unit is quite independent,” she says. “I like working here because I can decide if the woman is fit to deliver in our midwifery unit. Also, I am able to support her throughout the birth and care for the newborn.”

Martyna is, however, well aware that the independence she enjoys in the midwifery-led birth centre is unique in comparison to many other places in Poland.

As in many countries globally, Polish maternity care has become increasingly medicalized, with relatively high rates of medical interventions and low rates of spontaneous vaginal births. Prenatal care is almost exclusively provided by obstetricians or gynaecologists, which can be unnecessarily costly, and does not always allow for comprehensive care of pregnant women. Over medicalization of birth is also associated with higher rates of medical interventions than may be justified.

Martyna’s midwife colleagues who work in other places have witnessed pregnant women feeling conflicted that “they are not able to make their own decisions about the process of the birth,” she explains.

St. Sophia Hospital has made many accomplishments in the process of “normalizing” childbirth, ensuring midwives are always close to pregnant women, ready to support and provide care. “Sometimes it is difficult for new doctors – unfamiliar with this approach to birth – to understand why midwives are so important in this hospital,” she says.

Despite the support of physician colleagues for midwifery services, most women still trust a doctor over a midwife during pregnancy and birth. “We have a lot of work ahead of us in convincing women that a trained and licensed midwife is the right person to support them through pregnancy and childbirth,” Martyna says.

Since 2011, several acts and regulations have been passed in Poland to allow midwives to independently provide prenatal, intrapartum and postpartum care to women. The Ministry of Health made midwifery consultation a publicly funded guaranteed primary care service in 2020.

Around 10% of all births in St. Sophia Hospital now take place in the midwifery unit. The midwifery-led care follows the principles of natural birth without additional oxytocin and takes into account the speed of the contractions.

“Of course, a woman has to be perfectly healthy to be in this place,” Martyna explains. “But she can be here with her partner to support, and the midwife will be there throughout until she delivers the baby. This place is very cool and quiet – it’s actually an ideal place for delivering a baby.”