Away with Bottle Nipples and Formula
Article from the Russian national newspaper Tribune,
November 1, 2000

The Volgograd Region is among a select group of a very few regions of Russia, where the prognosis is for a positive increase in the birth rate. Physicians in the region are not at all surprised by this positive turn of events. Maternal and infant mortality is something that medicine can really have an impact on and with an enlightened approach actually direct it. 
This approach has been very successfully realized through the region wide activity of the Regional Clinical Perinatal Center, which at the same time appears to be the first regional center in the Volgograd area. What does it represent in the way of perinatal service and what distinguishes it from the usual services provided by maternity homes?

More than anything else the traditional birthing clinics in Russia are usually dealing with the surface issues of maternal and infant mortality, and as a rule are not winning the struggle to overcome this problem. In the Volgograd region the perinatal service is dealing with the underlying reasons for maternal and infant mortality and in that way overcoming the problem. In the Volgograd region there is family planning, and the protection of potential mothers with a high degree of risk (for example those suffering from sugar diabetes, cardiovascular disease) with contraceptive measures and the conduct of operations for pregnancy prevention and the treatment of infertility, and of course, the monitoring of pregnant women and helping them at birth.
Of course, this approach requires a much greater material investment. Several years ago, the regional the regional health administration tried an experiment, creating an association of all six regions of the TransVolga area and tying them into the regional clinic. "The success of this approach," related the head doctor of the Regional Clinical Perinatal Birthing Clinic, " is not the result of the quality of life here: in these six regions the population density is low as is the availability of medical help in general and in particularly obstetrical service has always been difficult. People for months have not seen their doctors, and for this reason for more than ten years the indices for maternal and infant mortality in the TransVolga area were very high." 
"In the Regional Clinical Perinatal Center we did not invent the bicycle," Dr., Kirichenko continued, "but we did visit the American City of Cleveland and observed how their services for perinatal protection function and something similar, taking into account local peculiarities, we set up for ourselves. The regional powers, understanding the importance of the problem, did not choose to economize and provided all birthing stations of these six regions with standardized equipment as the first order of business."
"In the regional center we established an infant resuscitation brigade, outfitted with all that was necessary. We made sure," continued Dr. Kirichenko, "that woman at high or medium risk from the TransVolga region were treated only with us. That means that infants born from such mothers find themselves immediately in circumstances necessary for their treatment. This is very important, inasmuch as here literally every minute is critical."
"The result? Infant mortality in the TransVolga region which for a period of ten years far exceeded the medium regional indices, decreased by 200% and reached the European levels. The number of stillborn infants here is two times less than the mean for the region. And not one instance of maternal death for the last six years!"
"Knowing about this, many expectant mothers from the entire region as well as from the City of Volgograd try to come to the Regional Clinical Perinatal Center, and also prospective mothers from many other cities of Russia. But what attracts them, of course, is not only medical statistics, but the attitude at the Regional Clinical Perinatal Center to women in childbirth. Here we operate under the principle that the first person in the center is the expectant mother and her word is law. Here we welcome various methods of giving birth that may be selected by the woman: she can give birth while sitting, or lying, or in the water (this last, by the way, is very popular among women). At the time of birth here we welcome the presence of the husband. And then the contented mother with her tiny infant we put in a separate room, affording them the opportunity of being together constantly: in this case the doctors consider it particularly important that the small baby bond with the mother, instead of lying in a hospital, and as a result illnesses caused by puss-infectious diseases have declined from 5-8 times. In addition, in the course of the first 30 minutes the infant must receive colostrum- that is a bookmark for health for all the child's future life. To the newborn we do not give any samples imitating the female breast. Bottle nipples here are persona non grata as is likewise all the different milk formulas. Even the advertisements for them are forbidden- the only natural and healthy way for feeding the infant is breast feeding." 
It should be noted that for its work in developing a modern approach and for making the birthing process more consumer friendly the Regional Clinical Perinatal Center received an international certificate from UNICEF (the International Children's fund) and the respected title of "Goodwill Hospital for Infants).
Incidentally, in the region there are eleven birthing centers, holding this UNICEF designation, but in all of Russia there are only 24. That means that almost one-half are in the Volgograd Region.
"This is the result of long and arduous work of the physicians, work not requiring a special layout of expense, but very positively affecting the health of the non-adult generation," concludes the vice chairman of the Regional Committee for Health, B.E. Lomovsky. "For the last three years when in the region there has been an active effort for the encouragement of breast feeding of infants, the mortality rate has declined along with the rate of growth of illness of infants in their first year of life from intestinal infection, disease of the respiratory organs, and the nervous system, the organs of feeling." There were many less infant-invalids. Now the administrative health authorities are preparing a packet of documents on the transition to a regime of goodwill to infants not just for separate birthing clinics, but for the whole region including the Kotovsky and Red Army districts.
All this is a plus for social guaranties for young families, which is supported by the regional administration and already steps taken in the region (payment of subsidies for newborns, granting of credit for apartments for young families and so forth) give the leaders of regional health a basis for a credible prognosis: in the next five years birth rates will steadily increase.

Anna Filippova

Translation by Edward R. Brown


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