The Flip Side of the Comfort Childbirth Coin: Some Legal Aspects

  • K. Y. Tereshko
Keywords: childbirth, partner childbirth, assistant (birth doula), obstetric supervision, medical care.

Abstract

Home births are becoming increasingly popular in the world. For example, in the Netherlands, a district childbirth specialist is pregnant and giving birth, so 40% of Dutch women give birth at home. In Germany, 20% of women give birth at home, and obstetricians are legally allowed to give birth at home. The UK allows district midwives, so-called midwife, to give birth. The Ministry of Health is not responsible for their activities, although it sends midwives to practice in a maternity hospital, after which the latter must pass an examination to confirm their qualifications. As a result, 18% of women give birth at home, but in all cases an ambulance or ambulance is on duty near the house [2].

Some Ukrainian women follow the experience of European mothers, despite the fact that, unlike in Ukraine, in most European countries, home births are allowed and clearly regulated by law. But in our state not everything is so simple.

According to Art. 3 of the Law of Ukraine "Fundamentals of the legislation of Ukraine on health care" from 19.11.1992 (hereinafter - the Fundamentals), medical care - the activities of professionally trained medical workers aimed at prevention, diagnosis, treatment and rehabilitation in connection with diseases, injuries, poisoning and pathological conditions, as well as in connection with pregnancy and childbirth [3].

In paragraph 9 of the section "Organizational requirements" of the Licensing conditions for business activities in medical practice approved by the Cabinet of Ministers of Ukraine from 02.03.2016 №285, medical practice by the licensee is carried out at the place (places) of its production, which (which) are specified in the application licenses and in the documents attached to it (taking into account the changes made to them, submitted by the licensee to the licensing authority).

At the place of residence (stay) of the patient can be provided: 1) primary medical care; 2) secondary (specialized) medical care that can be provided in an outpatient setting; 3) emergency and emergency medical care; 4) palliative care, in particular psychological care; 5) assistance in undergoing medical rehabilitation; 6) on-site (mobile) consulting and diagnostic assistance [4].

In Art. 35-2 of the Fundamentals states: “Secondary (specialized) medical care - medical care provided in outpatient or inpatient settings by physicians of the relevant specialization (except for general practitioners - family doctors) in a planned manner or in emergencies and provides advice, diagnosis , treatment, rehabilitation and prevention of diseases, injuries, poisonings, pathological and physiological (during pregnancy and childbirth) conditions; referral of the patient in accordance with medical indications for the provision of secondary (specialized) medical care in another specialization or tertiary (highly specialized) medical care "[3].

It should be emphasized that there is no clear regulation of this issue today. In addition, domestic legislation contains a document which records such births, it is about the Journal of maternity care at home (form 032 / o) approved by the order of the Ministry of Health of Ukraine "On approval of forms of primary accounting documentation and instructions for their use in health care facilities who provide outpatient and inpatient care to the population, regardless of subordination and form of ownership "№435 from 29.05.2013. Form № 032 / о is intended for registration of births that took place outside the maternity hospital (at home, in an ambulance, elsewhere) during pregnancy from 22 weeks and more, regardless of whether the mother and the newborn were subsequently hospitalized. (fetus) in the maternity hospital. This document is filled in by medical workers of rural outpatient clinics, primary health care centers, rural district hospitals, ambulance stations, medical and obstetric points, other health care facilities that gave birth at home or provided medical care, conducted observation of the mother. in the postpartum period. Therefore, it is not necessary to talk about a direct regulatory ban on home births.

Attention should be drawn to the judgment of the European Court of Human Rights (ECtHR) Kosaitė - Cypienė and others v. Lithuania (2019) [5]. In 2012, three applicants applied to local hospitals for medical treatment during home births. However, the hospitals refused because such care was prohibited under domestic legal requirements, namely Medical Requirements MN 40: 2006. The applicants then asked the Ministry of Health to amend the legislation to allow medical staff to provide home-based care. The representative of the ministry answered that it is not planned to make such changes in the legislation, as well as to introduce new norms that would regulate obstetric services at home. He noted that birth in a maternity ward was the safest option and that the applicants could inspect the wards and find the one that best suited their needs. One of the applicants unsuccessfully challenged the Ministry's response in the administrative courts. Finally, in 2012, the Supreme Administrative Court rejected her arguments that the lack of legal regulation of home health care violated her right to privacy. On the contrary, domestic law guaranteed her the right to choose the most acceptable medical facility and the opportunity to express her wishes about confidentiality, and in any case, the right to privacy could not be of higher value than the health of mother and child. Referring to Article 8 (right to respect for private life) of the Convention, the applicants complained that Lithuanian law did not allow medical workers to provide assistance in childbirth at home.

The court found that the applicants had been placed in a situation which had seriously affected their freedom of choice: they were either required to give birth in a hospital or, if they wished to give birth at home, to do so without the assistance of a medical professional. The Court considers that this was an interference with the applicants' right to respect for their private life.

However, this interference was in accordance with national law, which allowed applicants to provide that home births involving health workers were not allowed. The ban was also confirmed in letters from hospitals which the applicants had received while some of them were still pregnant.

In addition, it was determined that Lithuania had struck a fair balance between the applicants' rights and the State's legitimate interest in protecting the health and safety of mother and child during and after childbirth.

References

Доповідь про акушерське насильство в світі спеціального доповідача з питання насильства щодо жінок, його причин та наслідків, представлена на виконання резолюції 71/170 Генеральної Асамблеї ООН. URL: https://undocs.org/ru/A/74/137 (Dopovid` pro akushers`ke nasyl`stvo v sviti special`nogo dopovidacha z pytannya nasyl`stva shchodo zhinok, jogo prychyn ta naslidkiv, predstavlena na vykonannya rezolyuciyi 71/170 General`noyi Asambleyi OON. URL: https://undocs.org/ru/A/74/137).

Домашні пологи – реальна альтернатива чи модний тренд? URL: https://femida.ua/advices/domashni-pology-realna-alternatyva-chy-modnyj-trend/ (Domashni pology – real`na al`ternatyva chy modnyj trend? URL: https://femida.ua/advices/domashni-pology-realna-alternatyva-chy-modnyj-trend/).

Основи законодавства України про охорону здоров’я : Закон України від 19.11.1992. № 2801-ХІІ. URL: http://zakon.rada.gov.ua/laws/show/2801-12 (Osnovy zakonodavstva Ukrayiny pro ohoronu zdorov'ya : Zakon Ukrayiny vid 19.11.1992. № 2801-XII. URL: http://zakon.rada.gov.ua/laws/show/2801-12).

Про затвердження Ліцензійних умов провадження господарської діяльності з медичної практики : Постанова Кабінету Міністрів України від 02.03.2016 № 285. URL: https://zakon.rada.gov.ua/laws/show/285-2016-%D0%BF (Pro zatverdzhennya Licenzijnyh umov provadzhennya gospodars`koyi diyal`nosti z medychnoyi praktyky : Postanova Kabinetu Ministriv Ukrayiny vid 02.03.2016 № 285. URL: https://zakon.rada.gov.ua/laws/show/285-2016-%D0%BF).

Рішення Європейського суду з прав людини у справі Косайт-Куп’єн та інші проти Литви (Kosaitė-Čypienė and Others v. Lithuania) від 04.09.2019. URL: https://hudoc.echr.coe.int/eng#{%22tabview%22:[%22document%22],%22itemid%22:[%22001-193452%22]} (Rishennya Yevropejs`kogo sudu z prav lyudyny u spravi Kosajt-Kup'yen ta inshi proty Lytvy (Kosaitė-Čypienė and Others v. Lithuania) vid 04.09.2019. URL: https://hudoc.echr.coe.int/eng#{%22tabview%22:[%22document%22],%22itemid%22:[%22001-193452%22]}).

Про затвердження Правил державної реєстрації актів цивільного стану в Україні : Наказ Міністерства юстиції України від 18.10.2000 №52/5. URL: https://zakon.rada.gov.ua/laws/show/z0719-00#Text (Pro zatverdzhennya Pravyl derzhavnoyi reyestraciyi aktiv cyvil`nogo stanu v Ukrayini : Nakaz Ministerstva yustyciyi Ukrayiny vid 18.10.2000 № 52/5. URL: https://zakon.rada.gov.ua/laws/show/z0719-00#Text).

Про організацію профілактики внутрішньо лікарняних інфекцій в акушерських стаціонарах : Наказ МОЗ України від 10.05.2007 № 234. URL: https://zakon.rada.gov.ua/laws/show/z0694-07 (Pro organizaciyu profilaktyky vnutrishn`o likarnyanyh infekcij v akushers`kyh stacionarah : Nakaz MOZ Ukrayiny vid 10.05.2007 № 234. URL: https://zakon.rada.gov.ua/laws/show/z0694-07).

Доула (професія). Вікіпедія. Вільна енциклопедія. URL: https://ru.wikipedia.org/wiki/%D0%94%D0%BE%D1%83%D0%BB%D0%B0_(%D0%BF%D1%80%D0%BE%D1%84%D0%B5%D1%81%D1%81%D0%B8%D1%8F) (Doula (profesiya). Vikipediya. Vil`na encyklopediya. URL: https://ru.wikipedia.org/wiki/%D0%94%D0%BE%D1%83%D0%BB%D0%B0_(%D0%BF%D1%80%D0%BE%D1%84%D0%B5%D1%81%D1%81%D0%B8%D1%8F)).

Кодекс Доул Асоціації фахівців з природного батьківства : міжнародний стандарт практики. URL: http://doula.com.ua/articles/299413 (Kodeks Doul Asociaciyi fahivciv z pryrodnogo bat`kivstva : mizhnarodnyj standart praktyky. URL: http://doula.com.ua/articles/299413).

Published
2020-09-29
How to Cite
Tereshko, K. Y. (2020). The Flip Side of the Comfort Childbirth Coin: Some Legal Aspects. Medicne Pravo, (2(26), 76-83. https://doi.org/10.25040/medicallaw2020.02.076
Section
Articles