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Feature Story December 28, 2005
Birthing Pains
By Jake Rudnitsky Browse author Email

Even though Russia's in the midst of a demographic crisis, it couldn't care less about the plight of its poor pregnant women

Masha, an 8-month pregnant 17-year-old orphan, has been spending a lot of time in Roddom #25 - or maternity hospital - of late. The roddom, located just off Leninsky Prospekt near the Sputnik hotel and considered one of the best in the city, admitted her for two weeks in mid-December for a sokhranenie, when pregnant women are confined to a roddom for anywhere from a few days to several weeks for vague prophylactic measures. She was there to prevent going into labor prematurely. While the inexperienced minor had already gotten used to being pregnant, this sokhranenie was her first taste of what was to come - during her time in the roddom she came face-to-face with what giving birth as a poor woman in a Russian clinic is like.

After she'd been locked in Roddom #25 for about a week, at around 3 am one of the four other women in her room started undergoing contractions. As the woman's contractions got more frequent and more painful, the only attention her cries warranted was from a nurse orderly, who stepped in to yell at her to keep it down because others were sleeping. An hour later, when the staff finally started taking her cries seriously, the baby's head was already sticking out from between the woman's legs. They carted her off to the delivery room where, after just half an hour, the rest of the baby - a boy - slipped out. The woman later told Masha that the doctor present during delivery didn't even have time to wash his hands. This might seem surprising for a place that doesn't let husbands enter the building, ostensibly for sanitation reasons, but that sort of cavalier attitude towards the roddom's nonpaying patients was commonplace. And this is the essence of the problem - in a country which still retains a few remnants of its Soviet-era social safety net, those who pay get better treatment, and those who don't get what this story is about.

I met with Masha (whose name I've changed because at 17 years old, she's underage) just three days after she'd been released from her sokhranenie, on December 23. I got the sense that she was very happy to be talking with someone, as no visitors, not even the women's husbands and certainly not journalists, are allowed into roddoms for visits. Not during a sokhranenie, not during or after giving birth.

It wouldn't have mattered for Masha, anyway, as she doesn't have a husband and the father of her child has been MIA for the last 3 months. For Masha, the only noticeable result of her hospital stay was to scare her to death about her impending delivery. After two weeks of suffering medical negligence, being fed virtually inedible food, and listening to the daily screams of women giving birth in one neighboring ward and the wailing of newborn babies all night in another, who could blame her?

"Before I thought it would just be a natural process, maybe painful, but natural," she said. "But when I heard those screams, it made me kind of wish I'd had an abortion. It [going into labor] sounded like someone was getting stabbed."

I also talked with Tatiana Ivanovna Golosova, who gave birth in the same Roddom #25 in 1983, to get a sense of what has and what has not changed from Soviet to Russian times. The two differ in many respects - Golosova was a middle class, married woman who decided to have a baby, while Masha is poor, young, alone, and her pregnancy was a mistake. However, there is one common denominator: neither paid for their time at the hospital. While you can go online and find plenty of testimonials about women who have had good experiences at Roddom #25 in recent years, every one I read said that they chose that roddom because of blat, meaning they had connections at the roddom. Golosova told me that the closest thing to a bribe that she gave was flowers as a way to say thank you to the nurses that helped her. But in today's Russia, the only way to get humane treatment is either bribes or connections. If you're a vulnerable underage orphan? Forget about it.

While Golosova has good memories of her stay at Roddom #25, she was careful to qualify her statement. "In those days, we had fewer expectations," she said. "For example, nobody got ultrasound except through blat, so you didn't know the sex of your baby until it popped out." She also didn't have any complications, and gave birth without having to sit through a sokhranenie, which can shake the most stable woman's confidence. She spent about a week total in the roddom. Many of the conditions were identical to now; there were five women to a room, husbands weren't allowed inside, the sheets were old and stained. But in other aspects, it was profoundly different.

Every roddom patient's dream: a plate of food. Any food.

Back then, Roddom #25 was a model hospital affiliated with a medical school. The staff took pride in the institution and Golosova remembers international delegations trooping through to observe during her brief stay. She was even treated by an African intern who was doing his rotation at #25. She credits him with massaging her belly and getting her baby to flip, thereby preventing the c-section that the doctors thought would be necessary. These days, #25 is still a teaching hospital, but they certainly aren't showing off the free wards to medical students.

But the biggest change, it seems, has been in the staff's mentality; back then the staff was kind and helpful. Maybe it's because of the Soviet tendency to overstaff, or maybe because they earned decent money back then, but the nurses and doctors would answer any questions that the women had. Both before and after she gave birth, a doctor explained to her how to hold the baby, how to feed him and how to keep him clean. Simple enough, but extremely important info for a first-time mother. Her ward was disinfected several times while she was there and the food, while not great, was plentiful. Besides, she told me, all the pregnant women shared the food packages with each other. '83 might have been the height of the food shortages and bread lines in the USSR, but somehow pregnant women always had plenty of caviar, which Russians consider extremely healthy for pregnant women.

These days, according to Masha, if you're stuck in the free ward, chances are nobody's going to care enough to send you care packages, let alone caviar. She and the other women she was stuck with had to survive on whatever the roddom fed them. And that wasn't much. On her first day at the roddom, she asked a nurse if they had forgotten to give her the sausage that, at least according to the daily menu, was supposed to come with her kasha breakfast. The nurse told her that she could go complain to the kitchen if she wasn't happy. Masha soon understood that the kitchen workers were stealing the sausages and bringing them home. The menu also promised afternoon snacks that never materialized. They didn't even give kefir, a time-honored Russian tradition that all pregnant women are supposed to drink before bed, which was also on the menu.

Much of the food they did bring was literally inedible, like the bloody, undercooked chicken that they served her on several occasions. Last I heard, salmonella's bad for fetuses. While people will generally complain if there's no meat in their borsht, Masha said that at #25 they even skimped on the potatoes, making the soup basically warm beat juice. Breakfast was kasha with two slices of buttered bread (they wouldn't give a third even if you asked, a la Olivier Twist), lunch was thin soup, a piece of boiled chicken or fish and some carbs, and dinner was overcooked pasta. "Everyone was hungry all the time," Masha said. It sounded more like a gulag diet for ZEKs that didn't fulfill their quotas than something that expecting mothers should be fed. Ironically, while she was there for a sokhranenie to prevent premature labor, malnourishment can be a cause of it.

More startling still was the incompetence of the staff. Since she was there for sokhranenie, they hooked her up to an IV drip of magnesium and some drugs she doesn't remember. Nobody went out of their way to explain what they were giving her, or why. "Whatever they gave me made me almost pass out at first," she said. "But when I complained, they told me that I was free to leave and have a premature baby at any time." Quite an ultimatum to give a 17-year-old girl and, judging by the fact that, as I'm writing this story she's gone into labor two weeks early anyway, not entirely accurate.

Looking at Masha's face, you'd think the petite girl should still be in school (she graduated last spring), until you saw her swollen belly and droopy, milk-filled mammaries. In spite of her horrible life to date, she comes off more childish than jaded; she's shy, slightly ditzy, and totally unable to think practically.

Masha was raised by her grandmother after her alcoholic mother abandoned her and ultimately disappeared, presumably found dead in a snowdrift after a thaw. When her grandmother died several years ago, she was left bouncing around between various relatives and guardians. About a year ago, she threatened to run away unless her relatives let her live on her own, in her parents' apartment that had been privatized in her name. She clearly wasn't able to handle the responsibility and quickly managed to find a deadbeat, junkie boyfriend and get pregnant.

Nowhere in this whole story did the state intervene. The Russian state services never so much as offered her counseling, even after she got pregnant. Even though Masha is clearly unable to make informed decisions on her own, and hasn't had a legal guardian since her grandmother died, no government agency even tried to help her out. While Russian politicians rant on and on about the demographic decline, they have no time to help genuinely needy orphans like Masha. All she got, like any other pregnant Muscovite with a state medical insurance card, was the chance to go to a roddom for free. And that is hardly a privilege.

It might be tempting to think that, in a country with an acute demographic crisis, where a recent report by business group Delovaya Rossiya predicted that the falling population could cost the economy almost $400 billion in the next two decades, they would try to take steps to make expecting mothers feel safe and secure. After all, Russia suffers from just about the lowest birthrate in the history of the world. Last year, it was a meager 1.35, far below even sexless Protestant stalwarts England (1.71) and the Netherlands (1.73). By comparison, in the last years of the USSR, the birthrate was around 2.0. If the trend of losing some 750,000 people a year is going to be reversed, more women had better start popping out more kids. But they won't do it without better maternity care and social services.

Judging by Masha's experience at the roddom, Russia is a long way from that. When I met with her, she still had bruises on her arms from where nurses had missed her veins when inserting the catheter. She said one time when they'd put in the catheter poorly, her arm started to balloon and, when she asked for help, they blamed her. "'You shouldn't run around so much,' they told me. But the only time I'd get up was to go to the bathroom."

Masha was convinced that she was treated so poorly because she didn't have money to bribe anyone. "I was next to a window, but they wouldn't even give me an extra blanket," she told me. For anyone, this would be a real discomfort, but imagine how awful it must have been for a Russian that's convinced that she could catch her death from a draft. "They told me, 'If you want, tape the windows yourself." That seems to be the general attitude towards the women in the free ward. The roddom was obligated to take them in if they had the space, but that was all they had to do. And without getting bribes, no-one was going to go out of their way to help.

There was only one toilet for her entire hall (it had been designed to have two, but one of them was devoted to the few private rooms on the floor, which according to Masha cost about 2000 rubles a day), and it didn't have a door. The shower had only cold water and was right next to the reception area, with only a transparent shower curtain separating the bather from anyone who happened to be passing by. "Even the guards could see you, so everyone showered at night," Masha said. Of course, she had to bring her own toiletries, including soap and toilet paper. On cleaning days, Masha said, they must have used water from the toilet, because after they cleaned the whole room smelled like shit, literally.

Masha, in another sign of her immaturity, never bothered to quit smoking during her pregnancy, and only cut down to about three a day. While technically patients weren't supposed to smoke, when I visited the roddom I found an extremely pregnant woman huddled by a door taking drags on a cigarette. I talked with her briefly and asked if I could come in, but she seemed more afraid of getting caught talking to me than being found smoking. Instead, she gave me her number, as if I was part of an underground movement that could liberate her. "Call me and all tell you what really goes on here," she said. Unfortunately, she's still in sokhranenie as we go to press, so I wasn't able to get her story.

The state's commitment to Masha will hardly grow after she gives birth. According to Masha, Luzhkov's city government pays the mothers of all newborns a onetime payment of 15,000 rubles to help them get on their feet, and the help stops there. After that, she'll get a 140-ruble monthly stipend for the baby and... that's it. So Masha, who is herself a minor, will be getting about 5 bucks a month to support her baby. How she's supposed to take care of the baby with no income, no training and little extended family to help her emotionally or materially is anyone's guess.

She has already displayed her total inability to care for another living thing by her treatment of her 9-month-old puppy. The dog, traumatized by beatings by her deadbeat boyfriend, sounds, even from her fawning description, like it's half-starved. After her sokhranenie, she told me how she returned home to find everything in the apartment chewed to pieces, including the telephone outlet, leaving her with no phone service. She also told me about how one time, to escape a beating from her boyfriend, the dog hid behind her stove. Her boyfriend slammed the stove against the wall, hurting the dog so badly that it couldn't control its bowels for the next two weeks and leaked shit everywhere it went.

The abusive junkie father of her child, who I'm told beat Masha as well, skipped town three months ago after stealing money that his mother had given Masha to renovate her apartment. The idea was that his mother would give Masha money to renovate the apartment, then they'd rent it out and live on the income. The renovation was started: The floors and wallpaper in her one-room apartment in Yugo-Zapadnaya have been torn up in preparation for the renovation that never happened, and Masha sleeps on a thin mat on the floor. Worse still, her boyfriend broke one of the windows during a fight several months ago and she doesn't have the money to replace it, covering it instead with a few layers of newspaper.

In spite of all this, she has never received any counseling about whether or not to keep the baby (or get an abortion) and after she gives birth tonight, she'll be allowed to keep the baby without so much as a state social worker visiting her apartment to make sure she can handle the responsibility. Even the States, hardly known for its enlightened attitude towards pregnant teens, offers pregnant girls Planned Parenthood.

When I asked how she will support the baby, she told me about her plan to move into her half-brother Sergei's apartment and rent out her own. In her typically impractical way, she talks about this as if she'll start making money from this plan instantly, although last I heard it's tough to rent an apartment without a floor, wallpaper, or windows. And, before praising Sergei as a big-hearted savior, two of Masha's relatives, including my friend who introduced me to Masha, remember him groping them when they were under ten years old. Clearly, Sergei has interests other than Masha's in mind. It sounds like it's a Death Porn story waiting to happen.

Sometimes, by looking at how a government responds to its most needy members, you can get a sense of the government's humanity. It's hard to look at Masha, or the poor child she's giving birth to tonight, and imagine how Russia will genuinely stand on its feet again. And this isn't taking place in Tynda or Tomsk-17, but in one of the most expensive cities in the world. In order to start resolving its demographic crisis and keep from going extinct, Russia will have to do a lot more than bluster about the demographic problem and foreigners adopting their babies. It's something like the inverse of American politicians who get moralistic about abortions and then refuse to provide social supports for vulnerable women who have babies because they weren't honestly counseled about the alternatives.

But in Russia, unlike America, the country's very fate depends on finding a solution to this problem. It's very survival depends on figuring out a way to actually nurture and care for the few mothers and children it still produces. But until the massive, corrupt bureaucracy's voracious appetite for second and third Cote d'Azur vacation homes and Audis can be contained, mothers like Masha, and her baby, are going to be mere Death Porn tragedies in the making, rather than building blocks for Russia's future.

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