What Estestveno Association is lobbying for?

Definition of terms:

As Normal Birth is accepted every vaginal birth no matter how it goes.

Natural Birth is a natural labor process during which there is no medical interference or if it has it is minimal.

Active Management of Labour means active leading of birth with active doctor’s interference in the process aiming to achieve maximum effectiveness of birthing function, to shorten the period of labor and to relieve pain. Active Management of Labour includes the following methods: artificial rupture of membranes, antispastic medication, pain relief during labor; stimulation and regulation of labor through oxytocine; induction of labor at medical indications. During the second phase (pushing) medical personnel usually directs pushing of laboring woman. In fact this type of birth is practiced in most cases in Bulgarian hospital.

Under Active Birth we understand the process during which the woman has active role in her choice of conditions for delivery – procedures, atmosphere, attending persons. The medical personnel is directed by the individual needs of laboring woman and do not undertake routine interventions. The role of the doctor is to observe and be passive. The midwife plays supportive role. The labor is not provoked, accelerated or pain relieved. Laboring woman has the freedom to move, to drink and eat, to take different postures, to push in vertical position, without any interference on behalf of the medical team in the normal course of the process, regardless of its durability. She has the right to be accompanied and supported by her family. After birth the child is not separated by his mother. Breastfeeding is encouraged. Theoretically Active Birth may occur in non-hospital as well as hospital environment. In fact Active Birth in hospitals is almost impossible in Bulgaria.

Assisted Birth is every labor where qualified medical personnel take part – midwife or/and doctor. Unassisted Birth is a delivery where there are no such personnel.

Home Birth could be assisted or non-assisted. The Assisted Home Birth is not legally regulated in Bulgaria.

There is an option for Assisted Active Birth in birth house or birth centre in many countries around the world. The labor is supported by a midwife according to the individual necessities of the birth giver. There is possibility for immediate transfer to hospital in case of unexpected complications.

What Estestveno Association Lobbies For?

The aim of Estestveno Association is popularization of Active Birth in Bulgarian hospitals, because in cases of normal pregnancy and lack of contra-indications it is the best way of birth for the mother and her baby. Now Active Management of Labour is usually executed (which is associated with increased risk of perinatal disease for the mother and the baby and delivery through operational intervention).

Estestveno Association does not reject the necessity of operational delivery by caesarean section (according to WHO c- section is needed in 10-15% of all labor cases) when there are clear medical indications for its need.

Estestveno Association encourages natural birth after cesarean section without any interference for its provoking, acceleration or pain relief, which could worsen its end.

Estestveno Association lobbies for regulation of assisted outside-the-hospital birth in specialized birth centers or at home as well as for training of midwives who have the required knowledge and skills to support birth givers in conditions outside the hospital.

Estestveno Association does not support Unassisted Home Birth and does not encourage birthing mothers to do it. We believe the birth is a partnership between the laboring woman and the personnel who looks after her. Both sides should collaborate and have mutual trust.