Antropologicheskij forum, 2018, no. 37

STATE-FUNDED FACILITY-BASED CHILDBIRTH IN THE RUSSIAN SYSTEM OF HEALTHCARE: DIVERSITY OF APPROACHES

Anastasia Novkunskaya
European University at St Petersburg
6/1А Gagarinskaya Str., St Petersburg, Russia
anovkunskaya()eu.spb.ru

Abstract: Maternity services in modern Russia are formally regulated and coordinated by decrees of the Ministry of Health, by orders of the regional authorities and by internal orders of medical institutions. However, formally homogeneous facility-based childbirth in Russia shows considerable differences in the way healthcare professionals interact with each other and with their patients.

This paper is based on empirical datа of semi-structured interviews, participant observations, document analysis and expert interviews, which were collected in maternity facilities located in small Russian towns. It adopts as a conceptual framework the model of “negotiated order” and investigates how various types of interactions are practiced in different maternity wards of central district hospitals. Variations are analyzed across four key dimensions — notions of the ideal model of childbirth (“Soviet” vs. “Western”), openness to new approaches and methods, relations with patients and their families, and opportunities for midwives’ professional autonomy.

Results of the investigation allow allocation of at least two possible models of negotiated order produced in two studied cases. The first, more rigid and conservative implies orientation towards the “Soviet” model of healthcare, a more closed disposition concerning new recommendations and approaches, and reproduction of a strong professional hierarchy and reluctance to the inclusion of the patient perspective. An opposite negotiated order appeared to be more open and flexible in terms of the adaptation of new approaches and methods, inclusive in terms of interactions with patients and their relatives, and favorable for the midwives’ professional autonomy.

Keywords: system of obstetrics, facility-based childbirth, alternative approaches, healthcare professionals, healthcare reforms, recommendations of research centers and institutes.

To cite: Novkunskaya A., ‘Byudzhetnye gospitalnye rody v rossiyskoy sisteme zdravookhraneniya: razlichiya v podkhodakh’ [State-Funded Facility-Based Childbirth in the Russian System of Healthcare: Diversity of Approaches], Antropologicheskij forum, 2018, no. 37, pp. 177–197.

doi: 10.31250/1815-8870-2018-14-37-177-197

URL: http://anthropologie.kunstkamera.ru/files/pdf/037/novkunskaya.pdf