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. Last Updated: 07/27/2016

When Giving Birth at Home Goes Wrong

For MTA mother holding her newly born daughter after a home birth in a Moscow apartment in 1997. Home births are typically in water, which provides pain relief.

Yelena Yermakova is being held in a pretrial detention center in the eighth month of her pregnancy and is likely to give birth behind bars.

Ironically, she is on trial for her role as a midwife in a series of home births that ended tragically.

Many expectant mothers dread the thought of going to the hospital, where medical staff are known to swear and shout and babies are only reunited with their mothers at feeding time.

As a result, some Russian and expatriate mothers opt instead to give birth at home with the assistance of midwives — a practice that is unregulated and skates on thin legal ice.

Yermakova worked at a St. Petersburg center called Kolybelka, or Cradle,” headed by her husband, Alexei Yermakov. They organized prenatal classes and — unofficially — helped women give birth at home.

Eight women went to court after two suffered severe complications during childbirth and the other six lost their babies between 2001 and 2006.

In 2006, the Yermakovs were charged with unlicensed private medical practice that caused bodily harm and death. A St. Petersburg court is to hear their case next week in a rare instance of alleged medical malpractice making it to the courts.

Yermakova, 41, was detained in March after missing several court hearings on what she said were health grounds. She already has five children, including one who is barely 2.

Her husband has posted letters from her online in which she writes that she is suicidal. Supporters have petitioned the St. Petersburg human rights ombudsman and President Dmitry Medvedev.

 “She feels OK, physically,” Yermakov said in a recent telephone interview. “Of course, she can’t get a massage or move around much.”

He said the couple has conducted home births since 1992 with low complication rates.

Out of 1,500 births, only about 10 have required hospitalization, Yermakov said.

“If we are guilty, that guilt lies outside the legal case,” Yermakov said, describing the medical histories in the eight mothers’ cases as “very ambiguous.”

The trial has provoked strong emotions and debate in the media, with headlines such as “Death in the Cradle.” Both sides have used the Internet to argue their case. The eight women have set up a web site that includes graphic details of each birth.

In turn, the Yermakovs’ supporters have opened a LiveJournal page and posted medical details about the women.

The first woman to initiate legal action against Yermakova, in 2006, was Olga Vasilyeva, whose baby was born dead after a breech delivery, when the head comes out last.

Talking quickly and emotionally, Vasilyeva told The Moscow Times that the pathologist’s report found that the baby had traumatic brain injury and a basal skull fracture.

Vasilyeva blamed Yermakova for the baby’s death, saying tests found that the baby was otherwise healthy. “Birth traumas are always the fault of the midwife,” she said.

Yermakova removed all her equipment after the birth and left before emergency services arrived. “She told me not to talk about them,” she said.

Vasilyeva complied and told emergency services that she gave birth alone. “The baby had such injuries that suspicion fell on me that I had murdered the child,” she said.

The case began after she told investigators that she had given birth with Yermakova.

On the Yermakovs’ supporters’ site, details that sound like Vasilyeva’s are published without her name. They contradict her story, saying the baby died in the womb from a problem with the placenta.

Vasilyeva has posted an appeal on the Internet and appeared on television, asking for other mothers to come forward.

“When you go to Kolybelka, you only see happy mothers,” she said. “I didn’t hear of one bad case.”

As the case goes to the trial, the group of eight mothers has become close, Vasilyeva said. “We’re already like a family, we celebrate holidays together,” she said.
Yelena Yermakova and her husband, Alexei, in happier times. Yermakova, who is eight months pregnant, is in jail.

The earliest case dates back to 2001, when Olga Goncharenko gave birth to a son who is severely disabled with cerebral palsy.

She writes on the women’s site that her child was born blue after a long labor, with the umbilical cord wrapped around his neck, and it took Yermakova 20 minutes to resuscitate him.

Doctors told her that “all of this would have been possible to avoid,” Goncharenko said by telephone.

She is seeking compensation of $1.5 million to cover the cost of caring for her child.

“Drugs, doctors — it’s all endless,” she said.

Vasilyeva said she doubts that Yermakova will get a prison sentence if convicted because of her young children. “They should ban her from practicing. It’s not important whether they jail her,” she said.

The case has focused attention on the home birth movement, which is neither accepted by official medicine nor regulated in any way.

“Home births are extremely dangerous and completely unjustified,” Russia’s chief gynecologist, Vladimir Serov, told The Moscow Times. “The midwives are committing a gross error. It is not acceptable under our standards.”

He said a doctor should always be in charge of a birth, and the midwife should assist.

Serov said he hadn’t heard of Yermakova’s case, but said, “According to our law, she doesn’t have the right [to deliver a baby]. She should be punished.”

The Yermakovs’ case is high-profile partly because litigation over medical malpractice is still rare in Russia.

Supporters of home births argue that similar deaths in maternity hospitals go unpunished.

“There’s never been a big case about a doctor at a maternity hospital,” said Yekaterina Perkhova, who edits a magazine on home birth, Domashny Rebyonok.

She has signed a petition to Medvedev to free Yermakova from custody, although she doesn’t know her personally.

“We think it’s more dangerous to give birth in a maternity hospital than at home,” Perkhova said. “There is a lack of rights. They [medical staff] are still inhumane in their relations with the patients. They can shout at you or swear.”

“At a maternity hospital, they take away the baby and only bring it for feeding. If the baby dies, no one finds out what it died of,” said Tatyana Sargunas, who gives lectures on natural births and acts as an “instructor” at home births.

Evidence that the situation in maternity hospitals needs to be improved lies in the fact that Russia’s infant mortality rate is significantly higher than in Western Europe.

Health and Social Development Minister Tatyana Golikova said in March that infant mortality — deaths under the age of 1— fell from 10.2 children to 8.5 children per 1,000 births between 2006 and 2008. However, UNICEF puts Russia’s figure at 13 in 2007.

According to UNICEF figures, the infant mortality rate in 2007 was five deaths per 1,000 live births in Britain and seven in the United States.

Sargunas and Perkhova called for licensing of midwives who assist at home births, saying this would protect both sides.

Yermakova has medical training, but it is legally impossible to register as a private midwife, her husband said.

“Private midwives can’t get registered. There was never any need for this. The practice [of registration] was destroyed during the Revolution,” Yermakov said.

Yermakova studied at a midwife college and gained a medical degree from the St. Petersburg Therapeutic Institute, a private medical university, he said.

He estimated that there are 200 such private birth midwives in Russia.

Kolybelka was registered as a center that offered consultations, Yermakov said. “The fact that Lena helped women give birth was an agreement between themselves,” he said.

The center’s web site does not mention home births. It lists lectures as well as yoga, swimming and belly-dancing classes among its activities.

The mothers said they had no documents linking them to Yermakova. On their web site, they write that they paid 18,000 to 20,000 rubles for the births.

Yermakov described his wife’s role as “accompanying a birth.” He said that “natural births” do not involve medical intervention.

“Medical procedures must be carried out in a medical institution because they are fraught with all kinds of complications,” Yermakov said.

Asked what preparations the couple made for emergencies, Yermakov said no mother had needed a blood transfusion and maternity hospitals are obliged to admit a woman who is giving birth.

“Before a woman gives birth at home, she prepares quite seriously,” he said. “We minimize many risks with preventive measures.”

Molly Caliger, a U.S. midwife who has worked in St. Petersburg since 1992, said she didn’t know Yermakova personally but had talked to “a few dozen” women who gave birth with her.

“I would say for the most part their impressions were negative,” she said.

“She tends to talk about roddoms [maternity hospitals], convincing women it’s better to stay home and have a complicated birth,” Caliger said. “Women really seem to be brainwashed into the experience.

“The whole idea is that only healthy, low-risk women should give birth at home,” Caliger stressed.

Caliger also questioned Yermakov’s statement that only 10 mothers out of 1,500 required hospitalization.

It’s widely accepted that 8 percent to 13 percent of women having home births will require hospitalization, she said, while Yermakov’s figure is less than 1 percent.

“It’s hardly anything to brag about. It shows how dangerously they were practicing,” Caliger said.