MOSCOW — It's one of those sodden, snow-crusted days when the sky looks like dishwater, the office temperature won't budge above chilly and Dr. Vladimir N. Serov dreams of Santa Barbara.
Not the town. The soap opera. The television melodrama has set Russians swooning for years, and it has inspired Serov to dream as well. He marvels aloud at the medical care on the show. He wishes he could lift it from the TV and graft it onto Russian society. Starting with his own obstetrics practice.
For as Serov sadly acknowledges, Russia's maternity wards are scruffy, ill equipped, harried. They follow rules from Soviet days. Husbands cannot help their wives through contractions or cuddle their newborns. Women in labor cannot see family or friends, or even the obstetricians who handled their pregnancies. The Health Ministry regulations are so detailed that they control nursing posture as well: Mothers must lie on their sides to breast-feed their babies.
Compared with "Santa Barbara"--or even real-life America--Russia's "birth houses" are stern, stifling, scary. And dangerous.
Hundreds of mothers die each year from uncontrolled bleeding or raging infections after giving birth in the specialized state hospitals that handle all abortions and deliveries here. Hundreds more die from the lingering effects of bungled abortions, which wreck their reproductive organs and complicate future pregnancies.
True, Russia's maternal mortality rate is nowhere close to the abysmal tolls in China, India or impoverished Africa. But Russians do not like to compare themselves to Third World countries. They look at nations they consider equals--and cringe.
Russians are six times more likely than Americans to die in childbirth. For every 100,000 live births, 53 Russians die. The United States and Britain each report eight deaths; Japan records 11.
"Our system is bad," Serov said. "It's not in the least bit modern."
Indeed, little about Russian obstetrics is modern, at least by American standards.
In the birth houses, babies are treated almost as a commodity, to be churned out assembly-line style. Decrees from the Communist era regulate every aspect, from mandatory enemas during labor to postpartum attire.
In the United States, "we've made efforts to humanize the birthing process and make it more of a family experience," said Dr. Brian Koos, chief of obstetrics at the UCLA Medical Center.
In Russia, however, personal choice and individual relationships remain a low priority.
As Serov put it: "They're like factories."
He serves as deputy director of one such factory--the Center for Obstetrics and Gynecology, a cinder-block clinic with chipped floors. The cheeriest poster is an ad for Tampax.
This is supposed to be a showcase birth house, reserved for women with high-risk pregnancies or a lot of clout.
But it has communal delivery rooms, built when privacy was considered a bourgeois decadence. Each floor has just two pay phones, so proud mothers must wait in line to announce their deliveries. The grimy windows are marked with numbers so that husbands--banned from the clinic--can find their wives' rooms and shout greetings from the sidewalk below.
"Our maternity homes," Serov said, "look a little like jails."
Ironically, the few reforms that have swept through the birth homes may end up increasing the maternal mortality rate.
The new capitalist spirit, for example, has spawned a dangerous medical market. All women are entitled to free medical care--from ultrasounds to abortions--at their local maternity hospitals. But nowadays, many birth houses have opened "commercial departments" that offer better treatment to the rich. Bribes can secure top-notch service as well.
"The women who can't afford payments really get the minimum in care, which is not sufficient," said Rudolf Hoffmann, a UNICEF project director who oversaw a recent study of Russian obstetrics.
In some maternity hospitals, wealthy women can snag more than private rooms and attentive nurses. They can pay the equivalent of $800 to order a caesarean section. The operation is free when medically necessary. But some doctors now are willing to perform it at a woman's request and in exchange for cash--a practice that would "absolutely not" be accepted in the United States, Koos said.
Caesareans have been relatively rare in Russia, used in 10% of births, compared to about 25% in America. The percentage may well rise, however, as rich women try to avoid the pain of labor. And more operations mean more risks of infection.
Russia's heavy reliance on abortions--more than two-thirds of pregnancies are terminated--also drives up the maternal death rate.
Although sidewalk kiosks now carry condoms and pills, Russians still consider abortion a convenient, and free, form of birth control.
The average woman will terminate nine pregnancies. When she finally decides to carry a baby to term, she runs a much higher risk of premature labor, weak contractions and hemorrhaging, says the Russian Family Planning Assn.