I gave an interview for Iskreni.net (click)
“SOME THINGS IN MATERNITY HOSPITALS SHOULD HAVE CHANGED LONG AGO FOR THE BENEFIT OF WOMEN AND NEWBORNS”
I have been following midwife Nastja Pavel, “Moja babica” (My Midwife), for several years. I first saw her at a birth conference in Laško in 2013, where, even as a fresh midwifery graduate, she caught my eye with her active approach to knowledge and information. I continued to follow her with interest in the years that followed, as her enthusiasm and passion for learning more never ceased.
Today, Nastja is somewhat of a phenomenon, as she is one of the few midwives employed in a maternity hospital (Nastja works in the Maribor maternity hospital) who is visibly active in the field of birth practice, also by providing relevant and freshly verified information about birth, which often does not align with the established system of practice in some of our maternity hospitals.
Nastja, can you briefly introduce yourself? Who is Nastja Pavel?
I find it interesting when someone asks me: “Who are you? Who is Nastja Pavel?”
Nastja used to be a lively, positive girl who largely gave herself to others and who, when choosing her study path, opted for a profession that she found cool, but above all, a profession where she saw an opportunity to do what she had always wanted in life – to help and advise others in an area that is less known or even unknown to them.
Today, I am still that girl who tries to stay positive and smiling, yet perhaps sometimes expects more from others than they are willing to give. But she has become someone who realized that only giving to others, and not primarily giving to oneself and one’s loved ones, does not lead to the right path. Because you burn out, because you get run over, because you realize that in the end you are more or less alone and cannot save a flower.
Many of us also know you as “Moja babica” (My Midwife). When was Moja babica born and what was/is its purpose?
After finishing your studies, a job doesn’t await you, at least it didn’t for me. I thought to myself that this wasn’t good. If I waited for a job for several years without practice, I would completely “fall out” of midwifery. Okay, I won’t get a job, I told myself, what’s next?
I enrolled in the master’s program in nursing in Maribor, which I successfully completed last year, and at the same time, with the help of my partner, Moja babica was born. So, a more complete Nastja. I told myself I mustn’t stagnate. What should I do?
I decided to create a Facebook profile through which I would connect with other midwives around the world, read articles, and thus stay in touch with midwifery. At the same time, I would translate or share some things on the page so that other women would also get relevant and new/different information about pregnancy, childbirth, the postpartum period, and midwifery.
And – it took off! Many women became interested, and the thing grew and grew. Last year, with the help of my partner and a friend, I also created the website mojababica.si, where things are clearer than on the Facebook profile.
What model of the midwifery profession does Moja babica represent?
By creating my Facebook profile, I somehow realized who and what a midwife should actually be and what her work entails. I must admit that it wasn’t my studies through which I learned what I wanted to be and how I wanted to work, but rather getting to know midwifery through foreign literature and the experiences of foreign midwives.
The internet is a great thing; you quickly get information, but not only relevant and good ones. Moja babica strives to ensure that women have access to appropriate and relevant information, based on which they can then make their own decisions and conclusions. I try to translate as many things as possible into Slovenian, but as a graduate midwife, I am also employed in one of the Slovenian maternity hospitals, where I work shifts, and therefore “Moja babica” sometimes has to wait for its turn.
Every maternity hospital has an established system and way of working. How did you deal with this, and how do you deal with it now?
People often ask me: “How do you manage not to be run over by the system?” My answer is that satisfied women and families outweigh everything else. That’s what motivates me.
If I go back to my student days, I would say I was an average student, but with my own character. It always bothered me if injustice was done, and that has stayed with me. It bothers me when something is already a priori impossible, when things don’t change. We are afraid to try. Instead of trying to change something and then seeing: “OK, this is not a good solution, let’s find another,” we say from the start: “It won’t work” or “We can’t do that.” And when you learn about practices from abroad during your studies, which have been in place for years there, but here nothing seems possible, you become a little annoyed.
However, once you enter the system, for example, when you get a job in the public sector, you see that you cannot change things – or you cannot change them alone, but you can change them within yourself, through who you are, what you are like, and how you work, what kind of attitude you have, and how you accept others.
You say you can’t change the system yourself. What would benefit the work environment to be more open to improvements?
In my work, I particularly miss discussions, exchanges of experiences and opinions, as well as ideas and constructive criticism that people would accept without resentment. I miss discussions where one person suggests one thing, another something else, and when there’s disagreement, an attempt is made to find a third way, which might be the right one. It’s not just what you say that’s right, and it’s not necessarily what I say that’s correct. What matters is the perspective you’re looking from.
Employment in a maternity hospital was a great opportunity for me to get to know the healthcare system – perinatal and postnatal midwifery care – as we know it here. Of course, you don’t agree with everything when you start working. Already because things were presented differently at university regarding how certain things should be.
However, when you start working in an institution, in such an entrenched system, you have to accept the rules of the game, but at the same time always think about what you could do better next time and what could eventually be changed for the better together.
Your master’s thesis also touches on improving birth practices. So, how do you view changes and improvements in the maternity hospital system?
Changes in a maternity hospital require multidisciplinary cooperation from all employees. The initiative for changes can come from midwives, but pediatricians and obstetricians must agree with them, which is right, as we are one team. Most importantly, the management must recognize what needs to be changed and keep up with the times.
Some things should have changed long ago for the benefit of women and newborns. That’s why I decided to write my master’s thesis on six areas in the delivery room where we can improve birth practice.
Can you briefly introduce these six areas to us?
First and foremost, I define the importance of the relationship we have with the woman; I write about the significance of the first contact between the midwife and the woman, about communication, which significantly influences the relationship and the establishment of trust.
Secondly, I emphasize how we listen to the birthing mother to disturb the birthing process as little as possible. Here, I concluded that it is very important for us, as professionals, to have as much knowledge as possible, as most women come to birth unprepared. They attend parenting classes, but that’s generally it.
Thirdly, regarding birthing positions, I highlighted that it would be wonderful if women moved as much as possible during labor, but I conclude that in midwifery, we will have achieved a lot if we eliminate the semi-sitting position for pushing and introduce pushing on the side into regular practice – of course, when no medical interventions are needed. Let me say that the entire master’s thesis focuses on physiological pregnancy and birth, but something can be extracted from each topic for urgent and pathological conditions as well.
Nastja with world-renowned obstetrician Michel Odent, when he visited Slovenia in March 2016.
I also mention eating and drinking. It is important that a woman has the free choice to consume food and drink, provided there is no high risk.
Then I dedicate two chapters to newborns, specifically writing about the importance of the first hour after birth and the initial care of the newborn. This includes waiting at least 90 seconds before clamping the umbilical cord, and not oiling or washing the newborn with soap within 24 hours to avoid removing the vernix. Blood is removed with water, and that’s all. Mothers know that a baby never smells the same as immediately after birth.
In addition to my work as “Moja babica,” I hope that this master’s thesis will also contribute to better midwifery practice and perinatal care.
What is your vision for the midwifery profession in maternity hospitals?
In the future, I wish that more people who have chosen this profession and work with women would also work FOR women. Perhaps more connection among ourselves, and also among maternity hospitals. I wish for more established practices. And of course, I also wish for enough staff so that women’s care can be safe and high-quality.
I came across a quote that I often repeat to myself. In translation, it sounds something like this: “I don’t care where or how you give birth – at home, in a maternity hospital with an epidural, with a planned C-section, or if you give birth in the forest next to a fawn. What matters to me is that you had options and were supported and respected in your decisions” (January Harshe).
This is what I believe is important in our work; that women have different options where they are treated with respect.
First, we must clarify things within ourselves. Figure out who we are, what we are, and what we want to become, how we want to work. In our work, we must realize that the system will not improve overnight. What we can do is improve ourselves within this system, and thereby slowly improve the system.
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