It’s time to focus again on midwifery, as 2017 was the year with the lowest birthrate in Bulgaria in the last four decades. The country obviously is in a deep demographic crisis.

At a discussion in Sofia on the occasion of Babinden (Midwife Day January 21^st) midwives from all over the country upheld a declaration for changes in the 2006 regulation, as the latter obstructed independent midwifery. They insist on the regulating of prenatal, postnatal and patronage care; on the creation and adoption of a midwifery standard, complied with the European legislation; options for real independent midwifery practices and a start package of 3 minimum wages. Their demand was supported by doctors from the academic circles and the state administration.

“All we need is an amendment to the regulation, saying that the midwife can assist during child delivery on her own. She will cope, as a well-prepared midwife knows much better the problems of a woman in labor than a doctor who is not an expert in the sphere of gynecology” – words of Prof. Dr. Atanas Shterev, one of the leading experts in this country. Furthermore:

“The first major thing is the regulating of independent midwifery. The second one is the maintaining of a high level of training, so that only highly skilled experts come out of universities. This regulation now allows midwives to explain to patients what health and disease are, to uphold them emotionally, but they simply are banned from assisting to a normal delivery independently. It is written down in the law that this has to be under the supervision of a doctor. We have huge database with the names of 3,500 skilled midwives in this country. They also carry out consultations on their own and they usually know best what types of tests are necessary for the future moms.”

“We, nurses and midwives should always maintain a superb level of proficiency and skills, so now we are ready to say that it is time for a change,” says Milka Vasileva, chair of the Bulgarian Association of Healthcare Professionals and adds:

“Midwives and nursery experts as a whole face really serious issues. We do everything with the purpose of protecting our profession. As a professional midwife with 20 years of experience I can say that despite the regular meetings with the minister or the parliamentary healthcare committee, we receive only some attention and promises, but no one actually thinks of our problems.”

“I share your views and hence my participation in this forum”, said Dr. Luchezar Ivanov, deputy chair of the parliamentary healthcare committee.

“We – politicians, are in debt to you – midwives and to all Bulgarians in regard to the healthcare sphere. We failed to keep all our promises and also the big hopes for reforms in the system of healthcare. I participated in the constitution of the Law on Medical Institutions and it envisaged the establishment of midwifery or nursery ambulatories. However, that article of the law was withdrawn later on and it didn’t acquire the strength that it should’ve had.  The range was expanded no earlier than 2015, giving an opportunity to medical assistants, nurses and midwives to provide independent healthcare. The question is why doesn’t this law work? One of the reasons lies in the fact that the law is not bound financially in any manner. The National Health Insurance Fund and the Ministry of Healthcare are the financial bodies which pay for healthcare services. The financial basis of independent midwifery has been provided nowhere in these forms of payment.”

At the Sofia-held professional forum the midwives voiced to the public their intention to carry out protest actions in May, in case no one viewed their proposals for changes in the regulation of their professional practice.

English version: Zhivko Stanchev