Pregnancy and medical care

Pregnancy and childbirth may seem a difficult experience, as they are related to so many new challenges on the personal, legal and medical level. Having in mind the future mums who are not Polish citizens, their partners and their children, we bring you a text presenting the most important issues that parents in Poland need to deal with. We discuss the issues related to medical care, the registration of the child, his or her residence status and the benefits to which the family is entitled.

It is worth knowing that for almost three years now, the Perinatal and Postnatal Care Standards as specified in the Regulation of the Minister of Health of 20 September 2012, which established the standards of obstetrical and neonatal care, have been applicable. It is advisable to check them up to know what rights and privileges a pregnant woman has in Poland, as well as what examinations and procedures she should undergo. The most important provisions of the abovementioned regulation will also be quoted in this article.

The first issue worth discussing are pregnancy checkups. Regular doctor’s appointments and consultations with a midwife are necessary even if there isn't anything wrong with the pregnancy. It is accepted that during the first seven months, the woman should visit her doctor once a month. During the eighth and ninth month – it should happen every two weeks.

How to choose a doctor?

In Poland, obstetric care is delivered by a gynecologist-obstetrician or by a midwife. It is worth knowing that in case of pregnancy, no zoning applies – the pregnant woman is entitled to choose the hospital where the baby will be born and the doctor who will care for her during the pregnancy as she pleases. Men specialize as gynecologists-obstetricians more often than women. If, for personal or cultural reasons, the patient wants her pregnancy to be managed by a woman, she should indicate it during her registration as a patient.

How to choose the place for delivery?

Most women in Poland give birth in a hospital, however, a home delivery is possible, and such deliveries become increasingly popular. However, doctors strongly discourage that choice if there were even slightest complications during the pregnancy. The National Health Fund insurance does not cover the costs of the home delivery, which means that if a woman chooses it, she will need to pay for it. If a pregnant woman decides to give birth in a hospital, she is entitled to choose where the her baby is to be born. After making the decision on the hospital, it is a good idea to go there, talk to the staff, have a CTG and take a look around. This way, when the mum-to-be arrives there to give birth, it will not be an entirely alien place for her anymore. The standard of respective hospitals may differ, so it is a good idea to visit a few places to see what the delivery rooms look like. If there are any complications during the pregnancy, the woman should consider giving birth in a clinic prepared to receive her. If a mum-to-be doesn’t speak Polish very well and she would like to communicate with the doctors and the midwives in another language, she should check if the staff at a given hospital has the relevant linguistic competences. If the language barrier is a problem, she can come to the checkups accompanied by an interpreter. Interpretation during doctor’s appointments can be provided free of charge, among others, by the Warsaw non-governmental organization Stowarzyszenie Interwencji Prawnej.

What tests should be performed during the pregnancy?

The list of tests the women are directed to during the subsequent months of pregnancy differs depending on the country. Below, you will find the standards applicable in Polish healthcare institutions.

Before week 10 of the pregency	Medical history and general obstetric examination. During the appointment, the doctor should refer the patient for the following examinations: blood group and Rh, immune antibodies, blood tests, general urine analysis, smear tests, vaginal swabs, fasting blood glucose levels, VDRL, HIV and HCV antibodies, toxoplasmosis and rubella. A checkup with a dentist is also advisable.
Week 11-14 of the pregnancy	Wizyta kontrolna. W tym okresie lekarz prowadzący powinien skierować kobietę na następujące badania: USG, badanie ogólne moczu.
Week 15-20 of the pregnancy	Wizyta kontrolna. W tym okresie kobieta powinna wykonać następujące badania: morfologia, badanie ogólne moczu, badanie czystości pochwy.
Week 21-26 of the pregnancy	Wizyta kontrolna, podczas której kobieta powinna otrzymać skierowanie do szkoły rodzenia. W tym okresie wykonuje się następujące badania: badanie stężenia glukozy we krwi, USG, badanie ogólne moczu, przeciwciała anty-Rh u kobiet z Rh (-).
Week 27- 30 of the pregnancy	Wizyta kontrolna oraz następujące badania: morfologia krwi, badanie ogólne moczu, przeciwciała odpornościowe, USG.
Week 33-37 of the pregnancy	Wizyta kontrolna, skierowania na: morfologię krwi, badanie ogólne moczu, badanie czystości pochwy, antygen HBs, badanie w kierunku HIV, posiew z przedsionka pochwy i okolic odbytu na obecność paciorkowców B-hemolizujących.
Week 38-39 of the pregnancy	Wizyta kontrolna, badanie ogólne moczu, morfologia krwi.

After week 40 of the pregnancy, the pregnant woman should report to the doctor or to the midwife every 3 days for a CTG and a sonogram.

During week 41 of pregnancy mothers-to-be are referred to the hospital.

In accordance with ustawą z dnia 27 sierpnia 2004 r. o świadczeniach opieki zdrowotnej finansowanych ze środków publicznych, foreigners residing in Poland are entitled to free medical healthcare in the territory of the Republic of Poland if they or their family members have obtained refugee status or subsidiary protection. Otherwise, foreigners in Poland need National Health Fund insurance

What do the Perinatal and Postnatal Care Standards guarantee? What rights do mums-to-be have?

The mum-to-be is entitled to:
free choice of the place where she wants to give birth;
full and exhaustive information regarding her own health, as well as the baby's;
respect for her dignity and intimacy;
individual Delivery Plan (more information on that can be found in the Delivery In Poland chapter);
the company of a close friend or relative during the delivery. It may be her significant other, but also a friend, the mother or another close person;
active delivery;
use of non-pharmacological pain treatment (warm water, massage);
fluid intake during the delivery;
the first contact with the child immediately after the delivery, for at least two hours;
help in breastfeeding during the first days after delivery;
at least 4 visits from a midwife after her return home, in accordance with the individual needs of the mother and of the child.