Winter 1995 (3.4)
Empty Maternity Hospitals
and Traditional Azerbaijani Birth Practices
by Dr. Tamilla Dilbazi
It used to be that a woman's greatest wish was to have children. Traditionally, women gave birth to their first child during the first years of marriage. It was a joyous event for the entire in the family. Everybody paid particular attention to a woman when she was pregnant. In fact, she was extremely pampered. She wasn't allowed to carry anything heavy or do any task which might involve strain. She was always offered a seat on crowded buses or the Metro.
They liked to feed the mother-to-be milk and apples, believing that she would give birth to a white-skinned child with rosy cheeks. If she smiled a lot, the child would smile, too. Everything was done to create a quiet, non-stressful atmosphere and cater to her whims. Were she to catch whiff of a special dish even from her neighbor's kitchen, it's likely they would approach the neighbor just to satisfy the pregnant woman's cravings.
Left: A refugee baby in Baku. Photo: Oleg Litvin.
Nobody Wants Babies These Days
But these days, the story has changed. You don't see many pregnant women on the streets. Women don't want babies. Many do everything possible to avoid having them. It's the timing-it's a bad time to have babies. When it comes to contraceptives, a variety are available, the most popular being the intrauterine spiral coil (IUD). Oral contraceptives are not so widely used. Condoms are quite rare. In case of an undesired or unplanned pregnancy, a woman can apply to a hospital for help. If the ultrasound indicates that the pregnancy is still in its very early stages, the woman can opt for an abortion. The process is fairly common.
The main uncertainty in life is the economy and that's what is causing families to hesitate. Azerbaijan, like all other former Soviet Republics, is going through a transformation from a centralized economy to one driven by need and demand (market economy). Added to this are other problems that complicate the situation. Undeclared war has been going on for more than seven years (though a cease-fire has been in place for the last year and a half). The government has the additional burden of having to try to provide services for more than a million refugees who have been displaced from their homes, friends, and their psychological and economic base.
The breakup of the Soviet Empire has led to the unraveling of complex relationships throughout the Republics, especially in critical fields like medicine, which was highly developed. Hospital shelves are quite empty these days except for international humanitarian aid. Medical equipment, pharmaceuticals, and routine supplies used to come from various parts of USSR and Eastern Europe, especially Czechoslovakia and Eastern Germany. Today, it's hard to get drugs especially since Azerbaijan doesn't produce them and those from Western countries are too expensive and require hard currency.
Formerly, the Government spent considerable money on the development of medicine but now they can't. Medical care used to be entirely free including medicines. There used to be special funds available for the reconstruction and renovation of hospital buildings. Now there is no money for equipment or even basic necessities like painting clinic walls or repairing toilets and elevators.
Every aspect of life is affected by this miserably weak economy. People feel so uncertain about their own lives that they hardly want to risk adding more responsibilities and anxieties by having children. Therefore, the number of births has reduced dramatically since independence in late 1991. It used to be that an average family had three or four children, though in villages four to six was the norm. These days families prefer only one or two.
Left: Swaddling new born babies is still practiced in Azerbaijan. This photo was taken in Sumgayit Maternity Hospital on a blistering hot day in August 1994.
Photo: Oleg Litvin.
And for those women who do go ahead, too many of their babies are being born with defects and abnormalities. Many are premature or have low weight. Food is too expensive for many families. Women don't get adequate nutrition; they try to get by on mostly bread, beans, and pastas. Meat is rare. One chicken or a kilo of lamb costs one fourth of an average government worker's entire monthly salary.
Of course, Azerbaijan does have its share of wealthy businessmen, but the majority of people suffer dreadfully. Everyday life is a struggle. Even normal services can't be taken for granted. Too often there is lack of water, electricity and gas which complicates household chores like food preparation and sanitation which are so vital to good health when a woman is pregnant. All these factors make life stressful and many women are unable to bring their babies to full term which causes terrible shame. To lose your baby is a great failure-it's like a sin in front of God.
Costs of Having a Baby
It costs a lot of money these days to have a baby. On average, families pay between $150-$300. The low salaries of doctors and medical personnel force them to find ways to supplement their incomes, and so they charge for each medical service. Officially, it's illegal; but in reality, it's done all the time.
This grand sum is for the bribes that must be paid to all the doctors, nurses and medical staff involved. It's an enormous amount when you realize that the average government worker earns $10 a month. Besides that, the family usually has to provide food for the mother during her hospital stay. We have a national food called "guima" made from flour, honey and butter. It's mixed together and boiled. The family prepares this dish at home and brings it to the hospital to give to the mother right after her delivery. It's a sweet, pleasant-tasting, comforting food, very soft and nourishing.
In many cases, the mother also brings all necessary items that are used for delivery such as painkillers, antiseptics, sutures, and bandages. She finds out what to bring from a list given by the doctor. Then she goes around to the commercial drugstores and purchases the items before entering the hospital. She usually prefers to use her own bed sheets and blankets.
Obviously, poor women can't afford to go to the hospital. They give birth at home. Then only a small sum has to be paid to a single midwife, doctor or nurse, who organizes everything. But such arrangements can be risky to both mother and child if any complications arise.
No Men in the Hospital
When does the husband first get to see the baby? When the wife returns home from the hospital with the child. Men are not allowed inside the maternity hospital. Only women visitors may enter. Gynecologists and all medical personnel and staff in the maternity hospital are always women. We don't have the tradition that we've seen on western TV where the husband assists the mother and doctor in the delivery room.
That would be quite unusual for us. At the hospital, if a woman happens to have a room on the first floor, the mother will carry the newborn over close to the window for the proud father and male relatives, standing outside, to catch a glimpse. Actually, most women don't talk much about pregnancies and such related matters to men. For example, the first person a woman usually tells when she's pregnant is her mother, not her husband. That's just the way we are. Many things related to sexual relations go unspoken.
The length of stay in the hospital used to be nine or ten days with the first child and about seven with births that followed. But now the average has been reduced to five days for the first birth and four for successive ones. Conditions aren't really good enough to keep women longer than that. Besides, they want to go home. It used to be that when the umbilical cord fell off, it signaled the termination of the hospital stay for mother and child. But nobody waits for that any more.
The "Evil Eye"
After birth, the mother and child are protected and watched over for 40 days. Traditionally, no one is allowed to come and visit. The mother and child's health must be guarded. No one wants to risk the child being effected by the evil eye or bad thoughts that someone might harbor.
Actually, belief in the evil eye ("gyoz dayma") is quite widespread. It doesn't depend on the family's level of education. Highly educated people practice it, too, especially with their first born. Pinning a "blue eye" on a child's clothes somehow makes parents feel that their child is safer and that no unknown danger and no person can "harm" him-no disease, nothing evil. This "blue eye" is like a "defense" against all bad things. Whenever an infant gets sick, the first question friends or relatives invariably ask is whether the child was wearing the "blue eye". And if the answer is "no", then people blame the parents. It's a tradition some people don't grow out of. You'll even find adults wearing "blue eyes". It's like a talisman, a good luck charm, that people like to keep to protect themselves.
Naming the Baby
After 40 days, many people in the provinces follow the national tradition of the "Name-Giving Ceremony". A party is given which women attend while the men go to a separate place. An elderly, highly-respected woman, is invited to conduct the ceremony. After saying prayers and reading verses from the Koran, the big moment arrives when the chosen name is whispered into the baby's ear three times. Actually, it's usually grandparents that choose the name. In many families there is a tradition of giving the father's name to the first son (if the father has passed away). The practice usually doesn't carry down after the first child and the privilege is always given to the father's side. It's not uncommon for girls to receive names chosen from literary works. After this celebration, the child's name will be formally registered on the birth certificate.
We don't breastfeed our children in public. It's considered a private affair. It used to be that for the first three days, the baby was not even fed because the mother's milk was considered too thin. But there's a new theory now that the mother's milk, even in the early stages, contains valuable nutrients so now six or eight hours after birth, mothers begin feeding their babies.
We also have a tradition of swaddling the infants so they can stay quiet and warm. The temperature may be scorching hot outside, but we still wrap newly born children tightly in a blanket. It is believed that this helps their legs to grow straight, especially girls. Formerly, swaddling was continued for one or two months. But during the past two or three years, the babies are allowed much more freedom of movement.
Despite all the difficulties that Azerbaijan has today, you still see a lot of small children in the streets. They look so nice, attractive and well kept, smiling and playing. Fortunately, children are quite unaware of the difficulties and struggles that go on around them; and we, the adults and parents, are still very optimistic about their future. We hope that everything will soon begin to change for the better. Nothing concerns us more than being able to give our children a legacy of strong health and security.
Dr. Tamilla Dilbazi served as a Maternity Doctor for more than 40 years. Her late husband, Dr. Israfil Nazarov, was Director of the Rehabilitation Hospital for the Patients with Lung Diseases in Bilgah. Her daughter, Muzhgan, assisted with translation from Russian. Her seven-year-old grandson, Islam Mastanov, is hoping to grow up to be a doctor.
From Azerbaijan International (3.4) Winter 1995.
© Azerbaijan International 1995. All rights reserved.