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Guide to Childbirth in Romania – Part 2 – Giving Birth

Guide to Childbirth in Romania – Part 2 – Giving Birth

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If you’ve found yourself in a position of giving birth in Romania, you probably have many questions about what to expect. Giving birth, also referred to as labor, is one of the most significant moments of a woman’s life. Every child endures the passage of birth only once, it’s in a parent’s best interest to make that one passage as beneficial for the child as possible.

Informing yourself on the practices, customs, and procedures which are common in the country where your delivery will take place is one of the most important things for an expecting mother to do. Since like many other things in Romania, childbirth can be a hard subject to navigate, we’ve written this two-part guide to help you on your journey.

In the first part of our guide, we covered the overview of childbirth in Romania by discussing topics such as Romanian birth statistics, health care, and hospital choices.

In this second part of the guide, we cover everything you need to know about giving birth in Romania.

Childbirth in Romania – Part 2 – Table of Contents

Natural Birth in Romania

Perhaps one of the most asked questions relating to birth in Romania is if it’s possible to have a natural birth in the country. The answer is yes, it’s very possible. Although, if you consider the standards of a natural birth, the majority of births in Romania wouldn’t be considered natural births.

Romania, just like about every other developed or developing country, has adopted many routine interventions and procedures which hinder natural births. Even though most births which take place in Romania can be considered to not be natural, it doesn’t mean all hope for a natural birth is lost.

So how do you have a natural birth in Romania?

If you follow these outlined steps (all of which are covered in great detail in our guide) your chances of having a natural birth in Romania are virtually guaranteed.

  1. Find an OB/GYN who is in accordance with your desire for a natural birth.
  2. Find a Midwife who will support you having a natural birth.
  3. Find a Doula who assists natural births.
  4. Complete a robust Birth Plan for your delivery.
  5. Inform yourself on Labor Interventions in Romania
  6. Inform yourself on Newborn Procedures in Romania
  7. Attend Natural Birth Classes
  8. Choose the right Romanian Maternity Hospital

Find and Choose an OB/GYN in Romania

Expectant mothers in Romania have the right to choose which obstetrician-gynecologist (OB/GYN) or (obstetrician-ginecolog in Romanian) they wish to monitor their pregnancy and preside over their delivery.

OB/GYNs are found in small and large cities across the entire country. You can choose any OB/GYN in your county as long as they have a contract with and work with the hospital you will be delivering at.

Of course, since finding and choosing an OB/GYN in Romania comes down to personal preferences, you might want your options are in the matter. The following sections detail how to find and how to choose an OB/GYN in Romania.

How to Find an OB/GYN in Romania

The best way to find an OB/GYN in Romania is from the recommendation of others. Women who have had positive experiences with certain OB/GYNs are very likely to recommend them to others. Alternately, women who’ve had negative experiences with an OB/GYN can warn you about which ones to avoid.

Recommendations can come from family, friends, family doctors, and online message boards where OB/GYNs are given reviews by others. The best way to find if there are web reviews of the OB/GYN you might be interested in is by online searching their name followed by the city they live or work in.

One method we don’t recommend you use in finding an OB/GYN is through a referral from a hospital. You have to keep in mind that consultations with an OB/GYN typically require out of pocket payments. If you are referred to one or more OB/GYNs you don’t like, the costs can add up quickly.

How to Choose an OB/GYN in Romania

When it comes to choosing the OB/GYN that will monitor your pregnancy and attend your delivery, it’s in your best interest to choose the one most suited for your needs. You are never obligated to stick with any particular OB/GYN but you should ideally choose the one you plan on remaining with for the duration of your pregnancy.

Some of the criteria to consider when selecting an OB/GYN in Romania are things like the following

  • Gender and Age
  • Experience and Credentials
  • Popularity and Reviews
  • Accessibility and Distance

Aside from the above-mentioned criteria, one of the most important aspects to consider when choosing an OB/GYN is if they’re willing to let you give birth how you want. Some OB/GYNs might be more in favor of an intervention full delivery, while others might allow or prefer more of a natural type of birth.

When you meet for the first interview with an OB/GYN, make sure you discuss exactly how you wish to deliver if your birth will be risk-free. If they are opposed to any of your preferences or give you a hard time, you can thank them and search out a different doctor who will respect your wishes.

Birth Plan for Giving Birth in Romania

A birth plan is a set of instructions that provide an overall blueprint of how a woman wishes her delivery to take place. Birth plans include an expectant mother’s preferences in a matter of birthing related topics. Birth plans discuss things like preferences for use of pain medication, and amount of time before the umbilical cord is clamped.

Romanian Birth Plan

Romanian Birth Plan

Birth plans are used by women around the globe in order to provide them with some level of say during a process where decisions are predominantly controlled by doctors. A birth plan is a way to establish desires ahead of time because women’s communication is generally obstructed during the act of childbirth.

So why use a birth plan in Romania? By using a birth plan you will have a much higher chance of giving birth the way you wish, including natural birth. A birth plan can also help protect you against obstetric violence by demonstrating to doctors that you’re familiar with how the system works.

Acceptance of Birth Plans in Romania

Like in many other countries, medical staff in Romania don’t always respect or acknowledge birthing plans. Sometimes the reasons are justified, like in cases when medical emergencies require obstetricians to deviate from the birth plan. However, other times doctors ignore birth plans out of sheer arrogance and a desire to do things their way.

In Romania, birth plans are respected to some degree or other based on the hospital and medical staff. Some maternity staff will acknowledge and sign off on birth plans, while others might become hostile and aggressive towards them. The best ways to ensure your birth plan is acknowledged is by following the below steps.

Steps to Ensure a Birth Plan is Accepted in Romania

  1. Have the birth plan written in, or translated to Romanian.
  2. Provide it to the medical staff who will attend your birth in advance.
  3. Have the medical staff sign the birth plan and retain a signed copy.

*Note: Most state hospitals won’t accept most, or possibly any of the terms on a birth plan as they have their own protocols they have to follow. If a Romanian state hospital refuses to sign off and abide by your birth plan your best option is to give birth in a private Romanian maternity.

If after taking those steps the maternity staff who will preside over your birth still refuses to accept your birth plan, your only other option is to find new medical staff or give birth elsewhere.

Birth Plan Verification

All birth plan requests should be verified in advance by members of the medical staff. In general, birth plans should be verified by the; midwife, obstetrician, nurses, anesthetist, and any other relevant staff. If the staff attending your delivery have signed the plan, they are required by law to abide by it unless otherwise receiving your express consent.

As mentioned earlier, a birth plan doesn’t ensure that the birth will take place exactly as is written in the plan. Complications or other unforeseen events can cause medical staff to deviate from the birth plan. A birth plan, however, will state and make medical staff aware of your birth preferences under the conditions of normal birth.

Contents of a Birth Plan

A birth plan can contain anything related to a woman’s preference before, during, and after childbirth as long as it’s a reasonable request. Because birth plans by their nature are meant to be customized for individual preferences, no two birth plans will look the same.

Below is a small list of some of the topics which are typically found in birth plans.

  • Vaginal or C-Section Birth
  • Administration of Pain Medication
  • Induction Preference
  • Birthing Position
  • Episiotomy Preference
  • Vitamin K Shot

For a complete list of childbirth topics, you should consider mentioning in your birth plan, see the next sections on labor interventions and newborn procedures in Romania. The more you know of what to expect when giving birth in Romania, the better you can prepare your birth plan.

Downloadable Romanian Birth Plan

To get you started on preparing a Romanian birth plan you can download this pre-written plan which covers many delivery interventions and procedures common in Romania. You can customize the plan by omitting or adding different requests to suit your needs. In general, though, most women won’t need to modify it as it’s a robust birth plan.

The downloadable birth plan is written in Romanian and requires a person fluent in the language to be able to fill it out. If Romanian is not your native language, it’s vital that you have someone who speaks the language fluently translate for you. Keep in mind, some parts of the plan are filled out by your obstetrician.

Labor Interventions in Romania

Although birth interventions are similar in many areas across the globe, there also exist differences which distinguish labor customs across nations. Romania is no exception in this regard. As you can see by viewing Romanian childbirth statistics, compared to other countries, Romania has alarming rates of certain interventions.

The main objective to weigh when considering labor interventions is the degree of how “natural” you want your birth to be. Natural births are vaginal and have little or no interventions, while “unnatural” births have many interventions, or are done by cesarean section.

The degree to which you wish your birth to be natural is the degree to which you will allow non-mandatory birth interventions. Many of the interventions listed below appear as isolated procedures, but in actuality, they are usually followed up by other interventions. Allowing one intervention can “cascade” to needing many others, which can eventually lead to a C-section.

The next sections will discuss the most common interventions which take place during labor, their prevalence in Romania, and how to prevent against them (if desired). Although no birth is ever the same and some might require intervention while others won’t, it’s still good practice to stay informed on all the possibilities.

Pain Relief During Labor in Romania

One of the most common labor interventions worldwide is the use of pain relief medications during childbirth. Pain relief medications for labor come in two forms, analgesics, and anesthetics. In Romania, both forms of pain medications are routinely administered by delivery room staff during childbirth.

So what’s the difference between the two? Analgesics are designed to lessen pain without loss of feeling, while anesthetics are designed to relieve pain by blocking most feeling. Popular forms of analgesics include opioid drugs and nitrous oxide. Popular forms of anesthetics include epidural and spinal blocks.

Since pain is one of the harshest realities of childbirth for many women, the use of pain medications has become one of the most common practices. If you are opposed to either analgesics or anesthetics intervention during labor, the best way to ensure they won’t be administered is by having that preference stated in your birth plan.

Induction During Labor in Romania

Labor induction is a procedure which artificially starts labor before it can begin naturally. Induction interventions have become common practice in many countries across the globe. Although birth induction is needed in certain situations such as certain post-term pregnancies, it is advised against by the WHO unless there is a “clear medical indication for it.”

Unfortunately, labor inductions have become common in Romania, even for non-post-term pregnancies. Some of the reasons why that is have to do with Romania’s healthcare system. Doctors and other nursing staff are on tight schedules, are overworked, and oversee many patients. Labor induction is more convenient for their schedules rather than waiting for it to naturally occur.

The Most Common Types of Labor Inductions Practiced in Romania

  • Membrane Sweep – Separation of membranes from amniotic sac surrounding a baby from the cervix.
  • Amniotomy – Also known as Artificial Rupture of Membranes (ARM) – A special hook or finger is used to break the water.
  • Prostaglandin Gel – A hormone gel that is inserted into the vagina to cause contractions and to dilate and soften the cervix.
  • Synthetic Oxytocin – Also known as Syntocinon or Pitocin is a synthetic form of oxytocin that’s administered through an IV to stimulate contractions.
  • Antispasmodics – Drugs used for the prevention of delays during labor.

All the above-mentioned induction methods come with varying degrees of risk. It is in your best interest to research each method and decide which, if any, of them you’ll allow during labor. A good resource for more information on induction is the WHO recommendations for induction of labour.

To prevent, limit, or allow any of the above-mentioned inductions during labor in Romania, make sure you state your preference in your birth plan.

Fetal Heart Rate Monitoring During Labor in Romania

Fetal heart rate monitoring (FHRM) is the process of checking the status of a fetus’s heart during labor in order to detect potential abnormalities. There are two types of FHRM, auscultation, and electronic fetal monitoring (EFM).

Auscultation is the method of periodically monitoring the fetal heart during certain intervals of labor. EFM is the continual monitoring of the fetal heart and woman’s uterus contractions through instruments that are attached to the mother.

For low-risk births, the World Health Organization (WHO) has two completely different recommendations for the two types of fetal heart rate monitoring. The WHO recommends against continuous EFM monitoring, and they recommend for the use of auscultation monitoring.

In Romania, both forms of heart-rate monitoring are practiced during labor. Auscultation monitoring is the more common method used, while EFM is typically used during labor if complications arise. Requests for or against any form of FHRM should be stated in your birth plan.

Surgical Procedures During Labor in Romania

The two most common types of surgical procedures to occur in delivery rooms worldwide are the cesarean section (C-section), and the episiotomy. A C-section is the delivery of a baby through an incision made in the abdomen and the uterus. An episiotomy is an incision made in the perineum to enlarge the vaginal opening.

Although both C-sections and episiotomies can be life-saving under certain circumstances, the WHO strongly recommends against the routine use of both episiotomy, and C-section procedures. Unfortunately, as you can see by viewing Romanian birth delivery statistics both practices are highly common in Romania against the recommendations of the WHO.

As mentioned earlier, some of the reasons why C-section rates in Romania are so high have to do with the cascading effects that start with the unsuccessful induction of labor. High episiotomy rates in the country can be attributed to the false notion that episiotomies speedup up labor or protect against vaginal tearing.

Two ways to prevent an undesired C-section or episiotomy during labor in Romania

  1. Opt-out of the artificial induction of labor (unless it’s necessary).
  2. State your preferences for the use of the procedures in your birth plan.

Newborn Procedures in Romania

Newborn procedures are processes that take place after birth which can be described as forms of post-birth interventions for infants. Many newborn procedures that have become common practice in Romania, and around the globe, are actually advised against for routine use.

In this next section, we’ll detail the most common newborn procedures which take place after childbirth in Romania. We’ll cover what they are, why they’re done, if they’re recommended, and how to opt-out of them if you so choose.

Early Cord Clamping Procedure in Romania

Early cord clamping is defined by the WHO as the clamping of a newborn’s umbilical cord “less than 1 min after birth.” The WHO recommends that umbilical cords be clamped “approximately 1–3 min after birth.” Studies show that there are key benefits to delaying cord clamping for 1-3 minutes after birth, or after the cord has completely stopped pulsating.

After a child is born, the umbilical cord continues to pump blood and stem cells into the baby, clamping an umbilical cord early robs the child of those vital cells. Some of the benefits associated with delayed cord clamping are; lower anemia rates, higher red blood cells, and a host of other positives like better blood pressure and more oxygen.

While delayed cord clamping comes with many benefits, early cord clamping comes with many risks. Some of the risks include; low blood pressure, delayed lung opening, hypotension, hypovolemia, and many other cascading problems. So why is cord clamping done in? Early clamping is done to prevent the rare occurrence of possible jaundice and excessive bleeding of the mother.

Steps to Prevent Early Cord Clamping in Romania

Like many other countries around the world, Romania has adopted the post-birth procedure of routine early cord clamping. If you wish to delay cord clamping to WHO’s recommendations of 1-3 minutes or longer, the best two ways of doing so are listed below.

  • Communicate to the medical staff (pre and post birth) your desire to delay cord clamping.
  • Have delayed cord clamping be mentioned as your preference in your birth plan.

Antibiotic Eye Ointment Procedure in Romania

Erythromycin antibiotic eye ointment administration to the eyes of newborns is done to prevent against ophthalmia neonatorum (ON), a rare infection that in the past sometimes led to infant blindness. Recent discoveries have traced the cause of ON to mothers infected with either gonorrhea or chlamydia.

Even though ON is limited to women carrying one of those sexually transmitted diseases, the use of eye ointment to prevent against ON has become standard practice in many countries including Romania. If you’ve tested negative for either of those diseases, the use of eye ointment is virtually unnecessary.

If you’re free of STIs and wish to opt-out of having eye ointment used on your newborn, you need to communicate your preference to your medical team and mention it in your birth plan. Contrarily, if you tested positive for STIs, you should inform your OB-GYN and discuss your options.

Vitamin K Shot Procedure in Romania

Since the early 1960s, the American Academy of Pediatrics (AAP) has been recommending the routine use of the vitamin K shot on infants after birth. The vitamin K shot was designed in order to protect against a rare but potentially fatal condition known as vitamin K deficiency bleeding VKDB.

Since the AAP’s recommendation for the K shot, Romania, along with most nations, have adopted its routine use. Choosing whether or not to have the shot administered to your newborn can be a tough decision. It’s in your best interest to inform yourself about its potential benefits, negatives, and other available options.

Steps to Opt-Out of Vitamin K Shot in Romania

  • Mention to the medical staff (pre and post birth) your wish to not have the shot.
  • Include your refusal of the vitamin K shot in your birth plan.
  • Complete and sign a declaration to not receive the shot, request OBG-YN signature.

Infant Vaccines Procedure in Romania

In Romania, there are two vaccines that are routinely administered to newborns after delivery. The first vaccine is the Hepatitis B vaccine which is usually administered within 24 hours after birth. The second vaccine is the tuberculosis vaccine which is typically administered within the first 2-7 days after birth.

Hepatitis B virus (HBV) is a disease that is transferred either sexually or through blood contact. Tuberculosis (TB) is a bacterial disease which is obtained by breathing in air from the cough of an infected person. Both viruses can be can be cured in certain situations, but can be fatal in others.

HBV vaccination became routine in Romania like in many other countries as an attempt to protect the populace at large. The TB vaccine, however, has extremely high rates in Romania compared to other countries in the EU because Romania has one of the highest TB infection rates in Europe.

When it comes to vaccinations, parents are advised to research all the potential benefits and dangers associated with them. Child vaccinations are one of the most controversial topics of today. Proponents often claim they are risk-free, while opponents claim vaccines, including the HBV and TB vaccines, come with many dangers.

Refuse Post-Labor Vaccines in Romania

Romanian law currently requires medical staff to receive express consent from an infant’s parents before any vaccination is administered. However, future legislation is proposing to change the law from needing a parent’s consent in order to vaccinate, to vaccinating without consent unless a declaration of refusal is explicitly provided.

The Steps to Take Prevent Newborn Vaccinations in Romania are as Follows

If after taking those steps, for some reason a member of the medical staff still insists or tries to vaccinate your child against your wishes, you have one final option. Ask the staff member to sign the below declaration which makes them accept all responsibility in case of adverse effects of the vaccine.

Childbirth Registration

Romanian law requires that any child which is born inside the country be officially registered as a live birth in the country. Child registration is required for all Romanian citizen child births, as well as for all other births from non-citizens, including; tourists, residents, visitors, students, etc. If a mother does not register a Romanian born child in Romania she can’t receive an official birth certificate.

A parent or parents which originate from a country other than Romania may also wish to register their Romania born child in their home country. The process of registering a Romanian born baby to a parent’s foreign country differs from country to country. Most countries have a similar child registration process to that of a US citizen registering his Romanian born child with US authorities.

The following section covers both scenarios; how to register a child birth in Romania, and how to register a child of a US citizen that was born in Romania to the United States.

Registering a Childbirth in Romania

To receive a birth certificate for a child that was born in Romania you must first register the birth with the city hall (Primăria) in the county where the birth took place. The child registration process is pretty straightforward but does require a bit of bureaucracy to complete.

After the child is born, the mother will be issued a “live birth” certificate (certificatul constatator al nasterii) by the hospital that delivered the baby. The mother then has 15 days to visit the city hall of the county where the child was born to register the birth. If you miss the registration deadline you will be asked why you missed the deadline and possibly issued a fine if your excuse isn’t sufficient.

After you register the birth at the city hall, you will be issued a receipt for the registration and given a day to return. The wait time is usually 24 to 72hrs from the date you registered the birth. After 1 to 3 days has passed you return to the city hall with the receipt and obtain the child’s Romanian birth certificate.

Documents Required for Registering a Child Birth in Romania

To register the birth and receive a birth certificate, the mother and father will need to provide the below list of documents to the child registration office in the city hall. The documents need to be provided in original and photocopy versions!

*Note: If any of the below mentioned documents are not official Romanian documents, they need to be issued with an apostille by the originating country. The apostille document will then need to be translated into Romanian and notarized.

  • Mother and Husband ID Cards
  • Mother and Husband Birth Certificates
  • Marriage Certificate
  • Live Birth Certificate from Hospital (certificatul constatator al nasterii)

Registering a Romanian Childbirth with the US

Under the United State’s Immigration and Nationality Act (INA), any child that is born oversees to a US citizen parent or parents is automatically entitled to US citizenship. That means that if you are a US citizen and either the father or the mother of a child that was born in Romania, that child will automatically also be a US citizen.

Although the child born of a US citizen parent is automatically a US citizen, a few steps are required in order to establish the child’s citizenship and to obtain his US passport. The process involves completing Form DS-2029 (Application for Consular Report of Birth) and providing official records such as the child’s birth certificate and the parent’s proof of US citizenship.

For an official guide on how to register a Romanian birth with the US see US Embassy in Romania Birth.

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