"I wasn't asking unless he was breathing. That's it.
Every newborn, whether in Bucharest, Târgu-Mureș, Mediaş or Botoşani, has the right to receive the same care and the same chances at life. A foundation is investing in equipping maternity wards in smaller towns to make the previous phrase a reality.
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For 50 days, Mădălina waited to be Stefan's mother. For seven weeks, she waited to hold him in her arms, feed him, provide him with the care he needed.
Born prematurely in Botosani, her child was transported to Suceava, where she fought for every second of her life. During this time, my mother stayed in Botosani, waiting for the phone or the daily message that would tell her that it was good.
On November 28, 2021, at the maternity ward in Botosani, Mădălina prematurely gave birth to her third child. "Mum, here's the baby," the on-call doctor told Madalina as she weighed it. He had a kilogram and a few hundred grams and fit them in his palms, at least that's how he imagined. She did not get to hold him to the chest, nor to caress him. It was the last time she saw him so close to her. Seven weeks followed in which I "didn't ask unless I was breathing. Very much. I was afraid."
Mădălina is 25 years old and has two more children, aged 5 and 2. He lives in the Ungureni commune in the county, located 28 kilometers from the maternity ward in botosani. The third pregnancy was normal, just like the first two. Regular check-ups and her general condition did not give her any reason to care, but in the 30th week of pregnancy, the first contractions appeared, while taking a bath. She called her husband, and at 11 p.m. they were in the hospital.
"When I got here, I had bleeding and I was told I was going to give birth, but they would try to stop my contractions, maybe the baby stays for at least a few more hours to do the injection for the development of the lungs," she says. They managed to "postpone" the pregnancy for two days, and on Sunday, after 5 p.m., her baby gave birth at 1,250 kilograms.
"After I gave birth, I first asked what it was like, if it was whole. The doctor told me that yes, he just took my baby. A few minutes later, the doctor who was on call came and told me that he had to send the child to Suceava," she recalls.
"Can I see him at least a little bit before I leave?"
That weekend, the child was transferred to Suceava, and she remained in Botosani. She spent only a few moments with him, right after his birth, and now he was to be transported to another ward, to another city, without her being able to go with him. In those days, everything was black before her eyes. "I was told this: if you are not called it means everything is fine," but for her there was no good. "But I as a mother, at that moment, could no longer think of good. I didn't think for a second about the good. When I got home, I would look at the other kids, but my thought was always that he wouldn't be anymore," says the mother.
On Tuesday morning she was discharged, and the first trip she made with her husband was in Suceava. In about an hour, they were in front of the building where the child was hospitalized, but they were hit by bureaucracy: "you have to make a request first," the doorman told him. He didn't even have anyone to call from the hospital. He didn't know who to talk to.
„Am plecat marți seară de la Suceava, am ajuns acasă, iar a doua zi dimineață mă sună de la spital să-mi spună că mi s-a aprobat cererea. Doar mama are voie câteva minute, o dată pe săptămână, și să duc ceea ce mi s-a spus: pampers și șervețele. Doar atât are nevoie”, își amintește Mădălina.
On Wednesday morning he was there, thinking of finding out something about his child. The visits started only at 15.00, and the only response she received from a nurse was that "she is fine".
„Am vorbit cu o doamnă asistentă care era de la bebeluși, mi-a spus că doamna doctor care avea grijă de copilul meu nu era acolo. Am întrebat-o pe asistentă dacă totul e bine, a zis da și doar atât. Mi-a spus să vorbesc cu doamna doctor, eu neștiind când să o găsesc. Sunam pe secție, însă nu aveam voie să sun decât după ora 12, dar doamna doctor pleca la ora 12. Stăteam cu gândul că nu știu nimic, până într-o dimineață când m-a sunat dumneaei și mi-a explicat doar că e bine copilul. ”
"We know how to handle a more serious case, but we didn't have anything to do with"
Prin astfel de cazuri trec nenumărate mame din județul Botoșani. Deși are în jur de 400.000 de locuitori conform recensământului din 2011, județul are doar două maternități, cea de la Dorohoi, de nivel I și cea de la Botoșani, cea mai mare, care deservește întregul județ, având nivelul II.
Maternitatea din Botoșani are propria sa clădire, special construită pentru acest scop în 1983 (o raritate în infrastructura românească), însă potențialul clădirii nu a fost atins niciodată. În acest loc au loc cele mai multe nașteri din județ – circa 2.800 pe an. La Dorohoi nu se nasc decât circa 50 de copii pe lună, fără patologii, iar compartimentul de neonatologie încă nu are un medic neonatolog. Orice copil cu probleme ajunge la Botoșani, iar în ultimii zece ani presiunea a crescut pentru că alte spitale orășenești și maternități din județ (Darabani, Trușești, Săveni) au fost închise.
"The fact that we are self-sufficient motherhood has advantages and disadvantages. The disadvantage is that here we are only maternity, and the other structures are at the County Hospital (n.a. at a distance of 600 meters), we have access to them, but they are not in the same building. Before I didn't have an ultrasound," says Carmen Zaboloteanu, head of the Neonatology Department. And for a troubled newborn, even waiting for an analysis, the consultation of another specialist can influence the state of health.
Medicul Zaboloteanu a ajuns în Botoșani în 2014, după terminarea studiilor la universitatea ieșeană de medicină. În primele gărzi și-a dat seama de decalajele care există între dotarea unui spital din Iași și a unuia din Botoșani. În 2014, începea să se schimbe „vechea gardă” cum spune ea, iar odată cu asta, a vrut să îmbunătățească și modul în care echipa lucrează cu pacienții și nou-născuții.
"There was a child who was born at 600-700 grams, and the doctors who were then here found that that child was an abortifacient and behaved as such. I had learned that that child had a chance and I tried to intervene over the attending physician, but I was told no. It has no chance, do not torment yourself because even if it lives, it will be a baby-vegetable. We said it's not like that and we need to try to change the mindset," she recalls.
With small steps, this came out. At the moment, the team consists of young staff, taught by the same teachers, who believe in the same values as her: the child is worth saving at all costs.
The next stage was to grow and modernize the maternity apparatus, so that the county's children would not be immediately transferred to Suceava – where there was a higher level maternity – or to Iasi or Târgu-Mureș.
"A lot has been done in the last five to six years. The interface has changed and there is still work to be done, but if we look at some studies, two or three years ago, the infant mortality at the level of Botosani County placed us on the second place in the country, after Tulcea and now I think we went about halfway. We were 12% and now we are somewhere around 6%," she says.
"Poor pregnancy tracking in a poor region increases pressure on the neonatal team in decision-making"
For Botosani, a county with an underdeveloped infrastructure and always in the first places among poor counties, access to a medical service is extraordinarily difficult, and mothers are among the victims who suffer the most. "There are mothers who do not reach the doctor," says the head of the ward, but you cannot accuse them of carelessness. They have another 5-6 children at home, they do not have a car, they do not have money to transport to the city, and some services – such as better ultrasounds – cost money that a mother in a village does not have.
A recent case is that of a mother from the commune of Frumuşica, 60 kilometers from the city. The child needed a blood transfusion, but the mother could not come to the hospital. "I don't have the money to come, to get that blood sample," the doctor's mother told her. "That's kind of what the majority of kids with problems are like. The mother who can't stay in the hospital with the child because she still has children at home, but she can't even come to him to see him. And let's send it on? Much less, because they have no money."
Dr. Zaboloteanu remembers another mother, who already had two children, who carefully followed her third pregnancy and made regular visits to the doctor, but at the time of birth, the team found that the newborn had severe birth defects. The mother should have done a morpho-fetal ultrasound, which is only done in university centers and which costs a lot of money.
This case – rare enough – shows what it means for a mother not to have access to the necessary medical services. "If the child had had a congenital malformation and had been born directly in a university center that performs the surgeries, the child would have benefited from all the treatment from the first hours of life," she says.
Untracked pregnancies are in a fairly high percentage in the county – 20-30% – and this puts more pressure on the medical team, because the life of the newborn may depend on some machines that the maternity ward does not have or that are already occupied. And in order to send him to a higher-level maternity ward, the newborn must be stabilized in the first place.
Now, the ward has two ventilators. "But we are on guard and the third and the fourth may appear, you do not know what to do at that moment," says the colleague of the head of the department, Dr. Paraschiv.
„La început, când am venit la spital, a fost unul copil cu pneumotorax, nu aveam ventilatorul modern, aveam unul vechi care nu făcea niște presiuni și nu aveam cum să îl pun pe aparat. Acel copil a fost 12 ore ventilat manual. Făceam cu rândul ca să ventilăm copilul”, își amintește ea.
"It seems normal to me that the one who is born Romania has the same chance as the one who is born anywhere. Why should it be different?"
At the moment, one in ten newborns is premature, and the rate of transfers to the hospital in Suceava or to others in the country is 5-10%. The rate has dropped because the medical team wants to make sure that a transfer is not a handy solution, but the last step it takes. "We could very conveniently transfer. That's it, we can't, we rest assured that the salary goes, time passes, the pension comes, but... I don't know. We have invested so much time to learn a certain specialty and it is a pity. We want to make the young doctors not feel that it is different what is happening here compared to the medicine they have learned", says the doctor.
So they have always learned new procedures, they have trained from all the specialists who arrive on visits or from those they turn to for help.
„Marea noastră problemă aici sunt malformațiile congenitale de cord. Nu avem un medic cardiolog pediatru la nivelul județului, iar la nivelul județului vecin sunt trei-patru, și atunci eu și colegii mei am încercat să învățăm de fiecare dată să recunoaștem și să le tratăm până nou-născutul ajunge la specialist”, povestește ea.
Au primit donații cu care și-au dotat secțiile, de la alte organizații, dar și de la botoșăneni, au apelat la autoritățile locale. În momentul de față, maternitatea are 55 de paturi, din care 15 pentru terapie intensivă neonatală, un număr comparabil cu cel al secției din Suceava, de nivel superior. Diferența ține însă de personal.
There are currently four doctors, but until last year there were three, an insufficient number to cope with births and treatments. Carmen Zaboloteanu remembers when one of the doctors gave birth, and she and the other doctor had to ensure the operation of the hospital.
"That meant that 15 days I would stay in the hospital, start in the morning and finish the next day at noon, about 30 hours continuously," she says. They were doing 15 guards, while the monthly maximum is six. The third colleague returned to work after two months. The arrival of the new colleague already gives them more space, but ideally it would take 6-7 doctors.
„Problema este că suntem în capătul țării, unde nu sunt medici. Dorohoiul nu are medic neonatolog, ci este o linie de gardă cu pediatria comună, a existat Maternitatea Săveni, dar s-a închis pentru că nu este medic acolo”, adaugă ea.
For the head of the ward, every birth completed and every premature birth saved means more trust from the community, because a mother must feel that she is in good hands.
There are mothers who prefer to give birth here, because the cousin or neighbor was fine. But there is still a lot of work to be done and there is a lot to educate. Underage mothers continue to be a widespread phenomenon all over the country, and in 2020, 86 underage mothers arrived here.
„E oarecum frustrant pentru noi și pentru ele, pentru că nu prea înțeleg ce înseamnă un nou născut cu probleme. Ele au mers pe premisa că totul va fi bine. Mai au un copil sau doi acasă, la care totul a mers bine fără analize, fără investigații și trebuie să le explicăm de ce nu este bine. De multe ori le vorbim, le povestim și la final ne spun «dar în rest este bine?». Pentru mămici, nașterea înseamnă doar baloane și ursuleți de pluș și e greu să înțeleagă că poate fi o problemă cu copilul și sunt foarte vulnerabile”, povestește ea.
In addition, once they have given birth to healthy, trouble-free babies, mothers do not follow the list of consultations they should do with discharge. There are eye checks, in some cases, cardiological ones, which are postponed until a problem occurs. In this regard, she wants to equip the ambulatory so as to offer both day hospitalizations and checkups for which she would otherwise have to go to Iasi or Suceava.
"For mums, childbirth means only balloons and teddy bears; it's hard to understand that it can be a problem with the child"
"Transportation is a risk," said the head of the department. Beyond the shortcomings on the spot, the safest method is "transportation into the womb", but as 20-30% of the pregnancies that arrive in Botosani are untracked, the mothers often arrive much too late. As in Madalina's case, the doctors try to postpone the pregnancy through drug treatment, but when it is not possible, the stabilization is made, and only then the transfer follows. Then other unknowns appear: if there is a free place in Suceava, then it is tried in Iasi or Târgu-Mureș (when a helicopter already has to be ordered). Every moment lost means a greater risk to the child.
"The disadvantage is that Suceava does not have a neonatal ambulance and does not have staff. And then the transfer is made by our city ambulance", says doctor Zaboloteanu. "We have a transport fan of our own that we lend to the ambulance. One of the fans can become mobile and then leave with the baby. We once wanted to send a child to Târgu-Mureș and he called us from the road that the incubator on the helicopter had broken down. That's when the child left with all of ours."
"The nurse saw me desperate. I just wanted to touch it."
With the transfer another problem arises: the separation of the mother from the child. Like Mădălina, there are countless other mothers who remain in Botosani, without being able to be close to their child.
Pe Mădălina, Crăciunul a prins-o acasă, fără să fie alături de cel de-al treilea copil. „Stăteam într-un colț pe pat, cu telefonul în mână, și așteptam să primesc un mesaj sau să se facă ora 12 la Suceava și să mi se spună că e bine”, era rutina ei în fiecare zi, iar de sărbători fiecare zi departe de copil a devenit insuportabilă.
"If I felt like crying, I would go outside. If the little boy caught me, I would tell him that my head hurts, something hurts me. He caught me once that I was looking at a picture of him and I was saying he was someone else's baby," she says.
The eldest boy knew he was pregnant and was about to have a new brother. He was curious and asked her "why doesn't his belly grow anymore", but she wanted to protect him and told him "baby is in the belly, but you pray to God to be well". Until the moment he brought Eduard Stefan home, the child did not need to know the mother's suffering.
Every week, he was only allowed 5-10 minutes to visit. He would do 150 kilometers for each visit, where he could not take him in his arms, feel his warmth or tell him that everything would be fine. She looked at him, from a distance, at the protected baby in his incubator.
La naștere, copilul avea 1,25 kilograme, în următoarele săptămâni a pierdut din greutate și a ajuns la un kilogram. Eforturile echipei de la Suceava s-au concentrat, în primă fază, pe stabilizarea funcțiilor vitale și a organelor. Până la finalul anului 2021, cu fiecare telefon pe care ea-l făcea se pregătea pentru ce-i mai rău, dar Eduard Ștefan „a luptat pentru viața lui în fiecare secundă”, iar din ianuarie, următorul pas era luarea în greutate.
On Monday, January 17, Mădălina told the children that she was going to the hospital to bring Eduard Stefan. That's when they also showed them the picture she wore all these days.
„După atâtea luni, săptămâni, zile în care nu am putut să-i fiu alături, că mă simțeam o mamă neputincioasă, că nu pot să ajut bebelușul cu nimic”, Mădălina urma să fie alături de copilul ei. În aceeași zi, s-a internat în spital, cu gândul că „mă lipesc de el și nu mai plec de acolo”.
Copilul era stabil, a fost transferat fără nicio problemă la maternitatea din Botoșani, dar până la atingerea greutății de 2,5 kilograme, urma să rămână în spital. De data asta, alături de mama lui.
"Yesterday I changed it the first time, I was already afraid of it breaking," she says. Now she measures every drop of milk the baby swallows, sits and looks at it. "Last night I don't know if I've had enough ten minutes," she says.
Pe 20 ianuarie, avea circa 2,3 kilograme, ceea ce însemna că puteau pleca împreună curând la restul familiei. Însă pentru Mădălina, sănătatea copilului contează mai mult: dacă e să mai stea și o săptămână, nu-i nicio problemă.
In all these weeks, she admits that Dr. Zaboloteanu was one of the people who gave her the courage she needed. "I trusted her," the mum said, while listing countless phones she gave her.
"For me he was the best doctor. May God give him health, I came to terms with the idea of seeing that the doctor every day was interested in information about the child, even if she was not on guard," says Madalina.
"We have struggled a lot to keep motherhood at level 2"
For many mothers like Mădălina, the separations could disappear or could be shortened, if the maternity ward of Botoșănene had the necessary infrastructure. The head of the section makes small steps every day, and from this year, she managed to equip the section with vital equipment for premature newborns, thanks to a funding of almost 900,000 lei coming through the program of Vodafone Romania Foundation, Life for Newborns.
Among these devices there are also two ventilators, which will increase the availability of the ward and will be able to provide vital support to more newborns, because at the moment, more than 2-3 children could not take care of the ward.
Mai mult, cu ajutorul noilor aparate vor putea controla cantitatea de oxigen pe care fiecare nou-născut o primește, pentru că în funcție de gradul de dezvoltare al plămânilor, depinde și concentrația de oxigen. „Blenderele pe care le-am cerut vor fi pentru sălile de naștere și vom începe reanimarea pentru copiii prematuri cu oxigen în cantitate mică, nu cât avem acum, 30%”, detaliază șefa secției.
Aceste aparate vor ajuta echipa doctoriței să-și îndeplinească misiunea și să simtă că pot oferi tot ce pot nou-născuților din Botoșani. Rata transferurilor va scădea, iar mamele vor putea să rămână alături de copii lor încă din prima zi. Viitorul lor nu va mai depinde de locul în care se nasc sau de momentul în care se nasc.
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Six months later, Madalina and her baby are fine. The fears disappeared with each day that Edward Stephen ate and gained weight. He kept his word, and regular visits to the doctor gave him more peace of mind. "We're really good," she says.
Text made for the Life Fund for Newborns of Vodafone Romania Foundation.
Photos by Petruț Călinescu for Vodafone Romania Foundation.
