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The World of New Parents in Cyprus

By Pembe Mentesh

A recent online survey done in cooperation with Kidculture magazine on new parents in Cyprus reveals a huge deficit in the availability of publicly available, free ante- and post- natal education and services – despite the representation of Cyprus as an advanced modern society.

There is a prevalent dependency on private doctors for most of the information and services related to birthing and after birth care, with little or no culture of midwifery and community based health care. Of course this survey only scratches the surface, and further research is needed to fully analyse the reasons behind these trends.

Surveys can reveal a lot about a specific topic, and provide significant insight into the way society thinks and feels. What was unexpected from this particular survey was the wonderful anecdotes and stories that Cypriot women shared about their birthing experience and the early months following the birth of their baby.

Whilst the survey did not receive enough responses to qualify as a statistically representative research, it did reveal some trends and practices which are worthy of further research, investigation and follow-up action.

This article presents some of the main findings and shares some of the real experiences and comments that came out of the survey. It also highlights differences between the birthing experiences of Greek-Cypriot and Turkish-Cypriot women.

Information about birthing options, breast or bottle feeding, and newborn care

obstetricianWhen given several options for sources of information on the above topics, doctors were the main source of information, followed closely by books and the internet. To a lesser extent consulting friends, followed by family. Nurses, Midwives, and Doulas rated the lowest, possibly due to the non existence of community health care and centres in Cyprus.

Some public hospitals have ante-natal classes but we do not know what rate of pregnant women and/or their partners use these services. In the northern part of the island, this service doesn’t even exist.

Breast or bottle?
breastfeeding cyprusThe majority of respondents said they had breastfed their babies, however, very few breastfed exclusively with hardly any breastfeeding exclusively for 6 months (the WHO recommended duration). The majority of mums combined breast and bottle either from the beginning or within the first few months of the birth. The most popular reason for combined feeding was “I was told I did not have enough milk.”   Whilst a small proportion of women do indeed have low levels of milk production, this is the exception rather than the rule.

There are many strategies that can be used to increase milk supply and for most women it can take a good 3-4 months to establish a breastfeeding routine and stable milk supply, based on the needs of their baby. Unfortunately many women aren’t given the chance to establish their milk supply and, to my knowledge, many babies are given bottles from the time they are born because they are “hungry” and “this is why they are crying” – a much bigger myth than “I do not have enough milk”.

baby cryingFirst of all, newborn babies can and sometimes do cry a lot, not necessarily because they are hungry but more likely because they are cold, scared or stressed from the sensory overload presented by the modern world (lights, noise, smells) – a massive change from their warm, cosy and quiet environment in the womb! Secondly, a newborn baby has a tiny stomach and does not need large volumes of food – in fact, she hardly needs anything for the first two days before the milk actually comes in, before which they are sucking on the rich, nutritious colostrum which is full of antibodies that the baby requires to develop their immune system. In fact the majority of people surveyed said they knew what colostrum was so it is surprising that so many would choose to start combined feeding from the beginning.

Our bodies are an amazing machine, they’ll only make as much milk as baby needs, so the more bottles the baby has, and the less it sucks on a breast, the less milk the body will produce.

When it comes to information about infant formula, again doctors are the most common choice as the main source of information.

One mum who had very little support but successfully breastfed, wrote:
“I had to fight to breastfeed my baby. Our families were over anxious about the baby crying all the time, supposing she was hungry. They didn’t know what first milk was, they insisted I had no milk and that I should bottle-feed. My mother-in-law kept telling how she’d fed her sons with her unstoppable flowing milk, that apparently she believed I didn’t have.  On the first day, they gave a little formula milk to my baby, she threw up. I stopped them and insisted on breastfeeding for another week. My milk was never enough for them so we started breastfeeding and formula for a week. During that time my baby’s doctor gave me no support on breastfeeding or any kind of feeding at all. He just recommended a formula milk and said I shouldn’t insist on breastfeeding as formulas are really good too. Having done my research before the birth, I didn’t trust his advice. Afterwards, I became sick with mastitis. My doctor (a female doctor, who had also breastfed) supported me in just breastfeeding and using a breast pump to help my breasts produce more milk. To cut a long story short, I ended up having more and more milk over time as I worked really hard at it, and breastfed my baby for 6 months  until I got sick with something else and had to stop due to the medication I was taking.”

The Global Strategy for Infant and Young Child Feeding developed by the World Health Organisation (WHO) recommends the following actions:
•    All mothers should have access to skilled support to initiate and sustain exclusive breastfeeding for 6 months and ensure the timely introduction of adequate and safe complementary foods with continued breastfeeding up to two years or beyond.
•    Health workers should be empowered to provide effective feeding counselling, and their services be extended in the community by trained lay or peer counsellors.

C-Section or Vaginal delivery?
pregnant in cyprusThe World Health Organisation (WHO) recommends that the rate of Caesarean sections should not exceed 15% in any country. Recent media reports show the rate of Caesarean births as approximately 4 times this in Cyprus (55%), and probably even higher in the Turkish-Cypriot community (there are no statistics available). Approximately half of the Greek Cypriot women surveyed said they had a vaginal delivery whilst only very few Turkish Cypriots indicated the same.

Some of the reasons stated for Caesarean sections were the following:
•    “I was overdue/Did not go into labour”
•    “I was not dilating”
•    “The baby was too big”
•    “The baby was at risk”

These responses pose many questions which require further investigation such as:
If a pregnant woman is overdue, why not wait a few days to give her to opportunity to go into labour naturally rather than advocating induction or c-section both of which are invasive procedures? It is common practice in other parts of Europe to wait up to 14 days past the due date before inducing as long as there are 10 good foetal movements a day and no sign of the placenta failing. In some cases the women responding to the survey were only a few days or a week overdue and were recommended to have a Caesarean rather than wait or be induced.

If a woman is not dilating quickly enough, what is the cut-off time before a Caesarean is carried out? In some of the responses, the women had only been in labour for a few hours before being told they were not dilating quickly enough and that a Caesarean was needed. Most women in the early stage of labour can take up to 8 hours to dilate just a few centimetres. Many women can take a lot longer, with early labour stopping and starting over hours or even days, but with patience, many babies all around the world are delivered naturally, after a long labour by mums who did not fully dilate in the first few hours of labour!

Cyprus is not unique - the rate of Caesarean births is increasing in many parts of the modern world for many reasons. It’s important to remember though, that there are risks associated for both mother and child during and after a Caesarean birth – it is major abdominal surgery. Babies may have adverse reaction to the anesthetic, causing a period of inactivity or sluggishness after delivery, injury may occur to the baby during uterine incision and extraction, even at full term, babies are more likely to develop breathing problems than those delivered vaginally and they are less likely to successfully breastfeed than those delivered vaginally.

One study found an increased risk of complications if a repeat elective Caesarean section is performed even a few days before the recommended 39 weeks. While another study found that Caesarean born children have a 20% higher likelihood of developing type 1 Diabetes.

Due to extended hospital stays, both mother and child are at risk of developing a hospital-borne infection. Studies also show that mothers take longer to first interact with their child when compared with mothers who had their babies vaginally, mainly due to the absence of the bonding hormone oxcytocin.

Some of the risks mentioned here are rare, and of course are dependant upon individual factors such as complications, whether the operation is planned or done as an emergency measure, and how and where it’s performed.

Private or Public?
The vast majority of respondents said they gave birth in a private clinic. Whilst this is expected in a modern, advanced society like Cyprus, where private healthcare is an option, it does mean that less pressure is placed on the public system and with less demand comes less services or less need to improve existing services. With a user pays system, you have the luxury of your own room and your own doctor but once they are out of the clinic what services and support do new parents have in regards to breastfeeding, newborn care and general information about child safety or post natal depression?

The preference for private clinics could also explain the very low numbers of parents’ taking part in ante-natal classes. As mentioned earlier, Cyprus does not have a free community health care system, where parents’ can drop in and have their baby weighed or examined. A place where they can go where community midwives and nurses can provide immunizations and breastfeeding advice.

For most of these needs, parents take their babies to the doctor and when a baby is ill, it is always recommended that a doctor’s advice is sought, however, the concept of community health and free support for new parents is lacking here. The recent growth of the breastfeeding movement has seen the welcome start of a breastfeeding support hotline and breastfeeding support groups, however for women living in the northern part of the island, such services and groups do not exist.

What do parents need?
When asked what services or activities new parents’ need the most, the majority of respondents agreed that more is needed to help support, educate and prepare parents’ before and after the arrival of their new baby. Some of these suggestions include:

  • ante natal classes
  • information on birthing options and the birthing process
  • more midwives
  • natural birthing centres
  • breastfeeding/lactation consultants and support
  • baby friendly cafes and public spaces which cater for nappy changing and breastfeeding
  • support groups for new parents
  • detection of and support for post-natal depression
  • encouragement for men to take part!
  • support for multiple births                                                                                     

Many of the working women who took part in the survey commented that maternity leave needs to be longer and that workplaces need to have facilities for expressing milk. Childcare facilities and options were also a major concern for working families, particularly those who do not have extended family offering free childcare.

Here were a few of the comments from mums who experienced child birth in private clinics:

“We need midwives, natural birthing centres, and INFORMATION regarding the birthing process. There is so much to learn about the natural birthing process, our bodies, and our right to plan our births.”

“ We need to hear more stories about wonderful birthing experiences so that women get over their fear of pain and birth and stop requesting ceasarians. We also need to know who are the doctors and clinics that respect the wonder of natural birthing and are willing to assist it.”

“Private doctors are in the habit of persuading women to take loads of drugs and do not encourage them to take the natural childbirth path. I wish I had given birth in the UK.”

Most importantly, parents themselves need to actively seek information and demand services that they feel they have a right to enjoy.

If you recently gave birth in Cyprus but haven’t yet entered the New Parents’ Survey you can still participate online via the KidCulture website : , by sharing your experience today you can help contribute to more in depth research.

©Pembe Mentesh March 2010



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