Hiiumaa women face costs of around €1,000 to give birth in Tallinn
Since 1 July, maternity care has stopped at the hospital on Estonia's Hiiumaa island, forcing women to travel to the mainland. There is still no agreement on how they should get there and back or who pays.
Women living on Hiiumaa, an island off Estonia's west coast, have not been able to give birth at home since 1 July. The island's hospital has ended obstetric care, so expectant mothers must travel to the mainland, mainly Tallinn. It remains unclear how exactly they should travel there and back and who should cover the related costs. Estonia's Ministry of Social Affairs considers this primarily a problem for the local hospital and the municipality.
One family's experience
Karoliin Kivistik, who lives in Kärdla, expects her fifth child on 8 November. Her hospital bag is packed, but this time it was harder: previously her husband could quickly bring anything forgotten, and now that will not be possible. A mother of a large family, she wants to stay at home as long as possible, but will probably have to go to the capital a week before the due date. She notes that babies often arrive at night, when the ferries are not running. The family estimates the trip will cost about €1,000, of which around €500 is for renting a flat near the maternity hospital in Tallinn.
Staff shortages
The hospital has the facilities for deliveries, but lacks staff. A paediatrician retired on 1 July, since September there has been no gynaecologist on four days of the week, and in October there will be no anaesthetist for a week. Last week the hospital's supervisory board was presented with a plan for a possible route for women in labour, but chief physician Riina Tamm says these are only recommendations that do not settle the main question of transport and payment. By her estimate, if everything goes smoothly, a patient can reach the women's clinic of the East Tallinn Central Hospital in three hours and 45 minutes. A helicopter would take two hours, but only if the weather allows flying, the helicopter is available and its flight-hour limit has not been used up.
Responsibility shifted
Tamm calls it a regional policy problem and says the state has not done its job: closures of maternity wards were first discussed in 1998, and now the decision has been left to the hospitals. Viviane Arusaar, head of the obstetric care unit at East Tallinn Central Hospital, says women already in labour are not sent back, but the hospital cannot offer longer stays. She believes the Health Insurance Fund could enable hotel services at hospitals. Heli Paluste, a hospital network expert at the ministry, says hospital boards decide on closures because hospitals are autonomous, and she does not rule out similar decisions elsewhere. Hotels would require funds that are already lacking, and the ministry sees support for mothers in financial difficulty as a task for local government.
