Birth Pangs Russia's Communist-built Birth Houses Seem Designed To Serve A System, Not Individuals. Husbands Are Relegated To The Street; No Visitors Are Allowed. But Change Is Coming, Slowly.

"I made sure to scream really loudly when my time came," said Savina, 29, now almost laughing at what were the most terrifying moments of her life. ''After it was all over, I swore I'd never have another. Not me. Not again."

It's a vow that thousands of Russian women have repeated. Most urban

families in Russia have only one child, but perhaps as a sign of the country's transformation into a more benevolent society, Savina recently changed her mind. Five months ago, she gave birth to a chubby, blond girl named Daria. This time her labor wasn't the grim struggle it was the first time around,

because this time Savina wasn't alone.

Savina's companion, Volodya Safyanov, was there in the delivery room for every wrenching contraction. He massaged her back, watered her lips and coached her on breathing techniques. That's just a day's work for a typical American father, who may train for weeks to prepare for his delivery-room role, but for a Russian man, Safyanov's presence was little short of revolutionary.

Only a few dozen Russian men have taken a hand in the births of their children so far, but even this small number heralds a significant social milestone here, one that could portend changes in the relationship between men and women, doctors and patients, women and their own bodies. Such change doesn't come easily, especially at a time when Russia's birth rate is plummeting, down by nearly half since 1986.

Before being permitted into the sanctum of the birth house, Safyanov had to undergo a rigorous medical screening, proving that he was free of streptococcus infection, syphilis, AIDS and other diseases. Then he had to be vaccinated against diphtheria. And after all of that, he was still exiled to the street with the rest of the new fathers the minute Savina's delivery was over. Russian birth houses strictly prohibit visitors, fathers included.

Still, the birth experience "was so much better this time. I came out of it better," said Savina, her face aglow as she watched Safyanov cuddle their daughter in their tidy room in a Moscow communal apartment. "I'm so thankful to Volodya. If it weren't for his back and shoulders, I don't think I would have been able to stand it."

Savina, who works for a state housing authority, wasn't intending to strike a blow for women's rights in Russia when she asked permission for Safyanov, 33, an engineer, to join her in the delivery room at Birth House No. 17. She was simply afraid for her life, and wanted Safyanov by her side if anything

went wrong.

Mother Russia has not been kind to its mothers. There is hardly a mother in this vast country who cannot recount at least one delivery-room horror story: Tanya Vorobeychik, a biologist, did not see her newborn son for a month after his birth because doctors installed him in an intensive-care unit where parents were forbidden; Irina Listova, a teacher, spent the week after her daughter's arrival stumbling around the birth house in a blurry haze because doctors had seized her eyeglasses as a potential carrier of germs.

"The system is set up in a certain way, and either you follow it or you don't have a baby," said Rachel Mays, a field administrator for Magee WomanCare International, of Pittsburgh, which has embarked on a U.S.-funded project to change the Russian way of birth. "Everything is so institutionalized, so completely standardized, there's no room for personal anything."

In their harshness and standardization, the Communist-built birth houses mirrored Soviet society itself. They seemed designed to serve a system rather than individuals. Women are stripped of their personal possessions - everything from eyeglasses to books to family photographs - lest they carry infection, and then are run through a gauntlet of dehumanizing medical procedures that still includes mandatory enemas and shaving.

No wonder many Russian women compare their days in the birth house to a stint in the gulag. A woman entering a birth house is cut off from all family contact. At that most transcendental of moments, when two become a family, men had been excluded by law from the delivery room. Even now, most Russian fathers do not glimpse their new baby until mother and child are discharged, typically five to seven days after birth.

Usually built on a monumental scale, these Soviet-era birth houses were designed primarily to deliver as many babies as possible. The pre-delivery and delivery rooms are all large, open communal spaces with beds lined up in rows, without partitions or curtains, so doctors can commute easily between laboring women.

Amenities are nonexistent. No coat check. No gift shop. No cafeteria. No public toilets. During the week Irina Listova spent in the birth house after the birth of her daughter in 1981, there wasn't even a shower on her floor. It was broken.

Now this lack of privacy makes it difficult even for willing birth houses to retool and open themselves up to fathers and other visitors. "Can you imagine it?" asked Galina Bonashova, head doctor at Birth House No. 32, where all women deliver in the same communal delivery room. "How would the other women feel if one husband was present?"

Mays, who also organizes prenatal classes for the Magee program at Birth House No. 70 - now renamed Savior Hospital for Peace and Charity - said logistics are only one barrier to fathers taking part in the birth process. ''The traditional response here is that you can't allow husbands into the delivery room, because 'it's not something for a man to see - it's the secret of womanhood.' Or, they say, extra bodies will hinder the process, and men will be fainting all over the place. Or, there'll be an increase in the infection rate."

Men were just as rare in American delivery rooms 30 years ago. But today, in maternity hospitals such as Magee-Womens Hospital in Pittsburgh, Mays said, 98 percent of women share the birthing experience with a companion. As Russia sheds its Soviet habits, and learns to value individual choice, she believes more fathers will demand to be let in on the mystery of birth. In the last four years, two state birth houses in Moscow grudgingly have opened their delivery rooms to fathers, and for $1,000 couples can pay for the same privilege at a private maternity hospital called the Healthy Generation.

Still, Russia has a long way to go before words like Lamaze and parenting enter the vocabulary. Unlike America, Russia has had no women's movement, no sexual revolution.

"Russian men were brought up to believe there are women's spheres and men's spheres in life. As for pregnancy, this is something men consider a woman's business," said Olga Zaharova, deputy head of Birth House No. 17, which permits men to assist their wives in labor.

Though the men who do put on scrubs and join their wives are still few, ''they are great men," Zaharova added. "They always know everything about the wife. It means a baby is being born into the whole family."

Even with such support, Savina felt she was bucking the entire Russian medical establishment when she first proposed that Safyanov help during the birth. "One doctor at the polyclinic told me that men who helped their wives deliver usually jilted them afterward," she said. Her colleagues at work kept asking such questions as, "Why do you need him there?" and "Why should he be forced to see all that blood?"

For all Zaharova's enthusiasm, Birth House No. 17 remains ambivalent about encouraging men to join their wives in the delivery room. It is a spartan, clean, Western-style maternity hospital built two years ago in a leafy, high- rise neighborhood on Moscow's fringes. But like the old-style birth houses, the administration worries more about keeping out infection than letting in visitors - with one exception: Paying patients, whose numbers are on the rise, are permitted to receive as many visitors as they like.

The rest are relegated to the street, where they communicate with the new mothers by shouting up to their windows. Chants of "Show us the baby!" and ''Who does he look like?" can be heard outside nearly every Russian birth house.

"There's a great tradition here. You drop your wife off at the birth house. You get really drunk and every day you come and shout under the

window," said Larissa Yermolayeva, whose husband, Sergei, was present when their daughter Anna was born in February.

"From the very beginning of my pregnancy, I was thinking, why don't we have this practice here, where husbands participate. I remember seeing it on TV or on a video, and it seemed so natural to me," she said.

Sergei immediately accepted Larissa's invitation. But like most Russian men who take part in the birth, he had never been to a parenting class and had no idea what to do when he walked into the delivery room. "Then the doctor arrived and told me to get down to work, massaging Larissa's back," he said.

Nearly every aspect of delivery in a Russian birth house is dominated by a fear of germs. Yet the extreme measures to prevent infection have done little to deter infection in Russian maternity wards. Russia's infant mortality rates rival third-world countries, and were four times the U.S. rate in 1990. Anti- infection practices are based "mostly on superstition," said Mays, who noted that, "the birth houses that have the most strict policies on visitation, and what they consider to be infection control, have the highest rates of infection."

In other ways, too, she added, "this place is straight out of the 1950s." Even as Russian birth houses stock up on such Western innovations as ultrasound machines and isolator chambers, they are slow to reconsider their authoritarian attitudes toward patients.

Practices that have long been discredited in the West, things such as enemas, shaving and routine episiotomies, are mandated by law in Russia. All laboring women are given painkilling drugs and many are given drugs to speed up delivery. Rather than being allowed to hold and bond with their babies after birth, mothers are usually separated from their newborns except during feeding periods.

Infant care is also behind the times, Mays said. Although most Russian mothers nurse their babies, they also give them many other liquids, including cow's milk, a practice that the World Health Organization has long discouraged. But unlike the United States, Russia guarantees women an 18-month maternity leave at the minimum base salary.

Mays said she can sniff the scent of change. Russia's transformation from socialism to a market economy means, not just better shopping, but more lifestyle choices. Mays noted that Magee's four daily prenatal classes are all full of women eager to take charge of their own pregnancies. More private clinics are opening, promising Russians state-of-the-art health care and more pleasant surroundings.

"With the marketization of health care," she predicts, "even birth houses will soon have to start giving patients what they want."