A complete list of rights of a pregnant woman in the maternity hospital. Is it possible to choose a maternity hospital yourself? Whether to give birth in any maternity hospital

Photo: Ⅿeagan / Flickr / CC-BY-2.0

News about unfair treatment of pregnant women in maternity hospitals, unfortunately, appears with enviable regularity. Recently in Voronezh, a woman in labor was given a medicine to which she developed a severe allergy. In Kirov, a pregnant woman was asked to pay a bribe for urgency; in St. Petersburg, a woman expecting her first child was given an incorrect diagnosis... Of course, this does not happen everywhere and all the time: on many forums dedicated to pregnancy and childbirth, there are many comments containing gratitude to doctors. Another thing is that there are many questions regarding the rights of pregnant women.

What should a woman know about her rights in order to protect herself and her child during such an important period of life? After all, the future life, health and well-being of mother and baby depend on how the birth goes. What rights does he have? future mom who crossed the threshold of a antenatal clinic or maternity hospital?

Even before the maternity hospital

Remember: it is your legal right to decide where and how your baby will be born, and whether the father will be present. You and only you decide whether to go to the maternity hospital for preservation, whether to take the medications recommended by the doctor, or whether to do specific tests. You also have the right to change the doctor at the antenatal clinic if he seems rude or inattentive to you. Moreover, you can register not at your place of registration, but at the hospital that is more convenient for you. Refuse medical care you cannot, there is criminal liability for this. If this happens, write a statement addressed to the chief physician indicating a violation of your rights. In the event that the chief doctor refuses you, you should contact the prosecutor’s office or the investigative committee at the location of the medical institution. During visits to the doctor, you have the right to receive any information you are interested in about the course of your pregnancy. The doctor should not brush aside your questions, but explain in detail how the baby is developing, and in an accessible form. In addition, the prescription of medications must be explained to you and possible consequences from their reception.

Labor begins

So, nine exciting months are coming to an end. And you are faced with the difficult task of choosing a maternity hospital. Know: it is not at all necessary to go to give birth at your place of permanent registration. Choose a maternity hospital based on its location, reviews about it, specialization, equipment and qualifications of the medical staff. If it occurs with complications, opt for a maternity hospital of the same level perinatal center. You have the right to request hospitalization in advance.

Staff

Doctors are people too, and they can communicate with patients in different ways. However, when you get to the maternity hospital, you have the right to count on respectful treatment from the medical staff. Even if you then do not intend to sue the doctor, you can write a complaint against the doctor to his superiors. And if you or your baby were injured as a result of the actions of the maternity hospital staff, go to court and demand compensation for the damage caused.

Many people are not aware that, by law, a woman in labor must receive not only medical assistance during childbirth, but also free follow-up care. This includes consultation and assistance in establishing breastfeeding, as well as ultrasound internal organs before being discharged from the hospital.

Procedures

If contractions have already begun, doctors try to perform a set of standard manipulations: shaving the perineum, an enema, an IV.

– As for shaving, expectant mothers usually prefer to do this procedure at home. In the maternity hospital, a woman in labor can be forcibly depilated only if she has a stamp on her medical card with a diagnosis of pediculosis. In other cases, you have the right to refuse to shave your perineum. True, in fairness it should be noted that the medical staff is unlikely to be happy about this. What is important: the razor must be disposable, and the packaging can only be broken before your eyes.

– Enema is done only upon request. This procedure is not mandatory.

– Upon admission to the maternity hospital, you have the right to write a statement refusing vaccinations. The prescription of drugs and injections must be explained by a doctor. Open the drug for a dropper or injection and, again, take it only in your presence. You can refuse any injections during childbirth, as well as induction of labor, artificial opening of the membranes and episiotomy.

– Only you decide how to dispose of the placenta, so demanding its safety, if this is important to you, is quite legal.

Baby mode

As soon as you give birth to a baby, you have the right to demand that it be put to your breast immediately. And subsequently, the mother can completely refuse supplementary feeding and breastfeed the baby on demand. True, for this you still need to quickly recover after childbirth, which does not happen to all mothers.

Photo: Harald Groven / Flickr / CC BY-SA 2.0

You have the right to demand an explanation of why your baby is going to be given this or that drug. If the explanations and annotation alarm you, you can refuse vaccination. You can also refuse visits from a visiting nurse, as well as scheduled visits to a doctor. Moreover, when controversial situations(you think that the baby is sick, but the doctor is sure that he is completely healthy and ready for vaccination) trusting yourself is your full right.

5 possible difficulties

1. Pay for hospitalization. Even if you choose a free maternity hospital, you may be required to pay additional money for services, but free medical care should be provided to the mother in full. By law, a woman in labor is required to be admitted to any maternity hospital, but to ensure an even distribution of pregnant women among such institutions, there are special amendments.

Maternity hospitals are divided into three groups:

– the number of births in which does not exceed 500 per year;
– the number of births in which varies from 500 to 1500 per year (there are intensive care and intensive care wards);
– regional, regional and federal institutions (there are intensive care units for mothers and newborns, as well as a pathology department for babies).

Based on this, the gynecologist at the antenatal clinic selects suitable maternity hospitals for the pregnant woman and offers this list to her to choose from. Usually, if there are no pathologies, referrals are given to maternity hospitals of the first group. A woman in labor falls into the second category if she has a large fetus, polyhydramnios, a narrow pelvis, or multiple pregnancy. Thirdly, if the pregnant woman previously had C-section, there are progressive chronic diseases or there is a transverse presentation of the fetus. Your stay in the maternity hospital and hospitalization, if necessary, should be free.

2. “Put the money in the envelope”. The desire to thank the doctor has been cultivated in us for years. This is what our grandparents did, our parents, this is what almost everyone around us does. However, if there is no extra finance in the family, then you should not be upset. Indeed, in some cases, new parents commit illegal actions. The fact is that, according to the rules of the Civil Code, employees of medical institutions are allowed to make gifts worth no more than three thousand rubles. And that’s on a voluntary basis.

3. “Pay new way» . You may be asked to pay more modern way caesarean section. That is, using epidural or spinal anesthesia, with a small transverse incision above the pubis and subsequent suturing of the wound with absorbable threads. However, this method of caesarean section is officially prescribed in a letter from the Ministry of Health and Social Development.

4. “Daddy costs money too.”. You may be required to pay money for your father's presence at the birth, but the father has the right to attend absolutely free of charge. To do this, the maternity hospital may require him to undergo fluorography and tests for HIV and hepatitis. Important point: to attend the birth close person will only be possible if there are individual delivery rooms, and such conditions are not available in all maternity hospitals.

5. “You don’t have a birth certificate”. This situation is quite possible, but is not an obstacle on the way to the maternity hospital. They must admit you there even without this document.

The fact is that upon admission to the maternity hospital, you may immediately be asked to sign a document stating that you a priori agree to any procedures and operations, but this is illegal. The reasons and consequences of such actions must be explained to any patient so that he himself can decide whether they are necessary. But in practice, a pregnant woman does not always have time to do this, so best option here - issue a notarized power of attorney for one of your loved ones, and they will be able to give or not give consent to certain medical procedures on your behalf. It is also interesting how the patient’s rights change depending on the co-payment or lack thereof. For example, relatives are sometimes prohibited from visiting a “free” woman in labor, citing sterility. For some reason, this rule no longer works in the case of payment for childbirth. If you are asked to pay for services in the maternity hospital, first call your insurance company. If these payments are illegal, you can send a complaint to the chief doctor of the maternity hospital.

Anton Tsygankov

lawyer

So, once you get to the maternity hospital, it is very important to understand that your well-being and the health of your baby depend not only on the doctors. First of all, everything is in our own hands, because according to the law, any woman in labor has the right to refuse certain procedures. It’s another matter when the desire to maintain order turns into an obsessive desire to completely plan the birth process and refuse even the help that is vitally necessary for you. Therefore, trust doctors, but know: if your rights are really violated, you can defend them.

Japan. Monument to Unborn Children

For consultation or for torture?
In the Orthodox community, the need to create “our own” maternity hospital is increasingly being discussed. Many women who have gone through the theater of absurdity of antenatal clinics, the ordeal of maternity hospitals and gynecological departments of hospitals speak about this:
“When my daughter started bleeding, she came” ambulance”, took me to the hospital. And there I had to say twenty times: yes, this is a desired pregnancy; yes, I will keep it; Yes, I need this child."
“Every time I went to the antenatal clinic it was like torture. It was impossible to hear the same thing: you have high blood pressure, you are already old, you will give birth to a sick child, you will die during childbirth, have an abortion...”
“We definitely need either departments or Orthodox maternity hospitals, where abortions are not performed, where there would be a special attitude towards mother and child. When I was kept in the gynecology department, there were women in the same ward with me before and after abortions. It happened in a hospital near Moscow. So after the abortions, everything was poured into a bucket standing in the room next to the toilet. One day I got there by accident. How I didn’t lose my child after that, I don’t know.”
And these are all common situations. In most maternity hospitals, if a woman is admitted to continue her pregnancy, but her pregnancy is less than 20 weeks, she is placed in a department where everyone lies together: pregnant women, abortionists, women with gynecological diseases. And everyone is treated by the same doctors. How is this possible? Priest Igor Fomin, member of the Commission for Church Social Activities, head of the department for work with large families, father of three children: “A doctor who performs abortions before lunch and delivers babies after lunch has no moral right to do so. A child, entering this world for the first time, should not immediately fall into the hands of someone who has just killed the same child.”
Men support the idea of ​​Orthodox maternity hospitals: “I propose to organize a nationwide fundraiser for the All-Russian Orthodox Motherhood Center. The center should deal with all problems related to motherhood, from abortion prevention to pediatrics. It is necessary to collect as for the Cathedral of Christ the Savior. To save children, unborn and already born, for the sake of Christ. It seems to me that if the Church calls us to do such a thing, everyone will support us,” wrote one of the visitors to the website Mercy.ru.

An ideal maternity hospital - what is it like?Archpriest Maxim Kozlov, rector of the Church of the Holy Martyr Tatiana, father of four children: “I would like to clarify - what is this, “Orthodox maternity hospital”? This is, first of all, just a high-quality maternity hospital. After all, there is no Orthodox mathematics, physics or, for example, Orthodox trolleybus driving. There is simply quality work done. And in this sense she is godly.”
Priest Igor Fomin: “I would like, first of all, the Orthodox maternity hospital to be filled with attention and care for all women in labor, regardless of their religion.”
If we summarize the statements of people advocating for an Orthodox maternity hospital, as they see it, we get approximately the following picture.
The staff in such a maternity hospital should consist of people who are believers or at least sympathizers with Orthodoxy. The moral environment should be as healthy, friendly, and close to home as possible. Multiparous women will, of course, be welcomed here. And they won't have abortions. The staff of such a maternity hospital must be highly professional. In the postpartum department, orientation towards breast-feeding(joint wards “mother and child”). Pressure on mothers to get vaccinated is eliminated. It would be good if there was a gynecological department here, where they would try to preserve the health of the woman (in case of various complications) for future childbirth. And of course, in such a maternity hospital there should be an opportunity at any time to communicate with the priest, to baptize weak children, for those in care - to confess and receive communion, and to participate in a prayer service.

Georgian woman with a baby. Photographer D.A. Nikitin. 1881

Utopia or ghetto
However, many doubts arise about the possibility of creating such a maternity hospital.
The first doubt: a maternity hospital is a very expensive project. Who will finance it? According to the Ministry of Health and social development Russia, 58 million rubles were spent in 2005 on the maintenance of one state maternity hospital with 700 beds in Moscow. In 2006, these expenses will increase to 73 million rubles. Today, the cost of a bed-day in a Moscow maternity hospital in the obstetrics department or hospital with meals is 905 rubles per day, in gynecology - 700 rubles per day. And in an ordinary city hospital, according to official data, the state allocates 200 rubles per bed in the therapy department. Even if land is purchased and a building is built, we must not forget that medical equipment costs enormous amounts of money. A maternity hospital is much more expensive than a regular hospital.
Roman Nikolaevich Getmanov, obstetrician-gynecologist: “A maternity hospital is a specific institution in which babies and adults are located in one place. This requires very special sanitary and epidemiological conditions and huge costs. For example, keeping a newborn baby in intensive care is very expensive. How to exist under the sword of Damocles of sponsorship?
If a private Orthodox maternity hospital is built, will it not turn out to be a maternity hospital for non-poor Orthodox Christians? Head of the maternity hospital at City Clinical Hospital No. 70, Candidate of Medical Sciences Vadim Olegovich Lopukhin: “To maintain this maternity hospital, even with serious sponsors, you will still have to open a commercial branch. After all, among the Orthodox there is a certain percentage of wealthy people. And then we will have to divide people into whites and blacks.”
The second doubt: will it turn out that such a stream of women in labor will pour into the Orthodox maternity hospital that it will be impossible to cope? V. O. Lopukhin: “Fifty people will come to give birth at the same time. How to accept everyone? We'll have to refuse. Complaints will follow. Moreover, they will complain not only to the Minister of Health, but also to the Patriarch.”
Archpriest Maxim Kozlov: “On what principle will they be admitted to such a maternity hospital? On the recommendation of a priest, confessor? Moreover, for ethical reasons, an Orthodox maternity hospital must accept any woman, regardless of whether she is Orthodox or not.”
The third doubt: is it possible to recruit a sufficient number of Orthodox professionals? After all, a maternity hospital with 120 beds requires 200 employees. According to R. N. Getmanov, multiparous women, whom the Orthodox maternity hospital will focus on, are a very difficult contingent. For example, hypotonic bleeding, which is not uncommon in multiparous mothers, can quickly lead to irreversible consequences. “You need to understand what and how to risk. Therefore, we can only talk about an Orthodox maternity hospital in one interpretation - this maternity hospital must be provided with everything necessary to provide highly qualified care.”
The fourth doubt: “For some reason it is believed that if the staff is Orthodox, then everyone will be good right away. We know that this is not always the case. And won’t something like this start here: “Father blessed me to do this, I trust him more than doctors.” It is good if the priest gives his blessing after consulting with a doctor. What if the priest gives advice on how to manage childbirth? So the Orthodox staff will ultimately come into conflict with him,” says one of the doctors we interviewed.

It's not all bad For more than 15 years he has been managing the maternity hospital at City Clinical Hospital No. 70 in Moscow. This is an ordinary city maternity hospital that accepts everyone. Childbirth preparation courses are available for everyone. But there is one significant difference in this hospital: on the initiative of Vadim Olegovich, they do not perform abortions here. The maternity hospital is designed for 2.5 thousand births per year, but it always turns out to be more - for 3 thousand. There is a temple on the territory of the hospital, the priest comes to the wards, if necessary, and baptizes the children, and he can serve a prayer service.
It so happens that there are many Orthodox doctors here and many Orthodox people give birth. “Word of mouth helps,” jokes Vadim Olegovich. Icons hang in the maternity rooms. “Not only Orthodox Christians give birth under these icons. Both Muslims and atheists. Naturally, we accept everyone.”
Vadim Olegovich has to deal with different cases: “Recently a woman arrived at the onset of labor, and two years ago she had a caesarean section. She says: “My father blessed me to give birth on my own, without having to perform an operation.” However, she was not examined. I am trying to explain that if a woman wants to give birth on her own after a cesarean section, she needs to undergo appropriate preparation in advance, we must assess the condition of the uterine scar and so on, because if the uterus ruptures, this is a fatal risk. She insisted - I don’t know anything, my father blessed me. Then I tell her - call the priest, despite the fact that it is 12 o’clock at night. It turns out that the priest did not bless anything like that. An hour and a half later, she agreed to the operation. We operated on her, and during the examination it turned out that she herself would not have been able to give birth. healthy child. Therefore, correct orientation of pregnant women is very important.”

Orthodox pregnant women, unite!
Pregnant women should be properly guided by antenatal clinics. Most of our interlocutors admit that Orthodox consultation for pregnant women is even more necessary than their own maternity hospital.
“The situation in our consultations is much sadder than in maternity hospitals. We really need doctors who don’t send for abortions at the slightest suspicion of genetic abnormalities.”
What does it take to open a antenatal clinic? To begin with, find a room. Then register a legal entity. Recruit specialists and purchase necessary equipment. Then obtain a license from the relevant licensing authority, for which you must collect a package of documents consisting of several parts. There must be documents to obtain the conclusion of the sanitary and epidemiological service and the fire service; all specialists must have documents confirming their qualifications for the activity applied for licensing. And
it is necessary to find sponsors who will finance this project. Priest Igor Fomin: “We are ready to consider proposals and cooperate with medical institutions that want to help us, because it is incomparably more difficult to create an antenatal clinic outside the walls of an existing medical institution. And of course, it is very important to find investors. 23 kilometers from Moscow along Shchelkovskoye Highway there is land donated for a similar project. For now it’s empty.”


What to do?
“It seems to me that this problem is more of a missionary nature than a medical one,” says V. O. Lopukhin. “We need to engage in missionary work among health workers. It is very important to work among the population of reproductive age in order to form right attitude to pregnancy and its termination. The problem is that people who work in medical institutions, much less head them, have normal level moral rules. Then, in the antenatal clinic, a pregnant woman, even if she has a fifth child, will be spoken to with respect.”
Employees of the Diocesan Commission for Church Social Activities of Moscow are now in contact with several Moscow maternity hospitals: they are organizing prayer rooms there, giving various information, for example, about where they can provide help to a pregnant woman in a difficult situation.
In Yekaterinburg, an agreement was reached with the city’s chief gynecologist on the work of an Orthodox specialist in every antenatal clinic in the city (there are 14 of them). Every woman planning to have an abortion will be referred to a conversation with such a specialist. In most consultations, work is already underway. The salaries of specialists are paid by the diocese.
The missionary position is to churchize what already exists now. And perhaps it is worth putting no less effort into this than into creating an Orthodox maternity hospital. At least this task is no less urgent.

Marina NEFEDOVA,
Elizaveta PRAVIKOVA

Citizens are faced with the problem of getting medical care in any city. Russian Federation possible if you are registered in this region. It is enough to register in order to have the right to be served in a district clinic or hospital. But not all women living in the capital are registered. When pregnancy occurs, they begin to be tormented by the question of whether it is possible for nonresidents to give birth in Moscow.

Nuances of legislation

The regulations stipulate that pregnant women have the right to be observed in the chosen consultation, regardless of the place of temporary registration or permanent residence. But in practice, expectant mothers are faced with refusal to register. Women in labor manage to get into maternity hospitals by arriving with contractions.

Free pregnancy management carried out if you have health insurance. For a medical institution, the insurance policy and passport are the main documents. The unified insurance system allows you to go to any hospital in the country. This is confirmed by relevant regulations. If you refuse to register for pregnancy, you must refer to the order of the Ministry of Health, which confirms the right of patients to receive medical care in any region of the Federation.

This also applies to maternity hospitals. In Moscow, without registration with an insurance policy, you can give birth in any maternity hospital. If medical staff refuse to admit a woman in labor, then they are violating Law No. 323-FZ of November 21, 2011. It states that the state provides health protection regardless of place of residence. And having insurance makes this help free for those who apply.

If you don't have insurance, the situation is different. Women without a policy and exchange card are sent to an observational maternity hospital, as they are considered “conditionally infected.” Patients without documents can give birth to a child in Moscow at the maternity hospital of City Clinical Hospital No. 6.

List of services provided

Some believe that those registered in the capital are treated better. Women wait until the last minute and go to the capital's maternity hospitals with contractions. Expectant mothers believe that they will be denied planned hospitalization due to the lack of permanent registration or registration certificate. They don’t know for sure whether residents of other regions can give birth in Moscow.

When faced with a refusal to hospitalize, complain to higher authorities. The list of cases in which medical care is provided under the compulsory health insurance program includes the following:

• pregnancy;
• birth of a child;
• postpartum period;
• abortions.

In these cases, assistance to insured patients is provided free of charge in any city.

Attachment to medical institutions

Compulsory medical insurance policies are valid in any region of Russia. But the list of cases when they need to be replaced also includes moving from one region of the country to another. But even if there is no registration, you can do this. An application is drawn up addressed to the head of the municipal health department. In the text a request is written about attachment to a specific antenatal clinic, and all attached documents are listed. You should also complete the following points.

1. Enclose a copy of your passport and medical insurance in the letter.
2. Send a registered letter with notification.
3. A few days later, call the government agency employees and find out how to get a coupon to be assigned to the clinic.

Having collected the coupon, you can go to the consultation for registration. You can also indicate that if you refuse or there is no response to the application, you will contact the prosecutor’s office or the court. After registration, you don’t have to worry about giving birth in Moscow without registration.

Is it worth going to the capital?

If you live and work in Moscow without registration, then it is easier to register and give birth in this city. Once the child is born, he will have to be registered. This will require parental registration.

There is no point in going to the capital to give birth in Moscow. In other cities, conditions and material support for hospitals approximately at the same level. Traveling 1-2 times a month for routine examinations to a consultation is problematic, even if you live in the Moscow region. If there are indications, any hospital located in the Moscow region will give a referral to a specialized maternity hospital in the capital. This is done when serious pathologies are detected during pregnancy. In this case, even planned hospitalization in Moscow with registration outside Moscow will not cause problems.

It is advisable to be observed at your actual place of residence. The antenatal clinic and clinic store medical records of expectant mothers. The doctor will review your medical history and adjust pregnancy management tactics if necessary.

Metropolitan doctors who observe nonresidents are not given such a chance. The desire of patients to be observed in the capital leads to the fact that antenatal clinics and maternity hospitals are overcrowded. Is it worth giving birth to a child in Moscow in such conditions, think in advance.

Not all expectant mothers know when and how to choose the right maternity hospital.

IN Soviet times our parents went to the medical facility closest to home. Modern medicine gives pregnant women the right to choose any maternity hospital depending on their requirements and taste preferences. A woman is not limited in her choice; she just needs to fulfill several conditions.

Is it possible to choose a maternity hospital yourself?

On recent months Pregnant woman is puzzled by the question of whether the ambulance will take her to the chosen maternity hospital.

Many expectant parents make arrangements with the doctor in advance while the pregnant woman is registered. It is considered normal practice to first meet with your doctor and obstetrician 1-2 months before the expected date of birth.

During such a period of time, you can have time to meet with the doctor several times, he will be able to carefully look at the medical (exchange) card and find out about possible complications. In this case, you will be able to establish contact with a professional doctor.

When visiting the maternity hospital for the first time, the expectant mother is often asked to sign a contract on a paid basis, and she is introduced to the list of additional services. They require comfortable living conditions, necessary medications and attentive attitude of workers. So, you will be able to choose a separate room and stay in it with your husband, mother and other close relatives.

In the process of getting to know a doctor, it is strongly recommended to take his phone number and also clarify the possibility of calling at any time of the day if necessary. Such an agreement implies a monetary reward.

It is important to understand that even paid childbirth does not guarantee its easy resolution. Often, on a paid basis, the conditions for the expectant mother in the maternity hospital are improved.

If you are unable to pay for childbirth, you can use a birth certificate, which allows a mentally vulnerable woman to be confident in the future and not worry about the upcoming event.

In 2006 it was adopted Government program, which allows pregnant women to choose a consultation and maternity hospital. Its action has significantly improved the medical care of the population.

At the same time, young mothers and their children are provided with high-quality medicines completely free of charge. Having a birth certificate greatly simplifies financially the management of pregnancy, childbirth and further monitoring of children by pediatricians in the first year of their life. It allows a woman to choose in which maternity hospital she would like to give birth to her baby. The expectant mother has the right to come to any medical institution and declare her desire to become its patient.

When is it impossible to choose a maternity hospital on your own?

Today, there are a number of cases that do not allow a woman in labor to choose a maternity hospital according to her wishes.

1. The first reason is the lack of a birth certificate when contractions begin. In this case, the ambulance will take the woman to the nearest facility. The occurrence of such a situation sometimes leads to the most adverse consequences in the form of a lack of urgent qualified assistance from medical workers and the necessary equipment.
2. Secondly, all maternity hospitals are forced to close one or more times a year for sanitary treatment. Therefore, when the day of birth coincides with this procedure, the expectant mother will not be able to get to the chosen clinic.
3. Many maternity hospitals specialize in providing certain types of care. If complications arise during pregnancy, it would be advisable to contact an institution that meets the necessary requirements. Not all clinics are equipped with everything necessary to attend childbirth for women suffering from diabetes mellitus, problems with the cardiovascular system and so on.

The essence and purpose of the birth certificate

The state program “Health” organizes competition between medical institutions that strive to provide comprehensive care a large number pregnant women. At the same time, it is possible to improve the quality of medical services provided in all clinics.

Registration of a birth certificate helps to stimulate the desire of all health care institutions to provide assistance in gynecology, obstetrics and pediatrics. Hospitals are becoming interested in equipping with certified medicines, as well as modern equipment.

To obtain a certificate, you must complete the following steps:

• register (in the 1st trimester) at the antenatal clinic;
• Regular visits to the clinic (for at least 12 weeks);
• monthly visit to the pediatrician with an infant.

Who can issue a birth certificate:

1. All citizens of the Russian Federation, regardless of age, official employment or registration.
2. Women with any fetal condition, with or without a legal spouse.
3. Citizens of other countries with a temporary residence permit or residence permit also have the right to obtain a certificate.

The need to obtain a birth certificate

A birth certificate is a kind of financial incentive for modern clinics, maternity hospitals and antenatal clinics, which provide the population with high-quality medical care on favorable terms. They receive cash payments of a set amount from a special fund (FSS), ensuring interest in each expectant mother, as well as her baby.

According to the birth certificate, a woman chooses a maternity hospital for herself, taking into account the characteristics of the course of pregnancy. The presumable nature of the birth (complicated or uncomplicated) is also taken into account. When choosing a maternity hospital, it is strongly recommended to take into account the territorial criterion (the nearest place where contractions began).

You can receive a birth certificate absolutely free at 28-30 weeks of pregnancy at a consultation or obstetric center where the expectant mother is registered. The document allows you to choose the best medical institution.

You will need to obtain a birth certificate to select:

• consultations for pregnancy monitoring;
• maternity hospital;
• children's clinic for patronage monitoring of your child up to 1 year.

Having a certificate in hand, a woman has the right to apply to any she likes maternity hospital(with an exchange card) and agree on the upcoming birth. The manager is required to sign the card, so on the expected day of birth, the expectant mother can come to the selected hospital. When contractions occur at home, emergency doctors will take the woman in labor there.

The certificate cannot be sold or cashed out; it does not constitute financial assistance. The main purpose of the document is to pay for medical services in government institutions. The certificate will not be accepted by commercial private clinics.

Is an ambulance required to take you to the maternity hospital and admission without a certificate?

A birth certificate protects a pregnant woman from the provision of poor-quality and hazardous medical services. She has the right to choose any antenatal clinic (maternity hospital), even if the medical institution is located in another city or region of our country. The issuance of the document helps women receive comprehensive support during pregnancy and early after childbirth.

Even in the absence of a certificate, a pregnant woman will not be denied medical care. She will be able to go to the maternity hospital only at her place of residence. The document gives the right to choose any maternity hospital, regardless of registration. Moreover, in the hospital itself, if a woman has all necessary documents They will help her obtain a certificate on the spot. If a document is lost, it can be easily restored. The antenatal clinic will be interested in the efficiency of this process, since based on it, funds for the services provided are transferred to the institution’s bank account.

Modern maternity hospitals are divided into 3 types:

• the predominance of uncomplicated births (up to 500 babies are born per year), they do not provide for a 24-hour presence of an obstetrician;
• birth of up to 1,500 children per year (the department has intensive care and intensive care units);
• regional and federal institutions providing assistance during pregnancy and the postpartum period (often there is a pathology department).

Depending on the characteristics of bearing a child, the gynecologist issues a referral to a maternity hospital in one of the above categories. With such documents, you can go to the selected hospital during contractions. In case of post-term pregnancy (from 40 weeks), you can be admitted to a hospital in such an institution until you wait for the onset of labor.

How to choose a maternity hospital?

Which maternity hospital is better to choose? This question puzzles many women in labor starting from the first trimester of pregnancy. Expectant parents often visit several institutions, learn about the conditions offered, communicate with doctors and choose the most optimal option. It is important that an agreement is concluded between the pregnant woman and the maternity hospital. The attending physician makes appropriate notes in the pregnancy chart. Only in this case, when the water breaks or contractions begin, can you demand that the ambulance take the woman to the maternity hospital of her choice.

To understand how to choose the right maternity hospital, you need to study its following criteria:

• proximity of the institution to home;
• living conditions (availability of a separate shower, cleanliness, sterility, etc.);
• availability of good medical equipment;
• qualifications and experience of personnel;
• the possibility of partner (joint) childbirth;
• 24-hour stay with the baby.

When choosing a maternity hospital, it is necessary to study the attitude of all staff towards natural childbirth.

Domestic medical institutions focus mainly on natural childbirth. In this case, planned caesarean section is used exclusively according to indications.

Sometimes emergency situations occur when weak labor occurs when the water breaks. In this case, additional stimulation cannot be avoided, and the life of the newly born person will depend on the highly qualified personnel and the availability of modern medical equipment. After a successful birth, it is advisable for the mother and newborn to be cared for by experienced gynecologists, neonatologists and polite medical staff.

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Pregnancy is a time of pleasant worries and serious decisions. How to choose between free and contract services for pregnancy and childbirth, which is important to remember - in the column of journalist and mother of three children Anna Kudryavskaya-Panina.

When I found out that I was expecting my third child, the question was how to monitor the pregnancy? private clinic or antenatal clinic was not worth it for me. I even remember that I told my husband: “This was too expensive for me, so it’s not even discussed.” However, he did not discuss it. It was a long-awaited, hard-fought pregnancy - after two losses in a row. I couldn’t even imagine that I would go with her to what, in my opinion, was a cold and soulless conveyor belt. Despite the fact that about 20 years had passed since the birth of my older children, I perfectly remembered the depressing impression each visit to the antenatal clinic made on me. I was ready to pay for comfort and participation, for the fact that my fears would be dispelled, they would calm me down and support me when necessary, for the fact that they wouldn’t bark at me, wouldn’t look at me crookedly, wouldn’t say nasty things - in a word, for my happy pregnancy. The question of choosing a clinic was also irrelevant for me at that time: I was observed for two years in an excellent medical institution, whose doctors I trusted. She stayed there for almost nine months for 80 thousand rubles.

This is the average price in Moscow for pregnancy management. There are programs that are more expensive, and others that are cheaper. As a rule, clinics offer various options contracts - let's call them “Minimum”, “Optimum” and “Maximum”, differing in the number of services offered within the program. For myself, I chose “Optimum”.

My friends who recently gave birth are divided into two camps: the first claim that everything is more than good in free medicine now, the second avoid it like hell.

“There are no terrible queues now, and you can sign up normally. And the equipment is modern. Well, yes, they don’t blow on patients’ butts, of course, but everything is quite decent,” a representative of the first camp once said at a friendly meeting. “I’m not even going to check,” her counterpart protested, “and yes, I want to be blown in the ass!”

Indeed, now the capital’s antenatal clinics have become much, so to speak, more client-oriented. At least that's what many of those who go there claim. And in fact, if you don’t want to spend money and you have time and there is not a single reason to suspect that something will go wrong during pregnancy, if you are calm about the difficulties of making appointments with doctors and tests, to waiting and communication with the all-powerful receptionist, then you can also find advantages in managing pregnancy in a antenatal clinic. The first and main thing is the absence of fees and even the receipt of some (for some, perhaps dubious) bonuses in the form of a small allowance for early registration and free milk and juices every month. Some people also see the advantage that this is a state structure, which means that in the event of a medical error or some kind of conflict situation there is a transparent path and clear leverage.

Yes, of course, when choosing the path of paid medicine, we first look for a clinic and a doctor whom we decide to trust, this is a priori. And, by the way, often the same excellent doctor can work simultaneously in both a public medical institution and a private one. In addition to the possibility of free choice, we buy a wider range of services than in a antenatal clinic, there are no queues and, as a rule, more modern technologies and equipment. Of course, according to the law, a pregnant woman and within the compulsory medical insurance system also has the right to choose both a consultation and a doctor. But try to do it in fact. Not every woman expecting a child is ready for the costs in the form of bureaucratic obstacles, nerves and time.

Of course, a contract is concluded not only to “get blown in the ass.” In my opinion, the most important thing about it for a pregnant woman, and especially for an anxious pregnant woman, is the ability to communicate with a doctor on any issue 24/7.

Periodically, I began to go crazy when I stopped feeling my girl’s movements. I think that not a single woman who has lost a pregnancy at any stage will blame me for excessive anxiety. I endured it for a while, and then I couldn’t stand it and wrote to my doctor on WhatsApp. She patiently explained why this was possible and said the most important thing: “Come, let’s see, in any case, you will be calmer.”

The doctor who manages your pregnancy under a contract inevitably becomes a doctor for all occasions and a good friend. Of course, it was to her that I turned to the question of what could be taken for allergic rhinitis in my situation, was advised whether to fly on vacation to the sea a month before going on maternity leave, and discussed options for a place to give birth. Sometimes I thought: how could I possibly annoy my doctor with questions? I was dissuaded from this by a friend, an obstetrician-gynecologist at one of the large metropolitan medical centers, when she told me how one day at five in the morning the husband of her contract worker called her asking how much sausage a pregnant woman could eat.

The contract also has its downsides. For example, it does not guarantee the absence of additional costs if the suddenly required study is not included in the program for which you paid, or if more additional visits to a specialist are required than planned.

There is another compromise option - to carry out pregnancy for free, and for additional required studies that your doctor or you consider necessary, contact the paid sector of medicine. Well, make a souvenir recording of an ultrasound in 3D-4D with the face of the heir for your pleasure.

My pregnancy was perfect. And there were moments when the thought that I could have used my 80 thousand differently still treacherously crossed my mind. But I immediately remembered how many times the contract helped me out and saved my nerves, time and energy.

Childbirth is a story no less important than the nine months preceding it. Now, probably, all Moscow state maternity hospitals offer paid services and contract births. Each of these medical institutions will have its own flavor, its own set of medical services, its own options for contract programs: vertical birth, natural, water birth, in a family ward, and not in the birth block, childbirth with a psychologist.

By concluding a contract, you can choose to give birth with an on-duty team (cheaper) or with a personal obstetrician-gynecologist (more expensive). In ordinary maternity hospitals, the average price for natural childbirth− about 100 thousand rubles.

Is there a limit for the upper limit − big question. One day, out of curiosity, I went to the website of the Lapino Mother and Child Clinical Hospital, one of the most prestigious maternity hospitals in Moscow. I saw the contract price there, which reached almost 1 million rubles for the VIP program, whistled and closed it.

Most women give birth for free, and many of them are stopped not by a lack of money or a reluctance to spend it, but by a sincere misunderstanding of why it is needed. A friend of mine went to an open day at the maternity hospital at her place of residence. She liked everything and decided not to sign the contract because she was more than satisfied with everything. “Well, yes,” I agreed, “and being next to a couple more women and babies can be tolerated for a few days.” My friend didn’t understand me and sincerely exclaimed: “Yes, I’ll go crazy in a solitary ward from boredom!”

In fact, many Moscow maternity hospitals will offer you everything that is specified in the contract, for example, partner births, for free. Then what does the patient get for the money? A separate birth block, comfortable individual living conditions, and the attention of a doctor if you choose the option of giving birth with a personal obstetrician-gynecologist.

In my opinion, this option is the only correct one, because it all depends on who will give birth with you. We need to find a doctor. One that is right for you, with which you will feel confident at one of the decisive moments in the life of your child, your entire family. The plus is that from the last weeks of pregnancy until the end postpartum period You will be in the same hands, you will have the opportunity to discuss the upcoming birth in detail in advance.

It may seem that I am agitating for everyone to give birth under a contract. Not at all! But I can't help but be subjective. Any woman is capable of making her own decision. But my firm belief is: if you had problems with conception, pregnancy or childbirth, if you lost a pregnancy at any stage, it’s definitely worth at least considering the option of concluding a contract for pregnancy management and the birth itself.

But even if you have entered into a contract, there is no guarantee that you will give birth in the chosen maternity hospital with the chosen doctor. It may happen that you will give birth earlier or that everything will go too quickly, and the ambulance will take you to where the dispatcher commands.

It was for this reason that I abandoned the maternity hospital that I liked. He was very good in everything: equipment, services offered, repairs, living conditions, except for one thing - far from my home. Very far. The preliminary date of birth fell in the second ten days of December. Child three, things could have gone very quickly. Moscow, pre-New Year traffic jams in which you can stand for hours. The risk of ending up in an on-duty maternity hospital “in the area” seemed too great to me. And I took a different path: I found a regular budget maternity hospital closer, and in it, after reaching the last page of the Internet and re-reading tons of reviews, there was a doctor.

We met at the conclusion of the contract, and I realized that this was really my doctor. It’s like in love: either there is contact or not. At some point, I realized that I trusted this person completely and completely, and I knew that if at the most important moment something goes wrong, this woman will do everything so that I leave the maternity hospital healthy with healthy child. And she will do this not only for me, but for any pregnant woman, whether she gives birth with or without a contract. Everything that could go wrong with my birth went wrong. This is an unpredictable process, it happens. For almost 12 hours, my doctor did her job for the sake of the result that I wrote about just above.

My daughter is already ten months old, and the doctor and I are still in touch. Only now I don’t ask questions or ask for advice, I send photos. And recently we came to the maternity hospital to show my doctor a grown-up girl. Surprisingly, but true: she immediately went into the arms of the man who brought her into this world.