What documents are needed for paid childbirth? Childbirth: free and under contract. What is the difference with whom such an agreement is concluded?

BUT! The necessary conditions for granting benefits are:

An agreement concluded with a medical institution licensed to carry out medical activities (it is advisable to request a copy of the license in hand);

Documents confirming the fact of payment for treatment at a medical institution (for example, checks);

Certificate of payment for medical services to be submitted to the tax authorities of the Russian Federation (in the form, you can request it after the services have been performed);

Your written application as a taxpayer for a social tax deduction.

The listed documents are attached to the personal income tax return submitted to the tax authority.

A voluntary health insurance agreement concluded with an insurance company and receipts for payment of the insurance premium will not serve as a basis for providing benefits.

3. As experience shows, commercial medical centers are more attentive to clients who have entered into an agreement directly with them, and not through insurance companies.

The second time I chose a maternity hospital based on the same criteria as described above. But a little more than 3 years passed and in January 2007 a lot had changed.

So, story No. 2, how we selected a maternity hospital. We lived a little closer to the center of Moscow, and for myself I expanded the list of maternity hospitals, which in an emergency can be reached quite quickly.

However, I had to exclude several maternity hospitals from the list, including the previously mentioned No. 11 (metro station Biberevo), they had to be closed for preventive treatment.

I decided to opt for maternity hospital No. 6 (Belorusskaya metro station), which had already become my home. But I refuse my choice for the following reasons:

1. The composition of the maternity hospital staff has changed, including the doctor who delivered my first birth, no longer working there.

2. Another insurance company (a very large one) is already cooperating with the maternity hospital. The insurance amount under the program it offers has increased significantly (29 thousand rubles, if the birth will be attended by an on-duty team, 38 thousand rubles - a contract for the management of childbirth with the choice of a personal obstetrician-gynecologist), but the conditions of stay in the maternity hospital have not changed, including including the situation in the paid wards and maternity block. Considering that the maternity hospital building is very old and major renovations took place a long time ago, the level of comfort is quite low, and many rooms are cold. Thus, taking into account the actual conditions of stay in the maternity hospital, I considered the price of the contract to be unjustifiably high.

In addition, according to the terms of the insurance company, before concluding a contract, it became mandatory to conduct a number of additional examinations in the maternity hospital: Doppler ultrasound, cardiac monitoring, and consultation with specialists. These examinations must be completed independently of those done at the antenatal clinic; they are paid separately and are not included in the cost of the contract.

The situation with voluntary health insurance has changed a lot recently. If previously there were many small insurance companies operating in the paid childbirth market, since 2006 there have been only a few large insurers left. The main reason for this is the legislative change in the requirements for increasing the authorized capital of insurance organizations (the Federal Law of December 10, 2003 introduced amendments and additions to the Law of the Russian Federation “On the organization of insurance business in the Russian Federation” ). According to the changes made, previously created with insurance organizations are required to form their authorized capital in accordance with the requirements of the Law, in the following order:

Thus, in the second half of 2006, the majority of small companies that were unable to increase their authorized capital had their licenses suspended and later revoked due to failure to eliminate violations of insurance legislation.

The remaining larger insurance companies increased their prices significantly during 2006.

By the end of 2007, the number of insurance companies is likely to decrease further.

But, despite a significant increase in the cost of services, the quality of services has not changed. The insured amount of contracts for paid childbirth has recently increased 2-3 times, but the conditions for women in labor have remained the same. I believe that meeting an obstetrician-gynecologist before childbirth and a separate room with cosmetic repairs in the postpartum department are an insufficient amount of services; in any case, they should cost much less.

Increasing the authorized capital of insurance companies and reducing the number of small insurers is a means of preparing the Russian insurance market for accession to the WTO. Perhaps, after large foreign insurance companies enter the Russian market, the quality of services will improve.

Next, I decided to look at maternity hospital No. 17 (see Petrovsko-Razumovskaya metro station) and the maternity hospital at city hospital No. 29 (Aviamotornaya metro station), look at the conditions in paid departments, and get acquainted with a sample contract.

In maternity hospital No. 17 We had to work a little hard to find a representative of the insurance company. But, to be honest, they welcomed us warmly, in a room that, unlike the rest of the maternity hospital, had recently been renovated. The girl who received us offered to conclude an agreement with one of the two insurance companies whose interests she represented, showed photographs of the wards in the postpartum ward and the maternity ward, and a sample agreement. The insurance amount is 45 thousand rubles. Frankly speaking, I was simply surprised - it was not entirely clear what she was taking on. The conditions in the maternity hospital are simple, small rooms with modest cosmetic repairs. The girl, without hiding, explained that other insurance companies also work with the maternity hospital, and if you conclude an agreement to manage the birth with them, the payment will be 38 thousand rubles, but the birth will be attended by the team on duty. At the end of the conversation, we were asked a rhetorical question: “What is the point of concluding a contract for paid childbirth if a personal obstetrician-gynecologist is not assigned to the woman in labor?”

I didn’t argue with her, although I have a completely different point of view on this issue. If the birth is quick, not to mention rapid, the personal doctor may not have time for the delivery, and in this case the birth will be attended by the team on duty. Thus, not all women are interested in contracting with a personal obstetrician-gynecologist. In addition, not everyone can and wants to choose a specific doctor, and there is nothing wrong with having the birth team on duty, if it is qualified.

In the maternity hospital at city hospital No. 29(I had previously heard a lot of good things about this maternity hospital, about the doctors, about the attentive staff) we were not welcome at all. The question immediately arose, If a representative of an insurance company behaves this way before concluding a contract, what will happen then? In general, when visiting this maternity hospital, several curious situations arose.

Firstly To enter the hall where a representative of the insurance company sits, you must wear shoe covers. Shoe covers are paid, they are sold in the locker room, and the cloakroom attendant left for lunch.

Secondly Once inside the maternity hospital, you are surprised by the simplicity of the situation: a small corridor where, judging by the number of people, relatives come to meet young mothers, in the corridor there is a small sofa and two kiosk-type nooks where you can talk with representatives of insurance companies. The photographs of the chambers also impressed me with the modesty of the furnishings.

Third, on the insurance company’s website it was indicated: the cost of the “Childbirth and Caesarean Section” program is 37,000 - 43,000 rubles. During the conversation, they explained to us that the program in any case would cost 43 thousand rubles. (in addition, before concluding the contract, it is necessary to pay for an appointment with an obstetrician-gynecologist and, possibly, any examinations, as indicated). The amount of the insurance premium can be 38 thousand rubles. provided that I sign an agreement when I arrive at the maternity hospital with contractions. It’s even interesting to know if they have such clients? Since the insurer’s representative is present in the maternity hospital only on weekdays from 10.00 to 14.00.

The only general impression from both maternity hospital No. 17 and the maternity hospital at city hospital No. 29 is that representatives of the insurance company do not have all the necessary information about the maternity hospital, how the birth process is going, and the scope of services included in the contract. Clients are told practically nothing. And if you ask specific questions, they usually answer - you will clarify this with the doctor after concluding the contract. The impression is that they are only interested in us concluding an agreement and paying, and all the nuances are a personal matter for the clients. When you come to buy expensive services, you want a different, more friendly attitude, and you want the representative of the service provider to have all the necessary information.

To be honest, after all the trips listed above, I no longer wanted to communicate with representatives of insurance companies. The unjustified increase in prices with low quality of services from insurers was disappointing.

We entered into an agreement with a commercial clinic - the Euro-Med medical center(located in the building of the maternity hospital at City Clinical Hospital No. 67). The cost under the contract for paid medical services amounted to 42 thousand rubles. (and no pre-examination was required before concluding the contract).

After all the “adventures” traveling to maternity hospitals, I was more than pleased with my choice. It turned out that paying for real services to the organization that will provide them(and not to a third party who is actually only interested in the fact of concluding an agreement) not only more profitable, but also more enjoyable.

So, what did we get for the money spent:

1. Communication with friendly and attentive staff. Even my 3 year old daughter had something to do during my doctor visits.

2. A wider range of services under the obstetric care program (from 36 weeks of pregnancy and postpartum care).

The location of the maternity hospital on the territory of a multidisciplinary city hospital, which has in its structure, including children's and adult intensive care, is another plus, although I do not wish anyone to take advantage of such an additional guarantee.

True, before I chose this maternity hospital, I had to hear and read negative reviews about it. But all of them are either unjustified (I came to this conclusion for myself after visiting the clinic), or about 3 years ago (perhaps a lot has changed over time).

We were warned in advance about all the “cons” that I might encounter during my stay in the maternity hospital:

1. Double rooms equipped with showers. Toilets are on the floor, but there are several of them. This inconvenience is due to the fact that the maternity hospital building is very old and a different layout probably simply did not work out.

2. According to the agreement, after giving birth, patients are in the postpartum department in the physiological department for 3 days (5 days for a cesarean section) in the absence of postpartum complications.

The maternity hospital is small, I believe that the main reason for staying in the postpartum ward a day less than in other maternity hospitals is simply a lack of space. To be honest, I think that a long stay in the postpartum ward after a natural birth is completely unnecessary.

3. Delivery by cesarean section takes place in the premises of the maternity hospital at City Clinical Hospital No. 67; only physiological births are accepted on the territory of the Euro-Med maternity hospital. The patient is transported to the clinic premises after the operation.

If you are completely unsatisfied with any of the above points, you can enter into an agreement with the Euro-Med clinic for childbirth in the maternity hospital in Medvedkovo (in the building of maternity hospital No. 5). There are single rooms and the period of stay in the postpartum physiological department is 5 days.

I found the conditions at the Euro-Med clinic at maternity hospital No. 5 less interesting:

If the father wants to be present at the birth or see the child immediately after birth, he will need to undergo additional tests; visits on subsequent days are possible at strictly established evening hours;

Common maternity block (consisting of separate maternity wards) with maternity hospital No. 5;

The postpartum department of the clinic is located inside the building of maternity hospital No. 5, there is no separate entrance.

And yet, I have heard more than once the opinion that commercial clinics are engaged in “extracting” money from clients, you are constantly required to take tests and undergo examinations that are not included in the program under the contract. I haven't experienced anything like this myself. The antenatal clinic really didn’t have time to do everything for me before concluding a contract for childbirth, but the doctor asked me to complete everything I needed at the antenatal clinic, warning me right away that some tests at the clinic would be paid for. Since this is my second pregnancy, I looked at these areas realistically - these are the general requirements of maternity hospitals, and not the personal desire of a doctor or clinic.

In addition, if you enter into an agreement with an insurance company, in a paid department of a state maternity hospital you may also be asked to do separate tests and examinations for an additional fee, since the list of services under the program is quite limited.

Much also depends on the gynecologist and antenatal clinic where you were observed during pregnancy. For example, during my first pregnancy I did not have any questions, I felt the qualifications of the gynecologist, ready to answer all the questions I had, all examinations were scheduled in a timely manner. So, I had CTG done twice during my first pregnancy. During my second pregnancy at 36 weeks, for an unknown reason, I was never prescribed CTG (this study is mandatory in late pregnancy). It’s not surprising that Euro-Med immediately prescribed cardiotocography for me, albeit free of charge (a one-time examination is included in the observation program).

February 2007

Any woman is worried before childbirth and wants to be surrounded by care and attention at the moment of the birth of her child. Therefore, expectant mothers, wanting to guarantee maximum comfort for themselves and their baby, are increasingly choosing contract births. But in order to avoid pitfalls, before concluding an agreement, it is advisable to find out as much detailed information as possible about all the nuances of this procedure.

What is a birth contract?

No one can guarantee that unpaid services in a maternity hospital will be of high quality. Therefore, when a woman decides to give birth for free, she can only rely on the honesty and professionalism of the medical staff. Whereas, having concluded a contract for childbirth, a woman in labor can count on certain privileges and the high quality of the services provided. The contract states:

• the period during which the document remains valid;
• amount of payment;
• list of rights and obligations of the parties;
• a range of services that will be provided to the woman in labor.

With whom is such an agreement concluded?

An agreement can be concluded either directly with a maternity hospital or medical institution (which has the legal right to provide assistance during childbirth, as well as before and after it), or with the medical insurance company representing it. In the first case, from a legal point of view, it will be a contract for the provision of medical services, and in the second, a health insurance contract.

If you choose the first option, before signing the agreement, it is advisable to make sure that the medical institution has the appropriate license and certificate allowing it to provide medical services to pregnant women and infants. Typically, such a certificate is valid for no longer than 5 years (and if the form of ownership is not state-owned, then only 3 years). The license is valid for 5 years.

When a health insurance method is chosen, the expectant mother becomes an insured person, and the law “On health insurance of citizens in the Russian Federation” (dated June 28, 1991 No. 1499–1) comes into force. According to this law, the insurance company enters into a contract with the future mother, which obliges the insurer to organize and pay for the upcoming birth in a certain maternity hospital. At the same time, an agreement must already be concluded between the company and the maternity hospital regulating the provision of such medical services.

Before concluding a contract with an insurance organization, you must first check the availability of a certificate that allows you to engage in health insurance. Secondly, you should see with your own eyes the contract concluded between the company and the maternity hospital and check when it expires (so that this does not happen before the moment of birth).
Each maternity hospital draws up its own form of contract for childbirth, so the list of medical services in different medical institutions may differ significantly

Regardless of whether the agreement is concluded with a medical insurance organization or directly with a medical institution, it is advisable to make sure that it is signed by an authorized person. The fact is that the agreement must be signed by a person who has legal authority to do so (general director, director). But he, in turn, can transfer this right by proxy to one of his subordinates. And it is very desirable to see this very power of attorney in order to make sure that the signed document will have legal force.

To avoid unpleasant surprises, you need to make sure you have all the above documents and permits. Otherwise, all the promised benefits may turn out to be nothing more than a fiction. For representatives of a serious company, a request to show documentation will not cause indignation or dissatisfaction, because such a check is a normal and completely legal practice.

Several times I had to listen to complaints from women who entered into a contract for childbirth with a representative of an insurance company who did not have the legal authority to sign such documents. And then it turned out that the woman in labor, dissatisfied with the quality of the services received during childbirth, could not even complain about it, since, from a legal point of view, no one owes her anything. To avoid such situations, it is advisable to check the charter of the organization with which the agreement is concluded. This will ensure that her representative signing the agreement has the legal right to do so.

What are the advantages of contract childbirth?

The expectant mother gets the opportunity to choose not only the maternity hospital in which she will give birth, but also a team of specialists with a good reputation. And then indicate your choice in the contract. In addition, many women who have given birth note the fact that the attitude of the medical staff towards women in labor who have paid for their stay in the institution is more attentive and polite.
A birth contract gives you the opportunity to give birth with all the comforts

To avoid misunderstandings during childbirth, I recommend that women meet and personally talk with the doctor whose help they want to enlist in advance (even before signing the contract). First of all, you need to obtain the consent of the obstetrician that he will be the one to deliver the baby. Then important details should be discussed, such as the method of anesthesia, type of birth, tolerance of medications, and so on.

List of services guaranteed by the contract

In different maternity hospitals, the situation with the provision of certain benefits to women who have entered into a contract for childbirth may have its own nuances and differences. But the list of basic services is usually the same. It includes:

• guaranteed availability of a place in the maternity hospital at the time of the onset of labor;
• separate room with all amenities for mother and baby (with TV, shower, refrigerator)
• high-quality multi-course meals;
• additional procedures that have a beneficial effect on the condition of the mother in labor (aromatherapy, music therapy);
• assistance and consultation from a pediatrician;
• anesthesia (pain relief) at the choice of the woman in labor;
• the possibility of the presence of a husband or other loved one during childbirth;
• constant presence of doctors on duty near the woman in labor;
• use of disposable medical instruments;
• choosing a method of childbirth according to the woman’s wishes (for example, water birth, vertical);
• the opportunity to call your doctor at any time (during the period of prenatal preparation, as well as after the birth of the baby);
• medical support after childbirth (medical procedures, examinations).

What to pay attention to

When concluding a contract for childbirth, you must take into account some important nuances. Here are some tips to help avoid unpleasant surprises:

1. Be sure to include in the contract the name and surname of the obstetrician (or the name list of the duty team) who will attend the birth. Otherwise, the pregnant woman can be assigned to any doctor of the highest category who will be on shift at the moment when her contractions begin.
2. Please note that if the contract is concluded not directly with the maternity hospital, but with an insurance company, then taking into account the fees to insurers for mediation, its cost will be higher.
3. Carefully read the entire list of services that you will have to pay for - some of them may be absolutely unnecessary for you (for example, consulting with highly specialized specialists). In order not to overpay, write into the contract what benefits you will take advantage of and what you will definitely refuse.
4. Find out if your husband or other relatives will be allowed to be present at the birth.
5. Make sure that the agreement includes a clause that provides for the services of an experienced nurse who will care for the baby if the mother feels unwell or needs rest.
6. Not everyone wants to use anesthesia during labor. If you do not want painkillers to be administered to you, be sure to specify this in the contract and also recalculate the amount you must pay.
   If you do not wish to use anesthesia or refuse any other medications during childbirth, be sure to indicate this in the contract
7. Keep in mind that a contract that includes a cesarean section will cost more than if a woman decides to give birth naturally. Don't let anyone talk you into having this surgery without a good reason. The fact is that maternity hospitals make money on cesarean sections - this is an expensive and at the same time quick operation.
8. Check whether the agreement provides for medical care that you will receive after discharge from the department (medical examinations, counseling). It must indicate what specific services will be provided to you and the period during which you can count on them.
9. Be sure to include a clause in the contract guaranteeing urgent hospitalization for the mother and baby in the event of postpartum complications occurring within a week after birth.
10. Find out how much additional medical services that a mother or child may need in case of various complications will cost.
11. Pay attention to whether the contract states how many days the mother and baby must spend in a medical facility. And also find out what additional payment per day will be assigned if you have to stay in the ward longer than planned.
12. Finally, the agreement must indicate what liability the maternity hospital or intermediary insurance company bears, and how they will compensate for damages in the event of non-compliance with the conditions.
    Before signing a contract for childbirth, you should thoroughly study its contents.

When does the birth contract come into force?

You can find out from what time a specific contract begins to operate from a representative of the insurance company or the head physician. In most cases, according to such an agreement, the responsible doctor is obliged to manage the pregnancy starting from the 36th week.

From this moment on, a woman can count on the full range of necessary medical services (tests, examinations, etc.). But sometimes the agreement begins to apply at an earlier date - from the 31st or 34th week. This important point must be discussed and indicated in the document. The contract ends one month after the birth of the baby.

In some cases, the contract comes into force when labor begins. And if for some reason a woman in labor ends up in the maternity hospital earlier, she is placed in a general ward along with other pregnant women, and is transferred to a paid department only when she begins to give birth.
If there is a need for a longer stay in the maternity hospital than specified in the contract, you will need to pay extra for the extra day

Submitting complaints and claims

Unfortunately, a maternity contract does not always guarantee perfect care. Even when a woman gives birth on a paid basis, she may encounter negligence and dishonesty of medical workers. You can file a complaint to hold a medical institution accountable if:

• the terms of the contract were violated;
• the mother in labor suffered moral or material damage;
• due to the fault of the medical staff, the health of the mother or baby was damaged;
• the quality of service was low.

To whom and where to complain

If the contract was concluded directly with the maternity hospital, then first of all you should write a complaint to the head physician, demanding compensation for material or moral damage caused. Most often, maternity hospitals value their reputation, so they try to resolve such problems peacefully, without litigation.

If the claim is refused, you can take the case to court on the basis of the Law “On the Protection of Consumer Rights” (clause 3 of Article 16) by contacting the legal address of the maternity hospital. The procedure and form for filing a complaint are reflected in Article 7 of Federal Law No. 59-FZ of May 2, 2002. The document itself should indicate what the violation of rights was, under what circumstances it occurred, and against which officials there are claims. Typically, such claims are resolved within a month.

But if the contract was concluded with an insurance company, then according to the law “On Medical Insurance of Citizens of the Russian Federation” (Article 27), it is the insurance company that bears full responsibility for failure to comply with the terms of the contract. So in this case, you will have to file a claim not against the maternity hospital, but against the insurers.
In case of non-compliance with the contract, the injured party has the right to file a claim in court

I know of cases where the injured party could not file a claim in court only because important documents were not preserved. Therefore, I strongly recommend that you do not lose, do not throw away, and save until the last day your copy of the birth contract, as well as the receipt for payment for maternity hospital services.

How much does it cost to give birth under a contract?

In Russia, every woman has the right to give birth to a baby free of charge in a maternity hospital, while receiving qualified medical care. But paid childbirth seems to many expectant mothers to be a more reliable option, allowing them to count on high quality medical services.

Meanwhile, this is a rather expensive pleasure. Moreover, prices vary greatly depending on the city and the prestige of the medical institution. For example, the cost of contract childbirth in Moscow ranges from 70 to 120 thousand rubles. Almost the same high prices in St. Petersburg. In other large cities (Ekaterinburg, Vladivostok, Murmansk) prices are much lower - an average of 30 thousand rubles. In small cities prices are even lower - 17–20 thousand.
A successful birth is worth paying for

I have heard the opinion that supposedly the birth of a baby can cost a little less if you do not conclude a contract, but give money personally to the doctors. In many maternity hospitals, especially in the periphery, this version of the “agreement” is very common. But this is a risky practice, because then, if you receive poor quality care or a completely different obstetrician delivers your baby, you will not be able to prove anything to anyone. Therefore, it is safer and more reliable to formalize everything officially, in accordance with existing laws.

The birth of a baby is one of the most important processes in a woman’s life. Everyone wants everything to go without complications, quickly and correctly. This is precisely why birth contracts are concluded. Let us take a closer look at the aspects of such an important issue.

About the timing and subtleties of concluding a contract

The contract is an agreement between the pregnant woman and the maternity hospital. According to this document, the expectant mother is assigned to the selected maternity hospital for medical care.

As a rule, such contracts are drawn up at the 36th week of pregnancy, when you have an exchange card in hand. A passport is also required to complete the transaction. A woman comes with her husband or relatives to the selected maternity hospital. There she is examined by an obstetrician-gynecologist. It determines the possibility of concluding a contract. After all, sometimes it happens that some expectant mothers, according to indications, need to give birth in a specialized maternity hospital. If the doctor has not diagnosed any abnormalities in the course of pregnancy, then the document itself is signed for paid childbirth. From the moment of signing, the woman is observed by a specialist at the selected medical institution until delivery.

As practice shows, paid childbirth is trusted only by a narrow circle of doctors. But if a woman wants to give birth to a specific obstetrician-gynecologist, then she can stipulate this in the contract. If such a condition is prescribed, the doctor will arrive on the first call. It is necessary to conclude an agreement only with an institution that has the right to provide paid services. And to make sure of this, a woman must make sure she has a license or certificate. If there are none, then there is no point in concluding an agreement with a medical institution. Before signing a legal document, you must carefully read all the clauses of the contract. As for its cost, it varies depending on the process of childbirth and the presence of complications.

Please note that by concluding a contract directly with the maternity hospital, not through an insurance company, you have certain advantages:

1. You will know exactly who to file claims with and from whom to demand professional, correct treatment. In this case, the rights of the mother in labor are regulated by the Law “On Protection of Consumer Rights”. It provides a choice of the measure of liability applied to the service provider.
2. Be eligible for tax relief. We are talking about the return of 13% of income tax in accordance with Article 219 of the Tax Code of the Russian Federation. According to this document, new mothers can include in the tax deduction amount money spent on diagnostics, consultations with specialists, prenatal hospitalization and childbirth management.

Why sign a contract for childbirth?

The main reason is the peace of mind of the woman in labor, her confidence that she will receive prompt and professional assistance.

In any case, such a document is a guarantee that the specified medical services will be accurately provided. It specifies the rights of the woman in labor, the duties of the medical staff and the responsibilities of the parties. Knowing your rights, you have information about what exactly you can demand from a medical institution.

If a woman does not have the opportunity to get to the maternity hospital herself, then the obstetric ambulance will take her to the maternity hospital specified in the contract.

When a woman wants her husband or other relatives to be present at the birth, this is stipulated in the document, and they will be able to visit the new mother after the birth. Such visits are prohibited in free branches.

The agreement provides the woman with more comfortable conditions for her stay in the postpartum ward. This is almost home comfort and coziness in a separate room. Also, after concluding a contract for childbirth, a woman receives telephone numbers that can be called at any time of the day if an urgent consultation is required or labor has begun.

Some pregnant women believe that it is better to give birth by prior verbal agreement with the chosen doctor. But often in practice it turns out that he simply does not pick up the phone at the right time for the woman and, accordingly, does not deliver the baby. It is simply impossible to make claims against him, because a verbal agreement is not a guarantee of receiving qualified medical services. This is rather a question of the responsibility and reliability of the obstetrician-gynecologist.

is a special document that is part of the supplement to the government program “Health”. It performs a support function in assisting during childbirth. The project began to be implemented in Russia in 2006.

Thanks to the birth certificate issued to the expectant mother registered with the Women's Consultation Center, a woman gets the right to choose a maternity hospital, observing gynecologist and medical institution for consultations.

Thanks to competent medical supervision, recommendations, prevention and treatment, the chances of giving birth to a healthy baby are significantly increased, and numerous risks for both the unborn child and the mother are minimized. Complications during childbirth, the threat of miscarriage, anemia, late toxicosis, etc. - all these are dangerous pathologies, the prevention of which falls on the shoulders of domestic specialists.

Legislative side of the issue

They began to be issued to women who registered for pregnancy. This innovation resulted in a qualitative improvement in the medical care provided to women during pregnancy and childbirth. This program increases the financial interest of healthcare institutions. This issue is regulated by the Order of the Ministry of Health and Social Development of the Russian Federation dated November 28, 2005.

Having learned about pregnancy, a woman must register with the antenatal clinic at her place of residence before 12 weeks. During the entire obstetric period, the expectant mother visits her doctor consistently twice a month, a total of 10 times. Such regular appointments and examinations, ordering tests and observations ensure timely diagnosis of complications and identification of dangerous pathologies.

According to this document, a pregnant woman is given the right to choose a supervising doctor, a antenatal clinic for registration, in addition I have an opportunity choose a maternity hospital where the baby is to be born. The doctor cannot refuse the patient. However, this practice is rarely used by women in labor, since most of them have either entered into a contract with a specific institution in advance, or do not consider it necessary to fuss about this and go to the nearest free maternity hospital already with contractions.

But for such an important event as the birth of a new person, it is necessary to prepare well, choose personnel and a place for the birth, especially if the state bears the costs. The fact is that it itself consists of several parts, tear-off coupons, each of which has a specific purpose. One pays for the observation of a woman during pregnancy and the provision of medical services to her at this stage in the amount of 3,000 rubles. The state also transfers 6,000 rubles to the maternity hospital in the event of a successful birth for each patient. Additionally, funding was introduced for dispensary observation of a child during the first year of life in the amount of 1,000 rubles for each newborn.

Procedure

Usually, the treating gynecologist, along with the birth certificate, issues a referral to the maternity hospital chosen by the woman.

However, the fact is that this choice is limited territorial framework, more precisely, the administrative-territorial division of municipalities and affiliation with a specific department.

All maternity hospitals in the country divided into three categories:

The condition of the pregnant woman and the peculiarities of the course of the entire period decide which category of institutions the attending physician from the Women's Consultation Center will refer her to. Based on the results of the decision direction will be issued, you can go with him to childbirth already with contractions. Or you can go to the chosen maternity hospital to maintain the pregnancy when the appointed period has already approached, that is, exceeded 40 weeks. A woman in labor has the right to choose, taking into account the testimony of the gynecologist and existing pregnancy pathologies, a specialized or regular maternity hospital.

I’ll start my neophyte story about childbirth with two things: I liked it and there won’t be any horror stories inside - pregnant women CAN read it. But I will try to give as much useful information as possible about partner childbirth, paid childbirth, caesarean section, maternity hospital 68 in Moscow, choosing a midwife and doctor, maternity hospital and preparation for childbirth in general - I don’t even know where to place it correctly, I’ll have to split it up

Since this review is long, I'll break it down into parts:

1. Do you need a personal midwife - thoughts of a neophyte
2. Choosing a maternity hospital (68 maternity hospital named after Demikhov, Moscow)
3. Choosing a personal midwife (Obstetrics.Club)
4. The actual birth history (emergency “soft caesarean”)
5. My conclusions - was it worth paying? Do you need a birth partner?

Since the editor cuts “anchor tags”, you will have to navigate through sections by searching by title.

Do you need a personal midwife?

As a result of the fact that during pregnancy I was faced with a bunch of very important matters, including the housing issue, I practically didn’t think about the birth itself. My partner was thinking, for which I thank him very much. When they started pushing me into “preparing for childbirth” courses, I found out that I would finish them a month after the birth of the child. Then they forced me to find express courses, which we successfully attended. Express courses last for two weekends in a row - Saturday and Sunday, and judging by the reviews of those who attended the full course, they completely replace 10 lessons of the regular course. As they say, they will give you what you need there. I will write more about the courses separately, “not about that now.” I’ll just say that we attended courses at the CTA on Tulskaya, and in the end we went to two – “preparing for childbirth” and “newborn baby”. I may confuse the names, but the essence is clear. I went right away with my partner, and it was very correct - firstly, he understood what to expect during childbirth, and secondly, he remembered and wrote down much better than me (I repeat, my head was occupied with others at that moment problems). Each course is 2 days off in a row for 4 hours. The cost is paid for one person, the second (no matter who - partner, girlfriend, mother) goes free. So the presence of a partner in the courses does not cause damage to the family budget.

Almost simultaneously I was asked to choose a maternity hospital. Having started reading information (and, naturally, horror stories about childbirth), I quickly became stupefied and fell into pessimism. What amazed me most was that even those who had signed a contract with the maternity hospital were left “to their own devices” and were bitterly sad about it. But in these reviews, information about a “personal midwife” began to flash more and more often, and I began to search and read information on this matter.

My thoughts on this matter were as follows: the first stage of labor, namely contractions, is the longest for those giving birth for the first time, 8-16 hours. Both at the courses and at the maternity hospital they said that the problem is precisely that first-time mothers arrive too early, when the contractions have just begun. Accordingly, they spend the entire labor period in the maternity hospital, but at the same time they do not yet need medical assistance, so an experienced midwife (who has 5-8 other people giving birth) runs in once every hour or two, examines them and runs away. It is this period that leaves the greatest negativity, because it is scary, painful and unclear whether everything is going well. But neither the doctor (it’s still too early for him to approach the woman in labor) nor the midwife respond to questions and complaints - they say, “it’s too early.” Imagining myself in such a situation made me sad. But, after reading reviews about personal midwives, I realized that a solution had already been found.

What does a personal midwife offer? For first-time mothers, she comes to the home (if the woman in labor does not live very far from the planned maternity hospital), examines the woman in labor for real dilatation and the stage of contractions (it is clear that fear has big eyes, so for the first time everyone overestimates the real situation), and at home environment accompanies most of the contractual period. If he knows it, he can use massage, pain relief in the bath, and other methods. And only when the contractions begin to approach a certain point (I’m afraid to lie, but any midwife will tell you the frequency and opening), the woman in labor and the midwife go to the maternity hospital. At the same time, if a midwife is officially employed in a maternity hospital, then she is not considered an accompanying person, that is, her husband or another accompanying person can also go. In the maternity hospital, the midwife also assists in completing all documents as quickly as possible, after which everyone moves to the delivery room. Since personal midwives work only with those who have entered into an agreement with the maternity hospital, under which the woman in labor pays for a separate delivery room, the provision of a separate delivery room is a resolved issue. Next, the entire process of natural childbirth takes place in this delivery room, where there is a comfortable couch for the woman in labor, often there is other equipment (fitness ball, bath, chair for vertical birth, etc.), but this depends on the maternity hospital. A partner or accompanying person can be nearby at any time, but in particularly piquant moments he may be asked to leave. A personal doctor (as a rule, this is also paid for in the contract with the maternity hospital) comes to the same ward. After the birth itself, the mother remains in the delivery room for another 2 hours, after which she is transferred to the postpartum room. During childbirth, the midwife receives the baby, places him on the mother’s chest, lays him on his stomach on the mother or father, and helps carry out the first hygienic procedures. Her duties also end 2 hours after birth, when the woman who has given birth is transferred to the postpartum ward. This is how one of these midwives writes about it.

But there are also doulas. What is it difference between a doula and a midwife? Midwife has a medical education, experience working as a midwife in ordinary maternity hospitals (and this is a huge experience in very different births), and in addition to this, she is mastering the techniques of “soft childbirth”. The midwife has the right to carry out medical manipulations during childbirth, and in some maternity hospitals she even has the right to deliver the child herself (in other cases, the childbirth itself is performed by a doctor). But you can take a midwife with you to the birth only if you sign a contract with the maternity hospital, since her work with you requires a separate birth box (which, in fact, is why the contract with the maternity hospital is concluded). Midwives, as a rule, are employed by the maternity hospitals with which they work, and therefore are not considered accompanying persons, i.e. You can take both a midwife and a partner to the birth. One of the midwives I met left the birth, leaving the woman in labor with her mother and husband, i.e. the mother in labor took two accompanying persons with her.

Doula, even if he has a medical education, does not have the right to interfere in the medical part of the course of childbirth, but he knows non-medical methods that help ease contractions and the birth process. In fact, as I understand it, a doula is an experienced friend whom you take with you during childbirth. She travels instead of an accompanying person, so in maternity hospitals where partner births are practiced under compulsory medical insurance, you can take a doula with you. Of course, the financial part of this will be greatly reduced - you do not pay for the contract with the maternity hospital, but only for the services of a doula. But, firstly, even in Moscow there are few maternity hospitals where you can come with a doula. Secondly, I repeat, a doula is a person without the right to medical interventions and, often, without medical education. Thirdly, you take a doula INSTEAD of your husband/partner, i.e. you exchange a person who knows you well, but is inexperienced in childbirth, with a stranger who is experienced in childbirth.

Some women choose the third option - they enter into a contract with the maternity hospital, hire a midwife and a doula (regardless of the presence of the husband at the birth). For me personally, in this case, the number of people unfamiliar and not close to me is already off the charts. But everyone has different opinions and characters, and perhaps someone will need information that can be done this way.

Based on this, I decided that it was more important for me to have an adequate doctor nearby than an unknown gentle woman, because of whom I would lose the support of my loved one. Savings - yes, but such an event does not happen every day, and I wanted both of us to have memories of this. Therefore, I then chose a midwife, although the cost of the contract with the maternity hospital and the midwife’s services, of course, came out to a “round” sum. But health and a new life are more expensive.

I found out all this detailed information by traveling to meetings with midwives at the CTA and Obstetrics Club. In fact, in Moscow I found four main centers where personal midwives work - these are CTA (Center for Traditional Obstetrics), Obstetrics.Club ("Gentle Childbirth"), "New Life" and "Precious". The CTA had the largest staff of midwives, the Obstetrics Club - 6 people, the "Precious" - 13, the "New Life" I could not find a list of midwives, their website is very strange. After reading the reviews, I realized that I must first choose “my” midwife, and then enter into a contract with the chosen center. And it is right. But I’ll tell you one important nuance right away - if in the CTA the contract with a midwife is a medical one, and you can then get a tax deduction for it, then in the Obstetrics.Club it’s some kind of very strange contract for the provision of services, almost informational. In general, nothing. But these are moments of documentation. If you really liked the midwife from Obstetrics.Club, then you can skip this moment.

So, then I decided that I needed a personal midwife, because the contract with the maternity hospital is, in fact, the provision of a separate delivery room, the provision of a slightly less populated (in our case, double) postpartum room, and several “before” examinations. This agreement will not affect the process of natural childbirth in any way. But I just need a midwife so as not to be afraid, not to think whether the doctor is playing it safe, and in general - she knows!

While I went to meetings with midwives (at the CTA this is done very conveniently, and I learned a lot of useful information there), at the same time I found out that not any maternity hospital is suitable for childbirth with a midwife, but only one where there are teams of doctors ready to work with personal midwives. And to my great surprise, I learned that the main one of these maternity hospitals is No. 68 on Volzhskaya, which is located 15 minutes at a leisurely pace from me. In total, there are about 8 such maternity hospitals throughout Moscow, and at meetings, midwives tell where the living conditions are, and the doctors, and what the general mood is. In general, this information is all very useful, and it is worth going to such meetings.

2) Choosing a maternity hospital

Absolutely all centers of personal midwives work with the 68th maternity hospital (now called “named after Demikhov”) because, I repeat, it is now considered almost the leader in the direction of “soft natural childbirth”. Therefore, I decided “they don’t look for good from good,” and, having gone to the “open day” and asking all the necessary questions, I settled on it. I wrote more about maternity hospital 68 separately in the corresponding thread, and also posted photographs of the wards - I looked at them with interest in the reviews, and I was lucky to see paid wards at all stages of my stay in the maternity hospital.

While I was reading reviews about the maternity hospital, I saw a lot of positive reviews about one of the doctors. His answers to my questions satisfied me and I happily jumped off to conclude an agreement - at least one problem off my shoulders. Since at this point I still hadn’t decided on a midwife, I decided to ask the doctor who he was comfortable working with. The doctor just smiled: “I will find a common language with any midwife, choose for yourself.”

3) Choosing a personal midwife

By this time, I liked one midwife at Obstetrics.Club, but she was on vacation for the required dates. Another one, whom I found from another center, refused to take me - she already had several clients for the required period, it was too much of a risk. At the CTA, I simply didn’t have time to meet at least a few, and of the course leaders (they are taught by the same midwives who provide personal support), none of them really touched my heart. In general, I was rushing around, not knowing how to choose, and the deadlines were literally running out. Therefore, out of desperation, I looked at who was most often mentioned in reviews along with the doctor I had chosen, and thus chose a midwife. We came to meet her at the Obstetrics Club, talked - again, the answers to the questions suited me. The contract for Obstetrics.Club, unlike the CTA, is not sent by mail in advance; all questions are asked to be asked right there. Well, as I mentioned above, you will not receive a deduction for it. In addition to the main midwife, the contract specifies two more midwives in case the main one is busy. This is prudent, but considering that they have a very small staff, then I chose further without seeing people and focusing on their banal place of residence - why would I wait for a midwife from Pushkino if there is a person living closer?

The midwife asked me to ask her questions via WhatsApp, but I, like a mossy retrograde, do not have this type of communication. So then our communication went either through my partner, who had WhatsApp, or I sent her an SMS clarifying the possibility of a call. So before the birth, we communicated directly only once more - she was almost constantly at the birth, and once wrote that she spent the whole week with women in labor. And although I checked whether she really had the period of time I needed free, such popularity began to alarm me - on the one hand, this is an indicator of professionalism, on the other - if a person does not have time to simply rest, then will he be able to fully work indefinitely when the time comes? hour X?

In Obstetrics.Club there were two types of contracts - simply accompaniment of a midwife (50 rubles in 2017) or with additional patronage after leaving the maternity hospital (55 rubles). The partner insisted on the second view - let them show us everything again at home, tell us everything, look at the baby... Well, let it be.

My partner asked me to choose whether I wanted him to be present at the birth, and I hesitated for a long time. But in the end I decided that I wanted to. I wrote about the participation of a partner in the process of childbirth and after, and a small instruction for men in the section “Partner childbirth”. Just in case, I asked my partner to take a week off.

In general, I was surrounded by contracts and support from all sides, and hoped that I had not just laid out a straw, but had simply wrapped myself in it. Well, in vain, of course. As they say, if you want to make God laugh, tell him about your plans.

4) The story of my birth

And now comes the actual story “how I did it.”

I, like all other women in labor, was given my PDR on the day of my last period. Intuitively, this number suited me quite well, so there was somehow no doubt. I planned my affairs in such a way as to free up this week and the next - it’s not clear what and how it will happen.

Before the PDR day, I didn’t feel any precursors, and on the PDR day itself I felt as good as possible. Therefore, I came for a scheduled CTG and ultrasound, and at the same time an appointment with my doctor. Before this, all appointments took place with Antonova, a doctor at the emergency department. CTG did not raise any questions, we did it as usual, sitting, everything was normal. But during the ultrasound, the doctor started asking me where I was getting my water - and in response to my stunned face he said “oligohydramnios”. The attending physician, having looked at these conclusions, strongly suggested that I go to the pathology department today in order to take tests tomorrow morning and then make a decision based on this. I repeat, I live 15 minutes on foot from the maternity hospital, so I started begging to come tomorrow morning - but they asked me to go to bed in the evening so that in the morning I would already be registered at the department. They gave me a reprieve until the evening, so I still went on planned errands, took all (all, all!) of the trunks prepared for childbirth, and in the evening my partner and I went to go to the pathology department under compulsory medical insurance, because this trick is not included in the contract. In pathology there are paid wards, but in my case this did not make sense - the stay was expected to be too short.

During the appointment, the CTG was performed lying down, and it suddenly became incredibly bad. I was wary, and so was the doctor from the pathology department. She was warned that I would go to bed, but with the CTG during the day everything was fine. As a result, they decided to put him in the “diagnostic” ward for now, where they will constantly take CTG. The employee accompanying me, looking at my 4 huge bags, brought a cart. So I then moved around the maternity hospital - with an escort and a cart with luggage. Most of all it was like checking into a luxury hotel.

They put me back in the diagnostic ward, attached sensors and began taking CTG. It was bad again and I started to get upset. But at some point I got tired of lying down, and I tried to lie on my side, and - oh, miracle! – the indicators immediately returned to normal. After another hour, we discussed the situation with the pathology doctor, and she decided to transfer me to pathology.

By one o'clock in the morning I found myself in the department, where, out of the kindness of my heart, I was given a separate room. And very good.. As soon as I tried to lie down, contractions began. The most real ones that I have not yet known. I was incredibly happy - hurray, it all started on its own, but it was difficult to sleep. But from all the courses I remember the main thing - you need to get enough sleep before giving birth. And in general, you need to get some sleep. And during contractions you need to get enough sleep. It was somehow uncomfortable to sleep, so I either ran to the toilet next to the ward or lay down. If I had a neighbor, I would definitely feel uncomfortable. Finally, around four in the morning, it dawned on me that the contractions were stopping when I sat up. So I covered myself with pillows, sat down, and after texting my midwife and partner, I dozed off. And the next morning, when my partner, concerned about my SMS, called me, I suddenly felt so offended (hello, hormones!) that I simply sobbed into the phone. And I felt offended by the fact that I had everything paid for - both the delivery room and the presence of a soft, cozy partner nearby, but what instead? Instead, I am suffering alone all night, and not a single living soul is nearby. Moreover, sobbing into the phone, I realized the delirium of my offense, so I sobbed through laughter, which frightened the caller even more. He finally rushed in 20 minutes, and, it seems, in slippers

Meanwhile, the head of the department and my attending physician came into the room. After spending the night with almost no spam, I was eager to go to the delivery room - for some reason it seemed to me that happiness would finally await me there. Since there were contractions, I was transferred to the labor room, where the attending physician began to examine me. Here I want to note a very important point - the doctor told in great detail what was happening and how, what the forecasts were, what we would do next. He began to puncture the bladder (it doesn’t hurt at all), and it was at that shock moment that my partner burst into the room. The second important point is that the doctor’s eyebrow didn’t even twitch. He met his partner, and in the same calm voice began to explain to his partner what was happening, what strategy of behavior next.. I was in admiration, because I always “need to know what is here, what for and why.” After the puncture of the bladder, we again did not find any water . Therefore, it was recommended to do a CTG. At this point, our midwife arrived, a CTG machine was brought into the room, and she took a CTG scan for me. Since I was sitting, it was normal again. It only dawned on me later that due to the small amount of water, the child was comfortable when I stood or sat, and his head was in the water, but when I lay down, the water spread and he felt unwell.

Meanwhile, the contractions had almost stopped. Then I remembered a moment from the book about Shopaholic - everyone has gathered, the partner, the midwife, the attending physician, the head of the department are standing - and I’m not giving birth. Thank you everyone. It’s good that we didn’t order a photographer for the birth.

The doctor looked at me and suggested that I wait a couple of hours - perhaps the contractions would resume. The weather outside was wonderful, and we went for a walk around the territory of the State Clinical Hospital. After 2 hours we returned to the ward and the situation repeated itself - the CTG was ideal, the contractions were irregular and weak.

At this point, the doctor counted down the time from the puncture of the bladder, and again, calmly and in detail explained that we could wait for so much more time, then we would have to do something. Or, the second option is a caesarean section.

Now I'll go back to the midwife. Since nothing hinted at a cesarean section, I, of course, talked to her about natural childbirth, in which most of the time she is busy with me and generally leads the process. Since everything did not go as we expected, she waited patiently in the break room, coming to do a CTG and talk to the doctor. A midwife can also be hired for a caesarean section, but her role there, of course, is much less. However, I checked with her whether she would be with us during the caesarean section and after. Having received an affirmative answer, I calmed down. When choosing a midwife, medical experience in the role of an ordinary ward midwife was important to me (it is clear that such a number of different births as in compulsory medical insurance cannot be found in any paid clinic) and I hoped that she would be an intermediary between me and the doctor in terms of expediency certain actions, their consequences, etc. The doctor, as I mentioned above, explained everything perfectly, did not put pressure, and gave the woman in labor the opportunity to make a decision (naturally, within the limits of the possible). But our midwife always simply agreed with the doctor, and subsequently - not only with the doctor I chose, who was well known to her, but also with pediatricians unknown to her. I am alarmed when a person, without fully understanding the situation, answers: “Since the doctor said so, do it.” Doctors, unfortunately, are also different. This was the first not very pleasant nuance.

Well, in the meantime, it became clear that there was really nothing to wait for, so, after a brief consultation, we agreed to a caesarean section. I won’t describe the caesarean itself, the operation is well proven and flows. The partner, who had previously put on a disposable gown and headgear, was allowed to the glass doors (not inside) of the operating room and the monitor was turned towards him, allowing him to take off, because We both wanted to watch the progress of the operation, but there was only one monitor. Of course, instead of taking pictures, someone pressed the wrong button, so I never got to see the operation. But my partner watched it in all its glory through the monitor. for some reason, you don’t have to turn the monitor - then the person will only see your “talking head”, because Almost all the time of the operation there is an opaque divider between the chest and abdomen. I had a so-called “soft caesarean section”, i.e. they asked me to push so that the baby’s shoulders would go through (I, frankly, thought that this was a profanation purely for me, so that the woman in labor would think that she was really giving birth - but my partner assured that the doctor made such a small incision that he could not pry up the shoulders, and while I I didn’t push, the baby didn’t appear). Before the operation, spinal anesthesia is given (epidural is one of its types). In fact, this is a stab in the back, because... Again, I didn’t have much pain. But pushing when you can’t feel the muscles is a very strange sensation.

I would also like to note this point - during the courses we were told that it is very important to let the umbilical cord pulsate. Of course, during a cesarean section this moment is reduced, but the doctor himself gave time for this, and he himself monitored the right moment. As the partner said, this was the longest moment of delay during the entire operation. And after the birth of the child, the doctor asked us three times if we needed a placenta (it’s good that we took courses, otherwise we would have been shocked by such a question - practitioners of “lotus birth” or something like that need this).

When the child was born, he was treated by a neonatologist - a doctor who examines all newborns. At that moment, the partner was brought into the operating room and, after a medical examination, the child was immediately placed in his arms. After the examination, the midwife squeezed a drop of colostrum from my breast and placed the baby on it (I was still on the operating table at that moment). She then escorted her partner back to the delivery room, deftly changed and swaddled the baby, and, placing the newborn in her partner's arms, left. Since it was unknown how long it would last and what to do, the man simply carefully sat down with the child in his arms on the fitness ball (there was nothing else to sit on, the couch was high) and waited. And here was the second point that I didn’t like - they didn’t put the child “belly to belly” of the partner, and they didn’t even show how to swaddle. Although we discussed the moment of applying to the stomach at the initial meeting, apparently, with so many clients, she simply forgot about it. Or she didn’t like us as clients - I didn’t bother her from morning to evening with questions, minded my own business and, perhaps, in her opinion, paid little attention to the upcoming birth. It would be more honest for me if they immediately told me that I was not suitable as a client - and that would be normal, after all, there should be some kind of mutual understanding between the midwife and the woman in labor.

It’s hard for me to say where our midwife was the rest of the time, because... She came to me, as we later understood, immediately before she left, i.e. 2 hours after the birth of the child - measure my waist to buy a postoperative corset. Since she didn’t say goodbye, I thought that she had left to take care of the child, because... she was clearly in a hurry. As it turned out, she told her partner the parameters (unfortunately, without measuring the height of the corset and giving incorrect recommendations on this point), and left. In total, we had a midwife from about 10 a.m. to 8 p.m. It seemed to me that labor (especially for first-time mothers) could last longer.

We never saw our midwife again. A few days later, on WhatsApp, she asked her partner how I was feeling. We wrote to her one more time when the question arose about whether it was worth giving the child an artificial formula before the milk came in, as the pediatrician on duty suggested to us. Here was the answer: “Do as the doctor says.”

Postnatal care was carried out by another employee of the center, since our midwife was ill. Here we had no choice, just a free employee arrived, I didn’t even really understand if she was a midwife. She called herself a breastfeeding specialist, and for some reason she forced us to bathe the child, whose umbilical wound had not yet healed, in a large bathtub with tap water (despite the fact that I had no burning desire to bathe the child until the wounds healed). Regarding breastfeeding, she showed several poses, but did not say any nuances about flat nipples, large breasts - in general, atypical cases. Either she didn’t know, or she didn’t pay attention. I didn’t see any particular benefit in terms of breastfeeding again. In general, my feelings about the institute of personal midwives were very ambivalent. Perhaps due to the fact that in my situation there was simply nowhere for the midwife to demonstrate her abilities. Probably if it had been a completely natural birth, my opinion would have been completely different.

Another positive thing, funny as it may seem, was the postpartum ward. As soon as we found out about the caesarean section, I said that we would pay extra for the place and take a separate room. The midwife was asked to negotiate this, and I don’t know what was the decisive factor: either her authority, or the staff’s sympathy for the postoperative woman in labor, or maybe just luck - but we were given the best, “family” ward. Unlike ordinary double rooms, it had three beds, a wardrobe, a floor lamp that provided a very pleasant half-light, and even a shower. If this was the midwife’s initiative, then I am very grateful to her for it.

As for the operation itself, here is my complete and boundless gratitude, of course, to our doctor. The incision was made as low and narrow as possible, the threads were self-absorbable. After the baby was born, while I was being stitched up, the doctor talked to me periodically, so I wasn’t bored. As expected, after the operation I was transferred to the intensive care unit (ICU), where nurses monitored the condition of those who gave birth. I can say that neither in pathology, nor in postpartum, nor in the PICU did I see any difference between the attitude of employees towards paid and free patients. In the PICU with me there were two women who gave birth free of charge - the nurses were just as attentive (if not more - I somehow felt better, apparently) approached them, gave them painkillers, and performed the necessary procedures.

The only difference (thanks to the contract and the presence of a partner who was with the child at the time) was that they were allowed to bring the child to me. Every two hours, my partner came with the baby, and we tried to put him to the breast. Of course, our attempts were inept (and I couldn’t help, because my hands were fixed with an IV and pressure measurement). Therefore, the PIT staff, taking pity, helped both attach and change the baby (watching videos about swaddling on YouTube by a partner helped at least somehow swaddle, but, of course, a person performing this procedure for the first time is far from experienced nurses). There, at the PIT, they brought me a document about vaccinations (consent or refusal) to sign.

Since I felt quite normal, after the promised 6 hours I was brought to the postpartum ward. And then (the anesthesia had just worn off, apparently) I felt the effect of a Caesarean section - my shoulders and shoulder blade ached wildly. So wildly that I could not breathe, let alone sleep. I had to urgently call a doctor. First, my ward doctor came in postpartum and offered to put on a drip with painkillers. When this had no effect, the operating doctor was called. He suggested that this was the effect of spinal anesthesia in areas prone to osteochondrosis (to be honest, I didn’t have osteochondrosis before that). The situation with the spatula was explained more simply - when they transferred me from the operating table to the gurney, the sisters disagreed on the count, and I flew away diagonally. Apparently, it was at that moment that the shoulder blade was pressed into the lung. To be honest, this is a matter of chance, I don’t think anyone deliberately intended to do this

But in the end the night was enchanting - I settled down in a strange position, where I could somehow breathe and sleep, and dozed off. The next morning, when we both came to our senses, we remembered our favorite home device for treating all sorts of bruises, sprains, and other things. My partner went home and brought him back, and I felt much better. But I’m writing about this situation for someone else - when I was choosing a maternity hospital, I was glad that it was part of the City Clinical Hospital - if necessary, specialized specialists would come. So, for 5 days (after a cesarean they keep that long), the ward doctor repeatedly promised that a neurologist would come to see me - and in the end he never came, so the presence of other doctors in this case turned out to be a fiction, it’s better not to count on him too much .

Then our newborn life began to flow. I was able to get up on the third day (if we count the first day of the operation, when I was returned from the intensive care unit at midnight). The toilet with shower was located opposite the room, it was very convenient. By the way, in the first days I used the shower in the toilet, despite the presence of a shower in our room. This can be explained simply - in the general shower the tray is lower, and bending my legs and bending over was still a bit painful for me. But before being discharged, I happily washed myself in my own shower stall (how does that sound, huh?) and even calmly washed my hair.

There is also a cooler and a kettle with a hot drink on the floor (they make different drinks, and the rosehip infusion turned out to be very tasty). The posts of the adult midwife and the pediatric midwife are located in different places.

The supplement for the second place does not include food (“they didn’t promise to feed me on the way”), so the next morning the partner went home to get food and necessary things. Since we had such an opportunity (that same vacation), and I had not gotten up yet, we decided that he would spend as much time as possible with me in the ward.

Naturally, as soon as he left, the rounds began. Rounds are carried out from 11 to 14, the ward doctor-gynecologist, pediatrician and nurses come - all at different times. Unfortunately, most of the employees do not have badges and do not introduce themselves, so I will not be able to give the names of the doctors and nurses.

Incubators for children do not have height adjustment, and with my height of 158, it was simply difficult for me to reach the child - I had to stand on tiptoes, or pull myself up with my hands if the incubator was installed above the bed (it can be rolled up so that the child is above the sitting person). mom's couch). Postpartum women who are taller (and have healthy arms) will not have any problems

In general, if you are not getting up yet, then it is better to have your partner stay with you until the end of the rounds. I got up on the third day, and by the time I was discharged I was already running up the stairs quite confidently.

In each ward there are phone numbers for a “breastfeeding hotline”, posters about the benefits of breastfeeding and other propaganda items. However, breastfeeding was spoiled for me in this breastfed maternity hospital

But, as you can see, in many situations a partner is very necessary and his help is really invaluable.

5) Conclusions

In my case, the services of a midwife were probably unnecessary. Although, since I have nothing to compare with, I may simply not know what “charms” I avoided. But the contract with the maternity hospital came in handy to me in full, especially, including the possibility of having a partner present during the birth and after.

Therefore my conclusions are as follows:

1. for a natural first birth, a midwife is very necessary (of course, if you have such an opportunity); with a planned cesarean section, it is better to choose a doctor more carefully;
2. in any case, the presence of a partner is very, very important. If possible, it is ideal if a person takes a vacation for 7 days (they keep you in the maternity hospital for 3 days during a natural birth, and 5 days after a cesarean birth; spending a few more days quietly together at home to establish a routine will be very good) and all this will happen time with you;
3. concluding a contract with a maternity hospital does not affect the birth process (Cap!), but provides a lot of bonuses, ranging from preliminary acquaintance with the doctor to the possibility of relatives visiting you in the ward, the presence of a partner, etc. It would take too long to list everything, I’d better make a table.
4. the funniest, most obvious and incredible thing - be positive. Ideal childbirth is a spherical horse in a vacuum, it may occur in nature, but for the first time it is a utopia. No matter how much information you learn, something will go wrong - you won’t want to get into the bathtub, you’ll forget to press the contraction counter, or your water will break at the wrong moment. Therefore, be prepared for surprises and take them with humor. After all, an amazing surprise awaits you!

Easy birth and health for mothers and babies!