What is the difference between a perinatal center and a maternity hospital? Obstetrics and maternity hospitals in Tsarist Russia

The Perinatal Medical Center is a specialized medical facility focused on the needs of expectant mothers. The main tasks are the diagnosis and treatment of infertility, assistance in maintaining pregnancy and conducting labor. Moreover, the perinatal medical center provides comprehensive assistance in the postpartum care of a mother and her child. Thus, mandatory coverage of the full cycle of family planning is assumed, starting from the moment of conception and ending with postpartum activities.

Perinatal center and maternity hospital: differences

What are the main differences between these two medical centers?

A perinatal center may have a maternity ward, and there is no perinatal center in the maternity hospital. Thus, the perinatal medical center is a wide-profile clinic aimed at managing pregnant women and young parents. In addition, it is in the center that they can contribute to the successful solution of the problems of conception.

Among other differences, it is necessary to note the technical equipment, which is perfect. In most cases, medical centers offer only modern equipment that allows medical personnel to provide personal services to expectant and new mothers at a decent level.

Almost every perinatal center can boast of its own team, which includes representatives of medical universities and people involved in research work. The team is capable of developing state-of-the-art standards for pregnancy monitoring and, in some cases, treatment.

Who should apply to the perinatal center?

Some categories of citizens can be sent to the perinatal center:

1. Families who are forced to face problems in conceiving a baby.
2. Women who face difficult pregnancy.
3. Women with a history of miscarriages.
4. Pregnant women who have a danger to the life of the fetus or the expectant mother.
5. Pregnant women suffering from serious pathological processes.

It should be noted that childbirth should be carried out in a perinatal center if special medical assistance is expected. At the same time, care can be successfully provided at a level that is inaccessible to most maternity hospitals.

In addition, employees of perinatal centers may conduct childbirth if women are included in a high risk group.

How can I get to the perinatal center?

Taking into account the serious lack of wide-profile centers and the large number of people who still prefer the perinatal center over the maternity hospital, not every citizen can count on free services. In most cases, a range of services is provided only on a paid basis. However, the cost can skyrocket. What to do if you need to register at the clinic for free? How can the opportunity be used?

1. The first step is to have a telephone consultation.
2. In most cases, you need to provide a referral received in the antenatal clinic. The main task is to fully explain the reasons, to confirm a certain diagnosis.
3. The advantage remains with women who live in a village or village, because in such settlements there is initially no opportunity for full-fledged medical care.
4. In fact, every woman can independently choose the right perinatal center. However, the problem is related to the lack of vacancies, since the institution cannot be overcrowded based on norms. Otherwise, an epidemiological spread of nosocomial infection may occur.

Without a doubt, if you manage to successfully contact the perinatal center and agree on interaction, you can play it safe and use all the chances to find a full-fledged family that will certainly be happy.

What is required for registration in the perinatal center?

It is mandatory to go through registration at the perinatal center by contacting the admissions department. The following package of documents is expected to be provided:

1. Passport (first page and registration in the form of the original and a copy).
2. Medical policy.
3. SNILS.
4. Test results, all consultation statements, exchange medical records.
5. Generic certificate, which must be made based on the established pattern.

When registering for the antenatal ward, you must bring toiletries, washable slippers, and change of clothes with you. It should be noted that this is similar to maternity hospitals, where it is also assumed that a complete set of personal belongings is required.

If you are interested in the maternity ward, you need to take drinking water in a small bottle and special postpartum pads.

By fulfilling the appropriate requirements, you can successfully give birth to a baby who can be healthy.

Perinatal center or maternity hospital?

In most cases, perinatal centers are developed in big cities based on the latest trends. Moreover, only highly qualified personnel should work in such institutions. Taking into account such standards, one can only count on positive feedback.

Maternity hospital I Maternity hospital

a medical institution designed to provide inpatient and outpatient care to women during pregnancy, childbirth and gynecological diseases, as well as medical care for newborns until discharge from the maternity hospital.

The main tasks of the maternity hospital are to provide women with inpatient obstetric care during pregnancy, childbirth and after childbirth; ensuring proper nursing of newborns and qualified medical and diagnostic care for sick and premature babies; providing medical and diagnostic assistance to gynecological patients; work on hygienic education, promotion of a healthy lifestyle; transfer of patients according to indications to other medical institutions; implementation of rehabilitation measures and issuance of recommendations for their implementation after discharge from the obstetric hospital.

II Maternity hospital

medical and preventive institution designed to provide medical care to women and their treatment during pregnancy, childbirth and in the postpartum period; the composition of R. d. includes a hospital and.

1. Small medical encyclopedia. - M.: Medical Encyclopedia. 1991-96 2. First aid. - M.: Great Russian Encyclopedia. 1994 3. Encyclopedic dictionary of medical terms. - M.: Soviet Encyclopedia. - 1982-1984.

Synonyms:

See what "Maternity Hospital" is in other dictionaries:

A medical institution that provides assistance to pregnant women, women in childbirth and puerperas. Usually there are antenatal clinics at the maternity hospital, gynecological departments in large maternity hospitals ... Big Encyclopedic Dictionary

A medical institution that provides assistance to pregnant women, women in childbirth and puerperas. Usually maternity hospitals have antenatal clinics, large maternity hospitals have gynecological departments. * * * MATERNITY HOSPITAL MATERNITY HOSPITAL, medical… … encyclopedic Dictionary

The very first maternity hospital in Severodvinsk, now the Severodvinsk City Museum of Local Lore Maternity hospitals provide qualified medical care to women during ... Wikipedia

Medical and prophylactic institution designed to provide medical care to women and their treatment during pregnancy, childbirth and in the postpartum period; R. d. includes a hospital and a women's consultation ... Big Medical Dictionary

In the USSR, a medical and preventive institution that provides qualified medical care to women during pregnancy (See Pregnancy), childbirth (See Childbirth), the postpartum period (See Postpartum period) and gynecological ... ... Great Soviet Encyclopedia

Medical and prophylactic institution that provides medical care to pregnant women, women in childbirth and puerperas. (

It is no secret that the success of childbirth largely depends on how confident and comfortable the expectant mother feels. But most women are worried before childbirth, and for some, the arrival at the maternity hospital becomes stressful - after all, this is a completely unfamiliar medical institution. How is a maternity hospital set up? Let's take a closer look at the place where our long-awaited baby will appear.

Any maternity hospital begins with the admissions department. It is here that a woman comes with contractions or with some complication of pregnancy. The expectant mother entering the maternity hospital is first met by the midwife on duty: she will take an exchange card, offer to change shoes, and then escort her directly to the emergency department. The admission department usually consists of two reception and examination chambers isolated from each other: in one, they receive patients entering the maternity unit or the pathology department, in the other, those who need to go to the observation department (unexamined women without an exchange card or those patients who have any infectious disease). In each of the reception and examination chambers there is an examination room with an examination couch and a room for hygiene procedures with a shower and toilet. Here, the obstetrician-gynecologist will examine the expectant mother, draw up her documents, then the midwife will help her to do the necessary hygiene procedures (shave the perineum, give an enema), give out an individual set of linen - a dressing gown, a shirt, a diaper. Then, depending on the result of the examination, the patient is sent to one of the departments of the maternity hospital: a maternity unit, an operating unit, a pathology department for pregnant women, or an observational department.
The maternity block is the department where childbirth takes place, women with contractions enter it. In modern maternity hospitals, the maternity block consists of individual boxes, in each of which only one woman gives birth. In boxing there is a bed on which a woman in labor can rest during the first stage of labor (when contractions are going on); a special chair (Rakhmanov's bed) - on it the birth of the baby takes place; a CTG machine and a changing table with a heating lamp - here a newborn baby will be weighed, measured, and here he will make his first toilet. In addition, each box has a separate bathroom and shower. Thanks to this system of boxes, childbirth becomes an individual event: even if several women give birth at once, they do not interfere with each other, and future dads will be able to be present at the birth of the baby. In maternity hospitals of the old design, the maternity block consists of prenatal wards, in which several women can be, and a common delivery room. In the prenatal ward, expectant mothers wait out the first stage of labor (contractions), and before the start of attempts, the woman is transferred to the delivery room, where she gives birth to a child and afterbirth. Both the prenatal ward and the delivery room are fully equipped with everything necessary for the woman in labor and the baby. In rodblocks with a similar design, a shared shower and toilet are located in the corridor.
The mother spends the first two hours after giving birth in the maternity ward: doctors constantly monitor the woman during this time. Then, making sure that there are no complications, the doctor gives the go-ahead to move the mother to the postpartum ward.
Operational unit - childbirth takes place in it by caesarean section. A woman can be referred to the operating unit from the admission department if she needs an urgent caesarean section, or from the pathology department when a planned operation is due. The operating block consists of several operating rooms and a preoperative room, where doctors and midwives prepare for surgery. Immediately after a caesarean section, a woman is transferred to an intensive care unit or ward, which is equipped with equipment for constant monitoring of the patient's condition. There is a doctor or midwife in the intensive care unit at all times.
Postpartum department - mothers who have already taken place come here - immediately from the birth unit or from the intensive care unit after a cesarean section. Depending on the maternity hospital, the wards where women are after childbirth can be single, double or multi-bed. If the maternity hospital does not provide for the joint stay of mother and baby, then in the postpartum department there is also a “children's” ward, where newborn babies are under round-the-clock supervision of children's nurses and a pediatrician. However, today in many maternity hospitals there are “mother and child” wards, where the mother constantly lies with the baby. In addition, women who have contracted for childbirth can live in comfortable “family” wards with their dad or someone close.
Also in the postpartum department there is always an examination and treatment room, an ultrasound room and a dining room.
It is known that expectant mothers are very afraid of the words "observation department" - this is the name of the department where there are unexamined patients or women with any infectious disease (ARVI, influenza, etc.). In fact, there is nothing wrong with this department. The observational department is a mini-maternity hospital in a maternity hospital: with its own maternity unit, operating room, postpartum department. The only difference from ordinary wards is that in the observational department all the wards are always individual, and the sanitization of all rooms is carried out more often than in other departments (which can only please parents). In some maternity hospitals, relatives are even allowed to visit here; in addition, often in the observational department there are also “family” wards!
Department of Pathology of Pregnancy - in it are women with any complication of pregnancy (threat of interruption, preeclampsia, etc.). It usually includes chambers, treatment rooms, an examination room, a dining room. Shower and toilet can be both in each room, and one for all.

If, until recently, the maternity hospital was a completely closed institution, into which outsiders were not allowed, today the situation has changed. The expectant mother can choose the place where her child will be born, and the conditions in which this will happen; get to know the birth doctor and discuss your wishes with him. A woman has the opportunity to invite relatives (husband, mother, girlfriend) or a psychologist to the birth, as well as make a preliminary tour of the maternity hospital in order to learn more about the place where one of the most joyful days in her life will pass.

A maternity hospital is a medical institution designed to provide outpatient and inpatient care to a woman during pregnancy, childbirth and gynecological diseases, as well as medical care for newborns from birth to discharge from the maternity hospital. The maternity hospital includes a antenatal clinic (see Consultation) and inpatient departments, laboratories, treatment and diagnostic rooms, and administrative and utility rooms.

Stationary part of the maternity hospital consists of the following mandatory departments and premises.
1. The reception and examination department, in which pregnant women and women in labor are admitted, consists of a reception room, a filter, an examination room and a shower room. In the admission and examination department, the midwife conducts a survey and examination of pregnant women and women in labor (measuring the pelvis, weighing, measuring height, determining the position of the fetus, listening to it, etc.), as well as them. From this department, healthy women in labor are sent to the physiological maternity department, and pregnant women and women in labor with an infectious disease and suspected of an infectious disease are sent to the observational obstetric department. Pregnant women who need inpatient treatment or stay in a hospital for preventive purposes, or to clarify the diagnosis, are sent from the admission and examination department to the department of pathology of pregnancy.

2. The Pregnancy Pathology Department is intended for hospitalization of pregnant women with a aggravated obstetric history, abnormal position of the fetus, polyhydramnios, multiple pregnancies, patients with cardiovascular and other non-communicable diseases. In large cities, some maternity hospitals specialize in providing medical care for a particular type of obstetric and extragenital pathology (for example, in case of miscarriage, cardiovascular diseases, etc.). In research institutes of obstetrics, specialized assistance is provided to pregnant women and women in childbirth in many types of pathology.

In the department, in addition to the wards, there are manipulation rooms, treatment rooms, bathrooms, rooms for staff, etc.

3. The physiological labor department consists of prenatal wards, labor wards (for 1-2 beds), rooms for the first toilet, small and large operating room with preoperative and sterilization; rooms with light and sound insulation for patients or preeclampsia; bathrooms and other facilities. The presence of two delivery rooms allows for their cyclic functioning: while one delivery room is full, the second one is being cleaned and disinfected. The number of beds in the prenatal wards is approximately 12% of the total number of beds in the physiological postnatal ward, and in the delivery rooms - 8%.

4. The physiological postpartum department consists of wards for 1-4 beds, a manipulation room; rooms for expressing and storing breast milk; bathrooms, staff rooms, etc. The total number of beds in the wards of this department is 50-55% of all beds in the obstetric departments of the maternity hospital. In addition, 10% of the beds (in excess of the regular ones) are provided to comply with the cyclical filling and emptying of the wards and the implementation of the sanitary and hygienic regime. This requirement also applies to the observation unit and the neonatal unit. Such a system makes it possible, when discharged from puerperas, to completely empty certain wards and perform thorough cleaning (washing, irradiation, airing, etc.) of both maternal and children's wards. The puerperal is in the maternity hospital during the normal course of childbirth and the postpartum period of 7-8 days; her discharge from the maternity hospital with the child is carried out through the discharge room. At discharge, the mother is given a certificate of birth of the child, on the basis of which, in the antenatal clinic, the woman is given a sheet of temporary disability for the whole. The maternity hospital reports each discharged child to the nursery at the place of residence of the mother.

5. Observational obstetric department is intended for the reception of pregnant women, women in labor, delivery and treatment of puerperas and newborns who are or may be a source of infection (parturient women with fever, dead fetus, puerperas with, dead fetus, with skin pustular diseases, etc. .); puerperas are also transferred here from the physiological postpartum department in case of their illness or illness of the child. The department also admits women after childbirth at home or on the road. The department is strictly isolated from other departments and premises of the maternity hospital. It includes: a maternity ward, postpartum wards for 1-2 beds, a maternity box with a separate external entrance for especially strict isolation of a pregnant woman, a woman in labor or a puerperal with a newborn. The total number of beds in the department is approximately 20-25% of all obstetric beds in the maternity hospital.

6. The department for newborns consists of two parts. One is intended for children whose mothers are in the physiological postpartum ward, and the second is for children whose mothers are in the observational ward. Each part is strictly isolated from each other and from the mother's chambers and other rooms. Separate rooms are provided for and children with. It is recommended to have locks in front of the wards (usually for a group of wards).

7. The gynecological department consists of a surgical department and a department that uses conservative methods of treatment. The gynecological department is completely isolated from obstetrics, has its own reception and examination room, discharge room and other rooms.

The medical staff of the physiological department, the department of pathology of pregnancy, the department of newborns does not come into contact with the staff of the observational department. All employees of the maternity hospital, upon entering the duty, take a shower, put on a light (not woolen) dress, a clean dressing gown, a hat, and slippers. In addition to medical work, the staff of the maternity hospital conducts a lot of sanitary and educational work among women - they conduct lectures and talks on nutrition of a nursing mother, care for the mammary glands, sexual hygiene, etc.

What are maternity hospitals like in Russia and what is left of Soviet medicine in them, why do doctors treat patients as a “broken mechanism” and how ready are women in cities and villages for childbirth?

Anastasia Novkunskaya, a researcher at the European University Gender Studies Program, spoke with women in labor, doctors and obstetricians during her research. She said "Paper" how in Russia they provide medical care to women during pregnancy and childbirth and what problems they face in maternity hospitals.

Anastasia Novkunskaya

Sociologist, researcher of the program
"Gender Studies" European University

How maternity hospitals are arranged in Russia and why
not everywhere can help women with difficult pregnancies

Over the past 20–30 years, the Russian system of obstetric care (providing medical care to a woman during pregnancy, childbirth and after them - approx. "Paper") is constantly being reformed. There are some pretty good structural decisions - for example, hospital administrators are positive about the routing system that was introduced in 2012. This system assumes that all maternity facilities within the region are divided into three levels.

The first is small maternity wards, where they take no more than 500 births a year. They are located 200-300 km from the city, and there are three to five obstetrician-gynecologists and the same number of midwives.

The second level includes maternity hospitals, which are equipped with resuscitation beds, large teams of specialists and serious equipment. There are two or four such maternity hospitals per region. Third level institutions are perinatal centers and institutes of obstetrics and gynecology. They deal with complex births.

If a woman's pregnancy [flows] with risks, then she will be taken to the hospital and provided with super-technological assistance. At what time a woman will be taken to the third level depends on the pathology. Sometimes the informants were [in the hospital] four months before giving birth and the same amount after.

First level institutions are not prepared to assist in case of serious pathology. Such cases cannot be foreseen. You cannot, once a woman is pregnant, put her in a perinatal center.

Since 2006, a system of birth certificates has been introduced, which allows any woman, wherever she is, to give birth in the institution where she wants. Birth certificates are an ephemeral amount of money allocated by the CHI to women. It is interesting for maternity hospitals that as many women as possible give birth to them, because this way they will receive more compensation from the MHI. However, this does not always work - for example, one can get into the federal center either on a quota basis or on a self-financing basis.

Since 2015, we have had single-channel funding, that is, an institution cannot receive money from the city or district administration. The maternity hospital receives as much money as it accepts patients. Therefore, small departments that receive 200-300 births per year have become unprofitable. The hospital can't afford to keep five full-time gynecologists, five midwives, and maintain equipment for nothing at all in a year.

Another problem: doctors working at the first level are losing their qualifications. Until 2012, they could take difficult births. Now, when a woman is supposed to go to a cool perinatal center, but the day before she goes into labor, she finds herself at this first level, where doctors are not ready to work with her, because they haven’t taken difficult births for a long time. In addition, they may simply not have some drugs that are not supposed to be given to the maternity hospital because of the assigned level. For example, a hospital may not have pulmonary surfactant, which expands the lungs and is needed if the baby was born prematurely.

There are regions in which my colleagues worked - for example, the Yamalo-Nenets Okrug or the habitats of nomadic tribes. There are two or three hospitals per region, and routing is carried out by helicopters. The problem is that these are nomadic tribes that are engaged in reindeer herding. This is a whole quest - to pick up a pregnant woman, to deliver to the hospital. According to the law, air ambulance to the hospital is paid, and back - as you wish, no matter where you live. But to understand where your tribe went while you were in the hospital for a month is quite difficult. I was told a story about how a woman was landed at one station, and then she was looking for her children on dogs with a newborn in the snow.

Why are births so expensive in Russia?
and how they work in other countries

Our system of obstetrics is not sensitive, because the model is transferred from Western European countries. In Canada, such a system works, but there is a different way of transport communication, [sanitary] aviation. In addition, only midwives work for them at the first level. In Holland, a few years ago, 40% of births took place at home under the guidance of a midwife. If the pregnant woman has no problems, then the midwife delivers without doctors. It's just cheaper.

In our country, according to the legislation, a midwife cannot independently practice, so childbirth in Russia is expensive. Even if you have a trouble-free birth, you need the whole team: a neonatologist, a nurse, an obstetrician-gynecologist, a midwife, as well as five days of hospitalization, food, and more. In Russia, it is always assumed that something can go wrong.

We can assume that [birth] is a natural physiological process where no doctor is needed. This is the Dutch system of childbirth. Or we can describe childbirth as a manifestation of an illness, as something very different from the norm of the human body. In Soviet medicine, there was just such a model of health care: when the patient was understood as a broken mechanism and it was not so important to know what he feels, worries, whether he is comfortable or not.

Or maybe there is a third approach, which, on the one hand, assumes that something can happen, and on the other hand, that a person needs to be provided with comfort not only physical, but also psychological.

Anastasia Novkunskaya performing at science slam"Papers" in June. Photo: Alexander Palaev

At the micro level of my research, I considered the experience and experiences of the informants. If a negative experience [of childbirth] happens, then the mechanism of finding the guilty one is activated. It is very difficult in such a situation to say: "it's my fault" or "I myself brought the child to such a state that he died during pregnancy." This is an almost impossible narrative, even if, for medical reasons, it happened.

But for the woman herself it is difficult to admit this thought in such circumstances, and therefore the search for the guilty is underway. Doctors, midwives, improperly built health care fall under the hot hand. But when we talk to doctors and professionals, they answer that they understand everything. They understand why it is important for the patient to say that they are to blame.

Why Russian maternity hospitals adhere to the Soviet approach and how doctors treat their patients

Russia largely inherits the Soviet approach [to obstetrics], Soviet healthcare. This happens because the buildings themselves have remained the same, and with them the technical capabilities. Many professionals worked in the Soviet maternity hospital and continue to reproduce the Soviet approach, because they consider it to be the right one. This is about a centralized system, and about the attitude towards the patient. The Soviet model is reproduced at all levels.

In one of my articles, I compared the maternity wards of the Central Regional Hospital (central district hospitals - approx. "Paper") - formally similar institutions. But the doctors had radically opposite views on who a doctor is, how he should interact with the patient, what childbirth is, how it should be taken, what is the ideal model, and so on.

I called one model “conservative pro-Soviet”: its adherents claim that the USSR had an ideal healthcare system, an ideal medical education, and that it makes no sense to retrain. They are a little older than those who are ready to be retrained. And they will describe the relationship with the patient like this: “she does not listen to me”, “everyone gave birth, and she will give birth”, “what is special about you”.

Specialists with a different approach were able to integrate new knowledge into their practice, not because an order came from above, but because they themselves wanted to and learned themselves. My colleagues and I have observed that in situations where the midwife or ob/gyn can take the initiative, the system becomes more flexible, open and comfortable.

Every state maternity hospital has self-financing. It is necessary to compare paid services in different maternity hospitals rather than talk about how a private maternity hospital differs from a non-private one. The money will help you to ensure a more comfortable stay: you pay for the room and the attention of specialists, which will not be shared with others.

Another point that they pay for, although it is legally free, is the opportunity to bring a partner [for childbirth]. Since 2012, you can not give birth alone in any maternity hospital under compulsory medical insurance. The problem is that maternity hospitals built according to the Soviet system and often not rebuilt until now, are a delivery room with several beds. And if you are giving birth at the same time as someone else, then it is quite obvious that the other woman in labor will not want to see your husband nearby. Therefore, if you have not paid for a separate ward, where only you and no one else will give birth, then technically it may turn out that your husband, mother or girlfriend will not be allowed. Therefore, they often pay for childbirth, not because they want a luxury ward and a doctor nearby, but simply so that there is a guarantee that the husband can be with you.

How prepared are women for childbirth and why is it becoming more difficult for adolescents to get counseling

Women with higher education are more aware of various nuances, prepare more for childbirth, read, know more about the field of sex education.

In rural areas, women, I would say, are prepared to a lesser extent. They just live in conditions where it is much more difficult. I had informants who live 270-300 km from St. Petersburg. There are no schools for the preparation of female motherhood - neither in antenatal clinics, nor in private ones. A woman can only read the Internet or a magazine. And in the antenatal clinic in St. Petersburg they will offer different courses. Our environment is open and free.

Another trend is connected with the neo-conservative renaissance, the greater role of the church in the cultural life of Russia. This trend is quite influential. Our medical informants say that 20 years ago it was much easier for them to get access to schools by going there once a year, but now access to schools is difficult.

I had an informant-midwife who worked in the teenage youth counseling center of the Admiralteisky district. She says that in recent years the number of incoming schoolchildren has dropped sharply - largely because parents write refusals for religious reasons. If there are one or two children whose parents have written a refusal, then it is impossible to bring the whole class, and it is quite difficult to do it in private.