What gives direction to the hospital. When do they give a referral to the hospital? What is a referral to a maternity hospital

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

Thanks to a birth certificate issued to a future woman in labor registered with the Women's Clinic, 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 are minimized for both the unborn child and the mother. Complications during childbirth, the threat of abortion, 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 registered for pregnancy. This innovation was a qualitative improvement in the medical care provided to women during the period of bearing a child and during childbirth. This program increases the material interest of health care institutions. This issue is regulated by the Order of the Ministry of Health and Social Development of the Russian Federation dated November 28, 2005.

Upon learning of pregnancy, a woman must be registered with the Women's Consultation at the place of residence up to 12 weeks. For the entire obstetric period, the future woman in labor visits her doctor stably twice a month, a total of 10 times. Such regular appointments and examinations, appointments of tests and observations provide timely diagnosis of complications and identification of dangerous pathologies.

According to this document, a pregnant woman is given the right to choose an observant doctor, the Women's Consultation for registration, in addition I have an opportunity choose the maternity hospital where the child should be born. A doctor cannot refuse a patient. However, women in labor rarely use this practice, since most of them either signed 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 staff and a place for childbirth, 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 in favor of 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 attending 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 belonging to a particular department.

All maternity hospitals in the country divided into three categories:

The condition of a pregnant woman and the peculiarities of the course of the entire period decide which category of institutions the attending physician from the Women's Clinic will refer her to. As a result of the decision direction will be given, with him you can go to childbirth already with contractions. And you can enter the chosen maternity hospital to save the pregnancy, when the appointed time has already come up, that is, it has exceeded 40 weeks. A woman in labor has the right to choose herself, taking into account the indications of a gynecologist and the existing pathologies of pregnancy, a specialized or ordinary maternity hospital.

Not all future mothers know when it is necessary and how to choose the right maternity hospital.

In Soviet times, our parents went to the nearest medical facility from home. Modern medicine gives pregnant women the right to choose any maternity hospital, depending on their requirements and taste preferences. A woman is not limited in choice, it is only necessary to fulfill several conditions.

Can I choose my own home?

In the last months of pregnancy, a woman is puzzled by the question of whether the ambulance will take her to the chosen maternity hospital.

Many future parents agree with the doctor in advance while the pregnant woman is registered. Normal practice is considered to be a preliminary acquaintance with your doctor and obstetrician 1-2 months before the due date (estimated date of birth).

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

At the first visit to the maternity hospital, the expectant mother is often offered to conclude a contract on a paid basis, they begin to acquaint her with the list of additional services. They require comfortable living conditions, the necessary medicines and the attentive attitude of employees. So, it will be possible to choose a separate ward and be in it with her husband, mother and other close relatives.

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

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

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

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

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

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

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

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

The essence and purpose of the birth certificate

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

Registration of a birth certificate helps to stimulate the desire of all healthcare institutions to provide assistance in gynecology, obstetrics and pediatrics. Hospitals are becoming interested in being equipped with certified drugs, as well as modern equipment.

To issue a certificate, you must perform the following steps:

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

Who can issue a birth certificate:

All citizens of the Russian Federation, regardless of age, the fact of official employment and registration.
Women with any condition of the fetus, with or without a legal spouse.
Citizens of other states with a temporary residence permit or a residence permit also have the right to issue a certificate.

The need to obtain a birth certificate

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

According to the birth certificate, a woman chooses a maternity hospital for herself, taking into account the peculiarities of the course of pregnancy. At the same time, the presumptive nature of childbirth (complicated or uncomplicated) is taken into account. When choosing a maternity hospital, it is strongly recommended to take into account the territorial sign (in the nearest place where the contractions began).

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

It will be necessary to obtain a birth certificate to select:

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

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

It is impossible to sell or cash out the certificate, it is not financial assistance. The main purpose of the document is to pay for medical services in public institutions. The certificate will not be accepted by commercial private clinics.

Is an ambulance obliged to take to the hospital and admission without a certificate

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

Even in the absence of a certificate, a pregnant woman will not be denied medical care. She will be able to apply to the maternity hospital only at the place of residence. The document gives the right to choose any maternity hospital, regardless of registration. Moreover, in the hospital itself, if a woman has all the necessary documents, she will be helped to issue a certificate on the spot. If a document is lost, it can be easily restored. Women's consultation will be interested in the efficiency of this process, since on the basis of it, funds for the services provided are transferred to the settlement account of the institution.

Modern maternity hospitals are divided into 3 types:

the predominance of uncomplicated childbirth (up to 500 babies are born a year), they do not provide for a round-the-clock stay of an obstetrician;
the birth of up to 1500 children per year (the department has an intensive care unit and intensive care units);
regional and federal institutions with assistance during pregnancy and the postpartum period (often there is a pathology department).

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

How to choose a maternity hospital?

Which is better to choose a maternity hospital - many women in labor are puzzled by this question starting from the first trimester of pregnancy. Future parents often visit several institutions, learn about the conditions offered, communicate with doctors and choose the best option. It is important that an agreement be concluded between the pregnant woman and the maternity hospital. The attending physician makes appropriate notes in the pregnancy chart. Only in this case, when the waters break or the onset of contractions, can an ambulance be required to take the woman to the maternity hospital of her choice.

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

the proximity of the institution to the house;
living conditions (presence of a separate shower, cleanliness, sterility, etc.);
availability of good medical equipment;
qualifications and experience of personnel;
the possibility of partner (joint) childbirth;
24/7 stay with a baby.

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

Domestic medical institutions are guided mainly by natural delivery. In this case, a planned caesarean section is used exclusively according to indications.

Sometimes there are emergency situations when, when the waters break, weak labor activity occurs. In this case, additional stimulation is indispensable, and the life of a newly born person will depend on the high qualification of the staff and the availability of modern medical equipment. After a successful birth, it is desirable that experienced gynecologists, neonatologists and polite medical staff take care of the mother and newborn.

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What is a referral to a maternity hospital?

A referral to the maternity hospital is a document that is given to the expectant mother in the hands of the district doctor of the antenatal clinic at a gestational age of 38-39 weeks. The validity of this document is 10 days, and if for some reason the expectant mother does not appear during this period at the admission department of the maternity hospital, then the referral will have to be taken again from the local doctor.

Do not neglect the direction to the hospital and drag out time until the last. Most women, having received a referral from a gynecologist, are in no hurry to go to the maternity hospital and stay at home until the onset of contractions, after which they call an ambulance and worry in order to have time to get to the nearest maternity hospital. In this case, the situation is also complicated by traffic jams and the fact that the maternity hospital chosen in advance can suddenly close for a car wash. That is why it is very important to get a referral to the maternity hospital in time and know that they will be waiting for you there during the specified period of time.

How to get a?

In order to get a referral to the maternity hospital, the expectant mother must regularly attend the antenatal clinic and register with the doctor on time. The doctor observing the pregnancy, closer to the expected date of birth, issues a birth certificate to the expectant mother, and with it a referral to the maternity hospital. It is better to choose the institution where you would like to give birth in advance and tell your local doctor about it, however, in most cases, the referral is issued to the maternity hospital that is closest to the place of residence.

Is it necessary?

Perhaps every expectant mother wonders if it is necessary to get a referral to the maternity hospital? After all, you can just come with contractions and the doctors will take delivery anyway. It is best to have such a document on hand, because, as mentioned above, maternity hospitals in large cities are often closed for “washing” and then the woman in labor will simply not be accepted, but sent to another hospital. So it’s worth considering whether the expectant mother needs such an “adventure”, because in such cases, babies are often born right in an ambulance.

Sometimes one gets the impression that, in the modern local sense, giving birth is like serving in the army. Who was not there - will not understand)) But the question, regarding childbirth, is more about childbirth in the maternity hospital. And the direction that the gynecologist, often in a categorical form, issues to the hospital is tantamount to a summons to the draft board. Tremble women and come with things to the recruiting station in the emergency room exactly with the given direction. And if you don't show up...

You will be deprived (of the very one base value, which is given for the "timely" registration and, attention, the implementation of the recommendations of the district doctor). Not a bad way to manipulate a pregnant woman, it is bitter to realize this.

These are all jokes, but, seriously, there are a lot of threats to deprive the allowance (without specifying that the gynecologist can “punish” the woman by depriving her of only this one small allowance) and I regularly hear about them from pregnant women. The reason to hint that you may not receive this benefit may even be irregular tests. And this happens, alas.

Another funny-unfunny thing: one pregnant woman (out of 3 LCs), who refused planned hospitalization (the woman’s health was OK, but “according to the plan”), the gynecologist said to come to the next appointment with .. mom. For what? So that her mother, a long-age and married woman, would scold her at home? Don't know.

Pregnant women often ask, what will happen if I refuse the planned referral to the maternity hospital at 40 weeks?

Nothing will happen, it's your right.

In the same way, you can refuse hospitalization if you confused training fights with real ones and arrived at. A day or two passed, no childbirth, no health concerns either, you got bored and wanted to go home, but the doctor who leads your ward said no, they won’t let you out? Intimidating - you can easily write a refusal of further hospitalization and go home.

Forced hospitalization in our country only for mental patients who pose a threat to themselves or others. If you are not chasing loved ones with an ax and are not trying to go out the window, no one will forcibly put you in the hospital.

Legal side of the issue

Now, in some consultations, doctors give pregnant women to sign a paper on consent / refusal to be hospitalized in a maternity hospital, which cites the laws of the Republic of Belarus on the right of citizens to free medical care, on the rights of the child to medical care and Presidential Decree No. 18, which they like to scare parents :) At the same time, the gynecological service forgets, as it were, to mention the Law of the Republic of Belarus “On Health Care” dated 06/18/93, Articles 44 (Conditions for the provision of medical care to the patient) and 45 (Refusal of the patient from the provision of medical care, including medical intervention).

Those. on the one hand, I really like the tendency of women's consultations to increase the legal literacy of expectant mothers. A reminder that the responsibility for a healthy pregnancy and childbirth lies with the woman herself, and medicine is only help where this help is needed, where there is a health problem. But I do not like that this awareness is one-sided and looks like intimidation of women. How long can you manipulate and intimidate pregnant women? I want human ways to communicate :)

It is clear that closer to childbirth, the cerebral cortex of any, the most educated and self-confident woman, physiologically begins to slow down - this is the preparation of the body for childbirth. And so we become very sentimental, moody and gullible. And doctors are people who are unconsciously associated with the parental position, people who want to trust, and in general, rely on their professionalism.

But what kind of trust and professionalism are we talking about if every “extra” day after the DA becomes “overwearing” and a threat to the child? Childbirth in the period from 38 weeks to 42 (!). No one calls labor at 38 weeks premature. And 40 weeks is the ESTIMATED date of birth, the arithmetic mean, so to speak.

How many of us have heard the phrase “think about the baby” from doctors in the LCD or the maternity hospital as the last argument about resolving the issue of planned hospitalization, induction of labor (artificial induction of labor), an oxytocin drip, etc.?

Hello, can I have an operation to remove the fallopian tubes under the compulsory medical insurance policy with you for free, without having a Moscow residence permit!

Answer GKB 29:

Hello, Natalia! Thank you for your feedback. Yes, it's possible. You need to get a referral from the clinic to which you are assigned.

Hello, today we were at the study of planning pregnancy with SD. I liked everything very much, the only convenient time for everyone is at 13-00 in the middle of the week, because everyone works. Perhaps the next lesson should be set for an earlier time or even for the evening. We will be very grateful, many in the group agree.

Answer GKB 29:

Hello! Thanks for your feedback. We will consider your wishes.

Hello, tell me, please, I live in the South Administrative District, can I ask for a certificate for your maternity hospital and give birth to you. Thank you!

Answer GKB 29:

Hello! You can choose the medical facility you want.

Hello, what is the regime for visiting patients in the ENT department?

Answer GKB 29:

Hello! Visiting patients: Working days: from 17:00 to 19:00 Weekends and holidays: from 11:00 to 13:00 and from 16:00 to 19:00 Conversation with doctors: from 13:00 to 14:00

Hello! Tell me if natural childbirth is possible in this situation and who can be consulted: after laparoscopy in 2007. (removal of fibroids with a size of 3.0 cm) there is a scar along the front wall. Now IVF pregnancy is 30 weeks (going well). Age 42 years old. Thank you in advance for your response. Sincerely, Natalia.