How maternity hospitals are structured in Russia and why not everywhere they can help women with difficult pregnancies. What is the difference between a perinatal center and a maternity hospital?
The Perinatal Medical Center is a specialized medical institution, aimed at the needs of expectant mothers. The main objectives are diagnostics and treatment of infertility, assistance in maintaining pregnancy and labor activity. Moreover, the perinatal medical center provides comprehensive assistance in the postpartum care of the mother and her child. Thus, mandatory coverage of the full cycle of family planning is assumed, from the moment of conception to postpartum activities. 
Perinatal center and maternity hospital: differences
What are the main differences between these two medical centers?
The perinatal center may have a maternity ward, but the maternity hospital does not have one. perinatal center. Thus, the perinatal medical center is a wide-profile clinic aimed at caring for pregnant women and young parents. In addition, it is in the center that they can contribute to the successful solution of problems of conception.
Among other differences, it is necessary to note the technical equipment, which is perfect. In most cases in medical centers Only modern equipment is offered, allowing medical personnel to provide personal services to expectant and young mothers at a decent level.
Almost every perinatal center can boast of its own team, which includes representatives of medical higher education institutions educational institutions and people involved in research work. The team is capable of developing modern standards for monitoring pregnancy, and in some cases, for treatment.
Who should go to the perinatal center?
Some categories of citizens can be sent to the perinatal center:
- Families who were forced to face problems in conceiving a baby.
- Women who are faced with a difficult pregnancy.
- Women with a history of miscarriages.
- Pregnant women who are at risk for the life of the fetus or the expectant mother.
- Pregnant women suffering from serious pathological processes.
It should be noted that childbirth should be carried out in a perinatal center if special assistance from doctors is expected. At the same time, care can be successfully provided at a level that is inaccessible to most maternity hospitals.
In addition, staff at perinatal centers can perform 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 general-purpose centers and the large number of people who still prefer a perinatal center rather than a maternity hospital, not every citizen can count on free provision of services. In most cases, a range of services is provided only on a paid basis. However, the cost can be prohibitive. What should I do if I need to register with the clinic for free? How can you use this opportunity?
- You should first undergo a telephone consultation.
- In most cases, you need to provide a referral received from the antenatal clinic. The main task is to fully explain the reasons and confirm a certain diagnosis.
- 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.
- In fact, every woman can independently choose the right perinatal center. However, the problem is related to the lack of free places, since the institution cannot be overcrowded based on the norms. Otherwise, epidemiological spread of nosocomial infection may occur.
Without a doubt, if you can successfully contact the perinatal center and agree on interaction, you can play it safe and use every chance to find a full-fledged family that will certainly be happy.
What is required to register for a perinatal center?
It is mandatory to register at the perinatal center by contacting the admissions department. The following package of documents is expected to be provided:
- Passport (first page and registration in the form of original and copy).
- Medical policy.
- SNILS.
- Test results, all consultation notes, exchange medical card.
- A generic certificate, which must be based on the established sample.
When checking into the antenatal department, you must take with you toiletries, washable slippers, and a change of clothes. It should be noted that this is similar to maternity hospitals, where a complete set of personal belongings is also 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 healthy baby.
Perinatal center or maternity hospital?
In most cases, perinatal centers are developed in large 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.
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 giving birth, and for some, arriving at the maternity hospital becomes stressful - after all, this is a completely unfamiliar medical institution. How is the maternity hospital organized? Let's take a closer look at the place where our long-awaited baby will appear.
Any maternity hospital begins with the admissions department. This is where a woman comes with labor pains or any pregnancy complication. The expectant mother entering the maternity hospital is first met by the midwife on duty: she will take an exchange card, offer to change her shoes, and then lead her directly to the emergency department. The admission department usually consists of two reception and examination rooms isolated from each other: one receives patients admitted to the maternity ward or pathology department, the other accepts 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 rooms there is an examination room with an examination couch and a room for hygiene procedures with a shower and toilet. Here, an obstetrician-gynecologist will examine the expectant mother, fill out her documents, then the midwife will help her do the necessary hygienic procedures (shave her perineum, give an enema), and give her an individual set of underwear - a robe, 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: the maternity block, the operating block, the department of pathology of pregnant women or the observation department.
Maternity ward department where childbirth takes place, women with contractions are admitted to it. In modern maternity hospitals, the birth block consists of individual boxes, in each of which only one woman gives birth. There is a bed in the box on which a woman in labor can rest during the first stage of labor (when contractions occur); a special chair (Rakhmanov bed) - the birth of the baby takes place on it; a CTG machine and a changing table with a heating lamp; here the born baby will be weighed, measured, and here he will have 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 old-style maternity hospitals, the birth block consists of prenatal wards, which can accommodate several women, and a common delivery room. In the prenatal ward, expectant mothers wait out the first stage of labor (contractions), and before the start of pushing, the woman is transferred to the delivery room, where she gives birth to the baby and placenta. Both the prenatal ward and the delivery room are fully equipped with everything necessary for the mother and baby. In maternity blocks with a similar design, the 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, after making sure that there are no complications, the doctor gives the go-ahead for the mother to be transferred to the postpartum ward.
The operating room is where childbirth takes place via cesarean section. A woman can be referred to the operating room from the emergency department if she requires an urgent caesarean section, or from the pathology department when she is undergoing a planned operation. The operating unit consists of several operating rooms and a preoperative room, where doctors and midwives prepare for surgery. Immediately after a caesarean section, the 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 ward mature mothers are admitted here directly from the maternity ward or from the intensive care ward after a cesarean section. Depending on the maternity hospital, the wards in which women are kept after childbirth can be single, double or multi-bed. If the maternity hospital does not provide for the mother and baby to stay together, then the postpartum department also has a “children’s” ward, where newborn babies are under the 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 entered into a contract for childbirth can live in comfortable “family” rooms with their father or someone close to them.
Also in the postpartum department there must be examination and treatment rooms, 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 observation department is a mini-maternity hospital within a maternity hospital: with its own maternity ward, operating room, and postpartum ward. The only difference from ordinary wards is that in the observation department, all rooms are always individual, and sanitary treatment of all rooms is carried out more often than in other departments (which can only please parents). Some maternity hospitals even allow relatives to visit; In addition, there are often “family” wards in the observation department!
Pregnancy pathology department - it houses women with any complications of pregnancy (threat of miscarriage, gestosis, etc.). It usually includes wards, treatment rooms, an examination room, and a dining room. There can be a shower and toilet in each room, or one for everyone.
If until recently the maternity hospital was a completely closed institution into which outsiders were not allowed, today the situation has changed. Future mom can choose the place where her child will be born and the conditions in which this will happen; meet the doctor delivering the baby and discuss your wishes with him. A woman has the opportunity to invite loved ones (husband, mother, girlfriend) or a psychologist to the birth, as well as take a preliminary tour of the maternity hospital in order to learn more about the place where some of the most happy days in her life.
Figure 1. State Central Research Obstetrics and Gynecology Institute (Leningrad).
For proper isolation of sick people and especially septic postpartum women. All this is less ■provided in small maternity hospitals. In addition, in several small maternity hospitals taken together, there are generally more refusals of admission than if they were combined into one R. D. The main advantages of maternity shelters are the bringing of inpatient obstetric care closer to the population due to a reduction in the radius of the serviced area (in the presence of several maternity hospitals instead of one large R.D.). With 19 maternity shelters and 6 other maternity institutions in Leningrad in 1916, for each maternity institution there were 3.1 km 2. According to Rutkovsky, in 1909, 508 women in labor were admitted from a distance of 1 verst, and only 146 from a distance of 1-2 versts, and 81 of them sought and did not find shelter in other institutions. It goes without saying that the proximity of maternity shelters to the population is determined by their correct placement in the city. Further, the cost of maintaining a bed in a maternity hospital is lower (according to pre-war data), and maternal morbidity and mortality are lower in them; however, this latter is controversial in view of the fact that usually maternity hospitals refer all complex and severe cases to R. D. Recently, in Leningrad (as before in Moscow) and in other large centers there has been a tendency to organize large R. D. In small towns, maternity institutions at hospitals are b. or maybe separate sections of them. IN last years in medium-sized cities, due to the significant expansion of obstetric care, the concentration in one place and gynecological care, there is an increasing tendency to move maternity wards from hospital centers to special premises. Obstetrics and gynecology clinics, of course, always have fairly isolated obstetric departments. Central Research Obstetrics and Gynecology. Institute in Leningrad arose from the Midwifery Institute, founded in 1797 (see above). In 1904 it was built on the initiative of prof. D. O. Ott, architect Benoit, a huge luxurious 3-story stone building with 208 beds (25 of them for septic tanks). Building area 10,656 m 2 with a volume of 160,845 m 3. The cost of the entire building with equipment is 3,500,000 rubles. (Fig. 1). The building was built according to last word science and technology. Overall plan and all the details were discussed in advance by both Russian and Western European medical and technical institutions. On the first floor there are premises for an outpatient clinic, a pharmacy, offices and apartments for staff; The II and III floors are occupied by obstetric and gynecological departments, a museum, a library, classrooms and laboratories (Fig. 2 and 3). The main features of the new building are: the absence of poorly lit daylight places; large and bright corridos on one side; ill-lit rooms with only bright, bright operating rooms; perfectly equipped 
Scientific and educational outbuilding Figure 2. Floor plan: L-elevators for patients; I R
Provided auxiliary institutions (library, museum, laboratories). Ventilation is designed with a flow rate of 85.624 m z per hour of filtered, heated and humidified air through channels that are easily flushed and illuminated by daylight. Its own electrical, water supply, ice-making stations, sewerage, mechanized laundry, disinfection chamber, bakery, central station for heating and ventilation control with all necessary control instruments (thermometers, pressure gauges, hygrometers, rheostats, etc.). Wide use electrical energy for signaling the general and from the wards (for calling nurses to the sick). Internal telephone and microphone systems: 1) for signaling 
Scientific and educational outbuildingFigure 3. Third floor plan:- IN- lifting machines; S-steam sterilizers; R-devices for saline solution.
About the maximum temperatures in the premises, about the condition of heating devices, about the temperature and pressure of hot water boilers serving heating and ventilation 2) ~ for devices for monitoring employees at their posts and 3) for regulating the movement of 153 wall clocks. The obstetric department has 147 beds. Its features include 2 maternity pavilions, working alternately. The capacity of the obstetric department is 3,000-4,500 births per year. New women's clinic prof. Selheim in Leipzig. A 5-storey building in the shape of an extended letter P. Chambers with rooms occupy 17% of the premises. Relatively low ceilings - 3.5 m(easy to clean). No calls. There is a button for each bed's electric alarm; when pressed, a bright electric light in the corridor above the door of the room and under the clock hanging everywhere in the corridor lights up, and in the sister's room (with sound-muffling walls) the control bell begins to ring. To call the director by phone, yellow lights are lit everywhere, and for the doctor on duty, red lights are lit. Obstetrics department - 104 beds; infirmary - with 48 beds (including cancer beds). The principle of small wards is 6-8 postpartum women in each. The maternity ward has 6 maternity rooms with 2 maternity beds in each. The walls and doors are made in a sound-damping manner so that the screams of women in labor do not reach the neighboring rooms. The maternity rooms are located on 2 floors, 3 in each, and are connected to each other by a small internal staircase for medical staff. Maternity and duty rooms are connected to each other by a special telephone and a light alarm. The walls are painted dark gray-blue, the operating room is dark gray-green. The septic department has its own large operating room, dressing room and its own maternity room, equipped in the same way as in the clean department mentioned above. On the top floor there is a department for 40 women in the last months of pregnancy, who do not have a home in the city and who are taken from the street; they receive free board, clothes and everything necessary, help with the care of patients, work in the kitchen, and so on, practice their work during pregnancy, childbirth and the postpartum period (as in the R.D. in Charlottenburg). In contrast to German clinics, where obstetric institutions are often just their departments, they predominate in France. R.D., due to the fact that obstetrics there is completely separated from gynecology, the region is treated as a special department of surgery. An example of the simplicity and practicality of the device is the Maternite de GNo-s p i t a 1 S t.-A ntoine in Paris, opened in 1897. The general plan is shown in Fig. 4. R. d. - for 70 beds in the aseptic department and 8 in the isolation department. Consists of a main building in the form of a quadrangle 58 m lat. and 69 m long., in the center of which there is a garden with an area of 1300 m 2. Separate insulation wing and engine room with laboratories. Total area of the main building 2,602 m 2. Maternity room with 4 beds. Its dimensions: 8.90 x 9.67, high. 4.80 m. Capacity up to 2,000 births per year. The isolation department is located in a special building, has its own operating room and utility rooms, separate personnel and household facilities. Part. Nowadays, the composition of a typical R.-D. includes the following. departments: emergency room, department for pregnant women, maternity ward (maternity ward) with an operating room, postpartum, doubtful, septic, for newborns, consultation with a dairy kitchen. Most R. D. (excluding France) have at least small gynecological departments. Emergency room. In new and well-equipped hospitals and clinics, as can be seen from the descriptions, the waiting room consists of at least 3 rooms. In the waiting room, a preliminary survey, temperature measurement and general examination of women in labor take place. From the waiting room they are sent either to a clean obstetric department, or to a questionable one, or to a septic one. A woman in labor enters a clean obstetric ward through a “processing room” consisting of 2 rooms: in the 1st room a recording takes place, the woman in labor undresses, and from this room the dress and underwear are transferred through a separate door or window for storage and to the sterilization room, if equipped. . Here, or better in a separate room, the woman in labor receives an enema and washes herself in the shower; in the next room her hair is shaved off 
Figure 4. Layout of the St.-Antoine maternity hospital in Paris: 1 -lobby; 2-7 - department of pregnant women; 8 -16 - postpartum department; 17 -open gallery; 18 -closed veranda; 19 -28 - maternity ward with reception area; 29 -34 -consultation; 35 - 39- isolation department (separate building).
The external genitalia are disinfected. She then dresses in hospital scrubs and heads to the delivery room. Reception room furnishings: in the waiting room there are sofas, a couch, chairs, a table and a cabinet or drawer for cards and reference notes. In the processing room: a table for recording and receiving things; in the same or the next room there is a well-equipped restroom, a bath (with a shower, cold and hot water); in the 3rd room: a gynecological table, a washbasin, a cabinet, a table for the necessary medications and dressings 
Figure i>. i odilnan comlata of the Central Research Obstetrics and Gynecology Institute.
Material, brushes, instruments, care and treatment items for the patient and a tripod with an Esmarch mug. The maternity ward in small and old maternity hospitals is not large room with several maternity beds (Fig. 5) and washbasins (with cold and hot water), tables for recording and storing maternity certificates, for care items and a cabinet for medicines. The calculation of beds for the maternity ward is 10 - 12 per 100 postpartum. In most new obstetric clinics, in addition to one large maternity room, there are 1-3 small ones with 1 bed for eclamptics and for pathological births in general. In new maternity hospitals, the maternity ward sometimes consists of small separate wards with 1 bed, in which women in labor are kept until the start of pushing and only with the beginning of the latter are transferred to the general maternity ward. Maternity rooms should have good natural and artificial lighting. Approximately to a height of I 1/2 m from the floor they are tiled or painted with oil paint. Traditional White color in maternity wards and operating rooms, it has recently been inferior to gray-blue or gray-green, which is not visually tiring. A significant part of the maternity ward is the maternity bed, which is often also an operating table (for lowering the leg, removing the fetus, suturing the perineum and even applying forceps; all this, however, is best done in the operating room). In most cases, maternity beds are somewhat more massive and higher than usual. In maternity hospitals named after Snegi, the height of the bed is 1 m, Moreover, the partition at the foot end was removed. bed prof. Otta-on-wheels-
roar in her Maternity
Kah; at the foot end there is a metal stand with an electric light bulb and sockets for an Esmarch mug, a cup for a thermometer and tips; in addition, a retractable (hinged) metal circle at the foot of the bed for a bedpan. Bed height 0.67 m, width - 0.75 jw. (Fig. 6). Rakhmanov's bed (Fig. 7 and 8): length when extended - 1.75 m, width-0.62 m and height - 0.7 7 g Consists of 2 halves. Can easily be converted into an operating table by extending the foot end of the bed on wheels. Leg holders are attached to the foot end. Of the instruments, as well as medical care items, the following are required for the maternity room: metal and rubber catheters, umbilical and straight scissors, pelvis gauge, centimeter tape, obstetric and ordinary stethoscope, razor, scalpel, spatula, nail cleaner, nail scissors, mask with dropper for chloroform, mouth dilator, tongue- 
Figure 6. Ott's delivery bed.
A holder, a rubber wedge to protect the eclamptic from biting the tongue and devices for washing hands (brushes, soap dish, etc.). The maternity ward includes the operating room [usually in R.D. there are two of them: small- 
Figure 7. Rakhmanov’s maternity bed.
For small, more frequent obstetric operations (suturing the perineum, manual extraction, forceps) - and large - for abdominal sections (Fig. 9)]. A special feature of the obstetric operating room is a special set of instruments in addition to the usual instruments for transection (see. Obstetric instruments). Postpartum department. For better service, it is more profitable to have large wards with 10-20 beds, corresponding to approximately the same number of postpartum women discharged daily. At the St. Antoine Hospital, the postpartum wards with 20 beds do not have a corridor, and as a result, women in labor are under constant supervision of the duty staff located here (Fig. 10). Children are placed in these rooms around large tables in the middle; Of course, small rooms with 2-4 beds are also needed for the isolation of eclamptic patients, postpartum women after operations and with complications in the postpartum period (non-infectious). 
Drawing 8. Rakhmanov’s maternity bed.
Figure 9. Obstetric operating room at the Vienna Clinic.
The calculation of the area and cubic capacity of the postpartum department is carried out according to normal hospital standards. A necessary accessory for the postpartum department is a dressing room, equipped like a small operating room, but with a comparatively small number of instruments, mainly. arr. long and short tweezers, pointed scissors with short and long jaws for removing sutures, spoon-shaped mirrors, lifts, sides (if necessary for inspection), catheters and tips for douching. A room for washing oilcloths is also needed; Sometimes children are swaddled in it (Fig. 11). With the allocation of a room for newborns, swaddling and washing of children is carried out in the children's room. In many normal postpartum wards in the USSR there are so-called 
Figure 10. Postpartum ward of the St.-Antoine maternity hospital in Paris.
Questionable wards for postpartum women with suspected infection. For such cases, each hospital should have an isolated doubtful department with its own treatment room, delivery room and small wards with 1-2 beds, serviced by separate personnel. In many hospitals, both here and abroad, the setting of postpartum wards is adopted, which, if possible, bears little resemblance to a hospital room. Beds here may be regular type. It is advisable to have a bedpan nest at the bottom. The peace that the postpartum mother requires/forces 
Figure 11. Room for washing oilcloths and changing children at TsNIAGI.
convert Special attention for the installation of a spring net and mattress. TsNIAGI, from the time of its foundation, adopted the project designed by prof. Otto mattress with harmonica-shaped partitions; individual nests are filled with hair twisted on a stick (Fig. 12). Bedside tables should be as simple as possible. In foreign R.D. on the 2 lower shelves are placed necessary items care for postpartum women. For cleaning women in labor, there are mobile tables in well-equipped maternity docks, conveniently arranged to place everything necessary on them. 9#
items used: mugs, vessels with boiled water and solutions, tools (tweezers, forceps), rooms 1) for jars, 2) boxes with dressings and 3) necessary medications. Where individual cleaning is strictly carried out, each postpartum mother has her own Esmarch mug, 
Rice.
12. Otta postpartum bed mattress. tip, catheter, dressing material, and, most importantly, a separate bedpan. Isolation department (infirmary, septic department). In most foreign obstetric institutions, the isolation ward is located in a separate building and has its own maternity ward, operating room, kitchen,
I fij g: j
AttatzhM□ Sft laundry and separate staff. Sometimes gynecological and even cancer hospitals are located in the same building with maternity hospitals (Vienna Clinic and Selheim Clinic in Leipzig). However, it is fundamentally important that the isolation department must have a separate passage and is by no means connected to the pure obstetric department. The need for infirmary beds is calculated on average at the rate of 15-20 beds per 100 clean postpartum (Poltava) residents. Assuming■ that the average percentage of feverish people is 10, if there is a questionable department, we can limit ourselves to 5-10 beds per 100. The isolation department is set up with the same components, as well as pure obstetrics. In small maternity institutions, they are limited to the so-called device. a dubious maternity ward and a ward for febrile postpartum women. The isolation department of the Vienna Clinic with 36 beds is located in a 2-story building: 1st floor for obstetric cases, 2nd floor for gynecological and in particular cancer patients. Each floor has a separate operating room, laboratory, bathroom, cafeteria and room for nurses. Plan of the isolation ward of the hospital -St.-Antoine - see. Figure 13. The TsNIAGI infirmary is located on 2 floors of a wing, separated from the clean obstetric room by a long and narrow one, illuminated from both sides. Figure 13. Plan of the isolation ward of the St.-Antoine maternity hospital in Paris: 1- washroom; 2 and 3- restroom; 4 -chambers; 5 - official; 6- midwife room: 7 -room for nurses; 8 -operating room
Figure 14. Children's bed at the St.-Antoine maternity hospital in Paris.
Their sides are a corridor; It also has a separate entrance from the yard. On one floor there is a maternity hospital - an operating room and 3 maternity rooms with 2 beds each, 1 room for the midwife on duty, 1 for the students on duty. The other half of the floor and the entire upper floor make up the postpartum infirmary, 14 rooms with 2 beds each with a dressing room, bathrooms, pantry, linen and material rooms, one on each floor. Setting up small wards with 1-2 beds is beneficial for more convenient sorting of patients. From small maternity wards of provincial hospitals, sick postpartum women are isolated in gynecological or general practitioners. departments. The isolation ward should, as a rule, be serviced by completely separate personnel from the very beginning of the arrival of women in labor there from the waiting room. In order to protect clean obstetric wards from infection, a. also for better care of sick people T and in order to save money, some large cities are now striving to concentrate all septic postpartum women in separate large institutions (Moscow, Kharkov, Berlin). The department for newborns, the separation of newborns from mothers, has been carried out only in recent years; Therefore, many existing maternity institutions do not yet have specially designed rooms for newborns. It is necessary to have at least 2 rooms: one for healthy people. another for sick babies, preferably with isolation boxes various diseases. At TsNIAGI, 4 wards are allocated for newborns: 1) triage room, 2) for healthy babies, 3) for sick ones and 4) for healthy babies from sick mothers. Baby cots are usually arranged with high sides (Figure 14). Changing tables are a necessary accessory for the neonatal department (Fig. 15). a table and a cabinet for necessary medicines and care items, scales for weighing and a washbasin with cold and warm water complement the decor of the room for newborns. Department for taking others. Their design serves various purposes. In many nursing homes in Germany and France, these departments are, strictly speaking, boarding schools for poor pregnant women who, while receiving full board in the institution, at the same time perform light work in the kitchen, 
Figure 15. Changing table at TsNIAGI.
Linen, as well as for the care of patients, etc. work off their contents in the R.D. In the European SSR, pregnant women with certain deviations from the normal course of pregnancy are admitted to these departments as depending directly on the pregnancy itself (for example, toxicosis, abnormalities on the part of the ovum or fetal malposition, placenta praeVIa), and with diseases that existed before pregnancy - tbc, heart defects, hron. nephritis, etc. In general, all pathologies of pregnancy are subject to hospitalization, in particular pregnant women with a narrow pelvis, especially where one can assume the possibility of a cesarean section. Pregnant women living far from an obstetric facility are admitted to the ward in order to avoid accidents of emergency childbirth. In addition to its deep preventive value, the department for pregnant women also has an important educational value. Gig. The regime during pregnancy is easier to comprehend in practice and is better implemented by living example than by instructions. Advance admission to this department sometimes relieves you of excessive household stress. To establish required quantity There are no specific instructions for places in such departments. So eg. in the Vienna clinic with 232 beds - 48 places for pregnant women (approx. 20%), in CIIAGI-20 for 110 obstetric clean rooms (+ 30 isolation beds), in the St. Antoine-9 hospital with 78 obstetric beds, in the Zelheim clinic-40 beds for 104 obstetrics (48 isolation), etc. Levy estimates the number of beds for pathological pregnancy at 6% of normal postpartum ones. In addition to the wards in the department for pregnant women, it is desirable to have: an examination room, a bathroom, an isolation room, a pantry and a dining room. Instruments for the department of pregnant women are usually the following: a pelvis, a centimeter tape, scales, a stadiometer, a device for measuring blood pressure, obstetric and ordinary stethoscopes, a tripod with an Esmarch mug and tips, catheters, spoon-shaped mirrors, sides, tweezers, scissors, Esbach tubes, mugs with divisions for measuring the amount of urine, syringes 1-2-10 z and an examination table. The environment of the maternity ward should least of all resemble a hospital setting. Organization of dignity is necessary. education (conversations, supply of literature, arrangement of a red corner). The stay in the department for pregnant women is varied with non-tiring activities, partly of a hospital nature (preparing dressings). Separate medical personnel for healthy pregnant women it is not actually required. They are usually served by doctors working in the obstetrics department. Of the average staff in the prenatal clinic of TsNIAGI, 2 midwives and 5 nurses work for 20 pregnant women (the vast majority are pathological). Due to the lack of beds for inpatient obstetric care, the long distance and inconvenience of transport, many obstetric hospitals and clinics abroad (and here before, for example, in TsNIAGI) have organized obstetric clinics. (Doctors and midwives, in turn with trainees, leave the R.D. upon request to provide obstetric care at home; in severe cases, they deliver the woman in labor to the clinic.) Obstetric clinics in the West are organized on the principle of self-sufficiency and are usually for the insured, for whom they pay insurance office The improvement of the organization of emergency care in our USSR has eliminated the need for obstetric clinics. - With R. D. in the chain of institutions of ohmatmlad are in direct connection: 1) consultation(see) for women, 2) consultation(see) for infants and 3) dairy kitchen(cm.). The preventive value of R. d. is not limited only to the immediate prevention of complications of childbirth. Inpatient obstetric institutions are the best practical school for imparting to the broad masses of the population sound concepts about pregnancy, childbirth, and caring for the mother and baby. Maternity shelters. In Leningrad, a type of normal maternity façade, a 10-20-bed rural maternity hospital, was developed. shelter, for which the following requirements were considered necessary: a normal 20-bed shelter (Fig. 16 and 17) should have an area of 560 m? and volume 1 900 m 3 at height 3.4 m. Of these 225 m g-utility premises and 335 m 2- hospital premises (ratio 2:3). Of the hospital premises, 215 l * 2 are occupied by wards and 120 m?- other hospital premises: reception room, examination room, treatment room, maternity room, operating room (rel. 1.8: 1). From 225 m* household premises 140 m* allocated for apartments for midwives and nurses. In round numbers: hospital department 8/6 of the entire premises, household. room - a / 6 - At the same time, chambers - a / 5, examination room, etc. - "a for personnel and 
Figure 17. Plan of a 10-20-bed rural maternity hospital: 1- insulating; 2-midwife; 3- chambers; 4 -maternity; 5-operating room; V- linen; 7-viewing room; 8- bathroom; 9- restroom; 10- hallway; /1-pantry; 12- kitchen; 13- nurses; 14 - sterilization.
V 5 for the kitchen, linen and other household items. premises. Type of normal 30-bed shelter: area 825 m g, height slightly less than 4 m. Hospital area 500 m 2, chamber area 300 l* with air content 1,200 m 3. Thus, for 1 bed there are 10 m g area (according to Poltavtsev-9-11.5 zh 2) and 40 m 3 air (according to Poltavtsev-30-35 m 3) Household area premises-325 mK The obstetric departments of large clinics are similar in nature to maternity hospitals, and small obstetric departments are similar to maternity hospitals. In these latter, it is necessary to observe an indispensable rule (from which, unfortunately, deviations are often observed), namely, obstetric the department should not communicate with others, should have a separate passage, special personnel and its own linen. Isolation of sick postpartum women is usually carried out by transferring them to the gynecological or therapeutic department. Personnel R.D. Calculation of the required quantity, in compliance with all labor standards, is extremely difficult due to the need for at least 2 doctors to be constantly on duty in the maternity ward in order to be able to organize the necessary operational support. Often in large hospitals more than 2 doctors are on duty at the same time, and 1 or 2 regular doctors are joined by non-staff ones. Non-staff doctors are on duty for the purpose of improvements This explains the surprisingly small staffing levels in many R.D.s abroad. According to the NKZD circular dated 30/IX 1929, in the R.D. and maternity ward there were 35 beds for 1 doctor, 8 for 1 middle and junior staff, not counting the hostess for 40-50 beds and for each department 1 nurse in the bathroom, 1 in the pantry, cleaners and special staff for the operating room. For a children's room - 1 doctor for 40-50 beds and 1 nurse for 12 beds during the day and 20 at night. Most R.D. have adopted 12-hour shifts. Middle and junior personnel in the USSR are on duty according to labor standards. In large hospitals, doctors supervise the delivery of first-time mothers and carry out childbirth in a stalemate. cases. Midwives allow normal childbirth and assist with surgical procedures. For the delivery of infected women in labor, separate junior and mid-level personnel and a separate doctor from the team on duty in a clean maternity room are allocated. In severe cases, other doctors are also involved. In many foreign clinics, the septic department is completely isolated and clean. The postpartum clean ward has separate staff. The nature of work in maternity hospitals and maternity hospitals in large cities is different. Pat. cases are usually concentrated in R. D. This was the case especially in the past, so morbidity and mortality in R. D. were quite high. In the pre-antiseptic period, R. d., especially those in which teaching was carried out, were centers of terrible epidemics of puerperal fever. The mortality rate in them reached such limits that the question of their complete destruction was raised (Le Fort in France). With the introduction of antiseptics and asepsis, the risk of infection decreased significantly, although until now it has not been completely eliminated. Due to the concentration of severe cases in the R.D., the operational activity in them is much higher than in maternity shelters; therefore, an appropriate environment must be created for it. Back in the middle of the 19th century, in the St. Petersburg obstetric clinic for 8 1/2 years, for 543 births, forceps were applied in 30 births (5.5%), rotation on the legs - 14 (2.6%), on the pelvic end - 17 (3 .1%), manual separation of the placenta-26 (4.9%), perforation of the head-2. embryotomy-2, cephalotripsy-2, transection for ectopic pregnancy-1, caesarean section for a dead woman-2, accouchement force-3 and artificial premature birth-1. After the introduction of antisepsis and asepsis, with the improvement of surgical techniques, the so-called. hir. direction^ obstetrics, and the number of surgical procedures (caesarean sections) has increased significantly, especially in the United States. This, in turn, increased morbidity and mortality in R. D. According to Slavyansky’s statistics for 1889 for St. Petersburg: Maternity care facility Mortality puerper. (in %) nepuerper. (in%) In obstetrician, wedge. honey. fak. . . Genus. establishment with birth, school Rod. establishment without having lived, school Rod. dept. b-tsy with midwife 0.43 0.22 0.11 0.48 0.35 0.78 0.39 0.15 0.73 .0.71 Rod. dept. b-tsy without midwives - Morbidity in St. Petersburg for 1904-12 GG. Disease In the maternity hospital (in %) In the St. Petersburg maternity hospital (in %) Fever-free. period Septic disease Fever. without a diagnosis. . Postpartum nonseptic disease. . General diseases. . . 91.2 1.8 4.9 0.8 1.2 89.4 3.2 5.2 0.9 1.2 Likewise, due to the same conditions, infant mortality in maternity hospitals is slightly higher: Born dead Born Institution living non-macerated (in %) baths (in %) (in %) Maternity hospital. 96.6 1.9 1.5 St. Petersburg. maternity facility . 95.5 4.5 Midwifery gynecological institute 95.3 2.66 | 2.04 The role of RD in personnel training. Almost from the time of their inception, RDs served as a school for training obstetricians and midwives both here in Russia and abroad. Research activities in the R.D. began in Moscow from the time of Richter the Father, and in St. Petersburg in Med.-Chir. Academy since 1848, when the obstetric department was occupied by Keeter, a student of Pirogov (although works and articles of a pedagogical nature were published before that). Subsequently, many RDs and obstetric clinics became large scientific centers and produced dozens of scientists and hundreds of works on obstetrics. Lit.: Obstetric and gynecological institutions in Russia, VPB, 1910; Bublichenko L., Practical guidelines for setting up a maternity hospital, P., 1915; about n e, Obstetrics in Petrograd and its role in the protection of motherhood and infancy, Zhurn. ocher mat. and younger, 1916, No. 7; City maternity shelters in St. Petersburg in 1868-1885, St. Petersburg, 1887; State Obstetrics and Gynecology Institute in Leningrad in 1904-1929, M., 1929; Evnin I., Obstetrics and gynecology clinic and hospital departments in Berlin, Zhurn. ak. and nken. b-ney, 1929, No. 3; Egorov, New Women's Clinic prof. Selheim in Leipzig, Hynek. and Akush., 1929, No. 2; Kennedy R., Obstetric and gynecological activities of the Chicago Hospital and Dispensary for 1918-1925, M., 1928; Kiselev N., Description of the St. Petersburg obstetric institution, Journal of Ak. and wives b-ney, 1903, No. 8; O Sipov V., Maternity bed, Rus. doctor, 1909, No. 5; Pobedinsky N. and Stepanov L., Some materials for the 125th anniversary of Obstetrics and Gynecology. clinics 1 Moscow State University, Ginek. and Akush., 1931, No. 4; Poltavtsev A., Hospital construction, M., 1927; Read them, Obstetrics-gynec. Villiers Clinic, St. Petersburg, 1908; Feder E., Our tasks in the field of obstetrics, Journal of Research. wound det. age, vol. VI, No. 3, 1927. See also lit. to Art. Obstetrics. L. Bublichenko.OBTAINING CARE - the provision of obstetric care during childbirth. - AND STORY OF R. The correct organization of R., constituting one of the main prerequisites in the fight against deviations from the normal course of pregnancy, with maternal morbidity and mortality, is the main link in the chain of measures for protection of motherhood and infancy. R., that is, the system of organizing assistance during childbirth, in Russia, as in the West, did not immediately take on the forms that are now carried out. R. as such, as an elementary primitive aid during childbirth, existed in ancient times, existed among savages, existed among the ancient Russians, and among the ancient Slavs. It was carried out by experienced elderly women, who were called midwives. The first assistants during childbirth almost everywhere were shepherds, who, from observations of animals, knew how childbirth occurs, and in difficult cases were forced to provide assistance to their animals, removing the fetus, making a turn, etc. The first rudiments of organized obstetric care in Russia should be attributed only to the middle of the 18th century, when the first midwifery schools appeared. The first midwives were invited only to the royal houses and to the large serving nobility; the rest of the urban and rural female population was in the hands of ignorant midwives, illiterate village grandmothers. - In 1764, the first obstetric institution was created at the Moscow educational home. At first, it was organized with 20 beds for unmarried women, was in the nature of helping secret women in labor and was, in all likelihood, designed for those women in labor from the upper classes who, according to the conditions of that time, had to be resolved somewhere in a secret shelter. In 1771, a second maternity hospital was opened at the Orphanage in St. Petersburg. The third maternity hospital was organized in 1797 and already had the character of a real obstetric institution for all generally married women in labor, and it had a midwifery institute, from which the present Leningrad state grew. obstetrics-gynec. Institute (b. Prof. Otta). In 1801, the Midwifery Institute was organized at the Moscow Orphanage. In the provincial cities of that time, the position of a city obstetrician was introduced to provide assistance to the population according to R. The period of urban and zemstvo medicine can be called the third period in the development of R. Naturally, the landowner zemstvo could not organize medical care. assistance as widely, in a planned manner, as was required by the interests of the broad working masses of the peasantry. The medical organization was in the hands of city and zemstvo self-government. assistance in general and in particular R. until the revolution of 1917. In 1866, when the zemstvo had just been formed in the Moscow province after the publication of the Regulations on zemstvo and city self-government, the rank was elected at the zemstvo meeting. the commission compiled « proposal to organize a zemstvo medical care in the Moscow province." Paragraph 12 of these “proposals” talks about how to organize obstetric care for the population with the help of midwives. Each village was supposed to have an educated midwife, who would live permanently on the property and be known to the peasantry. With her there had to be a woman chosen from the villages located in this area. The chosen woman remains with the midwife for 2 years. For 2 years, the midwife is obliged to teach the peasant woman how to act during childbirth. This woman can look after patients in a rural hospital. After the expiration of the 2-year term, she is released to her family, and another elective from another village takes her place. That. it was assumed that in a few years each village would have its own midwife with practical knowledge. If we remember the cultural level of midwives of that time, who were trained by “oral instruction”, if we imagine this rural midwife, who in turn had to teach this business to peasant women, imagine her cultural level and the level of her knowledge, then we can judge that the quality of R. was extremely low at that time. In 1876, at the first congress of zemstvo doctors of the Moscow province, a similar “position” on the part of Dr. Peskov again emerged. who proposed that the zemstvo prepare peasant women in urban maternity institutions for the role of midwives. The congress made a decision on this matter: “It is desirable that the zemstvo take care of preparing midwives at their own expense, but that later they should not be entitled to a certain salary.” True, these midwives did not take root in the Moscow zemstvo, but the idea of learned midwives surfaced more than once in the Moscow and other zemstvos. Many zemstvos, at the suggestion of prof. Ott, in 1897 they formed a “contingent of persons with the rights of rural obstetric practice”, preparing these persons - midwives of the 2nd category - at courses at zemstvo district and provincial hospitals. In order to enroll in these courses, no educational qualification was required at all, only literacy was needed. The duration of training in these courses was one year. For a long time, obstetrics in rural areas, at best, was in the hands of these rural midwives and grandmothers, at a time when more qualified obstetric care was required for cities. In the cities there were midwives of the 1st category, who were already trained in special schools organized for training in obstetrics. Since about 1870 of the last century, the question of organizing R. has arisen. to the urban population. The reason for this was a colossal outbreak of puerperal fever, which in 1868 in St. Petersburg resulted in a mortality rate of 20% of all women in labor. It was then that the city government raised the question of taking urgent measures to develop obstetric care for the urban population, and midwives and rural midwives for the village and for the city - midwives and paramedics - began to be intensively trained. In addition to Moscow and St. Petersburg, maternity hospitals are being organized in Voronezh, Perm, Kharkov, and Yaroslavl. According to Dr. Grebenshchikov's statistics, in 1892 there were 10 state. maternity hospitals and 2 city maternity shelters. But if at this time we can talk about more or less satisfactory maternity care in cities*, its organization in rural areas still remained very weak and the issue of maternity care was often forgotten by zemstvos. Veselovsky, in “The History of Zemstvos for 40 Years,” when assessing the general state of maternity care, writes: “We don’t have to say much about the organization of obstetric care in the zemstvos, because almost nothing has been done in this regard.” In an effort to reduce the cost of obstetric care, zemstvos hired paramedics-midwives, who, being employed in the hospital, could not concentrate on the development of obstetrics, and obstetric care was provided by them insofar as they managed to do it in addition to their main responsibilities for obstetrics. -tse, at least only when they were called to give birth. As for non-Zemstvo provinces, the situation with obstetric care in rural areas was even worse. In 1904, 98% of all births, according to Rhine, were attended by illiterate midwives. Even in 1914, there were only 6,876 beds in European Russia with a total number of births of 299,038 and in addition 283,386 births attended by midwives at home, which amounted to a total of 10-12% of the provision of qualified obstetric care in relation to the total number of births and only 4-5% in relation to the number of births in rural areas. The development of R. as an organized system took two different paths in St. Petersburg and Moscow. After the epidemic of 68 in St. Petersburg, as an emergency measure to organize R., the organization of small maternity shelters was begun. Shelters were opened in ordinary apartments, with 2-3 beds, costing 250-300 rubles. This R. organization survived until the October Revolution. The revolution found this system in Leningrad and partly in Moscow, and the organization of small maternity shelters is distinctive feature Leningrad. In Moscow, city government took a different path, along the path of organizing large maternity hospitals and maternity wards at hospitals. Home care by city midwives has not been developed in our country, and the inpatient system is the main form of R. in cities. When studying the issue of inpatient R., one should dwell on the experience of Moscow and St. Petersburg, where the organization of obstetric care actually originated. In these two large cities, the growth of the stationary system has always been dependent on the overdensification of apartments, on the growth of the newcomer population and on the predominance of its poor sections. The more acute the housing crisis became, the more the number of migrant workers increased, the faster city governments were forced to develop a network of maternity beds. Maternity shelters in Leningrad were not organized as specially built maternity institutions. The shelter would be set up. h. in an ordinary apartment; it was primitively equipped; the birth was attended by a midwife. Even after the October Revolution, when the protection of motherhood and infancy began to be carried out on a state scale and in a planned manner, maternity shelters did not have independent doctors who would be in charge of this shelter. Sometimes 2-3 shelters relied on 1 doctor. There were no doctors on duty at all. The duty was carried out in such a way that one doctor was on duty at all maternity shelters in the city of Moscow. In maternity shelters, births were carried out by a midwife, the doctor was called only for stalemate. childbirth. Only the newly organized Department of Maternity and Infancy Protection of the Moscow Health Department destroyed this system of work in maternity shelters in 1921 and resolutely embarked on the path of consolidating maternity institutions, on the path of organizing large maternity hospitals instead of primitive maternity shelters. When was the Department of Maternity and Infancy Protection of the NKZDr organized? in 1918, there were only 600 maternity beds in Moscow. There were large independent maternity hospitals 2-Lepekhinsky and B. Abrikosovsky (now named after N.K. Krupskaya), organized only in 1900 by A.N. Rakhmanov. The following year, 1901, a great public worker, city government doctor G.L. Grauerman, made an extensive report on the organization of R. in Moscow. Grauerman and Rakhmanov can be considered the founders of the Moscow R. Before them, there were only 254 beds in Moscow, and 357 beds in St. Petersburg. Grauerman and Rakhmanov were among those specialists who were among the first to take part in the work of the Department of Maternity and Infancy Protection after the revolution. It would seem that this type of organization of obstetric care, such as maternity shelters, clearly seems imperfect in comparison with the maternity hospital. However, among zemstvo and city doctors there were defenders of both systems, and quite compelling arguments were given in favor of organizing obstetric care in the form of small maternity hospitals. It was pointed out that this care is cheaper, that it makes it possible to bring obstetric care closer to the population: a maternity hospital can be set up on any outskirts, in any house; there is no need for an operating room there; to provide surgical assistance, the woman in labor is transported to a specially equipped obstetric facility; The doctor is not on duty, but the midwife is on duty, therefore fewer doctors are needed. Maternity shelters are still being organized in the periphery, especially when rapid growth outskirts of large cities and in new buildings, where the construction of well-developed and well-equipped honey. institutions are not keeping pace with population growth. In 1906, inpatient obstetric care in St. Petersburg, according to Rhine, accounted for 58% of the need. In provincial cities it was 10.1%, and in district cities 1.2%. In 12 provincial cities there was not a single maternity bed. Obstetric traveling assistance in 33 zemstvo provinces. was 5.4%. Only in the Moscow province, where the best cultural forces were concentrated, where the richest zemstvos were, R. accounted for only 12.4% of the need. It should be noted that traveling obstetric care Ch. arr., belonged to villages, because, as mentioned above, home care in cities has always occupied an extremely insignificant place. True, at the end of the 19th century. The position of a city obstetrician was created, who could be invited to help at home and was intended for outlying residents - for workers, for the poor. But if we remember that on the outskirts of Moscow there are 13 people. 3-4 people lived in one cramped apartment. in the room, it will be clear that such a population did not call the obstetrician, but took the woman in labor to a maternity hospital or to a maternity hospital. There were also privately practicing midwives in the cities, but the help of these midwives was used by relatively wealthy circles. The poor and working population used the services of obstetric institutions, where there was free care, or did not use any obstetric care at all. After the revolution, private midwives almost disappeared. In the West, home care is prevalent. In Europe there are no urban maternity hospitals for mass service of the population. This assistance is provided only in the form of “Assistance publique”, i.e. assistance to the poor. Like all medicine in the West, R. is primarily the work of private practitioners and midwives. This assistance is also provided by health insurance funds, but health insurance funds also do not have their own hospital facilities and provide medical care, paying at a certain rate and agreement of any doctor, who is obliged to visit the insured at home or receive them at his place. Large, well-furnished obstetric facilities serve as clinics for university education. Soviet R. The organs of motherhood and infancy, having taken R. into their own hands, set the task of restructuring R., giving it, like all their institutions and activities, a preventive character. Prevention consists, first of all, in the fact that the organization of labor in the USSR begins not with the organization of a maternity bed, but with the first step, with the organization of consultations for women. By supplementing R. with the organization of consultations for women, this gives it a completely new, preventive character, because consultation plays a decisive role in the study of the pathology of pregnancy and the inevitably associated maternal morbidity and mortality. The work of the consultation is complemented by the organization of patronage for the pregnant woman. During the period of zemstvo and city medicine, midwives and doctors in the region of R. were limited to delivering births when a woman in labor was brought to them or they were called to the woman in labor. The task of the Soviet R. is not to wait, but to attract the woman in labor to the maternity bed, which is of particular importance in the village. Organizing patronage for pregnant women is one of the main methods of consultation for women. Continuity of observation of a pregnant woman, a postpartum woman and a mother with infant established by introducing mandatory so-called return letters: about each pregnant woman under the supervision of a consultation, when she is sent to a maternity hospital, this latter is notified by sending a double postcard. The tear-off part is returned to the consultation by the maternity hospital with notes about the time of discharge, the course of labor, complications, and the need for patronage. At the same time, the maternity hospital sends a similar notice to the consultation for infants, which must immediately, through its patronage nurses, take the newborn under observation. These preventive aspects change the entire nature of the organization of obstetric care in the Soviet Union in comparison with the past. The third new point, which the maternal and infant health authorities introduced into the organization of R., is the arrangement of departments for newborns in maternity hospitals and in maternity wards. Before the Soviet period, newborns were placed in the same room as the mother and did not have separate beds, but slept with their mothers. The authorities for the protection of motherhood and infancy consider it an elementary requirement for the maternity ward that the beginning of rational child care be laid there. It is necessary to create children's departments, where the child immediately gets used to a certain regime, and the mother has complete rest in the postpartum period. However, maternity hospitals do not occupy a predominant place in the organization of R. Independent maternity hospitals make up a relatively small percentage of maternity institutions. Most maternity institutions are maternity wards at large hospitals. Even now, in the hospitals of fairly large former district cities, very often these maternity wards are not allocated even to a special department with a separate entrance, a separate corridor, and separate technical staff. Most often these are separate rooms in a common corridor, which are often placed next to the hospital. and ter. wards and are protected to a very small extent from the introduction of infection, which is possible in general hospitals. In larger centres, maternity wards are more isolated, with best cases in separate b-tsy buildings. Independent maternity hospitals accounted for 3%* in 1926 and had 3,832 beds; in 1927, the number of beds in independent maternity hospitals reached 5,045; According to the 1930 census, the number of maternity hospitals in the USSR was 171 with a number of beds of 9,775. Thus. the number of independent maternity hospitals is growing, and since these are large institutions, they include about 30% of maternity beds and 223,163 births were carried out in them in 1930 out of a total of 780,575 births in the USSR. In maternity hospitals, a gynecological department is also required. - With the existence of maternity departments, within the general framework of the hospital, the relationship between the maternity and infant health authorities and the medical authorities is that the maternal and infant health authorities appoint the head of the maternity department; this manager is obliged to report to the authorities for the protection of motherhood and infancy and, in addition to reporting, is obliged to implement those internal rules prescribed by the authorities for the protection of motherhood and infancy. - With the transfer of R. to the jurisdiction of the authorities for the protection of motherhood and infancy, an undoubted shift occurred in it: the number of maternity beds increased annually, the number of obstetric stations increased sharply; consultations for women began to be developed; The nature of training for midwives changed, and new courses were introduced into the program of obstetric departments of technical schools - organization of maternal and infant health care, child care, which increased the type of midwife and made her a worker capable of carrying out, along with special work on obstetric care, extensive health activities in regarding women and children, especially important in the rural sector. To increase the pace and improve the quality of maternity care, the resolution of the NKZDr. dated November 1, 1931, 20% of all beds in all hospitals in the city and village were allocated for childbirth and maternity wards were organized in all medical outpatient departments (official department “On the Health Front”, NKZDr., No. 13-14 1931 ), and in 1932 it was allocated in the NKZDr system. a special department for R., the functions of which included the organization of gynecological care, abortion care and the fight against abortion (the Regulations on the Department of Obstetrics were approved by the Board of the People's Commissariat of Health. 15/X 1932). The relationship between the new obstetrics department and the management of hospitals, which includes maternity wards at hospitals, is outlined in much the same way as is indicated for the relationship between the maternal health department and the medical department. During the organization of the Soviet R. Maternity hospitals were given functions that they had not previously performed, namely, performing abortions according to social security. indications, and some of the maternity beds in the city network were allocated for abortions. Until now, abortion beds occupy a fairly significant percentage of maternity beds in general. Their number was at least 30% of the total network of maternity beds in the republic. When the authorities for the protection of motherhood and infancy took the organization of this care into their own hands, they were forced to allocate beds for abortions in maternity hospitals because other medical beds, such as surgical, gynecological, etc., were not provided for this type of care. Abortions cause a certain overload of maternity hospitals beds, correspondingly reducing the available network of beds for childbirth. And when the percentage of satisfaction with maternity care is calculated by the number of beds, it must be borne in mind that this percentage is actually lower. In general, practice has shown that it is more expedient to move abortion beds to a gynecological or surgical department. b-tsu, which, however, is rarely possible, or to take the path of organizing independent abortion clinics. That. the following new elements were introduced into the organization of Soviet R.: the organization of R. begins in consultations for women; a connection has been established between the consultation for women and the maternity hospital and the maternity hospital with the consultation for infants, etc. a successive chain of measures has been created to serve pregnant women, postpartum women and mothers with infants; R. took on an active character by introducing patronage for pregnant women, services for newborns were allocated to children's departments, and finally abortion assistance was included in the R. system. This should also include the organization of a special commission to study contraceptives. Quantitative indicators of childbirth are characterized by the following data. Table 1. Number of maternity beds (data from the Department of Maternity and Infancy Protection of the NKZDr. and the Department of Obstetrics). Years City Rural Transport Total 7,893 5,060 14,034 8,631 5,863 15,712 6,241 19,076* 12,994 6,993 water 19,987 13,793 6,923 - - 20,719 13,133 8,267 - 1 0 111 25 209 17 602 12 607 30,459 * Data from the People's Commissariat of Health without autonomous republics and the Nizhny Novgorod Region 1Ya. In 1927, at the beginning of the first five-year plan, servicing the demand in cities was 86.9%. This is the percentage of pure obstetric care provided: abortion beds are allocated. For the village, the figures are lower and are characterized by the following figures: 1925 - 11.6%, 1926 - 12.2%, 1927 - 12.8%, 1928 - 11.3%, 1929 - 12 .0%, 1931 -13.0%. Let us remember that according to statistics prof. The Rhine before the revolution had 4-5% service. The average service indicators throughout the RSFSR are as follows: Table. 2. Years Percentage of service Years Percentage of service 1925 1926 1927 20.8 21.0 22.8 1928 1929 1931 23.2 29.1 26.1 At the congress of gynecologists in Kiev in 1928, it was recognized that the provision of R.-in cities can be considered almost stable, that we have almost reached the maximum, that we have 86% of services without abortions and that 14% remains to be served in order to maximally cover the entire urban population with obstetric care. Reduces the average interest rate in the republic almost complete absence provision of obstetric care in rural areas. In Western Europe In clinics, women are discharged only on the 12th day. In the USSR, even in cities such as Moscow and Leningrad, the stay is only 6 days, and in large district cities and regional hotels this period is reduced to 3-4 days. When drawing up plans for organizing R., this coef. an amendment must be made. Accurate data on the number of births performed in obstetric institutions in cities and industrial areas. there are no centers, but data on the available number of beds in cities for 1931 show that they are enough to cover 100% of births, provided that one bed serves 50 births per year. Table 3. Data for 1931 for the RSFSR. Population of cities........23186.9 thousand Birth rate in cities........28.2°/ 0 o Number of births.........653 873 Number beds..............14,983 Number of possible births on beds (1 bed - 50 births).......749,150 The table shows that some of the maternity beds are either occupied abortion clinics, or is empty, or serves the population of nearby rural areas. By the beginning of the first five-year plan, regional obstetric service indicators gave a rather mixed picture. Table 4. Number of maternity beds per 10,00) population (data from the NKZDr. for 1S28-31). Regions On average In cities In rural areas local Ivanovo region . . Leningrad region. including Leningrad Northern Territory. . . Nizhny Novgorod region Northern Caucasus. . Western region. Middle Volga. . . Tat republic. . . Siberia...... Western Siberia. Eastern Siberia. Center-Black region . 3.9-4.8 3.5-4.6 3.5-4.1 3.2-5.7 2.0-3.06 1.9-3.7 1.5-2.4 1 .4-2.0 1.2-1.3 1.2-1.66 1.2-1.59 1.2-2.1 1.1-2.0 1.97 2.1 0.8 -1.79 10.2-11.8 6.5- 6.2 10.8 4.3- 4.47 9.0-12.9 1.1-12.5 7.0- 8.1 4.4 -10.6 4.1- 4.46 5.2- 6.07 8.9- 6.18 6.0- 5.3 8.1- 8.5 4.3- 7.5 3.7 6.7 5.5- 7.05 2 ,0-2.3 1.3-2.03 2.5-3.8 1.9-3.1 0.9-1.7 0.8-2.1 0.6-1.1 3, 7-1.4 0.8-0.8 0.4-1.05 0.6-1.02 0.4-1.1 0.5-0.98 0.98 0.93 0.7- 1.2 Thus, by the end of the first five-year plan, the relationship between city and village changed for the better, and figures show an almost doubling of maternity beds, Ch. arr. in rural areas. Norms of the organization of R. When drawing up the first five-year plan for R., it was believed that a maternity bed should work for 320 days. If we count the 8 days a woman in labor spends on a bed, then the bed will miss 40 births per year. In rural areas, a woman's stay in a maternity bed increased to 6.4 days, whereas in 1928 the average length of stay in a maternity bed in rural areas was 3.2. R.'s quality should be improved twice. The number of births allowed by a bed in rural areas was taken as 50. When drawing up the second five-year plan, the following norms were based on: 8 days of stay on a bed in cities, agro-industrial centers, MTS and state farms and up to 6.5 days for collective farms. Consequently, the quantitative indicators taken are the same as for the first five-year plan, since the control tasks of the first five-year plan turned out to be unfulfilled. According to the outlines of the first five-year plan, the average percentage of R. coverage should have been 40% (100% in cities and 26.2% in rural areas), and by 1/1 of 1932 an average of 26.1% had been achieved. The number of available maternity beds in 1927 would have to be nearly doubled to accommodate the population increase alone. And the bulk would remain at the same level of service, i.e. 12%. Taking into account all these numerical indicators, the authorities for the protection of motherhood and infancy came to the following outlines. The organization of inpatient care is undoubtedly the best form of organizing R., but it is inevitable and necessary to supplement it with the organization of obstetric stations. The maternity and infant health authorities gave a preventive character to the activities of the obstetric center and considered them as the primary unit for the protection of motherhood and infancy in the village. An obstetric center is a midwife equipped with a midwife bag, which contains everything necessary for a normal birth at home. Obstetric centers should complement the hospital and should be located close to the site. The average distance of the obstetric center from the hospital is 5 km on average, at least no further than 10 km. The obstetric center is located on the periphery of the site and is subordinate to the local doctor. The function of the obstetric center is prevention of pregnancy and childbirth, dignity. processing of the female population, carried out through the organization of patronage for pregnant and postpartum women; selection pat. cases of pregnancy, which the midwife should refer to local maternity beds; organization of initial proper care for newborns, organization of patronage for infants. Complications during childbirth account for about 25%. This percentage of complications during childbirth requires hospitalization. The midwife should carry out a normal birth at home using sterile linens that she has in her bag. Radius 5 km we have to consider it as the average that allows for a normal request for maternity care. Improvement of road construction, collectivization of agriculture, in which the collective farm ensures the delivery of women in labor to the hospital, should in the future ensure the possibility of using the hospital over longer distances. When organizing an obstetric center, a strictly defined area is assigned to it, determined by the size of the population. A midwife can perform approximately 100 births a year. With a birth rate of 45 per 1,000, there should be one midwife for approximately 2,000-2,500 inhabitants. It is necessary to give the obstetric station a certain territory, because the correct organization and proper operation of the obstetric station necessarily presupposes patronage of pregnant women, health education. work and nursing of infants. Along with the indicated forms of assistance, the obstetric center participates in the work to improve the health of women’s labor on the collective farm: determines the timing of pregnancy, provides certificates of exemption from work for pregnancy and lactation for periods established by the collective farm, provides certificates about the need to transfer pregnant collective farmers to lighter work, seeks from the collective farm board the allocation of vehicles for the delivery of women in labor to the hospital, participates in the organization of teams, pursuing the goal of the correct placement of female labor in the interests of pregnant and nursing mothers, and participates in the work of mutual aid funds for collective farmers, seeking benefits for children in case of need. pregnancy and childbirth. With the collectivization of agriculture and the massive expansion of collective and state farms, the approach to organizing honey radically changed. help in the village. The starting point for building healthcare is the center of the area of complete collectivization, the machine and tractor station. It is planned to build a large hospital there; qualified medical services will be concentrated there. assistance, including maternity institutions: maternity hospital or hospital maternity wards, consultation. For the second five-year plan of the NKZDr. designs the following preliminary outlines for the organization of R.: to bring R.’s coverage in cities to 100%, with a stay in a bed of up to 8 days. In new buildings: 100% coverage of inpatient obstetric care, at least by organizing temporary maternity facilities in barracks-type premises and the largest workers' settlements. In rural areas, two forms of maternity care are left - inpatient and obstetric care at home through visits from a midwife or obstetric center, and the nature of service to individual areas of the rural sector is differentiated: agro-industrial bases and energy centers of the region should be served 100% by inpatient care and 50% by obstetric care at home. Stay in a bed is increased to 8 days in agro-industrial bases, state farms and MTS and up to 6.5 on average for collective farms. The main groups of the female population of the village (in the agro-industrial base, state farm, MTS) should be covered by consultations for women: through them, the selection of pregnancy pathologies should be properly organized. Patronage visits should be increased to 2 for each woman in the postpartum period. Underground abortions must be completely eliminated, both in the city and in the countryside. Hospitalization of all abortions must be achieved with an average stay in bed of 3 days after the abortion operation. For this purpose, special clinics for induced abortion are established in cities or an appropriate number of beds are allocated in obstetric and gynecological institutions, and T rural areas - in all obstetrics and gynecology departments of regional hospitals at the rate of 1 per 5-10 maternity beds, and they must be separated from maternity beds. At all consultations, pregnancy prevention sessions are organized, covering the female population of productive age. The plan includes the organization of consultations on sexual hygiene at all consultations for women, at outpatient clinics with gynecological appointments, and in rural areas at obstetric centers. When planning an obstetric and gynecological network in cities and industrial centers, projects are based on per 100 thousand population: 80 obstetric beds, 60 gynecological beds and 12 abortion beds. Lit.: The second five-year plan for security. mat. and younger, Ocher. mat. and younger, 1932, No. 7; G i n o d m a n D. and L u r e A., Obstetric center, M.-L., 1929; Gruzdev V., Brief outline of obstetrics in Russia, Shuri. obstetrics and wives b-ney, 1906, No. 5-6; Report of the Commission elected by Obstetrics and Gynecology. society to resolve the issue of organizing obstetric care in Moscow, M., 1902; Kolossov M., Obstetrics in Moscow. lips; Levi M., Obstetrics in the system of maternal and infant health care, M.-L., 1929; Materials on organizing public education. assistance to the population Minsk, gub., vol. 2, 1905; Popova B., Obstetrics in the cities of Moscow. region, Moscow honey. zh., 1930, No. Yu; Rein G., Obstetrics in Russia, St. Petersburg, 1906; Selitsky S., The past and future of the Moscow Midwifery Institute and its significance in the history of obstetrics in Russia, Zh. according to the study. wound children's vozr., vol. IX, 1929; Proceedings of the I, II, III and IV congresses on conservation. mat. and younger., M., 1920, 1923 and 25, Moscow-Leningrad, 1929. See also lit. to Art. Maternity hospital. V. Lebeaeva.
The birth of a child is a monumental event, and the choices you make today can have a lasting impact on your child's life. One of the many important decisions you'll make during pregnancy is choosing where you'll give birth to your baby. If you've decided that you'd like to bring your baby into this world in a birth center rather than a hospital, you're halfway there, and finding the right birth center is the next step for you and your baby.
There are several important steps you need to take to ensure the right choice maternity hospital. Choose not only according to what suits you, but also based on other things that matter, since not all birth centers are the same. By making an informed decision about where to give birth to your baby, you can have peace of mind during the birth process.
Steps
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Walk around your area to find a maternity hospital nearby. There is no need to choose a maternity hospital that is too far from your home. Contractions can start abruptly, sometimes without warning. If your maternity hospital is located too far away, you may not have enough time to get to the site.
- In some places, such as Australia, there are maternity wards within a hospital, known as a "satellite hospital". If complications arise in this situation, you are in the same area and have an elevator or corridors close to medical care. A maternity hospital that is attached to a hospital facility may be in a great way to relieve any concerns you have about using the maternity hospital. However, be very careful - in maternity wards attached to a hospital, there may be hospital treatment that you are trying to avoid, such as membrane rupture, stimulation and vaginal examinations during labor. If the maternity hospital is full when you arrive, you may be pushed into a hospital room.
- If you don't have a maternity center attached to a hospital, check to see if there is a freestanding maternity center near the hospital? In case of complications, there should be a hospital nearby to properly deal with any emergency or risk that arises.
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Contact a maternity hospital in your area and schedule a time to travel to the center. Examine the object carefully. Ask questions and record how well the facility is managed and how prepared the staff are for complications.
- Are they licensed by a state, province or relevant government agency? To obtain a state license in the United States, for example, a maternity hospital must have certified obstetricians and nurses. Requirements vary from jurisdiction to jurisdiction, so check your local licensing laws.
- If you live in the United States, find out if the center is accredited by the Commission on Accreditation of Birth Centers. This accreditation is one of the main signs that a facility is properly equipped. To achieve CARD accreditation, birth outcome charts, proper sanitation, proper hot tub pH levels, etc. are required.
- Is the facility kept clean? Is information literature neatly displayed? Are the staff kind and caring?
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Choose a maternity hospital where you feel comfortable. Assuming you choose one that passes your test, ask yourself a few additional questions that tap into your own reactions to birth centers, such as:
- Do I like the atmosphere of the maternity hospital? In most cases, women choose a maternity hospital because it home furnishings. There is often a Jacuzzi to relax in, a shower or bathtub to relax in, a kitchen where the family can gather, soft lighting, a double bed that feels like a bed at home, exercise balls to bounce on, plenty of places to walk, etc.
- Do I like the staff? It is always important to feel comfortable with the people who will be assisting with your baby's birth. This is an extremely important experience for both of you, and personnel issues should not stand in the way of your peace of mind.
- If labor has started when you visit the center (often quite likely), what does the atmosphere seem like? Do you feel like this right place for you?
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Ask about how long you will be allowed to stay after the baby is born. The length of time for postpartum care varies depending on the rules and needs of the maternity hospital. You don't want to find out that you have to leave the hospital 24 hours after your baby is born if you were expecting to stay for 48 hours. Some maternity hospitals leave patients a few hours after birth, provided that you are completely healthy. In this case, consider switching to a private hospital or other type of care if you want more rest, or being willing to get help from friends and family (or even employees) at home during the first few days after giving birth.
- Don't view early departure as a problem. In accordance with the philosophy of maternity hospitals, you need to keep everything as natural and seamless as possible. And going home early is seen as a key way to get you into the rhythm of caring for a new baby, rather than feeling like you're being forced into a hospital routine. Some women like it. Others are afraid of the thought that the vacation will soon end! Plan according to what works for you, but it's wise to have helpers on hand ready to lend a hand for at least the first week after giving birth at home.
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Find out what the visiting policy is. Some maternity hospitals have no restrictions and allow an unlimited number of visitors to come and go as often as you like. Others have rules on how many visitors can be present at one time and what hours visitors are welcome. Some restrict visits to immediate family only. It's better to know your policy ahead of time rather than find out that your guests who drove hours to see you and your baby were shown the door.
- It's entirely possible that visitors staring at you when you're incapacitated isn't what interests you, at least not right now. People run back and forth to see you in a hospital bed - this is definitely not for a maternity hospital, which is why women who like peace come here.
- Make sure it is okay for your partner, spouse or birth partner to stay with you throughout labor. This important aspect maternity hospital philosophy. Of course, if you don't want to see anyone other than midwives, that's your prerogative.
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Find out if you are suitable for the maternity hospital. It's not just about your choice - your pregnancy should be low risk, and a reputable maternity hospital will check your tests and your doctor will monitor your progress throughout your pregnancy to make sure it's low risk. A reputable center will advise you if you are at risk of complications during pregnancy and will refuse to accept you or ask you to change plans later if you are already accepted but the risks change during pregnancy. Also stay in touch with your doctor to ensure you are properly monitored throughout your pregnancy by an independent source.
- Mechanisms for permission to bring your primary care physician or obstetrician with you to the hospital during labor will vary depending on hospital policy and local regulations, so ask in advance whether this is possible or not. Also ask about using an independent midwife if this is something you wish to do. The answers to these questions may determine your decision.
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Order in advance. If you're looking to use a maternity hospital, keep in mind that most are in high demand and can be booked within your time frame if you leave everything until later. Moreover, in a reputable maternity hospital you will be supervised regularly by staff and will be asked to undergo training before the birth of your baby, especially if it is your first child or it has been a long time since your last child was born. If you wait too long, you may miss your spot and have to go to a hospital facility.
- Be honest about your medical history. Maternity hospitals scan potential patients for previous pregnancy complications or twin births. If the hospital determines that your condition may be too risky, remember that this is for you and your baby.
- Take orientation classes at your chosen birth center. During these classes, you will be walked through what you need to know to prepare for the procedure. Attending classes will allow you to ask any questions you have. In many cases, you will even be given classes and demonstrations on postpartum adjustments, newborn care, and breastfeeding. One of the most great benefits This is because you can get to know the staff and learn important things about the upcoming birth and care of your baby. It is important to note that these facilities do not use local or general anesthesia. It uses natural and alternative pain treatments, as well as recreational drugs. They have something that most hospitals don't have - comfortable and relaxing amenities.
- In Australia, maternity wards attached to a hospital are covered by Medicare (Old Age Health Insurance). Housing units must be paid for by you, but check whether private insurance or old age health insurance covers this.
Warnings
- When searching, do not lose sight of whether the maternity hospital is accredited. If the maternity hospital is not accredited, then the facility has not passed the most basic safety requirements, which puts you or your newborn baby in danger. Use only accredited maternity hospitals. Make sure there are registered midwives and nurses working there.
- You will hear all sorts of stories. Some come from people numbed by childbirth or ill-informed. Don't let rumors put you off choosing a maternity hospital for yourself, research first-hand, ask direct questions and learn about potential complications and how they are handled. A reputable maternity hospital will tell you if you are not a suitable candidate for their facilities.
- Allow yourself to worry about family members who may not want you to give birth in a hospital. They have your best interests at heart, but are likely poorly informed or have read too many sensational stories. Explain to them that you have checked everything and are happy about this center, and the staff is highly qualified and easily accessible. Ultimately, remember that it is your decision and your comfort, so avoid stressing over other people's preferences.
Make sure you definitely want to give birth to your baby in a maternity hospital and not a hospital. These facilities are not for every pregnancy, and there are some amenities they lack compared to a hospital room. Consider the following questions before moving to the maternity hospital:
A maternity hospital is a medical institution where a pregnant woman can receive qualified medical care from the moment of conception to childbirth, including the process of childbirth itself and the early postpartum period. For a newborn baby, the maternity hospital is the first medical institution where he will be helped not only to be born, but also to adapt to life in the environment.
The rules in the maternity hospital are very different from the rules of other medical institutions, because infection is especially dangerous for the baby’s sterile body. Therefore, every maternity hospital has a strict regime which cannot be violated.
Maternity room
The delivery room is the main place in the maternity hospital where the baby is born. From the moment regular labor is established, the woman in labor is transferred to the delivery room, where she stays with medical staff, and, if desired, with a partner (husband, mother, sister).
Modern delivery rooms are decorated in warm colors and equipped with all the necessary equipment. The most important attribute of each maternity room is the Rachmaninov chair-bed, on which the birth of a child often takes place. The well-equipped delivery room also has a bed, gymnastic wall, fitball, and a special chair for supporters vertical birth, heated changing table and neonatal resuscitation kit in the delivery room.
How do women give birth in a maternity hospital?
Currently, active behavior of women in the first stage of labor is practiced. A woman in labor can move freely around the delivery room, perform exercises on a gymnastic wall and an inflatable ball, which helps reduce pain, rapid opening of the cervix and lowering of the fetal head. A woman can choose where and how she wants to give birth. Currently, childbirth is practiced while standing, sitting on a special chair, and childbirth in the knee-elbow position.
Care for a child in a maternity hospital begins from the moment he is born. The condition of the newborn is assessed using the Apgar scale at 1 and 5 minutes after birth, the maximum score is 10 points. It consists of 5 criteria, each of which is scored from 0 to 2 points: heart rate, skin color, breathing, muscle tone and reflex excitability.
The primary toileting of a newborn in the delivery room begins as soon as the head has erupted. A neonatologist removes mucus from oral cavity the baby is suctioned, then the child is placed on the mother’s stomach and applied to the breast if the child does not need additional medical care. Early attachment of a newborn baby to the breast is very important, as it helps to establish close contact between mother and baby, colonizes the skin and intestines with protective microflora, and also stimulates the production of oxytocin in the woman in labor, which helps the uterus contract.
Then the child is taken to the changing table, where the birth lubricant is wiped off his skin, conjunctivitis is prevented, he is weighed, measured, dressed and a bracelet is tied on the arm, where the birth history number, mother's last name, middle name, day and time of birth are indicated.
Many pregnant women are interested in how to dress a baby in the maternity hospital? There is one peculiarity: a newborn’s thermoregulation center is not yet mature and under the influence of the room temperature the child can become hypothermic, so the baby needs to be dressed a little warmer than the mother dresses, especially in the first days.
Vaccinations for children in the maternity hospital are given by the nursery nurse after examination by a neonatologist, the absence of contraindications and the mother signing special documents.
Maternity hospital care
After childbirth, the doctor on duty in the maternity hospital examines the woman in labor, checks the condition of the sutures, the size of the uterus, and the condition of the mammary glands. Examinations in the maternity hospital are carried out in special examination rooms under sterile conditions. 
after a woman performs hygiene procedures.
Recently, a lot of information has appeared about childbirth outside a medical institution (at home, in a swimming pool), and there are couples who decide to take such risky actions. It must be remembered that the process of childbirth cannot be predicted, and there is always a risk of a situation when the life of a woman and child depends on timely, qualified medical care, so you should not endanger yourself and your child.
