Concept of childbirth assistance:
assess the degree of risk for the pregnant woman and fetus on the eve of childbirth;
remember that first of all you need to ensure the safety of mother and child;
select a hospital;
choose an adequate method of delivery;
monitor the condition of the mother and fetus during labor;
prevent fetal hypoxia;
apply pain relief;
provide careful assistance during childbirth;
prevent bleeding during childbirth;
assess the condition of the child at birth and, if necessary, provide timely assistance;
carry out early attachment of the baby to the mother's breast;
take advantage of the opportunity for mother and child to stay together;
ensure the provision of adequate care;
respect the patient's rights.
Risk factor assessments are performed prior to delivery and reviewed throughout labor.
The assessment of risk factors both in the antenatal clinic and in the obstetric hospital should involve a doctor and only in his absence one midwife. In some cases, prenatal planned preventive hospitalization is required. The choice of hospital is made by the woman, but the midwife should help her in this, taking into account the midwife’s situation, the woman’s interests, and her financial support. This is true in large cities, where there are several maternity hospitals with different specializations and different conditions of stay.
In large maternity hospitals, the doctor assesses the woman’s condition and risk factors upon admission, draws up a delivery plan, delivery methods are agreed upon with the woman, and the woman’s consent is required to perform manipulations and prescribe medications. Observation, care, fulfillment of appointments, implementation of obstetric aid for childbirth, separation of the placenta, toilet of the newborn is performed by the midwife. The management of a normal birth is entrusted to an experienced midwife; if the midwife has insufficient experience, it is supervised by a doctor or a more experienced midwife, but if risk factors arise, and especially complications, the midwife calls a doctor.
Assistance during childbirth and the postpartum period in an obstetric hospital, as well as examination in a antenatal clinic, is free for Russian citizens in accordance with compulsory health insurance. In addition, assistance in childbirth is considered an emergency medical care for all applicants. Self-supporting departments have been organized for women interested in additional services. The presence of the husband or other relatives in the maternity ward is allowed. Persons present at the birth must be prepared so as not to be passive spectators or a hindrance during the birth.
Childbirth at home in our country is not official and is not encouraged, since it is very difficult to ensure the safety of the health of mother and child at home. Some countries allow home births. This is explained by the insufficient development of inpatient care or the possibility of organizing conditions close to inpatient ones at home. In both cases, this involves great risk. To conduct childbirth at home, it is necessary to have official permission for this type of activity, appropriate home conditions, trained medical personnel, appropriate equipment, provision of transport for urgent transfer to a hospital if complications arise, and a close location of the hospital.
The issue of managing childbirth at home requires study before introducing it into practice. A midwife has no right to abuse the trust of patients, just as she has no right to conduct unauthorized experiments. The midwife must remember the need to comply with the laws and the main principle of medical practice: “Do no harm.”
Organization of the work of the reception department. Procedure for receiving women in labor.
The admission of pregnant women and women in labor to the maternity hospital is carried out by the midwife of the admission department. A woman can go to the maternity hospital herself or be delivered with a sanitary passport in the direction of the housing complex or from home.
The reception department should have the following premises: lobby, filter, examination room, sanitary room, shower, toilet, office space, storage room.
The lobby should create conditions for waiting and provide written information that may be of interest to accompanying persons (telephone numbers of the help desk, rules for receiving packages, visiting postpartum women, etc.).
Filter - a room where a woman takes off her outer clothing and shoes (if she did not leave them with relatives), here the first conversation with the midwife takes place; the filter should have a midwife's desk, landline and local telephones, chairs and a couch, a closet for clothes and shoes (preferably an adjacent room - a dressing room), a closet for medical records. To carry out the examination: tonometer, thermometers, spatulas for examining the nasopharynx, necessary lighting.
The midwife of the emergency department is the first to meet a woman in the maternity hospital and should greet her cordially and kindly, she conducts:
collection of complaints: finds out the time of the onset of contractions and the breaking of waters, the nature of labor and fetal movements, certainly finds out whether there are headaches and blurred vision (signs of gestosis) and other complaints;
study of directions, individual records of pregnant women, examinations, collection of epidemiological anamnesis;
collecting anamnesis (according to the same scheme as when registering with the LCD), using information from the pregnant women’s card;
examinations: measurement of temperature, pulse, blood pressure, examination of the nasopharynx, visible skin and mucous membranes, hairline for lice.
The examination room should have a couch, a gynecological chair, a cabinet with medicines, a doctor’s desk, chairs, scales, a stadiometer, manipulation tables, examination lamps, instruments, means and devices for hand treatment, gloves, disinfectant solutions, storage devices, etc. Conducted general examination and obstetric examination (measurement of the height of the uterine fundus, abdominal circumference, pelvimetry, external obstetric examination, assessment of uterine tone, contractile activity, fetal heartbeat).
The gestational age and estimated fetal weight are determined.
As a result of these actions, the midwife must find out the reason for the visit, try to formulate a diagnosis, assess the woman’s condition, risk factors, find out the presence of infections or lack of examinations (contraindications for admission to a general maternity hospital and indications for hospitalization in an observation department).
After that, she calls the doctor to the emergency room and tells him the information received. In case of emergency, a doctor is called urgently. In the reception department there are facilities for providing assistance in emergency conditions, for childbirth (in addition, for the prevention of HIV infection, as well as for emergency actions upon admission of patients with particularly dangerous infections). The doctor collects anamnesis and examination according to the same scheme, using information from the midwife, and clarifies the data as a result of examination on mirrors and vaginal examination (in some cases, vaginal examination is carried out in the maternity ward). Smears for gonococci are taken in the emergency department by a doctor or midwife.
A diagnosis is formulated (the obstetric diagnosis diagram is presented below), and a delivery plan is drawn up.
In the sanitary room, sanitary treatment is carried out:
hair in the armpits and external genitalia is shaved (if the woman objects, it is not done), in modern conditions it is necessary to use only disposable razors and razors;
cleansing enema, especially if there has been no bowel movement for a long time, and the woman cannot spontaneously empty her bowels. If a woman objects or prefers to empty her bowels on her own, an enema is not given;
toilet, shower (provide the woman with toilet paper, a toilet pad, individual soap, a sponge and a sheet).
In the emergency department, a urine test is performed - a rapid test for protein.
The woman is given a sterile shirt, lining, robe and slippers. When preparing a woman for the maternity hospital, the midwife of the residential complex must prepare, together with the woman, a list of sanitary supplies and linen that need to be taken with her. If she doesn’t have anything with her, the reception department should provide her with everything she needs.
If the relatives did not take the woman’s clothes home, the midwife takes the woman’s things for safekeeping according to the census; they are stored in a special pantry, and valuables in a safe. Security at the reception department is provided by a special employee. The birth history is filled out and an entry is made in the book of patients admitted to the maternity hospital.
The woman in labor spends 30-40 minutes in the emergency department, after which she is transferred on a gurney or on foot to the maternity ward. In addition to examination and sanitary treatment, the duties of the midwife include carrying out psychoprophylactic work (to encourage, reassure the woman, assure her of the successful success of childbirth); When transferring a woman to the maternity ward, it is necessary to place her under the supervision of a midwife in the maternity ward and provide the necessary information.
9 months of pregnancy are over, the long-awaited due date has arrived. There are no women who do not worry at this point in their lives, and for some, arriving at the maternity hospital becomes a particular stress. We will tell you what awaits you behind the “Admissions Department” sign, who will meet you and how, where a natural miracle will happen - the birth of your child.
Just as a theater begins with a hanger, a maternity hospital begins with an emergency department. You should have an exchange card, a compulsory or voluntary health insurance policy and a birth certificate with you. 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 receives those who need to be admitted to the observation department (unexamined or with an infection). In each of the reception and examination rooms there is a doctor’s office and a room for hygiene procedures with a shower and toilet. Here, the obstetrician-gynecologist examines the pregnant woman, collects anamnesis, measures blood pressure, temperature, pelvic dimensions, listens to the fetal heartbeat and makes a decision on labor management tactics. Then the midwife will help the expectant mother do the necessary hygiene procedures and offer a set of linen: a robe, a shirt, and disposable slippers. Depending on the result of the examination, the pregnant woman is sent to one of the departments of the maternity hospital: the maternity unit, the operating unit, the department of pathology of pregnant women or the observation department.
If labor has already begun, contractions have become regular, or amniotic fluid has leaked, the expectant mother will be sent to the maternity ward. Women come to it with contractions. In modern maternity hospitals, the birth block consists of individual boxes, in each of which only one woman gives birth. The box has a multifunctional transforming bed, on which a woman in labor spends the 1st stage of labor (contractions) and the 2nd stage, when the baby is born. The transforming bed is very convenient for both the woman and the obstetricians; in addition, vertical birth is possible on it. In the box there is a CTG machine, which helps control the fetal heartbeat, and a changing table with a heating lamp; here the newborn baby will be weighed, measured, and here he will perform his first toilet. In addition, the 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 can be present at the birth of the baby. In old-design maternity hospitals, the birth block consists of prenatal wards and a general delivery room. Several women in labor can be present in the prenatal ward; the 1st stage of labor (contractions) takes place here, and before the start of the 2nd period (pushing), the pregnant woman is transferred to the delivery room. Both the prenatal ward and the delivery room are fully equipped with everything necessary for the mother and baby.
The duty team of the maternity unit includes an obstetrician-gynecologist, an anesthesiologist and a midwife. All these specialists constantly monitor the woman in labor and take an active part in the process of the birth of the long-awaited baby. The newborn is immediately shown to the mother so that she can loudly pronounce the sex of the child. After this, the baby is given to the hands of a neonatologist. The neonatologist determines the condition of the newborn using the Apgar score at the 1st and 5th minute of life. During this testing, heartbeat, breathing, muscle tone, skin color, and reflex excitability are assessed. After the initial treatment, the child is measured, weighed, wrapped in warm diapers and, if there are no contraindications, placed on the mother’s chest.
A woman spends the first two hours after giving birth in the maternity ward with ice on her stomach and under constant medical supervision. Then, after making sure there are no complications, doctors transfer the young mother 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 a planned caesarean section, or from the pathology department when an operation is to be performed. The operating unit consists of several operating rooms and a preoperative room, where doctors and midwives prepare for surgery. If there are indications, a cesarean section is performed under spinal or spinal-epidural anesthesia. The patient is observed in the intensive care unit for 68 hours after surgery. Here they take all the necessary tests, monitor uterine contractions, measure blood pressure and, if there are no contraindications, transfer the woman to a regular postpartum ward.
Postpartum ward already accomplished mothers are admitted here: straight from the maternity ward or from the intensive care ward after a cesarean section.
An important task of the postpartum period is careful care of the mother and newborn. A woman who has given birth is examined daily by an obstetrician-gynecologist, and on the 1st-2nd day after birth she undergoes an ultrasound. If the maternity hospital does not provide for the mother and baby to stay together, then the postpartum ward also has a children’s ward, where newborn babies are under round-the-clock supervision by pediatricians and pediatric nurses. In the absence of contraindications and with the consent of the mother, during the first day of life the baby is vaccinated against hepatitis B, and on the 3rd-4th day - a BCG vaccination (against tuberculosis). Every 3 hours (except
6-hour night break) children are brought to their mothers for feeding. 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, and an ultrasound room.
Department of Pregnancy Pathology - it houses women with pregnancy complications such as threatened miscarriage, gestosis, fetal hypoxia, Rh conflict, post-term pregnancy, placenta previa, multiple pregnancy, as well as in preparation for a planned cesarean section. It is convenient that modern maternity hospitals, for example the Perinatal Medical Center, are built in such a way that they do not need to be closed for preventive “washing” and pregnant women there can lie in “conservation” for as long as they need for medical reasons. Here, expectant mothers are examined daily by an obstetrician-gynecologist, a CTG of the fetus is performed, an ultrasound scan is performed if necessary, and procedures are performed when indicated to prepare for the upcoming birth. The department usually includes individual rooms, treatment rooms, an examination room, a shower and a toilet in each room. Patients order meals individually and the food is brought to their room.
In all departments of the maternity hospital there is a post of a nurse (midwife) who is on duty there around the clock. And if the patient needs help, she can always turn to a specialist for it.
It is known that expectant mothers are very afraid of the words “observation department” - this is the name of the department where there are underexamined patients or women with any 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 observation department may also have “family” wards.
If the postpartum period proceeds without complications and the child feels satisfactorily, then after spontaneous birth the woman is discharged on the 4th-5th day. If the birth was carried out by cesarean section, then on the 5th day the staples or sutures are removed and an ultrasound examination of the uterine cavity is performed and the mother and baby are discharged on the 6th-7th day.
Before discharge, the obstetrician-gynecologist and pediatrician will give you all the necessary advice and recommendations. You will receive a certificate of birth of the baby for submission to the registry office and social security and two exchange cards to the antenatal clinic and children's clinic. In a solemn atmosphere, a kind of ritual takes place - the ceremony of handing over the child to the father. You go home and now a new happy chapter begins in your life.
Markova Yulia Evgenievna,
obstetrician-gynecologist of the Perinatal Medical Center
Photo: Ⅿeagan / Flickr / CC-BY-2.0
News about unfair treatment of pregnant women in maternity hospitals, unfortunately, appears with enviable regularity. Recently in Voronezh, a woman in labor was administered a medicine to which she developed a severe allergy. In Kirov, a pregnant woman was asked to pay a bribe for urgency; in St. Petersburg, a woman expecting her first child was given an incorrect diagnosis... Of course, this does not happen everywhere and all the time: on many forums dedicated to pregnancy and childbirth, there are many comments containing gratitude to doctors. Another thing is that there are many questions regarding the rights of pregnant women.
What should a woman know about her rights in order to protect herself and her child during such an important period of life? After all, the future life, health and well-being of mother and baby depend on how the birth goes. What rights does an expectant mother have when she crosses the threshold of a antenatal clinic or maternity hospital?
Even before the maternity hospital
Remember: it is your legal right to decide where and how your baby will be born, and whether the father will be present. You and only you decide whether to go to the maternity hospital for preservation, whether to take the medications recommended by the doctor, or whether to do specific tests. You also have the right to change the doctor at the antenatal clinic if he seems rude or inattentive to you. Moreover, you can register not at your place of registration, but at the hospital that is more convenient for you. They cannot refuse you medical care; this is subject to criminal liability. If this happens, write a statement addressed to the chief physician indicating a violation of your rights. In the event that the chief doctor refuses you, you should contact the prosecutor’s office or the investigative committee at the location of the medical institution. During visits to the doctor, you have the right to receive any information you are interested in about the course of your pregnancy. The doctor should not brush aside your questions, but explain in detail how the baby is developing, and in an accessible form. In addition, you should be explained the purpose of the medications and the possible consequences of taking them.
Labor begins
So, nine exciting months are coming to an end. And you are faced with the difficult task of choosing a maternity hospital. Know: it is not at all necessary to go to give birth at your place of permanent registration. Choose a maternity hospital based on its location, reviews about it, specialization, equipment and qualifications of the medical staff. If your pregnancy is complicated, choose a maternity hospital at the perinatal center level. You have the right to request hospitalization in advance.
Staff
Doctors are people too, and they can communicate with patients in different ways. However, when you get to the maternity hospital, you have the right to count on respectful treatment from the medical staff. Even if you then do not intend to sue the doctor, you can write a complaint against the doctor to his superiors. And if you or your baby were injured as a result of the actions of the maternity hospital staff, go to court and demand compensation for the damage caused.
Many people are not aware that, by law, a woman in labor must receive not only medical assistance during childbirth, but also free follow-up care. This includes consultation and assistance in establishing breastfeeding, as well as an ultrasound of internal organs before discharge from the hospital.
Procedures
If contractions have already begun, doctors try to perform a set of standard manipulations: shaving the perineum, an enema, an IV.
– As for shaving, expectant mothers usually prefer to do this procedure at home. In the maternity hospital, a woman in labor can be forcibly depilated only if she has a stamp on her medical card with a diagnosis of pediculosis. In other cases, you have the right to refuse to shave your perineum. True, in fairness it should be noted that the medical staff is unlikely to be happy about this. What is important: the razor must be disposable, and the packaging can only be broken before your eyes.
– Enema is done only upon request. This procedure is not mandatory.
– Upon admission to the maternity hospital, you have the right to write a statement refusing vaccinations. The prescription of drugs and injections must be explained by a doctor. Open the drug for a dropper or injection and, again, take it only in your presence. You can refuse any injections during childbirth, as well as induction of labor, artificial opening of the membranes and episiotomy.
– Only you decide how to dispose of the placenta, so demanding its safety, if this is important to you, is quite legal.
Baby mode
As soon as you give birth to a baby, you have the right to demand that it be put to your breast immediately. And subsequently, the mother can completely refuse supplementary feeding and breastfeed the baby on demand. True, for this you still need to quickly recover after childbirth, which does not happen to all mothers.
Photo: Harald Groven / Flickr / CC BY-SA 2.0
You have the right to demand an explanation of why your baby is going to be given this or that drug. If the explanations and annotations alarm you, you can refuse vaccination. You can also refuse visits from a visiting nurse, as well as scheduled visits to a doctor. Moreover, if controversial situations arise (you think that the baby is sick, but the doctor is sure that he is completely healthy and ready for vaccination), you have every right to trust yourself.
5 possible difficulties
1. Pay for hospitalization. Even if you choose a free maternity hospital, you may be required to pay additional money for services, but free medical care should be provided to the mother in full. By law, a woman in labor is required to be admitted to any maternity hospital, but to ensure an even distribution of pregnant women among such institutions, there are special amendments.
Maternity hospitals are divided into three groups:
– the number of births in which does not exceed 500 per year;
– the number of births in which varies from 500 to 1500 per year (there are intensive care and intensive care wards);
– regional, regional and federal institutions (there are intensive care units for mothers and newborns, as well as a pathology department for babies).
Based on this, the gynecologist at the antenatal clinic selects suitable maternity hospitals for the pregnant woman and offers this list to her to choose from. Usually, if there are no pathologies, referrals are given to maternity hospitals of the first group. A woman in labor falls into the second category if she has a large fetus, polyhydramnios, a narrow pelvis, or a multiple pregnancy. Thirdly, if the pregnant woman has previously had a cesarean section, has progressive chronic diseases, or has a transverse presentation of the fetus. Your stay in the maternity hospital and hospitalization, if necessary, should be free.
2. “Put the money in the envelope”. The desire to thank the doctor has been cultivated in us for years. Our grandparents did this, our parents did this, and almost everyone around us does this. However, if there is no extra finance in the family, then you should not be upset. Indeed, in some cases, new parents commit illegal actions. The fact is that, according to the rules of the Civil Code, employees of medical institutions are allowed to make gifts worth no more than three thousand rubles. And that’s on a voluntary basis.
3. “Pay with a new method”. You may be asked to pay for a more modern method of caesarean section. That is, using epidural or spinal anesthesia, with a small transverse incision above the pubis and subsequent suturing of the wound with absorbable threads. However, this method of caesarean section is officially prescribed in a letter from the Ministry of Health and Social Development.
4. “Daddy costs money too.”. You may be required to pay money for your father's presence at the birth, but the father has the right to attend absolutely free of charge. To do this, the maternity hospital may require him to undergo fluorography and tests for HIV and hepatitis. An important point: a loved one will be able to attend the birth only if there are individual delivery rooms, and such conditions are not available in all maternity hospitals.
5. “You don’t have a birth certificate”. This situation is quite possible, but is not an obstacle on the way to the maternity hospital. They must admit you there even without this document.
The fact is that upon admission to the maternity hospital, you may immediately be asked to sign a document stating that you a priori agree to any procedures and operations, but this is illegal. The reasons and consequences of such actions must be explained to any patient so that he himself can decide whether they are necessary. But in practice, a pregnant woman does not always have time to do this, so the best option here is to issue a notarized power of attorney for one of your close people, and they will be able to give or refuse consent to certain medical procedures on your behalf. It is also interesting how the patient’s rights change depending on the co-payment or lack thereof. For example, relatives are sometimes prohibited from visiting a “free” woman in labor, citing sterility. For some reason, this rule no longer works in the case of payment for childbirth. If you are asked to pay for hospital services, call your insurance company first. If these payments are illegal, you can send a complaint to the chief doctor of the maternity hospital.
Anton Tsygankov
lawyer
So, once you get to the maternity hospital, it is very important to understand that your well-being and the health of your baby depend not only on the doctors. First of all, everything is in our own hands, because any woman in labor has the right to refuse certain procedures by law. It’s another matter when the desire to maintain order turns into an obsessive desire to completely plan the birth process and refuse even the help that is vitally necessary for you. Therefore, trust doctors, but know: if your rights are really violated, you can defend them.
1. The maternity hospital (department) provides qualified inpatient medical care to the population on a territorial basis. The territory of operation of the maternity hospital (department) is established by the relevant health authority according to its subordination.
2. If necessary, pregnant women can be sent to maternity hospitals (departments) of other union republics in the manner established by the Ministry of Health of the USSR, and to institutions located within the union republic - in the manner established by the Ministry of Health of the republic.
3. First and emergency medical care for pregnant women who apply to the maternity hospital (department) is provided regardless of their place of residence and departmental subordination of the health care institution.
4. Referral to the maternity hospital (department) for emergency care is carried out by the ambulance and emergency care station (department), an obstetrician-gynecologist, doctors of other specialties, as well as paramedics (midwife, paramedic, nurse). A woman can independently go to the maternity hospital (department).
Planned hospitalization of pregnant women in the maternity hospital (department) is carried out by an obstetrician-gynecologist, or in his absence by a midwife.
Hospitalization of pregnant women suffering from extragenital diseases and in need of examination and treatment in a hospital setting is carried out in hospital departments according to the pathology profile.
5. Pregnant women in the presence of medical indications, women in labor, postpartum women in the early postpartum period (within 24 hours after birth) in the event of childbirth outside a medical institution are subject to hospitalization in the maternity hospital (department).
For hospitalization in the department of pathology of pregnant women, a referral is issued by the antenatal clinic (or other health care institutions), an extract from the individual card of the pregnant woman (Form N 111/U) and an exchange card (Form N 113/U) after 28 weeks of pregnancy.
6. In exceptional cases, women candidates for adoption may be hospitalized in the maternity hospital (department) in order to maintain the secrecy of adoption if appropriate documentation is available in the prescribed manner.
7. Upon admission to the maternity hospital (department), the woman in labor and the postpartum woman present a passport and an exchange card (form N 113/U), a pregnant woman presents a passport, a referral for hospitalization in the maternity hospital (department) indicating the diagnosis and an exchange card (form N 113/ U), if it has already been issued (from 28 weeks of pregnancy). If applicants do not have a passport with them, it is noted that the information is recorded from the woman’s words, and the need to present a passport as soon as possible is indicated.
8. The appointment is carried out in the reception and examination room of the maternity hospital (ward) after examination by a doctor or midwife, who, if necessary, calls a doctor.
9. For each woman admitted to the maternity hospital (department), medical documentation is drawn up in the reception and examination room: birth history (form N 096/U), an appropriate entry is made in the logbook for the admission of pregnant women, women in labor and postpartum (form N 002/ U) and in the alphabet book.
10. The procedure for admitting a pregnant woman, a woman in labor, or a postpartum woman to the maternity hospital (department) and the profile of the department where the woman is sent is established in accordance with her state of health by the doctor (midwife) on duty.
Appendix 2
Toorder Ministry of Health of the USSR
If a pregnant woman is “in labor”, this means that the woman arrived either with contractions or with broken amniotic fluid and will have to give birth in the next few hours. In this case, the sequence of the procedure is as follows:
- conversation with the midwife, with the doctor on duty, who fills out the documentation - the birth chart;
- determining the weight of a pregnant woman;
- A pregnant woman changes into maternity hospital clothes or her own clothes.
- A cleansing enema is performed. If a pregnant woman is admitted in the period of pushing, an enema is not performed; she is immediately transferred to the delivery room.
- If necessary, the genital area is treated (shaving), followed by a shower.
- The pregnant woman is sent to the department - physiological or observational.
If bleeding or other life-threatening conditions are detected and requiring immediate delivery, the pregnant woman can be sent to the operating room directly from the emergency room with only minimal or no processing.
In this case, the pregnant woman is sent to the pathology department or home. The procedures that are carried out in this case are as follows:
- If the pregnant woman is not hospitalized, she is given an advisory report with further recommendations.
A pregnant woman may be in the pathology department, her birth may be planned, or contractions may begin at any time. In this case, she expects the following:
- CTG recording - fetal heartbeat.
- Cleansing enema and shower.
Cardiotocography (CTG) If a woman is planning to have a caesarean section, the procedure is the same. A light dinner is allowed the night before; in the morning you can only drink a little clean water.
In the delivery room the woman is assigned to one of the prenatal wards, where she will be monitored and CTG monitoring of the fetal condition will be carried out. The doctor clarifies the woman’s complaints and medical history, studies the birth chart and, if necessary, conducts an examination in the chair.
All the time contractions the woman is in the prenatal ward, she is also allowed to move along the corridor and take a shower (as a method of pain relief).
With the beginning of the pushing period, the woman lies down on a chair in the delivery room, the doctor monitors the condition of the fetus by heart rate (listened to with a stethoscope or CTG monitor).
After the birth of the child, the birth canal is examined for rupture. For another two hours, the woman is under close supervision of medical personnel for timely detection of complications, after which the postpartum woman is transferred to the ward.
If an emergency or planned caesarean section is performed, then immediately after the operation the woman is transferred to the intensive care unit for observation - for at least two hours, most often for 12-24 hours.
What else will happen after childbirth
- after a natural birth, women stay in the postpartum department for 3-5 days, after a cesarean section - up to 10 days;
- treatment of sutures twice a day - perineum (for natural childbirth), postoperative scar (after cesarean section);
- dispensing tablets for concomitant diseases;
- installation of intravenous infusions - after gestosis, cesarean section, after heavy blood loss or other complications;
- if necessary, women are talked to about breastfeeding and taught how to latch on to the baby;
- in case of complicated labor, the woman may be referred for additional examinations or procedures.
Procedures before discharge from the hospital include:
- blood and urine tests, biochemical examination, if necessary, in-depth urine tests;
- inspection of seams and their treatment;
- vaginal examination on a chair;
- examination of the mammary glands;
- Ultrasound examination of the pelvic organs.
The newborn undergoes separate examinations and examinations. If any abnormalities or complications are discovered, the mother and child may be left for some more time in the maternity hospital. In some hospitals, in such cases, transfer to another department is assumed.
As soon as mother and baby are ready for discharge, all documents are drawn up: discharge summary, documents for the child, and others if necessary.
Read more in our article about procedures in the maternity hospital.
Read in this article
What will happen immediately after admission to the maternity hospital?
A maternity hospital is for many a medical institution full of mysteries, because since Soviet times it has been customary for pregnant women and women in labor not to be allowed out even to relatives from the moment of admission until discharge, but to communicate “through the glass window.” In order to feel calm and be prepared for all manipulations, it is useful to know what procedures are carried out in the maternity hospital at different stages.
Pregnant women enter the maternity hospital for two reasons:
- by referral from a antenatal clinic doctor;
- on your own or in an ambulance with some complaints.
If a pregnant woman is “in labor”
This means that the woman arrived either with contractions or with broken amniotic fluid and will have to give birth in the next few hours. In this case, the sequence of procedures that will be performed upon admission to the maternity hospital is as follows:
- conversation with the midwife, and then with the doctor on duty, who fills out the documentation - the birth chart;
- examination by a doctor, listening to the fetal heartbeat;
- measuring the abdominal circumference and the height of the uterine fundus;
- determining the weight of a pregnant woman;
- blood pressure measurement.
- The pregnant woman changes into clothes (robe, slippers, underwear) from the maternity hospital or her own clothes - depending on the institution.
- A cleansing enema is performed. If a pregnant woman is admitted while pushing, an enema is not performed and she is immediately transferred to the delivery room.
- If necessary, the genital area is treated (shaving), then you should take a shower.
- The pregnant woman is sent to the department - physiological or observational, based on the clinical situation.
Expert opinion
Daria Shirochina (obstetrician-gynecologist)
If bleeding or other conditions that are life-threatening and require immediate delivery are detected, the pregnant woman can be sent to the operating room directly from the emergency room with only minimal or no treatment.
If there are signs of labor or other problems
In this case, the pregnant woman is sent to the pathology department or home (for example, if she refuses hospitalization or her condition does not require inpatient care). The procedures that are carried out in this case are as follows:
- Conversation with the midwife and doctor, preparation of the necessary documentation.
- Examination on a gynecological chair.
- Measuring weight, blood pressure, parameters of a pregnant woman.
- If the pregnant woman is not hospitalized, she is given an advisory report on her condition with further recommendations.
- If necessary, the woman is sent to the pathology department or the delivery room for observation.
Procedures to prepare for the day of birth
If a woman enters the maternity hospital with contractions or broken waters, the algorithm of actions and all procedures before childbirth are described in the previous paragraph.
But a pregnant woman may be in the pregnancy pathology department and her delivery may be planned, or contractions may begin at any time. In this case, she expects the following:
- Examination by the attending or duty doctor, and, if necessary, by the head of the department.
- CTG recording - fetal heartbeat.
- Cleansing enema and shower.
- Transfer to an observational or physiological maternity ward.
If a woman is planning a caesarean section, the procedure is the same. A light dinner is allowed the night before; in the morning you can only drink a little clean water.
Also, the pregnant woman must collect all her things if she was previously in the pathology department. Some can be taken with you to the delivery room, the other will need to be put in a storage room.
Watch this video about preparatory procedures before childbirth:
In the delivery room
The maternity room includes an examination room (usually several), prenatal wards where women are during contractions, as well as the maternity rooms (halls) themselves - they contain special chairs, a table for treating a newborn, as well as equipment and tools that may be needed during childbirth, everything is sterile, and consumables are disposable (diapers, etc.).
The delivery room also includes an operating room, where, if necessary, a woman can be sent urgently during childbirth.
After admission to the delivery room, the woman is assigned to one of the prenatal wards, where she will be monitored (including video), and CTG monitoring of the fetal condition is carried out. The doctor, who is in charge of the delivery room at this time, clarifies the woman’s complaints and medical history, studies the birth chart and, if necessary, conducts an examination in a gynecological chair.
If childbirth proceeds without complications, then the frequency of vaginal examinations is as follows:
- every four hours during labor;
- after the rupture of amniotic fluid;
- if complications are suspected.
The woman is in the prenatal ward throughout the contractions; she is also allowed to move along the corridor and take a shower (as a method of pain relief).
With the beginning of the pushing period, the issue of transfer to the delivery room itself is decided. Here the woman lies down on a chair, the doctor monitors the condition of the fetus by heart rate (listened to with a stethoscope or CTG monitor).
After the birth of the child, the birth canal is examined for rupture. If necessary, the doctor performs suturing, as well as additional manipulations. For another two hours, the woman is under close supervision of medical personnel for timely detection of complications. After which the postpartum woman is transferred to a ward with the baby.
If an emergency or planned caesarean section is performed, then immediately after the operation the woman is transferred to the intensive care unit for observation - for at least two hours, most often for 12-24 hours. After this, she is also transferred to the postpartum ward.
Watch this video on how to care for a suture after a caesarean section:
What else will happen after childbirth
As soon as doctors are confident that the woman’s condition is stable, she is transferred to the postpartum ward. After a natural birth, women stay here for 3-5 days, after a cesarean section - up to 10 days. If necessary, the period may be extended. What procedures a woman will undergo after this depends on how her labor progressed.
If necessary, women are talked to about breastfeeding and taught how to properly latch onto a baby.
If the course of labor is complicated, a woman may be sent for additional examinations or procedures (for example, physical therapy), which are done directly in the maternity hospital.
Features before discharge from the hospital
Depending on the condition of the postpartum woman, the doctor determines the time of her discharge. The day before you need to undergo a minimum examination and examination. Procedures before discharge from the hospital include the following:
- blood and urine analysis, if necessary - a broader study, including biochemical examination, in-depth urine tests;
- inspection of seams and their treatment;
- vaginal examination on a chair - the rate of uterine contraction and the nature of discharge from the genital tract are determined;
- examination of the mammary glands;
The newborn undergoes separate examinations and examinations. If any abnormalities or complications are discovered in the baby, mother and child may be left in the maternity hospital for some more time. In some hospitals, in such cases it is assumed that the patient will be transferred to another department (rehabilitation) or even a children's hospital.
As soon as the mother and baby are ready for discharge, all documents are drawn up - discharge summary, documents for the child, and others, if necessary. The woman should subsequently provide some of them to the pediatrician, and the other to the gynecologist at her place of residence.
Preparation for childbirth is universal and is performed in all maternity hospitals, but each medical institution has its own approaches and nuances. For example, in some places visiting relatives is allowed during the entire stay in the maternity hospital and even during childbirth. In others, this is strictly prohibited and even wearing your own clothes is not allowed. Therefore, when sending to a hospital on a scheduled basis, you should find out such nuances in advance.
Useful video
Watch this video about the features of the postpartum period:
