Admission of a pregnant woman to the maternity hospital. Principles of labor management

Gift ideas
09.03.2020

Many people are used to and love everything in life to go according to plan, and expectant mothers are no exception. However, is it possible to know the exact date of birth? No one knows this; a gynecologist can only guess from the parameters of the fetus and the last menstruation when exactly the baby will be born. Of course, it is better if the expectant mother is already in the maternity hospital when contractions begin, because childbirth can be rapid and complicated. How do you know exactly when to go to the hospital if there are no contractions? For this purpose, the expectant mother is given a special referral to the maternity hospital.

What is a referral to a maternity hospital?

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

You should not neglect the referral to the maternity hospital and procrastinate until the last minute. Most women, having received a referral from a gynecologist, are in no hurry to go to the maternity hospital and stay at home until contractions begin, after which they call an ambulance and worry about getting to the nearest maternity hospital in time. The situation in this case is also complicated by traffic jams and the fact that the pre-selected maternity hospital may suddenly close for cleaning. That is why it is very important to receive a referral to the maternity hospital on time and know that they will be waiting for you there within the specified period of time.

How to get a?

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

Is it necessary?

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

Quite often, an expectant mother goes to the maternity ward without any idea of ​​who and what is waiting for her there. Most likely, the woman knows a lot about the course, but does not imagine which specialists will meet her in the maternity hospital, what their powers and responsibilities are, what equipment is in the delivery room and what it is used for.

To fill this gap, we will try to talk about what awaits a pregnant woman upon admission to the maternity hospital and directly in the delivery room.

Maternity hospital What can a pregnant woman expect upon admission to the maternity ward?

Upon arrival at the maternity ward, you will be required to register.

  • The nurse who meets the woman at the emergency room records the time of admission of the woman in labor and provides information about her state of health. This nurse also records personal information according to the passport and insurance policy, if any.

Ideally, your escort will handle the transfer of all documents and a description of what is required to the staff.

If you find yourself in the maternity hospital alone, do not worry, the doctors will also clarify your personal data, information about diseases, previous births, if any. But this will not stop them from doing their main task - helping a woman in labor give birth to a healthy baby.

  • At the emergency room, the woman will have her blood pressure and temperature measured.
  • Next, the expectant mother will be asked to go to the prenatal ward.
  • Then the nursing staff or partner will help you bring things in, put them in a personal locker and lock them. Losing or stealing items in the maternity ward is extremely rare, so don't worry.

What awaits a woman in the prenatal ward?

  • You will be examined on the chair;
  • Monitoring the general condition of the woman in labor;
  • The doctor will assess the condition of the fetus and listen to the fetal heartbeat using a stethoscope.
  • If necessary, cardiotocographic monitoring of the fetal heartbeat (CTG) is prescribed.

Clothes for the delivery room

Most likely, in the delivery room you will be asked to change into a special maternity shirt. Previously, these were shapeless cotton shirts, with a deep neckline, literally down to the crotch.

Such a simple style is not a tribute to “maternity fashion”, but a necessity. Firstly, the doctor must have access to your stomach, and secondly, the baby will be laid on your bare chest after birth. This is how he tastes maternal colostrum for the first time, and “populates” his body with microflora that is beneficial for the immune system. In addition, tactile and visual contact with the mother, which is very important for the further development of the baby, occurs.

Maternity hospital doctors

Don’t be surprised if during the birth process you see new faces changing frequently next to you. Typically, childbirth takes place under the supervision of the team on duty, and not just your obstetrician-gynecologist. If you agree in advance, the doctor invites specialists whom he trusts to a greater extent to help him. If childbirth occurs without prior arrangements, the doctors on duty will help you.

Both options are completely normal, so don't worry. The maternity wards are staffed by professionals who have already delivered hundreds of babies.

So, get to know the people who might be around you in the maternity ward:

  • Obstetrician-gynecologist.

It is he who makes all strategically important decisions. If necessary, he is competent to examine the patient, open the amniotic sac, perform an episiotomy (perineal incision), or perform an urgent (urgent) cesarean section.

During the process of pushing, several more specialists from the duty team may be in the delivery room. If they have no other work to do at the moment, they may be assisting your doctor. But this is not a rule at all; in most cases, only a personal obstetrician-gynecologist and his assistant, a midwife, are present during childbirth.

  • Midwife.

Let's start with the fact that usually in a maternity hospital a woman meets two midwives at once. The first one meets her in the prenatal ward, she gives injections or puts on IVs, if there are indications for them. The second midwife helps the woman in labor right in the delivery room. She monitors the frequency of contractions, examines the abdomen, and literally “by eye” determines at what stage the fetus is along the long journey. She protects the perineal muscles from tears by performing certain techniques.

It is also important that the baby falls into the hands of the midwife immediately at the moment of his birth. She takes care of the baby in the first minutes of his life, after the newborn meets his mother. The midwife weighs the child, measures his height, records the exact time of birth and dresses him.

  • Anesthesiologist.

One of the main characters in childbirth, which requires pain relief. This specialist makes a decision on the use of one type or another. Often an assistant, popularly called an “anaesthetist,” comes to his aid in preparing and carrying out all the necessary manipulations.

  • Neonatologist or pediatrician.

This is a doctor who specializes in assessing the health of a newly born baby. He conducts a mandatory examination and gives the child the first important grades. If the neonatologist sees a need, he prescribes the necessary treatment and suggests further examinations. The same doctor or his “replacements” will look after the baby every day spent in the postpartum ward.

  • Nurse.

Assists the obstetrician-gynecologist during daily examinations, and acts as an assistant in the process of tissue restoration after ruptures or incisions. She also carries out, helps the young mother solve issues with personal hygiene, emptying the bladder or intestines (uses catheters, does an enema).;

Of course, such a number of doctors is not always present. Quite often, as we have already said, only three people successfully cope with their main task - an obstetrician-gynecologist, a midwife and a neonatologist. In private maternity hospitals, the same team can serve the postpartum woman throughout her entire stay in the maternity hospital, with the only exception being “night shift workers.”

Rodzal

Now, most maternity hospitals have made sure that the expectant mother feels as at home as possible while in the delivery room. They create coziness and a pleasant, calming atmosphere. However, there are some objects that can alarm a woman in labor with their unclear purpose. Let's talk about them.

  • Maternity bed.

Although today a woman has some freedom to choose the positions in which she will give birth to her baby, maternity beds are still present in most maternity hospitals. As a rule, it is on such a bed that a woman stays during the period of pushing. The bed has all kinds of devices so that a woman can take the most comfortable position, rest her feet or hands. Also, it is on the maternity bed that it is easiest for specialists to deliver a baby.

  • Heart monitor.

Such a device is necessary to control the fetal heartbeat. Special sensors with which it is attached to the mother's belly record the heart rate and display it graphically.

  • Apparatus for supplying special gases.

It is a device with a mask through which oxygen is supplied to the woman in labor if intrauterine fetal hypoxia is suspected. The same device is used to administer labor anesthesia, only in this case the mother in labor is given the drugs necessary for anesthesia.

  • Table for a newborn.

It is there that the baby’s height and weight are measured, his first hygiene and the choice of his first fashionable wardrobe take place. Quite often, such a table is equipped with a special lamp for warming the baby, as well as all kinds of sensors and tubes to provide the baby with oxygen if necessary.

  • Gymnastic equipment.

Many maternity hospitals have adopted Western European experience and equipped the delivery room with all sorts of items that a woman in labor can use on her own or with the help of a partner to relieve labor pain. We are talking about large gymnastic balls or bean bags in which a woman takes the most comfortable relaxing positions for her.

Sometimes in the delivery room you can see some kind of “buffet wall”; it is also used for relaxation during contractions.

When a woman giving birth comes to the maternity hospital with contractions, the most important thing for her is to maintain a calm state, focus on herself, the child, and the processes occurring inside her. The procedure for admission to the maternity hospital does not contribute to this in any way, rather the opposite.

Prepare for it, write down in advance the answers to possible questions for you, using our list of typical questions when entering the maternity hospital.

Most likely, you will still be asked to read these answers yourself, rather than take a ready-made list. But even in this case, simply monotonously reading ready-made answers “from the sheet” may turn out to be easier than trying during the next contraction remember legal address and telephone number of your last place of work or place of marriage registration.

Upon admission to the maternity hospital you will be asked the following questions

This list is approximate. In each specific maternity hospital and in each specific situation, it can be supplemented with other questions. Be prepared to answer them too.

  1. Full Name
  2. Age ( how old are you?)
  3. Nationality
  4. Permanent residence ( where are you registered)
  5. Place of actual residence: city, address, telephone ( where do you actually live currently) – after discharge, a doctor and a nurse will visit you at this address to care for the newborn.
  6. Place and legal address of work, profession, position, education
  7. Date of prenatal leave ( decree)
  8. Have you visited a doctor? midwife) during pregnancy? How many times?
  9. Name of consultation ( number and address of the antenatal clinic where you were seen during pregnancy)
  10. Which pregnancy is it? Which births? ( just answer as is)
  11. Last menstruation ( the same one from which your pregnancy and birth dates are calculated)
  12. First fetal movement ( as in the exchange card)
  13. General diseases ( as in the exchange card)
  14. Marital status, whether the marriage is registered
  15. Place of marriage registration ( city, registry office number as in the marriage certificate)
  16. Full name of the child's father, place of work, position, age, health of the child's father.
  17. When did your period start? ( age)
  18. Beginning of sexual activity ( age)
  19. Gynecological diseases ( as in the exchange card)
  20. Previous pregnancies - dates of birth, abortions, complications, surgical benefits, weight of newborns ( write down the exact data and features of the course of pregnancy and childbirth, for example, caesarean section, breech presentation, Rh conflicts, etc.)
  21. How many children ( now you have)
  22. The course and complications of pregnancy ( as in the exchange card)

Documents for admission to the maternity hospital

Be sure to take it with you passport, compulsory medical insurance or voluntary health insurance policy (if any) and exchange card. At the time of admission to the general maternity ward, the exchange card (from the 28th week of pregnancy the “exchange” should be given to you in your hands at your housing complex) must contain “fresh” results of blood tests for HIV, RV and a smear for gonococcal infection. You and your assistant will also be required to provide a certificate of recent fluorography and that you are not registered at the tuberculosis dispensary. Otherwise, if some test results are missing, you may be given birth in the infectious diseases department of the maternity hospital (as in an unexamined patient, possibly potentially contagious).

If you are incarcerated for childbirth contract with a doctor or a brigade, then it’s worth taking it with you.

But the presence or lack of birth certificate– the question is not so mandatory. Sometimes doctors at antenatal clinics like to scare impressionable pregnant women into not giving them a birth certificate. According to the law, even if a pregnant woman was not observed at all in the country’s antenatal clinic system (for example, she returned from abroad only on the eve of giving birth), then her birth certificate will be discharged right in that maternity hospital where she will give birth. (A pension insurance certificate will be required for registration). Since the birth certificate ensures that the state pays for the work of those medical specialists whose services the woman used - that is, doctors of the housing complex, maternity hospital and pediatricians from the clinic where the child is observed in the first year of life.

If an agreement (contract) has been concluded for childbirth support, that is, the woman pays for it “out of her own pocket,” then the funds from the birth certificate are usually not taken into account. In practice, the corresponding birth certificate coupon is still taken away from the maternity hospital. Thus, if a woman does not have a birth certificate upon admission to the maternity hospital, then she will be delivered, and a birth certificate will be issued for the children's clinic in the maternity hospital after the birth. If the birth certificate was not received at the antenatal clinic and maternity hospital, in order to pay for the observation of the child during the first year of life in the children's clinic, the birth certificate can be issued at the antenatal clinic at the place of observation of the woman after childbirth. The birth certificate has nothing to do with the payment of child benefits.

What else should you take with you to the maternity hospital?

Each maternity hospital has its own list of things allowed for childbirth and after it. It's worth finding out in advance if you already. In other cases, you can rely on our approximate list of things to take to the maternity hospital.

Have a successful birth!

On the eve of the birth, it is necessary to check whether all methods of examination and preparation were carried out in the conditions of the antenatal clinic, to clarify the duration of pregnancy and the expected date of birth.

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.
In assessing risk factors both in the antenatal clinic and in the obstetric hospital, a doctor should take part 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 during 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 her 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), while 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. Carried out 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.