The role of the midwife and doctor during childbirth. Paid (service) childbirth - “Is it worth signing a contract with a maternity hospital? What does it actually include? Do I need to take a paid midwife and what is the difference from a doula? Do you need a birth partner then? » Essay my future profession

In 1964, a young French obstetrician narrowly escaped responsibility for. A friend offered him samples of a new mind-altering drug. And Michel Auden tried to give very small doses of this drug to women in labor. The results were amazing. “Women seemed to lose their minds, they screamed in the corridors, pulled catheters out of their veins, frightened midwives ... but the baby was born right away! But since such behavior was "unacceptable in a medical institution," Auden quietly stopped his and never talked about him.

It is understandable, given that this drug, GHB (gamma-Hydroxybutyric acid, or gamma-hydroxybutyric acid), is notorious as a "date-rape drug", that is, a drug that, if added to a person, you can make him lose control of himself. Gamma-hydroxybutyric acid promotes the release of the hormone oxytocin, and in the case of these women (by the way, did THEY know about the experiment, Auden does not say ...) broke those cultural barriers that separated the woman from her rapidly giving birth to foremothers.

Auden suggested that champagne speeds up labor because it also contains inhibition-releasing gamma-hydroxybutyric acid. On the one hand, I would love to see this book, which, as the author hints, may be the swan song of this wonderful writer and thinker who advocates the use of GBH in rodblock instead of synthetic oxytocin.

Just imagine the results! (Not to mention the safety concerns of keeping such a drug under lock and key from various perverts, which I think is enough in every major teaching hospital...). It is enough that the hypothesis of such a high authority as Auden allows us doulas to consider a bottle of champagne in a doula bag as important as, for example, crocs ...

Since the beginning of the 60s, Auden has been trying to explain that human society is the main enemy of childbirth, because we cannot help but interfere. Only by suppressing the "thinking brain", the cortex, a woman can regain the ability of our foremothers - to give birth easily and quickly. In primitive societies, women are allowed to give birth by themselves, with an experienced helper waiting at some distance, but for thousands of years we have chosen to do the exact opposite.

And quite often (more often than we would like) we find that we did everything wrong. Auden recalls that very recently - terrifyingly recently - doctors found out that children immediately after birth physically needed to be near their mothers, and not in the children's ward.

We shaved women's crotches, gave them enemas, wiped their nipples with alcohol before they offered their breasts to a child, and now it turns out that these microbes turn out to be necessary for babies! (And, the author might add, the National Institute for Clinical Excellence recently informed us that, practiced for decades, immediate clamping and cutting of the umbilical cord deprived newborns of up to 30% of their natural blood volume.)

Women today, on average, give birth three hours longer than women of the same age, weight and height 60 years ago. Many women with not very successful deliveries pass on, thanks to the spread of caesarean sections, this “failure to give birth” to their daughters, so the proportion of women who cannot literally give birth without assistance is also growing in our society. At the same time, we are moving further and further away from being able to experience what Auden called the "fetal expulsion reflex."

As I discovered, in my time studying with Auden, his ideas, given in a large perspective, do not always manage to be applied “here and now”. Yes, I wholeheartedly accept the fact that a woman should turn off the cerebral cortex and allow the subcortex to turn on. But for the anxious, rational 30-year-old businesswomen whose births I attend, such a cortical shutdown is rarely possible (which is also why I mastered the HypnoBirthing technique).

Dr. Auden devotes a lot of time to studying the possible delayed effects of medical interventions in childbirth on humanity ... Recently, by the way, a major American lawyer specializing in "medical" cases admitted to me that pitocin (the American analogue of synthetic oxytocin) brought him more income than any other intervention in childbirth, since this drug is the cause of a huge number of birth injuries, including brain injuries.

It would be great to know Auden's opinion on this matter from the book. Instead, Auden is interested in less than credible research suggesting links between caesarean sections, oxytocinompitocin, and autism.

Autism is a relatively recent diagnosis. Its wording in the Diagnostic and Statistical Handbook of Mental Disorders, the "psychiatrists' bible", was changed again in 2013. And, as far as we understand, it can be changed more than once. It is also believed that there is a hereditary predisposition to autism. Thus, I am not convinced that an unexplored condition such as autism is associated with a caesarean section or induction of labor. Auden rightly warns about the phenomenon of "dead end research": the conclusions from the study are so socially unacceptable that the researcher practically buries his work. On the other hand, many questions about autism are still waiting to be answered, and pointing fingers is inappropriate in this situation ...

For a doula, the ideal Auden birth scenario looks wonderful: a woman giving birth alone (without a midwife or with an inconspicuous and non-participating midwife; and no man!), in a dark room. But for many of our clients, this description resembles torture: locked in a dark closet, accompanied by an ominous tricoteuse (tricoteuse (fr.) - a knitter; a hint of famous characters of the era of the Great French Revolution - women who were present with knitting at meetings of the Convention, the Revolutionary Tribunal and at the foot of guillotine during numerous public executions; under the monarchy, knitting was considered low labor, and “knitter” was a derogatory nickname; the new regime gave women many rights, crossing out old prohibitions; including the right to “take part in meetings of the Commune and knit”, - approx. .per.), silently knitting in the corner. This is not what our culture thinks of as "support in childbirth."

Auden also decorates the "cake" of his birth scenario with a "cherry": if a woman can't give birth within a certain amount of time, then, he explains, an emergency caesarean section is a better choice than continuing painful labor with more and more interventions. It's knife time!

I understand this very well. Every week I read stories about childbirth, either by women in my courses or by clients of my colleagues, in which a woman (and her cervix!) was exposed to one drug after another, while the woman was chained to a monitor and an IV for hours, and her tortured body experienced shock after shock - and all this only in order to "avoid caesarean".

On the other hand, it is difficult for me to imagine women who can really give birth in the conditions offered by Auden. Where can you find a woman who will turn off the cerebral cortex so well that she will give birth perfectly alone in a dark room and “on another planet”, KNOWING AT THE SAME TIME that a clock is ticking somewhere, measuring the time after which she will be taken to the operating unit for abdominal surgery? Definitely not where I live.

Michel Auden has a strong influence on everyone who thinks about physiological, but at the same time safe childbirth. However, I often find his theories more educational than practical. Women are not so stupid. Man has learned to fear easily. Unlearning ... is a completely different story.

So we have forgotten how to give birth, according to Auden? I ask myself.

Many women give birth under roughly the same conditions, and most of them, if they are not too young, emaciated, or female circumcised, succeed. Most women can't afford the clean, pretty operating room in the hospital next door. All they need is well-trained and supportive midwives; women need affordable health care, but they also need universal information about childbirth that tells women about their ability to give birth.
And yes, we still need Dr. Auden, even if that voice is Cassandra's, darkly prophesying our doom. May Auden continue to amaze and sometimes infuriate us for years to come!

Many different specialists work in the maternity hospital, but most of all, a pregnant woman is interested in who exactly from the medical staff will be with her in the maternity unit. Let's talk about the medical specialists who will be there at the crucial moment of childbirth.

Obstetrician-gynecologist: leader and assistant

The chief medical specialist in the rodblok is an obstetrician-gynecologist. His job is to make strategic decisions. This means that it is the obstetrician-gynecologist who decides how a woman can give birth, monitors the course of childbirth and the condition of the woman in labor and the child at this time. Without a doctor's order, none of the employees of the maternity unit can make any appointments or manipulations that may affect the course of childbirth. And this is justified: after all, it is he who is responsible for everything that the obstetrician-gynecologist prescribes and does in the rodblok. Looking ahead, let's say that the doctor does not directly accept the child during childbirth - this is the work of a midwife. Then what does this specialist do in practice?

First, the doctor examines the woman in labor, learns about how the pregnancy proceeded, and draws up a plan for the conduct of childbirth. Then the obstetrician observes the state of the woman in childbirth, although he is not constantly present with her in the maternity box. In the first stage of labor, the doctor examines the woman in labor every hour, conducts a vaginal examination in order to assess the birth process, to determine how the baby moves through the birth canal. In addition, an obstetrician-gynecologist evaluates the results of tests, (CTG), monitors the opening of the cervix, the nature of labor, and so on.

Another doctor conducting childbirth does manipulations such as amniotomy (puncture) or episiotomy (perineal incision). He decides at what point an anesthesiologist is needed, and also prescribes the necessary medications. During the birth of the baby, the doctor is next to the midwife and monitors how she provides obstetric benefits. After the baby is born, the obstetrician-gynecologist records the time of his birth, examines the puerperal and evaluates her condition. In addition, the doctor must observe the signs of separation of the placenta, and after her birth examines and evaluates her condition and integrity.

A woman has the right to know what medical procedures she is undergoing. She can always ask the doctor or midwife what this or that appointment is for and whether it can be replaced with something.

If, during the passage of the baby through the birth canal, tears have formed in the soft tissues of the mother or incisions have been made, the obstetrician-gynecologist puts stitches. He also has to perform more serious operations: for example, with incomplete separation of the placenta. Even after childbirth, the doctor does not leave the mother unattended. He will definitely appear in the ward on the same day or the next to see how his patient is feeling, to find out if anything is bothering her, and to make recommendations for the future.

Now you can conclude a contract for the management of childbirth with a personal obstetrician-gynecologist. This means that as early as the 36th week of pregnancy, the expectant mother meets the doctor, discusses with him the plan of her birth, and the doctor, in turn, talks about what and in what sequence will happen during childbirth. This is convenient for both the doctor and the expectant mother, because psychological contact is established between them by the time of childbirth, and this always has a positive effect on the course of childbirth.

Midwife: right hand

A midwife is a nurse in a maternity hospital. Each department of the maternity hospital has its own midwives, and their tasks are different - for example, the midwife of the admission department meets the expectant mother and fills out her documents, conducts an initial examination and helps to perform hygiene procedures (puts an enema, helps with shaving the perineum). Midwives in the pathology or postpartum department also have a lot to do: they usually perform normal nursing duties. But the midwife of the maternity ward has the most important task - to help the woman in childbirth, to accept the child and carry out his primary toilet. What is her job?

The word "midwife" comes from the French accoucheur, which literally translates as "one who stands at the bed", and its modern meaning is an assistant in childbirth.

During childbirth, the midwife, like the doctor, regularly examines the woman in labor, determines how much the cervix has opened, where the baby's head is. As prescribed by the doctor, the midwife measures blood pressure and pulse, installs a CTG machine. And she can also tell you how to breathe properly or restrain if the cervix is not yet sufficiently open or the fetal head has not sunk to the pelvic floor.

During the second stage of labor, after the baby's head has erupted (that is, when the head does not disappear back into the vagina between pushes), the help of a midwife is especially needed. In order for the head not to move forward too quickly and strongly, the midwife helps the woman, thereby protecting her perineum from damage. During the birth of the baby, the midwife gently guides the baby's head, and then, after the baby is born, helps the baby turn around and release the hanger.

As soon as the pulsation of the umbilical cord stops, the midwife puts clamps on it and crosses it (if the father of the child is present at the birth, they can entrust him with cutting the umbilical cord). According to tradition, the midwife shows the baby to the mother, asking: “Who was born?”. After this, the baby is applied to the mother's breast for a while, and then transferred to the changing table for processing.

The midwife washes the baby with warm water, removing blood, mucus, meconium, and wipes the baby with a warm sterile diaper. Then he processes the umbilical cord: he puts a clamp on it, and then a bracket. The rest of the umbilical cord is cut off and treated with an antiseptic, then a sterile bandage is applied. While the neonatologist assesses the condition of the newborn, the midwife, together with the obstetrician-gynecologist, monitors the birth of the placenta, then, if necessary, empties the bladder of the puerperal with a catheter.

As you can see, the midwife of the maternity ward is really an extra-class professional - she manages to help both mother and baby.

Anesthesiologist: Pain Control

Each duty team must include an anesthesiologist and a nurse of the anesthesiology-resuscitation department. They come to the maternity ward if a woman wants to give birth with anesthesia. First, the doctor asks the woman about her state of health, examines her, examines the results of examinations, and finds out if she is allergic to any medications. All this is necessary in order to choose the right type of anesthesia and prevent unwanted reactions.

Then the anesthesiologist decides which type is better to use (in each case individually). An anesthetist nurse helps the doctor: she draws medicine into a syringe, injects it into a vein, and measures blood pressure. Having anesthetized childbirth (most often done), the anesthesiologist is constantly next to the woman. He monitors how the anesthesia affects the woman in labor (whether the contractions are anesthetized enough), decides when to add the medicine, and when it is already possible to stop the anesthesia.

Neonatologist: the first children's doctor

Shortly before the birth of a baby, a new character appears in the maternity block - a neonatologist (a pediatrician for newborn babies). Immediately after birth, he should listen to the baby's heart, breathing, check muscle tone, reflexes and skin color. Based on these observations, the baby is graded on a scale (for example, 8/9). If necessary, medical procedures are immediately carried out (clearing the upper respiratory tract from mucus, restoring the normal rhythm of breathing and heartbeat).

Then the neonatologist decides which department to transfer the baby to. In old-style maternity hospitals, this is the children's department. In modern maternity hospitals there are “mother-child” departments, in which mother and child can always stay together, in such maternity hospitals, a baby and a healthy mother are not separated from the first minutes.

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Obstetrician-gynecologist: who is it?

An obstetrician (or, to put it correctly, an obstetrician-gynecologist) is a doctor. For six years he studied at a medical institute, that is, he has a higher medical education, then for another two years he studied in the specialty of obstetrics and gynecology. And only after that the doctor has the right to start official work. By the way, a doctor can have many specializations: someone deals only with gynecology (female diseases of the genital organs), others help women get pregnant if there are problems with this (fertility specialists), others - to endure pregnancy (miscarriage specialist). There are obstetrician-gynecologists who only conduct pregnancy (at the antenatal clinic or medical clinic), but do not take birth. And there are doctors who work in the maternity hospital (for example, in the pathology department or in the postpartum), and in parallel take birth (on duty or under contract).

Obstetrician at childbirth

In childbirth, the obstetrician has his own job: he controls the entire process, and only he decides what and how to do next. Speaking specifically, the doctor regularly examines the woman in labor, prescribes examinations, evaluates their results, and determines the tactics of childbirth. That is, he oversees the entire course of childbirth. Many manipulations are also done only by a doctor: he opens the fetal bladder, performs an episiotomy (perineal incision), sutures tears after childbirth, and makes a manual separation of the placenta. And of course, the obstetrician-gynecologist leading the birth performs a caesarean section. After childbirth, the doctor also has a lot of work: he assesses the degree of blood loss, decides whether any medical prescriptions and medications are needed. Then the doctor determines when the mother needs to be transferred to the postpartum ward, when she can get up, what to eat, and, finally, when the woman can be discharged from the hospital. It turns out that in childbirth and after them, the obstetrician among all medical workers is the most important.

Midwife - who is it?

The word "midwife" comes from the French accoucheur, which literally translates as "one who stands at the bed", and its modern meaning is an assistant during childbirth. But do not confuse the midwife with the now fashionable doulas or the so-called spiritual midwives. Unlike a midwife, a doula does not provide medical care; her work is more focused on moral and psychological support. By the way, they study as a doula for only a few months, and sometimes even online. A midwife is a specialist with a secondary medical education. This specialty is obtained in a medical college and study as a midwife for three or four years. And the work of a midwife in childbirth is no less serious and important than that of a doctor.

Midwife - what does she do?

As soon as a woman enters the birth unit, the midwife, with or without a doctor, examines the woman in labor and determines at what stage the birth process is. Then the main medical task of the midwife is to constantly watch how the cervix is opening and check where the baby's head is. The midwife will inform the doctor about all these changes. The midwife should also measure the mother’s blood pressure and pulse and, if necessary, carry out some doctor’s prescriptions: for example, give injections or install a CTG device. By the way, the midwife does not have the right to independently decide how the birth will take place, or prescribe any medical procedures - all this is the doctor's business.

Another important task of the midwife, and the doctor too, is to calm and support her if she can hardly endure contractions, to explain what is happening to her and the child. And the obstetrician and midwife can tell you how to breathe properly or restrain attempts, how to find a comfortable position to endure contractions.

If there are several births at once in the maternity hospital, then the midwife is forced to constantly approach one woman in labor, then another. She simply does not have time for psychological support, to have time to provide medical assistance! That is why it is often possible to hear that a woman saw a midwife only directly at the time of the birth of a child (at this time the midwife is always next to her mother)

Birth of a child

In the second stage of labor, the midwife performs her most important work: she directly controls the process of childbirth. She tells her mother when to push, and when to hold back, this is the time when the birth is commanded by the midwife. And so that the head does not move forward too quickly and strongly, the midwife holds it back with her hand, thereby protecting the perineum from damage. During the birth of the baby, the midwife gently, and then, after her birth, helps the baby turn around and release the shoulders.

The woman in labor almost does not pay attention to the routine medical manipulations performed by the midwife in labor (at this time she simply does not care), the other work of the midwife is much more significant for her

Important little things

After the birth of the child, the midwife puts clamps on the umbilical cord and crosses it (if the father is present at the birth, he can do this). Traditionally, the midwife shows the baby to the mother, asking, "Who was born?" After that, the baby is applied to the mother's breast, and then transferred to the changing table for processing. And here again there is work for the midwife: she washes the baby with warm water, removes blood, mucus, meconium and wipes the baby with a warm sterile diaper. Then he puts a staple on the umbilical cord, cuts off the rest of the umbilical cord. While the neonatologist is assessing the condition of the newborn, the midwife, together with the obstetrician-gynecologist, monitors the birth of the placenta, then the obstetrician looks to see if there are any parts of the placenta left in the uterus, and the midwife weighs and measures the “baby place”. But, again, all these medical manipulations of the obstetrician and midwife for the mother herself go unnoticed, she simply does not see them.

And finally, the doctor, together with the midwife, monitors the condition of the mother for two hours after the end of the birth in order to prevent possible bleeding.

A woman has the right to know what medical procedures she is undergoing. She can always ask the doctor or midwife what this or that appointment is for and whether it can be replaced with something.

As you can see, the obstetrician and midwife of the maternity ward are really top-class professionals - they manage to control the condition of both the mother and the baby and at the same time help them. Each of them does their job, and together they are a real team!

Photo - photobank Lori

I’ll start my neophyte’s story about childbirth with two things: I liked it and there won’t be horror stories inside - you CAN read pregnant women and preparation for childbirth in general - I don’t even know where to place it correctly, I’ll have to crush

Since the review turned out to be large, I will break it into parts:

Do I need a personal midwife - the thoughts of a neophyte
Choosing a maternity hospital (68 Demikhov maternity hospital, Moscow)
Choosing a personal midwife (Obstetrics.Club)
Actually the history of childbirth (emergency "soft cesarean")
My conclusions - was it worth paying? Do you need a birth partner?

Since the editor cuts "anchor tags", you will have to navigate through the sections by searching by name.

Do you need a personal midwife?

As a result of the fact that during pregnancy a bunch of very important things fell on me, including the housing issue, I practically did not think about the birth itself. The partner thought, for which many thanks to him. When they started kicking me into the “preparation for childbirth” courses, I found out that I would finish them a month after the birth of the child. Then I was forced to find express courses, which we safely went to. The express courses last two weekends in a row - Saturday and Sunday, and judging by the reviews of those who attended the full course, they completely replace the 10 lessons of the regular course. As they say, the most necessary will be given there. I will write more about the courses separately, “not about that now.” Let me just say that we attended courses at the CTA on Tulskaya, as a result, we went to two courses - “preparation for childbirth” and “newborn baby”. Names can be confused, the essence is clear. I went right away with a partner, and it was very correct - firstly, he understood what to expect during childbirth, and secondly, he remembered and wrote down much better than I did (I repeat, my head was busy at that moment with other problems). Each course - 2 days off in a row for 4 hours. The cost is paid for one person, the second (no matter who - partner, girlfriend, mother) is free. So the presence of a partner in the courses does not cause damage to the family budget.

Almost at the same time I was asked to choose a maternity hospital. Starting to read the information (and, of course, horror stories about childbirth), I quickly became stupefied and fell into pessimism. Most of all, I was amazed that even those who signed a contract with the maternity hospital were left “to themselves” and bitterly yearned for this. But in these reviews, information about the “personal midwife” began to flicker more and more often, and I began to look for and read information about this.

My thoughts on this matter were as follows: the first stage of labor, namely contractions, is the longest for those giving birth for the first time, 8-16 hours. Both at the courses and at the maternity hospital, they said that the problem was precisely that the primiparas arrive too early, when the contractions had just begun. Accordingly, they spend the entire labor period already in the maternity hospital, but at the same time they still do not need medical care, so an experienced midwife (who has 5-8 more people giving birth) runs in every hour or two, examines and runs away. It is this period that leaves the greatest negative, because it is scary, painful and incomprehensible - whether everything is going well. And neither the doctor (it’s still too early for him to approach the woman in labor), nor the midwife respond to questions and complaints - they say, “it’s too early.” When I imagined myself in this situation, I felt sad. But, after reading reviews about personal midwives, I realized that a solution had already been found.

What does a personal midwife offer? For primiparas, she comes to the house (if the woman in labor does not live very far from the planned maternity hospital), examines the woman in labor for real disclosure and the stage of contractions (it is clear that fear has big eyes, so for the first time everyone overestimates the real situation), and at home environment accompanies most of the contraction period. If he owns, he can apply massage, pain relief in the bath, and other methods. And only when the contractions begin to approach a certain moment (I'm afraid to lie already, but any midwife will say the frequency and disclosure), the woman in labor with the midwife go to the hospital. At the same time, if the midwife is officially employed in the maternity hospital, then she is not considered an escort, that is, her husband or another escort can also go. In the maternity hospital, the midwife also assists in the fastest possible execution of all documents, after which everyone moves to the delivery room. Since personal midwives work only with those who have concluded an agreement with the maternity hospital, according to which the woman in labor pays for a separate delivery room, the provision of a separate delivery room is a resolved issue. Further, the whole process of natural childbirth takes place in this delivery room, where there is a comfortable couch for the woman in labor, often there is other equipment (fitnessball, bath, chair for vertical delivery, etc.), but this already depends on the maternity hospital. A partner or escort may be nearby at any time, but at particularly piquant moments he may be asked to leave. A personal doctor (as a rule, this is also paid for in an agreement with the maternity hospital) comes to the same ward. After the birth itself, the puerperal remains for another 2 hours in the delivery room, after which she is transferred to the postpartum room. The midwife takes the baby during childbirth, puts it on the mother's breast, lays it on the mother's or father's belly, and helps to carry out the first hygiene procedures. Her duties also end 2 hours after the birth, when the woman who has given birth is transferred to the postpartum ward. Here is how one of these midwives writes about it.

But there are still doulas. What is the difference between a doula and a midwife? Midwife has a medical education, work experience as a midwife in ordinary maternity hospitals (and this is a huge experience in very different births), and in addition to this, she masters the techniques of "soft birth". The midwife has the right to conduct medical manipulations during childbirth, and in some maternity hospitals she even has the right to take birth herself (in another case, the birth itself is taken by a doctor). But you can take a midwife with you to childbirth only when concluding a contract with the maternity hospital, since her work with you requires a separate birth box (because of which, in fact, the contract with the maternity hospital is concluded). Midwives, as a rule, are employed by the maternity hospitals they work with, and therefore are not considered escorts, i.e. you can take both a midwife and a partner for childbirth. One of the midwives with whom I met, left the childbirth, leaving the puerperal with her mother and husband, i.e. The mother took two accompanying persons with her.

Doula, even if he has a medical education, he does not have the right to interfere in the medical part of the course of childbirth, but he owns non-medical methods that help ease contractions and the birth process. In fact, as I understand it, a doula is an experienced friend that you take with you to childbirth. She travels instead of an escort, so in maternity hospitals where partner births are practiced under compulsory medical insurance, you can take a doula with you. Of course, the financial part of this will greatly decrease - you do not pay for the contract with the maternity hospital, but only doula services. But, firstly, even in Moscow there are not many maternity hospitals where you can come with a doula. Secondly, I repeat, a doula is a person without the right to medical interventions and, often, without a medical education. Thirdly, you are taking a doula INSTEAD of a husband/partner, i.e. you are changing a person who knows you well, but is inexperienced in childbirth, with a stranger who is experienced in childbirth.

Some women choose the third option - they enter into a contract with the maternity hospital, take a midwife and a doula (regardless of the husband's presence at the birth). For me personally, in this case, the number of people who are unfamiliar and not close to me is already off scale. But everyone has different opinions and characters, and perhaps someone will need information that can be done this way.

Based on this, I decided that an adequate physician is more important to me than an unknown tender woman, because of which I will lose the support of a loved one. Savings - yes, but such an event does not happen every day, and I wanted both of us to have memories of this. Therefore, further I chose a midwife, although the cost of the contract with the maternity hospital and the midwife's services came out, of course, in a "round" sum. But health and a new life are more expensive.

I found out all this detailed information by traveling to meetings with midwives at the CTA and the Obstetrics Club. In fact, in Moscow, I found four main centers where personal midwives work - these are CTA (Center for Traditional Obstetrics), Obstetrics.Club (“Soft Childbirth”), New Life and Jewel. The CTA had the largest staff of midwives, Obstetrics.Club - 6 people, Jewels - 13, in New Life I could not find a list of midwives, their website is very strange. After reading the reviews, I realized that you must first choose "your" midwife, and then sign a contract with the chosen center. And it is right. But I’ll say one important nuance right away - if in the CTA the contract with a midwife is medical, and then it will be possible to get a tax deduction for it, then in Obstetrics. The club is some very strange contract for the provision of services, almost informational. In general, about nothing. But these are moments of documentation. If you really liked the midwife from Obstetrics.Club, then you can skip this moment.

So, then I decided that I needed a personal midwife, because the contract with the maternity hospital is, in fact, the provision of a separate delivery room, the provision of a slightly less populated (in our case, two-bed) postpartum ward, well, and a few examinations “before”. This agreement will not affect the process of natural childbirth in any way. But I just need a midwife so as not to be afraid, not to think whether the doctor is reinsured, well, in general - she knows something!

While I was going to meetings with midwives (the CTA implemented this very conveniently, and I learned a lot of useful information there), at the same time I found out that not any maternity hospital is suitable for childbirth with a midwife, but only one where there are teams of doctors who are ready to work with personal midwives. And to my great surprise, I found out that the main of these maternity hospitals is No. 68 on Volzhskaya, which is located 15 minutes at a leisurely pace from me. In total, there are about 8 such maternity hospitals throughout Moscow, and at meetings the midwives tell where the living conditions are, and the doctors, and what is the general mood. In general, this information is all very useful, and it is worth going to such meetings.

2) Choosing a maternity hospital

Absolutely all centers of personal midwives work with the 68th maternity hospital (now it is called "named after Demikhov") because, I repeat, it is now considered almost the leader in the direction of "soft natural childbirth." Therefore, I decided “they don’t look for good from good”, and, having gone to the “open day” and asked all the necessary questions, I settled on it. I wrote more about maternity hospital 68 separately in the corresponding thread, posted photos of the wards there - I looked at them with interest in the reviews, and I was lucky to see paid wards at all stages of my stay in the maternity hospital.

While I was reading reviews about the maternity hospital, I saw a lot of positive reviews about one of the doctors. His answers to my questions suited me and I happily galloped off to conclude an agreement - at least one problem off my shoulders. Since by this time I had not decided on a midwife, I decided to ask the doctor who he was comfortable working with. The doctor just smiled: "I will find a common language with any midwife, choose for yourself."

3) Choosing a personal midwife

At this point, I liked one midwife in the Obstetrics Club, but she was on vacation for the right dates. Another, which I found from another center, refused to take me - she already had several clients for the required period, too much risk. At the CTA, I simply did not have time to get acquainted with at least a few, and of the leading courses (they are taught by the same midwives who provide personal support), no one fell directly on my heart. In general, I rushed about, not knowing how to choose, and the deadlines were already running out in the literal sense. Therefore, in desperation, I looked at who was most often mentioned in the reviews along with the doctor I had chosen, and thus chose the midwife. We came to meet her at the Obstetrics Club, talked - again, the answers to the questions suited me. The contract in Obstetrics.Club, unlike the CTA, is not sent to the post office in advance, all questions are asked to be asked right there. Well, as I mentioned above, you will not receive a deduction for it. In addition to the main midwife, two more midwives are indicated in the contract, in case the main one is busy. This is prudent, but given that they have a very small staff, then I chose further without seeing people and focusing on their banal place of residence - why would I wait for a midwife from Pushkino if there is a person living closer?

The midwife asked me to ask her questions on WhatsApp, and I, like a mossy retrograde, do not have this type of connection. So then our communication went either through my partner, who had a WhatsApp, or I sent her an SMS clarifying the possibility of a call. So, before the birth, we talked directly only once again - she was almost always in childbirth, and once wrote that she spent the whole week with women in labor. And although I clarified whether she had exactly the period of time I needed, such popularity began to alarm me - on the one hand, this is an indicator of professionalism, on the other - if a person does not have time to rest corny, then will he be able to fully work indefinitely, when it comes hour X?

There were two types of contracts in Obstetrics.Club - simply accompanying a midwife (50 tr. in 2017) or with additional patronage after leaving the maternity hospital (55 tr.). The partner insisted on the second view - let them show us everything again at home, tell everyone, look at the baby .. Well, let them.

The partner offered me to choose whether I want his presence at the birth, and I hesitated for a long time. But in the end, I decided that I wanted to. I wrote about the participation of a partner in the process of childbirth and after, and a small instruction for men in the section "Partner birth". Just in case, I begged my partner to take a week off.

In general, I was surrounded by contracts and support from all sides, and I hoped that I had not just spread the straw, but had simply wrapped myself in it. Well, in vain, of course. As the saying goes, if you want to make the Lord laugh, tell him about your plans.

4) The history of my birth

And now the actual story "how I spent it" will go.

I, like all women in childbirth, was given the PDR on the day of the last menstruation. Intuitively, this number suited me quite well, so somehow there was no doubt. I planned my affairs in such a way as to free this week and the next - it is not clear what will happen and how.

Until the day of the DA, there were no harbingers, and on the day of the DA itself, I felt the best I could. Therefore, I came for a planned CTG and ultrasound, and at the same time my doctor's appointment. Prior to this, all appointments were made by the doctor of the admission department Antonova. CTG did not raise any questions, they did it, as usual, sitting, everything is normal. But on the ultrasound, the doctor began to ask me where I was doing the water - and in response to my stunned face he put "oligohydramnios". The attending physician, having looked at these conclusions, urged me to go to the pathology department today in order to take tests tomorrow morning and then decide based on this. I repeat, I live 15 minutes on foot from the maternity hospital, so I began to beg to come tomorrow morning - but they asked me to lie down in the evening so that in the morning I would already be registered at the department. They gave me a reprieve until the evening, so I still went on scheduled business, took all (everything!) prepared for childbirth trunks, and in the evening with my partner went to go to pathology under compulsory medical insurance, because this trick is not included in the contract. In pathology there are paid wards, but in my case it did not make sense - the stay was supposed to be too short.

When taking CTG, they performed it lying down, and it suddenly became incredibly bad. I was alert, the doctor from the pathology department was, too. She was warned that I would go to bed, but everything was fine with CTG in the afternoon. As a result, we decided to put him in the “diagnostic” ward for the time being, where they will constantly take CTG. The employee accompanying me, having looked at my 4 huge bags, brought a trolley. So I then moved around the maternity hospital - with escort and a trolley with luggage. Most of all, it was like checking into a luxury hotel.

In the diagnostic ward, they put me down again, attached the sensors, and began to take a CTG. It was bad again, and I started to get upset. But at some point I got tired of lying, and I tried to lie on my side, and - oh, a miracle! – the indicators immediately returned to normal. After another hour, we discussed the situation with the pathology doctor, and she decided to transfer me to pathology.

By one in the morning I ended up in the department, where, out of the kindness of my soul, I was given a separate room. And very well .. As soon as I tried to lie down, contractions began. The most real, which I have not yet known. I was unspeakably delighted - hurray, everything started by itself, but it was difficult to sleep. But of all the courses, I remember the main thing - you need to sleep before giving birth. And you really need to get some sleep. And during fights it is necessary to get enough sleep. It was somehow uncomfortable to sleep, so I either ran to the toilet next to the ward, then lay down. If I had a roommate, I would definitely feel uncomfortable. Finally, by four in the morning, it dawned on me that the contractions stop when I sit. So I covered myself with pillows, sat down, and after texting the midwife and partner, I dozed off. And the next morning, when my partner worried about my SMS called me, I suddenly felt so offended (hello, hormones!), That I just sobbed into the phone. And I was offended by the fact that everything was paid for for me - both the delivery room, and the presence of a soft, cozy partner nearby, but what instead? Instead, I suffer alone all night, and not a single living soul is nearby. Moreover, sobbing into the phone, I realized the delusional nature of my resentment, so I sobbed through laughter, which frightened the caller even more. As a result, he rushed in 20 minutes, and, it seems, in slippers

Meanwhile, the head of the department and my attending physician came to the ward. After spending the night almost without spam, I was very eager to go to the delivery room - for some reason it seemed to me that happiness was finally waiting for me there. Since there were contractions, I was transferred to the delivery room, where the attending physician began to examine me. Here I want to note a very important point - the doctor told in great detail what is happening and how, what are the forecasts, what will we do next. He began to pierce the bubble (it does not hurt at all), and it was at this shock moment that my partner burst into the ward. The second important point - the doctor did not even twitch an eyebrow. He met his partner, and in the same calm voice began to explain to his partner what was happening, what strategy of behavior to follow .. I was delighted, because I always “need to know what is here, why and why” . Therefore, it was recommended to do CTG. By this moment, our midwife arrived, the CTG machine was brought to the ward, and she took a CTG for me. Since I was sitting, it was normal again. It dawned on me later that, due to the small amount of water, the child was comfortable when I stood or sat, and his head was in the water, but when I lay down, the water spread and he was getting sick.

By this time, the contractions had almost ceased. Then I remembered a moment from the book about the Shopaholic - everyone gathered, the partner, the midwife, the attending physician, the head of the department were standing - but I did not give birth. Thank you all It’s good that we didn’t order a photographer for childbirth

The doctor looked at me and suggested that I wait a couple of hours - perhaps the contractions would resume. The weather outside was wonderful, and we went for a walk around the territory of the State Clinical Hospital. After 2 hours, we returned to the ward and the situation repeated itself - the CTG was perfect, the contractions were irregular and weak.

At this point, the doctor counted the time from the puncture of the bladder, and again, calmly and in detail explained that we could wait for so much more time, then we would have to do something. Or, the second option is a caesarean section.

And now I'm going back to the midwife. Since nothing hinted at a cesarean, I, of course, talked with her about natural childbirth, in which she is busy with me most of the time and generally manages the process. As things didn't go as we expected, she waited patiently in the break room, coming in for a CTG and talking to the doctor. You can also take a midwife for a caesarean section, but her role, of course, is much less there. However, I asked her if she would be with us during and after the cesarean. After receiving an affirmative answer, I calmed down. When choosing a midwife, the medical experience in the role of an ordinary ward midwife was important for me (it is clear that you will not find such a number of different births as in CHI in any paid clinic) and I hoped that she would be an intermediary between me and the doctor in terms of expediency certain actions, their consequences, etc. The doctor, as I mentioned above, explained everything perfectly, did not pressure, gave the woman in labor the opportunity to make a decision (naturally, within the framework of the possible). But our midwife always simply agreed with the doctor, and later - not only with the doctor I chose, who was well acquainted with her, but also with pediatricians unknown to her. It alarms me when a person, not fully understanding the situation, replies: "Since the doctor said, do it." Doctors, unfortunately, are also different. This was the first not very pleasant nuance.

Well, in the meantime, it became clear that there really was nothing to expect, therefore, after a brief consultation, we agreed to a caesarean section. I will not describe the caesarean section itself, the operation is well-established and streaming. The partner, who previously put on a disposable gown and headgear, was allowed to the glass doors (not inside) of the operating room and the monitor was turned towards him, allowing him to shoot, because. We both wanted to watch the operation, and there was only one monitor. Of course, instead of shooting, someone pressed the wrong button, so I never got a chance to see the operation. But the partner watched it in all its glory through the monitor. why, then you can not turn the monitor - then the person will see only your “talking head”, because. almost all the time of the operation, there is an opaque separator between the chest and abdomen. I had a so-called "soft caesarean", i.e. they asked me to push so that the baby’s shoulders would pass (to be honest, I thought that this was a profanity purely for me, so that the woman in labor would think that she was really giving birth - but the partner assured that the doctor had made such a small incision that he could not pry the hangers, and so far I did not push, the child did not appear). Before the operation, spinal anesthesia is done (an epidural is one of its types). In fact, this is a shot in the back, because. Again, I didn't have much pain. But pushing when you don’t feel the muscles is a very strange feeling.

I also want to note such a moment - at the courses we were told that it is very important to let the umbilical cord pulsate. Of course, during a cesarean, this moment is reduced, but the doctor himself gave time for this, and he himself followed the right moment. According to the partner, this was the longest moment of delay during the entire operation. And after the birth of the child, the doctor asked us three times if a placenta was needed (it’s good that we went to courses, otherwise we would be shocked by such a question - this is necessary for practitioners of “lotus birth” or something like that).

When a child was born, a neonatologist took care of him - a doctor who examines all newborns. At that moment, the partner was brought into the operating room, and after a medical examination of the child, he was immediately taken into his arms. After the examination, the midwife squeezed a drop of colostrum from my chest and put the baby on it (I was still on the operating table at that moment). Then she escorted her partner back to the delivery room, deftly dressed and swaddled the baby, and putting the newborn into her partner's arms, left. Since it was not known for how long and what to do, the person just carefully sat down with the child in his arms on the fitness ball (there was nothing else to sit on there, the couch was high) and waited. And here was the second moment that I didn’t like - the child was not put “belly to stomach” of the partner, and they didn’t even show how to swaddle. Although we discussed the moment of applying to the stomach at the initial meeting, but, apparently, with so many clients, she simply forgot about it. Or she didn’t like us as clients - I didn’t pull her questions from morning to evening, went about my own business and, perhaps, in her opinion, paid little attention to the upcoming birth. It would be more honest for me if they immediately told me that I was not suitable as a client - and this would be normal, after all, there should be some kind of mutual understanding between the midwife and the woman in labor.

Where our midwife was the rest of the time, it's hard for me to say, because. she came to me, as we later understood, immediately before her departure, i.e. 2 hours after the birth of the child - measure my waist for the purchase of a postoperative corset. Since she did not say goodbye, I thought that she had gone to take care of the child, because. she was clearly in a hurry. As it turned out, she told the parameters to her partner (unfortunately, she did not measure the height of the corset and gave incorrect recommendations on this item), and left. In total, we had a midwife from about 10 to 20 hours. It seemed to me that childbirth (especially in primiparas) can last longer.

We never saw our midwife again. A few days later, on WhatsApp, she asked her partner about my well-being. We wrote to her one more time when there was a question about whether it is worth giving the child an artificial mixture before the arrival of milk from the puerperal, as the pediatrician on duty suggested to us. Here was the answer: "Do as the doctor says."

Postpartum care was provided by another employee of the center because our midwife was ill. We didn’t have a choice here, just a free employee arrived, I didn’t even really understand whether it was a midwife. She called herself a breastfeeding specialist, for some reason forced us to bathe a child whose umbilical wound had not yet healed in a large bath with tap water (despite the fact that I had no burning desire to bathe the child until the wounds healed). Regarding breastfeeding, she showed several poses, did not say any nuances about flat nipples, large breasts - in general, atypical cases. Either she didn't know, or she didn't care. I did not see any particular benefit in terms of breastfeeding again. In general, my feelings from the institute of personal midwives remained very ambivalent. Perhaps due to the fact that in my situation the midwife simply had nowhere to show her abilities. Probably, if it were a completely natural childbirth, my opinion would be very different.

Another positive moment, no matter how ridiculous, was the postpartum ward. As soon as we learned about the cesarean, I said that we pay extra for a place and take a separate room. The midwife was asked to agree on this, and I don’t know what became the decisive factor: either her authority, or the sympathy of the employees for the postoperative woman in labor, or maybe just luck - but they gave us the best, “family” ward. Unlike ordinary doubles, it had three beds, a wardrobe, a floor lamp that gave a very pleasant half-light, and even a shower. If this was the initiative of the midwife, then I am very grateful to her for this.

As for the operation itself, here is my full and boundless gratitude, of course, to our doctor. The incision was made as low and narrow as possible, the threads were self-absorbable. After the birth of the child, while I was sewn up, the doctor periodically talked to me, so I did not get bored. As expected, after the operation, I was transferred to the intensive care unit (ICU), where the nurses monitored the condition of the deliveries. I can say that neither in pathology, nor in the postpartum, nor in the ICU, I did not see a difference between the attitude of employees towards paid and free patients. In the PIT, two women who gave birth for free were lying with me - the nurses were just as attentive (if not more - I somehow felt better, apparently) approached them, gave painkillers, performed the necessary procedures.

The only difference (due to the contract and the presence of a partner who was with the child at that time) was that they were allowed to bring the child to me. Every two hours, the partner came with the baby, and we tried to breastfeed him. Of course, our attempts were inept (and I couldn’t help either, because my hands were fixed with a dropper and pressure measurement). Therefore, the employees of the PIT, taking pity, helped both attach and swaddle the child (watching videos about swaddling by a partner on YouTube helped to somehow swaddle, but, of course, a person performing this procedure for the first time is far from experienced nurses). In the same place, in the PIT, they brought me a document on vaccinations for signature (consent or refusal).

Since I felt quite normal, after the promised 6 hours I was brought to the postpartum ward. And it was then (the anesthesia had just gone, apparently) that I felt the effect of a caesarean section - my shoulders and shoulder blade ached wildly. So wildly that I could not breathe, let alone sleep. I had to urgently call a doctor. First came my ward doctor in the postpartum, offered to put a dropper with painkillers. When this had no effect, the operating doctor was called. He suggested that this is the effect of spinal anesthesia in places prone to osteochondrosis (to be honest, before that I did not have osteochondrosis). With a shovel, the matter was explained more simply - when I was transferred from the operating table to the gurney, the sisters diverged in the score, and I flew away diagonally. Apparently, it was at this moment that the scapula was pressed into the lung. To be honest, this is a matter of chance, I don’t think that anyone specifically intended to create such

But in the end, the night passed enchantingly - I settled down in a strange position, where I could somehow breathe and sleep, dozed off. The next morning, when we both came to our senses, we remembered our favorite home apparatus for treating all sorts of bruises, sprains, and other things. The partner went home, brought him, and it became much easier for me. But I am writing about this situation for another reason - when I chose the maternity hospital, I was glad that it is part of the City Clinical Hospital - if necessary, specialized specialists will come. So, in 5 days (after a cesarean, they keep just that much), the ward doctor repeatedly promised that a neuropathologist would come to me - and in the end he never came, so the presence of other doctors in this case turned out to be a fiction, it’s better not to count on him too much .

Then our newborn life began to flow. I was able to get up on the third day (if we consider the first day of the operation, when I was returned from the ICU at midnight). The toilet with shower was opposite the room, it was very convenient. By the way, the first days I used the shower in the toilet, despite the presence of a shower cabin in our room. This is explained simply - in general, the shower tray is lower, and it was still painful for me to bend my legs and bend down. But before discharge, I gladly washed myself in my own shower cabin (how does it sound, huh?) And even calmly washed my hair.

On the floor there is also a cooler and a kettle with a hot drink (they make different drinks, and rosehip broth turned out to be very tasty). The posts of the adult midwife and the nursery are located in different places.

The supplement for the second place does not include meals (“they didn’t promise to feed on the way”), so the next morning the partner went home for food and necessary things. Since we had such an opportunity (that same vacation), and I had not yet got up, we decided that he would spend the maximum possible time with me in the ward.

Naturally, as soon as he left, the rounds began. Bypasses are carried out from 11 to 14, a ward gynecologist, a pediatrician with nurses come - all at different times. Unfortunately, most employees do not have badges and they do not introduce themselves, so I will not be able to give the names of doctors and nurses.

Incubators for children do not have height adjustment, and with a height of 158 it was simply difficult for me to get a child - I had to stand on tiptoe, or pull myself up on my hands if the incubator was installed above the bed (it can be rolled up so that the child is above the one sitting on couch mom). Taller puerperas (and with healthy hands) will have no problems

In general, if you are still not getting up, then it is better to have a partner stay with you until the end of the rounds. I got up on the third day, and by the time I was discharged, I was already running up the stairs quite confidently.

In each ward, there are telephones of a “breastfeeding hotline”, posters about the benefits of breastfeeding and other propaganda items. However, GV was spoiled for me in this breastfed maternity hospital

But, as you can see, in many situations a partner is very necessary and his help is really invaluable.

5) Conclusions

In my case, the services of a midwife were probably superfluous. Although, since I have nothing to compare with, I may simply not know what "charms" I avoided. But the contract with the maternity hospital was useful to me to the fullest, especially, including the possibility of the presence of a partner during childbirth and after.

Therefore, my conclusions are as follows:

at the first natural birth, a midwife is very necessary (naturally, if you have such an opportunity); with a planned cesarean, it is better to carefully approach the choice of a doctor;
in any case, the presence of a partner is very, very important. If possible, ideally, if a person takes a vacation for 7 days (they keep 3 days in the maternity hospital during natural childbirth, and 5 days after cesarean, a few more days to be calm together at home to establish a routine, it will be very good) and all this will be time with you;
concluding a contract with the maternity hospital does not affect the birth process (Cap!), but gives a lot of bonuses, ranging from a preliminary acquaintance with the doctor and ending with the possibility of relatives visiting you in the ward, the presence of a partner, etc. It's too long to list everything, I'd better make a table.
the funniest, most obvious and incredible thing is to tune in positively. An ideal childbirth is a spherical horse in a vacuum, it may occur in nature, but for the first time it is a utopia. No matter how much information you learn, something will go wrong - you won’t want to get into the bath, then you will forget to press the counter, then the water will leave at the wrong moment. Therefore, be prepared for surprises and take them with humor. After all, an amazing surprise awaits you!

Easy childbirth and health to mothers and babies!

Profession obstetrician

An obstetrician is a doctor who accompanies a woman from the beginning of pregnancy to the birth of a child, observing the condition of the expectant mother and baby throughout this long period. An obstetrician-gynecologist, examining a woman during the entire period of pregnancy, becomes her mentor, who must study his ward in order to facilitate the period of childbirth. The obstetrician takes childbirth, which takes place without complications, gives injections to the woman in labor, can take part in simple gynecological operations. The obstetrician also monitors the development of children up to one year.

The profession of an obstetrician is one of the oldest and most in demand. So, in the period of the birth of mankind, women in labor did not use help, but produced offspring alone, biting the baby's umbilical cord on their own. And only in a primitive society, experienced women began to help a woman in labor. There is also an opinion that the practice of cesarean section began at that time. Even at the beginning of the 20th century, midwives helped women in labor, who used the knowledge accumulated by generations. ...

"Midwife" is translated from French as "standing by the bed." Ancient superstitions associated with childbirth and obstetrics fade into the background and are forgotten, at the same time, the profession of an obstetrician-gynecologist is becoming more and more difficult and requires much more experience and skill. So, a specialist needs knowledge from managing pregnancy, both normal and with complications, to caring for newborns and feeding them.

The profession of an obstetrician-gynecologist always remains in demand, because almost every woman goes from pregnancy to childbirth, during the entire period of which she is accompanied by an obstetrician-gynecologist, who is called to support, help the woman in labor and accept the baby.

Nowadays, an obstetrician-gynecologist requires a rather large amount of knowledge that will help facilitate childbirth for a woman, provide competent care for a newborn in the first moments of his life, and also make the only right decision in an emergency.

There are a large number of medical colleges and schools in which you can get a noble profession of obstetrics. Only girls are admitted to the specialty "obstetrics", who are trained on average for 3 years. During this period, future doctors undergo preclinical and clinical practice. During preclinical practice, students in classrooms, using mannequins, study the theory of childbirth. During clinical practice, future obstetrician-gynecologists receive practical skills and pass a test for suitability for this profession.