Standard procedures for admission to the maternity hospital. What documents need to be signed at the maternity hospital? Rules for admission to the maternity hospital by referral
When going to the maternity hospital, a woman should take into account that right in the emergency room she will have to sign an impressive stack of documents. Why is this necessary and what kind of papers are we going to figure it out together with a specialist.
February 12, 2018· Text: Svetlana Lyuboshits· Photo: GettyImages
obstetrician-gynecologist
In accordance with Article 20 of the Federal Law “On the Fundamentals of Protecting the Health of Citizens in the Russian Federation” of 2011, a necessary precondition for any medical intervention is the voluntary consent of the patient or his legal representative. In other words, before touching you, the doctor must make sure that you do not object to this. Therefore, the expectant mother needs to be mentally prepared for the fact that literally from the moment she arrives at the maternity hospital and almost until her discharge from it, doctors will bring her various documents for her to sign and they will be called the same: “Voluntary Information Consent.” Let the word “consent” not confuse anyone: any medical intervention can be refused before it begins. And if the doctor is obliged to explain why this or that manipulation is being performed, a woman, refusing medical intervention, is not obliged to explain anything to anyone. The right to this is enshrined in another law of the Russian Federation - “Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens,” signed in 1993. So what is written in the texts of the documents that are brought to the expectant mother, when and for what specific medical interventions will a consent or refusal be written?
Emergency
In an emergency situation, when a woman’s life is in danger, and she is categorically against surgery or manipulation, doctors can turn to her closest relatives: her husband or parents. If they support the patient’s persistence, the final decision is made by a council of at least three doctors. Despite objections and protests from the woman in labor and her relatives, everything possible will be done to save lives. Unfortunately, in the case of a child, the procedure is different. When they can't convince mom, doctors turn to dad. If the parents are at the same time, the law provides for going to court in case of a threat to life. According to a court decision, the baby may, for example, have a blood transfusion (there has already been such a precedent) or even an operation.
Just in case
A hefty stack of documents appears in front of the expectant mother already in the emergency department. First of all, you must sign the “Voluntary Consent to Provide Information about Your Health Condition.” If a woman does not want to make such data public and transfer it to the general help desk, the corresponding line says: “Data transfer is not possible, except...”. Phone numbers or other contacts of people who future mom ready to trust this kind of information.
Another paper is “Voluntary informed consent to medical intervention.” Very often this document is combined with the previous one, so it has about five pages, or even more, and does not contain any specifics. It explains the patient's rights and why the patient's signature is needed. For example, it is reported that “all diagnostic and therapeutic measures will be carried out only with your voluntary consent. The necessary procedures and manipulations are in some cases invasive in nature and can cause the development of discomfort, side effects, and complications.”
Attention: the same document states that any procedure can be refused, and the refusal must be documented and a corresponding entry must be made in the medical record with a specific indication of the intervention that you refused. It will not have administrative consequences, but may affect the correct diagnosis and reduce the effectiveness of treatment.
By signing such a document, the expectant mother confirms that she agrees to provide medical care in this particular maternity hospital.
better in advance
During childbirth, a woman is often unable to carefully study documents and delve into details. Therefore, doctors strongly advise expectant mothers, when choosing a maternity hospital, to meet with the medical staff and find out all the details first-hand. It also wouldn’t hurt to take samples of all the documents at the maternity hospital or download them from the Internet and study them at home in a calm environment, if you wish, fill out the forms after consulting with your relatives.
An equally important document is “Voluntary informed consent for examination and treatment.” It is needed so that the attending physician can ask questions about the state of health (collect an anamnesis - medical history), if necessary, advise the woman, examine her, and invite specialist doctors to see her. The expectant mother also reports that she does not object to taking general clinical, biochemical, bacteriological and immunological tests. It also mentions oral (by mouth) medication, subcutaneous, intramuscular administration, intravenous injections and infusions, physiotherapeutic procedures, and application of bandages. Below you can list the manipulations that you do not agree to.
Attention: if consent (or refusal) to take a coagulogram (blood clotting test), a general clinical blood test and for antibodies to syphilis, hepatitis B and C is signed in one document, then there is a separate paper for a blood test for antibodies to HIV. This is a special case, the results of the study are not subject to disclosure, therefore consent or refusal is signed separately.
After reading “I give voluntary consent to undergo surgical intervention if necessary,” do not rush to grab your heart, it is better to read to the end, where a very important condition is stipulated: additional information about this. The doctor is obliged not only to inform about the need for an operation, but also to tell about it in detail and give a document of consent to this particular intervention for signature. And you again have the right to refuse everything. In the same way, when performing specific procedures, a separate “Voluntary Informed Consent” is signed, which lists not only the manipulations, possible side effects and discomfort, but also justifies the need for the procedure and possible consequences refusing it.
In the emergency room, consent (or refusal) for catheterization of a peripheral vein is also signed. Such manipulation, if the woman has nothing against it, will protect her from repeated injections into a vein, because during childbirth there may be a need for intravenous administration of drugs. And since any unforeseen situations can arise during the birth of a baby, here, in the emergency room, it is very often proposed to sign a consent for the manual separation of the placenta, as well as for a cesarean section and for the transfusion of donor blood components (these are three separate documents). Such foresight allows doctors, if something happens, to immediately take active action without wasting time on paperwork.
Along the way
Doctors often say that childbirth is an unpredictable process. It’s good when everything goes according to plan, but at any moment events can take a different turn. For example, there may be a need to stimulate contractions. In this case, the doctor must explain to the expectant mother why this is being done, tell what medications she will be given, how they will act and what side effects and discomfort there may be. The same is indicated in the document that the woman is asked to sign. The need for amniotomy (puncture of the amniotic sac) should also be explained to her in detail. The paper should describe exactly what manipulations the doctor will perform, what discomforts and side effects they may be accompanied by, and what complications refusal of this procedure may cause.
Another document is consent to the use of antibiotics. Before signing it, make sure that the type, dosage and frequency of medications are indicated. The doctor must also indicate for what reasons antibiotics are prescribed and list the drugs already prescribed, and the woman must inform the doctor about the allergies.
Consent (or refusal) to anesthesia must also be documented. The doctor describes the type of anesthesia he has chosen, possible side effects from its use, and specifically stipulates that the choice is made by the anesthesiologist, taking into account contraindications and the condition of the expectant mother.
Legal representative
Among the voluntary consents there are also those that concern the baby. In most maternity hospitals, such documents are offered to be signed after the baby is born. The most important of them are consent to the provision of medical services, blood sampling for perinatal screening and vaccination of the newborn against hepatitis B and tuberculosis, or refusal of these manipulations. Each of these consents is issued separately.
who is responsible?
Signing the “Voluntary Informed Consent” does not mean that doctors abdicate their responsibility. By signing such a document, a woman only confirms that all the risks have been explained to her, she is informed about the consequences that refusal may have, she knows how the manipulation will take place, she is familiar with the treatment plan (the intended delivery tactics) and agrees or refuses the offered services of her own free will , without outside pressure.
The documents list in detail what exactly the baby will have to endure. For example, the provision of medical services involves a daily examination of a newborn, consultation with the mother on issues of interest to her, measurement of height, weight, chest and head circumference, inviting specialist doctors to the child if necessary, conducting an X-ray examination, etc.
Perinatal screening refers to taking blood from the heel to determine the presence of severe hereditary diseases that cannot be “seen” during pregnancy.
Vaccination will protect the child from very dangerous infections that threaten his life. If there are contraindications, then, of course, vaccinations will not be given. The neonatologist will definitely inform the mother about this.
If the baby requires additional studies or interventions, the mother will be informed about them and will also be asked to sign a voluntary informed consent or refusal. For example, a document for catheterization of the central vein is signed separately, and the paper must state what caused the need for such manipulation and which vein (umbilical or other) the catheter will be installed on. Excision of the umbilical cord and antibacterial therapy are also impossible without the consent of the mother.
Although childbirth is a physiological process, it can also be extremely stressful for a woman. Entering a maternity hospital can also be an exciting event, since the unknown, fear of childbirth is frightening, and contractions are not the most pleasant sensation.
During such a period, you want at least a little support and attention. However, you don’t always come across friendly midwives and compassionate doctors. There is almost always someone who can ruin the mood. Sometimes we ourselves can provoke a medical worker into discourteous treatment, because we do not know what to do in a given situation.
In the maternity hospital there is a certain number of rules of behavior that must be observed. How to behave correctly in this healthcare institution? Let's look at some established rules of behavior.
Once you have decided on the choice of a maternity hospital, do not be lazy to call the admissions department or help desk and find out the basic rules and requirements of this medical institution. The best option would be to attend courses at the maternity hospital, where they will tell you everything in detail and give you a list of what you need to take with you.
Not worth taking a large number of of things. Take the essentials for yourself and your child. Large packages are not particularly welcomed by the clinic staff, and it will not be very pleasant for you to drag them into the prenatal ward, then into the postpartum ward (although the health workers help, they are not obliged to do this).
In the reception department it is necessary to change clothes and shoes. When going to the maternity hospital, do not forget to take your passport and exchange card.
It is best to trim your nails or remove polish in advance. What is it for? By color nail plate the doctor can determine the first signs of hypoxia. Long nails can injure the baby's delicate skin.
If you are not giving birth alone, your partner will also need a change of clothes and shoes, unless their provision is agreed upon with the maternity hospital.
After contractions become regular, you should not eat or drink. This is due to the fact that vomiting may develop against the background of contractions. If complications arise that require endotracheal anesthesia, a full stomach can harm the health of the woman in labor. You can fight unbearable thirst by wetting your lips with water or rinsing your mouth with it.
The expectant mother should remember that an examination by a gynecologist and recording of the fetal heartbeat are necessary to monitor the progress of labor.
In the absence of complications, the woman in labor is allowed to behave freely. This means that the expectant mother can take positions that relieve pain, walk, massage and breathing exercises within the ward. It is better to ask the medical staff about whether it is possible to walk along the corridor or visit the shower stall during contractions. Although in some maternity hospitals, midwives themselves offer to visit the shower.
Exercises on a fitball can help relieve pain during contractions, but it is better to talk to the staff in advance about the possibility of taking it with you.
During labor, do what your obstetrician says. Under the precise and qualified guidance of a specialist, you will succeed.
For two hours after giving birth, the woman remains under the supervision of medical staff. If all is well, then the mother and baby are transferred to the postpartum ward.
When leaving, do not forget to pick up the completed exchange card and the child’s birth certificate, which is provided to the registry office.
With wishes for an easy birth Yulia Ivanova
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 urgent health care pregnant women who apply to the maternity hospital (department) are provided with assistance 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
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 given 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 the expectant mother have when she crosses the threshold? 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 setting up breastfeeding, as well as 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, enema, drip.
– 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 units and intensive care);
– 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 multiple pregnancy. Thirdly, if the pregnant woman has previously had a cesarean section, there are progressive chronic diseases or there is 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. This is what our grandparents did, our parents, this is what almost everyone around us does. 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 new way» . You may be asked to pay more modern way 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. Important point: to be present at the birth close person will only be possible 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 services in the maternity hospital, first call your insurance company. 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 according to the law, any woman in labor has the right to refuse certain procedures. 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.
The wide range of opportunities provided to today's women in labor makes childbirth more individual, comfortable and, of course, less painful.
Freedom for women!
The popularity of free behavior during childbirth is growing every year. More and more medical centers and maternity hospitals are opening departments for “soft” or “home” births, and family rooms are appearing. All these innovations help a pregnant woman feel more comfortable in this process and contribute to a more active participation of her husband in obstetric care. For 5 years now, the presence of the husband or any other family member at the birth has been legally permitted (if the maternity hospital has individual delivery rooms). The institution should not charge money for this. A certificate confirming the absence of infectious diseases in relatives is required.
Once upon a time, obstetricians strictly forced women in labor to lie down without rising from the couch. Today, fortunately, such repressions are no longer used. A woman in labor can simply walk around, lie down, and in some places even soak in a jacuzzi - the water soothes, relaxes and relieves pain. True, water birth itself is not yet officially practiced in our country.
Let me stand up!
Vertical childbirth is in fashion today. They are considered more physiological and favorable for women and children. Here are their advantages.
1. Improves uteroplacental blood circulation and oxygen supply. After all, with a vertical posture of a woman in labor, the pressure of the uterus on large vessels decreases.
2. Reduces pain and the risk of perineal ruptures. The baby is protected from injuries to the cervical spine. After all, moving vertically, the fruit moves down more slowly and smoothly.
3. Reduces the risk of postpartum hemorrhage - the placenta in a woman in a sitting position separates faster.
4. They speed up and facilitate childbirth due to the fact that the woman has the opportunity to more actively participate in the process.
Transformers are coming
In addition to the classic - the Rakhmanov bed, which has been in every maternity hospital since the end of the 19th century and still stands - there are other devices. For vertical birth, a stool with a hole in the seat or a toilet-like chair can be used. Or a transforming bed, which allows a woman in labor to take any comfortable position. So far, only expensive foreign transformers exist, but today a similar Russian-made bed is being tested at one of the Moscow maternity hospitals. It is based on a classic model of a couch with footrests, but with the ability to transform the main part by 90 degrees. Tests will take place until the end of this year. When the experiment is completed, the design will receive a patent. And then, perhaps, such models will appear in all maternity hospitals.
It won't hurt
Today, various methods of pain relief are actively used during childbirth. In the early stages of labor - intramuscular and intravenous analgesics with sedatives. During dilatation of the cervix, a paracervical blockade can be used, that is, an injection of an anesthetic into the submucosal layer of the vagina. At any stage of labor - inhalation anesthesia, the so-called laughing gas (nitrous oxide). It is safe for the child, is eliminated instantly, but when inhaled, it blocks the transmission of pain impulses.
And of course, one cannot fail to mention epidural and spinal anesthesia. “Epidural” is used for natural childbirth, the second method is used for caesarean section. During spinal anesthesia, one injection is given in the lower back, which shuts off the sensation of the body below the waist for about three hours. The patient remains fully conscious and calmly gives birth with the help of a surgeon.
With epidural anesthesia, painkillers are continuously delivered through a catheter in small doses. This influence can be suspended at any time. Both types of pain relief are considered safe for babies, because the most gentle medications are selected and injected into the interthecal space of the spinal cord, so their concentration in the mother’s blood is low. But there are also disadvantages: for example, an epidural worsens uterine contractions, so by the time of pushing it is turned off. This type of anesthesia can be done either at the request of the patient or for medical reasons. For example, it is necessary if, despite intense uterine contractions, the cervix does not open, which can lead to acute hypoxia in the child. Epidural anesthesia is also used during childbirth in patients with high blood pressure, as it reduces blood pressure.
Important
These innovations are ideal for uncomplicated childbirth. If any complications occur (signs of chronic hypoxia, premature birth, labor abnormalities, etc.), more careful monitoring of the condition of the woman in labor and the fetus is required, which may interfere with the implementation of the chosen labor management plan. Therefore, unfortunately, it does not always work out as the woman planned in advance.
