Many people justify signing a birth contract with their own confidence and peace of mind. Some consider it a kind of guarantee that everything will go well, the child will be healthy, etc. In fact, much of what a contract for childbirth provides can be obtained under a regular compulsory medical insurance policy, that is, for free. What exactly and what myths should be debunked about paid childbirth, AiF.ru told pediatrician, organizer of the national award for children's goods "Parents' Choice" Tatyana Butskaya.

Better quality, more reliable

Many women, especially those who are going to the maternity hospital for the first time, naturally worry: how the process will go, how easy the birth will be, what can be asked from the doctors, what is better to refuse. Therefore, young mothers often enter into a contract, believing that this way they receive better medical services.

I would like to illustrate this myth with the answer of a doctor I know to the question about the difference between a “paid” and a “free” patient. He said, “Imagine that I am a pilot of a large airplane. And so we take off. I have business class and economy class on board. There is only one board. Can you imagine a situation where I would think more about the safety of business class than economy?”

So, firstly, the concepts of “paid” and “free” childbirth, in principle, do not exist. Any birth is paid for by the maternity hospital and the doctor, just from different budgets. If you give birth under compulsory medical insurance, this does not mean that the doctor will not receive money for your birth. This means that the funds will come to him not from you personally, but from the state.

In addition, as a doctor, I cannot even imagine a situation where I would prescribe the necessary tests or procedures to a “paid” patient, but not to a “free” one. This is my responsibility. Which, with this approach, can easily become criminal.

I also often hear stories about childbirth, where women complain that they were treated simply horribly “for free”: “they punctured the bladder, pressed on the stomach” and so on. Believe me, not a single procedure during childbirth can be performed for any other reason than the desire of the doctor to safely “get” a healthy child out of you. A woman during childbirth is in a slightly altered state of consciousness, and bodily sensations are also distorted, so she cannot always adequately perceive the necessary medical manipulations. “They pressed on my stomach,” the doctor checked how the uterus was contracting. “They pierced my bladder, but I didn’t want to,” the doctor will definitely write a justification for this in the birth report. Believe me, during the birth that you call “paid”, the doctor will puncture the bladder in the same way and check the contractions of the uterus when it is vital for you and the child inside.

We buy childbirth and a healthy child

Often, women, when concluding a contract, go into the mode: “Give birth for me.” That is, in this way they psychologically relieve themselves of responsibility for childbirth. Believe me, no one can give birth to a mother, either paid or free: in any case, you will have to do the work yourself.

The same applies to caesarean section. It's not worth paying for a contracted birth if you simply don't want to give birth yourself. No doctor will perform an operation without indications for it. Even if you pay for it. For money, you can only choose the method of delivery: vertical birth, birth in the bathtub, lotus, home. And then only if the conditions of the maternity hospital allow it and there are no contraindications. But you can’t buy yourself an operation. Therefore, you shouldn’t even overpay to save yourself from the “torment”.

Also, you should not draw up a contract in the hope that this will guarantee you a healthy child. No doctor, no matter how experienced, can predict at the very beginning of labor how it will go. Unforeseen situations can happen even in a textbook process. The only advantage in this situation that a contract can provide is that the expectant mother can choose a doctor with whom she would be comfortable or who specializes in certain cases of pathologies, if any were diagnosed during pregnancy.

Paired births

Often, ladies enter into a contract with the maternity hospital in order to go to a joint birth with their husband. Our legislation is such that today a husband can attend a free birth under the compulsory medical insurance policy. True, there is a small condition: the husband is allowed in only if there is a free box. If there is not one, the birth together may fail.

When is it worth paying?

The cost of the contract is determined by the number of options and services that are included in it. Everything here is very individual. For example, for some it is important to stay in a VIP room, but for others it is enough just to have an individual room. Some contracts include monitoring of mother and baby after discharge from the hospital. Again, think about whether you need such an option, carefully review the range of services offered and evaluate their need for the proposed volume. Perhaps you do not want to vaccinate your child or carry out any other procedures included in the contract. Situations can be very different, and it is worth starting from your preferences and characteristics of the course of pregnancy. The same goes for choosing a doctor. The definition of “dear and experienced doctor” is very vague. Choose a doctor based on the specifics of your pregnancy. If you are 25, this is your first birth and the pregnancy is going smoothly, this is one story that any good doctor should be able to handle. If you are 45 and this is your first pregnancy after 15 IVF attempts, it is better to choose a more experienced doctor from a multidisciplinary clinic. A contract with such a doctor may be more expensive, but in a particular case it will be worth it.

The contract can also guarantee constant communication with the doctor, up to 24 hours a day. But, as practice shows, not such a large percentage of pregnant women and women in labor need such a connection. In addition, a contract will be required if you want relatives to come to you after giving birth: without a contract and payment, such a function will not be provided in maternity hospitals.

However, there are situations when a woman, by coincidence and after a free birth, finds herself alone in the ward: the child will be with her, and even her husband can be allowed in by agreement. But this is a matter of chance and is not guaranteed. If all these options are important for a young mother, then it is worth concluding a contract. If not, you can do without it. Let every birth take place in conditions necessary and sufficient for the mother to feel calm and comfortable!

The compulsory insurance system provides citizens with the right to a certain list of free types of medical services and procedures. This list also includes pregnancy management, which is carried out by medical institutions selected to participate in the program. So why register during pregnancy? What is included in pregnancy management under compulsory medical insurance? What is the complete list of tests that should be taken free of charge at the antenatal clinic? What services and medical care are provided free of charge? What is an approximate plan for pregnancy management under compulsory medical insurance? We will answer these questions in this article.

Why register with a doctor during pregnancy?

The provision of services under the compulsory medical insurance policy becomes available to citizens upon the occurrence of an insured event, which includes a woman’s pregnancy. In order to officially record any insured event and make payment for the medical care provided, the state provides a procedure for proper paperwork in medical institutions.

Pregnancy management is also included in the list of mandatory types of services of the compulsory medical insurance policy, therefore, the possibility of receiving free types of medical care depends on confirmation of the fact of pregnancy. In order to fully receive the guaranteed list of services, a pregnant woman must contact a medical institution (antenatal clinic) to register, and she has the right to.

Not only the proper management of pregnancy and care for the health of the woman and the unborn child, but also the possibility of receiving additional payment depends on the timing of registration. When registering with a antenatal clinic before 12 weeks of pregnancy, a one-time benefit is paid, which as of 2017 is 543 rubles 67 kopecks.

What is included in the pregnancy management procedure?

The current compulsory medical insurance rules allow citizens to independently choose the medical institution where services will be provided. As part of recording and monitoring a pregnant woman, the following conditions must be met:

• Availability of the selected medical institution in the list of institutions participating in the compulsory medical insurance program;
• Filling out an application to the antenatal clinic at your place of permanent residence;
• Contacting the insurance company with a request to replace the medical institution with the chosen one.

After these steps, a pregnant woman will be able to receive the types of medical care she needs in any institution included in the compulsory medical insurance program. Pregnancy management within the list of compulsory medical insurance services includes:

• Consultations and observation by a treating specialist;
• Therapeutic and preventive procedures;
• Regular and extraordinary inspections;
• Physical and psychological prenatal preparation;
• Passing mandatory and additional tests.

All types of medical care and services included in the mandatory list of compulsory medical insurance are provided free of charge. Payment for the assistance provided is carried out at the expense of the Health Insurance Fund. As part of pregnancy management, the doctor may prescribe mandatory and additional tests, which are included in the mandatory list of compulsory medical insurance and are performed free of charge:

• General clinical tests;
• Blood test for biochemistry;
• Research and testing for the presence of infectious diseases;
• Determination of antibodies to measles and rubella viruses;
• Determination of blood group and Rh factor;
• Tests for the presence of syphilis, HIV infection;
• Blood clotting study;
• Tests for various types of hormones.

The list of necessary tests and studies is determined by the attending physician. But at the same time, every pregnant woman is required to undergo a medical examination, which is a list of procedures and consultations with narrow specialists, carried out free of charge under the compulsory medical insurance policy. Information about the features of medical examination for pregnant women can be found in the article on. As part of the provision of medical care under compulsory medical insurance, a woman has the right to file complaints about poor-quality services provided.

Approximate plan for pregnancy management under compulsory medical insurance

Management of pregnancy after registering a woman in a consultation is carried out in accordance with the sample program approved by orders of the Ministry of Health of the Russian Federation dated December 28, 2000 No. 457 and dated February 10, 2003 No. 2003. These regulatory documents approve mandatory and recommended parameters and standards for the provision of services in the process of observation and treatment of a pregnant woman. The contents of this program include:

• Observation (examination) by an obstetrician-gynecologist, and in some cases by a specially trained midwife, with a frequency of 6-8 times during the entire period (under standard pregnancy conditions);
• Examination by medical specialists (therapist, ophthalmologist, dentist, etc.) at the first visit, and subsequently – if indicated and specially referred by a gynecologist;
• Laboratory research (tests, examinations, etc.);
• Ultrasound examination, which is carried out 3 times during pregnancy;
• Physical and psychological preparation for childbirth.

The composition of the program, as well as the frequency of individual procedures and activities, depend on the conditions of pregnancy, as well as the availability of additional types of services according to the territorial list of compulsory medical insurance. The treating specialist is obliged to use the recommended provisions of the program to determine the necessary activities and types of procedures, however, their actual indicators may differ significantly from the normative ones. Based on the results of the procedures performed and the types of services provided, the medical institution will receive compensation from the Federal Compulsory Medical Insurance Fund at current rates.

Under the influence of hormones, many women during pregnancy become very suspicious and constantly worry about their baby. To eliminate any danger to him, they voluntarily agree to paid medical care, believing that this is the only safe option to carry and give birth to a baby. Meanwhile, the Ministry of Health of the Russian Federation has approved a pregnancy management program under the compulsory medical insurance policy. The expectant mother receives the full list of medical services she provides free of charge. As part of state pregnancy support, all necessary procedures are taken into account so that a pregnant woman feels protected. We will find out further what services and to what extent she can receive for free.

The compulsory health insurance policy (CHI), which is regulated by the Federal Law of October 29, 2010 No. 326-FZ “On compulsory health insurance of citizens in the Russian Federation,” gives expectant mothers the right to free medical care. Pregnancy support can be entrusted not only to specialists from the district antenatal clinic at the place of registration, but also to any other medical institution in your city that participates in the compulsory health insurance program.

What is included in pregnancy management under compulsory medical insurance?

Having a medical insurance policy provides free regular examination by a specialist, as well as basic diagnostic procedures and all necessary examinations. The original and a copy of the insurance document must be provided both when visiting a residential complex and when registering for a hospital stay. If a pregnant woman does not have a compulsory medical insurance policy, then she can only count on free emergency medical care.

The compulsory medical insurance pregnancy support program consists of a number of services:

• treatment and prevention of various diseases;
• patronage at home;
• instrumental and laboratory examinations;
• day hospital;
• hospitalization (if necessary);
• diagnostic studies for the presence of defects in the fetus;
• psychological support for a pregnant woman;
• educational program on breastfeeding;
• consultations and examinations with specialized specialists;
• referral to other medical institutions with the provision of free services, if necessary (for example, if the necessary equipment is not available in the institution where the woman initially went).

Taking into account Art. 19 Federal Law “On the fundamentals of protecting the health of citizens in the Russian Federation” dated 01/01/2012, we remind you that a person, when seeking medical help, can also count on the provision of the following services:

• free choice of government organization where treatment will take place;
• choice of the attending physician (with his consent);
• diagnostics and treatment and prophylactic procedures;
• medical rehabilitation after illness;
• competent consultation;
• anesthesia;
• the right to keep information regarding treatment confidential;
• refusal of surgery;
• visiting a medical facility accompanied by a lawyer, priest or legal representative who will represent the patient’s rights. This means that the expectant mother can safely go to the maternity hospital with her husband, mother or friend.

Management of physiological pregnancy under the compulsory medical insurance policy

Let's look at what pregnancy support based on the compulsory medical insurance program looks like in general terms.

Visiting a doctor during pregnancy under compulsory medical insurance policy

If the pregnancy is progressing satisfactorily and the expectant mother has nothing to complain about, she visits the gynecologist once a month until 20 weeks of gestation. From the second half of pregnancy, the doctor invites the patient twice a month. A month before the expected date of birth, you will have to go to the housing complex every week.

According to the compulsory medical insurance program, a woman is examined by a therapist 2 times during pregnancy: first after the first visit to an obstetrician-gynecologist, then at the 30th week of pregnancy.

As soon as a woman contacts the housing complex for registration, she is given directions for a free consultation and examination by an ENT specialist, an ophthalmologist and a dentist.

Tests and ultrasound during pregnancy under compulsory medical insurance policy

The health insurance policy provides the expectant mother with the opportunity to undergo all examinations free of charge, in particular:

• laboratory research;
• tests to detect intrauterine infections;
• genetic tests;
• hemostasis analysis.

As part of the compulsory medical insurance program, 2 screening tests are carried out during pregnancy: the first - in the period from 11 to 13 weeks, the second - in the period from 16 to 20 weeks. The procedure is also completely free. It is available to expectant mothers thanks to the state program for the improvement of the nation, which operates with the goal of timely detection of defects in the intrauterine development of the child.

Medication provision during pregnancy under the compulsory medical insurance policy

Under the compulsory medical insurance program, pregnant women receive free vitamins and medicines. In 2018, the list of basic vitamin preparations for expectant mothers looks like this:

• Elevit Prenatal;
• Vitrum Prenatal;
• Vita Spectrum;
• Hexavit;
• Complivit;
• Maltofer;
• Revit;
• Teravit;
• Undevit;
• Fenyuls;
• Ferrovit et al.

In addition, the regional government annually approves a list of medications that pregnant women need first, especially in cases where the child’s intrauterine development is associated with any acute or chronic pathologies:

• diseases of the digestive system;
• blood diseases;
• diabetes;
• pathologies of the endocrine system;
• osteochondrosis, etc.

The attending physician always has information about the exact list of medications and vitamins.

Management of pathological pregnancy under the compulsory medical insurance policy

No matter how well the pregnancy proceeds, there is always a risk that it will become pathological. There are many reasons for this. Some disorders can be caused by a simple lack of vitamins or a malfunction of the body's immune system, while others are so serious that they threaten the lives of the mother and child.

In order to maintain a problematic pregnancy, the compulsory medical insurance policy provides the woman with appropriate free treatment and a number of additional studies.

During pregnancy with complications, the woman will have to visit the gynecologist more often and the examinations will be free. The same applies to additional ultrasounds, Doppler sonography and screenings.

Negative Rh factor and pregnancy management under compulsory medical insurance

If there is a high risk of developing an Rh conflict, the Rhesus of the child's father is additionally determined, and if the father is Rh-positive, the expectant mother's blood is checked every month for Rh antibodies.

Hospitalization and inpatient treatment during pregnancy under compulsory medical insurance

If there are absolute indications for immediate hospitalization, the pregnant woman is placed in a hospital and prescribed the necessary treatment. Hospitalization and planned therapy for a patient under the compulsory medical insurance policy do not cost anything, as does a full examination, all measures to preserve the baby and the method of childbirth. The hospital must operate in accordance with the compulsory medical insurance program.

In the maternity hospital, the expectant mother will be examined and treated if there are such complications:

• gestosis at the beginning and end of pregnancy;
• recurrent miscarriage;
• fetoplacental insufficiency;
• fetal development against the background of pathological disorders in the activity or structure of the woman’s genital organs;
• scar on the uterus;
• benign neoplasm in the uterus.

Chronic, infectious and other diseases of a pregnant woman that put the very existence of the fetus at risk are treated in specialized hospitals, where the woman is referred by her doctor.

Rest for pregnant women

Every woman, while expecting a baby, is provided with the right to a free stay in a medical sanatorium for up to 21 days. To exercise this right, there must be compelling evidence and, of course, a doctor’s referral.

You can actually get a ticket in the following cases:

• habitual miscarriage;
• prolonged difficulty conceiving;
• tumors in the uterus;
• abnormalities of the uterus;
• scars after cesarean section and other surgical operations on the uterus;
• pregnancy under 18 and over 28 years of age;
• Iron-deficiency anemia;
• dysfunction of the endocrine system.

In vitro fertilization and compulsory medical insurance policy

Since infertility falls under the category of insurance cases, having a compulsory medical insurance policy allows every woman to qualify for a free IVF procedure.

In order not to pay a penny for in vitro fertilization, it is important to meet all the required conditions:

• have a compulsory medical insurance policy in hand;
• have medical indications for this method of becoming pregnant;
• be at a suitable age for the procedure (22 - 39 years);
• have no contraindications to artificial insemination;
• the future father should be diagnosed with “normospermia”;
• undergo a course of infertility treatment under the supervision of a physician.

Due to recent amendments to the law, attempts to become pregnant through IVF within the framework of compulsory medical insurance are not limited, that is, a woman can undergo the procedure until she gets the desired result. However, it should be taken into account that the federal quota sets a preferential limit of 106,000 rubles; future parents bear all financial expenses in excess of it.

The benefit covers the cost of the following procedures:

• stimulation of ovulation with hormonal drugs;
• sampling the optimal number of cells;
• artificial insemination procedure.

After the embryos are implanted into the mother, the newly pregnant woman can count on consultations with specialists, as well as free medicinal support in the form of vitamins and progesterone. When the pregnancy is officially confirmed, the patient is sent to the LCD for registration. There she will be observed as during a normal physiological pregnancy, but taking into account the characteristics of fertilization.

And what to do if this is not given

Theoretically, all roads are open to a pregnant woman - even a private maternity hospital cannot but accept her if she appears on the doorstep already in labor. However, in practice, the rights of pregnant women are sometimes violated. Therefore, it doesn’t hurt every expectant mother to know what she is entitled to free of charge under the compulsory medical insurance policy. Alexey Bereznikov, an expert at the Interregional Union of Medical Insurers, head of the working group on organizing compulsory medical insurance of the All-Russian Union of Insurers, told MK about this.

– What services and examinations can a pregnant woman expect at a medical institution under the compulsory medical insurance policy?

– As part of the basic and territorial programs, all insured persons, including pregnant women, are entitled to free medical care under the compulsory medical insurance policy for diseases and conditions of all organs and systems (including dental ones). In addition, expectant mothers are provided with free medical services for pregnancy, childbirth, the postpartum period and abortion. Cases of treatment of sexually transmitted diseases caused by the human immunodeficiency virus, acquired immunodeficiency syndrome, tuberculosis, mental disorders and behavioral disorders are not covered by the compulsory medical insurance policy. But the state guarantees citizens free treatment of these diseases at the expense of budgetary funds.

You can get more detailed information by contacting your medical insurance organization (HMO) by calling the hotline or visiting the office. There you can also familiarize yourself with the list of medical organizations operating in the compulsory medical insurance system of a constituent entity of the Russian Federation, with their addresses and operating hours. In addition, this information is available on the official website of the health insurance company in which the citizen is insured and on the official website of the TFOMS of the given subject of the Russian Federation.

– Where to complain if a medical organization charges money unlawfully, or if the maximum waiting period for a doctor has expired, or if a woman is not at all satisfied with the services provided?

– In such situations, you can contact both the management of the medical institution and the insurance representative of your health insurance company by calling the “hotline”, as well as by calling the “hotline” of the Federal Compulsory Compulsory Medical Insurance Fund of the constituent entity of the Russian Federation. Information about phone numbers is posted on the official websites of SMO and TFOMS. If a citizen is located outside the insurance region, then regarding the protection of his rights and interests, he must contact the Territorial Compulsory Medical Insurance Fund of the region where he wants to receive medical care.

– For what services, examinations, tests can medical organizations most often try to illegally take money?

– Observation of pregnant women in antenatal clinics is carried out in accordance with the standards and procedures for the provision of medical care. In our country, this area is quite well controlled at all levels, so cases of poor quality monitoring of pregnant women, including unlawful collection of funds, are quite rare. In addition, adequate response measures are immediately taken against them. For example, there were situations when a pregnant woman was offered to pay for laboratory tests or diagnostic examinations. In this case, you need to call your health insurance company, insurance representatives will clarify with the medical organization the reasons for the current situation and, as a rule, the pregnant woman will receive an analysis or examination, if, of course, it is included in the list of those paid for from compulsory medical insurance funds. As a rule, the cause of such situations is the “human factor”, when the doctor is not sufficiently informed about the list of services of the territorial compulsory medical insurance program provided to the patient free of charge.

– What are the most common violations of the rights of a pregnant woman in the compulsory medical insurance system?

– It is quite difficult to single them out, since such specific reporting is not provided for in the compulsory medical insurance system and, accordingly, there are no statistics. But based on the experience of the service for protecting the rights of the insured, it can be said that if cases of treatment or complaints about violations of rights among pregnant women are recorded, then they are approximately the same as for other patients. Sometimes the facts stated in the complaint are not confirmed or are confirmed, but it turns out that the patient (pregnant woman) interpreted them incorrectly, since, of course, not all patients are professionally versed in health issues and management of pregnant women.

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