Doules, midwives and gynecologists: Who is responsible for pregnancy and childbirth
To the choice of a specialist who will lead pregnancy and childbirthMany people take it seriously, but sometimes confusion in terms makes it difficult to make a decision: the same word in different countries can mean people with different education. Some women, having moved to Europe, are outraged that it is so easy not to get to the gynecologist and on all issues related to pregnancy, they are sent to the midwife. Others, living in Russia, avoid doctors, or even choose home births with a midwife or even doula, arguing that "the whole world does this." We understand the difference between an obstetrician and an obstetrician-gynecologist, what are the powers of midwives in different countries and what actions dole go beyond the law.
How does managing pregnancy in Russia
Now in our country only a doctor has the right to conduct pregnancy, and most often this is an obstetrician-gynecologist. This is a person who, after six years of study at the medical faculty of a university, received a diploma in the specialty of general medicine or pediatrics, and after internship or residency in the specialty of obstetrics and gynecology. It should be clarified that in the official nomenclature there is, for example, a gynecologist-endocrinologist - in fact, it is an obstetrician-gynecologist who has undergone professional improvement in endocrinology. Reproductive specialists are doctors of the same specialty, but also trained in assisted reproductive technologies.
The doctor makes all strategic decisions, and the obstetrician or, more often, the midwife - the health worker with secondary education in the specialty "obstetrics" helps him. You can study as an obstetrician in three years after eleven classes of school - or in four after nine. With quality training, a midwife should be able to lead an uncomplicated pregnancy from beginning to end and take delivery, but at present the doctor is responsible for these processes.
How it works in other countries
Higher medical education in Europe is expensive, and in the USA it generally means a loan that needs to be repaid for many years. Therefore, gynecologists are relatively few: in the United States in 2016, there were 2.7 practicing gynecologists per 10 thousand women (and 5.5 per 10 thousand women of reproductive age). Moreover, in recent years, there are fewer people willing to receive this specialty - and by 2020, in some states, a serious shortage of obstetrician-gynecologists is expected. The Japanese Medical Association studied the situation in fifteen different countries — and it turned out that eleven of them had too few of these specialists, and they had to work much more than forty hours a week (in Japan and Israel, up to 80 hours).
With correctly built practice, the doctor does not do what the nurse, paramedic or midwife can handle - in particular, does not weigh the patients, does not measure their pressure and does not administer the vaccine. In addition, narrowly specialized doctors in many countries do not lead patients with typical chronic diseases, which may not progress for many years or become complicated. If a person comes every few months for an examination to make sure that everything is in order and that the therapy does not need to be changed, then the general practitioner can examine it. So that specialists could be engaged in patients that no one else can help, the burden of maintaining a normal pregnancy lies on the shoulders of midwives (for example, "midwife" in English-speaking countries and "comadrona" in Hispanic).
Do I need to revive the system of obstetric points
It is sometimes said that the midwife can handle the “uncomplicated pregnancy” approach in Russia is irrelevant because we have a lot of gynecologists thanks to cheap or free education. According to Rosstat, in 2012, almost 44 thousand obstetrician-gynecologists worked in public health institutions alone - about six specialists per 10 thousand women, and taking into account those who work in private clinics, it turns out more. The problem is not in the absolute number of doctors, but in their distribution: if in large cities there are gynecological clinics at every step, then in villages and villages with specialists there are big problems.
Attempts are being made to revive the FAP system - first-aid and obstetric centers, which would ensure the availability of medical care for all; however, there are obvious difficulties with financing these items. Just yesterday, the head of the Ministry of Health, Veronika Skvortsova, promised to build 315 new FAPs (and update 1,200) by the end of 2021: “By the end of 2021, we will fully complete the formation of primary health care, including in the village ... We have a clear line: each the year we know what we will do, in 2021 the problem will cease to exist. "
According to the gynecologist Oksana Bogdashevskaya, the system of such first-aid posts, where midwives could conduct pregnancy, is simply necessary - otherwise it is impossible to provide help to everyone in a huge country. "There is evidence that the FAP service reduced the risks of maternal and infant mortality simply due to the fact that a midwife with a tonometer was planted under almost every bush," the doctor notes. It is clear that professional training should be improved so that women are not afraid to entrust their pregnancy to a midwife. In the United States, studying takes eight years (four of them go to the bachelor’s degree, without which it is impossible to continue studying).
What do doula have the right to do
Unfortunately, people who call themselves doulae can deceive women. There is no certified medical specialty "Doula" - however, there are organizations, for example, the "Association of Professional Dole" that monitor the ethics of the work of their members. Being a partner for the births that take place in the hospital is the only function of a law-abiding doula. She can only take non-medical part in childbirth, providing moral support and making the experience more generally pleasing (in fact, this is the same partner childbirth).
Unfortunately, not everyone listens to the law - and among those who call themselves doulae, there are agitators for home births, including solo births, during which the helper is not even present, but gives recommendations on Skype. At the same time, giving birth at home is associated with a very high risk of complications, and even mortality of children and mothers - and in Russia they are also illegal for a doctor.
Photo: Etsy, Your Doula Bag
