M. A. Kurtser: ``In Moscow the birth rate record``
is registered Today questions are answered by the chief obstetrician - the gynecologist of Department of health care of Moscow, the corresponding member of the Russian Academy of Medical Science, professor Mark Arkadyevich Kurtser. From 1994 to 2012 Kurtser headed “The center of planning of a family and reproduction“ on Sevastopolsky Avenue, at the end of 2012 opened the clinical hospital “Lapino“, largest in Russia. In new clinic we speak with Mark Arkadyevich about birth rate growth how to receive free EKO and whether it is necessary to take on childbirth of the husband.
- Now everywhere is said that birth rate grows. It`s true?
- Yes. In Moscow last year in Moscow more than 130 thousand childbirth are registered - it is a record. I work in obstetrics and the gynecology is more than thirty years old, and on my memory such high rate for the first time. Besides, this highest value among regions of Russia. About a third of women in labor in Moscow - non-residents who constantly live and work in Moscow.
- With what connected birth rate growth?
- Here, in my opinion, the whole complex of the reasons. In - the first, it is social guarantees and material welfare. With growth of welfare and social support also birth rate grows. In - the second, it is traditions and fashion. On the one hand, all faiths forbid pregnancy interruption, with another, today began popular to have many children, respect parents having many children in society - I notice it.
However the main reason, in my opinion, is possibilities of modern medicine. Modern ways of fight against infertility, methods of preservation of pregnancy and leaving after the delivery allow to have children to couples which were considered before as fruitless. Thanks to opportunities of medicine birth rate grows and child mortality decreases, this tendency is traced in all developed countries including at us.
If experience of the birth of the first child was safe if the woman got to professional, careful doctors, then she will want to give birth to both the second, and third child. The main thing to create for this purpose all conditions. It we as professionals, we are also engaged.
- What changed for the last five years?
- average age of first labor Increased. In general there were more patients who give birth after thirty and even after forty years. Both that, and another is characteristic of more safe, developed countries. Besides, became repeated childbirth much more. Now nearly a half, more precisely, than 45 percent are the second and third childbirth.to
It is interesting also that for the last seven years the number of polycarpous pregnancies including because popularity of such means of fight against infertility grows as EKO (extracorporal fertilization)
- In Moscow is the register of couples which receive free EKO was tripled. How to get to it when it is impossible to conceive independently?
- First of all it is necessary that the qualified doctor made the corresponding diagnosis and defined that there are all indications for EKO - and there are no contraindications. Through a maternity welfare unit information on the patient is included in the register of city department of health care - and the patient is registered in waiting list for two free procedures. The register exists more than seven years, annually in it 2,5 thousand people and about 1,5 thousand free of charge are registered every year undergo the EKO procedure. Paid extracorporal fertilization in Moscow costs from 60 to 90 thousand rubles without the cost of medicines.
- whether Really Cesarean section is popular today, and patients ask to do it even without visible medical indications?- Is not present
, it is hardly possible to call this procedure popular. There is absolutely small percent of patients who want that they made by it Cesarean section, however in the majority of the woman prefer natural childbirth. Is also such who wants to give birth at home.
- What do you think of house childbirth?
- It is extremely negative as it is very dangerous. I have a wide experience on treatment of such patients. Recently to us the woman who gave birth at home got to reanimation. It was brought with severe bleeding and the remains of a placenta so we hardly rescued it. In the course of childbirth bleeding can begin or pressure is sharp rise, the woman can faint, at her heart can stop. If heavy complications develop in house conditions, without reanimation access, it is serious risk for life. Comes to nobody to mind in house conditions to do heart operation or to cut out appendicitis? Childbirth also demands the qualified help and special conditions.
- Supporters of house childbirth refer to the nature and century history.
- Yes, however then it is necessary to be ready and to deadly risk which exists under natural conditions. The modern medicine allows to keep the maximum number of newborns. Today 24 children from 100 thousand perish. In the past perished from one to one and a half thousand babies. By the way, and average life expectancy reached 35 years in those days.
- whether the program of birth certificates started in 2006 Works? Whether allows to give birth in the Moscow maternity hospital the certificate received in the Moscow region and vice versa?
- the Place where the certificate is received, does not play a role: and the Far East certificate allows to give birth in Moscow. The sense of the birth certificate consists that for each childbirth the maternity hospital is paid extra by 6 thousand rubles, this additional stimulating financing. However it is important to remember that under the law the birth certificate is accepted only by municipal authorities, and private clinics do not accept them.
- Nevertheless, situations when refuse to the woman in labor reception happen, sending it to other maternity hospital.
- Yes, if medical contraindications or if the maternity hospital is crowded are. There are very popular maternity hospitals where it is very difficult to get.
- On what the anesthesia choice at the time of delivery depends?
- At natural childbirth around the world use epiduralny anesthesia at the request of the patient. At Cesarean section spinal anesthesia which differs from epiduralny in the place of introduction of a preparation and its dose becomes. If during natural childbirth there were complications and urgently operation is required, sometimes it is necessary to resort to the general anesthesia when the anesthetizing preparations get to blood. However around the world doctors gradually refuse the general anesthesia in favor of epiduralny or spinal anesthesia, it is not harmful neither to mother, nor to the child.
- What do you think of childbirth with the husband, the partner? Really from presence of the husband there is an advantage?
- We consider as extremely important condition of successful childbirth psychological comfort of the woman. 98 percent of patients of clinical hospital “Lapino“ come to childbirth with the spouse or with someone from relatives. The husband or other loved one certainly help the participation, care and support - and it is easier for woman to relax and be adjusted on successful childbirth.