Obstetric aid in the USA of
decentralization and prevalence of the medical institutions acting on the commercial basis irrespective of whether they are private or municipal are characteristic Of the model of health care accepted in the USA. The role of the state is reduced, mainly, to financing of state programs of medical insurance for elderly people, needy, representatives of indigenous people, and also to the state support of socially important projects in the field of fight against AIDS, drug addiction, mental diseases. Actually, in the USA there is no health care in the Russian understanding - doctors and hospitals provide the services ordered by clients, but do not protect health of citizens within any scheme centralized and existing by a unified plan. Everyone cares for the health according to the lights, financial opportunities and own ideas of expediency of these or those preventive and medical actions. As a rule, there are no specialized maternity hospitals in the USA and. Are delivered in delivery rooms (maternity ward) of usual hospitals.
System of medical insurance
Medicine in the USA - generally paid and insurance. It means that usually patients have this or that health insurance covering the most part of commercial cost (sometimes to 100%) the medical actions stipulated in the insurance contract. Now medical insurance in the USA is carried out mainly through granting a group insurance by the employer. The individual insurance - expensive pleasure, and the few people is able to afford it. At the same time, according to the latest data, about 40 million residents of the USA have no insurance, and their access to regular medical care is very limited. It is reduced, mainly, to service in intensive care units (emergency room) in case of accidents and other emergency situations or to visit of doctors in urgent occasions with payment of overall commercial cost of services. It is enough to tell that one ultrasonography in that case will cost approximately 200 dollars. Besides, in the USA there is a large number of free clinics (free clinics) where reception is conducted, as a rule, not by doctors, but the so-called registered nurses (registered nurses) given the right of an extract of recipes. Clients of such clinics, where the minimum volume of medical care is provided, generally poor and illegal immigrants are.
Fortunately, the state covers the cost of medical care for all pregnant women, women in labor and children through various, financed by separate states or the federal government, programs for needy and not having an insurance covering. The cost of childbirth for that who have an insurance is very small and in case of the normal course of childbirth can make less than 100 dollars. The cost of normal childbirth without insurance makes about 8000 dollars. The cost of medical consultation without insurance - about 100 dollars. A different insurance covers the different number and quality of medical services. Let`s tell, in an insurance the number of ultrasonography, these or those researches or time which the patient can spend in hospital at the expense of insurance company can be stipulated. In case of an exit for these limits it is necessary to pay an overall cost.As we found out
, the main financial burden on payment of childbirth is the share of insurance companies. As medicine in the USA - the pleasure quite expensive and tending to further rise in price, is quite natural that the economy on childbirth is reached by reduction of term of stay in hospital. If about fifty years ago the usual term of stay in maternity hospital after normal childbirth in natural patrimonial ways made 7 - 10 days, then by ninetieth years this term was reduced to 2 days, and in many cases even till 24 o`clock and less. If first reduction of term of stay in hospital after the delivery did not affect statistics of postnatal complications, then increase of number of complications was noticed further. It led to pressure upon insurance companies and the government from the professional organizations of physicians and the public, and in 1998 “The act of protection of health of the newborn and mother“ under which the woman cannot be discharged from maternity hospital without her consent before 48 hours after the delivery in natural patrimonial ways and before 96 hours after Cesarean section was adopted.
Supervision over pregnancy
Is supposed that the pregnant woman has a health insurance and “the“ gynecologist, that is the expert at whom it was observed earlier and which services plans to use during pregnancy. As soon as pregnancy was confirmed (for what blood test usually becomes), there comes time to go to the doctor. It is necessary to tell that the insurance usually covers not all cost of consultation and other medical actions so visits of the doctor in the USA are usually planned in advance and patients take them seriously, quite often in good time making detailed lists of questions and complaints. During the first visit of the gynecologist usually take dabs on definition of degree of purity of a vagina, existence of cancer cells on a uterus neck from the pregnant woman, on vaginal infections. The doctor tells the pregnant woman approximate date of childbirth, and also gives advice about the correct way of life during pregnancy, food, tells about medical problems which can arise during pregnancy, about the reasons for concern and ways of their elimination.
After the first eight weeks the doctor usually makes short ultrasonic research which allows to define whether twins are waited by future mother, gives an idea of the course of pregnancy and specifies estimated date of childbirth. The doctor can also advise groups and classes in preparation for childbirth and to write out vitamin complexes for pregnant women taking into account specific features. Further visits to the doctor are paid each four weeks, and every time undertakes the analysis of urine.
In the second trimester of visit of the gynecologist proceed time in four weeks. By the end of the second trimester usually conduct the second ultrasonic research.visits to the doctor should be paid to
In the third trimester at first each two weeks, and with 36 - y weeks - weekly till the moment of childbirth. On 36 - y usually do to week the third ultrasonography to define whether the fruit is correctly located. Last weeks pregnancies during each visit to the doctor vaginal research for the purpose of determination of readiness of a neck of a uterus for childbirth is usually carried out. If childbirth does not come within two weeks from the date expected them, doctors, as a rule, resort to stimulation.
Institute of midwifes
One of the main differences of the American system of obstetric aid from the Russian consists that in the USA the institute of midwifes represents traditional alternative to more modern way of conducting childbirth by doctors by obstetricians - gynecologists. Midwifes (midwives), that can also be translated an obsolete word of “midwife“, have the own professional organizations, editions, the websites on the Internet and so on. Before the midwife delivered generally at home on calls of women in labor, but now when more than 90% of all childbirth are accepted in hospitals, independent midwifes conduct practice at hospitals and maternity hospitals and their services become covered by an insurance as well as services of doctors. Associations of midwifes in the USA have own training courses and schools of vocational training, similar to medical sisterly. To have an opportunity to be engaged in practice as the independent nurse - the midwife, the candidate has to pass rather serious certified examination and then repeat it each eight years, and also do practical training under the leadership of the skilled midwife. Now independent nurses - midwifes in the USA carry out such procedures as ultrasonic research, imposing of nippers and vacuum of an extractor, a kolposkopiya, a biopsy an endometriya. At the same time they always emphasize that they are the independent and alternative institute focused on a family and needs of the woman. Doctors are assisted not by midwifes, but nurses (nurses). Both directions exist side by side, and future mother has an opportunity to choose what suits it more, relying on experience of girlfriends, literature or financial reasons.
At approach of labor pains the woman in labor arrives to hospital. Registration of papers, clarification of the questions connected with an insurance or payment of childbirth takes certain time. However and in case the woman in labor has no insurance and at all any documents, administration of any hospital, even the most expensive, the childbirth having no right to refuse to it reception. The obligation of medical institutions to give ambulance to the people who are in great need in it is specially stipulated in the American legislation, and the posters bringing this information to the attention of all interested, usually meet visitors at the entrance to any American hospital.
the Husband, the partner or in general anyone can be present, with the consent of the woman in labor, at childbirth. Specially such right is not stipulated anywhere, but presence of relatives at childbirth is the standard practice and does not raise any questions and objections at medical personnel. Right after families of the child usually put to a breast. Then the kid is examined by the pediatrician, he is weighed, measure and transfer to mother if she not against also does not feel too tired after the delivery. If childbirth took place normally and mother does not object, the child usually remains with her until an extract from maternity hospital. In postnatal office, as a rule, several given rise women with babies are in one chamber. If to consider that relatives and friends can visit them practically at any time, mothers should not miss. Gifts, flowers, a photo - and video filming are not forbidden.
Application epiduralny and other types of anesthesia is self-evident in many maternity hospitals of the USA while childbirth without anesthesia represents an exception to the rules. The right for the choice of Cesarean section also remains for mother, and quite often the woman chooses Cesarean section as a way of childbirth, irrespective of recommendations of the doctor. Popularity of Cesarean section grows, and now to a quarter of childbirth (26,1% in 2002) occur at means of this operation.
Interesting feature is the fact that doctors in maternity hospitals usually suggest to perform operation of trimming on newborn boys. Trimming in this context has no religious background - it is considered that this safe and simple operation helps to maintain hygiene of male genitals and prevents cancer at their future sexual partners. This opinion is not indisputable, but such point of view prevails in the American medicine, and most of parents, irrespective of religion and an ethnic origin, agrees to trimming. However, refusal of this operation does not represent any problems, it is enough to tell about it to the doctor or in registry. The extract as we already mentioned, occurs approximately in 48 hours after normal childbirth. The maternity hospital makes out the woman in labor a bill for the services which, fortunately, in most cases is met by either an insurance, or state programs. The little U.S. citizen, namely such status receives any person born in the territory of the USA irrespective of nationality of his parents, enters new life.