In order to protect themselves and the baby and get the best conditions, many wealthy people try to make an agreement in advance at the maternity hospital and come to the birth under a contract, although the cost of this service is high. People think that by paying, they eliminate all possible risks of postpartum complications. However, a successful outcome does not depend on the price paid. Contract childbirth for the most part provides the proper level of comfort and the opportunity to have a personal doctor.

What is the difference between childbirth in a paid clinic and a free one?

At such an exciting moment, when a woman is expecting a child, comfort and good attitude are very important. Expectant mothers are worried that everything will go well and that the baby will be born healthy, so many families decide to seek medical care at a private clinic or negotiate in advance with the staff of a regular maternity hospital about special care and concern. Additional services available to women in labor after concluding a contract:

• the ability to choose a doctor;
• constant consultations with the chosen doctor - starting from the 36th week of pregnancy;
• increased comfort, for example, a separate room with an interior close to home;
• the ability to personally use a TV, refrigerator and other household appliances;
• presence of husband or other adult family members;
• unhindered visits to relatives - some clinics allow husbands or other loved ones to even live in family units;
• the staff teaches how to care for the baby and helps in the first stages breastfeeding.

Is it better to give birth paid or free?

IN modern society We are accustomed to the fact that if you have money, then any problem can be solved. Finance provides a certain guarantee of success and security. However, when it comes to life and health, a lot depends on experience people, their abilities, level of professionalism. The characteristics of the body and many other factors play an important role, and private clinics provide comfortable conditions and attention. medical workers, so you should weigh the pros and cons of paying and free births.

Getting to know the maternity hospital and staff

On a commercial basis. The main advantage is the ability to independently choose a doctor and conclude an agreement with him. From the moment the contract is signed, this gynecologist will monitor the condition of the pregnant woman, advise her, and provide her with complete medical care. However, it is worth visiting the clinic not only to sign an agreement. Important to watch conditions mother's stay and level of competence personnel.

Choosing an obstetrician-gynecologist for labor and delivery

Free of charge. It is impossible to know in advance which doctor will help the baby be born, because it is not known which team will be on duty. You can only try to find out in advance about the competence of all the doctors in the clinic. If there are a lot of dubious specialists in it, then it is better to take a closer look at other maternity hospitals, studying the staff and statistics of mortality and pathologies.

On a commercial basis. The choice of a doctor becomes the main reason for the decision to attend a contract birth. Having concluded an agreement, you can ask the doctor how the delivery process will go, what methods of pain relief can be used, when a cesarean section is indicated, etc. The doctor will give the woman his contact phone number, and with the onset of contractions he should leave to the maternity hospital, to be close to the woman in labor.

Hospitalization

Free of charge. Any woman has the right to choose a maternity hospital at her own discretion. During prenatal hospitalization, you will need to take a referral from the supervising doctor from the antenatal clinic, a map and birth certificates. If contractions start or your water breaks, you can safely drive even without directions. However, there is a possibility that the chosen maternity hospital will be overcrowded or urgently closed for repairs, then the pregnant woman will have to go to another hospital.

On a commercial basis. During childbirth under a contract, there is a guarantee that the woman will end up in the desired hospital. She concludes an agreement in advance, she is assigned one of the single wards, and she can enter the maternity hospital at any time, even if the standard wards are overcrowded. There are two options when this is not possible: the hospital is closed for urgent reasons or the woman in labor is in dangerous situation for life, then ambulance takes her to the nearest maternity hospital.

Maternity ward

Free of charge. In the maternity ward there are rooms designed for several people (about 5), here women spend almost all the time from the start of contractions. They contain a bathroom, beds, bedside tables for personal belongings, and a table. The main place is the maternity rooms, each of which is designed for 1 or 2 women in labor. Here the birth of the baby and the postpartum examination of the woman take place.

On a commercial basis. A woman entering a maternity hospital on a commercial basis has the right to count on a separate ward in which she will carry out all stages of labor. There is a comfortable orthopedic bed, an obstetric chair, and there may also be fitballs, a wall bars, a mini-pool, a shower or a jacuzzi. There are even comfortable beds that can transform into an obstetric chair. Medical personnel should always be nearby, monitoring the patient’s condition and being ready offer anesthesia if severe pain begins.

Postpartum department

Free of charge. There are two types of stay for mother and child: joint and separate. When separated, mothers are in wards designed for 3-5 people, and newborns are in the children's department. Children are looked after by staff; mothers are brought in only for feeding. The rooms have beds, bedside tables, a sink, and maybe a table. When staying together, the rooms are designed for 2-3 mothers and their children; there are beds, cradles, bedside tables and a changing table.

On a commercial basis. After giving birth under a contract, a woman ends up in a ward that is very different from the standard one. It has an individual bathroom, 1 or 2 beds, a TV, a refrigerator, a kettle, a locker for baby's things, and a bathtub. Although the ward is equipped to stay with the baby, the woman in labor can ask him to take it away to the children's department so that there is an opportunity to rest and sleep. The child will be returned as soon as the mother asks for it.

Partner birth

Free of charge. According to the law, at the time of the birth of the baby, relatives can be present in the delivery room without any payment. However, in order for this to be allowed, it is necessary to carry out a number of actions: write an application addressed to the chief physician, attach passport data, certificates of the partner’s health, and completion of courses to prepare for the birth of a baby. If there are no free individual boxes, then this person will not be allowed in. In addition, if the partner specified in the application is unable to attend, another person cannot replace him.

On a commercial basis. Even several people can be with the pregnant woman at the birth under a contract. There is no need to write an application for them and collect a lot of certificates. The only requirement that must be met is the presence of an individual box, but it must be specified by default in the concluded contract, so close people can be nearby with the woman.

How and with whom is a contract for childbirth concluded?

A contract for childbirth under a contract can be concluded by a pregnant woman, her husband or a relative who acts on her behalf. In almost all state maternity hospitals, a contract is signed with an insurance company that cooperates with a specific medical institution. The insurance company will conclude agreement for certain insurance amounts. It is important to pay attention to when the insurance expires so that it is still valid at the time of the expected birth of the baby. If the contract is concluded directly with a medical organization, you need to check its documents and licenses.

How long does it take to conclude an agreement with a maternity hospital?

It becomes possible to conclude such an agreement upon the onset of the 36th week of pregnancy, only then is the woman attached to this medical institution before the onset of childbirth and after it for 1 month. In the complex of events included:

• consultations and examinations of the selected doctor during the remaining time of pregnancy;
• management of childbirth;
• care during the postpartum period.

What should be specified in the contract

The contract must stipulate the conditions of the patient’s stay in the hospital: a separate room, the presence of a TV and household appliances, the number of meals and other points. If at least one clause of the contract is violated, the woman can sue the insurance company demanding the return of all or part of the amount. The main points that must be specified in the contract:

• duration of the contract;
• the procedure for depositing, the total amount of funds;
• responsibilities, rights of both parties.

Tax deduction for contract childbirth

If the documents were completed correctly, then the woman has the right to a tax deduction in the amount of 13% of the amount spent. This money is returned by the state to patients who did not use free healthcare services. The interest is related to income tax. It is paid for various social expenses from the salary, so it is possible to compensate for expenses on paid services. However 13% the cost of childbirth under the contract should not exceed the amount paid by the woman to the state as tax for the year. Citizens of the Russian Federation have the right to such compensation.

How to choose a maternity hospital

A woman has been preparing for the birth of her baby for 9 months, she wants everything to go well and bring only joy, so she wants to give birth in the best medical facility. To choose a maternity hospital, you need to consider many criteria:

1. History and personnel - the number of years the clinic has been in operation, the level of knowledge of doctors (degree, category, merits).
2. Official statistics - the number of births delivered over any period of time, the number of cases of complications, mortality among women and infants. These data can be viewed on the websites of the League for the Defense of Patients' Rights and Roszdravnadzor.
3. Development of hospital infrastructure - use advanced technologies, new equipment.
4. Availability of additional services - partner birth, water delivery, rehabilitation, private ward, etc.
5. Living conditions - the number of women in the ward, necessary furniture, bathrooms, etc.

Where to give birth in Moscow

In any large city, such as St. Petersburg or Moscow, there are many maternity hospitals that differ in cost and service options. Choose ideal option It’s extremely difficult, if only because it’s unlikely to get to know all the medical staff. However, it is important to study the main points:

• price;
• living conditions;
• additional features.

Clinic of Obstetrics and Gynecology named after. Snegireva

The hospital was created on the basis of the Medical Institute named after. Sechenov, has existed since 1889, from the moment of its foundation until today it represents modern schools at domestic doctors obstetricians-gynecologists. Main activities: consultation, diagnosis, timely detection of pathologies, preparation for pregnancy and childbirth, infertility treatment. The price of physiological childbirth and caesarean section identical - 88,000 rub.

Scientific Center named after. Kulakova is a leading medical and scientific institution specializing in obstetrics and gynecology. The institution has the status of federal significance. The contract for contract childbirth is concluded starting from the 36th week of pregnancy. There are three types of contracts. You can give birth independently for an amount of 100-400 thousand rubles, and with the help of a caesarean section - 130 thousand - 5 million rubles. If several fruits, then the cost may be higher. Additionally, you can pay for a personal neonatologist or other specialist.

Family Planning and Reproduction Center

This clinic deals with the physiological method of childbirth. The second area of ​​their activity is patients with hematological problems: blood disease, incompatibility of group and rhesus in mother and child. Under the care of this clinic, there is less chance of death of a child who is at risk due to these complications. It will cost 92,300 rubles to give birth on your own, and 107,300 rubles to have a caesarean section.

Maternity hospital City Clinical Hospital No. 15

This is one of the oldest maternity hospitals in Moscow; in 2017 it celebrates its 80th anniversary. The clinic practices vertical childbirth, the presence of a partner is possible, free behavior at the time of contractions, independent childbirth with a scar on the uterus. The maternity hospital provides highly qualified care for low birth weight babies. The contract price is from 45,000 rubles.

Perinatal Center of the Mother and Child Clinic

The list of services of this clinic includes many possibilities: stem cell bank, natural childbirth in a hospital setting, but in a home atmosphere, physiological, vertical, in water. The paid maternity hospital provides services for pregnancy management from the 36th week, it costs 1,760 thousand rubles for the Lux category, and 198 thousand rubles for VIP. There are many programs for childbirth and assistance in the postpartum period, their cost varies from 120 to 930 thousand rubles.

Paid childbirth in Moscow maternity hospital No. 20

The maternity hospital has been operating since 1966. As part of paid services, you can be examined before conceiving a child, observed during pregnancy, go to school to prepare for the birth of a baby, have the right to free behavior during labor, etc. The contract price for a physiological birth is 75 thousand rubles, and for a caesarean section – 85 thousand rubles. The price includes a room for two women in labor and the presence of an individual doctor.

Maternity hospital No. 4

This maternity hospital provides the opportunity for paid childbirth with additional services. You can be examined before conceiving a child and monitored throughout pregnancy. If there is a desire and need, then during the delivery it is possible to hire personal specialist: midwife - 40 thousand, anesthesiologist-resuscitator - 40 thousand rubles. The cost of a paid physiological birth is 98-137 thousand rubles, the cost of a cesarean section is 114-152 thousand rubles.

Pros and cons of paid childbirth

Contract childbirth has many advantages. Except individual approach there are the following advantages:

• calmness and feeling of security;
• the right to choose in many matters;
• comfortable conditions;
• possibility of presence of a partner;
• In government institutions, payment is made after the birth of the child.

Among the disadvantages are the following:

• expensive;
• in private clinics you need to pay in advance;
• no confidence in the doctor;
• food is the same as for people under standard conditions;
• risk of caesarean section, which increases the cost of services.

Any woman is worried before childbirth and wants to be surrounded by care and attention at the moment of the birth of her child. Therefore, expectant mothers, wanting to guarantee maximum comfort for themselves and their baby, are increasingly choosing contract births. But to avoid pitfalls, it is advisable to find out as much as possible before concluding an agreement. detailed information about all the nuances of this procedure.

What is a birth contract?

No one can guarantee that unpaid services in a maternity hospital will be of high quality. Therefore, when a woman decides to give birth for free, she can only rely on the honesty and professionalism of the medical staff. Whereas, having concluded a contract for childbirth, a woman in labor can count on certain privileges and the high quality of the services provided. The contract states:

• the period during which the document remains valid;
• amount of payment;
• list of rights and obligations of the parties;
• a range of services that will be provided to the woman in labor.

By concluding a contract, during childbirth you can enlist the support of not only your husband or mother, but also an experienced friend or perinatal psychologist

With whom is such an agreement concluded?

An agreement can be concluded either directly with a maternity hospital or medical institution (which has the legal right to provide assistance during childbirth, as well as before and after it), or with the medical insurance company representing it. In the first case, with legal point In one view, this will be a contract for the provision of medical services, and in the second, a health insurance contract.

If you choose the first option, before signing the agreement, it is advisable to make sure that the medical institution has the appropriate license and certificate allowing it to provide medical services to pregnant women and infants. Typically, such a certificate is valid for no longer than 5 years (and if the form of ownership is not state-owned, then only 3 years). The license is valid for 5 years.

When a health insurance method is chosen, the expectant mother becomes an insured person, and the law “On health insurance of citizens in the Russian Federation” (dated June 28, 1991 No. 1499–1) comes into force. According to this law, the insurance company enters into a contract with the future mother, which obliges the insurer to organize and pay for the upcoming birth in a certain maternity hospital. At the same time, between the company and maternity hospital an agreement regulating the provision of such medical services must already be concluded.

Before concluding a contract with an insurance organization, you must first check the availability of a certificate that allows you to engage in health insurance. Secondly, you should see with your own eyes the contract concluded between the company and the maternity hospital and check when it expires (so that this does not happen before the moment of birth).
Each maternity hospital draws up its own form of contract for childbirth, so the list of medical services in different medical institutions may differ significantly

Regardless of whether the agreement is concluded with a medical insurance organization or directly with a medical institution, it is advisable to make sure that it is signed by an authorized person. The fact is that the agreement must be signed by a person who has legal authority to do so (general director, director). But he, in turn, can transfer this right by proxy to one of his subordinates. And it is very desirable to see this very power of attorney in order to make sure that the signed document will have legal force.

To avoid unpleasant surprises, you need to make sure you have all the above documents and permits. Otherwise, all the promised benefits may turn out to be nothing more than a fiction. For representatives of a serious company, a request to show documentation will not cause indignation or dissatisfaction, because such a check is a normal and completely legal practice.

Several times I had to listen to complaints from women who entered into a contract for childbirth with a representative of an insurance company who did not have the legal authority to sign such documents. And then it turned out that the woman in labor, dissatisfied with the quality of the services received during childbirth, could not even complain about it, since, from a legal point of view, no one owes her anything. To avoid such situations, it is advisable to check the charter of the organization with which the agreement is concluded. This will ensure that her representative signing the agreement has the legal right to do so.

What are the advantages of contract childbirth?

The expectant mother gets the opportunity to choose not only the maternity hospital in which she will give birth, but also a team of specialists with a good reputation. And then indicate your choice in the contract. In addition, many women who have given birth note the fact that the attitude of the medical staff towards women in labor who have paid for their stay in the institution is more attentive and polite.
A birth contract gives you the opportunity to give birth with all the comforts

To avoid misunderstandings during childbirth, I recommend that women meet and personally talk with the doctor whose help they want to enlist in advance (even before signing the contract). First of all, you need to obtain the consent of the obstetrician that he will be the one to deliver the baby. Then important details should be discussed, such as the method of anesthesia, type of birth, tolerance of medications, and so on.

List of services guaranteed by the contract

In different maternity hospitals, the situation with the provision of certain benefits to women who have entered into a contract for childbirth may have its own nuances and differences. But the list of basic services is usually the same. It includes:

• guaranteed availability of a place in the maternity hospital at the time of the onset of labor;
• separate room with all amenities for mother and baby (with TV, shower, refrigerator)
• high-quality multi-course meals;
• additional procedures that have a beneficial effect on the condition of the mother in labor (aromatherapy, music therapy);
• assistance and consultation from a pediatrician;
• anesthesia (pain relief) at the choice of the woman in labor;
• the possibility of the presence of a husband or other loved one during childbirth;
• constant presence of doctors on duty near the woman in labor;
• use of disposable medical instruments;
• choosing a method of childbirth according to the woman’s wishes (for example, water birth, vertical);
• the opportunity to call your doctor at any time (during the period of prenatal preparation, as well as after the birth of the baby);
• medical support after childbirth (medical procedures, examinations).

Typically, paid wards in maternity hospitals are more comfortable and better equipped

What to pay attention to

When concluding a contract for childbirth, you must take into account some important nuances. Here are some tips to help avoid unpleasant surprises:

1. Be sure to include in the contract the name and surname of the obstetrician (or the name list of the duty team) who will attend the birth. Otherwise, the pregnant woman can be assigned to any doctor of the highest category who will be on shift at the moment when her contractions begin.
2. Please note that if the contract is concluded not directly with the maternity hospital, but with an insurance company, then taking into account the fees to insurers for mediation, its cost will be higher.
3. Carefully read the entire list of services that you will have to pay for - some of them may be absolutely unnecessary for you (for example, consulting with highly specialized specialists). In order not to overpay, write into the contract what benefits you will take advantage of and what you will definitely refuse.
4. Find out if your husband or other relatives will be allowed to be present at the birth.
5. Make sure that the agreement includes a clause that provides for the services of an experienced nurse who will care for the baby if the mother feels unwell or needs rest.
6. Not everyone wants to use anesthesia during labor. If you do not want to be given painkillers, be sure to clarify this in the contract and also recalculate the amount you must pay.
   If you do not wish to use anesthesia or refuse any other medications during childbirth, be sure to indicate this in the contract
7. Keep in mind that a contract that includes a cesarean section will cost more than if a woman decides to give birth naturally. Don't let anyone talk you into having this surgery without a good reason. The fact is that maternity hospitals make money on cesarean sections - this is an expensive and at the same time quick operation.
8. Check whether the agreement provides for medical care that you will receive after discharge from the department (medical examinations, counseling). It must indicate what specific services will be provided to you and the period during which you can count on them.
9. Be sure to include a clause in the contract guaranteeing urgent hospitalization for the mother and baby in the event of postpartum complications occurring within a week after birth.
10. Find out how much additional medical services that a mother or child may need in case of various complications will cost.
11. Pay attention to whether the contract states how many days the mother and baby must spend in a medical facility. And also find out what additional payment per day will be assigned if you have to stay in the ward longer than planned.
12. Finally, the agreement must indicate what liability the maternity hospital or intermediary insurance company bears, and how they will compensate for damages in the event of non-compliance with the conditions.
    Before signing a contract for childbirth, you should thoroughly study its contents.

When does the birth contract come into force?

You can find out from what time a specific contract begins to operate from a representative of the insurance company or the head physician. In most cases, according to such an agreement, the responsible doctor is obliged to manage the pregnancy starting from the 36th week.

From this moment on, a woman can count on the full range of necessary medical services (tests, examinations, etc.). But sometimes the agreement begins to apply for more early stages- from the 31st or 34th week. This important point must be discussed and indicated in the document. The contract ends one month after the birth of the baby.

In some cases, the contract comes into force by the time labor begins. And if for some reason a woman in labor ends up in the maternity hospital earlier, she is placed in a general ward along with other pregnant women, and is transferred to a paid department only when she begins to give birth.
If there is a need for a longer stay in the maternity hospital than specified in the contract, you will need to pay extra for the extra day

Submitting complaints and claims

Unfortunately, a maternity contract does not always guarantee perfect care. Even when a woman gives birth on a paid basis, she may encounter negligence and dishonesty of medical workers. You can file a complaint to hold a medical institution accountable if:

• the terms of the contract were violated;
• the mother in labor suffered moral or material damage;
• due to the fault of the medical staff, the health of the mother or baby was damaged;
• the quality of service was low.

Who and where to complain

If the contract was concluded directly with the maternity hospital, then first of all you should write a complaint to the head physician, demanding compensation for material or moral damage caused. Most often, maternity hospitals value their reputation, so they try to resolve such problems peacefully, without litigation.

If the claim is refused, you can take the case to court on the basis of the Law “On the Protection of Consumer Rights” (clause 3 of Article 16) by contacting the legal address of the maternity hospital. The procedure and form for filing a complaint are shown in Article 7 Federal Law No. 59-FZ of May 2, 2002. The document itself should indicate what the violation of rights was, under what circumstances it occurred, and against which officials there are claims. Typically, such claims are resolved within a month.

But if the contract was concluded with an insurance company, then according to the law “On Medical Insurance of Citizens of the Russian Federation” (Article 27), it is the insurance company that bears full responsibility for failure to comply with the terms of the contract. So in this case, you will have to file a claim not against the maternity hospital, but against the insurers.
If the contract is not observed, the injured party has the right to file a lawsuit

I know of cases where the injured party could not file a claim in court only because important documents were not preserved. Therefore, I strongly recommend that you do not lose, do not throw away, and save until last day your copy of the contract for childbirth, as well as a receipt for payment for maternity hospital services.

How much does it cost to give birth under a contract?

In Russia, every woman has the right to give birth to a baby free of charge in a maternity hospital, while receiving qualified medical care. But paid childbirth seems to many expectant mothers to be a more reliable option, allowing them to count on high quality medical services.

Meanwhile, this is a rather expensive pleasure. Moreover, prices vary greatly depending on the city and the prestige of the medical institution. For example, the cost of contract childbirth in Moscow ranges from 70 to 120 thousand rubles. Almost the same high prices in St. Petersburg. In other large cities (Ekaterinburg, Vladivostok, Murmansk) prices are much lower - an average of 30 thousand rubles. In small cities prices are even lower - 17–20 thousand.
A successful birth is worth paying for

I have heard the opinion that supposedly the birth of a baby can be a little cheaper if you do not conclude a contract, but give money personally to the doctors. In many maternity hospitals, especially in the periphery, this version of the “agreement” is very common. But this is a risky practice, because then, if you receive poor service or a completely different obstetrician delivers your baby, you will not be able to prove anything to anyone. Therefore, it is safer and more reliable to formalize everything officially, in accordance with existing laws.

Paid childbirth, which is increasingly becoming a choice modern woman, imply the signing of an agreement between the expectant mother and the maternity hospital or insurance company. Pay attention to all its points - this will save you from many misunderstandings and disappointments.

October 9, 2015· Text: Svetlana Lyuboshits· Photo: GettyImages

lawyer

A contract for childbirth is a contract for the provision of medical care, guaranteeing the expectant mother not only service in the institution of her choice during childbirth and in the postpartum period, but also a certain set of benefits. It can be concluded either with the maternity hospital itself (medical, perinatal center, etc.) or with the insurance company. What nuances should be taken into account when signing this document?

Childbirth contract options

If the contract is signed directly with the maternity hospital, then an agreement is concluded for the provision of medical services. Relations between the parties are regulated, among other things, by the law “On the Protection of Consumer Rights”, because the expectant mother is a consumer of services. And in this case, the woman has more opportunities to make claims to the maternity hospital.

If the contract is concluded with an insurance company, the situation becomes more complicated, since insurers are intermediaries between the expectant mother and the maternity hospital. The guiding and guiding force in this case will be another law - “On medical insurance of citizens in the Russian Federation”.

A typical maternity contract from insurance companies begins to operate at different times - from the 31st, 34th or 36th week of pregnancy. Its effect ends approximately a month after birth.

You can sign the agreement either at the company’s office or with its representative in the selected maternity hospital. In the first case, the expectant mother buys a voluntary health insurance policy and receives a list of maternity hospitals with which the insurer has contracts. When contacting any of them, a woman in labor is placed in a paid department. It is difficult to choose a specific doctor in such a scenario.

The second case provides more benefits. The insurance agent and employees of the paid department of the maternity hospital will be able to give detailed answers to all questions, give a tour of the maternity hospital, and advise the team on duty or a personal doctor. And although the expectant mother receives the same VHI policy, the accompanying contract will be more detailed.

But there is also a fly in the ointment: the client pays not only the insurance policy, but also the agent’s remuneration, which makes the contract more expensive.

Agent check

When signing a maternity contract with an insurance company, check whether it is licensed to provide health insurance. If the contract is concluded with a representative of the insurance company in the maternity hospital, make sure that he has the appropriate authority. First of all, he must have a power of attorney to sign the agreement, and the insurance company must have the already mentioned license. You must also be shown the agreement between this organization and the maternity hospital. Pay attention to the validity period of the document: what if it expires tomorrow, and the birth should take place in 2 months. In addition, the maternity hospital must have a license for medical activities with the application. Please note that it is issued for no more than 5 years, and pay attention to the dates.

By concluding a contract for paid childbirth, a woman has the right to choose a doctor, a ward, if she wishes, her husband or another close person can be present at the birth. In addition, relatives can visit the young mother immediately after the baby is born. The document stipulates the conditions of stay in the postpartum department: the type of room (for 1 or 2 people, “luxury”, room for a mother and child together), the presence of a telephone, TV, refrigerator, etc.

And then there are the nuances. And in order for paid childbirth to be as comfortable as possible, when signing the agreement, one must not forget about the details. And first of all, immediately find out whether the expected date of birth coincides with the planned closure of the maternity hospital for sanitation. In this case, you will have to choose another institution.

When the contract for childbirth does not specify force majeure circumstances ( emergency surgery cesarean section, additional pain medications, costs and payment terms for other medical services), you are not required to pay for them. If you have already given the money, you can demand its return (Clause 3 of Article 16 of the Law “On Protection of Consumer Rights”).

When a contract is signed with an insurance company, the contract or an appendix to it must contain a list of proposed medical facilities. If a woman chooses a specific maternity hospital and a specific doctor, she must indicate the name of the institution and the surname, first name, and patronymic of the doctor. Otherwise, it will most likely be written in the agreement that the birth will be conducted by a doctor of the highest category who is on duty that day. The expectant mother will find out who it will be only during childbirth.

No doctor will ever guarantee that the birth of a baby will go without a hitch. So it is better to immediately choose an operating obstetrician-gynecologist. Otherwise, in an emergency, the surgeon on duty will perform a caesarean section.

Please pay attention to the duration of the contract, the size, timing and procedure for paying for services or making insurance premiums.

The agreement must stipulate possible types of pain relief during childbirth. When a woman wants to give birth without resorting to anesthesia, she should not only stipulate this option in the contract, but also determine the procedure for recalculation.

It is important to clarify whether drugs that enhance or slow down labor will be used, and to provide for the possibility of voluntary refusal to use these drugs. It is also better to document the chosen delivery technique in the contract.

The expectant mother has the right to independently form a team of specialists who must be present during childbirth (obstetrician-gynecologist, midwife, anesthesiologist, resuscitator, neonatologist). In addition, one of the clauses of the contract for childbirth may be the requirement to provide an experienced nurse to care for the newborn if the mother wants to rest after childbirth.

It is also better to specify in advance the responsibilities of the maternity hospital staff if the mother or baby needs emergency resuscitation or diagnostic care. Otherwise, you will be required to pay separately for this type of service or you will have to hospitalize the mother or baby at the place of registration of one of the parents under the compulsory health insurance program, that is, in a free department of a municipal hospital.

It is imperative to record how many days the mother and baby will stay in the maternity hospital. They can be detained beyond the term only on the written conclusion of a doctor. Provide for this option and ask the contract to indicate how much each additional day spent within the walls of the maternity hospital will cost.

State in the agreement that if the mother or baby develops postpartum complications that develop within 7 calendar days after birth, hospitalization is guaranteed.

It would also be a good idea to find out whether medical care after discharge from the hospital (ultrasound, consultations, examinations). If yes, then to what extent and for what period.

And finally, the contract must indicate what responsibility the maternity hospital or insurance company bears to the client, how and in what order they will compensate for inadequate performance of the contract.

How to make a claim

The terms of the contract always provide for the financial liability of the parties. For example, if an expectant mother is not immediately placed in a single room provided for in the contract, the woman has every right to demand that the maternity hospital pay a penalty for each day overdue.

A claim for compensation for material damage can be brought against an insurance company or a medical institution. Maternity hospitals prefer to resolve all disagreements amicably and return the money without bringing the matter to court. But you often have to sort things out with the insurance company in court. But in any case, the claim must be submitted in writing and have it registered.

Regardless of compensation for material losses, you can also demand compensation for moral damage. This is provided for in Article 15 of the Law “On Protection of Consumer Rights”. True, for the sake of fairness it must be said that in Russia the courts assess moral damage in purely symbolic amounts.

Now contract births are becoming increasingly popular - when in advance, even before giving birth, a pregnant woman chooses a doctor and a maternity hospital where her birth will take place, and enters into a contract. The contract specifies a list of all services that a woman can count on during childbirth, as well as the amount of remuneration for which she can receive all these services.

Unfortunately, everything usually depends on the amount of remuneration. A contract for childbirth is not a cheap pleasure, so women find themselves in a dilemma: should they enter into a contract for childbirth, shelling out a tidy sum for it, or rely on the integrity and professionalism of doctors who will deliver the child for free? It is believed that women who are especially concerned about their health and the health of their baby will feel more confident during childbirth by entering into a birth contract. Well, the decision is up to you, but we will try to explain what a contract for childbirth is, and what you need to know if you decide to give birth for a fee.

What is a birth contract?

The contract for childbirth, contrary to popular belief, is not concluded with a doctor or maternity hospital, but with an insurance company that “serves” a specific maternity hospital. True, if you decide to give birth not in a municipal, but in a private maternity hospital, then the contract for childbirth, quite rightly, is concluded with the maternity hospital of your choice.

Concluding a contract for childbirth gives you the right to give birth in a paid department of the maternity hospital of your choice and to use the entire list of medical services prescribed in the contract. To do this, you just need to present a voluntary health insurance policy issued by a representative of the selected insurance company and, of course, pay the money.

What is included in the list of medical services guaranteed when concluding a contract for childbirth?

The constant presence of a team of doctors on duty next to you throughout the entire period of childbirth and the postpartum period,

Management of pregnancy from the 36th week, assistance in delivery and observation for a month after birth;

Possibility of partner birth,

Possibility of administering epidural anesthesia or even caesarean section if desired,

Separate maternity box,

The ability to choose a personal doctor who will give you maximum attention before and during childbirth,

Presence of a pediatrician at the birth,

Free behavior during childbirth and the use of additional means of relieving the condition (aromatherapy, fitball, devices for vertical birth and birth in water, music),

Use of disposable instruments

Guaranteed availability of a place in the maternity hospital of your choice on the day you arrive to give birth (even if labor does not begin on time),

Nutrition,

Postnatal examination and procedures,

Teaching the basics of breastfeeding,

Comfortable stay in the maternity hospital (separate room, shower, TV, shared stay with the child),

In different maternity hospitals, the list of services specified in the contract for childbirth varies - therefore, before signing the document, be sure to ask all the questions you are interested in and read the text of the contract.

What should you pay attention to when concluding a contract for childbirth?

In order for a childbirth contract to give you only confidence, you need to know several important things that you simply must pay attention to when concluding a contract for paid childbirth.

The first thing you should pay attention to when deciding to enter into a contract for childbirth is the choice of the doctor who will deliver the child. Be sure to specify which specific doctor will be next to you at this important moment, write his name in the contract and find out all the necessary information about him in advance. The fact is that there are often cases when, even after concluding a contract for childbirth, it turns out that you end up on the shift of another doctor - and not the one who observed you and with whom you saw. To avoid such incidents, be sure to document your wishes.

Secondly, discuss with your doctor in advance the methods of pain relief during childbirth, stitching up tears and other medical procedures. It is better to choose epidural or intravenous anesthesia (after childbirth) rather than local anesthesia.

Remember, if you sign a contract for a natural birth, and not for a caesarean section, the cost of your contract will be less than the cost of the same contract, but with a planned caesarean section. By the way, if you are afraid to give birth on your own, you can always add this clause to the contract, pay, and go for the operation. The doctor himself will decide what diagnosis to give you so that everything looks like a caesarean section according to the indications.

But before you do this, think twice. Maybe there is no need to be so dramatic? After all, the maternity hospital makes a particularly big profit from cesarean sections - the contract for the operation is expensive, and such births take much less time. Do you want people to make money at your and your child’s expense? Of course, if we're talking about about a real caesarean section according to indications, this question is by no means raised.

By the way, about money. When concluding a contract for childbirth, provide for the case when the final bill may exceed the stated cost of the contract by 2-3 times. Such a strong increase in cost occurs due to the inclusion of additional services - and not always necessary ones. This could be daily pediatric intensive care (which is not necessary if the birth went well and the child is healthy), additional consultations with specialized specialists, additional examinations “for prevention,” etc.

And finally, the most important thing. A contract for childbirth really gives you confidence in only one thing - that in the event of various kinds of unforeseen cases or insufficiently competent provision of medical care, you can go to court with this contract to get your money back and receive payment for moral damages. If you have a competent lawyer, such cases are most often won. Another thing is that often the maternity hospital workers themselves can offer you not to bring the case to court and return the money. No maternity hospital wants to tarnish its name and get involved in a lawsuit.

What is the advantage of a birth contract?

The majority of the advantages of a contract for childbirth cite confidence in the good and attentive attitude of the medical staff, the opportunity to have someone close to you at the birth, staying with the child in a separate room, learning the basics of breastfeeding, as well as the possibility of anesthesia and caesarean section if desired. Let's try to figure out whether there is such a big difference between paid childbirth and free childbirth.

Firstly, even free childbirth must take place according to a birth certificate, which is given to you at the antenatal clinic. A birth certificate is, if you like, “payment” by the state for your birth. The purpose of birth certificates is to increase the financial interest of medical institutions in ensuring that your birth goes well. Therefore, attentive attitude of the staff and high-quality medical care a priori should be in any maternity hospital where you will give birth.

Secondly, modern maternity hospitals already quite fruitfully practice staying together between mother and child, and also, many maternity hospitals allow free behavior during childbirth - and absolutely free!

Thirdly, there is the possibility of partner childbirth in many maternity hospitals even without concluding a contract for childbirth. It is enough to pass all the necessary tests - and your husband, mother or sister will be with you throughout the entire birth!

Fourthly, training in the basics of breastfeeding is included in the mandatory program of all maternity hospitals, regardless of whether you have entered into a contract or not. This is a completely free service by law.

As for the administration of anesthesia, in some maternity hospitals this service is also provided free of charge - you may only have to pay for the drug itself. If the possibility of administering anesthesia is very important for you, simply choose a maternity hospital based on this criterion.

Free caesarean section is performed only when indicated. If you want a cesarean at will, then you really will have to conclude a contract for childbirth. But before you decide to take such a step, be sure to think again, do you need it?

Of course, it’s up to you to decide whether or not to enter into a contract for childbirth. But there are several criteria by which it will be easy for you to determine which option is more acceptable to you. If you are most worried about how the birth will go, it is better to negotiate personally with the midwife; if a comfortable room and comfort during the postpartum period are important to you, your option is a birth contract. If you are deeply confident that any doctor will professionally fulfill his duty, regardless of whether he was paid extra or not, go to a regular maternity hospital and give birth using a birth certificate. In the end, most women do just that - and they have beautiful kids!

In 2017, according to Rosstat, more than 1.69 million people were born in Russia. All more women those preparing to become mothers refuse free medicine and choose childbirth under VHI or a contract with a specific doctor or midwife. What are the advantages of paid childbirth? How is the contract concluded? Are there any disadvantages to such an agreement? What is the cost of a birth contract? When should you choose obstetric care under compulsory medical insurance, and when should it be paid? We will try to answer these questions in this article.

How to conclude a contract?

The contract can be concluded in several organizations of the pregnant woman’s choice - in a state maternity hospital, in a private clinic or in an insurance company. The choice directly depends on the desires of the pregnant woman and her financial capabilities. Paid childbirth in a maternity hospital can cost less than in a clinic, and concluding an agreement with an insurer can be beneficial, since it is the insurance company that will bear full responsibility for the quality of services provided and their timeliness.

Both the pregnant woman herself and her relatives or representative can conclude a contract. To sign the contract, you must visit the selected institution with a package of necessary documents (often this is only a passport and birth certificate) and pay for the service. If the contract is concluded directly with the maternity hospital, an examination of the pregnant woman may be required. Based on its results, the obstetrician-gynecologist will decide whether to agree to the contract or refuse to sign it. The last decision may be related to the presence of pathologies in the fetus or diseases in expectant mother, due to which childbirth must take place in specialized medical institutions with the necessary equipment (for example, with heart disease, women give birth in a perinatal center under the supervision of a cardiologist and resuscitator).

When to conclude?

A gynecologist from a private clinic or antenatal clinic, where the progress of pregnancy is monitored, can tell you how long a contract for childbirth is concluded. The duration depends on the condition of the pregnant woman - are there any health problems, is there a threat? premature birth, on the number of fruits, etc. In case of a singleton pregnancy with good medical indicators of the mother in labor, it is recommended to enter into a contract from the 36th week. If the pregnancy is multiple, there are any pathologies or there are indications for a cesarean section, then the contract is usually concluded at 28 weeks of pregnancy.

"Pitfalls" of the agreement

During the standard course of pregnancy, a gynecologist in a antenatal clinic writes out a referral to the maternity hospital at the place of residence of the expectant mother. IN emergency situation the ambulance will take the woman to the nearest maternity hospital, where she will probably have to give birth in less than ideal conditions. better conditions. To avoid such situations and to be confident in the competence of the medical staff and obstetrician-gynecologist, the pregnant woman chooses contract delivery.

But even with a paid contract, you cannot be 100% sure that everything will go as planned. The selected obstetrician-gynecologist may be on sick leave, visiting another patient, or absent for other reasons. A quarantine may be declared in the selected maternity hospital, which means that the husband or other accompanying person will simply not be allowed into the delivery room, etc. Before signing a contract, you need to take these factors into account and weigh the pros and cons.

Advantages and disadvantages of childbirth under VHI

As more and more women with sufficient financial resources decide to pay for childbirth, it becomes clear that the contract has a number of advantages over free childbirth. Most conditions, medical services and what is included in the birth contract cannot be provided for free. The advantages of obstetric care under VHI include the following opportunities:

• Choosing a doctor;
• Choice of chamber;
• Choice of procedure (standard, birth at home, in water, etc.);
• Monitoring the baby and mother after birth for as many days as the mother in labor wants;
• No need to stay in the maternity hospital without special indications due date(from 3 days and longer);
• The presence of a husband or other relative in the delivery room to provide support;
• Preservation of the umbilical cord and its cutting after the pulsation stops;
• Polite and helpful staff, etc.

There are not as many cons as pros. The main thing can be the rather high cost of such services. The remaining disadvantages are in many ways similar to those present during free childbirth. If the contract is concluded directly with the maternity hospital, then the food will be standard, the doctors and medical staff in the postpartum ward will not be as courteous as the midwife in the delivery room. The contract will not protect against the risks of an emergency caesarean section, the need for additional procedures (episiotomy, anesthesia) and manipulations, even if they are not provided for in the contract itself. Due to their implementation, the cost will increase, but it will not be possible to refuse payment. Doctors, for their part, will also not be able to follow all the terms of the contract and not perform an operation or not administer stimulants (oxytocin) if the mother and baby are at risk due to the termination of labor or for other reasons.

How much does a birth contract cost?

The cost depends on many factors, which include the chosen institution for concluding the contract, the qualifications of the doctor and midwife, the technical equipment of the maternity hospital, the range of services, the region of residence, etc. In the regions, the cost starts from 30 thousand rubles. In the central part of the Russian Federation it is more expensive. Below is a comparison table of several leading insurance companies, clinics and maternity hospitals where you can sign a contract.

Table - Cost of childbirth under a contract in 2018 in Moscow

Name of institution	Cost of childbirth, rub.	Contract services
IC "Ingosstrakh"	From 77 940	Installed individually
IC "RESO-Garantia"	From 90 000	Appointment with an obstetrician-gynecologist before birth, drawing up a birth plan, taking tests; Examinations and tests after birth; Hospital for complications and bleeding that developed in the next 7 days after birth
Private clinic "European Medical Center (EMC)"	From $7,500 to $12,000	Deluxe chambers, luxury studio, luxury apartments; Appointment with an obstetrician-gynecologist before birth, drawing up a birth plan, taking tests; Calling an ambulance at the onset of labor; Stay in the antenatal department; Stay in the postpartum ward (4 days); Examinations and tests after the birth of a child; Hospital for complications and bleeding that developed in the next 7 days after birth; Administrative support; Examination of the child, tests, research, unlimited medical care if necessary (there is a neonatology department)
Maternity hospital No. 4	From 55,000 to 133,920	Single birth box; Doctor on duty team or personal doctor; Joint birth; Single postpartum ward; Postpartum tests and examinations of mother and child; Visiting relatives; Consultation with an obstetrician-gynecologist after discharge from the hospital