A story with demographics: how a perinatal center works in a Russian province
Midwives at the Perinatal Center in Veliky Novgorod attend an average of 8-10 births per day. Small salaries and shift work are still no reason for many of them to give up their profession: many of them have been working in the same place for decades. Izvestia got acquainted with the work of those thanks to whom Russians are born.
Main and demographic
- Lena, come on, there's not much left! Come on, we can already see the head, but we need your help. Get more air! Okay, now hold your breath and push! Yeah, it hurts, Lena, it hurts, but you're doing great! Okay, now exhale! Let's do it again, from the beginning and by the book. You see, the head starts to move, and you stop pushing, and it stops....
Midwives Evgenia Kuznetsova and Julia Poderskaya have been helping to give birth to a new resident of Veliky Novgorod for the last twenty minutes, talking to 37-year-old Elena in smooth, calm voices, so that she finally calms down and concentrates on the labor process.
- Come on again, Lena, like before, only on command. Dialed air and push, well, here we go, come on, come on! That's it! That's it! Well, hello, baby, - calmly says Julia, pulling out of Elena her exact miniature copy, black-haired big-eyed girl and shows her mother with a raised leg. - Who you've got, Lena! Let's put her on your chest, let her get acquainted with you ...
The midwife records in the journal, sex, weight 4,176g, height 55 cm and head circumference 36 cm newborn and the time of birth, noting the absence of visible pathologies. Elena's labor began on the due date, in the afternoon. Before that, she had been lying quietly on her side on a bed by the window in an empty room for several hours. Information about her and her baby's heartbeat and general condition was transmitted through a special electronic CTG system to a station on the bedside table, and from there to the central CTG in the resident's room. This system makes it possible to quickly read fetal distress (oxygen deprivation) directly from the computer monitor and send women in labor for a C-section to avoid asphyxia in the baby, as happened the day before with one patient.
- When four babies were born one after another the night before, this system allowed us to know at a glance who was in labor and who was still in labor. It's a good system, but in general, we used to manage without it, and even 10 babies were born in a day during my shift," says midwife Yulia Poderskaya.
Now the demographic hole in Veliky Novgorod is slowly tightening, according to last year's report "Socio-Economic Situation of the Novgorod Region in 2023". According to the document, the number of people who came to the region and those who left it is approximately the same: 17902 people moved to Novgorod the year before last, while 17 207 people left it. In 2022 20 thousand people arrived in the city and 20 545 people left it. The migration trend is decreasing, and the increase, though small, is still there - it is almost 700 people. Measures to increase the birth rate in the region have also been taken. For example, women and men from 18 to 49 years old can undergo annual medical examination of reproductive health, infertility treatment and IVF treatment at the state expense. The Novgorod Regional Clinical Perinatal Center implements the project "Hello, Mother!" Families at the birth of their first child receive regional capital, and in medical organizations psychologists discourage women from having abortions. Last year the number of such abortions decreased by 16.6% to the indicators of the year before last, i.e. 137 women decided to give birth, the Novgorod Ministry of Health says.
However, the birth rate in the region, despite the measures taken, continues to fall, as in the whole of Russia. In the first quarter of last year 300.2 thousand children were born in the country, which is 10.8 thousand, i.e. 3.5% less than in the same period of the year before (Rosstat data). Novgorod medics also note a decrease, albeit insignificant. "In the past 2023, the perinatal center received about 3.5 thousand births, which is 5% lower to the data of the year before last. And if in 2022 4163 births in the past - 3880 births, in 2024 in our perinatal center took about 3700 births", - says the chief physician of the State Budgetary Institution "Novgorod Regional Clinical Perinatal Center named after V.Y. Mishekurin" Alexander Andrienko.
Midwives say that mostly boys are born. From month to month last year there were a few more of them, and only by the end of November girls were leading: 152 of them were born, and boys only 121. But no matter what the statistics, childbirth is always an unpredictable and complicated process, qualified people take them, in addition to the doctor in the delivery room with a woman works midwife, a medical assistant, a cadre that are forged for years in the maternity hospital. Preference when hiring a full-time midwife Perinatal Center give not just literate, but also stress-resistant candidates.
To become a midwife, you need to get an education. In the Novgorod region, professional retraining can be completed by students of the medical college in Borovichi, and in the Novgorod Professional Medical Personnel Center. The specialty of obstetrician-gynecologist can also be obtained at the medical institute of Yaroslav the Wise Novgorod State University. Now, as the head doctor of the perinatal center says, they have a set: 18 full-time midwives, 12 in the labor department and 6 - in the emergency room, and 34 gynecologists work in the Perinatal Center.
The old staff under a new roof
The midwife has a very stressful job. She is at her post 24 hours a day without sleep, she must stay close to the woman in labor. In a month a midwife may have 10-15 daily duties. The salary of a midwife of the Perinatal Center is not high and varies from 40 to 70 thousand rubles depending on the working conditions, seniority, schedule and additional duties, for example, extra pay for ultrasound, extraordinary duty. The average salary at the end of the year exceeded Br50 thousand, says the Ministry of Health. However, it is difficult to judge the amount of compensation for labor: how many births will have to take a day, no one can say. For example, the night before our visit, four children were born, one of them was born through an emergency Caesarean section, as the labor was delayed and had been going on for more than 16 hours, in this case it is done for medical reasons.
The large electronic clock in the operating room shows 10:25, but 36-year-old Svetlana from the regional village of Batetsky does not see it. She has just given birth to a baby. Her daughter's umbilical cord has already been tied, she was put on the changing table, the neonatologist and the nurse weighed and measured the newborn and recorded her parameters: 52 cm and 3.4 kg. Like Svetlana's two older children, the girl was born by Caesarean section. The case is not an unusual one, so the C-section was performed by Victoria Klishina, deputy chief medical officer, obstetrician-gynecologist, who has dozens of complicated births on her account.
For more than half an hour Dr. Klishina has been working with a needle, sewing up the uterine wall. The suture must be strong. If the patient decides to give birth to a fourth child, there is a high probability of its appearance through cesarean section, and then the strength of the scar on the uterus will be of great importance. Svetlana quietly pulls: "Why does it hurt so much, God..." Anesthesiologist-reanimatologist Timur Kolodnitsky closely monitors the woman in labor and, adding anesthesia, explains to the young trainee that it is better to increase the anesthesia as soon as the woman begins to move her fingers. Malika Khalmysheva, a midwife in the maternity ward, is on the windowsill filling out Svetlanina's chart. The document shows that this is her sixth pregnancy and third labor. That is, a few minutes ago Svetlana became a mother of many children. According to the statistics of the perinatal center, 46% of the total number of births fall on the third and subsequent births. That is, out of 3800 births in Veliky Novgorod, about 1700 families became large families in 2024.
A couple of years ago the building of Novgorod Maternity Hospital No. 1 on Derzhavina St. began to be reconstructed, it was opened in December of the year before last. It is quiet, reliable and bright. There are multi-bed rooms for those who have already given birth, emergency room, resident's room, labor rooms and operating room. Partner births are practiced, that is, husbands can be present with their wives at the time of natural childbirth and watch the birth of the child in the process of caesarean section from the so-called fathers' room. Now in this narrow room with a green sofa and a wall-mounted plasma TV sits 28-year-old Yuri, who followed his wife here from Stara Russa. Through the camera installed under the ceiling in the operating room, he sees his wife sitting on the operating table, the anesthesiologist injecting epidural anesthesia into her spine, putting a screen between his wife and the doctors.
When they make an incision in her abdomen a few minutes later, Yuri can't stand it, dials his mother-in-law's cell phone number, and she watches with him on the video as the granddaughter is taken out, her umbilical cord is cut, and she is handed over to the neonatologist. The clock on the wall reads 12:38. The worst part, Yuri believes, is over. It was harder to wait for the baby to arrive. The door swings open, neonatologist Natalia Klepko enters with a stroller with a baby wrapped in a pink blanket. According to local tradition, she loudly pronounces the name of the father, the parameters and sex of the child, announces the absence of visible pathologies. "Your girl, Daddy?" - smiling, the doctor asks.
While Yuri is getting acquainted with his daughter, Natalia Klepko says that the girl was born healthy, got eight points on the Apgar scale, that is, without visible pathologies. However, this does not mean that you can exhale. Apgar scale - a very conventional system of coordinates, not all modern children are born healthy, and the task of neonatologist to detect the disease in the early stages in the first days and take the necessary measures. The newborn is fine, but in general, resuscitation is needed for 5% of newborns in the Perinatal Center. "A few months ago, one newborn was diagnosed with pneumonia after birth, which required a stay in the NICU and intensive care. Cured, of course," says Natalia Klepko.
Young mothers are getting older
The average age of midwives at the perinatal center is 45, and some have been working here for decades, such as Yulia Poderskaya. She says that at one time she wanted to be a pediatrician, but did not go to medical school. She graduated from college, then came to work in the maternity hospital in Veliky Novgorod, and now almost 20 years in the same place. She says that she never focused on her career, it turned out to be very interesting to work in the maternity ward with children. "I like to help, not make reports," she says.
Even now she does not want to change her job in the perinatal center for a similar one in St. Petersburg or Moscow, although her salary with all the bonuses does not exceed 40 thousand rubles. In her opinion, the mothers of today's children have changed a lot over time. They have become calmer, more sensitive and older. According to official data, the average age of first-borns of the perinatal center is 28 years old, many women ask for anesthesia in the process of childbirth. In general, they behave courageously, and if anyone needs support in labor, it is their husbands, sometimes present at the birth. There were cases when fathers-to-be in partner births felt frightened to the point of fainting.
In partner births are mostly Russian men, foreigners do not like it.
- We also give birth to natives of former Soviet republics, but they are few, about 1-2% of the total number of births per month. That is, if every month we take 270-280 births, we will take at most five foreign women. There are no problems with them, as a rule. There is a residence permit, or husbands are citizens of the Russian Federation, many have policies, - says senior midwife obstetric physiological department Elena Rozanova.
On the clock 14:35. A wild scream rips the delivery room, screams recently admitted patient, a native of Kyrgyzstan, who has been preparing for labor since early morning. She walks around the room in circles, holding her stomach. The midwives do not rush to her immediately: wild screams in the delivery room are typical behavior of Asian women in labor. Judging by the data on the computer display, the fetus's heartbeat is normal and it is receiving oxygen. Nevertheless, the medical workers go to the woman, help her to get settled on the bed, and start working.
Переведено сервисом «Яндекс Переводчик»
