Fight for life: why enlarging maternity hospitals can be dangerous
The trial of the doctors of maternity hospital No. 2 has begun in the Kamchatka Territory: it is assumed that due to incorrect decisions of obstetricians and anesthesiologists, a woman who gave birth to a healthy child died from massive blood loss. In the same days, news came from the Irkutsk region, where a 28-year-old resident of Angarsk and her newborn child were killed. Statistics show that the situation with both infant and maternal mortality in the country is improving, but there are still alarming signals: the reformatted maternity care system has learned to cope more effectively with complex cases, but it risks moving too far away from patients. For more information, see the Izvestia article.
Why did women in labor die?
The tragedy happened in Petropavlovsk-Kamchatsky on March 3, 2025. A 37-year-old woman who gave birth to a healthy baby after IVF died from massive blood loss. The investigation found out that the doctors grossly violated the current standards and procedures for providing obstetric care. The patient had so-called atonic bleeding: a serious complication, which, however, should not be fatal if the correct treatment protocol is applied.
As a result, two intensive care anesthesiologists and two obstetricians and gynecologists were put on trial, they are being tried under Part 2 of Article 109 of the Criminal Code of the Russian Federation ("Causing death by negligence due to improper performance of professional duties").
The tragedy occurred in the Irkutsk region on June 22, 2026. A 28-year-old woman in labor from Angarsk and her newborn child died there. The relatives of the deceased said that Anastasia was taken from Angarsk to Irkutsk with the waters gone. The baby was large — about 4.2 kg, but the doctors decided that it was necessary to give birth naturally. For what reason everything ended tragically is unclear. The certificate states that the woman died from an amniotic fluid embolism.: This is a condition in which the probability of death of both the child and the mother is very high, but investigators are checking under Article 109 of the Criminal Code of the Russian Federation, Chairman of the Investigative Committee of the Russian Federation Alexander Bastrykin took control of the case.
What is the situation with infant and maternal mortality?
Official statistics show that both infant and maternal mortality in Russia have been declining in recent years, but the numbers have been shaken by the pandemic. At the end of 2024, Minister of Health Mikhail Murashko indicated that maternal mortality was 10.6 cases per 100,000 births. Compared to 2021, this is a very good indicator: during the pandemic, the rate was 34.5 cases. However, if we compare this level with 2019, the statistics will no longer be in favor of modern realities. Before the pandemic, the indicator was 9.0, and in 2017 it reached 8.8.
In 2025, the decline in maternal deaths appears to have continued. At least, Mikhail Murashko stated that this figure had decreased by 18%, but the minister did not specify specific figures.
Official operational statistics on maternal mortality in Russia are no longer published: access to the indicator has been temporarily suspended on the EMISS portal.
But the data on infant mortality is still open, and the Ministry of Health declares that it has reached a historic minimum in 2025: 3.6 per 1,000 live births. In 2019, the indicator was 4.9, and this is one of the most positive trends in Russian demography in recent years. Moreover, the downward trend continues: in January – May 2026, the coefficient is only 3.4.
However, you need to understand that these statistics estimate the mortality rate of children under one year old. There is no detailed data on how many children die during the birth period (that is, on intranatal mortality), although this indicator seems to be the key to assessing the work of maternity hospitals. However, this figure is found only in some regional documents. For example, in the Krasnoyarsk Territory, out of 172 infants under the age of 28 who died in 2024, only 12 died during childbirth. This level changed significantly only in the 2021 pandemic year (19 cases), all the other five years it has been kept within the range of 11-14 cases.
The same document indicates that, on average, in Russia, the intranatal mortality rate was 0.3 per 1,000 live births. Based on the data on the number of births in 2024, it can be concluded that the intranatal mortality in the country then amounted to just over 350 cases.
At the same time, in 2023, according to Rosstat, perinatal mortality (that is, under the age of seven days) was at the level of 1.23 per 1,000 live births. There were 8,234 such cases in total, of which 1.5 thousand died in the first seven days. Intrapartum mortality is included in this indicator.
Where babies die most often
At the same time, the infant mortality rate varies greatly from region to region. Of course, the statistics are also influenced by the total number of births: in regions with low fertility, one tragedy can have a significant impact on the infant mortality rate. However, you can see a certain trend behind the numbers. For example, when in 2024 the average infant mortality rate in Russia was 4, in the Republic of Tuva it reached 6.8, in the Jewish Autonomous Region — 7.9, and in Chukotka — 25.2. In 2025, two remote difficult regions are again in the lead: the coefficient in Chukotka is 11, in the Magadan Region — 7.2. And in January – May 2026, the leaders of the EAO (8,7) and the Nenets Autonomous Okrug (12,4).
According to statistics, the Chukotka Autonomous Okrug is the most difficult region in Russia. And this correlates with the way the obstetric care system is organized there. Women in labor are evacuated hundreds of kilometers away to Anadyr or even to neighboring regions. There are only emergency departments in the field. A similar problem exists in the Magadan Region and the Kamchatka Territory.
In this sense, statistics on infant mortality in a number of districts of Kamchatka are indicative: in the Penzhinsky district, the figure reached 47.6 cases per 1,000 births, in the Milkovsky district — 12.5, in the Yelizovsky district — 7.2. Penzhinsky district is one of the most remote and inaccessible in Russia, there is no normal road connection, and you can get to the hospital either by air, or by very difficult routes.
Meanwhile, back in 2022, researchers from the Universities of Iowa and Pittsburgh published a paper on the "Relationship between the distance to maternity hospitals by car and the outcomes for mother and newborn." They proved that the further away a pregnant woman is from the hospital, the higher the risks for her and her unborn child. Moreover, the threshold was identified, after which the number of complications increases statistically, is 60-80 km. If a woman in labor lives within these limits, there are fewer risks for her and the child's condition, but if further away, it is already dangerous.
Although the study was conducted in the American context, it is generally extrapolated to the situation in Russia, where infant mortality statistics are higher in remote areas than in regional centers. This also shows the risks of the modern Russian maternity care system, which is based on its centralization and the closure of obstetric departments in provincial hospitals.
How the maternity care system works in Russia
Russia has been consolidating maternity services since the early 2010s. The system is divided into three levels, and the main resources are concentrated on the latter, that is, in regional perinatal centers, where most complex cases are handled. At the same time, small maternity hospitals are closed, especially if there are few deliveries or no specialists. It is also possible to downgrade the department's status from a maternity hospital to an urgent room intended only for emergency deliveries.
The number of beds has also decreased significantly: in 2024, there were 48.2 thousand beds for pregnant women, women in labor and women in labor in Russia, which is 2.5 times less than in 1990. Experts, however, at the same time talk about an increase in the effectiveness of their use, as well as a reduction in the length of hospitalization of a healthy mother and child.
However, this leads to the fact that many pregnant women or women in labor are forced to travel long distances. For example, in the Sverdlovsk region in November 2025, 10 maternity hospitals that accept fewer than 100 births per year decided to transfer to the category of urgent care facilities. As a result, in Severouralsk, women with newborns are transported two hours after giving birth to a maternity hospital 60 km from there to Krasnoturinsk, the media reported.
By itself, the transition to large perinatal centers reflects a global trend, said Yan Vlasov, co-chairman of the All-Russian Union of Public Associations of Patients. However, the implementation raises questions.
— Sophisticated equipment, multidisciplinary teams, round—the-clock intensive care, and the care of extremely premature babies are all difficult to provide in a small maternity hospital. In this sense, centralization may be the right direction," the source told Izvestia. — But the way it is being implemented is worrying. When the focus is on reducing beds rather than safety and accessibility of care, we see the consequences in the form of tragic cases.
As a result, a child with an extremely low body weight, according to him, may not be provided with a real opportunity to survive, which leads to high mortality rates and "reflects the inability of the system to meet the stated standards."
Konstantin Smirnov, an expert at the Popular Front, also noted that the three-level model with the centralization of complex births in large perinatal centers has proven effective in densely populated regions, but the situation is different in vast and remote areas.
—And, for example, the analysis of citizens' appeals to the president's direct line, carried out by the Popular Front, reveals complaints related to insufficient access to maternity care in cities and rural settlements," he explained.
At the same time, people are faced with a lack of public transport routes and the inability to plan childbirth, the specialist added.
— For example, there have been cases when, in order to get to a doctor's appointment, you need to take a taxi and stay the night somewhere, - Konstantin Smirnov said, adding that the way out of the situation could be the creation of social hotels for pregnant women at perinatal centers or large maternity hospitals.
In turn, Tatyana Butskaya, first deputy chairman of the State Duma Committee on Family Protection, Fatherhood, Motherhood and Childhood, recalled that a solution to this problem has already been found: the Ministry of Health has decided that a pregnant woman who lives far from a maternity hospital or perinatal center should be provided with transport.
— It is now very clearly controlled that there should be no refusals here. And in perinatal centers and maternity hospitals in big cities, there are so—called obstetric control beds, where a woman waiting to give birth can be hospitalized if she lives far away," the parliamentarian added.
Tatiana Butskaya also noted that it is the quality of care that can be provided in a large perinatal center that is important.
—And this does not mean that expectant mothers who live in small towns, in remote territories, should live with the feeling that help is far away," she stressed in an interview with Izvestia. — Maternity hospitals definitely do not need to be closed — they need to be reoriented, for example, into centers for the support of Russia's reproductive potential.
What is the personnel situation
The main reason for the reformatting of the system is a decrease in the birth rate. However, there is another significant problem — the personnel shortage. Specialists of the Kulakov National Research Medical Center of Obstetrics, Gynecology and Perinatology announced in 2023 a shortage of 8,135 obstetricians and gynecologists, 3,686 neonatologists and 626 midwives. Since then, the situation has not improved: in 2024, the total number of doctors in the country has decreased, including the number of obstetricians and gynecologists — from 43.5 thousand to 42.3 thousand.
There is another important indicator — the quality and training of the staff of the maternity care system. It is difficult to measure this, although, apparently, it was this deficiency that caused the death of a woman in the Kamchatka Territory.
— You can draw an ideal routing, open perinatal centers, prescribe high criteria for viability, but if there are no midwives, intensive care specialists, trained middle staff in the hospital, and nurses perform their role, then nothing good will happen, — said Yan Vlasov.
Izvestia sent inquiries to the Ministry of Health of the Russian Federation and the Kulakov National Research Medical Center of Obstetrics, Gynecology and Perinatology. No response had been received at the time of publication.
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