Pregnancy is a special condition of the female body. For a long time, different peoples had special ways of protecting the expectant mother and baby from possible diseases and dangers. Somewhere from the moment of "visiting an angel" it was forbidden to see strangers, somewhere, on the contrary, they advised to immediately inform everyone about their condition, so that everyone treats the woman with care and respect. Tradition and superstition are a thing of the past, but medical programs for pregnancy management continue to differ from country to country. We understand the peculiarities of medical recommendations for expectant mothers in European countries.
Many people know about the "Dutch birth": a large number of children are born at home, and this is part of the public health policy program. But few people are aware that home birth cannot just be taken and chosen as an option for delivery. Only those mothers who have no contraindications are allowed to give birth at home. Ideally, if the mother was observed during the entire pregnancy only by the midwife, and she did not find any reason to include a gynecologist for a consultation.
Health insurance for pregnant women in the standard package may not even include childbirth in the clinic, and about 20% of women remain at home to give birth with the same midwife who led them during the gestational period. In this case, the first meeting, as a rule, is scheduled for a period of 10-12 weeks, until that moment you can count on a consultation with a "home" doctor-therapist. It is believed that pregnancy up to 12 weeks is neither observed nor maintained.
Personal experience
My pregnancy started with bleeding at 8 weeks and a visit to my family doctor. He said that, most likely, there was a spontaneous interruption, nothing can be done, “it happens,” and prescribed an ultrasound examination. On the study, it turned out that everything is fine with me and the child, but still nothing needs to be done.
A month later, the bleeding was repeated, and the words “it happens this way, embryo rejection is not treated” was repeated. Don't be upset and accept the situation. " As a result, at the end of the term, a healthy daughter was born, but by the second pregnancy I already understood that I would have to take all troubles calmly. If the body does not accept this particular pregnancy, it is not a tragedy. It happens, you have to think about what to do next.
This approach looks rather strange for Russian women who are accustomed to prescribing medications and hospitalizations to maintain pregnancy. However, in the Netherlands, miscarriage is treated as normal if it is not a persistent pathology. Only after 2-3 times in a row is it worth starting to find out the causes of the phenomenon and carry out health correction.
The very program of medical support for the expectant mother also fully meets the slogan "pregnancy is not a disease." Visits to midwives are scheduled once a month, they are weighed, blood pressure is measured, and the fetal heartbeat is listened to. At 20 weeks, the risk of chromosomal abnormalities is checked. Sports, intimate relationships with a husband are not prohibited, a diet is not prescribed, there are no contraindications to sun exposure, travel or work. The lifestyle does not depend on the presence of a fetus in the mother's belly. The only advice is to refrain from eating raw fish and unpasteurized dairy products.
All additional studies are prescribed only if the midwife (and this is a trained specialist after a special university, although not a doctor) sees the indications. You will not be referred to a dentist, ophthalmologist, or any other specialist; It makes no sense to appoint fluorography to all relatives who want to be present at childbirth in a country where every fifth child is born at home. Everything is calm, naturally. That also happens.
In Germany, on the contrary, early registration is encouraged: the sooner the expectant mother comes to the doctor, the better for her and the baby. The doctor will also tell you about the importance of a healthy lifestyle, good nutrition, and some restrictions.
Up to 24 weeks, mom (usually with dad) visits a gynecologist once a month, immediately before taking urine and blood for analysis and being examined by a specialist who monitors pressure, the presence of edema, and the condition of the blood vessels. All test data are recorded in the "social card of a pregnant woman", which it is advisable to always have with you.
After 24 weeks, the number of meetings increases: the indicators are checked twice a month, CTG is done and the position of the child in the abdomen is determined. At the very beginning of pregnancy, tests are done for major infections, about 4 weeks before childbirth, the bacterial background of the vagina is checked. The standard insurance program also includes 3 ultrasound scans for the gestation period and additional tests if necessary. But screening studies of chromosomal abnormalities, despite the fact that the average age of first childbirth in Germany is between 30 and 40 years, are not included in the insurance package and are carried out at will and for an additional fee (about 100 euros).
In the last month of pregnancy, the doctor will have to meet every week, and after the expected date of birth, every other day. If we can wait for the beginning of 42 weeks, the doctor will examine the mother every day. In this case, it is not necessary to constantly go to the doctor: you can choose a midwife examination program at home, and see the doctor only if necessary.
It is customary to congratulate the expectant mother, however, treat the state calmly, without the "crystal vase syndrome". Good German order: everything is under control, but nothing more.
In Italy, it is worth getting up for registration with a gynecologist as early as possible. However, this is not due to the thoroughness of medical supervision, but to the privileges of expectant mothers: the analysis of the presence of pregnancy makes it possible to partially paid medical support for gestation, including visits to specialists, discounts on tests and some free courses. So, in a gynecological consultation, every pregnant Italian woman is advised to consult a nutritionist to select the right diet and track weight gain. This is probably due to the belief still existing in the country that a mother needs to eat for two.
In the last trimester, you can take courses on teaching correct breathing in the pool, learn how to take care of your baby, take massage classes: mom learns to massage the unborn child correctly, dad learns to mom to help her during pregnancy and childbirth. It is also possible to make an absolutely official excursion to the hospital.
And pregnant women can park for free: with a pink ticket in the “pink” parking lot, you can leave your car right from the first day of pregnancy. At the same time, the attitude in society is quite consistent with the love of children for Italians: a pregnant woman is a queen, she should be congratulated and rejoiced at being added to the family, ask about the date of birth and the name of the baby. However, there are quite a few pregnant women on the streets, so there is no need to wait for special privileges in the queue at the checkout or on public transport. Some expectant mothers can be recognized even before the appearance of the tummy thanks to an old tradition: if you wear a small ringing ball on your chest, you can attract angels who protect the baby even before birth.
For the entire period of gestation, the expectant mother is entitled to several standard tests and three ultrasounds, the rest - as prescribed by a doctor or at the personal request of the parents, such as a screening test (about 120 euros). However, no one will call home or scold at the next appointment for a missed visit or an ultrasound scan, which, by the way, often requires an appointment several weeks in advance. The main recommendation is more fruit and (especially important) wash your hands before eating.
The public health insurance program in the UK is similar to the Russian one: all basic services can be obtained free of charge. But the standard management of pregnant women is different from our practice.
For example, just like in the Netherlands, you can actually not see a gynecologist: he sees the expectant mother at the very beginning of pregnancy, collecting anamnesis and conducting initial tests. Then the patient is dealt with by a professional midwife: every month (by the end of pregnancy - every two weeks) she listens to a story about the condition, checks the pressure, evaluates the size of the tummy, the presence of edema, the results of tests and studies, etc. Moreover, if the mother is uncomfortable attending the clinic, for example, due to the existing small children in the house, the obstetrician himself will come to visit her, and this is a normal practice. You only have to go to the clinic to take tests and undergo research.
As a standard, all expectant mothers are supposed to have three ultrasounds for the gestation period: at 11-14 weeks, 18-20 and in the last month. But if the midwife, and with her the doctor, see indications for additional tests or visits to specialists, then everything will be covered by insurance. So, if there is a suspicion of gestational diabetes and it is necessary to monitor the glucose level, then the clinic will issue a glucometer for independent use, and this is also included in the insurance. Screening for pregnant women is optional, it is not a mandatory option, but it is also free.
Only a visit to the dentist is not paid by the state, which is advised to all pregnant women. When prescribing special drugs, they will also be provided free of charge, although the general position of doctors is to refrain from unnecessary drug intervention in the physiological process, and even vitamins are recommended to be obtained with food, and not in the form of tablets.
Childbirth is also included in the insurance program, and at maternity hospitals there is a "hot line" for emergency calls: day and night you can call and consult, if necessary, call a doctor. All information about the pregnant woman is in a common database and is available to specialists, and the results of analyzes and research from laboratories are sent to the midwife, family doctor and to the chosen maternity hospital.
Although the British are distinguished by restraint and do not start talking on the streets about the date of birth or the well-being of their mother, you can count on a place in transport, respect and safety on the streets.
Traditions and scientific rationales for the management of pregnancy in different countries depend on national characteristics and on insurance programs. In general, one thing unites: a pregnant woman is not a sick person, and it is worth more to accompany the gestation process than to intervene in it unless absolutely necessary.
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Can i fly by plane during pregnancy? Doctors and airline representatives answer
The holiday season is approaching. And the questions of whether it is possible to travel during pregnancy, especially to fly by plane, is becoming relevant. Happy Mama asked four gynecologists, two representatives of the largest airlines, a phlebologist and a specialist in providing childbirth abroad, how dangerous long-distance travel is for expectant mothers and what to do if you still really, really want to go somewhere on vacation. We got a lot of letters, but for convenience we have highlighted the names of specialists and you can decide which specialist's opinion is especially important for you to find out at this moment.
Daria Tikhonova, obstetrician-gynecologist, reproductive physician at the Center for Reproductive Health "CM-Clinic":
“In general, during the normal course of pregnancy, it is possible to fly by plane, it all depends on the duration of pregnancy, the state of health and the remoteness of the place of rest. Until 12 weeks, flights and long journeys are not recommended, since at this time the woman's body is undergoing hormonal changes. After 33–35 weeks, flights are also undesirable, because during this period a woman needs complete calmness, and the pressure drops that occur during takeoff and landing do not contribute to this in any way. Other risks are associated with a possible lack of oxygen at high altitude, motion sickness, and the absence of medical personnel on board the aircraft. Thus, for air travel, the second trimester is most favorable with a normal pregnancy.
Short trips by car and bus are possible at any time without restrictions, but it is necessary to make stops and rest every few hours. The most optimal form of transport for pregnant women is the train. Unlike a car or a bus, there is less motion sickness and there is an opportunity to change position, walk around the carriage. However, in each specific case, you need to weigh all the pros and cons - it is easier for someone to endure several hours in the air or by car than a day in a carriage.
Water transport should be used only in the absence of toxicosis and seasickness.
Before planning a vacation, be sure to consult with your obstetrician-gynecologist about the presence or absence of contraindications. "
Yulia Viktorovna Chernysheva, obstetrician-gynecologist of the Semeynaya network of medical clinics:
“A woman can safely fly on an airplane only in the second trimester of pregnancy, that is, after 13-14 weeks. At this time, the placenta has already formed, which protects the fetus and takes over the main production of the hormone progesterone, which significantly reduces the tone of the uterus. As for flights in the first trimester of pregnancy, there are no absolute contraindications. But a woman needs to remember that at this time there is a high probability of miscarriage, and air travel can become an additional risk factor. The third trimester is fraught with the possibility of premature birth.
I do not recommend long flights, because they are physically difficult for pregnant women, and prolonged static position and pressure drop increase the risk of thrombosis and edema in pregnant women. If you still need to fly, you should definitely wear compression stockings, try to change your body position regularly, walk around the cabin from time to time, do a little exercise, “stretch” your legs. To make it more comfortable to sit in the chair, you can take with you special pillows under your head and lower back.
Regardless of the flight range, there are other factors that can affect the health of the child and the woman herself: the level of the aircraft, the skill of the pilot, weather conditions, etc. If the plane gets into a thunderstorm and passengers are shaken and thrown in air holes, the child will be uncomfortable ... The woman will experience stress, due to which adrenaline will be released. And it can lead to vasospasm, in particular, the vessels of the placenta. "
Davydenko Viktor Vasilievich, gynecologist at the Medicina clinic, doctor of the highest category:
“Traveling early in pregnancy is not prohibited in the absence of contraindications, such as the threat of termination of pregnancy or placenta previa. The gynecologist who leads the pregnancy must determine if there is any concomitant pathology that may be a contraindication for flights. Even if there are none, it is advisable not to plan flights after 22 weeks of pregnancy, especially long ones - more than 4 hours. It is better to travel by means of transport that are not associated with shaking and vibrations, such as rail or water transport. Driving by car is also not advisable after 22 obstetric weeks. When braking hard, there is a risk of being crushed by the seat belt, which could result in placental abruption or fetal injury.
It is also necessary to pay attention to exactly where the trip is planned. Is there an opportunity to provide qualified medical obstetric care? If there is none, then you need to think about whether it is worth going there to rest. "
Dmitry Loginov, obstetrician-gynecologist, DoktorRu medical clinic:
“Pregnancy itself is not a reason to give up flying. However, it is important to consider a few points that will allow you to minimize any risks.
First, giving birth on an airplane is not a good idea. The airlines are well aware of this and therefore try not to take on board pregnant women over 28 weeks old or those who have had a preterm birth before. Some airlines require a doctor's certificate stating that the flight is not contraindicated. In this regard, it is advisable to clarify the conditions of air travel in advance with your airline.
Second. A long flight creates an increased risk of blood clots. Therefore, it is advisable to refuse flights for more than 3 hours, and during a shorter flight it is worth getting up from time to time and walking through the cabin of the aircraft. Sitting periodically imitate walking in place, shift from foot to foot. If possible, during the flight, put on special compression underwear: stockings, or better - tights. Drink plenty of fluids during the flight (preferably water) - this way you can prevent stagnation of blood in the veins and minimize the risk of blood clots.
Third. Some categories of women should still abandon the idea of air travel. In the presence of severe chronic diseases, toxicosis, edema, high blood pressure, heart disease (including those operated on), kidney or gallbladder stones, severe varicose veins, low location of the placenta, grade 2-3 anemia, bleeding from the genital tract is better choose to travel by train or refuse the trip altogether. "
Dmitry Loginov touched upon an important topic of airlines, so we could not help but ask them for a comment.
British Airways representativestold Happy Mama the following:
“Many airlines have their own rules regarding pregnant women. We care about the safety of expectant mothers, and therefore the airline team stops letting them on board after the end of the 36th week of pregnancy (if the woman is expecting one child) or the end of the 32nd week (if two or more children are to be born).
If the gestation period is more than 28 weeks, then you must definitely take with you a medical card, as well as a letter or certificate from a doctor indicating the approximate date of birth and confirmation that the pregnancy is proceeding without complications. Such a document must be drawn up no earlier than 7-10 days before the trip.
By the way, the entire crew and team of the airline undergo special training in emergency delivery as part of the training course, and a first-aid kit is on all our aircraft. "
Boris Ogursky, spokesman for the Lufthansa Group:
“In general, there are no flight restrictions for women with a normal, uncomplicated pregnancy. We recommend that pregnant women visit a doctor in charge of the pregnancy prior to their planned travel. Women in a situation with uncomplicated pregnancy can use our flight without presenting a doctor's certificate until the end of the 36th week or no later than four weeks before the expected date of birth. From the 28th week of pregnancy, the traveler must carry a medical certificate with the following information:
1. Confirmation that the pregnancy is proceeding without complications.
2. Estimated date of birth of the child.
3. The doctor must clearly write that there is no risk to the child during the flight.
In the case when a woman is expecting twins or several babies, the flight is possible until the 28th week of pregnancy. Due to the increased risk of thrombosis during flight, we recommend wearing compression stockings. "
Such increased attention of specialists to the topic of stockings for pregnant women directed our attention towards phlebology (a branch of medicine that studies the structure and function of veins).
Came to our aidMarina Petrovna Berezko, MD, PhD, surgeon-phlebologist, lymphologist at the Center of Phlebology clinic, phlebology consultant at medi:
“As a rule, doctors do not recommend air travel during the first trimester - this is the most crucial time for the successful development of pregnancy, when stress, physical exertion and a sharp change in climate should be avoided. For obvious reasons, you should also refrain from flying in late pregnancy.
At the same time, there are currently no scientifically proven facts that air travel can seriously harm a pregnant woman and her unborn child, but the benefits of positive emotions from the vacation are obvious. Therefore, if a woman feels well, and her doctor sees no contraindications for travel, then you can safely choose a plane. Of course, you need to take into account your position and make sure in advance that the flight is comfortable and safe.
It is very important to remember that due to the low oxygen concentration in the cabin air, pressure drops and a static position during the flight, the risk of leg edema and thrombosis increases. At the same time, pregnancy is itself one of the risk factors for the appearance of problems with veins. An increased level of progesterone leads to a softening and increased elasticity not only of the connective tissues, but also of the venous walls. The enlarged uterus presses on the large veins of the small pelvis, which makes it difficult for blood to drain from the lower extremities.
All these factors can lead to the development of varicose veins and the appearance of discomfort during the flight: a feeling of heaviness in the legs, pain and swelling.
Therefore, when flying during pregnancy, I recommend using compression hosiery. These can be preventive stockings or, if there have been no vein problems before, special compression socks for travel. They create a distributed pressure, due to which the diameter of the dilated veins decreases, the blood flow rate increases and the risk of congestion decreases. It is easier to prevent problems with veins than to eliminate, compression hosiery will help to avoid acquaintance with varicose veins, while maintaining the beauty and health of the legs.
When choosing compression products, you need to accurately and carefully take measurements (preferably with the help of an employee of the orthopedic salon where you plan to buy knitwear). To guarantee the medical effect, you should focus on brands that meet the requirements developed for compression hosiery, for example, the RAL GZ-387 standard. "
Well, in light of the fact that in recent years it has become so possible to give birth abroad, it seemed to us that you would be interested in the commentVictoria Komissarova, managing partner of AURA VNIMANIA, which regularly sends women to childbirth in the United States:
“It's not dangerous to fly if you have: everything is in order with the level of hemoglobin, there is no threat of miscarriage, no placenta previa, no lack of water - all this will be confirmed by your doctor, because you are sure! consult with him before flying.
Some of our clients before the flight (7 days before departure) start taking magnesium B6. When buying an air ticket, ask to take into account your delicate situation and allocate a seat with more legroom. Choose an extreme place so that you can walk along the aisle if your legs get numb.
In flight, if you have varicose veins, buy compression socks. Take a pillow to the salon, which you put under your back - so the lower back will not swell and hurt.
Do not forget to take a certificate for the airline from the antenatal clinic. If you are flying abroad, in addition to compulsory medical insurance, we recommend insuring yourself against an accident. "
Every pregnant woman is prescribed good rest, fresh air, fortified nutrition and positive emotions. Lying at home watching TV, even if surrounded by caring relatives, and overeating on fresh fruits and vegetables, you are unlikely to get the entire set you need.
Much more useful will be a trip to the country, to the reservoir, and better abroad. In general, if pregnancy proceeds naturally and without complications, then why not leave your native walls and get poisoned on a trip?
First of all, this issue should be discussed not with your husband, but with your gynecologist. Already he knows better whether it is possible to perform such actions in your "interesting position." The optimal time for a trip is the second trimester of pregnancy, when the belly is not yet in the way, and toxicosis is no longer tormenting, while the threat of miscarriage is reduced and there is no risk of premature birth. In general, if you are 14-28 weeks pregnant and your gynecologist sees no cause for concern, feel free to pack your bags and plan your vacation, having previously clarified some of the nuances.
Where to go?
Choosing a place to spend your "pot-bellied" vacation is very important. The time zone, climate, epidemiological situation, cuisine, method of transportation and the recreation program itself depend on this. So, going on a trip to Europe, you will find numerous walking excursions, visits to museums, exhibitions, architectural structures and other attractions. Such a rhythm is simply incompatible with proper sleep, nutrition and physical rest, which is so necessary for a pregnant woman. Therefore, it is better to postpone a trip to European capitals until the postpartum period.
Exotic countries are also not the best vacation option for a future mom. Firstly, such a trip requires vaccination against "overseas" diseases, which is unacceptable during pregnancy. Secondly, the colorful and picturesque resorts of Asia, Africa and South America doom many guests to diarrhea, which leads to dehydration and is extremely dangerous for the future baby and the mother herself. If the above dangers do not affect your desire to visit exotic resorts, consult your doctor and consider all possible options for maintaining your health. For example, vaccinations made last year may still be valid.
As for recreation in the highlands, it is, in principle, not contraindicated in pregnancy. Of course, if we are not talking about mountaineering and other extreme sports. The main thing is not to climb to a height of more than 3500 meters. And given that this indicator is considered average, you need to listen to your condition. For some pregnant women, even at an altitude of 1800 meters, there is not enough oxygen.
When planning a trip in an "interesting" position, give preference to a beach holiday. An ideal pastime for the expectant mother and her "paunchy" is leisurely walks in the park area and along the coast, swimming in the sea, air baths in the shade of trees. Avoid high ambient temperatures. +28 º С and slightly lower is the optimal thermometer reading for beach procedures.
Medicine, insurance and paperwork
When booking a hotel or purchasing a tour, inquire in advance about the possibilities of obtaining emergency qualified assistance "on the spot." Representatives of the insurance company or travel agency are required to provide information about nearby medical facilities.
It is also worth taking care of insurance. As a rule, a standard travel insurance policy, which is compulsorily issued by a travel agency, covers insurance cases related to the development of pregnancy up to 12 weeks, or does not provide for assistance to pregnant women at all. Therefore, it is better to take care of insurance yourself. Fortunately, there are insurance companies that specialize in just such cases. In principle, abroad you will not be denied the necessary medical care, but considering how much it will cost you, it is better not to risk it.
When packing your suitcase, be sure to put extracts from your medical record, the results of examinations and analyzes, and preferably the coordinates of your gynecologist in it. Also, do not forget about the prescribed medications and medications that you may need. Remember that in foreign pharmacies unfamiliar foreign names and requirements of a pharmacist to present a prescription from a doctor are waiting for you.
Flight by plane
Despite the fact that a pregnant woman on board the plane causes indignation and condemnation among many passengers, flights for expectant mothers are not contraindicated, that is, they cannot provoke premature birth.
Although many airlines do not sell tickets to women late in pregnancy (over 7 months). Therefore, when planning a trip by air, get a certificate from your doctor about the expected date of birth.
For a comfortable and safe flight, follow these instructions:
- When going through the pre-boarding check, ask for a manual inspection to avoid radiation exposure to conventional control systems.
- Be sure to wear your seat belt under your belly.
- Every half hour of the flight, take a walk through the cabin of the aircraft in order to prevent the appearance of edema and varicose veins.
- Drink plenty of fluids (at least half a liter every hour).
- Use a comfortable neck roll and back pad.
- Wear comfortable clothing and shoes.
Listen to the doctor, the above information and travel abroad, while "waiting for a miracle", with pleasure. Relax, recharge your batteries and get a lot of positive emotions, gaining strength for the upcoming changes in your life.
Can pregnant women go abroad? The season of vacations, trips has come. You do not need to be afraid if the given time coincides with the period. Quite the opposite, it will be a good opportunity to relax, gain strength before childbirth, the first months of caring for a baby. In order for summer holidays to truly become positive, it is necessary to take into account the important nuances of an interesting situation from all sides. Pregnancy that a woman has without complications is not a contraindication to travel. Especially when the pregnancy is very short. However, if there are absolutely any problems associated with bearing a child, for example, the threat of miscarriage, the presence of late toxicosis, then it is better to refrain from long trips.
If the future mother plans to visit an exotic country, then it is worth thinking at the planning stage whether it is worth going there at all now. The level of hygiene of the country will be an important factor.
When to go to the seas?
Probably the most basic question: When is the safest ride? Better to go on a trip during the second, it is between and. During this period, the risk of a case of premature / miscarriage is very small. You should also consider your own circumstances. For example, if a woman is expecting triplets, then it is not recommended to go anywhere during this period, since frequent medical examinations will be needed. Back in 2008, the gynecologists and obstetricians of the American College strongly recommended that women not go abroad, go on any trips, in case of pregnancy less than 18 weeks or more than 24 weeks of pregnancy. Before the trip itself, you should consult with your doctor in advance. The visit to the doctor (control) should be immediately before the trip. There are such desperate mothers who decide to travel after. But obstetricians-gynecologists say it is very dangerous. The risk of premature birth increases. It will be worse if you start in an unfamiliar area with other people's doctors or on a trip. There is no need to be shy, but you should ask for the contacts of your gynecologist, perhaps there are doctors who are friends in the country, city where the pregnant woman will go, ask about clinics that inspire confidence.