Obstetric Care

Obstetric Care—the provision of obstetric assistance during childbirth. History of Obstetric Care. The proper organization of obstetric care, constituting one of the fundamental prerequisites in the fight against deviations from the normal course of pregnancy, and against maternal morbidity and mortality, is a key link in the chain of measures for the protection of motherhood and infancy. Obstetric care, i.e., the system of organizing assistance during childbirth, in Russia, as in the West, did not immediately take the forms that are implemented now. Obstetric care as such, as elementary primitive assistance during childbirth, existed in ancient times, existed among savages, existed among the ancient Russians, and among the ancient Slavs. It was carried out by experienced elderly women, who were called midwives. The first assistants during childbirth almost everywhere were shepherds, who, through observations of animals, knew how childbirth occurs, and in difficult cases were forced to provide assistance to their animals, removing the fetus, performing a version, etc. The first seeds of organized obstetric care in Russia should be attributed only to the middle of the 18th century, when the first obstetric schools appeared. The first midwives were invited only to royal houses and to the high-ranking service nobility; all the rest of the urban and rural female population remained in the hands of ignorant midwives, illiterate village grannies. In 1764, the first obstetric institution was created at the Moscow Foundling Home. At first, it was organized for 20 beds for unmarried women, had the character of assistance to secret parturients, and was in all probability calculated for those parturients from the upper strata who, due to the conditions of that time, had to deliver in some secret refuge. In 1771, a second maternity hospital was opened at the Foundling Home in St. Petersburg. The third maternity hospital was organized in 1797 and already had the character of a real obstetric institution for all married parturients in general, and a midwifery institute was attached to it, from which the present Leningrad State Obstetric-Gynecological Institute (formerly Prof. Ott's) grew. In 1801, a Midwifery Institute was also organized at the Moscow Foundling Home. In the provincial cities of that time, the position of city obstetrician was introduced to provide assistance to the population regarding obstetric care. The period of urban and Zemstvo medicine can be called the third period in the development of obstetric care. Naturally, the landlord-dominated Zemstvo could not organize medical assistance as broadly, in a planned manner, as the interests of the broad working masses of the peasantry required. In the hands of urban and Zemstvo self-government lay the organization of medical assistance in general and, in particular, obstetric care, right up to the 1917 revolution. In 1866, when the Zemstvo had just been formed in Moscow Governorate after the issuance of the "Regulation on Zemstvo and Urban Self-Government," a sanitary commission was elected at the Zemstvo assembly, which drew up a "proposal on the organization of Zemstvo medical assistance in Moscow Governorate." Paragraph 12 of these "proposals" speaks precisely about how to organize obstetric assistance to the population with the help of midwives. It was proposed to have an educated midwife in every village, who would constantly live in the district and would be known to the peasantry. A woman chosen from the settlements located in this district was to be with her. The chosen woman remains with the midwife for 2 years. During these 2 years, the midwife is obliged to teach the peasant woman how to act during childbirth. This woman can care for the sick in the rural hospital. Upon the expiration of the 2-year term, she is released to her family, and another elected woman from another settlement takes her place. Thus, it was assumed that in a few years every settlement would have its own midwife with practical knowledge. If one recalls the cultural level of the midwives of that time, who were prepared by "oral instruction," if one imagines this rural midwife, who in turn had to teach this craft to peasant women, and imagines her cultural level and the level of her knowledge, then one can judge that the quality of obstetric care was extremely low at that time. In 1876, at the first congress of Zemstvo doctors of Moscow Governorate, a similar "regulation" again surfaced from Dr. Peskov, who proposed that the Zemstvo prepare peasant women in urban obstetric institutions for the role of midwives. The congress made a decision on this matter: "It is desirable that the Zemstvo take care of preparing midwives at its own expense, but that no definite salary be assigned to them afterwards." True, these midwives did not take root in the Moscow Zemstvo, but the idea of trained midwives surfaced more than once in both Moscow and other Zemstvos. Many Zemstvos, at the suggestion of Prof. Ott, in 1897 formed a "contingent of persons with rights to rural obstetric practice," preparing these persons—second-class midwives—on courses at Zemstvo district and provincial hospitals. In order to enter these courses, an educational qualification was not required at all; only literacy was needed. The duration of training in these courses was one year. For a long time, obstetric care in rural areas was at best in the hands of these rural midwives, grannies, at a time when more qualified obstetric assistance was already required for cities. In cities, there were first-class midwives, who were already trained in special schools organized for teaching obstetrics. Approximately from 1870 of the last century, the question of organizing obstetric care for the urban population arose. The reason for this was a colossal outbreak of puerperal fever, which in 1868 in St. Petersburg caused a mortality rate of 20% of all women in childbirth. It was then that the urban self-government raised the question of taking urgent measures to develop obstetric assistance for the urban population, and midwives and rural obstetricians for the countryside began to be trained intensively, and for the city—midwife-feldschers. Besides Moscow and St. Petersburg, maternity hospitals were organized in Voronezh, Perm, Kharkov, and Yaroslavl. According to the statistics of Dr. Grebenshchikov, in 1892 there were 10 state maternity hospitals and 2 municipal maternity shelters. But if at this time one can speak of more or less satisfactory maternity assistance in cities, its organization in rural areas still remained very weak and the question of obstetric care was often forgotten by the Zemstvos. Veselovsky, in "History of the Zemstvo for 40 Years," when assessing the general state of maternity assistance, writes: "We will not have to say much about the organization of obstetric assistance in the Zemstvo, for almost nothing has been done in this regard." Striving to make obstetric assistance cheaper, the Zemstvos took on service feldscher-midwives, who, being busy in the hospital, could not concentrate on the development of obstetric care, and obstetric assistance was provided by them only insofar as they managed to attend to it besides their main duties at the hospital, in any case only when they were called to childbirth. As for non-Zemstvo governorates, the situation with obstetric assistance in rural areas was even worse. In 1904, 98% of all births, according to Rein's data, were attended by illiterate midwives. Even in 1914, there were only 6,876 beds in European Russia with a total number of 299,038 births and, in addition, 283,386 births attended by midwives at home, which amounted in total to 10-12% of qualified obstetric assistance in relation to the total number of births and only 4-5% in relation to the number of births in rural areas. The development of obstetric care as an organized system followed two different paths in St. Petersburg and Moscow. After the epidemic of '68 in St. Petersburg, as an emergency measure for the organization of obstetric care, the organization of small maternity shelters was begun. Shelters were opened in ordinary apartments, with 2-3 beds, costing 250-300 rubles. This organization of obstetric care survived until the October Revolution. The revolution found this system in Leningrad and partly in Moscow, and the organization of small maternity shelters is a distinctive feature of Leningrad. In Moscow, the urban self-government followed a different path, the path of organizing large maternity hospitals and maternity wards at hospitals. Assistance at home by city midwives did not develop here, and the stationary system is the main form of obstetric care in cities. When studying the question of stationary obstetric care, one should dwell on the experience of Moscow and St. Petersburg, from where the organization of obstetric care actually arose. In these two large cities, the growth of the stationary system was always dependent on the overcrowding of apartments, on the growth of the migrant population, and on the predominance of its destitute strata. The more acute the housing crisis became, the more the number of migrant workers increased, the faster the urban self-governments were forced to deploy a network of maternity beds. Maternity shelters in Leningrad were not organized as specially built maternity institutions. A shelter was arranged mostly in an ordinary apartment; it was primitively equipped; births were attended by a midwife. Even after the October Revolution, when the protection of motherhood and infancy began to be carried out on a state scale and in a planned manner, maternity shelters did not have independent doctors who would be in charge of this shelter. Sometimes 1 doctor was assigned to 2-3 shelters. There was no duty rotation of doctors at all.

Duty was organized in such a way that one doctor was on duty for all maternity shelters in the city of Moscow. In maternity shelters, births were conducted by a midwife; a doctor was called only for pathological births. Only the newly organized Sub-department for the Protection of Motherhood and Infancy of the Moscow Health Department abolished this system of work in maternity shelters in 1921 and decisively embarked on the path of consolidating maternity institutions, on the path of organizing large maternity hospitals instead of primitive maternity shelters. When the Department for the Protection of Motherhood and Infancy of the People's Commissariat of Health was organized in 1918, there were only 600 maternity beds in Moscow. There were only two large independent maternity hospitals: the Lepekhinsky and the former Abrikosovsky (now named after N. K. Krupskaya), organized only in 1900 by A. N. Rakhmanov. In the following year, 1901, a great public figure, a doctor of the city self-government G. L. Grauerman, made an extensive report on the organization of obstetric care in Moscow. Grauerman and Rakhmanov can be considered the founders of Moscow obstetric care. Before them, there were only 254 beds in Moscow and 357 beds in St. Petersburg. Grauerman and Rakhmanov were among those specialists who were the first to take part in the work of the Department for the Protection of Motherhood and Infancy after the revolution. It would seem that such a type of organization of obstetric aid as maternity shelters clearly appears imperfect compared to a maternity hospital. However, among Zemstvo and city doctors there were defenders of both systems, and quite weighty arguments were brought forward in favor of organizing obstetric aid in the form of small maternity shelters. It was pointed out that this aid is cheaper, that it makes it possible to bring obstetric aid closer to the population: a maternity shelter can be set up on any outskirts, in any house; an operating room is not needed there—for the provision of operative aid, the woman in labor is transported to a specially equipped obstetric institution; a doctor is not on duty, but a midwife is, therefore fewer doctors are needed. Maternity shelters are still organized on the periphery even now, especially with the rapid growth of the outskirts of large cities and at new construction sites, where the construction of fully developed and well-appointed medical institutions does not keep pace with population growth. In 1906, inpatient obstetric aid in St. Petersburg, according to Rein's data, accounted for 58% of the need. In provincial cities it accounted for 10.1%, and in district cities 1.2%. In 12 provincial cities there was not a single maternity bed. Mobile obstetric aid in 33 Zemstvo provinces accounted for 5.4%. Only in the Moscow province, where the best cultural forces were concentrated, where the richest Zemstvo was, did obstetric care account for only 12.4% of the need. At the same time, it should be noted that mobile obstetric aid mainly related to villages, because, as mentioned above, home aid in cities always occupied an extremely insignificant place. True, at the end of the 19th century, the position of city obstetrician was created, who could be invited for home aid and was intended for residents of the outskirts—for workers, for the low-income population. But if we recall that on the outskirts of Moscow 13 people lived in one small apartment, 3-4 people per room, it will be clear that such a population did not call an obstetrician, but took the woman in labor to a maternity shelter or a maternity hospital. There were also private-practice midwives in cities, but the services of these midwives were used by relatively well-to-do circles. The poor, the working population used the services of obstetric institutions where there was free aid, or did not use any obstetric aid at all. After the revolution, private-practice midwives almost disappeared. In the West, home aid is prevalent. In Europe, there are no city maternity hospitals for mass service of the population. This aid is provided only in the order of 'Assistance publique', i.e., aid to the poor. Like all medicine in the West, obstetric care is predominantly the business of private-practice doctors and midwives. This aid is also provided by health insurance funds, but health insurance funds do not have their own hospital institutions and provide medical aid by paying according to a certain tariff and agreement to some doctor, who is obliged to visit the insured at home or receive them at his place. Large, well-appointed obstetric institutions serve as clinics for the purposes of university education. Soviet Obstetric Care. The organs of motherhood and infancy, having taken obstetric care into their own hands, set the task of restructuring obstetric care, giving it, like all their institutions and measures, a preventive character. Prevention consists first of all in the fact that the organization of obstetric care begins in the USSR not with the organization of a maternity bed, but with the first step—with the organization of consultation for women. By supplementing obstetric care with the organization of consultations for women, they thereby give it a completely new, preventive character, because the consultation holds a decisive role in the study of the pathology of pregnancy and the maternal morbidity and mortality inevitably associated with it. The work of the consultation is supplemented by the organization of patronage of the pregnant woman. In the period of Zemstvo and city medicine, midwives and doctors in the field of obstetric care were limited to delivering births when a woman in labor was brought to them or they were called to a woman in labor. The task of Soviet obstetric care is not to wait, but to attract the woman in labor to a maternity bed, which is of particular importance in the village. The organization of patronage of the pregnant woman is one of the main methods of work of the consultation for women. Continuity of observation of the pregnant woman, the woman in labor, and the mother with an infant is established by introducing mandatory so-called return letters: about every pregnant woman under the supervision of the consultation, upon her referral to a maternity hospital, the latter is notified by sending a double postcard. The detachable part is returned to the consultation by the maternity hospital with notes about the time of discharge, the course of labor, complications, and the need for patronage. At the same time, the maternity hospital sends a similar notification to the consultation for infants, which must immediately take the newborn under observation through its patronage nurses. These preventive moments change the entire character of the organization of obstetric aid in the Soviet Union compared to the past. The third new moment that the organs of protection of motherhood and infancy introduced into the organization of obstetric care is the arrangement of wards for newborns in maternity hospitals and in maternity wards. Before the Soviet period, newborns were placed in the same room as the woman in labor and did not have separate cribs, but slept with their mothers. The organs of protection of motherhood and infancy consider it an elementary requirement for a maternity ward that the beginning of rational care for the child should be laid right there. It is necessary to create children's wards where the child is immediately accustomed to a certain regimen, and the mother in the postpartum period has complete rest thanks to this. However, maternity hospitals do not occupy a predominant place in the organization of obstetric care. Independent maternity hospitals constitute a relatively insignificant percentage of obstetric institutions. In the majority, obstetric institutions are maternity wards at large hospitals. Even now, in hospitals of fairly large former 'district cities', very often these maternity wards are not even separated into a special department with a separate entrance, a separate corridor, and separate technical personnel. Most often these are separate wards in a common corridor, which are often placed next to surgical and therapeutic wards and are to a very insignificant degree protected from the introduction of infection, which is possible in general hospitals. In large centers, maternity wards are more isolated, in the best cases in separate hospital buildings. Independent maternity hospitals accounted for 3% in 1926 and had 3,832 beds; in 1927 the number of beds in independent maternity hospitals reached 5,045; according to the 1930 census, the number of maternity hospitals in the USSR was 171 with 9,775 beds. Thus, the number of independent maternity hospitals is growing, and since these are large institutions, they include about 30% of maternity beds, and 223,163 births were conducted in them in 1930 out of a total of 780,575 births in the USSR.

Maternity hospitals must also have a gynecological department. When maternity wards exist within the general framework of a hospital, the relationship between the organs of maternity and infant protection and the medical institutions consists in the fact that the organs of maternity and infant protection appoint the head of the maternity ward; this head is obliged to report to the organs of maternity and infant protection and, in addition to reporting, is obliged to implement those internal regulations prescribed by the organs of maternity and infant protection. With the transfer of obstetric care to the jurisdiction of the organs of maternity and infant protection, an undoubted shift occurred within it: the number of maternity beds increased annually, the number of obstetric stations increased sharply; consultations for women began to be deployed; the nature of midwife training changed, and new courses were introduced into the program of obstetric departments of technical schools - organization of maternity and infant protection, child care, which raised the standard of the midwife and made her a worker capable of carrying out, along with specialized work in obstetric care, broad health-improving measures in relation to women and children, which is especially important in the conditions of the rural sector. To strengthen the pace and improve the quality of maternity care, by a decree of the People's Commissariat of Health dated November 1, 1931, 20% of all beds in all city and village hospitals were allocated for childbirth, and maternity wards were organized in all medical outpatient districts (official section 'On the Health Front', People's Commissariat of Health, No. 13-14, 1931), and in 1932, a special administration for obstetric care was allocated within the system of the People's Commissariat of Health, the functions of which included the organization of gynecological care, abortion care, and the fight against abortions (Regulations on the Administration for Obstetric Care approved by the Collegium of the People's Commissariat of Health on October 15, 1932). The relationships between the new administration for obstetric care and the hospital administration, which includes maternity wards at hospitals, are outlined in approximately the same way as indicated regarding the relationships between the department of maternity protection and the medical care department. When organizing Soviet obstetric care, maternity homes were assigned functions they had not previously performed, namely, the performance of abortions for social indications, with a portion of maternity beds in the urban network being allocated for abortions. To this day, abortion beds occupy a fairly significant percentage of maternity beds in general. Their number amounted to no less than 30% of the total network of maternity beds in the republic. When the organs of maternity and infant protection took the organization of this care into their own hands, they were forced to allocate beds for abortions in maternity homes because other medical beds, such as surgical, gynecological, etc., were not provided for this type of care. Abortions cause a certain overload of maternity beds, reducing accordingly the available network of beds for childbirth. And when the percentage of satisfaction with maternity care is calculated by the number of beds, it must be kept in mind that this percentage is actually lower. In general, practice has shown that it is more expedient to move abortion beds to a gynecological or surgical hospital, which, admittedly, is rarely successful, or to embark on the path of organizing independent institutions—clinics for abortions. Thus, the following new elements have been introduced into the organization of Soviet obstetric care: the organization of obstetric care begins in the consultation for women; a connection has been established between the consultation for women and the maternity home, and between the maternity home and the consultation for infants, and thus a continuous chain of measures has been created in serving the pregnant woman, the woman in labor, and the mother with an infant; obstetric care has taken on an active character through the introduction of patronage of pregnant women, the care of newborns has been separated into children's wards, and finally, abortion care has been included in the obstetric care system. The organization of a special commission for the study of contraceptives should also be included here. Quantitative indicators of births are characterized by the following data. Table 1. Number of maternity beds (data from the Department of Maternity and Infant Protection of the People's Commissariat of Health and the Administration for Obstetric Care). In 1927, by the beginning of the first five-year plan, the satisfaction of needs in cities was 86.9%. This is the percentage of pure obstetric care provided: abortion beds are excluded. For the village, the indicators are lower and are characterized by the following figures: 1925 - 11.6%, 1926 - 12.2%, 1927 - 12.8%, 1928 - 11.3%, 1929 - 12.0%, 1931 - 13.0%. Let us recall that according to the statistics of Prof. Rein, before the revolution, it was 4-5% service. Average service indicators for the entire RSFSR stand at the following figures: Table 2. Years: 1925 (20.8%), 1926 (21.0%), 1927 (22.8%), 1928 (23.2%), 1929 (29.1%), 1931 (26.1%). At the congress of gynecologists in Kiev in 1928, it was recognized that the provision of obstetric care in cities can be considered almost stable, that we have almost reached the maximum, that we have 86% service without abortions, and that 14% remains to be served in order to maximally cover the entire urban population with obstetric care. The average percentage for the republic is lowered by the almost complete absence of obstetric care in rural areas. In Western European clinics, women are discharged only on the 12th day. In the USSR, however, even in such cities as Moscow and Leningrad, the stay is equal to only 6 days, and in large district cities and regional hospitals, this period is reduced to 3-4 days. When drawing up plans for the organization of obstetric care, this correction coefficient must be introduced. There is no exact data on the number of births conducted in obstetric institutions of cities and industrial centers, but data on the available number of beds in cities for 1931 show that they are sufficient for 100% coverage of births, provided that one bed serves 50 births per year. Table 3. Data for 1931 for the RSFSR. Urban population..........

The table presented shows that part of the maternity beds are occupied by abortions, are vacant, or serve the population of the nearest rural areas. At the beginning of the first five-year plan, the indicators for obstetric care by district presented a rather varied picture. Table 4. Number of maternity beds per 10,000 population (data from the People's Commissariat of Health for 1928-31). Regions On average In cities In rural areas Ivanovo region . . Leningrad region incl. Leningrad Northern region . . . Nizhny Novgorod region Northern Caucasus . Western region Middle Volga . . . Tatar Republic . . . Siberia ....... Western Siberia Eastern Siberia Central-Chernozem region . 3.9-4.8 3.5-4.6 3.5-4.1 3.2-5.7 2.0-3.06 1.9-3.7 1.5-2.4 1.4-2.0 1.2-1.3 1.2-1.66 1.2-1.59 1.2-2.1 1.1-2.0 1.97 2.1 0.8-1.79 10.2-11.8 6.5- 6.2 10.8 4.3- 4.47 9.0-12.9 1.1-12.5 7.0- 8.1 4.4-10.6 4.1- 4.46 5.2- 6.07 8.9- 6.18 6.0- 5.3 8.1- 8.5 4.3- 7.5 3.7 6.7 5.5- 7.05 2.0-2.3 1.3-2.03 2.5-3.8 1.9-3.1 0.9-1.7 0.8-2.1 0.6-1.1 3.7-1.4 0.8-0.8 0.4-1.05 0.6-1.02 0.4-1.1 0.5-0.98 0.98 0.93 0.7-1.2 Thus, by the end of the first five-year plan, the relationship between city and countryside had improved for the better, and the figures show an almost twofold increase in maternity beds, mainly in rural areas. Standards for the organization of M. When compiling the first five-year plan for M., it was considered that a maternity bed should operate for 320 days. If one assumes 8 days of stay for the parturient in bed, then the bed will accommodate 40 births per year. In rural areas, the stay of the parturient in bed was increased to 6.4 days, whereas in 1928 the average duration of stay in a maternity bed in rural areas was 3.2. M. should be qualitatively improved twofold. The number of births that a bed accommodates in rural areas was taken as 50. When compiling the second five-year plan, the following standards were used: 8 days of stay in bed in cities, agro-industrial centers, MTS and state farms, and up to 6.5 days for collective farms. Consequently, the quantitative indicators were the same as for the first five-year plan, since the control targets of the first five-year plan were not fulfilled. According to the targets of the first five-year plan, the average coverage of M. should have been 40% (100% in cities and 26.2% in rural areas), but by January 1, 1932, it was 26.1% on average. It would have been necessary to almost double the number of existing maternity beds of 1927 to serve only the population growth. And the main mass would have remained at the same level of service, i.e., at 12%. Taking into account all these numerical indicators, the agencies for the protection of motherhood and infancy came to the following targets. The organization of stationary assistance is undoubtedly the best form of organizing M., but it is inevitably and necessary to supplement it with the organization of obstetric points. The agencies for the protection of motherhood and infancy gave the activities of the obstetric point a preventive character and conceived them as the primary cell for the protection of motherhood and infancy in the village. An obstetric point is a midwife equipped with an obstetric bag, which contains everything necessary for conducting normal births at home. Obstetric points should supplement the hospital and should be located at a close distance from the area. The average distance of an obstetric point from the hospital is 5 km on average, in any case not more than 10 km. The obstetric point is located on the periphery of the area and is subordinate to the area physician. The function of the obstetric point is the prevention of pregnancy and childbirth, sanitary treatment of the female population carried out through the organization of patronage of pregnant and postpartum women; selection of pathological cases of pregnancy, which the midwife should refer to the area's maternity beds; organization of initial proper care for newborns, organization of patronage of infants. Complications during childbirth constitute about 25%. This percentage of complications during childbirth should be hospitalized. The midwife should conduct normal births at home on sterile linen, which she has in her bag. A radius of 5 km must be considered as the average that allows for normal access to maternity care. Improvement of road conditions, collectivization of agriculture, under which the collective farm ensures the delivery of parturients to the hospital, should in the future ensure the possibility of using the hospital even at greater distances. When organizing an obstetric point, a strictly defined area is attached to it, determined by the population size. A midwife can conduct about 100 births per year. With a birth rate of 45 per 1,000, one midwife should serve approximately 2,000-2,500 residents. The obstetric point must be given a certain territory, because the correct organization and proper functioning of the obstetric point necessarily implies patronage of pregnant women, sanitary-educational work and patronage of infants. Along with the forms of assistance mentioned, the obstetric point participates in the work to improve women's labor in the collective farm: determines the duration of pregnancy, provides certificates for exemption from work due to pregnancy and lactation for periods established by the collective farm, provides certificates for the transfer of pregnant collective farm women to lighter work, seeks from the collective farm board the allocation of transport for delivering parturients to the hospital, participates in the organization of brigades with the aim of proper placement of female labor force in the interests of pregnant and nursing mothers, and participates in the work of the mutual aid fund of collective farm members, seeking benefits for pregnancy and childbirth when needed. With the collectivization of agriculture, the mass development of collective farms and state farms, the approach to organizing medical care in the village changed fundamentally. The starting point for building the health system becomes the center of the district of complete collectivization, the machine-tractor station. It is planned to build a large hospital there, where qualified medical assistance will be concentrated, including maternity institutions: a maternity hospital or maternity departments of a hospital, consultation. For the second five-year plan, the People's Commissariat of Health projects the following preliminary targets for the organization of M.: to achieve 100% coverage of M. in cities with a stay in bed of up to 8 days. For new construction: 100% coverage with stationary obstetric assistance, at least by organizing temporary maternity institutions in barrack-type buildings and in the largest worker settlements. In rural areas, two forms of maternity care are retained - stationary care and obstetric care at home through visits by the hospital midwife or the obstetric point, with differentiated service for individual rural sectors: agro-industrial bases and energy centers of the district should be served with 100% stationary care and 50% obstetric care at home. The stay in bed is to be brought to 8 days in agro-industrial bases, state farms and MTS and to 6.5 on average for collective farms. The main groups of the rural female population (in agro-industrial bases, state farms, MTS) should be covered by women's consultations: through them, proper selection of pregnancy pathology should be organized. Patronage visits should be brought to 2 for each woman in the postpartum period. Illegal abortions should be completely eliminated both in the city and in the countryside. Hospitalization of all abortions should be achieved with an average stay in bed of 3 days after the abortion procedure. For this, in cities, special clinics for performing artificial abortions are being developed, or a corresponding number of beds are allocated in obstetric-gynecological institutions, and in rural areas - in all obstetric-gynecological departments of district hospitals at the rate of 1 per 5-10 maternity beds, and they should be separated from the maternity beds. At all consultations, services for the prevention of pregnancy are organized, covering the female population of working age. The plan includes the organization of consultations on sexual hygiene at all women's consultations, medical outpatient clinics with a gynecological reception, and in rural areas also at obstetric points. When planning the obstetric-gynecological network in cities and industrial centers, projects are based on the calculation per 100,000 population: 80 obstetric beds, 60 gynecological beds, and 12 abortion beds.