Exchange card, registration, a contract with a doctor: what maternity hospitals can actually require from a pregnant woman

From the moment a woman learns she is pregnant, she follows a certain path through the healthcare system, formalized by clinical protocols and medical guarantee packages. Women often have questions about whether an antenatal record is mandatory or whether they must give birth at the maternity hospital where they are registered. UNN tried to clarify these and other issues. 

First consultation and registration 

Let us imagine that a woman has learned she is pregnant after receiving a positive test result and has decided to see a gynecologist at a hospital that has a contract with the NHSU. Importantly, such a consultation does not require a referral from a family doctor. However, it is still worth signing a contract with a family doctor if you do not have one yet, as this will make it easier to receive free medical services in the future. 

It is generally considered best to have the first examination during the first 12 weeks of pregnancy. During this visit, the doctor will confirm the pregnancy, determine its term, take a medical history, and identify possible risks. The following tests are also mandatory: blood type and Rh factor, complete blood count, urinalysis, testing for infections (HIV, syphilis, hepatitis), and others as indicated. If you visit a hospital that has a contract with the NHSU, all these services are provided free of charge under the medical guarantee package for pregnancy monitoring. 

During the visit, the gynecologist enters information about the patient into the Electronic Healthcare System. It will also contain the results of tests, screenings, and other examinations. This provides a degree of autonomy: if you want to change doctors, for example, because the security situation in your region has deteriorated, you will not need to carry paper documentation with you—the new doctor will be able to obtain all the necessary information from the electronic records. 

First trimester 

The first trimester of pregnancy lasts 13 weeks. During this period, the expectant mother usually undergoes the first prenatal screening, which includes an ultrasound examination, a blood test for hormones, and an assessment of the risk of chromosomal abnormalities. 

Detection of a high risk of abnormalities or other deviations in the health of the pregnant woman or fetus is grounds for additional examinations—the vast majority of them are free of charge under the medical guarantee package. Even if it is impossible to obtain a consultation at your hospital, from a geneticist, for example, you will be referred to the nearest hospital where this option is available. 

Second trimester 

The second trimester of pregnancy lasts from week 14 through week 27 inclusive. Even if the pregnancy is progressing normally, visits to the doctor should be regular. 

An anatomical ultrasound examination is performed at approximately 18–22 weeks, during which the development of the baby's organs is examined in detail. Also important during the second and early third trimesters is a glucose tolerance test, which makes it possible not to miss the development of gestational diabetes. Monitoring antibodies is also important for Rh-negative women. 

Third trimester 

The final, third trimester begins at week 28. Doctor visits become more frequent, and at approximately 30 weeks, a medical conclusion necessary for arranging maternity leave is prepared. As for medical procedures, at around 35–37 weeks of pregnancy, the woman should be tested for  group B streptococcus. The fetus's position is also assessed, and the method of delivery is planned: vaginal birth or cesarean section when indicated. 

Choosing a maternity hospital and doctor 

A woman may give birth at any maternity hospital that has a contract with the NHSU, regardless of her place of registration or actual residence. At the same time, under the medical guarantee package, she may choose only the facility, not the specific doctor she wants to deliver the baby. As for choosing a specific doctor, most facilities officially provide this as an additional paid service. 

"If you have not signed a contract with the doctor of your choice, the on-duty team will deliver the baby free of charge," explains Dmytro Hovsyeiev, director of the Kyiv Perinatal Center. 

No additional agreement with a doctor is required to give birth at any particular maternity hospital. Likewise, your official place of registration makes no difference. An exchange card is not mandatory either. 

However, if you give birth prematurely or develop complications, you will likely be referred to the nearest Perinatal Center (either during pregnancy or once labor has begun). Such centers are level III medical facilities—everything necessary to provide emergency care to both the woman and the child is available here: intensive care, equipment for nursing premature infants, a surgery department, and experienced staff. Under the medical guarantees package, this care is also provided free of charge. 

If everything goes according to plan, you can prepare a birth plan: choose pain relief, decide whether the birth will involve a partner, and determine the conditions for the first contact with the baby. This is also covered by the medical guarantees package. However, a separate upgraded room is an additional service that can officially be paid for at most public or municipal maternity hospitals.