The organizational structure description of the Center for the pregnancy and childbirth management at the juveniles, having created on the “The Maternity Hospital № 10” (Saint-Petersburg) basis, where since 2013 the “Little Mother” Municipal Social Program is implemented, has been given in the paper. So, the minors, pregnant girls and their parents, within the framework of this Program, can attend the obstetrician – gynecologist, take the additional tests, examine the functional status of the fetus. The consultations of the family psychologist and lawyer are being carried out, and the juvenile pregnant minors attend the lectures and the classes of the physical therapy in the Training for Childbirth Center. If it is necessary, the medical treatment in the day hospital, or at the Pregnant Pathology Department are being carried out, the childbirth and the postpartum period are being maintained in the “Little Mother” separate chambers and wards. The main purpose of the Project of the Center creation for Juvenile Pregnant, on the basis of the large obstetric Institution of Saint – Petersburg, has been aimed at the quality further improvement of the care assistance for the pregnant juvenile women, who have already decided to keep the baby, in order the early pregnancy from the tragedy would be turned into the family joy, and be allowed the very young woman to be established herself physically and psychologically, as in the family, well as in the society.
The Introduction. The various aspects study of the pregnancy, at the young age, has been devoted the large number of the papers, both in Russia, and abroad [6, 8, 9]. So, numerous papers have also been devoted to the medical and social, organizational nature studies and researches of the given challenge [2, 4]. However, up to the present date, the urgent and valid bases for the organization of the complex medical, medical and social, psychological, rehabilitation and legal assistance to the juvenile pregnant women are being remained. Thus, the main challenge is, practically, being solved in two possible ways: either early marriage and the child birth, or the termination of the pregnancy, and, very often, for the longer period. For any outcome, the pregnant adolescent has the strongest psychological and the physical stress, which, in its turn, is affected and is left its unforgettable traces and stamp on the whole her further life, and, that is why, the special medical and the psychological help and assistance are much needed to the juvenile patients, in order the early pregnancy from the tragedy would be turned into the family joy, and be allowed the very young woman to be established herself physically and psychologically, as in the family, well as in the society [5]. So, the quality of the medical, and even more so, the psychological, and social assistance and corresponding support in the primary care establishments is often poor, and it, frequently, is left much desired, as the specialists and the experts have no suffice their necessary fundamental training on the physiology and the pathology aspects of the adolescence age [3], and, moreover, the juvenile patients’ satisfaction of the doctor, having led their pregnancy, is made up only about 50 % [7]. Also, about 50 % of the pregnant girls – adolescents and their parents would still receive in addition to the medical care in the general stream, and even psychological and social support [1]. Therefore, the scientific justification of the organizational bases of the specialized Centers for the pregnancy and the childbirth management at the juveniles, having provided the comprehensive medical and social, psychological, and legal assistance of this rather complex patients’ category of the population is relevant and urgent. Thus, in the publicly available scientific literature, the necessary information on such similar Centers organization on the Russian Federation territory could not be found by us.
The Results of the Study and Their Discussion. “The Maternity Hospital № 10” is specialized and focused on the birth conduct at the juveniles, since 1997. During this time, 482 pregnant underage women have successfully been delivered, in the framework of the special Program on the pregnancy and childbirth management, at the juveniles “The Little Mother”. So, the juvenile pregnant woman (e.g. the age is under 18 years), may, at any stage of her pregnancy, apply to the outpatient – polyclinic department “The Maternity Hospital № 10”. The female consultation physician, in which the juvenile pregnant girl has already been registered, also may apply to the outpatient – polyclinic department “The Maternity Hospital № 10” with her request to be recorded the juvenile pregnant at the first visit to the leading specialist of the Maternity Hospital. Such appeal is practically made to the current calls registry of the outpatient – polyclinic department. Her participation in the “Pregnancy and Childbirth Management at the Juvenile Females” Program in “The Maternity Hospital № 10” is not practically substituted for the juvenile pregnant conducting at the female consultation, but it is complemented it, at the woman’s request. So, all the consultations, further hospitalization for the medical departments, the classes in the preparation for the childbirth Center are held for the juvenile pregnant girls free toll. At the first visit, the obstetrician – gynecologist physician is practically made up the preliminary management plan of the juvenile pregnant girl, having based on the pregnancy length and the woman’s social status, tells her on the Program. To all the visits of the obstetrician – gynecologist, and the psychologist, the juvenile pregnant, if desired, can come with her parents or the legal guardians, the representatives of the orphanage or with her boyfriend (e.g. the child’s father). So, the special programs of the pregnancy and childbirth management at the juveniles have already been developed by the “The Maternity Hospital № 10” specialists and their experts. So, the “Pearl” Training Center for the Childbirth is practically played the special role in the pregnancy management at the juvenile girls in the outpatient – polyclinic department, the work with the juvenile girls, in which the following areas and the directions are being consisted: the physiotherapy, the lectures on the midwifery, the care for the newborn, and the lecture on the cosmetology. The sessions with the psychologist are allowed to be removed the internal stress, the anxiety, to be discussed “everything, that in the soul” while waiting for the new family member. Thus, the first and early pregnancy months – this is the time of the revolutionary changes not only in the female’s physiology, but also in her psychology. Even, if the child is the welcome, and long – waited, not everyone can be accepted all these changes, at once. The numerous emotional and the social challenges, having piled heavily on the shoulders of the young and pregnant woman, are caused not only the fatigue feeling, and sometimes even the despair, but also they can be led to the many pregnancy complications, to be caused of the threatened abortion, and even the miscarriage. So, Little Mother, to the certain degree, feels herself to be trapped. The work with our psychologist in the small groups, the opportunity to be communicated with the similar, as she, helps to be understood, that she is not alone, and that others have successfully cope with their difficulties. So, in this quite difficult situation, it is very significant to be enlisted the support of the non – indifferent and caring adult – mother, father or the psychologist, who will not indiscriminately condemn, but help the girl to be coped with her numerous challenges, helps to be understood, that she is not so “bad”, and, moreover, that she can be happy! The work individually or in the group with other pregnant girls under the guidance of the experienced psychologist is helped to be understood all these difficult moments of the new life of the girl and also her family. So, the lectures of the lawyer and the social worker are being affected the aspects of law and legislation of our country, regarding the work and the rest of the pregnant, the maternity leave, the child care, the social benefits to the young parents. Thus, much time is paid on the rights of the juveniles, in general, and their parental rights, in particular.
If it is necessary, the obstetrician – gynecologist physician sends the juvenile pregnant girl for the hospitalization: at duration of the gestation up to 22 weeks for the Gynecology Department of the “Maternity Hospital № 10”, at duration of the gestation over 22 weeks for the Pregnancy Pathology Department. So, the juvenile pregnant management at the Gynecological Department or at the Pregnancy Pathology Department is practically carried out by the Head of the Department. In any case, all the pregnant juvenile women, at full 38 weeks are usually sent to the Pregnancy Pathology Department, for the purpose of the further preparing for the childbirth and the delivery. So, the deliveries at the juvenile women are being carried out in the Maternity Department, in the single delivery room № 2 of “The Little Mother”. At the request of the juvenile woman, the childbirth is carried out at the presence of her loved man. In the post-natal period, the juvenile puerperant is in the double chamber of the Post-partum Department. The juvenile puerpera management at the Post-natal Department is carried out by the Head of the Department. At the discharge, the juvenile mother is offered the free consultation visit of the obstetrician – gynecologist physician, neopathologist, psychologist in 1–2 weeks and also to do the ultrasound.
Thus, in their work with the juveniles, the “The Maternity Hospital № 10” employees interact intensively with the social services and the law enforcement agencies, and bodies. So, it is significant to be noted, that in the period from 2004 to 2013, there were only two special cases of the child abandonment by the juvenile mother.
The Conclusions. The final results, having obtained during the lifetime, on the basis of the “The Maternity Hospital № 10” of the specialized Center on the on the pregnancy and childbirth management, at the juveniles “The Little Mother”, and as well as the many years experience on the Maternity Hospital staff working with the pregnant teenagers and the juveniles, are given the bases to be suggested, that the implementation of the comprehensive medical, medical and social, psychological, and legal assistance to the young girls, who become pregnant, under the specialized Center for the pregnant juveniles conditions, will be improved the pregnancy outcomes and the quality to be assisted them, in general. During this time, the complications frequency in the pregnancy and childbirth at the juveniles, who gave the birth in the Maternity House, had already been decreased, there was no the perinatal mortality, and, moreover, it had not been the abandoned children. At the same time, it is quite obvious, that more additional studies and researches are needed of that role, which is played the creation of the specialized Centers on the pregnancy and childbirth management at the juveniles for the further quality improvement of the health, medical and social assistance for the given challenging category and group of the patients.