In early 1878, the Moscow Governor-General drew the Mayor’s attention to the fact that the obstetrical capabilities of the Moscow Foster Home were exhausted. The daily number of expectant mothers could reach 90, with the institution’s maximum capacity at 60 people. There were problems not only with financing allocated for fewer people but also with hygiene control.
“‘For 113 years, the maternity centre of the Moscow Foster Home has provided assistance to all needy women living in Moscow, surrounding villages and remote areas, and it never received support from the city authorities,’ Vladimir Dolgorukov wrote in his request. ‘But in recent years, the number of patients has been growing rapidly. Thus, in 1871, their number was 2,657 people, in 1872 – 3,064, in 1873 – 3,021, in 1874 – 3,315, in 1875 – 3,468, in 1876 – 3,659, and in 1877 the number of expectant mothers reached 4,000’” .
The situation was complicated by an 1877 law which required a new mother to stay in hospital for at least nine days after giving birth. In this regard, the administration of the obstetrical centre notified the city authorities about its intention to reduce the number of patients.
In addition to this centre, there was a maternity department of the university clinic, a maternity unit at the Golitsyn Hospital and six maternity shelters of the Moscow Committee for the Poor of the Imperial Philanthropic Society. At the same time, the university clinic with a capacity of 1,000 pregnant women used to close for summer holidays, and the capacity of other institutions did not exceed 19 beds, which allowed them to receive only 800 women.
Some simple calculations show that even in 1878 Moscow had to deny assistance to 2,400 women. Given that the vast majority of pregnant women turning to maternity centres were “giving birth illegally” and members of the poorest class, the situation reached a stalemate. So, Moscow had to resolve the problem at its own expense and resources..
“The lack of charity maternity institutions for the poor in Moscow is beyond any doubt. And it is important to resolve this problem. We need to find the best solution. The State Duma may take the following two steps: to establish a new major maternity hospital or a few smaller maternity shelters in different parts of the city” .
In parallel, the Public Healthcare Commission raised the necessary issue of reducing mortality in maternity hospitals. A medical report of the maternity centre of the Imperial Moscow Foster Home reads that “the average normal mortality in large maternity hospitals should be defined as 30 per 1,000, while that for births outside maternity hospitals (in flats or small shelters) should be 6 per 1,000” . To tell the truth, the mortality rate did not exceed 2 percent (20 per 1,000 women) even in the busiest year.
As a result, on 12 February 1880, the Commission proposed to open small maternity shelters:
“…five free maternity shelters (each with 3-4 beds) should open at police private houses or rented flats” .
Rules for city maternity shelters were developed. Shelters were headed by midwives, assisted by maternity nurses, including assistant maternity nurses if a midwife was absent. Also, shelters were serviced by maids and cooks, as well as workers to carry water and wood.
“9. Maternity shelters take in free of charge, at any time, pregnant women, both married and unmarried, regardless of their social class or religion. They do not have to present forms or passports when being admitted, but after giving birth, women, except for so-called secret mothers, must provide information about their identity and place of residence.
“10. Secret pregnant women are those who, for family or other reasons, are afraid of disclosing their pregnancy. They are allowed to remain anonymous. They just have to give a midwife or maternity nurse their name and title in a sealed envelope, which is returned to them unopened when they are released from the shelter and can be opened only in the case of their death…”
There should be a coloured lamp with the words “Maternity Shelter” hanging above the gate or entrance to the building and lighted all night long.
Given that the city assumed all costs to establish and maintain shelters, there were many people who wanted to rent out their premises. Four shelters opened by the end of 1880 and two in 1882 and 1883.
“I would like to rent out a comfortable space for a maternity shelter in my house. It’s located on Sofiiskaya Embankment, at the Yakimanskaya part of the first block, and consists of five rooms, a kitchen and a hall. The cost is 800 roubles per year. If this space is too small, I would be able to provide more,”  Semyon Podgoretsky wrote to the Moscow City Municipal Council.
In total, the city allocated 1,720 roubles per year to maintain a maternity shelter in rented flats.
With the growing population, the demand for maternity hospitals also increased. By 1903, there were 12 maternity shelters with 138 beds. In this period, the first large maternity hospitals appeared in Moscow. In St Petersburg, for instance, small maternity shelters (for two or three beds) remained until 1917.
In Moscow, the Abrikosova Moscow City Maternity Hospital (50 beds) opened in 1906. In 1907, the Lepyokhin Maternity Hospital (63 beds) opened. In 1909, the new building of the Morozov Maternity Hospital (74 beds) was built. In the same year, outpatient clinics for pregnant women and patients with gynaecological diseases started to open at maternity hospitals. However, they were not very popular among women.
In 1921, all small maternity shelters were closed.
 Main Archive Directorate of Moscow. F. 179. L. 31. F. 97. P. 11.
 Same source. P. 13g.
 Same source.
 Same source. P.14.
 Same source. P.14g.
 Same source. P. 45.