Wednesday, June 24, 2015

Prenatal Care & Giving Birth in Stockholm, Sweden

Overall, the prenatal care, labor and delivery seem pretty similar to what I am used to hearing about in the US.  I will say that for a girl who likes to have a solid plan and know what is going to happen . . . Stockholm is helping me learn how to give up that control :).  The level of care here really is excellent but the way they do things is a bit different.  If you think of any questions after this post leave them in the comments and I'll see if I can answer them!

Prenatal Care
Our First Appointment
For your prenatal care you see a midwife, not an OBGYN unless there is something wrong with the pregnancy.  My first visit with the midwife was at 8 weeks and 5 days which is pretty early here.  They usually like to see you around 10 weeks.  Since we did IVF to get pregnant she didn't do a pregnancy test to confirm the pregnancy at my first appointment.  Instead, I handed her a paper from the IVF clinic that said when they transferred the embryo and that at the 7.5 week ultrasound they saw a heartbeat.  At the first MVC (mödravårdscentral - Mother's Care Center) appointment we gave her some paperwork that we filled out with our medical history and we talked about what questions I had and kind of what to expect from the appointments.  The first midwife appointment was the only one Jake went to because we quickly figured out there wasn't much happening at these appointments.
After giving her our medical history she took my blood pressure, took some blood and checked my urine for something and sent us on our merry way.  She said around week 12 we could do the CUB test which is a blood test and ultrasound looking for abnormalities.  At first we thought we would do it but after talking to some friends and thinking about it more we decided to skip the blood test and just have the ultrasound.  We wanted to see the baby but we didn't want to worry about false positives with the abnormality screening.

*It really helped that my friend Lisa went through her pregnancy and delivery in Stockholm while we were friends so I knew what to expect.  Her advice was "don't expect much" and that actually helped!

Ultrasound
We had the ultrasound at 12 weeks and 2 days at a different office so I never saw my midwife during that time.  It was great seeing the baby moving all around.  I also gave blood before the ultrasound to check different things (like my rubella immunity which I failed when we were doing infertility testing).

Appointments
My MVC appointments with my midwife over the entire pregnancy were at: 8 weeks, (12 week ultrasound at a different clinic), (18 week ultrasound at a different clinic), 19 weeks, 25 weeks, 29 weeks, 33 weeks, 35 weeks, 37 weeks and 39 weeks.  I have one scheduled during week 41 but I'm hoping I won't need it :).  They let you go 42 weeks before they induce you in Stockholm.  In the southern parts of Sweden they let you go to week 43 before inducing you.  All of the medical records here are electronic so when I do have something done it goes to into my file and any medical professional can pull it up.  I think this is really great but I know others might disagree.

Almost every midwife appointment followed this order: Do you have any questions? How are you feeling? Are you still taking your vitamins? Then she checks my blood pressure and listens to the baby's heartbeat.  She also pricked my finger to get my blood sugar and iron levels at several appointments.  At week 33, she started poking around more to see if the baby's head was down.  She did this again at week 35 and then at week 37 she has to make sure it is down.  My overall opinion was that she didn't have a clue so at 37 weeks, after she asked me if I thought it had moved, she checked with a ultrasound to make sure it was down and it was.

Birth Plan
The midwife you see for your prenatal appointments is not who delivers the baby.  I feel like this could have gone on the list of "things that freaks Kara-the-planner out but it really hasn't.  (This freaks some people out since in the US you go to the same doctor for your prenatal care and delivery but I know that most people don't actually have their doctor deliver the baby.  It all depends on if they are working when you go into labor.)  Since the person delivering your baby doesn't know you or how your pregnancy went they will read the notes my midwife gives them along with anything I want to tell them in my birth plan.  At my 35 week appointment, I helped my midwife write my birth plan.  She included general things about my pregnancy and if it was normal or if I had any complications.  The birth plan also includes some of my medical history and medical allergies.  She asked me a few questions about how I was feeling about giving birth and what medication I might want during labor.  I didn't have her add much other than I'd like for them (the midwife and the midwife/nurse's assistant that will be assigned to me) to speak English to me and to each other if possible so I know what is going on.  I also said I might want an epidural so I'd like to know if I'm getting too close to not being able to have one.  Short and sweet because if I've learned anything through this whole "let's have a baby adventure" it is I am not in control so why try now?

Giving Birth - Labor & Delivery
Where do you Deliver?
You get to pick which hospital you would like to give birth at and then you register with that hospital around 25 weeks.  If you have any complications after 25 weeks or so you call the hospital not your midwife.  Once you are in labor, you call the hospital and answer some questions (so they make sure you are actually in labor).  If they think you are far enough along with your early labor stage then they will check to see if they have room for you.  If they do have room you get to go there but if they don't they will send you to another hospital. You could say that is a bit different than what happens in the US and could be added to the "freak out list."  The good news is that whenever I've asked which hospital people have delivered at and what they thought they've had all good things to say.  I'm hopeful we will get our first choice but if we don't we should be in good hands regardless.  Again, I am trying to go with the flow which isn't always easy but I have made a lot of progress!

Hospitals 
There are what I would consider "regular" public hospitals, private clinics (some located inside hospitals) and birthing centers where you can choose to give birth.  I think there is only one private birthing center that doesn't have the ability to do c-sections or complications so if something does come up you have to be transported by ambulance to a hospital.  All the other birthing centers are located in a hospital so if something does happen and you need a c-section or have a medical emergency you should be fine.  You can pick a public or private hospital/clinic and they both cost the same, nada.  I haven't paid for a single prenatal or ultrasound appointment.  You do pay a small amount for your partner to stay with you after the birth but it is $60 a day or so and that is it.

We are registered at Danderyds (which is where the Swedish Princess just had her baby).  However, like I said before if they are full we could go to BB Stockholm (which is a private clinic located in Danderyds Hospital), Huddinge, BB Sofia, SÖS, Söder BB (private clinic at SÖS), and Karolinska.  (I might have missed a few or mixed them up but I think that covers the choices.)  I asked for advice about which hospital to pick on a "Moms in Sweden" group that I am a part of on Facebook and everyone had a great things to say about where they delivered so that is reassuring.

It seems that all of the hospitals and clinics seem to be geared more towards what we could consider birthing clinics in the US.  They try not to induce you, do c-sections or use a lot of medical interventions unless it is absolutely necessary.  Laboring on a pilates ball or a birthing stool is very common.  They don't really want you to labor in a bed or on your back.  One big difference is that you can eat during labor.  Obviously you probably won't want a normal sized meal but you can eat small amounts of food.  They suggest eating nuts, dried fruit, chocolate or another sugary treat to keep your energy up.
Starting on the left: The blue thing on wheels is a gåbord (walking table) so you can walk through the halls and then brace yourself during a contraction, pilates ball, labor bed, and a birthing stool.

When to Go to the Hospital
Before you go to the hospital you are supposed to call when you are having regular, painful contractions each lasting about 60 seconds and you are having 3 or so in 10 minutes and this happens several times.  You can also call if you think you need help, if your water breaks without contractions or if you are bleeding.  When you call they will ask you questions to find out if you are in active labor and to make sure there is a place for you.  The goal is for you to go through the early labor stage at home as long as possible so when you arrive at the hospital you are dilated to 4 cm or so.  Once you get to the hospital they will check to see if you are dilated (which is the first time during your pregnancy that they will check you), check your vitals and then you will be admitted and assigned a midwife and an assistant.

Pain Relief
You can get an epidural but it doesn't seem to be as common here as it is in the US.  The epidural they typically do here is called a walking epidural.  They numb you but you can still feel your legs, walk around and go to the bathroom.

The most popular choice of pain medicine is gas and air, like what you can get at the dentist office.  In our birthing class we learned that 91% of women use gas and air during their delivery.  Some women really like it.  Others don't because it made them feel too loopy, like they've had a glass or two of wine.  Considering I've never had enough wine to feel loopy I'm hesitant to try this.

You can also use a TENS machine during early labor which sends shocks to your body during contractions (you can control the intensity with a remote) to help counteract the painful contractions.  I've used a machine like this before on my knee and shoulder for therapy after I injured them.

Another form of pain relief is called sterile kvaddels which is when they inject water just under your skin.  They say it feels like a wasp sting for 20-30 seconds but it can provide pain relief for an hour or so.  The idea is to fight pain with pain so if you shock your system with the water injection it will "forget" about the painful contraction.  I'm just not so sure about that one . . .

Postnatal Care
Delivery & Postnatal Care
After delivery they want you to do skin to skin with your newborn for the first 2 hours.  They don't take the baby right away to weight it or do any tests.  They strongly encourage breastfeeding instead of using formula.  They wait for the umbilical cord to stop pulsing before they clamp it and then offer to let the dad cut it.  None of this has to be in the birth plan because it is standard protocol assuming everything was fine with the baby and the mom after delivery.  They do give the baby a vitamin K shot to help coagulate the blood.

You usually stay in the hospital for 2 nights.  There is a patient hotel at the Danderyd hospital that we can move to if we don't have any complications.  Then it feels more like a hotel and less like a hospital.  They still have midwives working at the patient hotel to check on you and the baby.  There isn't a nursery where you can send the baby to let you get some sleep.  Once the baby is born you are responsible for it.  The nurses will come in to help you and give you tips for changing the diaper and breastfeeding but you will be the ones doing all the hands on work which makes sense since you will be leaving in a few days and will be responsible for another human being!

Co-sleeping seems to be pretty popular in Sweden.  Lots of babies also sleep in something called a baby nest.
You either put the baby nest in your bed between the two of you or inside the crib/bassinet.  The American in me just can't go there.  Seems like the opposite of what they encourage babies to sleep in in the US.  I'm assuming we will have a hospital bassinet on wheels and the baby can sleep there while we are at the hospital.  

BVC - Barnavårdscentral - Baby Care Center
You pick a BVC or Baby Care Center where you will take the baby for checkups.  I think these check-ups are also done by midwives.  A midwife from your BVC should come visit you at your home within the first week of coming home from the hospital.

I'm sure I'll remember something else I wanted to include but for now this is all I've got.  Let me know if you have questions!  I'm interested to see how I feel about the whole system after I give birth.  I have a follow up post to this about maternity/parental leave (that I've already written) but I didn't want to put them all in one long post so check back for that soon!

4 comments:

  1. I think the coolest thing about all of this is that a midwife comes to YOUR house within the first week after delivery! I did not enjoy taking the baby to he doctor when they were a few days old, so that will be so nice! Praying for you. Remember that although you may not be in control God is. And His plans are good!

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  2. Thank you Kara for quite comprehensive post. How did the delivery pass? Are you satisfied with the Danderyd? Any advices from your side re this hospital and postnatal care woul be appreciated since we are currently on a stage of choosing the hospital.

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    1. Hi Yevgeny, I was very satisfied with Danderyd. The labor and delivery was long, 37 hours, but I felt very well taken care of and it ended with a vaginal delivery instead of a c-section which was great after such a long labor. I felt like they really fought for me to not have a c-section if it could be avoided. I've heard great things about all the hospitals in Stockholm so I really don't think you can go wrong but we did enjoy our experience at Danderyd. I would welcome the opportunity to give birth there again. I think choosing one that is close to you is key and remember if they are full you will be sent somewhere else so it may not matter where you choose if they are full. If you are interested in Linnea's birth story here it is, http://karajanzen.blogspot.com/2015/07/best-birth-day-present-ever-linneas.html, it tells you more about our experience. Good luck choosing a hospital. Hope everything goes well for you! Thanks for reading the blog!

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  3. Thank you Kara for reply, I and my wife Anna will read your birth story. Take care and enjoy being a mother ;)

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