• Sweden edition
 
Swedish midwives cut health care costs

Swedish midwives cut health care costs

Published: 02 Oct 2013 07:32 GMT+02:00
Updated: 02 Oct 2013 07:32 GMT+02:00

Swedish midwives monitor women's well-being during pregnancy, keeping costs low by keeping 'test-happy' doctors at bay. Tradition and a strong midwives union have kept them in charge, with Sweden the second best place in the world to give birth.

Only one ultrasound in nine months and no need to see the doctor or obstetrician: at first glance, Sweden's pregnancy care appears rather simplistic.

But while it may be far from the medical approach to pregnancy seen in most Western countries, where mothers-to-be have a series of doctor's appointments and tests, the Swedish system, where midwives reign supreme, has proven its merits.

According to the organization Save the Children (Rädda barnen), Sweden is the second-best country in the world to become a mother, behind Finland.

Neonatal mortality is low, at 1.5 deaths per 1,000, the second lowest in Europe behind Iceland, as is maternal death in childbirth, at 3.1 per 100,000 births, according to the European Perinatal Health Report from 2010.

In Sweden, midwives are entrusted with caring for the health of the expectant mother and the foetus. It is the only pregnancy care available to women, and is free for the patient, falling under state health care benefits.

"A doctor can be called in at the midwife's initiative as soon as she notices that something is not right," says Sofie Låftman, a midwife in central Stockholm.

For those accustomed to intensive medical care during pregnancy, the Swedish way may seem rudimentary: a few blood and urine tests are done to detect vitamin deficiencies or anomalies, the mother's blood pressure and the heartbeat of the foetus are checked, and a little nutritional advice is doled out.

During a normal pregnancy without complications, just one ultrasound will be done over the whole nine months, and not a single gynaecological exam.

Meanwhile, in France for example, a 2011 report from the health ministry showed 20 percent of expectant mothers had more than six ultrasounds and four percent had more than ten -- without any obvious benefit.

"Pregnancy is a normal condition" and not an illness, says Marie Berg, professor in health and care sciences at Sahlgrenska Academy at Sweden's University of Gothenburg.

Låftman echoed that notion, saying most women under 40 did not need more medicalized care since their bodies were healthy and capable of giving birth, which is after all a natural process.

A scientific study published in August by the Cochrane Collaboration, an organization of health practitioners, concluded that "most women", those who have no complications in pregnancy, would benefit from seeing a midwife during pregnancy rather than a doctor.

Care by a midwife can actually reduce the number of premature births, the study's authors say. In Sweden, only five percent of babies are born prematurely. But the lack of contact during pregnancy can be tough for some expectant mothers.

Christina Singelman, a 31-year-old expecting her second child, recalls the sense of loneliness she felt during her first pregnancy: from the time she registered at the clinic until her first ultrasound, some 10 weeks went by without a single appointment.

But if the woman is under the age of 40, has no prior medical conditions and has fallen pregnant by natural methods "there's no reason to have more frequent checks in the beginning", insists Laaftman, the Stockholm midwife, who cares for about 100 pregnant women at a time.

Adina Trunk, 33, saw two different midwives for her two pregnancies.

"They were both very competent but the system puts them in a very passive position. It's always up to the expectant mother to take the initiative, to ask questions and possibly ask to see a specialist," she says.

"And since this is a culture where people don't like to make a fuss, it keeps costs down," she adds.

Midwives also take care of the delivery, although that is with an entirely different team than the one that has followed the mother throughout her pregnancy.

A doctor will only intervene if there are complications during the delivery, or if the woman in labour asks for an epidural, which is the case in about half of all deliveries.

Entrusting pregnancy and delivery care to midwives to such an extent is unique in the world. Midwives in Sweden have been in charge of pregnancy care since the 18th century.

While the rise of the modern medical profession meant midwives in much of Europe were forced to yield at least part of their responsibilities to doctors, Sweden's midwives held onto their traditional role thanks to doctors' consent and, in recent times, a strong union.

The system has never been called into question, owing primarily to its strong track record. The number of Caesarian sections is relatively low in Sweden, at around 17 percent of births in 2011, and only 10 percent of women undergo episiotomy, an incision to widen the opening for delivery.

"It's an efficient system in terms of cost management," says University of Gothenburg professor Berg.

In countries where doctors care for pregnant women, she says, the number of "tests and ultrasounds often multiply, which opens the way to easy money".

AFP/The Local/at

Follow The Local on Twitter

The Local (news@thelocal.se)

Don't miss...X
Left Right

Your comments about this article

Today's headlines
Malmö Nazi attack victim on the mend
Showan Shattak pictured in Malmö before his attack. Photo: Facebook

Malmö Nazi attack victim on the mend

The 25-year-old man, whose stabbing by neo-Nazis sparked mass demonstrations across Sweden, has made a strong recovery in hospital and took to social media to thank supporters for campaigning against fascism. READ () »

Police seeking missing Swede in London
Sofie Marie Jansson, who is currently missing in London. Photo: Metropolitan Police

Police seeking missing Swede in London

British police have issued a plea for tips in the search to find Swedish national Sofie Marie Jansson who hasn't been seen for almost a week. READ () »

University applications rocket to record high

University applications rocket to record high

Swedish universities continue to draw vast amounts of applicants with the number of prospective students seeking a third level education increasing for the seventh year in a row. READ () »

Man jailed in US over Lars Vilks murder plot
Swedish artist Lars Vilks pictured in New York in 2012. Photo: Linus Sundahl-Djerf/TT

Man jailed in US over Lars Vilks murder plot

American authorities have sentenced a 20-year-old accomplice of 'Jihad Jane' to five years in prison for an attempted terror plot to kill Swedish artist Lars Vilks, after getting involved with the murder plans when he was a teenager. READ () »

Sweden scraps 'new start zones' after EU input
Integration Minister Erik Ullenhag visits a school in Tensta, one of the neighbourhoods mentioned when he and his colleagues first floated the new start zone proposal. File: TT

Sweden scraps 'new start zones' after EU input

Sweden has abandoned a plan to ease taxes for small companies in blighted areas after the European Commission challenged its legality. READ () »

'Easter eggs an invitation to spread germs'
A typical Swedish Easter egg. Photo: Jessica Gow/TT

'Easter eggs an invitation to spread germs'

A Swedish microbiologist has warned that traditional Swedish Easter eggs laden with candy are an open invitation to the spread of bacteria and viruses. "Is this really a good idea?" he asked. READ () »

Jammed truck snarls Stockholm rush hour
Photo: Anders Wiklund/TT

Jammed truck snarls Stockholm rush hour

PICTURES: A truck got wedged inside a tunnel in central Stockholm on Thursday, with authorities concerned the accident may have damaged cables in the tunnel's ceiling. READ () »

Kids in Victorian garb mark Swedish Easter
A Swedish Easter witch holding daffodils. File photo: TT

Kids in Victorian garb mark Swedish Easter

In India, I'd notice Easter only from the traffic jam outside the churches, but here witches, egg hunts, and feathers mark the Christian holiday. The Local's Deepti Vashisht brings you the various shades of Swedish Easter. READ () »

Swedish MP ordered chemtrail probe
Chemtrails?: Shutterstock.

Swedish MP ordered chemtrail probe

A Swedish MP who launched an official government investigation into the existence of chemtrails tells The Local why he thinks Swedes deserve the truth, even if it may leave some conspiracy theorists unsatisfied. READ () »

PM pleads ignorance of Vattenfall's Nuon bid
Fredrik Reinfeldt answers the constitutional affairs committee's questions. Photo: TT

PM pleads ignorance of Vattenfall's Nuon bid

Sweden's prime minister on Thursday said Vattenfall itself, not its owners the Swedish state, had responsibility for the loss-making Nuon deal. READ () »

RECEIVE OUR NEWSLETTER AND ALERTS
Society
Swedish supermarket Ica pulls contested Easter commercial off air
Kungahuset
Society
Swedish royals set baptism date for princess
finest.se
Gallery
People-watching April 16
Politics
Who's the prime minister's heir?
Alfie Atkins
Society
Are children's books the key to families integrating in Sweden?
National
'Sweden Dem protests cater to party's martyr image'
National
'Swedish research grants were fantastic, but now it's like Australia'
Society
Only in Sweden: The ten problems you'd never encounter elsewhere
National
Swedes stopped to take my picture, but didn't look me in the eyes
Business & Money
A swipe of the hand replaced cash and cards in Lund
YouTube
Features
Video: Oliver Gee finds out how to embrace The Swedish Hug
TT
National
Abba duo hints at reunion
Advertisement:
Private
National
Flash mobs hug it out across Sweden
Finest.se
Gallery
People-watching April 11-13
TT
Politics
Swedes to give six-hour workday a go
TT
Society
Aussie choir member wows Abba in Sweden
YouTube
Society
Stockholm magic a surprise YouTube hit
Fastighetsbyrån
Society
Gallery: The Local's Property of the Week
Private
Society
Swedes find 200-year-old gravestone in living room
Stockholm School of Economics
Sponsored Article
Why a bachelor's degree is no longer enough
Deepti Vashisht
Features
Deepti Vashisht dissects the magic of Sweden's personal ID number
Shutterstock
Society
Ten signs you've been in Sweden too long
Society
Jimi Fritze heard every word when doctors discussed taking his organs
Society
A Swedish farmer explains why the new bestiality ban is 'pointless'
ESL
Sponsored Article
Learning Swedish the easy way
Latest news from The Local in Switzerland

More news from Switzerland at thelocal.ch

Latest news from The Local in Germany

More news from Germany at thelocal.de

Latest news from The Local in Spain

More news from Spain at thelocal.es

Latest news from The Local in France

More news from France at thelocal.fr

Latest news from The Local in Italy

More news from Italy at thelocal.it

Latest news from The Local in Norway

More news from Norway at thelocal.no

Blog Update: The Diplomatic Dispatch

28 October 15:16

The Green Growth Group Summit »

"Today on the 28 October in Brussels, a large group of key EU Ministers and business people, including UK Secretary of State for Energy and Climate Change Edward Davey, and Swedish Environment Minister Lena Ek, will meet to discuss green growth. They all have a stake in resolving a challenge which, although it is crucial..." READ »

756
jobs available
Swedish Down Town Consulting & Productions
Swedish Down Town Consulting & Productions is an innovative business company which provides valuable assistance with the Swedish Authorities, Swedish language practice and general communications. Call 073-100 47 81 or visit:
www.swedishdowntown.com