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CHILDREN

Swedish parenting: Back to a traditional future?

Four years on from the start of the great “curling” and “helicopter” debates, the issue of parenting is back in the news. This time round, the focus has switched to the unprecedented popularity of state-sponsored parenting classes. Peter Vinthagen Simpson takes a closer look.

Swedish parenting: Back to a traditional future?
Photo: Göran Assner/Swedish Travel and Tourism Council

In the spring of 2004, Sweden was awash with debate about the growing prevalence of so-called “curling parents”. Drawing an analogy with the sport of curling, the phrase refers to parents who rush ahead of their children, frantically sweeping their path clean of even the most minor obstructions.

The phrase was coined by Danish child psychologist Bent Hougaard in a challenge to the perceived status quo. Parents had become slaves to their children, who ruled the roost, rejecting adult authority in all its forms.

The discourse was joined later by “helicopter parents,” a term describing parents who pay very close attention to their children, hovering around them at all times.

In recent months, parenting in Sweden has again been under the microscope, with some 20,000 parents turning to state-sponsored parenting courses for help last year. But the courses are controversial and experts fear a traditionalist backlash.

Critics argue that the courses signify the return of shaming and the naughty step. Advocates however contend that the courses, which focus on behaviour, work.

Is Sweden, proud of a more “enlightened”, cooperative approach to parenting, losing faith in itself and rediscovering a more “traditional”, hands-on approach to raising its children?

Lars H. Gustafsson, paediatrician and author of several books on children and youth, is critical of the broad application of parenting courses and writes that many of the methods taught in courses such as Komet and Cope are not suitable for the average family. Many of the methods are designed for families with serious problems and could be counterproductive when applied universally, he argues.

“I want to emphasize that I am positive to the idea that parents should meet and discuss parenting, but there should be more of a menu of courses that parents can choose between. It is the content that I react against. There is an important distinction between treatment therapy for families with serious problems and the majority of parents that can manage perfectly well,” says Gustafsson.

Agneta Hellström at Cope, just one of the courses available to parents in Sweden, argues that attitudes have changed over the past thirty years and that state-sponsored courses are not as controversial as they were in the 1970s and 1980s.

“The courses are offered to parents and not imposed upon them. In my experience there has been a professionalization of parenthood. In the same way that the owner of a boat wishes to learn to sail, parents wish to learn to develop in their new roles. The courses are very much part of an ’empowerment programme’ and it is the parents and not the course leader who shape the content.”

Gustafsson agrees that the courses are not as controversial and parents are less sceptical towards authorities today. “They should be though,” he warns, adding that “the recent vigorous media debate is perhaps an indication that there remains a healthy scepticism to being told by society how to be a parent.”

He reacts against the behaviour focus of many of the modern courses and would like to see courses focused more on “interplay,” “teamwork” and “parental dialogue.”

“Along the lines of a French language study circle.”

Methods such as “time out” and ignoring the child have been the focus of much of the debate. The “time out” method is argued by Gustafsson to be reminiscent of the “room arrest” that was once common in parenting. “Room arrest” was cited by the government in 1979 as an example of what could be considered a “prohibited violation of the rights of a child” and thus equivalent to the use of corporal punishment and thereby prohibited by the new legislation.

Sweden was the first country in the world to outlaw the corporal punishment of children, in 1979. In fact the right of parents to beat their children was removed in 1966.

Hellström argues that the “time out” method has been misunderstood. The method, she emphasizes, should be used selectively and only to “break a vicious circle,” in extreme cases, such as when the child is hitting another child.

“Time out is part of the ‘positive reinforcement’ taught in Cope’s courses and does not mean room arrest,” Hellström explains.

“It is important that parents remain in control. Time out is a so-called ‘sharp tool’ – a means of breaking a more negative situation and reinforcing a positive one,” she adds.

It was not until after the end of the Second World War that physical punishment and shaming began to be questioned as methods of parenting in Sweden, Gustafsson writes in ‘The return of the naughty step.’

Children’s author Astrid Lindgren created the characters of Pippi Longstocking, Emil, Madicken and Ronja and was influential in embedding new attitudes towards children and parenting in the Swedish popular self-identity that led to a re-think in the 1970s and early 1980s.

“I was part of the process to develop parenting courses in the beginning of the 1980s. The thought was that we would develop a three-stage process taking the child up to school age, but financial concerns came in the way. Even then we were careful to avoid the word ‘education’ and we went for ‘parent groups’ instead,” Gustafsson tells The Local.

Hellström argues that today’s parents are not familiar with the 1970s tradition and seek “concrete, pedagogical methods for improving their daily lives with their children.”

One such “concrete” method is the so-called “balance of trust.” Deposits are made, in the form of praise, gold stars or “quality time” and, later, withdrawals in the form of punishments. Hellström emphasizes that it is important to consider what we mean by punishment.

“If I turn off the TV because it is time for my child to get to bed is that really a punishment? – It doesn’t fit the Swedish definition.”

Hellström compares this “balance of trust” to an employment contract that most adults at some point enter into. “Built on an agreement and most importantly, renegotiable”

The National Institute of Public Health (Folkhälsoinstitutet) has developed parenting courses in a Swedish cultural context. Sven Bremberg at the institute explains to The Local that “foreign” methods such as “time out” have been consciously omitted from its new parenting course material which has an emphasis on “warmth and limits.”

The popularity of parental courses could be argued to be a result of a period of introspection by parents prompted by the curling and helicopter debates. So what of the children?

One might ask whether these parenting courses aren’t more for the benefit of parents struggling to find a balance to “life’s puzzle” in the high-stress, “I want it all” 2000s, than for their children. Children are one more piece of the puzzle needing to be effectively managed; squeezed in alongside a career, a rewarding social life and free-time activities. Hence the focus on controlling behaviour, or perhaps more accurately, output. Gustafsson agrees:

“The definition of normality has narrowed in today’s society. That which was once considered normal is now considered to be deviant. Take sleep for example. Small children sleep badly, that’s normal, but parents today live with such tight schedules they cannot run the risk of their child having a bad night’s sleep.”

“I miss the children’s perspective,” he concludes.

PARENTING

What you need to know about giving birth in Sweden

Going through pregnancy and childbirth is a momentous experience and doing it all in a foreign country may seem daunting. Here's The Local's guide of the steps you need to take before giving birth in Sweden.

What you need to know about giving birth in Sweden
Sweden is one of the world's safest places to give birth, but there are some key changes in pre-natal care compared to other countries. Photo: Jessica Gow/Scanpix/TT

The first thing to know is that Sweden is an extremely safe place to give birth. Its maternal mortality rate is one of the lowest in the world: the under-five mortality rate is fewer than three per 1,000 births, while less than four in 100,000 women die while giving birth. Sweden also has an extremely low caesarean section rate, with just 16.4 percent of live births carried out by c-section, compared to an average of around 28 percent across the OECD.

Each year, around 100,000 babies are born in Sweden, so you're not going through it alone. But there are differences between giving birth in Sweden and in other countries, so as a parent-to-be, it's good to have an understanding of how things will work.


This is the second part of The Local's series about maternity care in Sweden. Read the first part here. Photo: Christine Olsson/TT

Firstly, the entire birth process, including pre-natal and post-natal care, is managed by midwives, rather than doctors. This has been the case for decades, and the only exception is for mothers with certain existing health conditions or if any complications arise, in which case the mother will be referred to a hospital doctor.

It's also good to know that everyone working at maternity centres has a duty of confidentiality, and that generally midwives in Sweden will speak English. You can let the centre know about your language requirements beforehand, and you have a right to an interpreter at your appointments if needed – just let the clinic know when you first book.

READ ALSO: Swedish blogger films her entire childbirth and puts it on YouTube

Contacting the midwife

Once you've confirmed you're pregnant (tests can be bought from a pharmacy, usually for under 100 kronor), the first step is to get in touch with a local health centre. The easiest way to do this is by calling Sweden's health helpline at 1177, or looking on the healthcare website for your county.


A pregnancy test. Photo: Claudio Bresciani/TT

You'll be put in touch with a midwife clinic or mödravårdscentralen (MVC), which you should contact to arrange your first appointment.

There's also the option of going private, which will cost more money (the costs associated with pre-natal care and childbirth are treated like any other medical expense in Sweden, meaning you only pay a small amount up to a cost ceiling, and then it's free) but may mean you get appointments more quickly.

After asking you a few questions over the phone about how far along the pregnancy is and your state of health, the clinic will give you a date for the first appointment, usually between the eighth and 11th weeks of your pregnancy. This is later than in the US, for example, but in line with most European countries. And of course, if you have any concerns or questions before that time, you can get in touch with the midwife again.

You can also ask for a 'profylaxkurs' or Lamaze course to prepare for childbirth; these are available in Swedish and English. These courses include breathing techniques and physical strategies to alleviate pain and stress in childbirth. The kind of courses and discussion groups vary depending on which area you're in, so while you should have access to 'samtalsgrupp' or discussion group wherever you are, some areas might also offer yoga aimed at pregnant women, water gymnastics, or other kinds of preparation.


A pregnant woman relaxes on her sofa with a cat. Photo: Pontus Lundahl/TT

First appointment

The first appointment will mostly be a question and answer session covering the mother's medical history (based mainly on these questions) and the Swedish pre-natal care system, as well as blood, blood pressure and urine tests.

Be aware that midwifes aren't authorized to prescribe medication, so if this is necessary at any point, you'll be referred to a gynecologist or other doctor, usually at a separate hospital or doctor's clinic to the MVC.

Further appointments

According to 1177, the average pregnant woman will visit her midwife between six and ten times, typically eight or nine, in the absence of any complications. First-time mothers will typically have more visits than those who have already had a child, and if you have any sort of risk factor (such as having had previous miscarriages, complications in previous pregnancies, or being over 33) there will be more scheduled visits to check how things are going.

The visits will take place approximately monthly until the 30th week, and then between every one to three weeks for the final part of the pregnancy. But of course there's not really any such thing as an average pregnancy, so these timings may vary. 

The midwife will keep a journal throughout the pregnancy, including test results, weight, health information, and additional information about how the mother is feeling. The pregnant woman should also be informed about the different forms of pain relief available, including medical pain relief and non-medical, and any preferences will be recorded in the journal. Towards the end, it's recommended that mothers-to-be write up a birth plan summarizing any special requests or needs for the birth itself.

Sweden-based Jill Leckie, a podcaster and writer who runs the online parenting magazine Littlebearabroad, tells The Local that she appreciated the opportunity to see the same midwife throughout her pregnancy, allowing her to build up a relationship and trust. “I felt more at ease and more cared for. I also felt like my concerns, questions and anxieties were taken more seriously,” Leckie says.


A pregnant woman looks at her phone in a Stockholm office. Photo: Jessica Gow/TT

However, she stresses the need for women to read up on their rights and to ask questions if they ever feel the need.

“If you don't like the care you're receiving or the way in which your pregnancy is being managed by your midwife, change it. You don't have to stick with the same midwife,” she says. “Have someone who can act as an advocate for you in the room. Be honest with your advocate about what you want, how far you are willing to go. Make sure they really know you and are prepared to make difficult decisions on your behalf.”

As for what the routine tests will include, there are usually around five blood tests (done by pricking your finger). If these results show high blood sugar levels, you may be asked to take the blood glucose test. Your blood pressure and weight will also be measured at each visit.

If you need any extra help, whether medical or psychological, your midwife will be able to refer you to the relevant professional.

Around halfway through the pregnancy, there will be a chance to attend a group talk about diet, exercise, and any other issues you're experiencing. This is also the time when you'll be given a 'certificate of pregnancy' which is sent to Sweden's Social Insurance Agency, to ensure you get your parental benefits. From this point, the fetal heartbeat will be measured at each of the appointments too.

From around the 25th week, the midwife will start measuring the woman to record the growth of the fetus, and from the 33rd week, they will also carry out checks on the woman's stomach (using their hands) to work out the position of the fetus.

Ultrasound and screening

At around 18-20 weeks into the pregnancy, the (voluntary) ultrasound screening will be offered. This is a big difference to many other countries: in the absence of complications, there will only be one or two ultrasounds throughout the entire pregnancy.

The ultrasound will help your midwife work out the expected delivery date, whether there's more than one fetus, and can also detect certain abnormalities.


A midwife carried out an ultrasound test. Photo: Gorm Kallestad/NTB Scanpix/TT

The results from the ultrasound, a blood test, and the age of the mother are used to calculate the probability of the baby being born with Down Syndrome. If this is calculated to be more than a one in 200 chance, the mother will be offered further testing in the form of a chorionic villius sampling (CVS) or an amniocentesis. These tests, carried out either on the placenta or amniotic fluid, can detect Down Syndrome and some other abnormalities.

Pregnancy guidelines

There are a few differences in the standard guidelines offered to pregnant women in Sweden compared to other countries: for example, there's a stricter attitude towards drinking alcohol during pregnancy than in many countries where the occasional glass of wine is considered perfectly acceptable, but caffeine is less frowned upon. Detailed advice on the current dietary guidelines can be found here (in English).

READ ALSO: Ten reasons why it's awesome being pregnant in Sweden

Labour

When the baby's on its way, you'll have to call a 'labour coordinator' – your midwife will give you the necessary contact number well in advance – to be assigned to the nearest hospital maternity clinic with an available bed. This means you may not know for certain where you'll give birth until the day itself, unless your pregnancy is considered high risk.

However, the vast majority (in 2017, around 95 percent) of women give birth in their chosen clinic (and your midwife should be able to help you choose a clinic that isn't already oversubscribed for your due date). Even if that's not the case, the hospital will have all the information about your birth plan submitted by your midwife, including your language, any requests about pain relief or relevant medical history as well as other preferences or needs for childbirth.


Signs marking the entrance to a hospital maternity ward. Photo: Emil Langvad/TT

You may have heard Swedish media talk about a 'crisis' in maternity care, and it is the case that maternity wards are under pressure and, particularly in the summer months when the majority of births happen, are often full. If you're concerned about this, make sure to speak to your midwife beforehand and they will be able to give you a better idea of the situation in your local area.

But in general, you can rest assured that the majority of women in Sweden are satisfied with their experience of childbirth, and that local authorities are putting money and resources into improving the care in the country's maternity wards further. There are also plenty of resources out there aimed at international parents, including for example the blog Littlebearabroad and several Facebook groups for parents-to-be in Sweden.

IN DEPTH: Why family-friendly Sweden is talking about a maternity care crisis

At the hospital, there will usually be a midwife and an assistant in attendance at your birth, with the possibility that a trainee midwife may also be present. If there are any complications, there will be a doctor too.

If the labour doesn't start naturally, after a certain point doctors will induce labour. This is done either after 41 or 42 weeks, depending on where you are in the country.

READ ALSO: New dad gets free t-shirt for delivering baby

Pain relief

Pain relief is something you'll discuss with the midwife in the appointments throughout your pregnancy, and there are several options which may differ from what's available in other countries.

As well as using breathing techniques learned in preparation classes, there are a variety of non-medical methods of pain relief available in Sweden, including heat, massage, sterile water injections, pilates balls, and electrical currents.

In terms of medical pain relief, the most common options are nitrous oxide and different kinds of anesthetics; there's detailed information available in English on the Swedish healthcare system (here). One significant difference between the Swedish system and others, including the American and British system, is that standard epidurals are less common, with combined spiral or 'walking' epidurals being the usual option. This allows the mother to use her legs and walk around.

Different clinics may use different kinds of pain relief more than others, but the decision ultimately lies with the person giving birth, and you can request changes from your birth plan if you want to.

Home births

Some mothers may choose to give birth at home, and this is something to speak with your midwife about as early on as possible. If your pregnancy is high-risk, they will likely advise you to go to a maternity clinic to give birth.


A newborn baby. Photo: Christine Olsson/TT

Your local clinic will be able to help you find out about what opportunities are available in your area, and put you in touch with a midwife who assist with home births. In some counties, you pay a fee for this yourself, though in some this cost is covered for mothers who meet certain criteria (such as living a specific distance from the nearest hospital, and having undergone a medical check-up shortly beforehand).

Then, you'll make a plan for your home birth with this midwife, who will give you information on how best to prepare yourself and the area at home, and you'll decide at what point you'll contact the midwife once labour begins.

Aftercare

New mothers will be invited to an aftercare visit at an antenatal clinic between eight and 16 weeks after giving birth, to check blood pressure, weight, and have blood tests. If you have questions or concerns earlier on, you can get in touch before that.

Did we forget anything, do you have more questions about giving birth in Sweden, or about life in Sweden in general? Please let us know by e-mailing [email protected] – we would love to hear from you.

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