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.
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
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.
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.
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).
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.
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.
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.
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.
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.