How has the coronavirus changed childbirth in Sweden?

How has the coronavirus changed childbirth in Sweden?
Giving birth in a foreign country during a pandemic brings challenges. Here's how maternity care has adapted in Sweden. Photo: Christine Olsson/TT
For pregnant women, the coronavirus outbreak has added extra uncertainty and complications to one of the most important, and potentially nerve-wracking, days of their life. Here's a look at the different rules and measures in place due to Covid-19 that affect pregnancy and childbirth.

Risk factor?

Sweden has not named pregnant women as a high-risk group as some other countries have done, saying that based on current knowledge, pregnant women do not appear to be at a higher than average risk for serious illness from coronavirus.

But respiratory illness in late pregnancy can pose a risk. As of April 29th the Public Health Agency has said pregnant women and particularly those in the late stages of pregnancy (week 36 onwards) should be especially careful in following the agency's general guidelines – such as washing hands regularly and thoroughly.

Those who are pregnant and also have another risk factor, such as diabetes, obesity, or high blood pressure, have been urged to be especially cautious. That means speaking to a doctor or midwife and limiting contact with people outside your household as much as possible. Read the Public Health Agency's full advice for pregnant people here, or contact your doctor or midwife.

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Prenatal classes

Sweden's hospitals often offer sessions where they give information about childbirth and show expecting parents around the maternity wards.

These have been cancelled to avoid exposing patients and healthcare workers to unnecessary risk of infection, and to reduce the burden on hospital staff who are currently working in tough conditions. Instead, soon-to-be parents are directed to information online.

Other pre-natal classes organised outside hospitals may still be taking place either online or in person, as long as the guidelines around meeting other people – keep a two-metre distance, avoid gatherings of over 50 people, and limit contact with people outside your immediate household – are observed.


A birthing room at the Karolinska Hospital in northern Stockholm. Photo: Tomas Oneborg/SvD/TT

Ban on hospital visits

At most hospitals in Sweden, there is a general ban on visits. That means no friends, parents, or wider family may come to see you and your child after the birth.

Pregnant women will also typically attend pre-natal appointments such as ultrasounds alone, unless there are very special circumstances.

It may be possible for your partner to participate in the meeting via a phonecall or video app, or to attend in person – make sure to speak to your healthcare provider to find out your options, and raise any special factors that might mean your partner should be there in person. If you as a pregnant person have concerns about leaving your home, it may also be possible to do some of these appointments entirely over the phone or online.

The ban on accompanying partners also applies to most aftercare wards or hotels (called BB in Sweden) across the country, although in some places it's possible for a healthy symptom-free partner to stay with the new mother. In most cases this decision is made at a regional level, but it may also vary between hospitals; for example, in Stockholm a partner may accompany the mother to the BB unit apart from at Danderyd Hospital. This could depend on factors like staffing, room availability, and whether the BB rooms are private or shared.

Birthing partners must be symptom-free

There is an exception to the general ban for women who are going to give birth.

In most cases, it is possible for one healthy person (a partner or other friend) to attend the birth, but only one person, and they must be symptom-free, which means no fever or respiratory symptoms. You should make sure to call the hospital before coming in, especially if you are in any doubt about whether your or your partner's symptoms could be linked to coronavirus.

These rules might mean it's an especially good idea to think about a back-up birthing partner who could accompany you if your birthing partner develops symptoms.

There are often further restrictions on the partner too; it may only be possible for them to be with the mother once active labour has begun, and in many cases they may not leave the room once they have arrived. 


File photo: Maskot/Folio/imagebank.sweden.se

What about caesareans?

If you have a caesarean, whether it is a planned one or carried out as an emergency, you will go to the operating room alone without your partner. They will usually be able to wait in another room and to be with the child straight after the birth. The whole family will get some time together before you and the child are moved to the aftercare unit.

In two regions, Östergötland and Dalarna, many non-medical caesareans have been cancelled. In a survey carried out by Swedish Radio Ekot, these two regions said they were being more restrictive with caesareans due to fears of childbirth, because of a need to prioritise use of the operating theatres for more serious illnesses such as cancer operations.

Several other regions, including Gotland, Västernorrland and Värmland, told Ekot there was a possibility of similar measures depending on how the coronavirus situation developed.

If it's not possible to offer a caesarean at your first-choice hospital, it may be possible to have the procedure elsewhere. That's the case in Region Stockholm, for example, which said women with fear of childbirth are still receiving caesareans as planned.

Healthcare

In most regions, soon-to-be parents are now asked to call the hospital before coming in to give birth.

You should tell your doctor or midwife about any symptoms you experience that could be related to coronavirus, including a fever, headache, or cold-like symptoms. This means that staff will be able to prepare and protect you and themselves in the most appropriate way.

For pregnant women who test positive for the coronavirus, care should take place in an isolated room and with staff wearing protective equipment to reduce the risk of infection. But there likely won't be any difference in the treatments, delivery method, and actual care you receive, including nitrous oxide. As long as both you and the child are well enough not to need special care, you should be able to be together after the birth.

Healthcare in Sweden is managed by the country's 21 regions, and the measures in place may change due to the changing situation around the coronavirus outbreak. This information was gathered from region and hospital websites and was correct at the time of publication, but to find out exactly what applies in your region now, contact your midwife, hospital, or 1177.


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