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HEALTH

‘How are we going to manage?’ New parents in Sweden face coronavirus challenges

No visits from family, and potentially no partner with you during childbirth if they develop a cold – these are just some of the challenges being faced by new parents during the coronavirus epidemic.

'How are we going to manage?' New parents in Sweden face coronavirus challenges
What's it like bringing a child into a world so different to the one you had imagined? Photo: Pontus Lundahl/TT

Healthcare in Sweden is managed at the regional level which means some restrictions vary depending on where you live. Along with the fast-changing situation with the coronavirus, this has meant added uncertainty for many parents-to-be – and foreign-born parents especially may struggle with discrepancies in advice for pregnant women from their home countries and Swedish authorities.

Pre-natal classes at hospitals have been mostly cancelled, with expecting parents directed to find information online. Olga, originally from Russia but resident in Stockholm for eight years, said she struggled to find online courses in English ahead of her birth in April. This left her unprepared for some things, for example the pain she experienced when breastfeeding.

She praised the healthcare she received, which included a coronavirus test, but was nervous when needing to travel to get various tests carried out on her baby, worried about exposing them to infection.

“Initially we went by taxi but after few days we realised that it was getting too expensive for us, so I had to use public transportation, increasing the risk of infection. This was not a good point,” she said.

She also has less access to her planned support network after her parents had to cancel their trip to Sweden and she felt unsafe attending in-person meetups with other prospective parents. 

But looking on the bright side, Olga says social isolation during pregnancy helped prepare her for life as a new mum without time to socialise. “Now my partner is working from home, so he has more opportunities to help me with the baby. I'm getting so much support from him,” the researcher added.

RAISIN A FAMILY IN SWEDEN:


It's currently not possible for partners to accompany patients to ultrasound appointments, apart from in special circumstances. File photo: Simon Paulin/imagebank.sweden.se

Jill Leckie runs LittleBearAbroad, a community for parents in Sweden offering advice and meetups.

She said that after safeguarding your family, the biggest concern for many parents in her network was isolation. “Loneliness is one of the foremost issues among parents and parents-to-be that can cause post-natal depression, anxiety, family break-down and self-identity loss. It's a catastrophic issue among international parents, particularly foreign-born mothers,” she said.

“The coronavirus pandemic has exacerbated these concerns tenfold. But to make matters worse, the international community has been bombarded with information from all of their home countries too. The cognitive dissonance that a lot of us have been experiencing these last three months has been profound. We're trapped between two cultures and two very different ways of managing this crisis and it's caused a lot of trauma for a lot of people.”

Unlike several other countries, Sweden has not labelled pregnant women as a risk group. One Italian reader, who is due to give birth in July and asked not to be named, said she was “not happy” about this. The reader was also concerned about the lack of protective equipment worn by healthcare staff while meeting pregnant women. Doctors and midwives in Sweden are not currently expected to wear extra special protective equipment when dealing with pregnant women who are not in a risk group and are symptom-free.  

Sweden allows partners to attend the birth as long as they are symptom-free, which is more lenient than in some other places. But Leckie highlighted that giving birth alone could be especially stressful for foreign-born women who may not be fluent in Swedish and struggle to communicate easily with doctors and midwives.

“The coronavirus has highlighted deep social flaws in the ways in which countries acknowledge certain social circumstances,” she said. “But, the worst of this situation has to be new mothers with no family, no loved ones and no hope of seeing close family because of the risk of infection. It's been heartbreaking to hear from members of our community suffering from mental health traumas who are unable to get the help they need, quickly.”

The extra regulations mean that many couples spend the weeks leading up to the birth anxious about contracting the virus or even catching a common cold.

Indian PhD student Kavitha is another first-time parent, who gave birth on May 8th in Umeå. 

When she gave birth, her husband was only allowed to attend the birth once the active labour had begun, a rule currently in place in several regions across Sweden even for healthy birthing partners.

“I was stressed that my husband was not allowed inside. Handling the pain alone at that time was very difficult and challenging. He was called during my active labour which lasted for 25 minutes. We live nearby so he made it, I could not imagine if we were outside of the city. The previous 26 hours was handled by me alone. Although the midwifes were helpful it is always soothing to have your loved one around,” she said.

CORONAVIRUS IN SWEDEN:

After the birth, she and her child went to the maternity ward where her husband was not allowed to join them. “I missed having my husband because I was learning as a new mum, sleepless. I wish my husband could have supported me.”

Now enjoying her first few months as a new parent, Kavitha is also missing out on family support she was hoping to have, after her parents-in-law had to cancel plans to travel from India to spend the first three months in Sweden helping out.

Annelise, a nurse originally from the US now living in Nyköping, is in a similar situation.

“I have felt quite isolated at times. My mom was supposed to fly over from the States but, of course, her trip was not possible. This is her first grandchild and I was really counting on the emotional and physical support from her in the weeks after giving birth. I also long to meet other new parents at community activities. Thank goodness for Skype and FaceTime!” she said. 

Her birth in late March came at a time of uncertainty in Sweden; the first fatalities due to coronavirus had been confirmed, and while other countries in Europe were introducing lockdowns it was unclear what would happen here. Although Annelise felt “incredibly well cared for”, she still experienced miscommunication due to the fact rules were changing fast at the time.

Her husband went home after the birth to collect more of their belongings, and when he returned the staff were at first reluctant to let him in due to a very recent change in the rules around visitors.

“A great precaution in my opinion, but the communication from staff could have been better,” she said.

Annelise also appreciated the aftercare provided by the Swedish healthcare system, which included a home visit from a nurse and visits to a children's doctor. But as with the other mothers who shared their experience, this care can't replace a hug from a friend or family member. 


Both pregnancy and time as a new parent can feel especially isolating with a lack of in-person support groups or meetups. Photo: Stina Stjernkvist/TT

Anuradha, an Indian student in Gothenburg who moved to Sweden in 2017, gave birth in February before the coronavirus had been declared a pandemic and before Sweden had reported its second known case. She said she was impressed by the standard of care during the pregnancy and birth, and felt Sweden was the “best place” to be a parent.

Although there is currently no evidence that newborn babies are especially vulnerable to the virus, and studies so far suggest children are affected to a lesser extent than adults, she is concerned about her baby's health due to the limited data on the virus and the low immune system of newborns.

“We still do not take her outside unless very necessary. My husband is working from home and going outside only for groceries,” the new mum explained. “We had planned to go back to home to India to introduce our daughter to her grandparents but now the plan is postponed. We want to take her out and play with her, we also want to introduce her to friends and family [but] we are social distancing for her safety.”

Jill Leckie of LittleBearAbroad says her team quickly noticed that the international community were following social distancing measures to a high degree, and adapted accordingly. As participation in in-person events dropped, the team worked to produce a digital events programme, ranging from online daytime discos to Zumba for pregnancy classes on Zoom, and English-language storytelling online. 

The group has now begun hosting the international playgroup outdoors and at a safe distance, and Leckie hopes to slowly reopen further over the coming months with smaller events and outdoor activities.

“Throughout this time, we've tried to communicate to our community that their feelings, concerns and actions about what is happening here, and back in their home countries, are valid. We want to offer international parents options and help people feel comfortable in how ever much social interaction they want, within the recommended guidelines,” she said.

READER VOICES:


Photo: Christine Olsson/TT

Another reader of The Local, a scientist from the UK who moved to Stockholm 18 months ago and asked not to be named, said that she had found both positives and negatives in her experience so far. 

“Covid-19 added a whole new level of stress to pregnancy!” she said, now just a few weeks away from her June due date.

Her partner was living in Germany with plans to move to Sweden in April along with their pet cats and belongings. But by April, Europe had become the epicentre of the coronavirus pandemic with Germany under lockdown and many flights between the two countries cancelled.

“My biggest concerns were: would my partner make it to Sweden before I gave birth, will my partner be able to be at the birth, and we will not have any other family support once the baby is here, so how are we going to manage?” she explained.

Fortunately, he was able to relocate, although the couple's family members who had hoped to visit before the birth have been unable to travel due to the risk of spreading infection.

Although she was sad not to have her partner at pre-natal appointments, the scientist added: “In some ways it's made me feel less anxious about pregnancy, as I haven't had time to research or prepare and have had to embrace the 'let's just wing this' approach. I've managed to find a couple of online groups for other mums. Hopefully once the baby is here we will be able to meet other new parents.”

With the due date now approaching, the couple are being especially cautious in avoiding social contacts, knowing that if her partner experiences cold or flu symptoms he will not be able to attend the birth. But they are looking forward to the months to come. 

“We're embracing the fact that it will just be us, the baby and two unimpressed cats for the first few months after birth,” she said.

You are not alone – living abroad in the time of corona

Thanks to everyone who responded to our survey and shared their experience. Some comments have been edited for length and clarity, and although we were not able to include all the responses, we selected a representative sample and read every response – these will help inform our reporting and understand your experiences. If you'd like to share how the coronavirus outbreak has affected your life in Sweden, or have a question, you can always contact our editorial team and we'll do our best to help.

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HEALTH

EXPLAINED: What to do if you face a long wait for healthcare in Sweden

Sweden theoretically has a "healthcare guarantee" limiting your wait to see a GP to three days, and to see a consultant to three months. The reality is somewhat different. Here's what you can do if you face a long wait.

EXPLAINED: What to do if you face a long wait for healthcare in Sweden

What is Sweden’s ‘healthcare guarantee’? 

Sweden’s “National Guaranteed Access to Healthcare” or vårdgaranti, is a right to care, protected by law, that has applied in Sweden since 2005. You can see the latest version of the relevant laws here and here. Here is a summary of the guarantee on the website of the Swedish Association of Local Authorities and Regions (SKR).

Under the system, all patients are guaranteed:

  • contact with a primary care centre by phone, in-person, or by video-link on the day they seek care 
  • an appointment with a doctor, nurse, physio, or psychotherapist within three days of seeking help 
  • an appointment with a specialist doctor or consultant within 90 days of seeking help 
  • treatment or operation within 90 days, if the specialist considers this necessary 

Does the guarantee mean I have a right to treatment? 

No. If the doctor at the primary care centre, after examining you and questioning you, decides that there is no reason to refer you to a specialist doctor, they do not need to do so. 

Similarly, if the specialist doctor, after examining you, decides that no treatment is necessary, then your case is considered completed.  

Can the waiting times to see a specialist or to get treatment be longer than 90 days? 

Absolutely. In fact, they very often are. 

According to the Swedish Association of Local Authorities and Regions (SKR), in February, 32 percent of patients had been waiting 90 days or more to see a specialist, and 43 percent of those who had seen a specialist had been waiting for treatment for more than 90 days.  

The situation in primary care was a little better, with 80 percent of those seeking care in contact with their primary care centre on the same day, and 83 percent having their case assessed by a doctor or nurse within three days. 

In addition, if you agree with your specialist doctor that you are willing to wait longer for an operation, then that wait doesn’t get counted in the statistics. 

So what can I do if I’ve been waiting longer than the guaranteed time? 

In reality, it’s actually less a guarantee than a target.

In primary care, there is no way for individual patients to complain that they have had to wait too long to see a doctor or nurse, or to cut their waiting times by citing the guarantee. 

“There’s no system for enforcing that guarantee,” says Emma Spak, the primary care doctor who doubles as section chief for SKR’s healthcare division. 

It would make no sense to set up a complaints line for those who have had to wait too long for phone contact with their primary care centre, she points out, when they could instead talk to patients seeking a primary care appointment in the first place. 

“It’s more of an incentive system for the regions,” she explains.

Every primary care unit and every region reports their waiting times to the national waiting time register, and then as part of the access agreement between SKR and the government, the regional health authorities receive a bonus if they meet their waiting times goal, or if they improve their waiting times. “That’s one way of sort of enforcing this guarantee,” she says. 

When it comes to specialist treatment, though, patients do have the right to demand to be examined or treated by an alternative specialist or hospital if they’ve had to wait longer than 90 days.

If your primary care centre issues you a referral to a specialist, and the specialist cannot then offer you an appointment within 90 days, the specialist, at the same time as offering you a later appointment, will often put you in contact with a unit at the regional health authority who will offer to find you an alternative specialist, either within the region or elsewhere in Sweden. 

The regional health authority will then have to reimburse any extra travel or hotel costs incurred by the patient.  

Similarly, if after examining you, a specialist cannot offer you treatment within 90 days, they will normally put you in contact with the same unit. 

Some regions have a phone line for people who have been waiting too long, or else you can contact your specialist or primary care centre and ask for information on seeking an alternative specialist. 

What happens if I don’t want to travel to see a specialist or get treatment? 

If your regional health authority offers you an alternative specialist, either within your region or in another region, so that you can get treated within the 90 day period, and you are unwilling to travel, then you lose your rights under the guarantee. . 

“If you’re in Gothenburg, and they say you have to go to Stockholm to get your treatment, and you say, ‘no, I want to go here, then then you’ve sort of forfeited your right, and you have to take what’s on offer,” Spak says. 

What happens if I agree with my specialist to wait longer? 

If your specialist says that they can treat you in four months, but also offers you treatment elsewhere within the guaranteed 90 days, and you choose to be treated by your specialist, then that counts as a patient choice, which will not then be counted in the statistics. 

“The specialist might say, ‘I don’t think you will get any worse for waiting two months extra, and if you wait five months, then I can make sure that you get your surgery done here, and we can make sure that you get all the aftercare and everything here as well,” Spak says. 

But these patient decisions are also counted in the statistics, and if a region sees a sharp rise in patients choosing to wait, SKR will tend to investigate. 

“If some region all of a sudden has a lot of patients choosing a longer waiting time, then we will call them and ask what’s going on here, because patients don’t tend to want to wait extra,” Spak says.  

Can I get financial compensation if I’ve been waiting too long? 

No. 

What other ways are there of speeding up the wait for treatment? 

Don’t underplay your symptoms

When drawing up their timetable for treatment and assessment, specialists will tend to give different patients different wait times depending on the urgency of their case.

For this reason, it’s important not to underplay your symptoms when visiting a primary care doctor, as they will tend to include a few lines on the urgency of your case when they write their referral. 

Stress your flexibility 

If you are unemployed, a student, retired, or have a very flexible job, it is worth telling your primary care doctor about this, because they may write in your referral that you are able to make appointments at very short notice. The specialist may then put you on their list of people to ring if one of their patients cancels. 

“Sometimes I write in my referrals that this patient could easily come at short notice, so please put the patient on the list for people you can call if there’s a time slot available,” Spak says. 

If you haven’t told your primary care doctor this, it’s not too late. You can ring the specialist yourself and tell their receptionist that you are very flexible, and ask to be put on the back-up list. This is particularly useful if you’re waiting for a scan, but you could also potentially work even if you’re waiting for heart surgery or a hip replacement. 

“If they’ve accepted you as a patient, and they’ve made sure that you fulfil the criteria for having that scan or whatever, then you can call them and say, ‘I have a really flexible job, I can come anytime if you have a gap,'” Spak says.

“A lot of people do that, because they can have [back-up] waiting lists. If you tell them ‘I work around the corner and I only need 15 minutes to be there’, then they might call you if someone doesn’t show up.” 

Ring up your specialist 

The queue system tends to be quite ad hoc, with no strict rules over who should be treated first, so it is often possible to reduce your wait by ringing up your specialist a few times a month, just to bring your case to their attention. Sometimes the receptionist will remember a slot that has just come free and bring forward your treatment while you are still on the telephone. 

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