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‘Fantastic childcare, but disappointing maternal care’: How Covid-19 has stretched Sweden’s maternity wards

Women who gave birth in 2020 told The Local how they were affected by hospital staff shortages, as a new study shows that more than 900 women in Stockholm could not be offered a place on maternity wards when they gave birth.

'Fantastic childcare, but disappointing maternal care': How Covid-19 has stretched Sweden's maternity wards
Staff shortages and limited hospital beds have changed the experience of childbirth in Sweden. Photo: Tomas Oneborg/SvD/TT

It’s the first time the region has reviewed how many people were not given an appropriate hospital bed when they gave birth. A total of 28,362 births were recorded last year in Stockholm, but 80 women were directed to a different region for care and for a further 929 women there was no suitable hospital bed available.

Instead these women usually gave birth in rooms not intended for childbirth, SVT Nyheter reported, which in some cases had negative effects on patient safety, for example if the room did not have the right equipment.

In one case, a woman was sent home and gave birth in her own shower, and the report found that one child died because of the lack of hospital bed.

Sweden has faced issues in maternity care for several years, with rates of injury in childbirth above the OECD average. Between the years 2000 and 2017, nine maternity clinics were closed nationwide, with the sparsely populated northern regions particularly affected. After protests, recent years have seen regions invest in improving maternity care.

But during the pandemic, pressure on healthcare has only increased, with staffing problems reported in multiple regions last summer. 

One woman who gave birth in Gothenburg, Jessica, described her labour of over 40 hours, in which she suffered significant blood loss and had an emergency Caesarean.

During her time in the postnatal ward (BB in Swedish), she told The Local staff were “so busy that when I rang the bell for help it could take upwards of 20-30 minutes for someone to arrive. I wasn’t allowed to leave the room, either, due to Covid-19. It was like prison.”

“Furthermore, due to Covid-19 I never saw a midwife for a postpartum check-up,” she said. “They changed that meeting to a phone call, with a midwife I’d never met before. It was a pointless phone call in my opinion. I am highly dissatisfied with the post care, or lack thereof, that I received.”

As well as worries about their physical health, several women who gave birth in Sweden in 2020 have said their mental health concerns have not been addressed. While many had found support from fellow parents, through social media and WhatsApp groups, and some had been able to access support from healthcare clinics digitally, several felt neglected.

“I’m really disappointed with the maternal care in Sweden and I know that other women who have had babies in 2020 have felt the same. The childcare is fantastic and I feel my baby couldn’t be better taken care of, but I feel forgotten and not really sure where to turn to for questions about my own health,” said a Stockholmer who moved here in 2014.

Her concerns included a lack of follow-up after receiving a high score in a screening for depression, a lack of information about how the hospital had changed its procedures due to the pandemic, and the difficulty of not being able to be accompanied by her partner at emergency care visits for her young child.

Another woman, who gave birth in Stockholm in October, said that the shortage of staff due to Covid-19 had a direct impact on her birth.

“We went through so many different midwives, doctors and nurses that it was ridiculous. It was pretty common to hear from the nurses and midwives, ‘I don’t actually work at this hospital, so I am not sure how they do things here’. There was a huge communication problem where midwives were not passing on information to each other or not documenting it in the journal. [When] I finally went into active labour, I had a failed epidural and they were unable to get the anesthesiologist back to my room that evening due to short staff. I had no pain relief apart from gas and air for 15 hours,” she said.

The new parent also described the stress of going through regular check-ups alone, saying she was told her partner could not even join virtually. Throughout the pandemic, rules about whether a partner can accompany new parents to appointments and even during the birth have varied between regions and over time. In some cases when the partner cannot join in person, they can join digitally through apps like FaceTime, but this parent said she was not allowed to use this option and her husband missed out on the scans.

“I had a tricky pregnancy and required a scan every two to three weeks to make sure that baby was growing well,” she said. “There were a few times where the sonographer would go very quiet and this would then trigger worry and concern, this made me feel very alone and scared not having my partner with me. So I would just then dread each appointment through my whole pregnancy.”

“My husband could attend the birth but had to leave a few hours later when I went to BB [maternity ward]. I don’t have much knowledge with Swedish medical terms and I felt very bullied about breastfeeding while alone,” said another woman, who moved to Sweden three years ago.

According to figures from the umbrella organisation for Sweden’s municipalities and regions (SKR), nationwide the proportion of new parents receiving after-birth follow-up from a midwife rose from 79 percent in 2015 to 86 percent last year. And the gap between foreign-born women and native Swedes has reduced, with the figures changing from 69.6 and 82.1 percent respectively in 2015, to 81.8 and 88 percent in 2020.

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FAMILY

How to use all your parental leave in Sweden before it expires

The parents of fully 70 percent of children in Sweden fail to take all the parental leave available to them before it expires. But there are some tricks to make sure you use it all.

two parents and two children in a car
You could save some parental leave days to use for a long holiday – but be careful so that they don't expire. Photo: Simon Paulin/imagebank.sweden.se

“The Swedish Social Insurance Agency has decided that you will not receive child benefit for Finn from December 24th to January 8th,” read the letter that dropped into my secure digital mailbox over Christmas. 

My son turned eight on December 23rd, and as he was born just a week before a new more generous policy became valid in Sweden, that marked the end of our eligibility for child leave.

And just as had happened with his elder sister, we had let his leave expire with more than a month of leave yet to claim.

It turns out, we are far from alone.

The parents of fully 72 percent of the children born in Sweden in 2010 failed to claim all of their shared 480 days of parental leave by the time they expired in 2018, according to the latest statistics from the Social Insurance Agency. On average, parents in Sweden failed to claim about a month, but 21 percent of parents had, like us, failed to claim more than 60 days.

In total, that amounted to 1.4 billion kronor ($154.4 million) in unclaimed benefits, and according to an analysis by the agency, it was those with the lowest incomes who had the most days left over.

A graph showing how many days of parental leave was not claimed for children born in 2010, divided up by (from left) low-income, mid-income and high-income families. The dark green shows days paid at 80 percent of the salary (sjukpenningnivå) and the light green the lowest-paid days (lägstanivå, 180 kronor a day). Photo: Försäkringskassan

A change in the rules since my son was born has made using your days quite a bit easier. Parents of children born after January 1st in 2014 (a week after my son), can now continue to take out leave until their children’s 12th birthday.

But be aware that all but 96 of these days expire when the child turns four, so the race is still on.

If you want to understand how parental leave in Sweden works, here’s The Local’s detailed guide to how the system works

But to avoid other foreigners in Sweden suffering the same disappointment as I did, keep scrolling for some tips for how to make sure you use all that leave.

Take leave together 

Swedish rules allow both parents to take leave at the same time. In the first few months, this can really take the pressure off the mother, allowing her partner to take over while she makes up for lost sleep, or takes a precious hour or so to herself. 

The rules allow each couple to claim a maximum of 30 of these so-called dubbeldagar or “double days”, which taken together will use up 60 days of leave. 

These days cannot be taken from the 90 reservdagar, or “reserve days”, which are tied to each parent to prevent fathers from taking out days at the same time as leaving the mother to do all the actual childcare. They also can only be taken before the child is one year old. 

Claim leave for ordinary holidays 

My mistake was to see parental leave as something to take only when I was off work specifically to look after my children. In fact, you can take it out any time you are not actually working: when you take time off over Christmas, Easter, during the sportlov or höstlov school holidays, or over the long Swedish summer. 

“My husband takes all of the school holidays and the summers off so we can travel and all be together,” says Martha Moore in Malmö. “I’m a teacher, so I will probably give all of my days to him, since I get to be off when my kids are off anyway.”

You can even claim for days which you are also claiming as holiday from your work, or days which are public holidays in Sweden, but you can only claim parental leave for these days at the so-called lägstanivå, or base level of 180 kronor a day.  

You can claim some days at the same time as the other parent. Photo: Magnus Liam Karlsson/imagebank.sweden.se

Take a very long holiday 

One Australian living in Stockholm said she was off to Thailand for two and a half months this February in order to use up some of the days from her second child, which are due to expire when she turns four later in the year.

She recommends planning one long holiday to use up any of the 384 days that will expire when your child turns four, and then saving up the other 96 days for a second long holiday before they turn 12. 

She is putting her eldest child into a Swedish school in Thailand while they are there, using one of the chain of Swedish schools set up in Thailand, primarily for parents holidaying on their parental leave.  

She deliberately didn’t use as many days as she could have in the first 12 months, so that she and her husband could do this. “My tip is to not use many days at all paid that first 12 months, and to burn your savings instead,” she says. 

As her child is more than one year old, she and her husband cannot take leave simultaneously, however, so he is using holiday time he has saved up. 

Take leave before the birth 

The pregnant parent can start taking parental leave and collecting benefits up to 60 days before the due date. It’s actually compulsory for the mother to take two weeks of leave in connection with the birth, which can either be before or after. New fathers or secondary caregivers can also start taking leave up to ten days before the birth. 

This could be a waste of days, however, as if a difficult (or, let’s face it, even fairly normal) pregnancy makes it impossible to do your job, you can claim sickness benefits instead of parental leave, and get the same level of benefits without using up any of your 480 days. 

This does not apply, however, to “normal pregnancy difficulties such as back pain and fatigue”, so to claim sickness benefits, you will have to convince your doctor to certify that you have pregnancy difficulties that are “unusually severe”. 

A father carrying his child in a Baby Björn in Sweden. Photo: Melker Dahlstrand/imagebank.sweden.se

Take a chunk out to do private projects 

People less good at forward planning sometimes take a chunk of leave just before their child turns four or twelve (or eight if they were born before January 1st, 2014), even if they don’t have anything planned in particular.  

You can use this time to do the sort of home chores that it is so hard to find time to do once you have children. 

“I had a colleague who took two months’ maternity leave when her daughter was seven years old,” says one woman in Malmö. “She took it as a vacation in the summer to fix her apartment.” 

Use parental leave to work a short week 

Once the child is in preschool (dagis or förskola) many people, including Moore’s husband, use parental leave to take Friday and/or Monday off work for six months or more, allowing them to spend more time with their child.

This is obviously something you have to square with your employer, but in Sweden most employers are more than willing to put employees on 80 percent. 

You can either use this time to take some of the pressure off your partner during their parental leave, or to reduce the amount of time your child spends in preschool.

A parent walking their child in a pram through a snowy Stockholm. Photo: Jann Lipka/imagebank.sweden.se

Use parental leave to work short days 

You don’t need to take each allotted day as a full day, you can also reduce your working day by three quarters, a half, one quarter or one eighth, and receive proportional parental benefit for the time not worked.

Parents of a child under the age of eight can reduce their working hours by up to 25 percent, whether or not they decide to take parental benefit for the remaining 25 percent.

This can be extremely helpful in making combining childcare and work a little less stressful.

Claim leave for weekends 

You can claim parental leave on weekends as well as on normal weekdays, but unless you normally work on the weekend, you can only claim these at the lowest base level of 180 kronor. 

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