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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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How does the cost of childcare in Sweden compare to other countries?

Parents in Sweden benefit from a cap on childcare costs, with parents paying different fees based on their household's income. But how does the generous scheme compare to other countries?

How does the cost of childcare in Sweden compare to other countries?

Preschool childcare is not free in Sweden, but fees are income-based, with a maximum fee across the country 1,572 kronor (€145) per child per month (fees for 2022).

There are also deductions for each child if you have multiple children attending preschool at the same time – in this case the maximum fee would be 1,048 kronor for the second child and 503 kronor for the third, with parents paying no fee for any further children.

Children over three are entitled to 15 hours of free preschool education per week, so these are deducted from your fee once your child reaches this age.

To get an idea of how much you would have to pay based on your income, you can use this calculator (in Swedish – similar calculators exist for other municipalities). These fees are adjusted yearly by the Swedish school authorities and are applicable to all municipalities. If your child has a preschool place, you have to pay even if you do not use it – over summer or during holidays, for example.

School meals and preschool meals are free in Sweden, meaning you don’t need to pay extra for your child’s lunch, breakfast, or any snacks served during the day.

Denmark

The exact amount parents pay for childcare in Denmark depends on the municipality. In Copenhagen Municipality, the cost of nursery (vuggestue up to 2 years and 10 months) is 4,264 kroner a month including lunch (roughly €573). For kindergarten (børnehave from 2 years and 10 months to 6 years) it is 2,738 kroner a month including lunch (roughly €368).

The government pays 75 percent of the cost of a place or even more if your household income is below a certain threshold. 

If you have more than one child using childcare, you pay full price for the most expensive daycare and half-price for the others.

Norway

The cost of nursery and kindergarten is capped at 3,050 Norwegian kroner, regardless of the hours attended or whether that facility is state-run or private. This means you’ll never pay more than roughly €295 a month per child in childcare costs.

Germany

The costs for daycare centres (Kindertagesstätte, or Kita for short) can differ greatly depending on where you live in Germany, as the fees are set by the local government.

In Schleswig-Holstein in the far north, parents pay on average nine percent of their after-tax income on childcare costs. In Hamburg, 4.4 percent of parent’s income goes on childcare as every child in entitled to five hours of free care a day. In Berlin, daycare is completely free. 

Spain

Costs can vary depending on whether it is a  private or public guardería or centro infantil (as nurseries are called in Spanish).

Public ones are heavily subsidised by the government and cost around €100-260 per month, depending on where you live in Spain and your situation. Private nurseries cost between €150 and €580 per month. There is also a fixed yearly fee called a matrícula or enrolment fee, which is around €100.

There is a 50 percent discount for large families and single parents don’t have to pay anything for childcare.

There’s also a deduction of up to €1,000 (cheque guardería) that is applied to the income tax return and works out at around €100 to €160 per month which is aimed at working mothers and is available up until the child is three years old.

France

In France, crèches tend to be the most affordable option and the cost is based on the family’s income. High earners might pay up to a maximum of €4.20 an hour (€33.60 for an 8-hour day), whereas low-income families might pay €0.26 an hour (€2.08 for an 8-hour day) at a crèche collective, which is for three months to three year olds. At the age of three, compulsory education begins in France.

The cost of a childminder is around €10.88 an hour and up to 50 percent of the costs of a nanny or professional childminder can be reimbursed by the government.

The OECD calculations on the percentage of income spent on childcare – based on two parents both working full time – is 13 percent in France. This is roughly similar to Spain and Italy.

Austria

Public nurseries and kindergartens are heavily subsidised and in some cases free, depending on where you live. For example in Vienna, parents only need to pay €72.33 a month to cover meal costs, with low income families being exempt from that fee.
 
Vienna also subsidises private kindergartens, paying up to €635.44 a month directly to the institution. 
 
In other provinces, kindergarten is free for part-time hours. It is mandatory for all children in Austria to attend part-time kindergarten from the age of five. They start school aged six.

Switzerland

The average Swiss family spends a massive 41 percent of their net income on childcare, three times the OECD average of 13 percent.

The average cost of childcare in Switzerland is CHF130 a day (€136). Due to tax breaks and subsidies paid out in the cantons, many parents will pay between 30 and 80 percent of this cost, depending on income. This equates to paying between €41 and €108 a day, roughly €902 to €2,376 a month. 

It’s even more expensive to hire a nannie, which will cost between CHF3,500 (€3,678) and CHF5,000 (€5,255) a month, including mandatory pension contributions.

United Kingdom

According to charity Coram in their Childcare Survey 2022, the average cost of full-time nursery is £1,166 (around €1,304 a month), which is even higher in some parts of London. There are some government subsidies available for low-income families and those receiving benefits and every parent is entitled to 15 or 30 free hours of childcare the term after their child turns three years old.

Childcare conclusion

The cost of childcare varies within each country, depending on family circumstances. However, for guaranteed low childcare costs for every parent, Sweden comes out best, with a maximum of €145 a month.

Average monthly cost of state-run childcare:

Sweden: €145 maximum

Norway: €295 maximum

Austria: €72.33 – roughly €500

Spain: €100 – €260 

Germany: €0 –  €368

Denmark: €368 – €573

France: €45,76 – €739.20 

Switzerland: €902 – €2,376 

U.K. €1,304 which reduces the term after the child turns three.

By Emma Firth and Becky Waterton

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