Having a child in Sweden as a foreigner: a guide about pregnancy, labor and postpartum care

I remember moving to Malmö and feeling overwhelmed by trying to navigate all the bureaucracies, healthcare system, lifestyle, and more. It was a completely new reality in Brazil. There are great differences between Sweden and other countries and regarding pregnancy care, giving birth process, and postpartum care, no exception takes place.

So, you may wonder: How is the prenatal assistance in Sweden? Where can one give birth? Is the birth process centered on the doctors? Is C-section a choice? Will it cost tons of money? How is the care immediately after and weeks later? Will the new parents be entitled to holistic postpartum care and support?

Well, after 2+ years living here, a postpartum doula and birth doula education, having 10+ open tabs of 1177 webpage and others on my browser, reading books, and checking notes from lectures I have attended, I dare to share my compiled information regarding pregnancy, giving birth and puerperium in Sweden.

1. General information about healthcare

First things first, let's talk about the golden ticket to accessing healthcare in Sweden – the Swedish tax identification number known as personnummer (PN). This unique identifier opens doors, ensuring you and your little one get subsidized care throughout your journey. Visits to midwifery clinics (barnmorskemottagningar) or pregnant women and child health centers ( barnavårdscentraler - BVC)  are free of charge!

If you have moved here and do not have one yet, you can still access it. Maternity care is considered medically necessary care (nödvändig vård) and you will have it with reduced costs instead. Short-term visitors without a PN must obtain private health insurance or a European Health Insurance Card (EHIC) for EU/EEA nationals before coming. Note:  Iceland, Liechtenstein, Norway, and Switzerland are covered by EHIC and Sweden has special agreements with Algeria, Australia, Quebec, and Israel.

Regarding prices, basic healthcare visits are usually pocket-friendly, ranging from 110 to 220 SEK, depending on where you live. However, there is an important fact: thanks to the high-cost protection card (högkostnadskort), capping expenses at 1.400 SEK under twelve months for residents.

Specialist appointments might dig a bit deeper into your wallet, going up to 400 SEK. Hospital stays? About 130 SEK per day. In some regions, there are additional restrictions on how much you need to pay, such as for long stays. To finish the topic, giving birth without personnummer or EHIC can come with bills racking up to around 65,000 SEK. Quite a lot, huh?

  But let’s move forward and discuss the other points!

2. Prenatal phase and care

Upon discovering your pregnancy, you may reach out to a maternity care center (Mödravårdscentral - MVC) to initiate your prenatal care journey. There, you will meet with a midwife, not an Obstetrician, to discuss your pregnancy, health concerns, and preferences for childbirth. The visits are free of charge and not mandatory.

If you have a low-risk or regular pregnancy, you will meet your midwife around 6 to10 times.  In case of certain illnesses or conditions, you may need to go to something called specialist prenatal care (specialistmödravården). The referral is made by your midwife or doctor.  

A basic program includes guidance, tests, and check-ups.  These examinations are typically performed at different stages of pregnancy, and you can see it in more detail below:

Week 4-8: During the first visit you will talk about your health, your pregnancy, your lifestyle and get guidance regarding the topics. You will also be informed about prenatal ultrasounds, tests and check-ups.

Week 8-14: It is time for follow-up on your health. During this time, you will have the opportunity to undergo the first ultrasound examination, typically scheduled between weeks 12 and 14. It shows how long the pregnancy has lasted, when you are expected to give birth and how many fetuses are in the womb. Another available option is the KUB test, which stands for Combined Ultrasound and Blood test. It assesses the likelihood of certain chromosomal abnormalities in the fetus. The blood sample required for the test is usually taken after you've passed week 9, while the ultrasound is conducted between weeks 11 and 14. In some cases, additional tests may be recommended for further clarity, such as NIPT (Non-Invasive Prenatal Testing), amniocentesis, or placenta sampling. These tests are only conducted if necessary and under referral from your healthcare provider, who will also explain any associated risks. It is entirely normal to have questions or concerns about these tests. You can always discuss your options and any potential outcomes with your midwife. They can provide guidance on whether the KUB test is right for you and offer support and information if the results are unexpected.

Week 18-20: You can have an organ screening ultrasound of your baby. It also shows the location of the placenta.

Week 24-25: Pregnancy check-up (urine test, blood pressure, baby movements and heartbeat), as well as discussing preparation for breastfeeding and parenting. You will receive a certificate of pregnancy to send to the Swedish Social Insurance Agency.

Week 28-29: Time for glucose tolerance test to detect gestational diabetes.

Week 31-39: Usually, the visits occur every 2 weeks and cover your feelings; pelvic floor function and training; your thoughts about the birth and further plans; how to choose a child healthcare centre (BVC); exam of the uterus’ growth and how the baby is in there; contraception guidance. Around weeks 35-36, the midwife will make a summary of the pregnancy together with you.

Week 39 – delivery: Usually, the visits occur every 2 weeks. Your midwife will tell you how to contact the hospital if the birth does not take place in week 41.

6 to 8 weeks after delivery : After giving birth, your midwife will check in with you to discuss your physical and mental well-being. A follow-up visit, includes conversations about your pregnancy and childbirth experience, breastfeeding, contraception, and pelvic floor exercises. Additionally, a gynaecological examination is offered during this visit.

2.1 Doulas and additional support services

In addition to the support provided by healthcare professionals, many parents in Sweden also choose to enlist the help of doulas. These trained professionals offer emotional, physical, and informational support to expecting parents before, during, and right after childbirth. Their goal is to contribute to a birth experience that parents can remember fondly.

 While doulas’ services are not typically covered by the Swedish healthcare system, many parents find the investment to be well worth it for the personalized care and support they receive.

You can find a doula by looking on websites like ODIS (Organisation for Doulas in Sweden) and Birth Rights Sweden, or just by doing a Google search..

3. Childbirth

Vaginal birth or caesarean? Hospital, birth center or home? You may have doubts about what is common, so let me explain.

 

3.1 Venue

First off, it is essential to note that the Swedish healthcare system primarily covers births at hospitals. While planned home deliveries or births at birth centers are options, they're typically offered privately by midwife-run companies. As of May 2024, Sweden has only one birth center, located in Gothenburg.

Now, if you are leaning towards a hospital birth and wondering whether you have a say in which hospital to choose, the answer is yes! You do have the option to select a hospital for your childbirth journey. However, there is a slight catch – if your chosen hospital is at full capacity when the time comes, you might find yourself redirected to another facility.

Here is how it works: You express your preference for a specific maternity ward and keep them informed about your labor status. But, if your chosen hospital is unable to accommodate you due to capacity issues, they might refer you to an alternative hospital. For instance, if you are residing in Malmö and plan to give birth there, but the maternity ward is full, you might be redirected to Lund or another city instead.

3.2 Knowing when to go to the maternity ward

During pregnancy, understanding when it is time to head to the maternity ward is crucial. It is generally recommended to stay home during the early stages of labor, allowing yourself to rest while monitoring the progression of labor. As labor begins to intensify, it is worth considering a trip to the hospital maternity ward.

However, before making your way there, it is recommended to give the maternity ward a call first. This step allows them to prepare for your arrival and offer guidance over the phone. They may ask you a few questions to assess the situation and help you determine whether it is time to come in or if you should wait a bit longer.

Curious about what signs may prompt you to go? I tell you!

- The contractions are regular and very painful. The contractions come 2–3 minutes apart. - Each contraction lasts about one minute.

- You have given birth previously. In such case, labor may progress more quickly.

- You must travel a long way to get to the maternity ward.

- Amniotic fluid has come out of your vagina. This is especially true if the fluid smells bad and is brown or brownish.

- There is blood coming out of your vagina. - You have pain all the time.

- Your contractions are not severe but have been going on for a long time. You may need comfort measures to help you rest and regain your strength.

3.3  At the maternity ward

 When you arrive at the maternity ward, a midwife will be there to greet you and check on your labor progress. Depending on how things are going, they might suggest going back home if labor hasn't fully started or encourage you to stay if it is well underway.

You will also find obstetricians or pediatricians on the ward, ready to lend their expertise if needed, especially for procedures like vacuum extraction, C-sections, or specific procedures to check on your baby’s status during labor. And if you decide on an epidural for pain relief, you will meet an anesthesiologist too.

It is worth noting that the midwife looking after you during labor will not be the same one you've seen for your prenatal check-ups. In Sweden, there is a distinction between midwives who handle prenatal care and those who assist with deliveries.

Midwives in the delivery ward usually work alongside an assistant nurse, and sometimes you might even have two midwives or a midwifery student present during the birth. And don't be surprised if you see a medical student observing in larger hospitals!

As for the delivery room, they can vary in layout, but you can expect a birthing bed and comfy seating. You will also have access to nitrous oxide for pain relief, and you are welcome to take a shower or bath nearby. Oh, and don't forget - you can snack and sip drinks during labor, whether you bring your own treats or enjoy what the ward staff offers!

3.4  C-sections

In 2023, Sweden's C-section rate hit 19.4%, showing a rising trend with variations across different clinics. This rate is actually seen as favorable on an international scale.

In Sweden, C-sections are typically performed only when there's a valid medical reason, especially in emergency situations where a normal birth isn't safe anymore. It's rare for a C-section to be done solely on a parent's request.

While obstetricians ultimately make the call on whether to perform a C-section, midwives play a crucial role in these discussions. In non-emergency scenarios where it's clinically safe, it's common practice to discuss and consider the parent's preferred mode of birth.

If you are anxious about vaginal birth, Sweden offers a program called AURORA to address such concerns. Staffed by experienced midwives, counselors, and doctors, AURORA specializes in assisting women with childbirth-related fears. You can access this program upon referral and scheduling via 1177. Whether you need a single session or multiple visits, support is available to provide a safe and positive childbirth experience for you, your partner, and your baby, regardless of the delivery method. Discussions will focus on alleviating fears and crafting a personalized birth plan to ensure your needs are met during labor.

4. Postpartum care

Your baby has arrived, the placenta is out and you all have been taken care of by the caregivers.  What now? Well, in case of vaginal birth and no complications, you are allowed to go home after 6 hours. In case of c-section, 2 days.

When staying, you will be sent to BB-avdelning. You will have your baby with you, and you will receive assistance with postpartum care, baby care, and breastfeeding. The sectors can be different depending on the region, but sometimes the other parent can also stay in the maternity wards. Relatives and siblings of the newborn child are usually allowed to visit.

If you choose to go home before your baby is 48 hours old, you will be given an appointment for a postnatal check-up, where a midwife will assess your baby's health and offer essential tests like the PKU and hearing exams known as OAE.

As mentioned before, there is an appointment to check your physical and mental well-being, including a gynaecological examination

Once home, while you may receive visits from midwives through the BB Hemma program, managing the postpartum period largely falls on you and your partner. “There is talk of the "baby bubble" where the family should be given time to enter the new life without being disturbed, but many experience the baby bubble as claustrophobic and filled with anxiety, fatigue and worry.”  - Maria Borda & Opokua B. Cavaco in Det nya livet, 2024, p. 53.

Although Sweden offers comprehensive state support with free maternal care and check-ups, some parents miss the traditional community support that once characterized the postpartum period. In a system focused primarily on the baby's well-being, the needs of the new parent and family dynamics may sometimes take a back seat.

4.1 Additional support services: Postpartum doulas

 You've learned about (birth) doulas earlier. They are quite popular worldwide and in Sweden. But there's another kind of doula which is newer and less known - the postpartum doula.

Postpartum doulas, like their counterparts, are trained professionals who offer informational, physical, emotional, and practical support. However, they specialize in caring for new parents after the baby's arrival.  Yes, caring for the parents, not only the baby.

A skilled postpartum doula knows what new families need and bases their care on scientific evidence and values, aiming for a smooth recovery, rest and comfort. They can also connect you with other professionals if necessary to support the transition to parenthood.

To find yours, you can again explore ODIS website or conduct a search on Google. It is worth noting that according to ODIS, there are currently four certified postpartum doulas in the country.

5. Conclusion

Navigating pregnancy, childbirth, and postpartum care in Sweden can be overwhelming at first, especially for newcomers. However, with the right resources, education, and support, individuals can access comprehensive and holistic care that prioritizes the well-being of both parents and their babies.

As you embark on this new chapter in your life, take comfort in knowing that you are not alone. Whether you are leaning on healthcare providers, doulas, fellow parents, or community resources, there is a network of support ready to assist you on your parenting journey in Sweden.

I hope this information has been helpful!

Do you have any experiences or insights you'd like to share? Or perhaps you have additional questions about navigating the healthcare system?  

Leave a comment below - I would love to hear from you!

References

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