This hospital has a 14% c-section rate. The hospital in my Florida hometown has a 39% c-section rate.
I was also scheduled for childbirth classes (in English) that will be offered in January. I am taking the classes in hopes of learning more about the maternity system here, as well as possibly meeting other English speaking couples with new babies. The surprise was that all childbirth classes are during the day. Mine are at 9 am on Friday mornings! Because midwives don't want to work at night for classes, right? This was funny, since all American childbirth classes are at night, to accommodate working parents. Here, you generally get pay if you take time off work for family stuff, so its no big deal to offer them in the day I guess.
If I was like most normal people here, and I would just keep going to the clinic, take my classes, and when I was in labor I would go to the hospital and who ever was on call would take care of me. But I am not normal, so I am choosing a home birth! But for the average person who goes for the hospital birth, there would be one midwife assigned to them on arrival at the hospital, a second or third if she labored through multiple shifts. The midwife would be the primary care giver for labor and birth. There would be no labor and delivery nurse (taking care of 6 people at once) trying to monitor the baby and report to a doctor who was off site at his office doing clinic or at home in bed...I think this may be one of the big keys to the success of the Swedish system- it is safer when the same person who collects information - who knows how mom is, how is labor going, how is the baby- is the same person who makes decisions about the pair. In the US, I think both doctors and nurses are in a bad situation, since the nurses collect the information but have no power to decide what to do with it, and doctors decide what to do but are not with the patient to know what is really going on. It creates a situation where everyone ends up thinking the best thing is to just do something, just in case, since they are out of touch with what is really happening (or needs to) for the patient. The Swedish midwives do as I did at my birth center, and attend a mother for all of labor and birth. The Swedes have water tubs for labor in the rooms, and use water for labor, but there is a national policy against water birth. This is one of my reasons for having a home birth here- I really like using water for labor and want to birth in it if I feel like it, which I can only do if I go outside of the system.
In the hospitals, you can get epidurals, but most women do not. At my hospital in Florida, there was a 90% epidural rate. Women are often signed up for them at their first prenatal visit!!! In the US, epidurals are pushed because 1) A hospital needs to do enough of them to pay the anesthesiologist on staff and keep him busy 2) If you are under staffed, it is far easier for one nurse to monitor six numb and bed ridden patients with belt that's printing out the status report at the nurses station than monitoring six women who are moaning, groaning, and walking the halls and getting in and out of bathtubs 3) Women in Sweden are met with reassurance and guidance when they feel afraid in birth, instead of offered medicine 4) Swedes use nitrous oxide/ laughing gas (yes, whippets!) as the most common pain relief for labor. After giving birth, women can stay anywhere from a few hours to week, depending on their preference. There is a patient hotel where they can stay postpartum and get served food, and get breast feeding help, for about as long as they choose.
Painting in the waiting area at the Swedish Hospital
I am the type that would want to go home as as quick as I was allowed, so I will just plan to stay home for the whole birth! I guess I will miss out on the gas/whippets for labor. In the UK, home birth is part of the official national health system and the midwives do carry gas with them.Here, home birth is not very common. As far as I can tell there were only about 100 home births in all of Sweden last year. In the Stockholm area, you can have a home birth as part of the standard care, but it is a fairly new choice. Home birth was phased out sometime ago in Sweden and is considered very fringey. The criteria for home birth is very selective in Stockholm- only women who have had previously had a vaginal birth are eligible. And so of course no home birth after a previous Cesarean. The strict risk screening, like the water birth policy, is actually pretty Swedish. I find Swedes to be a bit over cautious in many ways. There is a big push for evidenced based medicine here, but it is not with out biases against things that are new and different to them. Alternative medicine is integrated into the system in many ways- like you can get acute acupuncture for birth issues, dentistry, or back pain, but systemic treatment and healing from acupuncture is uncommon.
I would be disqualified from home birth in Stockholm, the one place there is an official Swedish home birth policy, due to the previous c-section. So it is a blessing and curse that home birth is not officially part of the health care system in my region. On one hand, I have to pay out of pocket for my midwife to come to the birth, but on the other hand, home birth is still an option for us.
I arranged for a home birth by contacting a home birth midwife I found from the the Fodda Hemma website. We set up a time to meet, and after talking sometime she determined that with my history of c-section, I would need an OB consult for her to feel comfortable attending me. So that is what we did this week.
We are hiring her only for the birth. She works at the hospital, and only attends births, and does not do prenatal care, as per the normal version of maternity care in Sweden. She does home births as a side business. She does not do prenatal care, even for the homebirthers. Hommebirthers go through the regular village clinic for prenatal care like everyone else. When I was a midwife, I always did the whole person's care- prenatal, birth, and follow up. For many years, I also taught water prenatal exercises classes and childbirth classes. The advantage of that is it gave me many times to meet the woman and her partner, and really build a relationship. I will have one home visit by the midwife and her midwifery partner before the birth. We set it up for 36 weeks, since that is when I did home visits for people. I am a bit discouraged that I will not have more chances to get to know her better, feel out her style, as well as for her to get to know me. But if I was going to a Swedish hospital, I would not know the midwife at all until I got there. She said I can call and email her, so I am sure I will to check on her style and approach to specific things and well as let her know my preferences on things before hand. But she has been doing births for 30 years, really believes in natural births, and has a passion and love of home birth. She got turned on to home birth after reading Ina May Gaskins, and had a home birth herself. She seemed sweet, capable, level headed, and had little turquoise earrings, which made me feel she had a bit of a bohemian edge in her.... I like that I will have someone from a good system, but willing to come meet me with in my own environment. And should we need to transfer for birth, she can still care for me at the hospital.
So we are on our way, we are planning our homebirth!