Friday, February 12, 2016

Giving birth in Sweden: Labor, delivery, and the cost

Gamla Stan & Södermalm, Stockholm, Sweden  |  Giving birth in Sweden: Labor, delivery, and the cost on afeathery*nest  |
Now that our little guy is just over two months old, I've finally had a little time (and brain power) to think back on giving birth to him with something less akin to panic and more akin to fondness.

I mentioned before that I didn't put too much thought or preparation into the particulars of going through labor and delivering, but there were a few things that I wanted to have happen, namely, the use of water therapy, the avoidance of medical intervention, and no need for stitches (all of which I've been thinking about for many years).

Instead? No bathtub, lots of medical (read: chemical) intervention, and: stitches.

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My contractions began the evening of the day after my due date, but we didn't go to the birthing center until 24 hours later, after I had been experiencing contractions at home for an entire day. I had been in contact with the midwives at the birthing center ever since I first saw signs of impending labor, which happened 15 hours prior to my contractions starting, and we stayed in contact until I was finally told to come in.

I first called them (excitedly!) at 4AM when I lost my mucous plug—they talked me through what would happen next and how to manage the latent phase contractions when they started. Since my labor progressed so slowly, we ended up calling them quite a few times (each time a little less excitedly and a bit more frantically) before actually going in, and each time a patient, supportive woman reassured me and—thinking back on this now makes me a little emotional—made sure to tell me that I was strong and doing great.

Stockholm apartment buildings  |  Giving birth in Sweden: Labor, delivery, and the cost  |

Even after 24 hours of contractions had passed, they were still not close enough (i.e., 3-5 minutes apart, mine were 7-9 minutes apart) to warrant leaving the house, but when we called the midwives (again) to update them on my condition, they suggested I come in to be checked given how tired I said I felt and how far away I still was from active labor.

We called a taxi, grabbed our bag and headed in around 10PM. A midwife greeted us and did an exam, after which she related the (frustrating) news that I was only 2 cm dilated—you aren't admitted until you're at 4 (out of 10 cm) dilated, but I couldn't face the thought of going home as I was exhausted and nervous because of how slow my labor was advancing and R knew that, so he spoke with the midwives on call and they allowed us to spend the night in the "new family hotel", even though we were clearly not yet a 2+ family.

As the pain accelerated I took a dose of Alvedon (like Tylenol), a hot shower, and had a round of acupuncture, but by 3AM I couldn't breathe through the contractions anymore, so we pressed the call button for the midwives. Another painful check revealed I was almost 5 cm dilated and we were finally ready to be admitted to a birthing room. We quickly put our things together and moved to the room where we'd meet our little one.

Stockholm apartment buildings  |  Giving birth in Sweden: Labor, delivery, and the cost  |
I hadn't expected the pain to be so intense at that point—or rather, I had expected to have a higher pain tolerance, but whether that was just wishful thinking or my exhaustion at having experienced contractions without end for 30'ish hours had weakened me, or a combination of both, I immediately asked to try the lustgas (laughing gas), one of the natural pain therapies available. And when the midwives saw, as by then I was strapped to a monitor, that I was experiencing double contractions (overlapping ones, fun!), they had me hooked up to the gas in no time.

(There was absolutely no way I could have gotten into a tub at that point, which is why my hoped-for water labor didn't happen.)

The laughing gas worked well for a few hours, but not enough that I was able to rest before I would have to begin pushing so R and I talked with the midwives and made the decision that I would begin to get a small dose of an epidural—the one thing I'd hoped to avoid (given what I'd read about how it can make it hard for a woman to feel the final contractions and push effectively and how it can affect when your milk comes in*), but I knew that in order to get our baby out I'd need to rest, so I acquiesced.

The anesthesiologist came, prepped me, and began the dosage, which (luckily) in Sweden is done gradually, in very small amounts, versus one huge one, which helped me make the decision to have it. It did the trick and I was able to sleep for a few hours, which meant that R finally could, too.

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Our son's birth day had dawned beautiful and blue-skied, and dozing off in a sun-filled room while staring out picture windows to the greenery outside was a teensy bit magical (and not just because of the drugs).

Gustavs Kyrka, Odenplan, Stockholm, Sweden  |  Giving birth in Sweden: Labor, delivery, and the cost  |

When we woke up around mid-day it was go time.

In Sweden, women are encouraged to try multiple positions and apparatuses to help the baby descend. I tried a few things: sitting on an exercise ball, standing with a birthing "walker", and sitting on a birthing stool with R positioned behind me.

None of those did the trick, so I moved to the actual birthing bed and rather than laying down with knees bent as you see on T.V., I tried pushing while on all fours with R standing behind the bed and facing me, but still no baby.

By then my energy level was nonexistent, so the midwives helped me lay on my side while one raised a leg, another applied warm compresses, and the third, most senior one, guided our little boy out.

Not even two seconds had passed between him emerging and the midwife laying him next to me so that both R and I could stare down at the wondrous little being we'd created. I would go through everything again just to relive that singular moment of joy we shared when we first locked eyes with our son and were transformed from wife and husband to mamma and papà.

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It wasn't until a few moments had passed that I realized we didn't know if the baby snuggled up to me was a boy or a girl—in another departure from what you see on T.V., the midwife didn't call out what she saw (or didn't see) when she delivered the baby and handed it to me. I had the delight of peeking down below myself to see what was what and excitedly proclaim to R, "it's a boy!".

We stayed in our birthing room for a few hours while I was cleaned and sewed up—and unlike what I've heard about the majority of post-birth activities in the U.S., our baby stayed in my arms the entire time. He wasn't taken away to be cleaned up or even weighed.

A good two hours passed before I was able to sit up and then R, who had taken off his shirt in preparation, was finally able to cuddle with his son warm against his chest while I showered and dressed.

Then a midwife brought in the Swedish spread I had been promised—flutes of sparkling cider, coffee, open-faced sandwiches and a wooden Swedish flag tchotchke taking center stage on the tray. After we'd had our little bedside feast, another midwife came back to measure and weigh the baby and help R to give him his first bath.

View of Gamla Stan from Norr Malarstrand, Stockholm, Sweden  |  Giving birth in Sweden: Labor, delivery, and the cost  |
At that point we were ready to be moved to the Patient Hotel, where new parents and their brand new babies can stay for up to two nights (for births without complications) to recover and get to know their little one while all their needs are taken care of and midwives are on call in case any help is required.

When people back home saw photos of our room they were astonished—it contained a queen-size bed (with two mattresses and separate adjustment controls so both the mamma and papà can choose whether to lay down or sit up), night stands, a table and two chairs, a closet, and a private bathroom with a shower. Throughout the room small red buttons were installed, and pressing any one of them would bring a midwife to the door.

It happened that we were at the hotel over the Santa Lucia feast day and in true Swedish fashion we were treated to a Santa Lucia procession at dawn. I was nursing the baby when I said to R, "do you hear singing?". A few minutes later there was a gentle knock at the door and then someone poked their head through to ask if we'd like to have our door opened so we could enjoy the procession. Of course we said yes, and we soon saw the preceding glow of candlelight from around the corner before a group of ladies dressed in white robes, clasping candles, and with green crowns on their heads came to our door to serenade us.

As they moved on to the next room we were brought mugs of glögg (warm spiced wine, but ours were nonalcoholic) and lussekatter (saffron buns). There's no way we could have had a more perfect first morning with our winter baby—snuggling with him and R in the glow of candlelight and the scent of saffron made everything about the previous days' labor vanish from my memory ( least temporarily).

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The biggest and perhaps best advantage of giving birth in Sweden is the incredible care provided by the midwives. No matter where you give birth in this country, the pre-natal maternal care and actual delivery are all handled by midwives. You'll only see a doctor if there's a serious complication.

We chose to give birth at BB Stockholm, one of the birthing centers within a hospital (Danderyds Sjukhus) in Stockholm. There's a stand alone birth center in the center of the city (BB Sophia), but we opted to be close to a hospital, just in case. (One of the Swedish princesses gave birth to her son there last summer, not that that's why we chose it, but it was nice to know that it met royal standards.)

Stadshuset City Hall Stockholm, Sweden  |  Giving birth in Sweden: Labor, delivery, and the cost  |

I'm sure that all of the birthing centers and hospital labor and delivery wings provide amazing care, but we both felt that the care we received at BB Stockholm was incredible and could not possibly have been better anywhere else.

Despite not getting to have the birth I wanted, I never once felt scared (at least for my health or safety, for my pain, yes) or alone or helpless. At every step of the way there was a midwife offering encouragement to me, explaining everything to us that was happening (in perfect English!), laying a calming hand on my forehead or on my arm, and always being warm, chatty and sympathetic. There was a level of intimacy and kindness that I can't imagine having somewhere else (certainly not in NYC if I'd given birth at a hospital that accepted whatever insurance I happened to have). And when our son was finally born even the midwives were moved (I saw a tear!) and gave us both big hugs.

While the three teams of women that saw us through from my admittance to us taking our little boy home (plus the ones who answered our phone calls for the day-and-a-half prior to us even walking into the birthing center) officially carry the title of midwife, we'll always think of them as the angelic, blue-smocked shepherdesses who helped me bring our son into this world.

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And the cost of the tremendous care we received?

Gamla Stan from Norr Malarstrand, Stockholm, Sweden  |  Giving birth in Sweden: Labor, delivery, and the cost  |
Not only did I not pay a single thing over 40 weeks of prenatal care (nor are we paying anything now for our son's initially weekly, now bi-weekly checkups), but the actual price of giving birth in Sweden was zero.

The only thing that comes with a cost is the stay at the Patient Hotel—mammas pay 100 kronor, or ~$12 per day for care and all meals, while the papàs/the other partner pay 500 kronor, or ~$60 per day. For the two-and-a-half days we were at the hospital, the total cost we paid upon leaving was $144. Not too shabby for giving birth and recovering in the 5th best country in the world for maternal health.

Although that midwife care? We could never put a price tag on that.

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More on Swedish healthcare, prenatal care and giving birth in Sweden:

* Whether it was an effect of the epidural or not I don't know, but in the last moments of delivery I did indeed (terrifyingly) have trouble "feeling" when to push, the result of which was a painful-to-recover-from set of stitches. My milk also came in "late". (But even if I'd known that that would have been the case for me, I'd still have taken the epidural.)

One year ago: The end of the year festivities & A wintry sunset walk
Two years ago: 2014: the beginning & Week 1
Three years ago: Postcard from Honduras & A sheaf of the past

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