When I learned I was pregnant and started planning this blog a few months ago, the intention was to help those newbies to Sweden navigate the public health system for their first pregnancy in Sweden. As a mother of a toddler born in the US, navigating the Swedish system for this new pregnancy was daunting.
Even confirming the pregnancy was more complicated than I expected. In the US, I stopped at the grocery store and picked up a pregnancy test. When it took longer than expected to conceive, I was able to buy bulk tests from the internet for a fraction of the cost. Here, I found myself needing to find a pharmacy to buy tests and the least expensive I found was 120 SEK. Ouch! Expensive. Those of you now facing this dilemma, I recommend checking out tradera.com; after my own debacle I did more research and discovered you could find the bulk tests there for a much more reasonable price.
Going public or private with your pregnancy
Once I tested positive at home, I spent hours scouring the internet to determine my next step and found myself more confused than when I started. Finally, I posted on Facebook sites and messaged friends asking what to do. In particular, because I suffered from hyperemesis during my first pregnancy, I wondered if we should use the public system or the private system.
The public system was recommended by an overwhelming majority and after extensive discussion with my husband, we decided to save more money for when the baby was born and use the public system.
One friend recommended contacting my local Närhälsan and asking what to do. Rather than phone them, I walked in and asked at the reception desk. They recommended speaking to a nurse, who in turn chided me for not calling. Apparently, a phone call would have provided me the correct answer and saved me 80 SEK.
Learn from my mistake and just pick up that phone. To date, I’ve never had a returned phone call from someone who couldn’t communicate with me in English; which I appreciate because my Svenska needs a lot of work.
The nurse ended up spending quite a bit of time on the computer trying to pinpoint the correct phone number for the local midwife clinic — mödravårdscentralen (MVC). She recommended that I give them a call right away, as they would want to schedule my first appointment between my 8th and 12th week of pregnancy. I called that day and was surprised and thankful that they got me in within one week (approximately my 8th week of pregnancy. You may be wondering why I was both surprised and relieved. Well, unfortunately, I was quite ill. In fact, I realized I was pregnant well before my missed period due to the nausea I was already experiencing. In the US, they were able to help me with medication and I was hopeful the same would be true of Sweden. My husband and I both attended the first appointment. I do not recommend this for those of you reading.
Pregnancy and the first steps
The first appointment was largely a talking appointment. We discussed medical history, past pregnancy experience, what to expect during a pregnancy in Sweden, took blood and urine, and scheduled future appointments.
There is no doppler to check the heartbeat or ultrasound at this appointment. In fact, in the Swedish system there will be very little doppler and likely only 1 or 2 ultrasounds unless you are considered high risk.
I completely understand this from a fiscal perspective, but my husband was quite disappointed to miss work just to watch me chat. We determined that he would skip all future appointments unless they involved an ultrasound or the midwife specifically requested his attendance. So far, this has been a good choice. As an extra plus, the midwife explained that there would be no fasting blood test with the horrible sweet drink they make you do in the US to check for pregnancy-related diabetes. Thank goodness!
After discussing my illness with the midwife, at my request she helped me to find an acupuncture clinic (only 80 SEK per visit) to help with the nausea and explained that she could not prescribe medication, but could recommend something that did not require a prescription that might work. By this point, I was throwing up several times a day, so I gladly accepted all recommendations. The recommended medication is called Postafen. It is a very safe medication and somewhat effective, unfortunately, if you take it, be prepared to be exhausted. I slept all of the first day and a half and could not get out of bed for another week. I don’t recommend this medication if you have a toddler. They don’t seem to mix.
After a couple of weeks, it was clear that the non-prescription medication was not quite strong enough for my illness. Thankfully, the midwife had already scheduled me to meet the gynecologist for additional testing and discussion. That appointment was not at the same location as the midwife appointment. This is important for you to know, as I do not believe many gynecologists work out of the MVC.
This appointment was shockingly efficient. In 20 minutes, I knew my thyroid levels needed watching, had a prescription for a new medication, an ultrasound, a blood test, and a full pap smear. Swedish efficiency is amazing. I was stunned and also pleased at how quickly everything progressed.
My husband was unfortunately out of town and missed the ultrasound, but the doctor was kind enough to print off a picture for him. The doctor explained that my midwife would contact me with my thyroid results and continue to retest throughout the pregnancy if needed. Those of you who are new to pregnancy, it can be common to experience a major drop in your thyroid hormones when your pregnancy hormones build up. In most cases, your body regulates itself once the pregnancy hormones start to level out. However, for a small percentage of people, this can lead to Graves Disease; which is why the doctor was insistent on keeping close watch of the levels. No treatment is needed if your body manages to sort things out. Mine is still gradually working its way back to normal, so I am still doing blood tests. Thankfully, it will likely have no problem getting back to normal.
As another week passed, it was clear that the new medicine was not working. I decided to stop into my local Närhälsan for assistance. They asked that I call at 7 am promptly to schedule a callback and walk-in appointment.
Please note that 7am promptly does not mean 7:05am. It took three days, but I finally made it happen. The doctor was very nice.
She retested my thyroid and also prescribed a new medication.
As you just read, I had now received blood tests at three different clinics. Thanks to the joined systems they use in the public health system, each doctor and midwife had full access to my results.
Another week passed, another medication did not work and finally, after almost an hour on hold with 1177, I ended up at the gynecological emergency room at midnight for IV fluids and emergency medication. Thankfully, the nurses were amazing and I felt a lot better later. I should note that apparently 1177 usually recommends a trip to the emergency room, so you may want to keep that in mind and save yourself the hold time. Unfortunately, less than a week later, I ended up back at the ER with a bad reaction to the new medication from the hospital. At this point I gave up on the public system and unfortunately can’t give you any more advice on how the first trimester proceeds.
The next morning I called a private midwife clinic and have not once regretted my choice. The fee is a bit pricey, but if you are suffering extreme nausea or other complications and can budget it in, I heartily recommend going private.
The public system is designed to handle the majority of pregnancies really well. Unfortunately, if you are (as one doctor told me) “really unlucky”, it is not necessarily your best choice. I now have the cell phone number of my midwife and can call her at any time.
The gynecologist for the clinic meets me at the same location as the midwife. The new medication (a common one in the US) is helping enormously, and most importantly, I have peace of mind. Fear of having something go wrong and needing to wait on hold to discuss it with someone does not help with nausea at all. I will still deliver this child at the public hospital and will have a new midwife randomly assigned to me at that time. My experience with the nurses at the hospital emergency room as well as my current gynecologist who works out of the hospital gives me complete faith in that arrangement.
There is one last bit of information I must share with you because I was completely shocked when I heard it. Due to logistical issues, when you go into labor in Göteborg, your first call should be to a local phone number that your midwife will provide, to notify them that you are in labor. At that time, they will assign you a delivery hospital.
This means that until the day of arrival, you just won’t know where you are delivering. The logic here is that it is better for you to go to a hospital that has availability than one that doesn’t.
The exception to this will include some high-risk pregnancies and apparently anyone with a body mass index (BMI) over 35 at the time of conception. Those individuals will deliver at Östra Sjukhuset.
I hope my narrative here helps someone out there who is scouring for information on the internet. In my situation, having experienced severe nausea throughout my last pregnancy, I wish I had immediately opted for the private option. However, for someone who experienced a complication free pregnancy previously, or who is afirst-timee mother, I think the public option is a good one. The midwives, nurses, and doctors I worked with were all courteous and knowledgeable. My friends who used the public option were all satisfied with the care they received.
Until next time…
Written by Jessica Arifianto
Hej! I’m Jessi, a newbie to Sweden and a blogger over at When Quirky Met Nerdy. Nearly three years ago I left the United States with my husband and young son to begin this crazy awesome journey, from Seattle to Surrey, to Sweden. Göteborg became our home during the height of the snowstorm this past January and it’s been an adventure every day since. I hope you enjoy my newbie stories–thanks for reading!