Routines in Swedish Hospitals
Here you can inform yourself about routines carried out in the hospital setting, that may not be explained to you beforehand. This can inform your choices and help you make decisions to help you have the best possible childbirth experience.
Abdominal Palpatations
The midwife will use their hands to externally examine how the baby is position in the womb and to determine whether the head is fixed or moveable. This can help to roughly asses the progress of labour.
Vaginal Examinations
The midwife will insert their hand into the vagina and feel whether the cervix has completely receded or not. The midwife will also be able to tell how open the cervix is and where the baby's head is. A vaginal examination can help understand how open the cervix is, but is no indication of the progress of labor and is not necessary for labor to progress. Repeated vaginal examinations can disturb the physiological process of birth.
IV
A small plastic tube is inserted into a vein in the hand with the help of a needle. It is common for this to be made routine "just in case" even if there is no current indication.
CTG
CTG is an abbreviation of cariotocography. It measures the baby's heart rate (cardio) and the activity of the uterus (toko). Electrodes are attached to the birthing person's stomach. CTG is used for monitoring during childbirth and to check the baby is getting enough oxygen. CTG is routinely used upon arrival for 20 minutes to get a curve of he child's heart rate. It is very hard to say no to this routine however research indicates that continual monitoring in healthy pregnancies leads to an increase in caesarean section rates and instrumental deliveries, and scalp blood tests. It increases medical interventions and the risk of complications for the woman.
Scalp Electrodes
As the baby moves in the uterus throughout childbirth, external CTG monitering electrodes might not pick up the heartbeat. Therefore it has become routine in Sweden to insert small screws into the baby's scalp to more securely register the heartbeat.
Contraindications for scalp electrodes are
- Infections from the mother can be trasmitted to the child such as HIV, Hep B and C, Gonorrhea, syphilis and herpes.
- Premature Births
- Infections from the wounds where the electrode is attached
Amniotomy
A midwife will make a hold in the membranes of the amniotic sack so that the water will 'break' and flow out. By triggering the water to 'break' labor can be accelerated. After an amniotomy, the experience will become more intense quite quickly for the birthing person.
Pushing Phase Routines
Fundal Pressure
The "fundal pressure" technique is performed during the second stage of labour by manually pushing or applying constant downward pressure with the hands inside the vagina towards the birth canal.
Oxytocin Drops
A synthetic oxytocin will be dropped through the IV to help increase the frequency and strength of uterine contractions. This form of routine can put the birthing person at risk of uterine rupture and make their body less sensitive to the natural oxytocin their body produces which is necessary for breastmilk production.
Perineal Massage and Compress
A midwife can hold their hands against to perineum when the baby is crowning in the attempt to prevent tearing. They may also hold warm wash clothes against the area for the same reason. However there is no clear research that this technique helps prevent vaginal tearing.
After Birth
Umbilical Chord Testing
In the late 1990's, routine umbilical chord sampling was introduced in Sweden to be used for research, statistics as well as the child's PH level. If a child is born with a good APGAR then this test is not necessary and has no benefits for the child. There is clinical value when the child is born deprived of oxygen. The test itself is not harmful, but it can interfere with the autotransfusion of blood from the placenta to the baby at birth. This is because blood leaks from the two injection sites created during the sampling and quite soon a clot forms around the perforation.
Delayed Chord Clamping
Waiting at least 3 minutes before the umbilical chord is cut is the minimum for it to be classes as 'delayed clamping'. After 3 minutes not all umbilical chords have stopped pulsating nor emptied of blood, which could deny the child of up to 100ml of nutrient rich oxygenated blood. Allowing all the blood to flow out of the chord towards the baby help them to recover after birth as well as reducing the risk of iron deficiency later on. "Wait for White" is a good benchmark.
K-vitamin
This is routinely given to all newborns as it helps coagulate the blood in the event of a bleed. Newborns cannot form vitamin K themselves and it is not produced in breastmilk. The general risk of bleeding is very low and the parents should give their consent before this shot is administered.
Skin to Skin
Nils Bergman, a swedish doctor, founded the skin-to-skin movement after his research into how laying the naked newborn on the mother's chest after birth, maintains body temperature, regulates hormones, controls blood sugar levels as well as increasing oxytocin and prolactin for breastmilk production and increasing healthy latching and breastfeeding. This is now routine is all maternity wards in Sweden.
Inspection of Tearing
After a vaginal birth it is a routine to inspect the vagina to see if there is any rupture that needs to be stitched. If stitching occurs, usually a Pudendal Nerve Block anaesthesia will be administered which blocks the nerves around the pelvic floor so the person can feel no pain. It is routine for the midwife or doctor to palpate their fingers inside the vagina and anus to check for tearing. This will be done without anaesthesia and causes pain. It is important they obtain consent before doing so.
Vitals of Mother and Child
After the "Golden Hour" which is the recommended period the new baby and parent(s) are left alone to bond with their baby, and all suturing is complete, and the fika is served, the baby is checked:
- weight and length
- head size
- temperature
- anus is open and palate intact
- Blood pressure and pulse
- Temperature
- If the uterus has contracted
- If urination is OK