Tuesday, May 14, 2013

Pregnancy, Delivery, and Our Birth Plan in Norge

Even though we haven't yet had a baby in Norge (Norway) we've gotten a lot of questions from friends and family as to the differences between the States and Norway when it comes to pre-natal care and delivery. Obviously the delivery portion is yet to come (and even then I won't have a comparison perspective to the States), but we have seen some differences in what's standard here and how things are approached in Norway. (Some of these might very well be the same or similar in the States, but perhaps not standard or routine.)

1. You have a choice between doing your pre-natal care with a routine physician that's part of the public system or choosing to see a private midwife and/or ob-gyn. Since I have insurance with ConocoPhillips and the coverage is amazing it didn't make sense for us to use the public system. The care you get at either is going to be great, but we have the flexibility of spending more time at each visit and getting additional ultrasounds if we choose (which as you know has worked so well, read here).

2. Every woman is allowed one ultrasound at 18 weeks. This ultrasound is done at the hospital (since everything in the hospital is covered and you pay nothing inside) and they check the baby's measurements, look for any signs of potential genetic disorders, and inform you of the gender if you choose. This is the only ultrasound that you would receive if you opted to visit a public physician (pending any health risks/concerns obviously).

3. Your pre-natal caregiver (whether midwife or ob-gyn) does NOT deliver your baby. There are midwives and an ob-gyn who work at the hospital 24/7. If you are having a natural delivery and have no complications, than a midwife does the delivery. If you have an epidural or a c-section, than they have the ob-gyn there to assist. My midwife does work in the hospital so there is a slim chance that she would be working when I go into labor, but probably not.

4. You carry all of your medical information with you, called a helsekort for gravide (healthcard for pregnancy) to every appointment and to the hospital. We had an appointment today at the hospital to register and they put all of my information in the system so that it doesn't have to be done when we arrive in labor.

5. There is no genetic screening/testing or gestational diabetes testing unless the doctor sees a concern. When you have your 18 week ultrasound they will recommend genetic testing if they see anything of concern. Pregnancy is viewed as a natural process which does not constitute testing unless there is a reason.

The same goes for gestational diabetes. Every appointment I have to bring a urine sample with me. Yes you read that correctly. I bring my own urine sample to the appointment (which amused Jason's coworker Ingrid when I asked her to clarify if I had misunderstood when I made the appointment!) They test for protein levels and sugar levels and, once again, if they see anything of concern only then will they test you.

6. Is an epidural available? Yes, they are available and an option when giving birth in Norway. It's the less intense "walking epidural". However, they encourage you to go natural is you've had a healthy pregnancy and there are no complications, but they will not prevent you from having an epidural if you choose to take one.

7. Labor. If you choose to go natural, then you will be on the 7th floor called the fødeloft (birth loft) of the hospital (there is only one in Stavanger). There you will have the freedom and flexibility to labor as you please - eating, walking around, taking a bath, changing positions, have acupuncture, etc. You will have a midwife and/or nurse checking in on you, but otherwise the atmosphere is very non-hospital like. It's laid back and relaxed with no rushing around or major emergencies since everyone on that floor is delivering and doing so naturally. If you choose (or it's recommended) to have an epidural, then you will be on the 1st floor and have a more "hospital-like" feel, be checked more frequently, and have your delivery with an ob-gyn.

8. After your delivery you are transferred to the hospital hotel. You stay in the hospital, obviously, for the delivery and a few hours afterwards go to the hospital hotel, which is connected to the hospital. You stay there for roughly 3 days depending on how long it takes for you to get your milk and how your delivery went. There are midwives showing you how to feed, how to take care of the baby and yourself, and allowing you to rest if you need additional recovery. Your spouse can stay at the hotel with you and there is a restaurant there which you can order food or go down for meals during your stay.

9. Women in Norway get one year paid maternity leave mandated by the government. They are mandated to start their maternity three weeks prior to their due date. I do not qualify for this since I am on US payroll and considered a US expatriate. When a co-worker asked me when I was headed out on maternity I replied "when my water breaks, hopefully not in the middle of a meeting". :-) Additionally, dads receive two weeks after the birth as well as a three month paid paternity leave after the mother returns to work. Jason as well does not qualify for either of these benefits. 

Instead, I qualify for the "maternity" policy in my home country so I will have either six or eight weeks paid leave falling under Short Term Disability. I do not qualify for FMLA as it's a jurisdictional regulation and does not apply outside the States. Fortunately, I have a very supportive company and boss who have all agreed to my taking a six month Leave of Absence after Madison is born. I will not return to work until January 2014! Additionally, Jason's bosses told him to plan to take two weeks after Madison's birth to spend at home with us. How incredible!! We feel very blessed that we have been given the opportunity to spend additional time with our daughter after she's born!!

10. Babies born in Norway do not receive dual citizenship. Madison will be a US citizen once we travel to the Embassy in Oslo (a good 9 hour drive or 1 hour flight away) and report her birth. Until then she is an illegitimate alien belonging to no country. And we plan to tell her that. ;-)

11. It's recommended to put together a birth plan that you bring with you to the hospital for your midwife. Since we're engineers it was only natural to make ours a flow chart.

After attending a yoga session, homeopathy course, and birth preparation weekend (including a hospital tour this evening), Jason and I are very reassured about the care that we are going to receive here in Norway. The most important thing to us is getting to meet our beautiful, happy, healthy, baby girl Madison and we are encouraged that our desire to labor and deliver naturally (pending any health concerns with me or Madison) will be supported and encouraged here.

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