Tag Archives: midwife

Supporting fathers in the Swedish child health field

I recently published a literature review and meta-ethnography entitled Literature review shows that fathers are still not receiving the support they want and need from Swedish child health professionals in Acta Paediatrica.

This article received a lot of attention when it was first published. For example, Sverige’s vetenskapsradio first interviewed me on the findings. Then TT picked it up, meaning that the story was in every newspaper, from national to local newspapers. Before being interviewed by a national news program, Rapport.

It was further promoted by different organizations, such as Män för Jämställdhet. And other writers/bloggers talked about it.

What was really cool was that Sven Bremberg was asked by Acta Paediatrica to write an editorial which he called Supporting fathers is essential in the child health field

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So I had my 15 minutes of fame.

Now, a year or so later, I have finally had the time to make my first video. I’ve always wanted to promote my research through videos, but haven’t had the time. I’m highly critical of the final product, both of the video and the content, but it was my first attempt and it was a fun learning experience.

In fact, as a researcher, it’s hard to see your work lose it’s nuance. I thought enough nuance was lost when publishing it, as word counts affected how many details I could say. But trying to make a 5 minute video left very little room for nuance.

What I attempted to do was to show four examples–one from each arena within the child health field: prenatal, labor & birth, postnatal, and child health centers. I wanted to show two positive examples of ways midwives and nurses support fathers and two examples where support could be improved. However the two examples of improved support are more on the organizational/managerial level, rather than critiques of midwives’/nurses’ attitudes and support given to fathers.

Perhaps future videos will be made to provide a more nuanced understanding of the support fathers receive in the different child health arenas. Until then, I have my first overview video.

The Second Ultrasound: A Scary Proposition

In Sweden you have one ultrasound, typically around week 18 to 19 (see my previous post about that experience here). We were told that you only have more than one ultrasound if there are potential complications.

Yesterday we received news that our baby did not appear to be growing, although our midwife said that it was possible the baby had just shifted position; thus resulting in the uterus appearing like it wasn’t growing (read that story here). We were scared, I cried, Lisa comforted me, and off we went to see what the hell was going on.

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Quick Background on Uppsala:
Thankfully, we live in a city with a hospital. Also, we live in Sweden–where health care for pregnancy is completely free. So we didn’t need to ask ourselves if it was worth the money to get the check up. We didn’t need to consider the expense of another ultrasound. We could totally focus on our family’s health.

That was more than enough to focus on.

Even though we had time to walk to the hospital (20 minutes), we were too anxious, and called a taxi to drive us there (5 minutes).

The Visit:
Once we arrived and checked-in, there were two main tests that would be performed: 1) check the baby’s heartbeat over a period of time and 2) get an ultrasound.

Lisa was in the bathroom when they called for us. I sauntered over to let them know.

“Hi, she’s currently in the bathroom,” I politely and semi-quietly said. “Oh wait, here she is.”

The midwife popped out of her chair, walked immediately passed me and greeted Lisa.

Checking the Heart Rate:
She then said, “come this way Lisa” and led the way to a private room complete with a bed and a heart rate machine. It had two circular sensors that would be strapped onto Lisa: one to monitor the baby’s heartbeat and the other to monitor the number of contractions. Lisa also had a joystick-like object, where she should press the top button with her thumb whenever she felt the baby move.

Lisa was all strapped in, and I sat on a chair next to her bed.

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“Oh, I forgot to introduce myself,” the midwife said. We shook hands and quickly exchanged names (my name was never spoken again).

I miss my prenatal midwife! I thought.

“How long will the heartbeat be monitored for” I asked. After all, we had just heard the baby’s heartbeat at the prenatal clinic, where they said everything was fine.

“It’s different. It could take 10, 15, 20+ minutes. Just look for a check box to be on the machine, and then you’re done,” the midwife reluctantly replied.

“You said the number of contractions will be counted. Is there a number or range that’s good?”

“Everyone’s different.”

I prodded her more to get more specifics. “So should we expect to see 5?”

“Yes, that’s possible. It’s also possible to have 0. Anything is possible.”

“So we could have 100,” I asked, looking for a limit to the number of contractions.

“No, not 100. That would be too high.”

No more was discussed on this or any other topic, since she decided to leave the room. The language that the midwife used was always non-helpful, even with multiple questions.

Lisa and I continued to talk, hold each other’s hands, and tried to relax. Meanwhile, I sent out texts to different parents letting them know what was happening–I always need a support network.

I buzzed for the midwife to come back after the “check-mark” was on the screen. She then informed us that the doctor would look at the output and then determine if an ultrasound was needed. She failed to ever mention how our output looked. I still have no clue if Lisa had any or several contractions while the baby’s heartbeat was monitored.

Thoughts on the Support the Midwife (Didn’t) Give:
It was clear that the midwife made no decisions and could provide few answers, as she placed the results on the doctor the way a guy places his results on his wife–“aw guys, I want to come play poker tonight, but I’ll have to check with my wife first.”

There was clearly no accountability to be had via the midwife. She was there to perform the tasks instructed and to not provide us with advice or support or results.

She could however explain what different machines do or what she’s currently doing–although these responses often left more questions than answers.

Nevertheless, we figured the baby’s heartbeat was good, since we had just had that test completed, and we knew how to interpret the results (this time, the baby’s heartbeat was often around 140-150 compared to the slower 130 heartbeat 30 minutes earlier).

The Second Ultrasound:
We were then taken to the ultrasound room.

“Lisa, please come this way,” the midwife said walking us down the hallway.

“I’m not going to measure the baby,” the midwife said after laying on a thick layer of jelly on Lisa’s belly. “Are you ready Lisa,” she asked.

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She then studied the baby, mainly measuring the baby’s head, stomach, and femur. She was silent, clearly focused on her work. This ultrasound was a lot different than the first. The first time we felt a great joy in seeing our baby on the screen. This time, we felt overly anxious, concerned, and in constant wonder of what was being found as the midwife measured these areas.

Brief side note: The stomach was measured twice, from NW to SE and NE to SW, making an X pattern on the screen.

“Did you also check the umbilical cord?” Lisa asked.

The midwife then checked the flow (of blood or nutrients???–this was never explained, but the answer was simple–after hearing a few beeps and seeing wave-like formations show up on the screen, the midwife announced–“looks good.”

The midwife seemed to remeasure the head, stomach, and femur two or three times, and then called in a second midwife to assess her assessment (although leading questions were asked).

“I measured from here to here and I got a normal number. Do you see that?” she said to the second midwife.

We were then abruptly told that everything was normal. No pomp, no circumstance. It was just black-and-white with no explanation.

I prodded.

“How do you know?”

The midwife then when into a litany of how numbers are calculated based off of the mean size for a baby in the week you’re in (e.g. week 36) compared to the size our baby is.

After the ultrasound, we found out that our baby was -6 on their head size and -3 + -3 on their tummy = -12 overall. Of course these numbers meant nothing to me, so I inquired further.

I can’t remember how long the femur was except that whatever the average was for a 36 week baby, ours was one (cm, mm???) longer.

Turns out that there is a scale for the average head, stomach, and femur (for some reason the femur length isn’t calculated, but is still measured. This was never fully explained to me).

Great, the one part that’s above average isn’t calculated into the proper growth of our baby’s size, I thought.

Then they take how long our baby’s head and stomach are, and those numbers are subtracted from the average baby at our week.

You’re considered “normal” or “healthy” if you’re between +22 to -22.

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Meeting the Doctor
We then met the doctor. She had only one agenda–to reassure us in as many different ways as she could that there was no problem. Again, without going into as many (apparently needless) medical details as possible.

“Do you know why you’re here?” she asked as an opening statement.

“To check on the growth or lack of growth of our baby,” Lisa quickly responded.

“Yes, that’s right. Well, this is as perfect as it gets. You’re great. You fall within the normal range. Everything is fine. You have nothing to worry about,” she said.

“You can go home and enjoy your New Years,” she continued.

Again–I had lots of questions, but clearly could see that those were not welcomed. In fact, at one point I even called her out saying “Yes, I get the point that you clearly have one job–to make us feel calm and safe, but…” and then I continued asking several questions of things to look out for or how to prepare ourselves should this arise again, and what to do at our next prenatal meeting.

Conclusion: The doctor could only guess like our original prenatal midwife–that the baby had just shifted position in the body, making the uterus appear as though it’s not growing.

I told her I was quite interested in what was happening with our baby, which is why I had so many questions.

Rather than finding it beneficial to have involved parents seeking answers from a professional, her response to me stating my interests was simple, but dumbfounding.

“Google it,” she said.

“Really? We come to the hospital seeking answers from a professional and your response it ‘Google it’?”

She then argued why Googling was a good method, but that people can’t interpret the results well.

Well no shit! That’s why we’re talking with you right now. We want to be informed parents and understand the potential situation our baby may or may not be going through. Plus it just doesn’t hurt to know more, in case this same thing happens again in the future with another child, I thought.

We left the hospital feeling glad that nothing was wrong with the baby (as far as they could tell). The first baby scare was over. For now.

But I also left the hospital with a pain in my stomach, knowing that I could have a midwife as inattentive, unsupportive, and unwelcoming as her when we give birth.

Fingers crossed that we have one like our prenatal midwife!

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Tried to go into town to enjoy the Christmas lights.

PS–Interesting side-note, the midwife said it wasn’t a problem to take pictures during the ultrasound, despite the first ultrasound midwife saying that we weren’t allowed to take pictures. Of course, no explanation was given on why it could or could not be ok to take pictures during the ultrasound.

PPS–This has so far been our fifth midwife, and we haven’t even given birth! Talk about a lack of continuity of care, as well as trying to develop trustful, stable relationships! Not ideal, Sweden!

Prenatal Visits: Measuring and Testing

Three weeks after our last appointment, we met our prenatal midwife.

This visit was basically a repeat of the previous visit.

She answered our questions, did a iron-level blood test, measured the belly to see how the baby was growing, monitored the baby’s heartbeat, and took Lisa’s blood pressure.

 

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Since we knew the routine, this visit went a lot faster than the previous one–mainly because I was so curious and asked a lot of questions at the last visit. But since there was nothing new, I had little new questions to ask.

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The baby grew as expected. They have three lines on their computer chart–and upper limit, mean (or median [not sure]), and lower limit. Both measurements of the size of the baby is right below the mean (median) level.

 

However, Lisa’s iron levels were apparently “off the chart”–not literally. This must have been about week 29 (this may be off by one or so weeks). Lisa’s iron level was 137, but 110-120 is considered to be the average iron level for that week in her pregnancy. This was kind of funny too, because the baby’s heart rate was at about the same number.

Side note: I noticed on the first visit that I saw numbers of the baby’s heartbeat to be between 140-145, but the midwife said it was “140.” And then on the second visit, the heart rate jumped around from 134-141, and again she wrote 135. So I’m now wondering why they pick basically the lowest number, rather than the average number that they witness?

 

First Antenatal Visit: Gender issues, limited office hours, and language problems

Prior to the first visit, Lisa called to make an appointment at a prenatal clinic close to our home. Since we wouldn’t meet them for two more weeks, she asked them about what types of food she can and can’t eat while pregnant.

They responded by saying to visit Livsmedelsverket to see the latest food recommendations.

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As a fatherhood researcher that focuses on child health, you might be surprised to learn that I never thought about my research when my girlfriend and I went to our first antenatal visit.

All I could think about was how nervous I was, how nervous she was, and what information we might glean from attending.

So, pure usual, I nervously coughed, hacking out a lung, before entering the building and climbing the stairs.

We had picked a prenatal clinic close to our home, figuring that would be the best option–convenience always has its rewards. It happened to be a public clinic, although I’m not so sure how important that is?

We walked in and patiently waiting in the lounge area for our names to be called. Within minutes, we heard the beckoning sounds of an older, albeit experienced, midwife: “Lisa,” she announced.

We sprung up. She exchanged some quick words with Lisa while shaking her hand. No eye contact was exchanged in my direction, so I hopped in and held out my hand. She shook it, while turning her head, preparing to walk back to her office.

She didn’t even ask my name, I thought. My research came flooding into my mind. It was certainly one thing to read about the misfortune of others, and quite another to experience gender discrimination. My first encounter with a medical profession about my changing role from man and partner to father, and I’m met with an abrupt non-introduction. Shit!

I can’t ever be too judgmental though. After all, I don’t speak much Swedish, so perhaps I need to be more engaged in the conversation in order to garner more attention. Fair enough.

We meandered back to her office, and took two seats opposite the midwife. We asked if it was ok to speak in English, but that Swedish was fine, especially for more complicated questions. The midwife happily agreed, and in shyness, excused her “bad” English. It wasn’t bad at all. In fact, I would call it quite good, and so we both reassured her.

She began typing on her computer before asking “Lisa, can you please tell me your email? I’d like to send you some parenting information and information about your upcoming visits.”

Lisa did so. After a couple of other short exchanges with Lisa, such as, what do you do for a living and other small talk, the midwife looked over at me and asked “And what is your name? And can you give me your contact information?”

“Do you want my email address too,” I asked.

“No, I just need your phone number in case we can’t reach Lisa,” she replied.

What the hell! I thought. Why can’t I also be emailed the same information? Oh well, Lisa will just forward the email to me. I gave her my phone number.

Then she proceeded to ask Lisa several questions about her drinking and smoking habits via completing some survey forms.

While Lisa completed the forms I asked, “what are these forms for?”

“Oh, to see if there are any drinking or smoking problems. If so, then we like to recommend places where people can see support, since it’s not healthy to smoke or drink when you’re pregnant,” the midwife politely replied.

So many thoughts went through my head. So my drinking and smoking habits don’t matter for the health of the baby? What if I was an alcoholic–would it benefit my child and the mother, as well as myself, if I also got some support for my habits? Isn’t second-hand smoke not ideal? Can’t I get support if I need it?

It was hard to raise these issues though, since I don’t smoke and only occasionally drink.

“How much is too much drinking during early pregnancy?,” I asked questioningly. I was actually interested in this answer, because I have heard some conflicting reports on if drinking during the first 6 weeks of pregnancy can hurt the baby (plus I had time to kill while Lisa completed the forms).

“Oh, Lisa’s amount is fine,” she said looking at Lisa’s drinking record (side note–the survey asks how much you drink, on average, over the past year–not specifically on how much you’ve been drinking while pregnant).

Her immediate and thoughtless answer really upset me. She clearly hadn’t listened to what my question was, and instead was just trying to calm me from being worried about drinking while pregnant by giving me a non-descript answer. Now I need to inquire more.

I lied (but she doesn’t know that). “Lisa has been doing a lot of drinking since she’s been pregnant. Way more than before being pregnant because of different end of the year parties. So I’m wondering if she has been having too much.”

“No, no, she’s fine,” the midwife answered back quickly.

What the fuck! You didn’t even ask me how much she’d been drinking while pregnant, and yet you can still give an answer basically saying there is no limit to how much she could have drank? I thought, while also simultaneously thinking Oh crap, now Lisa is mad because I just made her sound like she drinks a lot. Maybe I should only stick to issues that actually matter to us, because I’m clearly not getting medical answers.

The visit continued, discussing various issues, like how often we’d come, what week we were in, and other topics we had questions about–like parenting classes in English and their hours of operation.

Around 40 minutes into the meeting, and after me asking several questions to show that I’m engaged in the conversation, the midwife finally asks me “what do you do for a living?”

Now I’m a bit embarrassed. “I research father involvement in the child health field.”

“Oh that’s interesting,” she responded hesitantly. “I have two thoughts about fathers coming here, but maybe it’s because I’m old. Either they need to work and so they can’t come here, or they come here because they are controlling of their partner.”

Wait. What the hell? Did I just hear what I thought I heard? Was she accusing me of being controlling, or just men in general? I can’t be here because I’m interested in my pregnancy? I can’t be here because I want to learn and be involved?  I can’t be here to support my partner in pregnancy? I can’t be here because I want to experience my work first hand? I don’t believe it. Quick, look at Lisa and see if she heard the same thing…..She did, she heard the same thing. 

Well that shut me up. I am no longer engaged in the conversation. I’m not upset, outwardly, but I’ll just want her finish up the visit, so we can get out of there.

The rest of the conversation was pleasant, and we finished about 15-20 minutes later, after talking the ultrasound visit, the various types of tests you could get at that visit, and the prenatal parenting classes.

To their credit, she stated that I could get an interpreter for the parenting classes and that they were going to start up their first fathers’ group class ever, even if she said that reluctantly.

On the way home Lisa started the conversation, “did you hear what she said about fathers?”

“How could I not?,” I replied with disgust.

After a short conversation at home, we decided the closest antenatal clinic isn’t necessarily the best. Not only were there obvious gender issues (especially since both Lisa and me want both of us to be there as often as we can), but there were other problems too–for example, not having parenting classes in English and having limited office hours. Office hours definitely matter for commuting expectant parents, because we need early morning or evening hours. 3pm doesn’t work when you work in another city.

Luckily, this hasn’t deterred me from being involved with my partners and my pregnancy. But it certainly didn’t encourage me to be involved with the child health field. For the record, Lisa didn’t have any problems, and felt ok continuing to go there for her sake, but not for mine. Luckily I have a very supportive partner (plus she would also like a place with longer opening hours).