TYNSET, NORWAY Expecting her first child Sindia Hemli the midwife jumps onto the double bed in the delivery room Janne Uthusin to be investigated. Here at Tynset’s “birth center”, Sindia has had check-ups and ultrasound examinations throughout her pregnancy.
In the Norwegian model, the mother can freely choose where to give birth, but first-time mothers are not allowed to choose a midwife-led delivery room. Sindia’s baby is also head up and therefore the planned caesarean section will be performed in Lillehammer right after Easter.
Sindia would have given birth in Tynset if it had been possible. After the surgery, she and the baby return to Tynset’s maternity ward to recover before actually going home. He likes it.
– This is not a big hospital, but small, cozy and feels very safe. There are few places like this. And there is a very nice staff here, Sindia reasons.
Workplace of experienced midwives
Vivian Halvorsen is a ward nurse at Tynset’s maternity ward. There are a total of 18 employees, half of whom are midwives and half are nannies.
According to Halvorsen, there are strict boundary conditions for those who give birth in the maternity ward, so that the birth goes smoothly.
– In order to give birth here, you must have given birth before, you are healthy and you are expecting a healthy child. And the previous birth went without any problems, Halvorsen lists.
This year, 18 babies have been born, last year 48. There are three delivery rooms, but Halvorsen says that they are almost never in use at the same time. Most of the time, the birthing family is the only one in the shelter. The midwife supports the family throughout the birth.
Halvorsen describes the job as suitable for an experienced and responsible midwife, not a recent graduate. Because of the long distances, the midwife must be able to assess the progress of labor two to three hours ahead.
If there are any risks, in that time it will be possible to transfer the child to a hospital in either Elverum or Trondheim, both of which are less than a three-hour drive from Tynset.
The delivery room is comfortable.
– Most give birth either in a double bed or in a bathtub. For pain relief, there is nitrous oxide and massage, but not spinal anesthesia, for example, because we don’t have doctors.
With modern technology, the midwife can connect Tynset’s ultrasound devices so that the hospital’s doctor can watch the screen remotely at the same time and the decision about the transfer can be made together. According to Halvorsen, there are extremely few transfers.
Midwives’ work includes an annual period in the hospital’s maternity ward, where they have the opportunity to update their skills and get a quantitative feel for childbirth.
Halvorsen says that midwives in the maternity ward receive a small salary supplement for their responsibility.
Konrad was born at his mother’s workplace
Tuva Rosten is in many ways the experience expert of Tynset’s maternity hospital. She works as a midwife in the hut and six weeks ago she also gave birth to her son in the hut Konrad’s. The family already has a 2-year-old daughter.
Rosten studied to be a midwife in Oslo. After graduating, he worked in the maternity wards of Lillehammer and Hammerfest hospitals. 1,000 babies are born in Lillehammer every year, 400 in Hammerfest.
Rosten thinks about the pros and cons of big hospitals and Tynset’s small birthing room.
In terms of a midwife’s work, the difference is that only those who have already given birth before and whose pregnancy does not involve risks give birth in the delivery room.
– From a midwife’s point of view, it is the most straightforward job.
There are first-time and high-risk births in hospital maternity wards, births can be very different, and there are many of them.
Rosten considers the only downside of the birthing room to be that there are few births. Only five of them happened to his shifts last year. Therefore, the mandatory annual hospital period strengthens the feeling for childbirth.
But Rosten mentions the same thing as the others as an absolute advantage of the shelter: mothers and families get to know each other much more holistically, when the same midwife may have been doing the first examinations of the pregnancy, participated in the birth and continued with the post-natal visits.
– Warning signs of depression can be noticed much faster, because he has already met the mother many times before the birth.
Like Halvorsen, Rosten likes the versatility of the work at the maternity hospital.
They are responsible for the maternity clinic for all pregnancies in the region, including those families who give birth elsewhere than in Tynset.
Families giving birth elsewhere come to the room for a few days after the birth to make sure that, for example, breastfeeding is going well. In addition, mothers come to the room for follow-up examinations and to agree on their birth control.
The maternity ward also takes care of taking loose cell samples from women in the area, whether the woman is of childbearing age or not.
That’s why ward nurse Vivian Halvorsen is surprised by the question if she could imagine returning to the maternity ward of a large hospital.
– No, I’ll stay here. I didn’t feel comfortable in the department of a big hospital.
Births are part of regional policy
The population numbers of Finland and Norway are practically the same, but in Norway there are twice as many places to give birth as in Finland. Last year, 51,980 babies were born, which is almost nine thousand more than in Finland.
Norway has to give rise to three-level places.
They offer the most versatile medical care for those giving birth women’s clinics, where special expertise is available for both mothers and newborns. At least 1,500 births per year.
Maternity wards do not offer as extensive specialist knowledge as women’s clinics, but they take care of some high-risk pregnancies. There are 200–1,000 births per year.
Giving birth are midwife driven simple units. Previously, there were dozens of birthing rooms.
But also in Norway, the development has gone to larger and larger units, even though the Norwegian Grand Assembly has ruled that no one’s journey to give birth should be unreasonably long.
Could birth centers like Norway be a solution in Finland’s sparsely populated areas?