Growing baby Elsie

When Aaron and I decided we were ready for another baby, we knew were embarking on a very different type of pregnancy. A different health care system, a different language, different standards of care, plus I would be chasing around our toddler part time.

And then, of course, the pandemic struck, and even our newest plans were demolished.
But let’s not jump too far ahead. 

Today I want to talk about the BIG culture differences in pregnancy care comparing America and Finland!

(I used the private system for the first 36 weeks, and that may affect some of my observations)

BUT WAIT

Before you ask, no, we did not get the infamous baby box. 😭 Long story short, we are still paying into American social security, so we are not covered 100% by Kela which is who distributes the boxes.

1. “In Finland, we are just naked”

This is an actual quote from one of my doctors in Finland 😅 Finns are accustomed to naked saunas (family or same gender). Combining this with an extremely efficient model for giving care, there is no illusion of modesty in gynecology appointments. When you see a doctor, they will not leave for you to get undressed. There’s no robes, no paper blanket for you to pretend you’re covered. Often there’s little more than a little curtain blocking the main door. At some point the doctor just says take off your pants, and you comply.

It was a bit jarring at first. But once I knew to expect it I honestly preferred it. By treating nakedness as an issue of little importance it was easier to not care. 

2. Doctor or midwife, rarely both.

The standard American appointment always starts with a nurse. They take your vitals, enter everything into the computer, and get a brief overview of why you’re there. They brief the doctor, who will come in later (giving you plenty of time to get undressed and under the paper blanket).

In Finland you see the doctor for big appointments like the first one and the 20 week anatomy ultrasound. Other than that, you will see the midwife for appointments, unless something needs a prescription or advanced care. If the midwife decides you need to doctor, it will probably be a separate appointment on a different day unless your issue is urgent.

The midwife and doctor work together through communication, rather than physically both attending every appointment.

The biggest advantage of this setup is time. In America my visits with the doctor were roughly 20 minutes. In Finland, closer to 15. But my midwife visits were an hour every time. We discussed physical health, but also mental health. We talked about my fears and my activities and my preferences. She helped me understand the birthing processes and got me translated documents so I could be fully prepared. It was a very different relationship.

3. Ultrasounds as standard care

In America, most insurance policies cover exactly 2 ultrasounds. Anything else must be deemed medically necessary or it won’t be covered, and ultrasounds are crazy expensive. To keep costs down, an ultrasound technician will do the ultrasound rather than the doctor.

This never struck me as weird before I moved. The Finnish OBGYNs have the same ultrasound machines in every room. They are a standard part of most doctor visits, because you’re already there, they may as well check. 

There’s no going to a different room to see the technician. There’s no waiting for results because the tech can’t legally comment on your scan. There’s no extra fee for turning on the 4D mode or printing some pictures. 

I can’t even count how many ultrasounds I had. There were standard ones, like the dating scan and the anatomy scan. But there were also “let’s see baby as long as you’re here” scans. I’ll talk about my birth stories in another post, but there were concerns that this baby would have to big of a head. So the measured and measured and measured... roughly once a week for the last 5 weeks. And I got pictures (when the baby cooperated) every single time. 

4. It’s All No Big Deal

This might be a general culture thing more than a healthcare thing specifically.

Childbirth is just much much more chill here, and a lot of value seems to be placed in maintaining the sense of “everything is normal, it’s all natural, everything is fine.” 

The American system gives you a lot of numbers. All the metrics. Lots of tests and printouts and discussion of ranges. Data analytics is prized, and let’s you know your health is being take seriously. Let me just say, as a data person, I usually love this. This is my style.

However, there’s something to be said for the opposite approach. Finland midwives are more likely to say “It is good” or “it’s in range” and never mention the number unless you ask. They also ask a lot more general gut feeling questions rather than running tests by default.

I want to point out that this style is DEFINITELY not for everyone. But, after having and extremely traumatic first birth, it was wonderful for me. Even when we started discussing strategies to avoid repeated complications, everyone was always very calm and nonchalant about everything. They didn’t give me numbers to obsess over - and I would have obsessed over them.

Because, in the end, everything WAS totally fine with Elsie’s pregnancy. Besides some slight anemia, there was nothing going wrong, nothing to treat, and it was really special to be treated like my body was doing everything exactly as it should. 

(Especially after one doctor in America prematurely told me that I should never ever try to give birth without a c-section ever again. He was an ass and he was wrong.)

That’s all for now!

Next post, I’ll talk about actually giving birth! This includes the public health care system, the “nest” hotel, and, of course, birth stories!