Daily Archives: 2013/05/31


Healthblog: Maternity Services in Switzerland – Postpartum Support

As mentioned in our post about Pregnancy & Birth in Western Switzerland, moving abroad whilst pregnant, or starting a family abroad, whether or not you speak the local language, is difficult and raises several questions about what to expect in terms of prenatal and postpartum support.

Living abroad, far away from family, the question “what support is available once baby is here” is usually a big one.  The Swiss healthcare system offers quite a lot in terms of medical support and it is possible to apply for practical help at home too.  Postpartum doulas are also available to offer emotional, informational, practical and other support around your home — which is especially helpful to expatriate families (and can be reassuring to Dads/Partners who return to work quickly after a baby’s birth).

To help you understand what is available, we’ve put together this post outlining the basics for Western Switzerland (i.e. between Geneva and Lausanne).  We also offer consultations to anyone who would like to discuss his/her specific family-dynamics or family history.   We can also help families figure out what THEY need and how they might go about finding such support.   We can also offer a prenatal consultation to any family who is considering hiring a postpartum doulas.

HEALTHCARE IN WESTERN SWITZERLAND AFTER BABY IS BORN
For Birth in Hospital or in a Private Clinic

The hospital’s midwives are responsible for your care whilst you are admitted.  Your doctor will normally visit at least once after the baby is born, as will your chosen paediatrician (if he/she does hospital visits, if not, it will be the paediatrician on call).  If, whist in hospital, you are having difficulties with breastfeeding, you can ask to see an IBCLC (International Board Certified Lactation Consultant) who can provide evidence-based and up-to-date breastfeeding advice.  Breastfeeding is a learned skill (lactation is innate), so don’t expect it to just “happen”, both you and your baby have to learn what to do.

Baby Nurseries (pouponnieres) are still common, though BFHI hospitals do not have them (they have neonatal observation rooms).  Rooming-in is standard in BFHI hospitals and available at other institutions but not necessarily promoted.  If you want your baby with you at all times, let the staff know.  Rooming-in helps the motherbaby dyad in various ways, including helping you get additional rest, which is why it has become standard in many maternity wards worldwide.

Returning home
You can stay in hospital up to five days (longer after cesarean births or in case of complications) or leave right away.  No matter when you decide to leave, once at home, your immediate postpartum care, and monitoring of your baby, will be the responsibility of an independent nurse-midwife (i.e. does not work within a hospital or clinic).   Your midwife will come to your home.  Your baby’s care is also followed by your chosen paediatrician or family-doctor.   The first visit to the doctor’s office is usually around one month.

Just like you select a paediatrician or family-doctor before the birth, it is also possible to select an independent midwife before the birth.  Expatriates often contact different midwives ahead of time, ensuring they find one who is available around their EDD, has similar cultural and parenting philosophies, and/or who speaks one of their languages.  If you haven’t talked to someone ahead of time, the hospital/clinic will arrange a midwife for you.

Within the first ten days of your baby’s birth, visits by your assigned/chosen midwife are covered by basic insurance.   As mentioned above, the midwife will come to your home (you do not need to go to your midwife’s practice or your OB/GYN’s office, unless of course the midwife has detected a problem).  If you are having problems with breastfeeding (which may manifest itself in baby not gaining weight), a visit by a lactation consultant (IBCLC) in the first ten days postpartum is ALSO covered by basic health insurance.  After the first 10 days postpartum, additional visits by an independent midwife or IBCLC are covered if accompanied by a prescription “ordonnance” (or if you have complementary insurance).  The level of coverage is dependent upon your insurer.

For Birth at Home or at a birth house/centre
If you chose a home birth or birth house/centre birth, your independent homebirth midwife will continue to be responsible for your care.   The care at the birth house or at home is covered by basic insurance (additional charges for lodging, etc. may apply).  After baby is born, your midwife will come to your home (once again, you do not need to go anywhere unless of course the midwife has detected a problem).  As above, if you are having problems with breastfeeding (which may manifest itself in baby not gaining weight), a visit by a lactation consultant (IBCLC) in the first ten days postpartum is ALSO covered by basic health insurance.  Telephone consultations with our breastfeeding counsellors is also available free of charge (though visits are charged and are not covered by insurance). You can call us or LLL for a list of English-speaking IBCLCs.

After the first 10 days postpartum, additional visits by an independent midwife or IBCLC are covered if accompanied by a prescription “ordonnance” (or if you have complementary insurance).  The level of coverage is dependent upon your insurer.

ADDITIONAL POSTPARTUM SUPPORT

Practical Help
If you think you need additional help at home following the birth of your baby, you can ask your doctor to prescribe “home help” (Services d’aide et de soutien à domicile).   To be claimed against your Swiss insurance,  you would contact either the AVASAD (in Vaud) or the IMAD in Geneva.  Help at home is especially worthwhile after caesarean surgery or with multiple-births.

Postpartum Doulas & Breastfeeding Counsellors
If you want a more tailored postpartum service, you may consider hiring a private postpartum doula who can offer help at home in the immediate days/weeks/months following the birth of your baby.  A postpartum doula’s role is to help the family adapt to life with a baby and become independent, confident parents, as such the services they provide are diverse.  They also usually work short shifts over a few days or weeks.  Postpartum doulas are especially helpful to expatriates who do not have local family support as they can provide the help traditionally offered by extended family, with additional help navigating parenthood in a foreign country & culture.

Breastfeeding counsellors can also be contacted for breastfeeding information and support.   They offer telephone support, support groups & workshops, and/or private consultations in your home.  Postpartum doulas and breastfeeding counsellors can often also help you navigate the Swiss maternity system and even translate documentation.

Baby Nannies / Baby Nurses
Families who are welcoming twins or multiples may want to consider not only a postpartum doula, but also a baby nanny or baby nurse.  Baby Nurses/Nannies help you take care of the baby (rather than the household) and when you are juggling two or three, it’s nice to have an extra set of hands (especially if one parent travels or is returning to work soon after the birth).

Parents’ Groups
Becoming a parent is a monumental life-changing event and it is very easy, especially for expatriates, to feel lonely or overwhelmed by the changes a baby brings.  To limit the feelings of isolation, there are many Groups, Clubs, Playgroups, and baby classes in Geneva, Vaud & Neighbouring France for mothers and fathers.  Sign up before the baby arrives so that you’ll have a group of parents to turn to once baby has arrived.


HealthBlog: Maternity Services in CH – Pregnancy & Birth

Moving abroad is a difficult thing to do, moving abroad whilst pregnant, or starting a family abroad, whether or not you speak the local language, is even more difficult. Not only that, it raises several questions about what to expect in terms of prenatal and postpartum support.

The most important thing new families should probably remember is that what we would expect AT HOME (wherever that is) is not what is available here in Western Switzerland, even if it looks the same at first glance. This fact is a really big hurdle for childbearing families as “becoming a family” is a very cultural construct, so what we expect, how we look for support, and what we ultimately get in terms of maternity services is going to be affected by our culture.  As such, new families automatically, often without realising, look at things in a way that is DIFFERENT from how the Swiss system is run.

To help families get through the maze, I put together this post outlining the most important things you need to know about having a baby in Western Switzerland (i.e. between Geneva and Lausanne).

CHOOSING A HEALTH-CARE PROVIDER

Doctor or Independent Midwife? 
Your pregnancy can be followed by an OB/GYN, gynecologist, or an Independent Midwife (sage-femme independante) and some family-doctors will also follow your pregnancy (though few attend births). There are six standard prenatal check ups, plus two diagnostic ultrasound scans, which are covered by Swiss basic insurance (not towards deductible). Additional check-ups and/or scans are usually extra (sometimes covered by complementary insurance).  Whether or not the birth itself is covered by basic insurance is dependent upon where you choose to give birth.

Doctor-led  (Clinic or Hospital Births)
Some gynecologists and some OB/GYNs do prenatal check ups, but do not attend births.  Those who attend births often only attend births at specific hospitals or specific clinics.  A mother and her partner, once admitted to the maternity ward, will be in most contact with the institutions’ nurse-midwives (sage-femmes hospitalieres), who are responsible for the mother-to-be’s care once she has been admitted.  These midwives report to each mother’s attending OB/GYN (or the OB/GYN on duty) (though there is currently a petition to ask the state to allow for midwife-led units).  Some doctors who attend births will come to the hospital or clinic as soon as they know his/her patient/client has been admitted, others will liaise with the hospital midwifery staff by phone, and will only come to the hospital later (to attend the actual birth).

If your baby arrives after 9 months of pregnancy (e.g. after 38 weeks) your doctor or the hospital/clinic’s doctor will attend your birth.  If your baby arrives VERY early, however, this might not be the case.  In fact, for premature births, you are limited to birthing at a cantonal hospital (H.U.G., C.H.U.V., etc.) and you may be Medivac’d in these instances to a hospital with space for you & your baby.

Midwife-led (Home, Birth House/Centre, Clinic or Hospital births)
Independent Midwives offer global coverage (a.k.a. continuity of care) and if you choose an independent midwife for your prenatal care, your pregnancy will be under the responsibility of that midwife or practice. This means you will see her (or another in her practice) for prenatal check ups (which are generally quite intimate), which includes not only clinical work, but also emotional and informational support.  The care is also covered by basic insurance.

For home births and birth house or birth centre births, your midwife (and those in her practice) also may act as a labour support person. Some independent midwives can also attend your birth at Geneva’s Cantonal Hospital (H.U.G.).  Independent midwives cannot attend births in other public hospitals or private clinics, so if you’d like to birth at a hospital or clinic, but want your pregnancy followed by an independent midwife, the ob/gyn on duty at the hospital will be responsible for the outcome of your birth.

CHOOSING ADDITIONAL SUPPORT PERSONS
Birth Doulas, trained pregnancy & labour support professionals, can be hired to provide additional prenatal information and support and labour accompaniment. This emotional support is offered to the woman and her partner.  Doulas do not offer any clinical or medical check-ups or follow-up.   They cater their services to what HER CLIENT(S) feel they need, free of judgment.  Doulas accompany all types of pregnancies and all types of births.  As mentioned, doulas do not offer any clinical accompaniment but can do research for their clients and provide evidence-based information to help them make an informed-decision as to their care.

 

PREPARING FOR LABOUR & BIRTH
Independent Midwives and Doulas both offer childbirth and other pre- & postnatal classes (private or in groups) to families in the area, either independently, through a midwifery clinic or hospital, through a doula practice, through the Red Cross, or through another family association. There are English childbirth classes available.