Tag Archives : baby


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.


BabyBlog: Breastfed babies at 3-8 weeks 3

You’ve gotten through the first couple of weeks with your new baby and you think you’ve figured things out and then WHAM!  Something changes.   We often forget this, but our children are constantly growing, maturing, changing (and so are we), so this is only the first change we’ll face as new parents.  And they happen weekly, if not daily!  Unfortunately, if we aren’t used to babies and are getting used to parenting on our own, with only our partner…. (and many fewer people to turn to for guidance, especially as expatriates), well, the numerous changes that occur in the initial weeks are often tricky to comprehend.  And, we’re recovering from pregnancy and childbirth too.   So, to help the new parent, let’s talk about some of the changes that occur in the baby in the first two months.

There are several growth / developmental spurts that occur one after the other starting around 2-3 weeks and lasting until about 4 months (with another at about 6 months).  Lots of things are going on during these spurts, not just growth in length and weight, but also in abilities and understanding, i.e. the brain and muscles are developing too (see publications like The Baby Book or Your Amazing Newborn to learn more). In other words, newborn babies are growing, learning and developing at a fast pace.  When these spurts occur, babies need additional nourishment (water, food, immune support, suckling, affection), so want to be at the breast more often.  And as a result a mother’s milk supply fluctuates up and down.

So long as you let baby stay at the breast as he/she seems to want and there are no issues with latch or tongue or lip ties, nor any physiologic issues in your ability to make milk (e.g. hormonal imbalance, thyroid issue, hypoplasia) your supply will keep up!  This said, in addition to often feeling like you don’t have enough milk (because you are unused to newborn behaviour and/or you hear comments around you like “feeding AGAIN?” or “you are going to spoil her if you keep picking her up”), you might feel like you have too much!  The latter is because milk supply fluctuation can often result in fast let-down (with babies sometimes pulling off or spitting up more, which is not fun for the mother, but it means they are naturally managing this stage of breastfeeding).

Sometimes the fluctuations also result in a higher amount of lactose in the milk (as the mother’s body has adjusted to make more milk, but with more milk there is also more lactose). Lactose is simply milk sugar so it’s always there, but when there is a lot of it, babies sometimes get unsettled tummies, can seem fussy, and as lactose is digested differently their stools can turn green and frothy/mucousy (or like algae).

The green stools can worry many a new parent, but in general, if green or changed texture stools are the only thing going on and the baby seems otherwise content (even if fussy), has enough wet and poopy diapers, has periods of alertness, etc., then a parent can just think of this as a normal stage of infant development.  If, on the other hand the fussiness is making the days harder or making the baby not only fussy but apparently uncomfortable (or the mother is getting a lot less sleep as a result), then a mother can “manage” breastfeeding by doing things like:

  • Feeding against gravity (so leaning back more, using laid-back positions)
  • Letting the first flow (let-down) of milk go into a towel/diaper (or bottle to freeze for another purpose) and then re-latching baby to breast afterwards (or hand-expressing off a bit and then latching baby)
  • Feeding with shorter intervals between feeds
  • Increasing time at the breast (& using breast compression to stimulate additional let-downs) and using only one breast at a time
  • etc.

Often mothers will do these things automatically and won’t realise it until later.   But these are NOT things that must be tried or that all new mothers try.  They’re just things to think about “in case” of need.  And they are short term fixes, think days & weeks.   Anything longer than that and you can end up with the opposite problem: slow flow & lower supply!

Parents must also remember that stools can also be green (and also smelly) from allergies (to cow’s milk protein, gluten, etc.) and in these cases in addition to the stronger smell, there can be traces of blood.  Whenever there is blood in a baby’s stools, a quick call to the baby’s paediatrician or other health care provider can provide guidance, but in general blood simply means that there is a broken blood vessel in the bum or that mother has a few cracks on her nipples (check baby’s tongue and latch and think about silverettes for healing) and baby has swallowed some blood himself.  If the latter two are ruled out and it’s not a normal fluctuation of milk supply, then mothers look into eliminating common culprits from their diets (milk, gluten, eggs). Unfortunately it takes around 3 weeks for things like cow’s milk protein (casein) to totally leave the system, but a marked improvement should already be felt about a week after elimination.   Allergies often show up around the same time as the first growth spurt, i.e. ~4 weeks.  Other mothers ADD things to their diets, such as probiotics, to ensure their own physical well-being.

Now let’s go back to the changes in baby:  her eyesight is improving, she’s starting to recognise patterns and people, her muscles are developing, including stronger head control, stronger abdomen, etc.  (see The Baby Book for more ideas).   This means that from around 2-3 weeks of age, baby is transitioning out of the “newborn” phase.  Every day, every week, parents will notice things that baby wasn’t able to do before.   And all these changes mean that every day a baby’s active alert time, sleep time, and overnight time will also change.   There’s just too much going on developmentally in baby’s brain for patterns to last more than a few days/weeks. In fact, it’s VERY common for babies to wake 4-5 times overnight in these 6-7 weeks (not every day, but 2-4 nights in a row repeatedly is common and physiologically expected).  This is because not only do they need to be at the breast more, which satisfies:

  • Thirst
  • Hunger
  • Development & Immune-Defense
  • Need to suckle
  • Need for affection

But also she may wake more because she wants to communicate with her parents about her day, relay information, etc.    A baby’s evening might be between 11-14 hours long, but overnight wakings are expected to continue during this time and for the first few YEARS of a baby’s life.  With 1-3 wakings a common pattern (more during spurts), usually with a long overnight period of sleep of 5-6 hours (either at the beginning of the night or later, if at the beginning, you’ll want to go to bed early!).  A baby’s sleep is quite easy to understand, once you know why it is the way it is.  To learn more about baby’s sleep, read Nighttime Parenting or visit the Ask Dr. Sears web pages about sleep.

What changes did YOU notice in your newborn in the first three months?  Comment below!