Prenatal care in Finland: from primary to tertiary health care?

Understanding the social organisation of maternity care systems: midwifery as a touchstone

Theories of professions and healthcare organisation have difficulty in explaining variation in the organisation of maternity services across developed welfare states. Four countries - the United Kingdom, Finland, the Netherlands and Canada - serve as our case examples. While sharing several features, including political and economic systems, publicly-funded universal healthcare and favourable health outcomes, these countries nevertheless have distinct maternity care systems. We use the profession of midwifery, found in all four countries, as a 'touchstone' for exploring the sources of this diversity. Our analysis focuses on three key dimensions: (1) welfare state approaches to legalising midwifery and negotiating the role of the midwife in the division of labour; (2) professional boundaries in the maternity care domain; and (3) consumer mobilisation in support of midwifery and around maternity issues.

Finnish women's experiences of antenatal care

OBJECTIVE

to explore and describe women's experiences of antenatal care.

DESIGN

semi-structured interviews, dialogical interviews and non-participant observation in two phases both during and after pregnancy were analysed according to Colaizzi's phenomenological method.

SETTING

four maternity clinics in one rural and one urban primary health care centre and one outpatient maternity clinic at a central hospital in Finland.

PARTICIPANTS

in the first phase a purposive sample of nine women were interviewed at 36 weeks gestation, three weeks, three months and two and a half years after birth. In the second phase, data were collected for further breadth and depth and 31 women, who were going through different stages of pregnancy, delivery and the puerperium participated. Data were collected by means of interviews supplemented by non-participatory observation. In the total sample of 40 Finnish women, one half was primigravidae and the other half multigravidae.

FINDINGS

a main thread running through the women's experiences of antenatal care were their needs and wishes that concerned the health of the unborn baby, but also the health and dignity of themselves and their family. The pregnant women wanted to share their pregnancy and childbirth story in a confident relationship based on humaneness and interest in a peaceful atmosphere. They needed protection safeguarded through scientifically based and humane surveillance, and professional competence was expected. They wanted to continuously participate in the new situations through knowledge in dialogues and they wanted to involve their family in the care on their own terms. The childbirth preparation groups had an important multidimensional role in the care.

IMPLICATIONS FOR PRACTICE

the findings challenge the antenatal care that so far has been focused on the physical health, the needs of the primigravida and a blurred family perspective. The family perspective implies knowing both the pregnant woman and her partner in terms of the pregnancy, the birth and a new parenthood. Humane, scientifically based perinatal care can be developed by innovations from these findings, especially considering the multidimensional role of the parent groups.

A description of birth in Finland

The health care of women and children living in Finland is described. In the Finnish health care delivery system, perinatal health care is family centered, maximizing professional support through use of nurses in the delivery of primary care across the childbearing year and technological interventions are judiciously used based on evidence of efficacy.

Maternal substance abuse: infant psychiatric interest: a review and a hypothetical model of interaction

Substance abuse problems have strongly increased among Finnish women during the last decade. The negative effects that maternal substance abuse is thought to have on the quality of early mother-baby interaction are an area of interest and concern to specialists in infant mental health. During pregnancy and the newborn period of the infant, substance-abusing women have been shown to be especially willing and able to reduce use once the problem is identified. The desire to stop abusing substances appears to be predicated on a strong desire to be a good mother to the child. Interventions that focus on abstaining during pregnancy and on the early mother-child relationship have shown promise in helping these mothers improve the developmental prognosis of the child and become better parents through sobriety.

Quality of contraceptive services in Finland

OBJECTIVE

To investigate whether the quality of contraceptive services in Finland varies by the type of care provider.

DESIGN

A cross sectional questionnaire survey.

PARTICIPANTS

A random sample of 3000 Finnish women aged 18-44 years (response rate 74%) in 1994.

RESULTS

Almost all women (94%) had used contraception at some time and 75% were current users. Although self care was common (29% had obtained their latest method outside the health services), 83% had sometimes used the health services for contraception. For their last visit, 55% of women had chosen a health centre (a publicly administered and funded health service), and 33% a private unit. In the health centre, the care provider was usually a general practitioner or a public health nurse, whereas in private care the providers were gynaecologists. Women who used private care were more likely to be from higher social classes and urban areas. After adjustment for a women's background, the two groups were similar for most indicators of the quality of care, but access to care and woman's experiences of treatment were better with private care.

CONCLUSIONS

In terms of availability and choices the current system of contraceptive services in Finland is adequate. It is not always an integral part of municipal primary health care, and many women prefer private care for gynaecological services; this may case problems of comprehensiveness and equality of care.

Cultural perceptions of childbirth: a cross-cultural comparison of childbearing women

The purpose of this comparative cross-cultural study was to describe the cultural/religious perception of the childbirth experiences of selected childbearing women. Finnish Lutheran women's beliefs and perceptions of childbirth were compared with those of Canadian Orthodox Jewish and American Mormon women. Methodological triangulation was achieved through semistructured, open-ended interviews and use of the Utah Test for the childbearing Year (UTCY). Canadian Orthodox Jewish women showed a significantly higher level of reliance on authority figures to ensure positive outcomes and significantly less active participation in childbirth care decisions. The Finnish Lutheran women showed less valuing of childbearing and childrearing, which may be related to a less active religious belief system and the view by Finnish women that motherhood is only one of a multiplicity of roles viewed as important. There is a need to understand and appreciate the cultural beliefs and values of childbearing women to facilitate more culturally sensitive and holistic nursing care.

Birth outcomes by level of obstetric care in Finland: a catchment area based analysis

STUDY OBJECTIVE

To study whether hospitals of different levels are equally safe places to give birth in a regionalised system of care.

DESIGN

This was a population based, cross sectional survey comparing birth outcomes in nationwide catchment areas of different levels of hospital care. All women and low risk women were examined separately.

SETTING AND SUBJECTS

The study population comprised all women who gave birth in Finland in 1987-88. The data were obtained from the Finnish Medical Registry, complemented by official data.

MAIN RESULTS

No statistically significant differences were found in crude or birthweight specific perinatal mortality rates between the catchment areas, nor did the other outcomes studied favour tertiary care compared with other levels of care in the area based analysis.

CONCLUSIONS

In a regionalised system of birth care with a proper referral system, small local hospitals are as safe places to give birth as tertiary care hospitals.

Women's satisfaction with maternity health care services in Finland

The purpose of this study was to describe the Finnish maternity health care system and to determine the level of satisfaction in general with maternity health care services and specifically with hospital clinic visits in Helsinki, Finland. Information was collected using both interviews (N = 63) and questionnaires (N = 408). Care during pregnancy takes place in maternity centers, and risk pregnancies are referred to hospital clinics for consultation. The maternity health care system in Finland is regarded internationally as effective and well functioning. In recent years, however, increasingly more prenatal visits have taken place in hospital clinics. This change may lead to a system similar to Great Britain's where a large part of prenatal care takes place in hospital clinics. Although the women in this study are satisfied in general with the content of maternity health care services and regard them necessary for their well-being during pregnancy, data also indicated that women are more satisfied with visits to maternity centers than with visits to hospital clinics. The factors women complained most about in hospital clinic visits, were long waiting times, unsatisfactory doctor-patient communication, the 'assembly-line' routine of the clinic, and seeing a different doctor at each visit. The lack of social and psychological support involved in the care given at hospital clinics was also evident. In planning and evaluating maternity health care, it is important to consider women's views and experiences.