Once in a month my husband and I pack Amos in his stroller and walk a few blocks to our closest health care center. We take the elevator to the fourth floor and enter Neuvola, the maternity and child care clinic, or ‘Place for Advice’ as translated freely from the Finnish word.
Neuvola is a Finnish public health care service available for all expectant mothers and children for free.
Maternal and child health is crucial, a cornerstone of development for all countries. Currently in the world approximately 830 women die every day from preventable causes related to pregnancy and childbirth and an estimated 5.9 million children die annually before they reach the age of 5.
The numbers for maternal and child mortality used to be staggering in Finland as well. Just 80 years ago, out of 1000 children a total of 95 died before reaching the age of 5. Now that number is less than 3, one of the lowest in the whole world. Similarly, the rate of maternal deaths used to be high, with 400 mothers dying per 100,000 births. Today, such deaths do basically not occur.
Who are we to thank for this?
The story of Neuvola dates back to the 1920s.
Mr. Arvo Ylppö, a Finnish pediatrician, was determined to decrease infant mortality in Finland. He got his motivation from Germany where he studied and observed, for instance, that the cause of death for prematurely born infants can be traced to treatable conditions instead of simple underdevelopment.
The ideas he then implemented in Finland are, in essence, preventive health care measures.
He supported efforts to educate health care professionals, along with midwives, to municipalities. The services provided by Neuvola were to be free of charge and voluntary. At its core were to be the provision of guidance for mothers and families, a complete vaccination programme as well as the detection of abnormalities in a child’s development as early as possible.
These remain the activities of Neuvola even today.
Neuvola started small, but today it reaches practically all expectant mothers and children in Finland from their birth to the beginning of primary education which is usually at the age of 7. It has been a tremendous success story. My mother used Neuvola services, now I do too. It is a privilege shared by many generations.
It is not an exaggeration to say that Finland is one of the best countries in the world for parents.
[Press release]Link found between pain during or after sexual intercourse and mode of delivery | EurekAlert! Science News
Women who have a caesarean section, forceps or vacuum extraction are more likely to experience persisting pain during sex in the year after childbirth than women who have a vaginal birth.
The findings from a longitudinal study by the Murdoch Childrens Research Institute showed that women who had an emergency caesarean or vacuum extraction were twice as likely to experience pain during sex at 18 months postpartum, compared to women who had a vaginal birth with no medical intervention.
The vast majority of women (86%) experienced pain the first time they had sex after childbirth. Women who had a caesarean section or vacuum extraction experienced pain for a longer period.
According to lead author Doctor Ellie McDonald, the unexpected finding dispels the common myth that caesarean section results in fewer sexual problems after childbirth.
“Almost all women experience some pain during sex following childbirth,” Doctor McDonald said. “Our findings show that this was equally true whether couples resumed sex at six weeks or six months postpartum.”
For most women pain does resolve over time, but for around one in three women having a caesarean section or vacuum extraction pain persists to 18 months postpartum.
A new Cochrane Review concludes that all countries should consider establishing proper home birth services. They should also provide low-risk pregnant women with information enabling them to make an informed choice. The review has been prepared by senior researcher, statistician Ole Olsen, the Research Unit for General Practice, University of Copenhagen, and midwifery lecturer PhD Jette Aaroe Clausen.
In many countries it is believed that the safest option for all women is to give birth in hospital. However, observational studies of increasingly better quality and in different settings suggest that planned home birth in many places can be as safe as planned hospital birth and with less intervention and fewer complications.
“If home birth is going be an attractive and safe option for most pregnant women, it has to be an integrated part of the health care system,” Ole Olsen says and adds, “In several Danish regions the home birth service has been very well organised for several years. This is not the case everywhere in the world.”
The updated Cochrane Review concludes that there is no strong evidence from experimental studies (randomised trials) to favour either planned hospital birth or planned home birth for low-risk pregnant women. At least not as long as the planned home birth is assisted by an experienced midwife with collaborative medical back up in case transfer should be necessary.
Fewer interventions in home birth
Routines and easy access to medical interventions may increase the risk of unnecessary interventions in birth explaining why women who give birth at home have a higher likelihood for a spontaneous labour. There are 20-60 per cent fewer interventions, for example fewer cesarean sections, epidurals and augmentation among those women who plan a homebirth; and 10-30 per cent fewer complications, for example post partum bleeding and severe perineal tears.
“Patience is important if women want to avoid interference and give birth spontaneously,” says Jette Aaroe Clausen. “At home the temptation to make unnecessary interventions is reduced. The woman avoids for example routine electronic monitoring that may easily lead to further interventions in birth.”
Jette Aaroe Clausen adds that interventions in childbirth are common in many countries, but also that there is a growing concern internationally because interventions may lead to iatrogenic effects; iatrogenic effects meaning unintended consequences of the intervention. Routine electronic monitoring may for example lead to more women having artificial rupture of membranes which in turn can lead to more interventions.
Evidence and human rights
While the scientific evidence from observational studies has been growing, the European Court of Human Rights in Strasbourg in the case Ternovszky versus Hungary has handed down a judgment stating that “the right to respect for private life includes the right to choose the circumstances of birth”. This is quoted in the review.
Thus the conclusions of the review are based on human rights and ethics as well as on results from the best available scientific studies.###
Ref.: Olsen O, Clausen JA. Planned hospital birth versus planned home birth. The Cochrane Library, Issue 9, 2012.
The full review may be available here (depends on country): http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000352.pub2/abstract
[Check your local medical, academic, and public libraries for access to this article.
Many medical and academic libraries are open to the public. Ask a reference librarian for assistance]
- Cocharane Reviews
Cochrane Reviews are systematic reviews of primary research in human health care and health policy, and are internationally recognised as the highest standard in evidence-based health care. They investigate the effects of interventions for prevention, treatment and rehabilitation. They also assess the accuracy of a diagnostic test for a given condition in a specific patient group and setting. They are published online in The Cochrane Library.
- Birth is no reason to go to hospital (eurekalert.org)
- Birth is no reason to go to hospital, review says (medicalxpress.com)
- Balanced Birthing Options (betternature.wordpress.com)
- Home births: Midwives ‘risk not being objective enough’ (telegraph.co.uk)
- SOCIAL GOOD: One Mom’s Mission to Save Lives in Laos (worldmomsblog.com)
- Autumn’s Homebirth (thebirthinterviewproject.com)
- The Myth of a Safer Hospital Birth for Low-Risk Pregnancies (foodconsumer.org)