Last week I covered the subject of pre-natal care in Aalborg. Today’s post concerns the end of pregnancy and beyond: labor & delivery and the care you and the baby receive after the birth. As with pre-natal care in Aalborg, there are various actors involved during these stages. They include the hospital (Sygehus Nord – Fødegangen; please note that the hospital on Hobrovej does not have a maternity ward), the patient hotel that is connected to the hospital, the post-partum sundhedsplejerske (visiting nurse), and the mothers’ group you are assigned to two to three months after the baby’s birth. I’ll take each of these in turn.
[Disclaimer: There are books written on the subject of labor and delivery and post-partum care. The aim of this blog post is not to serve as an exhaustive guide on the subject but rather to focus on some of the main points that are specific to having a baby in Aalborg. If you are reading this, it’s safe to assume you have access to myriad other sites about the general topic of having a baby and have probably already read up a lot on the subject. Please take the following information and advice for what it is – a very brief look at the essential points of giving birth and the resources available to you after the baby is born in North Jutland (Nordjylland).]
In North Jutland you have two choices of where to give birth: at home or at the hospital. (As far as I could determine, there are no private birthing clinics in this region of the country and only one in the Copenhagen area.) Around 600 babies are born each year at home in Denmark; 75 of those in the North Jutland region. While the vast majority of women choose to give birth in the hospital, home births are not discouraged (depending on how your pregnancy progresses, among other factors). If you choose to deliver at home the midwife who takes care of you during pregnancy will be the one who attends your birth. In contrast, it would be a coincidence if the midwife who has followed your pregnancy is also the one who delivers your baby at the hospital.
Perhaps one of a pregnant woman’s most burning questions as she nears the end of her term is, “When should I head to the hospital?” I know it was for me. To some extent the answer depends on your condition and how your pregnancy has progressed. However, the general rule of thumb in Aalborg is that if you have any doubts, they will tell you to come in. They may very well send you home again if you are not far enough along but it’s better to be safe than sorry. The three signs that labor has begun are: your water breaks; contractions begin; you experience some bleeding. Here are tips on what to do in each case, as detailed on the Region Norjylland web page titled ‘When am I in labor?’
When contractions are the first sign that childbirth is imminent, you are encouraged to contact the hospital once they become regular. For a first birth, regular contractions that are 4-5 minutes apart and getting stronger and longer in duration are a good sign to call Sygehus Nord (tlf 97 66 31 08) and ask whether to come in. With a second, third, etc. birth women with regular contractions that are 5-7 minutes apart are generally encouraged to contact the hospital. In either case, since it is not uncommon for the contractions to cease after you enter the hospital, you may be sent home again to wait for further signs of progress.
Water breaking (fostervandsafgang)
If your water breaks, you should immediately call the hospital to talk with a midwife. Water breaking can mean a literal gush of water or small amounts of water that seep out, making it sometimes difficult to tell whether it is indeed amniotic fluid, urine or thin vaginal discharge. If after discussing details with the midwife over the phone she agrees that your water has broken you will be invited to the maternity ward for an initial examination. She will then decide whether you should stay or go home to wait for spontaneous labor to begin in earnest.
Bloody show (tegnblødning)
Some bleeding prior to childbirth is normal. It is a sign that the cervix is opening and can result in light bloody discharge ranging from light pink to brown in color. Bloody show can appear many days before labor actually begins so it does not necessarily require a call to the hospital. However, if you experience bleeding similar to a menstrual period, you should contact the hospital immediately.
Once you have been examined at the hospital and the midwife determines you should stay, you will be sent to the delivery room. There the midwife tries to make you feel safe and comfortable by getting to know you and your birth partner/s. Her goal is to make labor as hyggelig (comfortable) an experience as possible and to reduce the need for painkillers. (The logic is that if women feel safe and secure, they will not require as much in the way of pain medication. That is NOT to say that they expect you to labor without help to ease the pain.) Midwives encourage the participation of whomever you choose to have at the birth; they will do all they can to accommodate your wishes. As a general rule the midwife attends you throughout the labor and delivery process; a doctor only comes in if there are signs of trouble, e.g. the baby’s heart rate drops.
Birthing and pain management options include heating pad, massage, laboring in water, movement and different positions as well as the following:
- Sterile water injection
- Pudendal block
- Local anesthesia
- Spinal block
You can read more about Region Norjylland hospitals’ use of these forms of pain management here (in Danish only). According to the women I spoke with, the staff don’t encourage epidurals but rather gauge the situation and suggest one if the situation warrants it, i.e. labor is prolonged and the woman is tiring quickly. Only about 20% of women are administered epidurals at Aalborg Sygehus. (For what it’s worth, that is significantly lower than the 50% of women who receive them at the university hospital in Lausanne where I had both of my girls.) According to Libero’s Pregnancy Booklet, in 2007 22.3% of births in Denmark were by Caesarean section, 12% of those were by request and the percentage was not increasing .
If you go beyond your due date without labor beginning spontaneously, you will have an extra examination and most likely be induced at no later than 41 weeks 5 days (12 days past your due date, in other words). Induction can involve any one (or more) of several procedures, including intravenous administration of oxytocin or other drug to stimulate contractions, insertion of a vaginal suppository, etc. You will discuss this with your midwife if you get to that point.
How long you stay in the hospital after the baby is born depends on one of several factors – whether it is your first child, whether you have had a Caesarean section, whether there have been complications, etc. A mother who meets any/all of these conditions, as a rule, stays in what is called the the patient hotel (barselshotel) for 2 days. A second-, third-time, etc. mother who has an uncomplicated vaginal delivery, however, remains only four hours after the baby is born, regardless of time of day. The patient hotel, which is one floor above the delivery rooms and was recently renovated, consists of private rooms where the mother can stay with her baby and husband. It is run by midwives and nurses, who help you start breastfeeding and answer any questions you have as you begin life with the new baby.
In the first couple of weeks after you return home from the hospital you will receive a visit from the ‘sundhedsplejerske’, who is a visiting nurse that specializes in helping mothers and their babies. She will make between three and seven visits to your home in the first 8-12 months after you give birth. She will weigh and measure the baby, check the baby’s motor and cognitive development, and also check on you as a new (or repeat) mother. You and the baby will also visit your general practitioner eight and five weeks, respectively, after delivery. When the baby is between 2 and 3 months old, the sundedsplejerske will invite you to the Sundhedsplejerskes’ office (there are four in Aalborg) with some other mothers who have recently given birth and live in your neighborhood. This is your ‘mothers group’, the point of which is to have a small support network of women going through the same things with their babies. After the first meeting at the Sundhedsplejerskes’ office, you will arrange meetings at a location of choice. If you prefer an English-speaking group, you may request this.
One thing that became very clear as I spoke with each of the three mothers for this post was that the information they received about various aspects of giving birth and post-partum care varied greatly, depending on whom they talked to. As one of them put it, ‘Everyone tells you something different. Even among the women in my mothers’ group, we received very different advice from our caregivers, i.e. midwives, nurses, sundhedsplejerske, etc.’ So I suppose the take-home lesson is to ask lots of questions and do your homework. Here are some anecdotes from the women I spoke with about their experiences giving birth and the care they received afterwards, which illustrate this point:
- Just after the baby is born (if it is a vaginal birth), it is standard protocol that the midwife gives you an injection to make your uterus contract. If you prefer not to have this, you must make this clear ahead of time by talking with your midwife and writing it in the notes you make together prior to the birth. One of the women with whom I spoke had done some reading and declined this procedure; however, she emphasized that you have to be knowledgeable about such things and do your own research. When she asked her midwife about the benefits of the injection, the midwife was not convinced that it was necessary either.
- Another of the mothers with whom I spoke said that the hospital staff were very good at listening to her. “When you call to see whether you should come in, they were very accommodating and supportive.” In contrast, another woman was frustrated by the experience of trying to get admitted to the hospital. It was her first birth and the first sign that labor was imminent was that her water broke, which, as you can read above, calls for an immediate telephone conversation with hospital staff. However, when she called the hospital, they encouraged her to wait at home until contractions were regular. An hour later the couple headed to the hospital and were sent home. When the pain became unbearable, however, they returned to the hospital and were told she could stay but encouraged her to go back home. They decided to stay. She ended up laboring at the hospital for 20 hours (17-18 hours of which was with the help of an epidural) before her baby was born.
- The women I talked to were mixed about breastfeeding. One felt pressured to breastfeed, while two did not. It seems that breastfeeding is definitely encouraged but whether you feel pressured to do so depends, like most things, on whom you talk to. The women who did not feel pressured said that the midwives and nurses were supportive either way. Guidelines used to call for exclusive breastfeeding until the baby is 4 months; this has now shifted to 6 months. One friend gave the following advice on the subject (and asking questions more generally): ‘I wish I had gotten more specific help with breastfeeding. The midwives will come check on you once a day, but if you have questions, be assertive about getting answers that make you comfortable. I think I was far too worried about being a pain in the butt, but in hindsight I wish I had asked lots more questions in order to feel more confident when I left the hospital. This could go for anything that you’re unsure of. Remember that no one expects you to know everything and as a woman giving birth in a hospital in a foreign country, you might not have the benefit of your own mother coming to help. There are usually a few days between coming home from the hospital and your first visit from the sundhedsplejerske (visiting nurse). Also, there’s no guarantee that your visiting nurse will be able to always give you the answers or support you in the way/s you need. My point: Ask lots of questions, be assertive, leave feeling as confident as you can. The midwives are wonderful and patient, but they aren’t mind readers. If you feel like you need information, rest assured that they’ve heard everything under the sun already. They’ll give out a fair bit of information on paper in Danish, but while my Danish is OK, having a newborn is not really the time when you want to be “figuring something out.” And there’s no substitute for hands-on help, especially with something that can be a little complicated like breastfeeding.’
Here are also some great tips on what to take with you to the hospital from the same friend:1) Music. They offer music on their computer/speakers, but it’s terrible. Just terrible. I wish I’d made a playlist on my phone and brought a small pair of speakers, it would have been well worth it, and also nice to have in the barselshotel.2) Clothing for you. I wish I had brought more clothing to the hospital that was easy to get into and out of, i.e. yoga clothes and second trimester maternity wear. I brought some, but an extra pair of everything would have been nice. You don’t really know what time of day your baby is going to make an appearance, which can affect how many nights you stay in the barselshotel. For example, I gave birth in the afternoon on a Thursday. While you are only officially given two nights in the hotel, we were allowed to stay until Sunday morning. Your concept of day and night is bound to be a little screwy anyway, and a fresh shirt can sometimes make a big difference.3) Soap. I took some nice soap with me and I was really glad I did this. Obviously, this is a matter of personal preference, but the all purpose hospital stuff is not fantastic.4) Diapers. They provided about ten diapers, which will last you through the first night. After that, I sent my husband to the Kiwi grocery store around the corner (on Vesterbro) for more.5) Food for father. When you are at the barselshotel, food is provided free of charge for the mom, but the father has to pay. Hospital food in Denmark isn’t really worth paying for…but there is a wide variety of options just outside the hospital’s front door. Personally, we found this to be a much better solution for him!6) Clothing for newborn. I should have brought more clothing for baby! And make it cute, because there’s gonna be lots of picture taking. We brought pajamas and maybe one onesie. Your baby will spend a lot of time just in a diaper as skin-to-skin contact is highly encouraged (whether you are breastfeeding or not!) But you’ll still want something to put him/her in at some point.
- Also, please note that there is NO public parking lot at Sygehus Nord…one woman’s husband had to drop her off at the front door at midnight (and you have to ring to get let in at that time of day) and then went to find street parking (which is also hard to find.)
And this concludes my two-part series on having a baby in Aalborg. As stated above, it is brief but covers what I think are the essentials specific to labor & delivery and post-partum care in this city. A free online guide to pregnancy, labor & delivery and post-partum care in Denmark written by Libero (the diaper company) is available in English here.
If you are a mom who has given birth in Aalborg and have additional information and/or advice for expectant parents, please comment below! Alternatively, if there is anything in this post that you find is incorrect or misleading, please let me know as well in the comments section. Thank you!
A big thanks to Ditte, Kylene, Lauren, and Rachita & Parul for their contributions to this post!
 Gravid igen, pg. 15; http://www.onlinecatalog.dk/clients/c_14/u_27/Gravid_igen_DK_7152959/
 Pregnancy, giving birth and the new family, p. 7. http://www.libero.dk/Global/14_Nordic/Nordic%20common/Documents/Pregnancy%20book,%20English%20version.pdf