FAQ

We are happy to support you throughout the birth process. We would like you to call, write or contact us whenever you have a concern during the on call weeks. When you call, we will answer immediately around the clock. At night, we sometimes do not hear the SMS signal - so please call us at night.

We will be grateful for your call, because the more we stay in touch, the more confident you will be that we are following your process and can prepare for when the birth starts.

This is up to you. Barnmorsketeamet has no criteria or minimum number of contractions you need to have, or to be open a certain number of centimeters to enter BB Gårda you can come in when you or your partner want and need!

Throughout the birth, the midwife will monitor the mother's condition, taking her temperature, blood pressure and pulse if necessary. In order to monitor your well-being, it is important that your midwife is welcome in the room where you give birth. The midwife/your team will encourage you to drink regularly and have light meals such as smoothies, snacks etc. They will advise you to go to the toilet, rest and have active periods during labour. She will be there to support and strengthen you with massage, pressure and other relaxation techniques that you have practised together before the birth. This is what we have talked about together at our preparation classes and appointments.

The midwife will ask you if she can listen to your baby's heartbeat at regular intervals. She will use a handheld doppler or Pinard´s (the same one used by the midwives at the MVC) and listen to the heartbeat using the IIA method, which involves listening and following the baby's heart rate during the opening phase, the pushing phase and until the baby is born. The frequency of listening varies depending on the length and frequency of contractions.

The midwife also checks the colour of the amniotic fluid after the waters have broken, as stained water can be a sign that the baby is stressed. If this happens along with other signs of stress or infection in the mother or baby, the midwife will advise you to change your place of care to hospital. Bot in most cases it is just a normal sign so we always make an individual evaluation of our findings.

It is very important that you inform your midwife if you have any concerns or objections to us monitoring your baby before the birth starts. We cannot carry out our work properly if we do not have your permission to monitor your baby's heart rate.

Most people in labour choose to have one or more support persons present during the birth. This could be your partner, a relative, friend or doula. We have no opinion on who you want to support you and accompany you here at BB Gårda.

Siblings can also be present at the birth. In that case, it is a good idea to have another adult with you who can be there for the siblings, as we midwives can be completely occupied with supporting you as you give birth.

We always like to have 2 midwives on site from the time you start pushing so that we can support you and your partner in the way you need. At least 1 hour after the birth of the placenta, the second midwife remains. It is good to have 2 midwives on site after the birth to help with charts, removal, examinations, possible suturing, etc.

Disposable mats to protect the floor, mattress, carpets, etc. .

Technical devices to check on the mother and baby during labour. We are also equipped to deal with any complications that might unexpectedly arise during the birth, such as heavy bleeding or a baby that is breathing slowly.

We also have medicines. Anaesthesia for possible suturing, vitamin K for the baby, and Oxytocin. It is given as an injection in the thigh and can be used to speed up the birth of the placenta and membranes. Mostly we don´t need to offer it. If you choose to take Oxytocin or if the midwife recommends it, the placenta needs to be born within 30 minutes. Otherwise, we need to change the level of care and then it is always by ambulance to hospital. This is because you may then need to actively help the placenta out.

If there are any problems with you or your baby during labour, the midwife will inform you about possible suggestions on how to avoid the problems, for example by changing the position or many other options in the range of midwifery wisdom.

If this does not have the proper effect we are expecting a transfer to hospital may be necessary. The midwife will always accompany you for a safe handover to the health professionals on site. If you would like your midwife to stay with you in the hospital, we will offer this, but we cannot continue to have medical responsibility. This will be taken over by the hospital staff.

Your partner may be asked to accompany you in his/her own vehicle if the transfer needs to be made by ambulance.

If you do not want to follow the midwife's advice and decline the transfer to hospital, the midwife will inform the nearest hospital of her recommendation but that you decline the recommendation. She will also call a senior midwife from Barnmorketeamet who will then attend the birth and both midwives will continue to care for you. We never abandon someone in labour unless you actively request it.

However, you must be aware that the midwife does not have access to the more advanced equipment and medical expertise available in the hospital. If you choose not to follow the recommendation to go to the hospital, this could put you and your baby at risk.

After the baby is born and comes to the mother's chest, the ‘golden hour’ begins.

This is a very important time for you as a family. It's a time for everyone to rest and for the baby to do the 9 steps for a good start to breastfeeding. They need to be undisturbed to promote attachment and breastfeeding. An undisturbed skin-to-skin meeting also reduces your risk of bleeding after birth and promotes a risk-free birth of the placenta.

After the first breastfeeding, the midwife examines the baby, weight, length, reflexes, general condition, tone, skin colour, etc. We also check the baby's oxygen saturation, POX.

If you have a tear, it can be inspected and stitched, read more on the next question.

If you give birth at BB Gårda you may stay as long as you wish on the first day, but we would like you to stay for at least two hours after the placenta has left. Then it's time to get up and maybe take a shower, pee and eat before you go home. Many families want to come home to their own bed to be in the ‘bubble’ of home for the first few days.

Your midwife will try to help you deliver your baby as slowly as possible to prevent rupture. If you wish, the midwife can guide you, which you may have already practised during your prophylaxis class.

The midwives can both examine and stitch any tears that have occurred. We use anaesthesia and offer a blockage of pudendal nerves that is really efficient. We always want to be 2 midwives who help to inspect and suture so that the result is as good as possible for you.

The most common anaesthetic we use is a blockade applied from the outside of the skin, a so-called pudendal blockade. We use Carbocaine/ Xylocaine, the same anaesthetic you get at the dentist. The anaesthetic makes you feel our touch but not pain. For minor ruptures that need stitches, we use anaesthetic cream, Tapin or Xylocaine.

Large tears are very rare in physiological births, but they do happen occasionally. If the tear is more complicated, you may need to go to the hospital to be sutured by a doctor. You may also need a stronger anaesthetic. If this is necessary, your child will accompany you and you can take your own car to the hospital.

We offer vitamin K to all newborns by injection in the thigh, but we never give the vitamin K injection without parental consent and we discuss this at our preparing meetings.

For all births, we recommend that the new mum has plenty of support at home by their partner, a friend or relative during the first days after the birth.

When you are home the first week after birth you can call us if you have any worries or concerns at any time of the day or night. Together with the midwife, you will draw up a care plan for the next few days.

On day 1 after the birth, you will be offered a visit to check on mother and baby at BB Gårda or via telephone/digital meeting.

If you are Rh-negative and the baby is positive in blood group, the midwife will offer a pre-filled injection and give it to you in a muscle usually in the buttock. This is called an Anti-D injection. This injection must be given to you within 72 hours of birth.

Paediatrician visit after birth

You and your midwife will agree on the day you wish to go to the maternity ward at the hospital for the routine newborn check-up by the paediatrician, with a hearing check and PKU sampling.

Your midwife will book the appointment for you and notify you via SMS of the procedures for that visit.

1) Labour starts before 37 or after 42 weeks of pregnancy. Before 37 weeks, it is recommended that a paediatrician or a neo-nurse is present at the birth. After 42 weeks, it is recommended that you have closer monitoring during labour, as the baby is slightly more at risk, therefore it is recommended that the birth takes place in hospital.

2) Water breaking before labour starts. The majority of women go into labour within 24 hours after their waters break. The incidence of serious infections in the baby is 1% after water breaks compared to 0.5% for babies born to mothers with intact membranes. If your waters break and labour does not start within 24 hours, you will be offered either induction of labour in hospital or expectant management at home where we wait to see if labour starts naturally.

Hospital induction is offered because of the risk that you may be carrying group B streptococcus, a bacterium found in the vagina in between 10 and 30 per cent of women and which can very rarely cause a serious infection in the baby.

If you opt for expectant management at home, you will be asked to check your temperature twice a day and to contact your midwife if it exceeds 37.5°C, if your waters change colour, or if you feel unwell or notice a decrease in your baby's movements.

Your midwife will give you further information about the risks and benefits of both expectant management and induction of labour in hospital. Barnmorsketeamet recommend that you can wait 72 hours after your waters break before you need to transfer to hospital if labour has not started. Evidence on waiting longer has not been done any research on so the risks of waiting longer are not known.

3) If the water is brown/green (meconium) when it breaks... We know that the baby has pooped a little in the water, which is not uncommon and does not necessarily mean anything negative. But it could be a sign of stress and in some circumstances, (depending on how far along you are in your labour) we recommend that you are transferred to a hospital where the baby's heart rate can be continuously monitored and a paediatrician can attend the birth.

4) Abnormalities in the baby's heart rate. Both a fast, and a very slow heart rate can be a sign of something abnormal. If any of these occur and persist and the birth is not imminent, you will be advised to move to hospital for closer monitoring and/or a paediatrician may attend the birth.

5) Heavy blood loss during or after birth. Some bleeding after birth is perfectly normal, but if you bleed heavily at any time before or after the birth of your baby, we recommend that you are transferred to a hospital where there are more staff and more equipment to reduce the bleeding.

6) Elevated blood pressure during labour. A slightly elevated blood pressure is expected when you give birth. You are working hard and your blood pressure will rise. However, there is a limit to what is considered normal and if the midwife is concerned she will recommend that you are transferred to hospital. If your blood pressure stays below 140/90 it is considered normal.

7) Exhaustion. Sometimes labour can be very long or difficult to cope with, despite good support and preparation. If you need stronger pain relief, you may choose to move to a hospital where additional help is available, such as nitrous oxide or an epidural.

8) Retained placenta. Sometimes the placenta is not born normally and transfer to hospital may be necessary for manual removal of the placenta, usually requiring a spinal anaesthetic.

9) In case of major rupture, which we feel needs to be assessed by a doctor or which needs to be sutured using a spinal anaesthesia, a stronger spinal anaesthetic. We are always two midwives who check the tear and we suture grade 1&2 but grade 3&4 need to be sutured by a doctor at hospital.

10) If there are concerns about the baby's well-being. If there are any problems after birth, you may be advised to go to the hospital with your baby for observation and/or treatment by the paediatrician, as appropriate. The reasons for this may be that the baby is not responding normally after birth, or if the waters had broken for a long time before the baby was born and there are signs of infection.

Research over the past two decades has shown that planned birth center births is at least as safe as hospital birth for healthy women with normal pregnancies and is associated with good outcomes for both mothers and babies. Babies born at BC:s are less likely to suffer birth injuries and are less likely to need resuscitation.

Serious outcomes have been shown to be broadly similar for mother and baby but those planning to give birth at the Birth Centre regardless of whether they then gave birth in hospital have been shown to have:

• less risk of emergency caesarean section
• less risk of vacuum extraction
• less risk of a caesarean
• less risk of haemorrhage
• less risk of large tears
• less risk of having their labour accelerated with an oxytocin drip

Studies have shown that women who give birth at BC:s feel more in control of their birth, that the birth was a positive and empowering experience, that they have better self-esteem when they become mothers, and that in the majority of cases they plan to give birth in the samt setting again in future births.

Giving birth at a BC has many advantages and is generally safe. This is especially true for women who have given birth before and have not experienced any problems with either the baby or themselves. However, some studies have shown that the risk of a poorer outcome for the baby is slightly higher for first-time mothers. But there are also studies that show that the outcomes are the same for first-time mothers compared to giving birth in hospital.

Complications can occur without warning. Even if midwives are trained to provide emergency care, a transfer may be necessary. Emergency complications are extremely rare, but they can happen. So these are rare events that we are trained in emergency management and response. We talk about and practically demonstrate how this is done in our Midwifery sessions before your birth.

The 3 emergency situations are:

1 Shoulder dystocia, which means that the baby's head has come out but then the baby does not rotate its body as it should, so that the shoulders can be born. The midwife will ask you to stand on all fours to give the baby plenty of room to rotate its body. The midwife may also help to manually release the baby with various hand holds.

2 If the baby is having difficulty breathing and is somewhat tired, he or she may need respiratory support through a mask and bladder that we use to puff out the baby's lungs. After a shoulder dystocia, for example, the child may be affected and may then need respiratory support.

We go through this carefully with you at our consultations and show and explain. If we need to ventilate the baby, we always do it with the umbilical cord uncut so that the baby can continue to oxygenate via your placenta until the baby's breathing is normal.

By far the most common cause of oxygen deprivation in a baby is medically induced, it comes from labour stimulant drips and it is not used at all in physiological births but only in hospitals.

3 Haemorrhage after the baby is born. This is usually due to the uterus having difficulty contracting. Massage of the uterus, breastfeeding, antihemorrhagic drugs are the first mactions that can solve the situation. If this does not help, we perform aorta compression and call an ambulance for transport to hospital.

A research study of 500 000 home births (study published in 2020 in The Lancet) reported no maternal deaths due to haemorrhage. Midwives can safely manage haemorrhage at home.

During a physiological birth, where the body's birth process is not disturbed by unexpected sounds, bright lights and unfamiliar voices, your body has a high production of your own calm and peaceful hormone oxytocin. This hormone interacts with your pain-relieving hormone endorphin and increases the release of it as well, but of course the pain may need to be alleviated even during a physiological birth.

We start from natural methods that support your own hormonal balance in the body and strengthen it. It is common for the birthing person to choose to be in motion and use upright dynamic positions, which in itself can provide good relief. Even breathing and relaxation techniques can give you peace of mind in both body and mind. Many also enjoy soothing massages, various pressures and pressure methods, rebozo-shawl techniques, heating pads, water such as showers and baths, TENS, acupuncture, acupressure, sterile water douches.

Many women in labor find that the bath is what really helps best to deal with the pain and to be able to maintain their "bubble". The heat soothes, the water makes you weightless and you can easily move as you need in the large bathtub/birth pool. The vast majority who choose to try the water as pain relief stay in the bath to also give birth there. Even the placenta can usually be born in the water without any risk.

We have medical pain relief such as local anesthesia if you need to be examined and possibly have something sewn into the abdomen afterwards.