Call the Midwife? But how?
Learning that you’re expecting a baby can be so exciting, but it can also be stressful as you worry how your baby is growing, moving and developing as the days and months pass. With your first pregnancy you have lots of questions and often anxieties as you travel a road unknown.
Both of my pregnancies and deliveries took place in my home country so I was lucky that whilst my body and mind prepared itself for delivery I could rely on a health system that I already knew and trusted, as well as being sure that everything would be in my mother tongue.
So how do things work here in Switzerland? We spoke with Louise Colassis, an independent midwife in Vaud since 2015, about the system here; covering everything from pre and post-natal care, to insurance quirks to be wise to and how to register your baby’s birth.
Louise has been a midwife for 37 years, and we were introduced to her when one of The Hub volunteers recently had her first child in Switzerland. What did she have to say?
At first it may seem like you are bombarded with choices, and if you are relatively new to Switzerland as well as pregnancy this can seem overwhelming. However, having choices does allow you to decide what you want your pre and post-natal care to look like. So whilst you might need to add a few extra things to your to-do list at the beginning, in the long-run will have the reassurance of knowing who will be caring for you.
First things, first – like everything in Switzerland, the canton in which you live shapes the main options you have (but exceptions are possible!), and the level and type of insurance you have largely determines what extras are available to you. But please be reassured. The standards of care in Switzerland are very high and the system is very supportive of mothers before and after the birth. You are in safe hands.
Where to give birth?
When it comes to where you can deliver your baby the following are the key options;
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Geneva |
Vaud |
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Private Clinics – several throughout Geneva |
CHUV (centre hospitalier universitaire vaudois) – Lausanne |
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HUG (hôpitaux universitaires de Genève) – Geneva |
EHC (Ensemble Hospitalier de la Cote) – Morges |
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La Rosarie (birthing home) – Geneva |
GHOL (Groupement Hospitalier de l’Ouest) – Nyon |
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Home (if suitable for your pregnancy) * |
Birthing home (there are several across Vaud) |
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Home (if suitable for your pregnancy) * |
* although typically only 1% of births in Switzerland overall are at home.
Unless you are crazily new to Switzerland and about to give birth imminently, you will in all likelihood already have an existing Obstetrician/Gynaecologist. They are the specialist doctor for all things related to women’s reproductive health, including having babies and whilst you can choose where you wish to deliver, they will advise you as to which option they consider to be most suitable given the risk profile of your pregnancy and your insurance level.
Insurance – confirm your cover
Insurance, that word already sneaked in. If you come from a country with little or no insurance prerequisites, just the word alone can be slightly terrifying. It screams of admin, of caveats and exclusions, but in Switzerland it is simply part of every aspect of healthcare and because everyone has to deal with it, it isn’t nearly as complex and overbearing as you might first fear.
Louise suggests that you start by checking what type of Health Insurance you have. There are lots of different levels possible, starting with LAMal Insurance (la loi sur ll’assurance maladie) which is the most basic health insurance in Switzerland and amongst other groups is often held by “frontaliers” – those that work in Switzerland, but live in France.
As every health insurance is different it is not possible to explain all the options that may be available to you, so it is well worth checking your Insurance paperwork directly and then calling your Insurance company to clarify your understanding and ask any questions you have. They will almost certainly be able to speak to you immediately in English, but even if you need to accept a call back, it is worth it to be confident you have understood fully.
And if all that sounded like a giant caveat, Louise illustrates what is included with LAMal insurance, giving you a clear and reassuring idea of the basics.
Typically included in basic insurance (with tips for possible exclusions)
- birth preparation course/meeting with a midwife is reimbursed to the amount of 150 CHF – so if you take a course in a hospital that costs 300 CHF you have to pay the difference
Notes: if you have Swiss complimentary insurance this will often cover up to 300 CHF for courses and often foreign/UN insurances reimburse very little and expect you to cover the travel costs of the midwife for example (2 CHF per KM). So always check and ask if there are additional costs. Some will give you a certificate confirming what is covered, which is extremely useful to avoid surprises when looking to engage professionals
- Prenatal care is covered after the 13th week of pregnancy and the OBGYN will often ask for these to be completed at home for a medical reason. Monitorings with a CTG (cardiotocography, where the baby’s heart rate is checked), urine and blood pressure checks can be done to avoid a hospital/practice visit.
- Delivery is covered (usually with a midwife) and a multi-bed room in the maternity ward of a hospital in your canton.
- Postnatal care (up to 56 days after delivery) for women delivering for the first time, having twins/triplets, a premature baby or a caesarean, can have up to 16 midwife visits within the 56 days that follow the delivery. All other women have 10 visits.
Note: Additional visits can be sanctioned with a doctor’s prescription.
- Postnatal care (after 56 days) there are 3 breastfeeding consultations that can be taken whenever you wish during your breastfeeding journey. There is no time limit on these visits.
Note:
- If you deliver prematurely and the baby/babies are still in hospital after the 56 days, all visits will be covered with a prescription for the doctor for follow up of the baby/babies.
- maternity leave only starts once a premature child leaves the hospital, not on the day you deliver.
This all seems pretty comprehensive, and if you’re lucky to have additional insurance or means to consider private add-ons, you can also upgrade your delivery to include private rooms which aren’t altogether different to hotels, with sophisticated meal choices included.
Midwives
Whilst lots of focus is undoubtedly given to the main event of the birth, pregnancy isn’t a swift process and before, during and after you will need support – which in Switzerland is typically delivered initially by your OBGYN and then by a community midwife.
One of your key actions and decisions, after deciding where to deliver is to choose a midwife. However, Louise explains, as she and her colleagues are self-employed rather than appointed by a hospital, they can choose if they wish to take on a patient, so be aware this is a two-way process!
Finding a midwife
And where do you start? A recommendation would be ideal, but unless you already have friends who have given birth here, you’ll probably need to seek one yourself. Luckily Louise explained two helpful options:
- Take a look at the website for the federation Suisse des sages-femmes www.hebamme.ch It has a search tool to find a midwife by area and requirements, including which languages they speak. Each midwife provides a profile of themselves so you can get an idea of their background as well as any specialisms – some offer complementary therapies for example. And many have their own websites to provide further details of their credentials.
- If you live in the canton of Geneva you can also visit the office of Arcade Sages Femmes www.arcade-sages-femmes.ch on Boulevard de Carl-Vogt. As well as representing midwives in Geneva, they also organise a wide range of courses, including some in English.
Once you have found a midwife you can discuss with them how they work: do they come the same day you leave hospital, the following one, how many visits they do etc?
Louise likes to visit the day after baby comes home, then see how things are going and usually visits again after a further two days before then slowly spacing out the visits until around the 23/24 days postnatal when she remains available for any problems.
However, she also advises that some midwives are more freely available than others so suggests discussing with them if a text at 22:00h is acceptable or not. As each midwife is independent they can work as best suits them, so it is worth an early conversation to see if your chosen midwife has a style that will suit you.
In addition, it is useful to know that community midwives can remove staples or stitches after a caesarean, do the Guthrie blood test on the baby (72 to 96 hours after birth), do blood tests on the mother prenatally or postnatally and those that work in a birthing home can even do the postnatal check up which is due at 6 weeks.
With a midwife found and engaged, the bulk of your preparation is done, however, Louise had some additional tips to offer for the end of your pregnancy.
Later Tips
- Arrange health insurance for your baby in plenty of time. Contact your insurer to arrange this in your 3rd trimester, as you need to ensure that your baby has health insurance as soon as it is born, and babies don’t always arrive on cue! Don’t worry though you won’t get charged until they are born
- If your chosen midwife isn’t also a lactation consultant, consider researching and speaking to someone before your baby is born. It will be reassuring to know you have someone to call if you are in need of additional support when the time comes. You will have lots of demands on your time when your baby is here.
- Also, if breastfeeding is your plan, consider finding some supportive breastfeeding resources in advance. Emily Hardwicke has written a children’s book about weaning a breastfed baby (as well as a fantastic blog “Becoming a Mum in Switzerland” for The HUB.
Follow her on Instagram @sebtheseries as she shares her realities as a mum, including breastfeeding support and links to other breastfeeding resources. She also has a website www.sebtheseries.com where you can also buy her book ‘Seb’s big change’.
- Register your baby with a paediatrician. In Switzerland children are followed by a paediatrician (or GP with paediatrician expertise) typically until they are 16. The first check up is done at 4 to 5 weeks after birth so find a paediatrician whilst you’re pregnant. The visits are then at 2, 4, 6, 12 months unless there’s a problem in which case you’ll return earlier. Just remember that the majority of hospitals have a 24 hour emergency paediatric unit so when your paediatrician is out of office the hospitals are still open.
Louise has very helpfully managed to condense and clarify a lot of key information here and we are very grateful that she took the time to speak to us. You can find further details about her experience and services on her website – www.bumpsandbabies.ch
And if you are currently pregnant and still feeling disorganised – use Louise’s checklist below to focus you onto the key tasks.
CheckList
- Ask your OBGYN what sort of delivery they would recommend for you
- Check your insurance paperwork and call your Insurer to check what cover is not included
- Consider what you want in terms of delivery and support and discuss with your partner too. You may instinctively feel more anxious about some options over others and there are no right or wrong answers!
- Choose your midwife – call as early as possible to secure a midwife. There are plenty of skilled midwives, but if you have a preference for a language other than French it might reassure you to have their services confirmed sooner rather than later.
- Remember that once your baby is born it will need Health Insurance too! Organise this in your third trimester.
For our next blog, Louise explains to us some of the differences with registering a birth in Switzerland.