Äitien hyvinvointi unohdetaan Suomessa, vaikka terveydenhuollon pitäisi olla huipputasoa

Vaikka Suomi on tunnettu hyvästä terveydenhuoltojärjestelmästä, kohtaavat suomalaiset äidit silti valitettavan usein haasteita. Kun neuvolasta ei löydy tarvittavaa apua tai synnytyssalissa kohdataan traumaattisia tilanteita, suomalaiset äidit turvautuvat yhä enemmän yksityisten palveluntarjoajien apuun. Tarjontaa on entistä enemmän, ja se on hyvä asia, mutta kehitys liittyy myös valtavaan yhteiskunnalliseen ongelmaan. Tässä blogikirjoituksessa käsitellään Suomen julkisen äitiysterveydenhuollon nykytilannetta, tuodaan esiin äitien kokemuksia ja avataan, miten yksityiset palveluntarjoajat pyrkivät vaikuttamaan tilanteeseen.

*Huomio: Tämä blogikirjoitus on saatavilla vain englanniksi. Voit lukea Talouselämän julkaiseman artikkelin suomeksi tästä.

"If I wasn't in this industry, I'd be pretty lost with my first child. I feel totally alone and neglected."

Kati Kaikkonen, a 37-year-old expectant mother and a nurse by profession, shares a common sentiment among many Finnish mothers, highlighting the challenges in the public care system. "I've had a different nurse every single time I visited the clinic". Recounting her experiences, Kaikkonen expresses frustration with inconsistent care and how her SF measurement, which measures the size of the uterus, has varied in size between all the visits. According to professionals, this inconsistency may be due to the different hand sizes between nurses. "Why on earth is it even measured in that case?”, Kaikkonen wonders.

On another check-up, Kaikkonen was diagnosed with gestational diabetes. "I had to insist it myself that I start the medication and treatment. Or else it would have been treated only with a diet change."

Kaikkonen belongs to the risk group for pre-eclampsia, i.e. pregnancy poisoning, and this group is recommended to take mini aspirin for the final 16 weeks of pregnancy. They forgot to give her this recommendation at the maternity and child health clinic. "When I asked about it, the maternity nurse told me that it was still worth starting, even though the recommended weeks had already passed. This instruction was only sent to me electronically and not in person, and I did not even notice until a week later. It really feels like everything is so uncertain."

As a nurse, Kaikkonen has a good knowledge of the healthcare system and what she can demand as a customer. "If I wasn't in this industry, I'd be pretty lost with my first child. I feel totally alone and neglected." Her diagnosis exposes a system where mothers often find themselves advocating for their own health needs.

Kaikkonen isn't the only one who feels this way. The turnover of nurses is one of the main issues of public pregnancy monitoring, which drives mothers and families to pay for services out of pocket and go private. Kaikkonen has used her own money in early pregnancy to purchase ultrasound imaging, NIPT chromosome research, and a 4D ultrasound. In addition, she has consulted private specialists regarding her ferritin and haemoglobin levels and received guidance on the intake of iron supplements and vitamins.

Learn more: Ferritin And Iron Deficiency: How Low Iron Levels Affect Fertility

Kaikkonen and her spouse plan to take out private health insurance for their baby at birth and will continue to rely on private care. "If needed, we will seek private osteopathy or physiotherapy. I will seek breastfeeding guidance from a private lactation consultant if the baby happens to have a tongue tie."

In Finland, there is an ever-increasing supply of private service providers operating in the pregnancy and newborn sectors. Statistically, the increase is not significant, as private operators report incomplete information to the Finnish Institute for Health and Welfare.

When Demand Arises, Supply Follows Suit: Private Maternity Service Providers Emerge in Finland

In 2020, the Finnish Institute for Health and Welfare conducted a survey to which nearly 15,000 parents of families with babies responded. "Prenatal coaching surfaced as a critical concern in the survey, revealing an unmet need for support", says Reija Klemetti, Research Director of the Finnish Institute for Health and Welfare. After giving birth, a whopping 37% of moms felt they weren't getting enough help with their babies' crying or sleep struggles.

"No wonder more parents are leaning towards private services with experiences like these", Klemetti says. She further suggests that the growing demand is partly fueled by what's often referred to as the 'new kind of parenting', where parents are increasingly willing to invest not only time but also financial resources into their parenting journey.

"Women often find themselves unprepared for childbirth and feel isolated after giving birth."

Aura Pyykönen, who holds a doctorate in gynaecology and obstetrics, brings a unique perspective to the conversation. With over a decade of experience in maternity hospitals in Helsinki and briefly in Malmö, Sweden; Pyykönen, alongside her colleague Marjo Pant, opened the Isla Terveys remote GP service last spring. This service offers consultations to expectant and newly postpartum mothers and their partners through phone calls or video links. Providing services from psychologists and psychotherapists to physiotherapists and midwives remotely, Isla Terveys charges 110 euros per session. "The company was born out of frustration. I was exhausted because I couldn't practice medicine in the way I wanted to." While she emphasizes that she is proud of Finnish hospitals when it comes to physical care, she notes a critical gap and information void between public maternity clinics and hospitals. Pyykönen points out, "Women often find themselves unprepared for childbirth and feel isolated after giving birth."

Finnish midwives express a shared concern that mothers are unprepared for birth, with 79% of midwife respondents in a recent survey indicating that mothers are not adequately equipped for the birthing process. This sentiment is underscored by concerning trends in various metrics, including a rise in caesarean sections, an increased fear of childbirth, and a growing preference for home births.

The recent 'Me Too at Childbirth' campaign in Finland saw women bravely sharing their traumatic and, at times, violent birth experiences. According to Pyykönen, these distressing stories are, in part, a result of the systemic oversight of birthing mothers as unique individuals. Women in Finland are having children at an older age these days, with the average age of first-time mothers rose by 1.6 years over the past decade. "There's simply more time and space to think about what could go wrong", Pyykönen describes. Birthing mothers need a more individual approach at birth, they need to have their concerns heard and addressed.

”Why is the famous Finnish maternity box called the ´maternity´ package when almost all of the contents are for the baby?”

When Laura McGrath's son was born, there was only one product for mums in the maternity package: a lubricant. "Is that really the only product that mums need after childbirth!” McGrath says and laughs. "A few others would come to mind."

In all honesty, the maternity boxes have included at least reusable nursing pads and nipple cream in the past, but McGrath´s observation is still apt. "Why is the box called the ´maternity´ package when almost all of the contents are for the baby? This also sends a message from society that only the baby matters."

According to Reija Klemetti of the Finnish Institute for Health and Welfare, Finland differs in its emphasis from many other countries. "Elsewhere, maternal care focuses more on the mother, but in Finland we take a family-centric approach and talk of an expecting family rather than an expecting mum", says Klemetti.

The WHO recommend three check-ups to monitor the health of mothers after childbirth. In Finland, two are recommended. The first of these is a postpartum home visit or a clinic reception where the baby is also measured and examined. The second is the postpartum check for the mother.

In McGrath's first birth, a lot went wrong, and her life was in danger. She felt that the focus of the hospital shifted to the baby immediately after birth and that they were not interested in her condition at all. McGrath´s childhood friend, Kati Hovikari took three years to get her core to recover from childbirth, and it was difficult to find help or information.

Read more: Female Changemakers: The Birth of Lola&Lykke

So, the friends started a company that focuses on the mother. Lola&Lykke sells breastfeeding products and support bands for pregnancy and postpartum but aims to become a holistic start-to-finish support collective for mums. "The maternity market is still quite fragmented. There is no single actor who would support you all the way. That's a huge opportunity", McGrath says.

Award-winning products for every stage of motherhood

On its website, Lola&Lykke offers free advice and answers to general questions from a panel of experts. Providing free assistance is part of the company's philosophy: it wants to provide mothers with reliable information at a low threshold so that no one must struggle with their questions alone.

”Parenting advice, like sleep, is a nuanced journey, and what works for one might not work for all.'"

Why does the baby cry? Why does she not eat? Why does he not sleep? A quick Google search can give you millions of answers. It’s safe to say that the information is readily available.

However, the world of online knowledge is a double-edged sword for new parents. While they benefit from valuable peer support on baby forums, social media groups, and blogs, they're also bombarded with advice that may be either fitting or completely unsuitable for their unique situations.

Certified sleep consultant Annukka Karttunen gives an example. "There are a lot of families who have read that a particular way has worked really well for a child to sleep. They tried it and found that the situation just got worse instead. "

Karttunen's sleep guidance service, Sleepy, is dedicated to addressing sleeping issues in babies and young children through both in-person and remote consultations. ”I entered the industry a couple of years ago when my firstborn had trouble sleeping.” At Sleepy, Karttunen, along with another part-time consultant, engages with families daily who feel a sense of failure because they can't get their child to sleep. ”Upon closer examination, we often find that the sleep method they've read about isn't suitable for their child's unique needs. For instance, if a child experiences a high density of wakefulness, ending night feeds may not be the solution; it could be found in adjusting daytime naps or bedtime", Karttunen explains.

In the realm of maternity and baby companies, the desire to provide accurate information is universal. For some, like Sleepy, it's a product. A half-hour telephone consultation costs 49 euros. Similarly, for Lola&Lykke, ensuring customer engagement and happiness is the ultimate goal. Pyykönen, from Isla Terveys, questions whether peer support can be curated to prevent the spread of misinformation in communities. Karttunen also offers breastfeeding guidance, and the story remains consistent: incorrect information or misguided attitudes from discussion forums can needlessly stress new parents. "This surge in misinformation leaves parents feeling overwhelmed and questioning their parenting skills. If navigating the challenges with a baby is tough, when does a mother find time to focus on her own well-being?"

“Coaching has a hidden agenda, it’s like giving mothers a big hug and saying ‘You’re doing great!’”

Abdominal muscle separation, a common occurrence during pregnancy, becomes a concern if the muscles don’t recover after birth, impacting the core's function and causing other long-term symptoms. The right rehab does wonders, but hitting the gym without a plan can make things worse.

Learn more: Lola&Lykke Experts Answer: Diastasis Recti in 6 FAQ's

Maternity clinics provide exercise instructions postpartum, with the GP guiding on when and what types of exercises to start. But once you leave the clinic, you are pretty much on your own. In 2014, Riina Laaksonen, balancing full-time work in IT with a sports coaching hobby, founded a sports studio in Helsinki. The demand for maternity and abdominal separation topics grew rapidly. "We started to get inquiries from all over the country. We thought hard about how to help these mums as we were based in Helsinki." Responding to requests nationwide, Laaksonen and partners initiated an email course, sending exercise instructions and postpartum recovery information. And they founded Nordic Fit Mama.

Learn more: Exercising Safely Postpartum

Since 2019, Nordic Fit Mama focuses solely on digital coaching, addressing shortcomings in health and social services through digitalization. A monthly membership, starting at €16.60, offers access to an extensive library of online training. With rapid expansion and continuous offerings, Nordic Fit Mama aims to cover a woman's entire life cycle, "Our goal in the long term is to cover the entire life cycle of a woman. From puberty – when menstruation begins, there is a very strong need for information and peer support – until menopause.”

Laaksonen says that her coaching has a hidden agenda, it’s not just about physical health. "It's like giving mums a big hug and saying, 'You're doing great!' Feedback keeps rolling in, telling us our support is something mums rarely find elsewhere."

The Complex Realities of Finland’s Falling Birth Rate

The negligence of mothers has consequences private businesses can't easily fix. Finland's birth rate declined by a quarter between 2010 and 2019, posing a significant social problem. After two marginally better years, between January and June 2022, the number of births hit an all-time low. This demographic challenge impacts the economy, with fewer new taxpayers and an insufficient labor force to sustain prosperity.

The decline in Finland's birth rate is a complex issue, with over a quarter of women in their childbearing years hesitating to have another baby due to traumatic past birthing experiences. According to the 2018 Family Barometer survey, 27% of individuals aged 20-45 with at least one child attribute their reluctance to expand their family to trauma from previous pregnancies or childbirth. This hesitation has manifested in a significant increase in the fear of childbirth, rising from a modest 1.8% in 2006 to a substantial 11.1% in 2021.

According to Aura Pyykönen, the increased fear of childbirth was one of the main reasons why she founded Isla Terveys. "The treatment of fear of childbirth has been developed a great deal and it is effective. But many industry veterans are exhausted and have resigned," Pyykönen says. Some Isla Terveys clients just want advice on whether it's sensible to consider a new pregnancy after a traumatic experience. The birth rate decline in Finland spans all age groups but is most pronounced among less educated individuals. This accumulates disadvantages as those with lower education, limited employment opportunities, and lower income are more likely to remain childless.

Private maternity care clientele tends to be highly educated and financially stable. When the public healthcare system overlooks the birth fears and traumas of mums, it's easy to identify those who will bear a disproportionate burden.

”Women have always given birth and childbirth is the most natural thing in the world.” Laura McGrath from Lola&Lykke has heard this outdated mindset since starting her business. In some markets, this view remains prevalent. "All other areas of health have experienced immense development and digitalization. The more ways we can find to improve the experience of becoming a mother, we should use them", emphasizes McGrath. Moreover, she contends, "Childbirth is not a very natural experience for most women. None of us know what we are doing when we enter the birthing room."

Lola&Lykke and Isla Health have collaboratively introduced a groundbreaking "Ask the Doctor" remote service, offering pregnant and postpartum women a 20-minute telephone consultation with an OB-GYN Specialist. Priced at an affordable €58, this service enables women to discuss childbirth, postpartum discharge, menstruation, or any female health concerns from the comfort of their homes. Recognizing the gaps in women's health, Lola&Lykke emphasize the need for digital innovation and increased attention to address the gender health gap.

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Isla Health founder, Aura Pyykönen, sheds light on the challenges in gynecological care, emphasizing the importance of self-initiative and the need for a holistic approach to women's health: ”My work as a gynecologist offers a vantage point on how women's health problems are viewed in our society. The public healthcare sector is in turmoil and resources are scarce within every field of health. I am however glad to hear that there is a plan to offer more compensation for using private health services.”

The collaboration aims to provide accessible and expert support to mothers during crucial phases of their reproductive journey. Learn more and explore further details about the service.