As mentioned in our post about Pregnancy & Birth in Western Switzerland, moving abroad whilst pregnant, or starting a family abroad, whether or not you speak the local language, is difficult and raises several questions about what to expect in terms of prenatal and postpartum support.
Living abroad, far away from family, the question “what support is available once baby is here” is usually a big one. The Swiss healthcare system offers quite a lot in terms of medical support and it is possible to apply for practical help at home too. Postpartum doulas are also available to offer emotional, informational, practical and other support around your home — which is especially helpful to expatriate families (and can be reassuring to Dads/Partners who return to work quickly after a baby’s birth).
To help you understand what is available, I have put together this post outlining the basics for Western Switzerland (i.e. between Geneva and Lausanne). I also offer consultations to anyone who would like to discuss his/her specific family-dynamics or family history. I can also help families figure out what THEY need and how they might go about finding such support. I can also offer a prenatal consultation to any family who is considering hiring a postpartum doula.
HEALTHCARE IN WESTERN SWITZERLAND AFTER BABY IS BORN
For Birth in Hospital or in a Private Clinic
The hospital’s midwives are responsible for your care whilst you are admitted. Your doctor will normally visit at least once after the baby is born, as will your chosen paediatrician (if he/she does hospital visits, if not, it will be the paediatrician on call). If, whist in hospital, you are having difficulties with breastfeeding, you can ask to see an IBCLC (International Board Certified Lactation Consultant) who can provide evidence-based and up-to-date breastfeeding advice. Breastfeeding is a learned skill (lactation is innate), so don’t expect it to just “happen”, both you and your baby have to learn what to do.
Baby Nurseries (pouponnieres) are still common, though BFHI hospitals do not have them (they have neonatal observation rooms). Rooming-in is standard in BFHI hospitals and available at other institutions but not necessarily promoted (“let me take the baby so you can rest” is still often heard). If you want your baby with you at all times, let the staff know. Rooming-in helps the motherbaby dyad in various ways, including helping you get additional rest, which is why it has become standard in many maternity wards worldwide.
You can stay in hospital up to five days (longer after cesarean births or in case of complications) or leave right away. No matter when you decide to leave, once at home, your immediate postpartum care, and monitoring of your baby, will be the responsibility of an independent nurse-midwife (i.e. does not work within a hospital or clinic). Your midwife will come to your home. Your baby’s care is also followed by your chosen paediatrician or family-doctor. The first visit to the doctor’s office is usually around one month.
Just like you select a paediatrician or family-doctor before the birth, it is also possible to select an independent midwife before the birth. Expatriates often contact different midwives ahead of time, ensuring they find one who is available around their EDD, has similar cultural and parenting philosophies, and/or who speaks one of their languages. If you haven’t talked to someone ahead of time, the hospital/clinic will arrange a midwife for you.
Within the first ten days of your baby’s birth, visits by your assigned/chosen midwife are covered by basic insurance (LAMAL). As mentioned above, the midwife will come to your home (you do not need to go to your midwife’s practice or your OB/GYN’s office, unless of course the midwife has detected a problem). If you are having problems with breastfeeding (which may manifest itself in baby not gaining weight), a visit by a lactation consultant (IBCLC) in the first ten days postpartum is ALSO covered by basic health insurance. After the first 10 days postpartum, additional visits by an independent midwife or IBCLC are covered if accompanied by a prescription “ordonnance” (or if you have complementary insurance). The level of coverage is dependent upon your insurer.
For Birth at Home or at a birth house/centre
If you chose a home birth or birth house/centre birth, your independent homebirth midwife will continue to be responsible for your care. The care at the birth house or at home is covered by basic insurance (additional charges for lodging, etc. may apply). After baby is born, your midwife will come to your home (once again, you do not need to go anywhere unless of course the midwife has detected a problem). As above, if you are having problems with breastfeeding (which may manifest itself in baby not gaining weight), a visit by a lactation consultant (IBCLC) in the first ten days postpartum is ALSO covered by basic health insurance. You may also want to take advantage of a free telephone support call and/or attend a free support groups offered by breastfeeding counsellors & group leaders from La Leche League Switzerland (see below “Additional Postpartum Support).
After the first 10 days postpartum, additional visits by an independent midwife or IBCLC are covered if accompanied by a prescription “ordonnance” (or if you have complementary insurance). The level of coverage is dependent upon your insurer.
ADDITIONAL POSTPARTUM SUPPORT
If you think you need additional help at home following the birth of your baby, you can ask your doctor to prescribe “home help” (Services d’aide et de soutien à domicile). To be claimed against your Swiss insurance, you would contact either the AVASAD (in Vaud) or the IMAD in Geneva. Help at home is especially worthwhile after caesarean surgery or with multiple-births.
If you want a more tailored postpartum service, you may consider hiring a private postpartum doula who can offer help at home in the immediate days/weeks/months following the birth of your baby. A postpartum doula’s role is to help the family adapt to life with a baby and become independent, confident parents, as such the services they provide are diverse. They also usually work short shifts over a few days or weeks. Postpartum doulas are especially helpful to expatriates who do not have local family support as they can provide the help traditionally offered by extended family, with additional help navigating parenthood in a foreign country & culture. Many birth doulas also offer such postpartum support.
Breastfeeding counsellors can also be contacted for breastfeeding information and support. They offer telephone support, support groups & workshops, and/or private consultations in your home. La Leche League‘s counsellors and group leaders (LLL Leaders) offer this service free-of-charge (though they rarely do private consultations) any money offered is as a donation to LLL. Other private counsellors charge a fee (but are not covered by LAMAL). Breastfeeding counsellors can often help you navigate the Swiss maternity system and though who are bilingual even translate documentation.
Baby Nannies / Baby Nurses
Families who are welcoming twins or multiples may want to consider not only a postpartum doula, but also a baby nanny or baby nurse. Baby Nurses/Nannies help you take care of the baby (rather than the household) and when you are juggling two or three, it’s nice to have an extra set of hands (especially if one parent travels or is returning to work soon after the birth).
Becoming a parent is a monumental life-changing event and it is very easy, especially for expatriates, to feel lonely or overwhelmed by the changes a baby brings. To limit the feelings of isolation, there are many Groups, Clubs, Playgroups, and baby classes in Geneva, Vaud & Neighbouring France for mothers and fathers. Sign up before the baby arrives so that you’ll have a group of parents to turn to once baby has arrived.