Moving abroad is a difficult thing to do, moving abroad whilst pregnant, or starting a family abroad, whether or not you speak the local language, is even more difficult. Not only that, it raises several questions about what to expect in terms of prenatal and postpartum support.
The most important thing new families should probably remember is that what we would expect AT HOME (wherever that is) is not what is available here in Western Switzerland, even if it looks the same at first glance. This fact is a really big hurdle for childbearing families as “becoming a family” is a very cultural construct, so what we expect, how we look for support, and what we ultimately get in terms of maternity services is going to be affected by our culture. As such, new families automatically, often without realising, look at things in a way that is DIFFERENT from how the Swiss system is run.
To help families get through the maze, I have put together this post outlining the most important things you need to know about having a baby in Western Switzerland (i.e. between Geneva and Lausanne). This is basic information and additional intricacies and comparisons to other systems can be discussed if you set up a consultation.
CHOOSING A HEALTH-CARE PROVIDER
Doctor or Independent Midwife?
Your pregnancy can be followed by an OB/GYN, gynecologist, or an Independent Midwife (sage-femme independante) and some family-doctors will also follow your pregnancy (though few attend births). There are six standard prenatal check ups, plus two diagnostic ultrasound scans, which are covered by Swiss basic insurance (not towards deductible). Additional check-ups and/or scans are usually extra (sometimes covered by complementary insurance). Whether or not the birth itself is covered by basic insurance (a.k.a. LAMAL) is dependent upon where you choose to give birth.
Doctor-led (Clinic or Hospital Births)
Some gynecologists and some OB/GYNs do prenatal check ups, but do not attend births. Those who attend births often only attend births at specific hospitals or specific clinics. A mother and her partner, once admitted to the maternity ward, will be in most contact with the institutions’ nurse-midwives (sage-femmes hospitalieres), who are responsible for the mother-to-be’s care once she has been admitted. These midwives report to each mother’s attending OB/GYN (or the OB/GYN on duty) (though there is currently a petition to ask the state to allow for midwife-led units, which for now only exist in German-speaking Switzerland). Some doctors who attend births will come to the hospital or clinic as soon as they know his/her patient/client has been admitted, others will liaise with the hospital midwifery staff by phone, and will only come to the hospital later (to attend the actual birth).
If your baby arrives after 9 months of pregnancy (e.g. after 38 weeks) your doctor or the hospital/clinic’s doctor will attend your birth. If your baby arrives VERY early, however, this might not be the case. In fact, for premature births, you are limited to birthing at a cantonal hospital (H.U.G., C.H.U.V., etc.) with a NICU and you may be Medivac’d in these instances to a hospital with space for you & your baby.
Midwife-led (Home, Birth House/Centre, and some Hospital births)
Independent Midwives offer global coverage (a.k.a. continuity of care) and if you choose an independent midwife for your prenatal care, your pregnancy will be under the responsibility of that midwife or practice. This means you will see her (or another in her practice) for prenatal check ups (which are generally quite intimate), which includes not only clinical work, but also emotional and informational support. The care is also covered by basic insurance.
For home births and birth house or birth centre births, your midwife (and those in her practice) also may act as a labour support person. Some independent midwives can also attend your birth at Geneva’s Cantonal Hospital (H.U.G.). Independent midwives cannot attend births in other public hospitals or private clinics in Western Switzerland, so if you’d like to birth at a hospital or clinic, but want your pregnancy followed by an independent midwife, the ob/gyn on duty at the hospital will be responsible for the outcome of your birth.
CHOOSING ADDITIONAL SUPPORT PERSONS
Birth Doulas, trained pregnancy & labour support professionals, can be hired to provide additional prenatal information and support and labour accompaniment. This emotional support is offered to the woman and her partner. Doulas do not offer any clinical or medical check-ups or follow-up. They cater their services to what HER CLIENT(S) feel they need, free of judgment. Doulas accompany all types of pregnancies and all types of births. As mentioned, doulas do not offer any clinical accompaniment but can do research for their clients and provide evidence-based information to help them make an informed-decision as to their care.
PREPARING FOR LABOUR & BIRTH
Independent Midwives and Doulas both offer childbirth and other pre- & postnatal classes (private or in groups) to families in the area, either independently, through a midwifery clinic or hospital, through a doula practice, through the Red Cross, or through another family association. There are English childbirth classes available. Contact me for a consultation to find out what I offer and/or what’s available in your area.