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HEALTH

Swedish health watchdog criticizes doctor over woman’s toilet birth

Sweden's health watchdog has criticized a doctor after a pregnant woman was sent home and gave birth in the toilet moments after being told to take paracetamol.

Swedish health watchdog criticizes doctor over woman's toilet birth
File photo of a baby not related to the story. Photo: Christine Olsson/TT

As The Local reported last year, the woman from western Sweden was 31 weeks' pregnant when she started getting stomach pains on a visit to Ystad in southern Sweden and contacted the hospital.

The obstetrics and gynecology unit found traces of blood in her urine, gave her antibiotics and sent her home.

Later that evening she contacted the hospital again, but a CTG and vaginal ultrasound did not show anything out of the ordinary, so the same doctor sent her home once again.

Her husband called health services once more that night explaining that his wife was in so much pain she was unable to speak, but was told that she should take an Alvedon – a Swedish brand of paracetamol-based painkillers.

In the report filed to the Health and Social Care Inspectorate the woman explained that she then threw up and ran to the toilet, where she had three contractions, pushed and gave birth to a son in the toilet chair. Half an hour later an ambulance came to get her.

Both the 39-year-old woman and the child are understood to have been at good physical health afterwards, but the woman later contacted the hospital in Ystad to get an explanation about what happened.

“I have thought a lot about the incident and called Ystad to see if they had done any investigation and if it had provided some answers as to whether or not they could have done something differently. For example let me stay the night for observation,” regional newspaper Kvällsposten quotes the woman as writing in her report to the inspectorate.

But when she called the hospital none of the senior doctors were aware of her birth.

The health inspectorate found that she should have been admitted for observation, especially considering that it was believed she had an infection which could trigger early birth, Kvällsposten reports. The watchdog also criticized the doctor who examined her for not signing the medical log.

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HEALTH

Who should get vaccinated against TBE in Sweden?

Tick-borne encephalitis (TBE) has more than doubled in Sweden in the past decade. Who should get vaccinated against it and how much does it cost?

Who should get vaccinated against TBE in Sweden?

TBE, or Tick-borne encephalitis, is one of the two main tick-borne diseases in Sweden (Lyme disease is the other one).

It is a viral brain infection, which can cause a range of symptoms, usually starting with typical flu-like symptoms and then developing to include nausea, dizziness, and in around a third of cases, severe problems.

Symptoms usually appear around a week after the bite, but can take longer. There is no cure, but it can be treated, and there is a vaccination too.

The tick season tends to last from March to November, peaking in April to mid-June. According to the Public Health Agency, most TBE cases however tend to be recorded during the summer, as that’s the period when people spend the most time outdoors.

TBE is relatively rare, but has been on a fairly steady increase in Sweden in the past decade, from 178 confirmed cases in 2014 (or an incidence rate of 1.83 per 100,000 people) to 595 cases in 2023 (incidence rate 5.64), according to the Public Health Agency’s statistics.

Who should get vaccinated?

Because the infection can in a few cases lead to serious consequences, anyone who lives in an area where there’s a high concentration of ticks carrying TBE is recommended to get vaccinated.

That includes people who live there permanently and who have temporary summer homes, as well as people who spend a lot of time outdoors in these areas, but there’s no strict cut-off point.

Not all ticks carry TBE, and they have historically been concentrated in southern parts of Sweden and the Stockholm archipelago, but have been spreading across the country in recent years.

The regions that recorded the most number of cases last year were Stockholm (160, or an incidence rate of 6.52 per 100,000 people), Västra Götaland (121, or 6.85), Södermanland (55, or 18.22), Uppsala (52, or 12.85), Västmanland (33, or 11.75) and Värmland (31, or 10.93).

The only region that didn’t record a single case of TBE in 2023 was Gotland. Jämtland, Västerbotten and Västernorrland recorded one case each, and Norrbotten two cases.

You may want to contact your regional health services for specific information. Skåne, for example, only recorded 21 cases last year (an incidence rate of 1.48), but TBE is more common in certain parts of the region than others, and the region recommends that people living in these parts get vaccinated – there’s more information to be found on the region’s TBE vaccine page.

You can of course also get vaccinated even if you don’t live in a high-risk area, especially if you spend a lot of time in the forest or tall grass.

How can I get vaccinated?

You can search for healthcare centres near you through 1177.se or the website Fästing.nu (fästing is the Swedish word for tick – don’t confuse it with fästning, a fortress). To view regional information on 1177, go to the top of the page and click välj region (choose region).

The vaccine is not part of Sweden’s national vaccination programme, so you have to pay for it.

In Östergötland, the vaccine is subsidised by the region, so each dose of the initial three doses costs 200 kronor for adults. In a lot of other regions, including Stockholm, it costs around 400 kronor.

Only Sörmland, Uppsala, Västmanland, Östergötland and Jönköping offer the vaccine for free to children and teenagers, at least the basic vaccination schedule of the initial three doses.

How does the vaccine work?

You start with three doses (or four if you’re over 50), usually the first two within the space of one to three months and the third dose ahead of the next season, no more than a year after the second dose.

Each of these doses increases your level of protection, but because you need several to be fully protected, it’s recommended that you begin the vaccination programme well ahead of tick season.

You then get a fourth (or fifth if you’re over 50) top-up dose after three years, and will need top-ups every five years.

Children under the age of 15 are recommended to get the second dose one month after the first dose, then the third dose after 5-12 months. After that they follow the same schedule as adults, so a fourth dose after three years followed by top-ups every five years.

People with an impaired immune system due to underlying health issues are recommended to follow the same schedule as over-50s. They may not be able to reach a full level of defence against TBE, but the vaccine will offer enough protection that they are still recommended to get it.

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