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‘Fantastic childcare, but disappointing maternal care’: How Covid-19 has stretched Sweden’s maternity wards

Women who gave birth in 2020 told The Local how they were affected by hospital staff shortages, as a new study shows that more than 900 women in Stockholm could not be offered a place on maternity wards when they gave birth.

'Fantastic childcare, but disappointing maternal care': How Covid-19 has stretched Sweden's maternity wards
Staff shortages and limited hospital beds have changed the experience of childbirth in Sweden. Photo: Tomas Oneborg/SvD/TT

It’s the first time the region has reviewed how many people were not given an appropriate hospital bed when they gave birth. A total of 28,362 births were recorded last year in Stockholm, but 80 women were directed to a different region for care and for a further 929 women there was no suitable hospital bed available.

Instead these women usually gave birth in rooms not intended for childbirth, SVT Nyheter reported, which in some cases had negative effects on patient safety, for example if the room did not have the right equipment.

In one case, a woman was sent home and gave birth in her own shower, and the report found that one child died because of the lack of hospital bed.

Sweden has faced issues in maternity care for several years, with rates of injury in childbirth above the OECD average. Between the years 2000 and 2017, nine maternity clinics were closed nationwide, with the sparsely populated northern regions particularly affected. After protests, recent years have seen regions invest in improving maternity care.

But during the pandemic, pressure on healthcare has only increased, with staffing problems reported in multiple regions last summer. 

One woman who gave birth in Gothenburg, Jessica, described her labour of over 40 hours, in which she suffered significant blood loss and had an emergency Caesarean.

During her time in the postnatal ward (BB in Swedish), she told The Local staff were “so busy that when I rang the bell for help it could take upwards of 20-30 minutes for someone to arrive. I wasn’t allowed to leave the room, either, due to Covid-19. It was like prison.”

“Furthermore, due to Covid-19 I never saw a midwife for a postpartum check-up,” she said. “They changed that meeting to a phone call, with a midwife I’d never met before. It was a pointless phone call in my opinion. I am highly dissatisfied with the post care, or lack thereof, that I received.”

As well as worries about their physical health, several women who gave birth in Sweden in 2020 have said their mental health concerns have not been addressed. While many had found support from fellow parents, through social media and WhatsApp groups, and some had been able to access support from healthcare clinics digitally, several felt neglected.

“I’m really disappointed with the maternal care in Sweden and I know that other women who have had babies in 2020 have felt the same. The childcare is fantastic and I feel my baby couldn’t be better taken care of, but I feel forgotten and not really sure where to turn to for questions about my own health,” said a Stockholmer who moved here in 2014.

Her concerns included a lack of follow-up after receiving a high score in a screening for depression, a lack of information about how the hospital had changed its procedures due to the pandemic, and the difficulty of not being able to be accompanied by her partner at emergency care visits for her young child.

Another woman, who gave birth in Stockholm in October, said that the shortage of staff due to Covid-19 had a direct impact on her birth.

“We went through so many different midwives, doctors and nurses that it was ridiculous. It was pretty common to hear from the nurses and midwives, ‘I don’t actually work at this hospital, so I am not sure how they do things here’. There was a huge communication problem where midwives were not passing on information to each other or not documenting it in the journal. [When] I finally went into active labour, I had a failed epidural and they were unable to get the anesthesiologist back to my room that evening due to short staff. I had no pain relief apart from gas and air for 15 hours,” she said.

The new parent also described the stress of going through regular check-ups alone, saying she was told her partner could not even join virtually. Throughout the pandemic, rules about whether a partner can accompany new parents to appointments and even during the birth have varied between regions and over time. In some cases when the partner cannot join in person, they can join digitally through apps like FaceTime, but this parent said she was not allowed to use this option and her husband missed out on the scans.

“I had a tricky pregnancy and required a scan every two to three weeks to make sure that baby was growing well,” she said. “There were a few times where the sonographer would go very quiet and this would then trigger worry and concern, this made me feel very alone and scared not having my partner with me. So I would just then dread each appointment through my whole pregnancy.”

“My husband could attend the birth but had to leave a few hours later when I went to BB [maternity ward]. I don’t have much knowledge with Swedish medical terms and I felt very bullied about breastfeeding while alone,” said another woman, who moved to Sweden three years ago.

According to figures from the umbrella organisation for Sweden’s municipalities and regions (SKR), nationwide the proportion of new parents receiving after-birth follow-up from a midwife rose from 79 percent in 2015 to 86 percent last year. And the gap between foreign-born women and native Swedes has reduced, with the figures changing from 69.6 and 82.1 percent respectively in 2015, to 81.8 and 88 percent in 2020.

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MOVING TO SWEDEN

Reader question: How can I retire to Sweden?

Although Sweden may be a less popular retirement destination than other European countries like Spain or Portugal, there are many pensioners who plan on retiring in the Nordic country. What are the rules for foreigners?

Reader question: How can I retire to Sweden?

Nordic citizens

Perhaps unsurprisingly, it’s easiest for Nordic citizens to retire in Sweden, as they enjoy unrestricted rights to live and work in any of the Nordic countries without the need for any kind of work or residence permits or EU residence documents.

This means that citizens of the Nordic countries can essentially just move to Sweden and register their arrival at the Tax Agency upon their arrival, bringing with them a passport or national ID card, as well as documentation proving their civil status (married, registered partner, single or divorced), and the birth certificate of any children moving with them.

EU citizens

The situation for EU citizens is similar to that of Nordic citizens. 

EU citizens also report their move to the Tax Agency upon arrival in Sweden, and will need to show identity documents (such as a national ID card or passport), provide their full address in Sweden, including four-figure apartment number if applicable, as well as the name of whoever they are living with if they are living in someone else’s home.

They will also need to prove that they have EU right of residence. This can be done in a number of ways, including proof of work or proof of studies, but the relevant path for most retirees is proof of self-sufficiency, which essentially means documenting housing costs, including electricity and home insurance, and showing that you have some means of covering these financially, such as via a bank statement with a high enough balance, confirmation of a pension of a sufficient size, or an employment contract and payslip from another country, if the applicant is not planning on fully retiring straight away.

It’s also possible to prove self-sufficiency by providing a document or letter confirming that someone else can support you financially, along with a bank statement to back this up. There’s no application fee.

EU citizens may also need to provide proof of their civil status, whether they’re moving alone or with someone else.

Non-EU citizens

As a general rule, it’s not possible to retire to Sweden as a non-EU citizen unless your partner is a Swede or an EU citizen, or unless you’re a long-term resident of another EU country (if that applies to you, see below for details of these routes).

This is due to the fact that non-EU citizens need residency permits to live in Sweden, and these are only granted due to work, studies, or moving to live with someone who already has the right to live in Sweden.

If you don’t have a Swedish or EU partner but you have plans to retire to Sweden at some point in the future, you could in theory get a work permit in Sweden and work until you qualify for permanent residency, which usually means working in Sweden for at least five years.

Note that Sweden’s government is planning on reforming the permanent residency rules, so it’s likely that applicants choosing to do this would have to take language and civics tests in order to qualify for permanent residency in the future. 

It is also likely that the residence requirement for permanent residency could be extended or otherwise altered within the next five years, so be prepared that the rules could change in the future if you do decide to go down this route.

What if only one of us is an EU citizen?

If you’re planning to move as a couple but only one of you is an EU citizen, the non-EU citizen should be able to qualify for a residence card as a family member of an EU citizen.

This allows the non-EU family member to live in Sweden as long as their EU citizen partner fulfils EU right of residence rules (by documenting self-sufficiency as explained above, for example). There is no application fee.

In order to get an EU residence card, the non-EU citizen must have a valid passport, be able to show that they belong to the same family as the EU citizen (through, for example, a marriage certificate or proof of cohabitation), and the EU citizen must be able to show that they meet the EU right of residence requirements.

This doesn’t just apply to partners or spouses of EU citizens either – it can be used for children of either parent aged 21 or under, or other family members who are financially dependent on the applicant (including children over 21 and parents, or anyone the applicant takes care of due to serious health reasons).

You may also need to provide proof that you are either covered by the social insurance system in your country of origin, or proof that you have taken out full-coverage private healthcare insurance for your stay in Sweden.

Swedes are not normally considered EU citizens in this context, unless they were recently living with their partner in another EU/EEA country or Switzerland. See below for the rules for couples consisting of a non-EU citizen and a Swede.

What if one of us is a non-EU citizen and the other is a Swede?

The process for non-EU citizens wishing to retire to Sweden with their Swedish partner varies, depending on where the couple lived before retiring.

If the couple lived together in another EU country (this includes the UK if they lived there together before Brexit), they can apply under the route described above for non-EU partners of EU citizens.

If that is not the case, they can apply for a residence permit to move to a spouse or cohabiting partner in Sweden, sometimes referred to as a “sambo visa” (sambo is the Swedish word for a cohabiting partner).

In this case, the Swede must be able to support both themselves and their partner (which in 2023 meant having at least 9,445 kronor left after housing costs are paid each month), and have a house which is big enough – a home of at least one room with a kitchen or kitchenette, for a couple without children. The application fee is 2,000 kronor for an adult.

What about non-EU citizens who previously lived in Sweden?

In some cases, non-EU citizens who have previously held a permanent residence permit in Sweden are eligible for a new residence permit if they can prove sufficient ties to Sweden.

If they have been living abroad for three years or less, they must have lived in Sweden for at least four years in order to be eligible for a new permit. 

Non-EU citizens living outside Sweden for more than three years must usually have lived in Sweden for at least ten years to qualify for a “returning to Sweden” permit, or if they can prove sufficient ties to Sweden in some other way.

The Migration Agency will assess your application to determine how strong your ties are to Sweden compared with your home country or the other country you have been living in since you left Sweden, and factors such as where you chose to have a family or whether your reasons for leaving Sweden were out of your control will be taken into account.

If your permit is granted, your partner or any other family member wishing to come with you will also need to apply for a permit to join you in Sweden, most likely a residence permit to move to a spouse or cohabiting partner in Sweden.

What about non-EU citizens who have long-term residence permits from another EU country?

In some cases, non-EU citizens who have lived in another EU country for at least five years are able to move to Sweden under EU freedom of movement rules.

This particular route applies to holders of the EC/EU residence permit for long term residents. This grants them certain rights similar to the rights of EU citizens, including the right to move to other EU countries to work, study, start a business or live off a pension.

Not all EU countries issue these permits – Denmark and Ireland do not issue long-term resident status cards to their non-EU residents – and they have different names in different countries, but if you have one of these cards you will be able to move to Sweden as long as you also fulfill the self-sufficiency rules for EU citizens. You will need to apply for the card in your country of residence before moving to Sweden.

You cannot, however, register your arrival at the Tax Agency, like EU citizens, and will instead need to apply for a residence permit from the Migration Agency within three months of arrival.

You will need to fill in this form (Application for a residence permit for persons who have long-term resident status in another EU state and their family members, 137011), and either hand it in directly to a Migration Agency permit service unit or post it to the Migration Agency office responsible for EEA and long-term residence permits. The fee costs 1,500 kronor for adults and adult family members, or 750 kronor for children under the age of 18. 

What about Brits?

Brits moving to Sweden after December 31st, 2020 are subject to the same rules as non-EU citizens. This means that they will need to apply for a residence permit or a card proving right of residence as a family member of an EU citizen if they wish to move to Sweden, or will need to hold a EC/EU residence permit from another EU country.

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