Today I am 36 weeks pregnant. Which is absolutely mind boggling to me. Also today, I officially start my maternity leave. With 4 weeks to go (maybe less, hopefully not more), a job that requires me to be on my feet quite a bit (therefore giving me contractions), and a country and employer that take care of their pregnant women, I decided it was time to rest and take care of me, and savor the last few weeks of childless life.
I'm bringing this blog back from the dead today because I thought, since most of my friends are parents and/or labor and delivery nurses, you might find it interesting to hear what its like to have a baby in another country.
After living in France and Switzerland for a little while Adam and I decided that we wanted to have at least our first baby in Europe because 1) the benefits offered here are better than we could get in the US (the only developed country without countrywide, legal paid maternity leave) and 2) Lots of reports coming out that the US has by far the highest maternal mortality rate of any other developed country, for many reasons, and Europe's maternal mortality rate is less than half of that of the US.
So here's a list all the things Switzerland provides to pregnant women and new moms and some of the differences in insurance and care. (i'm sure some of this is the same as the US, but I don't know as I've never been pregnant in the US)
1. First a little overview of the Swiss health insurance situation. There are 2 types of insurance, basic public (which is required for all citizens and residents) and private. They both include the same prenatal care benefits but the difference is that people who pay the high price for a private insurance plan can be delivered by the OBGYN who has followed them their entire pregnancy and they can deliver in a fancy private clinique, which is essentially a small hospital with 5 star hotel amenities. (I work at one of these). The people with basic public insurance must deliver at a public hospital and at the end of pregnancy, their medical records are transferred to this hospital and the last few prenatal visits are done by the midwives there, and then you are delivered by a midwife there, whoever is on shift at the time. (there are also residents and an attending physician for complications and c-sections). Labor and Delivery nurses don't exist here, midwives do all levels and stages of maternity care. Private cliniques ensure a private post-partum room where the dad is allowed to stay overnight, the public hospital has double post-partum rooms, dads are not allowed overnight. Anyone with public insurance can pay to deliver at a fancy, private clinique, for the small price of $5500-9000. Private insurance allows moms to stay in the hospital for 5-7 days or more after delivery. Public I believe is 3 or 4 but I'm not entirely sure.
I do not have a private health insurance plan, therefore I will deliver at the large public hospital in Lausanne. Early on, I signed up for and paid $800 for the possibility of a private room at the public hospital, if available. They do a little over 3000 deliveries a year and I am told they have the highest quality NICU and maternal-fetal medicine care in the country, at least in this region. Even if I had private insurance, I would choose to deliver here for this reason. Private cliniques can only handle full term, non-complicated deliveries.
The only downside of delivering at this hospital is that with over 3000 deliveries a year, they only have 6 labor and delivery rooms, are always full to the gills, and therefore only accept you into the actual L&D room when you are in full blown, active labor. Before this you are allowed to stay at home, and if hospitalized, early labor is done in a pre-labor unit and you're not allowed an epidural on this unit. And I've heard that their midwives are crazy busy and have little time to dedicate to you during the early labor stage and in the post-partum unit. So from everyone I've talked to who has either worked there or delivered there, I have heard mixed reviews. Some had great experiences, others not. I'm just hoping that my knowledge and experience as an L&D nurse, and my many L&D/midwife/OB friends will help me if I encounter any issues with this.
2. No matter what insurance plan you have, the rest of the care and benefits are the same. Maternity leave officially starts the day you give birth and is 14 weeks long and paid at 100% that entire time. What I am doing right now until delivery is considered a regular sick leave, but is also paid at 100%. For the last 6 weeks, I was only working part time, but was getting paid my full time salary (nurses here are salaried, not hourly). After the 14 weeks paid maternity leave, if for some reason I want more time off, I can easily get it, but it won't be paid. Time off before or after delivery is easily granted by doctors and employers and most people take advantage of that. In fact, I must be the only nurse at my hospital to have worked so far into her pregnancy because starting at 5 months I have gotten daily comments and questions about when I'm going to stop working. Most of my co-workers are from France, and there maternity leave starts at 34 weeks. So the last couple weeks I got a lot of "What the heck are you still doing here?!?!"
3. While you are pregnant and working, there are some restrictions. The big one is that starting at 16 weeks you cannot legally work more than 9 hours in one day. And starting at 20 or 24 weeks, half of your shift must be sitting, half must be standing (which is difficult to regulate when you're a nurse). Since night shifts are all only 12 hours long at my hospital, I was taken off night shift at 16 weeks (yay!), and I was working four 9-hr shifts per week. My 6th month of pregnancy I had a lot of braxton-hicks contractions so my doctor put me at part time, so two 9-hr shifts per week, that I started at 30 weeks.
While I was at work, everyone was very careful about what I did. I couldn't push a patient bed or wheelchair. If I went to get a patient out of bed for the first time after surgery or delivery I had to do it with another person. Sometimes they wouldn't let me carry the patient's dinner tray to them. On slow days they usually told me to stay sitting when call bells went off. And on extra slow days, or if i was contracting, they let me go lay down in an empty room. My managers knew I wasn't sleeping well and usually let me start my shift at 11 so I could get extra sleep in the morning.
4. During pregnancy, a lot of things are covered by insurance, or at least partly reimbursed. Plus I have a complimentary insurance plan for alternative therapies, so I took advantage of it all. Physical therapy, massage, osteopathy (a really cool alternative therapy that is hugely popular in Switzerland), sophrology (breathing and relaxation techniques), accupuncture, a psychologist, and more that I can't think of, are usually all covered at 75% during pregnancy. Although you need to go to someone who is recognized by your insurance company or else it won't be covered. I was burned a few times by this.
Everyone also gets $150 towards prenatal classes of any kind. We did not take any childbirth classes but I did take a prenatal aquagym pool class for 5 weeks.
Also, 2 pair of full thigh-high pregnancy compression stockings are also fully covered. My legs aren't swelling but I went and got one pair anyways because, why not.
5. One thing I didn't know until it was too late was that insurance covers the cost of prenatal vitamins. I bought 8 months worth of expensive prenatal vitamins in the US and brought them back here and then found out this information. But I was also prescribed to take a magnesium supplement so that is paid for every time I fill the prescription.
6. 100% of all my prenatal visits have been covered and I get an ultrasound at every appointment. We have pictures on our fridge from 7, 11, 16 and 22 weeks. The ultrasounds I got at 27 and 32 weeks were quick and I didn't get pictures, although I probably could have asked. But it was cool to get to see the baby every month.
I don't know if this has changed in the US, so please tell me, but my doctor wasn't concerned at all with weight gain, or in my case, lack of weight gain. Apparently now there is no minimum requirement for weight gain, as long as both mom and baby are healthy and baby is growing like normal. Pregnancy did not slow my lightning fast metabolism and I've only gained 15 pounds. But the baby measures smack dab in the middle of the growth curve every time so all is good.
7. After delivery everyone gets a home midwife of your choosing. You are allowed 16 home visits from her in the first 2 months after delivery. Then 3 more any time after that. The early visits are great for establishing breast feeding and making sure the baby is gaining weight. Especially since after leaving the hospital the first pediatrician visit isn't until 1 month of age. The extra 3 later on are usually used for help weaning off the breast.
8. Every little neighborhood in the city has a community center and once a week they have a midwife there for anyone to go and ask questions and weigh your baby. You can also go there any morning to meet other moms over coffee and let your kid play.
9. Another standard post-partum benefit is you get perineal physical therapy sessions. This is great if you don't want to pee every time you sneeze or get an operation when you're 60 to lift back up everything down there.
10. The city gives every new parent a certain amount of free garbage bags to account for the extra trash all those diapers require. In Switzerland, to promote recycling, non-recycled trash has to go in a specially marked trash bag that costs more than regular ones. (you're fined if you're caught using any other bag). For a mini trash-can sized bag, its $1 per bag, each size up is an extra $1 per bag. So this is why the trash bag allowance exists. In our city, the allowance is $160 worth of trash bags.
11. My particular health insurance company gives us a gift of $100 for the birth of our baby. And since we registered him/her with the same company, the baby will get a complimentary upgrade to private insurance status for the first year of its life. I'm not entirely sure what this means for a baby but its still cool anyways I guess.
12. In Switzerland I can choose at what percentage I want to work at after I come back from maternity leave. 100% is 42 hours a week here, for nurses it is averaged over the month since 42 hrs/week is impossible with 12 hr shifts. My contract states that I work 80% with a potential to also work the extra 20%, which I always did before announcing my pregnancy. I have requested to come back to work at 60%, which equals about two 12-hr shifts per week. I could have also requested to not come back at all, and this would not have affected my paid maternity leave at all, which I am entitled to as an employee. These requests are usually always granted but I still haven't gotten mine accepted yet.
13. Daycare. Daycare is just as difficult to find and expensive as in the US. Again there is public and private. For public, you turn in a general request form once you are 16 weeks pregnant, with the days and hours you are requesting, and you are put on the waiting list for a few daycare centers within a certain radius of your home address. There is a daycare that prioritizes employees of my hospital and is right next door to it so there's the most chance I'll get into that one. You have to resubmit this request form every 4-6 months, until you are accepted to a daycare center. I just submitted my second request form last week.
The cost is based on your income, so everyone pays a different amount, and if you make less, you pay less, and vice versa. Based on our combined salaries, for the 3 days a week I requested, we would pay approximately $1000-1500 per month. I've heard you can wait up to a year before getting accepted to one. and if you need to go back to work before a spot opens up then you get involved in the very complicated game of nannies and the babysitter black market.
Once your kid is accepted into a public daycare, then they are automatically accepted into the after school programs when they are older. So most people want public.
Private daycare is more expensive, $140 per day for a full day and doesn't ensure this after school program thing, but its also easier to get into for new babies since most people then switch to public once they are accepted. So I also put myself on the waiting list for 1 private daycare.
So that's my experience so far. Obviously I don't know how the labor will go and since I'm not allowed to work in the delivery room here, I don't know if there are any differences in labor care than what I'm used to but I will soon find out. If its anything extremely interesting or different I'll attempt to write about it if I have time. But just like I learned being a travel nurse for 4 years, all hospitals have slightly different ways of doing things but the goal is always a healthy mom and health baby.
So now I'm going to take a nap. Because since about 27 weeks, I've been sleeping like crap, whether its heartburn, back pain, my overactive brain, or this baby that really enjoys 4am kickboxing.
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