Guide to Danish Health Care during Pregnancy

For most of us, it begins with a home pregnancy test. That second line on the stick heralds changes to our lives to profound to fathom. To help with the practical steps, here is a short guide to Danish health care during pregnancy. Please note that this is only a summary and your personal care will depend on your health and pregnancy.

During your pregnancy, you will be offered a range of free examinations performed partly by your doctor (egen læge) and partly by midwives (jordemoder) (find an overview in Danish here). Regular midwife appointments are likely to take place at a health center where midwives hold office hours, while the ultrasound scanning appointments tend to take place at local hospitals.

The first step is to call your doctor to make an appointment. Have your CPR number ready and an idea of when the first day of your last period was. They will use this information to find the right time for your appointment. The doctor will likely want to see you from week 8 of your pregnancy onwards, and pregnancy weeks are counted from the first day of your last period.

During this first doctors appointment, your pregnancy will be confirmed through a urine test. Your general health condition will be examined (blood pressure, weight, etc.) and it will be established if there are any risk factors for your pregnancy (e.g. a family history of high blood pressure or diabetes or unfavorable work conditions). The doctor will also take a blood sample to test among others for Hepatitis B, HIV, and syphilis. She will also calculate your due date.

During the first appointment, you will further be offered prenatal screening for the chromosomal abnormalities trisomy 13, trisomy 18, and trisomy 21. If you agree to this, then they will test your blood for specific markers (called double test). Some woman might not have thought about whether or not they want to have prenatal screening. I recommend saying yes at this first appointment because you can still decline later on to hear the results. However, the blood test for the prenatal screening has more reliable results if blood samples were taken early during pregnancy.

Eventually, the risk for these chromosomal abnormalities is determined statistically based on three different sources of information. First, the results of the blood test, second, known risk factors (e.g. advanced age of the mother), and third, fetal measurements made during the first ultrasound screening.

The first regular ultrasound scan occurs between pregnancy weeks 11 and 13. During the scan, the due date will be confirmed based on the development of the fetus, and it will be checked if the fetus develops normally. As mentioned above, for establishing the risk for chromosomal abnormalities, the nuchal fold (the neck fold) will be measured and the risk for the chromosomal abnormalities will be calculated and shared with you immediately. It is, therefore, a good idea to bring a support person and no other children to the scan in case you will receive negative news. If the calculated risk is deemed too high, you will be offered further invasive tests to establish a diagnosis with certainty. These tests occur later in the pregnancy.

When and how often you will see a midwife depends on, among other factors, whether you are pregnant for the first time and whether your pregnancy is considered low or high-risk. Most women will visit a midwife about 5-6 times during pregnancy. The midwives will take some measurements and talk to you about all topics related to pregnancy and birth. They will furthermore share with you which options of prenatal classes are available to you. In Odense, from the public sector, there is unfortunately only one short course in English at the OUH (Odense University hospital) available. All other classes are in Danish. Promisingly though, a hypnobirthing instructor has recently started to offer classes in Odense (find her webpage here).

Additionally to the midwife appointments, you will be asked to see your doctor in pregnancy week 25 and 32. These appointments you have to schedule yourself. It is noteworthy that you will not receive any internal gynaecological exams, unless it is medically necessary, until the very end of your pregnancy, when the question how far the neck of your uterus has softened and shortened becomes important for further decision making.

Another exciting event occurs around pregnancy week 20, your second ultrasound scan. During this scan, it will be checked again if your fetus develops how it should. And you will learn the sex of your baby if you choose to.

Approaching your due date, the frequency of midwife appointments will increase. If you pass your due date, you will at some point be asked to come into the hospital for scans and CTG readings to monitor the baby and contractions. In Denmark, the recommendation is that babies should be born between 37+0 and 42+6 weeks of pregnancy. Accordingly, you will be offered to have labor induced between 41+2 and 41+5. You do not have to agree to this as you have medical decision power over your body unless you are deemed a medical emergency.

All women in Denmark have the right to give birth at home. That means the Danish Health Care system has to provide you with the support of a midwife to give birth at home. In Odense, you will be sorted into a specific scheme for home birth, run by a small circle of midwives. This increases the chances that you will know your midwife and you will also receive a home visit before to help you set up the logistics for the birth.

I have spoken to many international women who have given birth in Denmark. One observation I often hear is that the coverage of care can appear low with appointments few and far between. In my opinion, this is a cultural misunderstanding. Where some cultures take the route of frequent appointments and tests, the Danish system places more responsibility on the woman to monitor her health and to contact the doctor or midwives if there are any problems. The moment any problems are flagged, the density of appointments and treatments increases to a much higher level. During my two pregnancies, at no point did I have the impression that any risks were taken with my baby’s or my health. Speak up! Change your doctor if you don’t feel heard. And get in touch with me if you need help.

From Denmark with Love,

Julia

Health care during pregnancy and birth is included in general health care accessible to foreigners in Denmark. It is a combination of doctor and midwife appointments and includes prenatal health tests for both the baby and the mother. Pregnancy care can appear low with long waiting times between appointments but this is a cultural misunderstanding. Woman are tasked to report any problems or irregularities, triggering an immediate increase in the density of care. No one takes any risks with the health of the baby or mother. Speak up and make yourself heard by both your doctor and midwife.


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