Asabea Britton, Sweden
Photography by Trina Cary Photography
Asabea Britton, mother of two based in Sweden shares her experiences as a midwife giving birth to two boys in Stockholm. Through her informative stories, Asabea shares everything you need to know about the female body going through pregnancy, birth, and postpartum. She explains everything from stretch marks to cesarean birth and constantly raises important issues during the perinatal period. Here she shares her expertise from her job as a midwife, as well experiences from her personal journey to motherhood.
Introduction
Where were you born and raised?
I was born in Sweden and have lived here most of my life, but I’ve also lived periods of my childhood in Ethiopia, Ghana and Uganda due to my parents' work. My dad is an infectious disease doctor and my mother is a parasitologist.
Can you give me a little background on yourself and what you do?
I'm 32 years old and I live in Stockholm with my boyfriend and my son. We have another son on the way, expected any day now. I've been a midwife for about 2.5 years - it's my dream job. When I’d just finished midwifery school and was pregnant with my first child, I started posting about things related to midwifery and my own pregnancy on Instagram. I didn't have a goal with it, I just wanted to share what interested me. It's grown to something bigger than I'd expected and I now have quite a big platform to inform about topics that are really important to me.
You’re an incredible wealth of knowledge for others - what inspired you to share your knowledge about pregnancy, childbirth and postpartum with other mothers?
I was pregnant with my first child and fresh out of midwifery school when I started posting about these topics, so I was particularly invested in everything regarding pregnancy-related at the time. I was eager to share the things I'd learned, and also the new things I was experiencing for the first time. I didn't have a plan to start a midwifery account, that just kind of happend with some encouragement from my friends.
One day, I posted a picture of some illustrations of vaginal tears (which we used at my workplace to show women who’d just given birth what kind of tear they’d gotten during labour) to my Stories, as I thought it was a bit funny how I walked around with them sticking out of my pocket on the subway. The post got a bigger reaction than I’d expected. My friends asked me to explain what the illustrations meant, as some of them were frightened by what they saw. I never wish to scare anyone so I thought it was my responsibility to give some more context to what I just showed in passing.
I created a story I called ‘Bristningskolan’ (translated loosely to ‘tearing school’) where I explained in detail the different kinds of tears and how they’re treated. The response from the story was amazing and my friends encouraged me to keep posting about things relating to my work. That's how it all started.
How old is your first child? And when is your next one due?
My son is two, and the due date for my current pregnancy was yesterday! I'm not so fond of the concept of due dates, though. I think it's easy to get obsessed with the date and feel discouraged when it passes, so I usually just say ‘he’ll be here by the end of the month.’
Did you find out if you’re having a boy or girl the first time? In this pregnancy?
We didn't find out for my first pregnancy - thought it would be a fun surprise and it really was. This time I wanted to try something different so we decided to find out. I wanted to know beforehand if I was going to be the mother of two boys, and yes, we're expecting another boy.
Pregnancy
As a midwife yourself, what type of prenatal care do you receive throughout your pregnancy?
Since my previous pregnancy was a normal one and I don't have any health issues, I follow what's called the ‘base program’ for second-time mothers in the prenatal care program. That means I see a midwife for the first time around week 10 to do blood and urine tests, take my blood pressure, and talk about my health history. From there, we plan how many visits I’ll need throughout pregnancy and if I need help from other health providers.
Since everything was normal, my next visit was in week 25, when the midwife measured the uterus for the first time, listened to the baby's heart rate, and checked glucose and iron levels. From then on I visited the midwife once a month up until week 35, and after that the visits became fortnightly. So as long as everything is normal, it's a midwife I see during pregnancy. Since I plan on giving birth at home this time, I’ve also been in contact with the two midwives who plan on assisting me at home.
Are scans/ultrasounds readily available, and how often do you have them during pregnancy?
It depends where you live. All regions offer a routine scan at about 18 weeks. Some regions, like Stockholm where I live, also offer an ultrasound to check for signs of chromosomal anomalies at about 12 weeks. Besides that, no ultrasounds are offered if you don't choose to pay for them privately or there’s some circumstance in the pregnancy that motivates extra ultrasounds.
During my last pregnancy, my placenta was low so I did an additional ultrasound at 32 weeks as well as one around 40 weeks because my uterus was growing slightly less than normal. During the COVID pandemic, some regions no longer offer the 12 week chromosomal scan and private scans have also been reduced. But everyone still gets the 18 week routine scan, as far as I know.
What are the attitudes towards pregnant women? Do you receive any special ‘care’?
I feel like I receive a lot of extra love and care from my friends and family. From society in general? Maybe not so much.
Sweden is quite an individualistic society where you’re expected to fend for yourself and mind your own business. I think that goes for pregnant women as well. For instance, it's not that common for people to offer you a seat on the subway, even if they see that you're pregnant. But it happens occasionally. It annoys me at times, but all in all I feel very well taken care of in my personal life and that’s the most important thing. When someone actually does offer me a seat, it makes my day!
Birth
What are the attitudes towards birth in Sweden?
More medical based, definitely. It's made apparent by the fact the only birthing place offered to most women is a large hospital. The few midwifery-led units we have had, which worked with normal, low risk pregnancies, have been shut down. A year ago the possibility of financed home birth in Stockholm was withdrawn, and now homebirth is offered in only one region in Sweden.
Healthcare here is governmentally funded. You can still have a home birth but you have to organise and pay for it yourself. Various restrictions and rules also make it hard for the few midwives that do home births to be able to work. This is something I really hope will change - I wish women were given options to give birth the way they prefer and that politicians would listen more to science, experienced midwives, and what women want instead of letting anecdotal experiences and fear of birth and possible complications rule the decision making.
Can you tell us a little bit about your first birth?
My first birth was at a hospital in Stockholm. I chose the clinic where I’d had my last midwifery placement as a student because I liked the way they worked and knew quite a few of the staff. Their philosophy is to put the birthing person first and work for a normal birth. On paper, I don't think my birth sounds particularly fun, but I was really happy with the experience, largely due to the great support I was given from the midwives as well as from my partner and my big sister who were with me all the way.
All in all, it was a normal birth, but the reason I say it might not seem a great experience on paper is the fact it took some time - 52 hours in fact from my first very painful contraction until he was born. I was sent home from the hospital once because I wasn’t dilated enough and the contractions weren't regular enough. They wanted to send me home the next time we came as well but I refused. I asked to get some pain relief and something to help me sleep, which made all the difference. After a few hours’ sleep I was like a new person.
When I finally got my room at the delivery ward, everything improved. I was able to bathe (which I loved), but unfortunately I got a slight fever which meant I had to get out of the bath and had a much harder time dealing with the contractions ‘on land’. After a while, I had an epidural which helped a lot. I got some rest and dilated quickly but my son then took a while transcending down the birthing canal. Towards the end of labour I had a temperature of 39.5 degrees and received antibiotics, then it was time for me to push. I thought it went well, despite the epidural numbing the real sensation of having to push. I just got a superficial tear which was sewn by the midwife in my hospital room right away.
After birth, I had 950 ml urine in my bladder after I'd been to the bathroom (the limit before you're given a catheter is 1 liter), so that and the fact that I had a fever and needed antibiotics meant we were required to stay at the medical antenatal ward instead of the antenatal hotel (which is a regular hotel with midwives working there). I loved giving birth. Even though it was really hard, it was the most amazing experience.
Are you doing anything differently to prepare for this birth?
Yes, definitely. Last time was a good experience - it was my wish to give birth at a hospital because I didn't know how I would react to the pain and wanted all the anesthesia available. This time, however, I’m planning for a home birth. In Sweden, home birthing is seen as quite alternative, which means I have to make all the arrangements myself. It's not that much to prepare, but I’ve hired two lovely midwives to assist me and I've rented a birthing pool which I plan on having as my main form of pain relief. I have a great big birthing team this time. My partner and sister will be there, as well as my other sister and a good friend who will be in charge of taking pictures and filming the process.
We're all organised with things like towels, mattresses, a sieve for the pool etc. at home, and I've also got different supplements and foods that are meant to ease birth (following recommendations from my midwife). I've also taken a hypnobirthing course! I listen to relaxing hypnobirthing sound files before I go to sleep every night to help me relax. I've also put up affirmations about birth in my apartment to help me stay positive and believe in myself and my ability.
Will you hire a doula to support your birth and/or postpartum? Is this common in Sweden?
My sisters will be my doulas - one of them became a certified doula after she attended my first birth. Doulas aren't that common here but I feel like there’s an increased interest in their services.
What type of follow-up care do you receive after birth, for both yourself and the baby?
You’re offered a follow-up appointment with the midwife you’ve been seeing throughout your pregnancy. It’s a short visit where you talk about labour and breastfeeding, and get a vaginal exam. A government agency called Barnavårdcentralen (BVC) then takes over the care of the baby, and partially the care of the parents as well. They make a home visit a week or so after birth, and then assign a specialised nurse to have regular check ups with the child. During the child’s first year, the visits are closely spaced and then after two years there’s a check up once a year up until the age of five. At BVC, you as a parent or a couple can also get help if needed, like counseling for example if you're having relationship issues or psychological help if you’re depressed.
Visits with a midwife/nurse following birth are quite scarce and many women feel left alone after birth, finding it hard to get help with physical problems if they need it.
As a midwife, do you recommend any specific foods or diet to aid in postpartum recovery? Will you be utilising these in your own recovery?
I'm just learning more about this now. In Swedish midwifery school, we don't learn much about these things since it's quite medically-oriented, so it's not really my area of expertise. But after advice from my midwife, I'm drinking raspberry leaf tea every day to help my uterus contract after birth. My sister has also prepared a chicken soup for me and my birth team which we’ll eat after my labour for strength. I’ll also try to eat foods that are rich in iron and beneficial for digestion after birth, like the six dates a day I've been eating for the past few weeks to help my contractions during labour. Dates are rich in iron, high in energy, and help with digestion.
What do you personally believe are the most important things in aiding postpartum recovery for mothers - both physically and emotionally?
Rest and lots of support from friends and family. In Sweden, we’re quite independent as a people, and I think that can leave a lot of new mothers feeling lonely and scared to ask for help. I wish there was more of a culture of community in Sweden around a newborn mother and child.
There’s also an expectation to get back to normal life quite quickly that I wish we could get away from. As a midwife, I recommend new mothers lower their expectations and demands on themselves. It’s enough for a new mother to take care of a newborn and her healing body; all the rest can take a break.
Postpartum
What’s the culture around taking newborns out in public?
There’s no recommendation to wait a certain period of time before taking a newborn out in public. Most people expect to go out with their babies quite quickly following birth. With my first son, I went out as soon as we got home from the hospital. With my second, I plan on taking it easy and not rushing things.
Is there government-supported maternity or paternity leave?
Yes, there’s paid family leave for both the mother and the father. That's one of the best things about living in Sweden. With my first son, I had a year of paid maternity leave and his father had nine months.
Who typically cares for the baby during the newborn stage?
The mother or both parents - both parents have 10 days paid leave right after the birth, so both parents will care for the child at the beginning. After that, the couple can decide how to divide the parental leave between the two of them, but a certain number of days have to be taken by each partner.
I plan to be home during the first few months with my second baby, but I haven’t decided on the exact length of time. Unfortunately, both my parents work a lot so they can't help me with daily care of the baby. My partner’s mother, who’s retired, helped me after the birth of my first son and I'm sure she’ll be happy to help this time around too. I expect my partner will take a greater responsibility with everything relating to my eldest son so that I can focus on the baby and recovering from birth.
Can you speak at all to the culture around newborn sleep in Sweden (particularly expectations for sleeping through the night, self soothing, etc.)?
The official recommendation is that newborns should sleep in a separate bed from birth due to evidence that it lowers the risk of Sudden Infant Death. I never managed that though. Had I insisted on having my son sleep in a separate bed, I think I would’ve been a wreck! He wanted to breastfeed at least once an hour all day and night, and slept best when close to me, as I feel is the case for many newborns. I believe the recommendations reinforce the idea that newborns are able to sleep separately, while in my experience as a mother and midwife, this hasn’t been the case. I know many parents who secretly co-sleep because they’re afraid they’ll be judged if they’re open about it. I think it’s important for caregivers to inform mothers on different sleeping options, and I’ve written about safe co-sleeping as an option.
The notion of a baby’s sleep in Sweden is the same as in many Western countries. We tend to compare children's sleep patterns to our own, expecting them to sleep through the night by the time he/she is a few months old (and if not by then, definitely by the first year). However, this isn’t the case for most children. There’s also demand for babies to learn to self soothe quickly. Breastfeeding your child to sleep, for instance, can be seen as spoiling them - but this never resonated with me.
I try to practice gentle parenting and follow my son’s sleep and wake patterns rather than trying to change them. It’s worked out well for us - the only time I’ve forced a pattern on him is when I stopped breastfeeding during the night when he was 15 months because it wasn't making me feel well mentally, and I also felt like it was disturbing his sleep rather than soothing him at that point. However, I continue to breastfeed him to sleep at times if he wants to. He doesn't sleep through the night yet, but I don’t have expectations on him to do so. He falls asleep in his own bed, in his own room, and comes into our bed sometime during the night when he wakes up. It will be really interesting to see how it will be co-sleeping with two children. Perhaps then, I’ll be more eager for my eldest to sleep through the night.
Breastfeeding
What was your breastfeeding journey like with your first son?
I breastfed him exclusively for the first six months. He was slow to start with solids, so I breastfed a lot during the entire first year. I still breastfeed him once or twice a day. I planned on stopping when I got pregnant because we were in Ghana at the time and I was on a malaria medication that wasn’t safe for breastfeeding. However, I couldn’t bring myself to make him (or me) stop so abruptly, so I took a big risk and quit the malaria medication to be able to continue breastfeeding. I've really enjoyed breastfeeding and still do, but as I hit mid-pregnancy with my second son, my nipples got very sore. That was the first time it was painful for me, but I continued breastfeeding. Now at the end of my pregnancy, I’ve had some nursing aversion several times which has led to me to nurse less. The next part of my breastfeeding journey is tandem nursing.
Is breastfeeding in public socially accepted in Sweden?
Yes, at least when it comes to younger children. I very rarely see toddlers being nursed in public, but babies, yes.
Is breastfeeding support readily available?
It could be more available, especially in smaller cities, but yes, there’s help available if you seek it out. There are outpatient clinics you can attend with midwives specialising in breastfeeding support.
How long do babies typically breastfeed in Sweden?
The recommendation is exclusive breastfeeding for six months and partial breastfeeding for the remainder of the first year. According to statistics from 2017, 95% of babies breastfeed after one week, 75% at four months, 63% at six months, 44% at nine months, and 27% at 12 months.
Sweden
What’s your favourite thing about being a mother and raising children in Sweden?
That we’re given an opportunity to be with our children when they’re little. The parental leave system is great, and culturally, there’s no expectation to get back to work quickly. I also love the fact that due to the parental leave policy, dads/partners are given the opportunity to be a big part of the child’s life.
Our childcare system is also very good. My son gets full-time daycare with lots of activities, thought-out pedagogics, home cooked meals, and diapers paid for - all for the cost of around 1600 SEK (about $250 AUD) a month. I feel like the Swedish Government tries to make it easier for parents.
If the world could learn one thing about the way Swedes approach pregnancy, birth, and motherhood, what would it be?
To not make parents have to choose between having a career and being there during your child's first few years of life. And also, maybe most importantly, actively including the fathers/partners in the role of raising a child.
Interview with Asabea Britton
WANT TO KNOW MORE ABOUT SWEDEN’S PARENTAL LEAVE POLICY?
Click here to learn more about Sweden’s Parental Leave Policy through our interview with Dr. Charlotte Evlander, a midwife and policy maker in Stockholm, Sweden.