September/December 2006 Neonatal Care in Finland. Written by Kristina Leppala Marimekko, Nokia, Kone, Finnair, Kalevala Koru, Sibelius, sauna, and ’land of the midnight sun’ – all words which conjure up Finland. Finland, is a Northern Scandinavian country with a small population of 5,255,580 (end of 2005). Of them, 97.8% were Finnish citizens and 2.2% were foreign nationals. All of these people take great pride in their high standard of living, and in their public healthcare system, which produces some of the healthiest babies in the world. Finland is well known in perinatal circles for continual excellence in infant mortality figures. The base of these results is rooted in the Finnish maternal-infant clinics (MIC), which are across the nation. Almost 100% of pregnant women go to MIC for scheduled follow-up of pregnancy. After the child is born, the mother still goes to the clinic for check-ups (even home visits can be made by the midwife), and the newborn child is enrolled into the well-baby clinic system (Finnish=neuvola). During the perinatal time, the MIC follows the mother’s pregnancy carefully, assessing for any problems, promoting health, and also providing childbirth and childcare preparation classes for the parents. These visits generally start at 8 – 12 weeks’ gestation for primiparas. Multiparas with a negative history may go to neuvola at a later date. During this first visit, blood values are taken (complete blood count, hepatitis B, blood group), and other tests may be taken as well. During each visit thereafter, weight is obtained, urine is examined (protein, sugar), blood pressure is measured, and a finger stick hemoglobin is taken. Fetal heart rate is assessed with a Doppler. Other tests are administered as needed. There are approximately 10 – 15 visits per normal pregnancy, most with a nurse midwife and 3 – 4 with a physician. Mothers-to-be get routine pregnancy checks, as well as ultrasounds (95% of mothers have ultrasounds). If the mother has a chronic illness or has a prescription medication which may cause an adverse effect to the infant, the mothers are sent to maternal clinics

even during the planning stages of pregnancy. Infertility care has increased in Scandinavia, and this can be done either through the general healthcare system, or through the privatized side. Healthy mothers are followed up in a general care setting, if problems are encountered, specialised medical care

is provided in cohort with the neuvola. Both nurses and physicians can refer a patient to specialized care. Another unique feature to the Finnish maternal healthcare system is that mothers who contact the neuvola before their 16th week of pregnancy are entitled to a new baby package. This package contains everything needed for the baby’s first months of life: high quality starter clothes, blankets and sheets, soaps, diapers, a comb, scissors, books, outdoor clothing, etc…even hygienic pads for the mother! The contents come in a large, sturdy box with a foam mattress. Many decorate the box and use it as the baby’s first or spare bed. In case a family has twins, they receive two boxes.

Finland’s exceptional maternal and paternal compensation package (from http://www.kela.fi/in/internet/english.nsf/NET/081101125811EH?openDocument) All mothers are entitled to a maternity allowance. Compensation for the costs arising from pregnancy, childbirth and medical care is also available, though not for hospital charges. Maternity allowance is paid for the first 105 days of entitlement (not including Sundays and other holidays). Mothers are entitled to a special maternity allowance, if they in performing their work or at their workplace are exposed to a chemical substance, radiation or infectious disease that is considered to endanger the health of the unborn baby or the course of the pregnancy, and if suitable alternative work cannot be found. Entitlement to a parental allowance begins immediately after payment of the maternity allowance ends. The mother and the father can take turns receiving the parental allowance. Parental allowance can be paid to either the mother or the father, but generally not to both at the same time. Parental allowance is normally paid for 158 weekdays. In case of multiple births, the payment period is extended by 60 weekdays for each additional child born. The extension, or part of it, can be inserted anywhere into the maternity or parental allowance eligibility period or be tagged onto the end of such period. In the case of a premature birth, the payment period is extended by the same number of weekdays as it was moved forward. Parental allowance is paid also to the parents of a child adopted before age 7.

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If the parents so agree, parental allowance can be paid also to the father while he is caring for the child. Special cause must be shown to have the allowance paid to the father for less than 12 weekdays.

Parents of a small child who are working part-time are entitled to a partial parental allowance. This means that they can take turns in caring for their child by working split shifts as arranged with their respective employers. Such an arrangement must be made for a period of at least two months. Partial parental allowance is not payable to students or single parents. Anyone receiving partial parental allowance is not eligible for partial

care allowance under the provisions for child day care subsidies. Mothers qualify for the maternity/parental allowance from the 154th day of pregnancy. The mother must have been insured under the National Health Insurance for at least 180 days immediately before the date on which the baby is due. Entitlement to maternity allowance begins 30-50 weekdays before the due date. The maternity/parental allowance is usually paid in installments of 25 days at the end of each 25-day period. The first installment is paid on the last weekday before the due date. Payment of the parental allowance is conditional on the mother undergoing a postnatal medical examination 5-12 weeks after childbirth. Benefits for fathers, unique to Finland! Fathers living in Finland who take a leave from work to participate in childcare are entitled to a total of up to 18 working days in up to four segments during the maternity or mother's parental allowance period. The paternity leave can be extended by 1-12 working days if the father takes the last 12 working days of the parental leave. The extension must be taken in a single period immediately following the parental leave. Paternity allowance is paid in arrears in one or more installments, as requested in the claim. Adoptive fathers are also eligible. A minimum-rate allowance is payable to fathers who are on paternity leave or other leave from military or alternative service. Fathers must have lived in Finland for at least 180 days before the due date and must be living together with the mother of the child. In addition, the mother can obtain an automatic extension of parental leave from her permanent job until her child is 3 years of age. Her job is secured to this time. After this, the mother may choose to work a six hour work day until her child is seven years old. This requires a mutual agreement between the mother and her employer. I have just returned to my job after taking a full parental leave, and am now working a six hour workday. The system does work. Neonatal care There are five high level NICU’s in Finland. They are all university based, and are located evenly throughout the country. They are located in Turku, Helsinki, Tampere, Kuopio, and Oulu. Secondary and tertiary neonatal units are scattered all over the country, in central hospitals. Staff includes RN’s and childcare technicians. Nurses can and have obtained PhD level education. Neonates who need intensive care are treated with all of the high tech equipment and methods that are available worldwide. Breastfeeding and breastmilk are the food and method of choice. Mothers state that they feel a greater connection to their preterm infant when they are able to provide breastmilk to them.

Parental involvement is highly encouraged, and kangaroo care just celebrated its 20th year in Finland. It was pioneered in Turku. NIDCAP training is going on in Helsinki, and many hospitals belong to the Vermont-Oxford database. Well over 300 of the neonatal nurses belong to the Finnish Society of Neonatal Nurses, which celebrates its 15th year in 2007. The organization has held numerous educational and study days, supports nurses with scholarships, leads nurses on tours both within Finnish NICU’s and internationally. There is bi-yearly publication of some 90 pages sent to the members, and its topics cover everything from psychosocial issues to technology, case studies to newest care methods.

This website will highlight various country activities of the international neonatal nursing community. If you would like to have your country or activities highlighted or you are interested in becoming a regional representative or want COINN’s help on a project please send information to us at: [email protected]