Forfatter: Oslo jordmor- og ultralydklinikk

Who can recieve pegnancy follow-ups in Norway?

Pregnant women, women giving birth and women on maternity leave who are residents in Norway or who are refugees, asylum seekers or family reunified shall receive both municipal health care and care services as well as specialist health services, cf. the Health and Care Services Act §§ 3-1 and 3-2 no. 2 (lovdata.no). This also applies to pregnant women and women giving birth without legal residence in the country. If the pregnant woman is not able to pay, the expenses must be covered by the health authorites.

Questions from our patients

We have both Norwegian and foreign patients who come to Oslo midwife – and ultrasound clinic early in their pregnancy. Many have questions about how the pregnancy follow-up is assessed in Norway. Where and how they should be followed up, how many pregnancy checks-ups they should have and how often it is common to have an ultrasound of the fetus, among other things.

The public sector offer check-ups for free, and will ensure that the woman receives advice and guidance throughout the pregnancy.

It is recommended to contact a doctor or midwife to arrange the first pregnancy check-up as early as possible. The woman chooses whether she wants the controls with the midwife at the health station, a GP or at a private clinic, such as the Oslo midwife and ultrasound clinic.

Our goal and what we offer

The goal for Oslo Midwifery and Ultrasound Clinic is to offer pregnancy follow-ups of the best quality. We want to ensure that the woman receives advice and guidance so that she and the baby have the best possible experience during pregnancy and at childbirth. The pregnant woman must receive knowledge-based information and she will also influence the follow-up appointments.

“Mother’s somatic, mental health and her social well-being must be ensured in the best possible way. Maternity care must also ensure the health of the fetus, so that the baby is born viable and without disease and injury that could have been prevented. The consultations shall detect and treat illness and other health-threatening conditions in the mother, so that the pregnancy entails the least possible risk for her and the baby ”(Ref .: Guidelines for maternity care, National professional guidelines, Directorate of Social Affairs and Health, 2005).

This must be ensured through maternity care. The Norwegian Directorate of Health recommends a basic program with eight check-ups until pregnancy week 40, and an ultrasound in pregnancy week 17-19 is included. The actual content of the pregnancy follow-ups is standardized, but various topics such as diet, physical activity, breastfeeding and childbirth will also be central. Continuity with one or as few professionals as possible during pregnancy is important for the quality of the follow-ups.

Oslo Midwifery and Ultrasound Clinic can offer a first-time check up for filling out the health card that the pregnant woman must keep with herself throughout the pregnancy. Blood samples are ordered to be taken between pregnancy weeks 8-12. We will apply for you at your desired hospital where you will both give birth and do the routine ultrasound. In addition to the check-up itself, there will be plenty of time for conversation and information, and a full hour has been set aside for this first check-up. We are happy to follow up the pregnancy further. 30 minutes will then be set aside for each pregnancy check-up. We also offer several controls beyond the recommended basic program if there is a desire or need for it.

It is also possible to order follow-ups of the pregnancy, later in your pregnancy. It will then be appropriate to order a “first-time consultation” which is 60 minutes so that the pregnant woman can both provide and receive the necessary information and so that we can get a correct picture of the pregnancy so far.

Pregnancy check-ups

In this blog we have gathered all the information regarding the various check-ups, when they are performed and what is performed.

The content for all the check-ups throughout your pregnancy has been prepared by the Norwegian Directorate of Health and Social Affairs.

First check: pregnancy week 8-12

• You will be informed about topics related to daily habits, information about maternity care, social security rights and information about samples taken during pregnancy, so that you can make informed decisions.
• Decide if you need extended follow-ups beyond the normal maternity care and possibly plan this follow-up.
• You will be informed about genetic fetal diagnostics and genetic guidance on indication.
• Be informed about blood type and antibodies, screening for anemia (Hb), rubella (rubella), HIV and syphilis, hepatitis B and C if necessary.
• Be informed about urine sampling as screening for asymptomatic bacteria in the urine, this is especially true for those who have previously undergone several urinary tract infections.
• Be informed about ultrasound screening in pregnancy week 17-19.
• Calculate BMI, measure blood pressure and test for protein and glucosuria.
• Be evaluated for sickle cell anemia or thalassemia in ethnic groups where appropriate.
• Take a chlamydia test in women under 25 years of age or on indication.
• You will receive the user version of maternity care and information about ultrasound.

Second check: pregnancy week 17-19 – routine ultrasound

• This ultrasound examination is offered to you at the hospital where you are going to give birth. The examination can also be done with us at Oslo Midwifery and Ultrasound Clinic.
• Gestational age is assessed here, ie measuring the size of the fetus to find the exact due date.
• Identify those who are pregnant with twins.
• The location of the placenta in the uterus is examined.
• The fetal anatomy is examined.

Third check: pregnancy week 24

• Review, discuss and note the results of tests taken at the first check-up. Furthermore, consider whether you need additional follow-ups or to be referred to a specialist.
• Be informed about birth preparation and maternity leave/breastfeeding courses.
• Measure uterine size, blood pressure, weight and test for protein and glucosuria.
• Listen to the heartbeats of the fetus and inform you that you should be able to feel life/movement.

Fourth check: pregnancy week 28

• Measure uterine size, blood pressure, weight and test for protein and glucosuria.
• Listen to the heartbeats of the fetus and address the topic of feeling life/movement
• Information about breastfeeding.
• Discuss your health during pregnancy.

Fifth check: pregnancy week 32

• Measure uterine size, blood pressure, weight and testing for protein and glucosuria.
• Rh negative women are tested for antibodies.
• Listen to the heartbeats of the fetus and address the topic of feeling life/movement
• Discuss and be prepared for breastfeeding.
• Discuss your health during pregnancy.

Sixth check: pregnancy week 36

• Measure uterine size, blood pressure, weight and test for protein and glucosuria.
• Listen to the heartbeat of the fetus and address the topic of feeling life/movement
• Determine the baby’s position and in case of suspicion of breech position, this will be confirmed with ultrasound.
• Rh-negative: New antibody test.
• Discuss your health during pregnancy.

Seventh check: pregnancy week 38

• Measure uterine size, blood pressure, weight and test for protein and glucosuria.
• Listen to the heartbeat of the fetus and address the topic of feeling life/movement
• Assess the baby’s position and in case of suspicion of breech position, this will be confirmed with ultrasound.
• Discuss your health during pregnancy.

Eighth check-up: pregnancy week 40

• Measure uterine size, blood pressure, weight and test for protein and glucosuria.
• Listen to the heartbeat of the fetus and address the topic of feeling life/movement.
• Assess the baby’s position and in case of suspicion of breech position,  this will be confirmed with ultrasound.
• Discuss your health during pregnancy.

Ninth check-up: pregnancy week 41

• Measure uterine size, blood pressure, weight and test for protein and glucosuria.
• Listen to the heartbeat of the fetus and address the topic of feeling life/movement.
• Assess the baby’s position and in case of suspicion of breech position,  this will be confirmed with ultrasound.
• Refer you to an overtime assessment.

Welcome to our clinic! To book apointment press here! (The bookingpage is only in Norwegian, if you need help call us at 004795414740)

En del kvinner kommer til oss med spørsmål om de kan ha spontanabortert, eller får en uventet og trist beskjed ved en ultralyd hos oss.

En spontanabort oppstår når fosterutviklingen stopper opp og fosteret støtes ut av livmoren før det er levedyktig. De aller fleste spontanaborter skjer før graviditetsuke 12.

Det er ingenting man kan gjøre for å hindre eller stoppe en spontanabort.

Vi snakker om ulike typer spontanaborter:

• Missed abortion (stille abort) betyr at fosteranlegget/fosteret er dødt i livmoren uten at det støtes ut.
• Delvis abort (inkomplett abort) innebærer at noe, men ikke alle graviditetsproduktene er støtt ut av livmoren
• Fullstendig spontanabort (komplett abort) som betyr at alle graviditetstester er ute av livmoren

Det finnes ulike behandlingsalternativer ved en spontanabort, hovedsakelig tre:

• Å la aborten gå sin naturlige gang. Det kan ta ca. to til fire uker før livmoren tømmes helt
• Medikamentell behandling
• Utskrapning, kirurgisk inngrep

Mellom 10 og 30 prosent av alle svangerskap resulterer med en spontanabort, flesteparten av disse I første trimester og allerede før svangerskapsuke 8.

Livmoren kommer som oftest tilbake til det normale relativt raskt etter en spontanabort, og de fleste får en eggløsning etter ca. 4-6 uker Det finnes ingen medisinske grunner til å vente med å bli gravid igjen.

De aller fleste opplever likevel å bli gravid og få friske barn senere. Årsaken til spontanabort blir sjelden undersøkt, men studier viser at flertallet oppstår av genetiske feil som hindrer fosteret i å utvikle seg normalt.

Følelsesmessige reaksjoner etter en spontanabort

De aller fleste blir veldig triste og lei seg etter å ha vært igjennom en spontanabort, noe som er en helt naturlig reaksjon. Når graviditeten er ønsket er allerede mange følelser og forventninger om det som skal skje blitt sterke og positive.

For kroppen påvirkes ikke bare fysisk av en abort, det er også vanlig å få en psykisk reaksjon etter aborten. Hvor sterk reaksjonen blir varierer veldig fra kvinne til kvinne. Også partner blir berørt. De færreste kvinner får alvorlige følelsesmessige problemer i etterkant.

Snakk om det!

Mange vil ha behov for å snakke med noen etter å ha vært igjennom en spontanabort.

Samtidig opplever noen at det er vanskelig å snakke om aborten, kjenne på og anerkjenne sine egne følelser rundt det som har skjedd. Det er fortsatt noe tabubelagt å snakke om dette i det offentlige rom.

Tror man- helt til man snakker med andre kvinner som har opplevd det samme.  Mange finner støtte og trøst i å dele opplevelser og såre følelser med andre som har vært igjennom det samme som en selv.

Den følelsesmessige bearbeidingen av en abort kan ta tid. Faktorer som påvirker er flere. Det er av stor betydning hvor langt svangerskapet hadde kommet og om kvinnen har hatt spontanabort tidligere.

Å snakke med helsepersonell; jordmor, gynekolog eller fastlege er lurt. Støtte fra familie og venner kan også hjelpe gjennom sorgprosessen.

Gravide som kommer til oss på klinikken og opplever å få en trist beskjed om at svangerskapet ser ut til å være over, tas godt vare på der og da.

Vi bruker tid og viser omsorg. Forklarer hva som skal skje, og formidler at de alltid har mulighet til å ringe oss dersom det dukker opp spørsmål. Om ting blir vanskelig er det rom for en liten prat på telefon.

I de fleste tilfeller henviser vi kvinnen til gynekologisk poliklinikk på det sykehuset hun tilhører. Vi følger opp med sms eller vi ringer etter et par dager.

Vi opplever at kvinnene setter stor pris på denne henvendelsen fra oss.

Hvilke tilbud eller oppfølgning finnes for kvinner som har vært gjennom en spontanabort?

Svært lite. På sykehuset er det lite rom for ekstra samtaler og støtte i etterkant av en spontanabort.

På klinikken hos oss tilbyr vi en time som vi har kalt “Helhetlig oppfølging etter abort eller dødfødsel”. Denne timen er det vår gynekolog/fødselslege Thorbjørn Brook Steen som tilbyr. Den inneholder både mental støtte og medisinsk undersøkelse. Ut ifra ultralydundersøkelse og samtale vil Thorbjørn sammen med kvinnen/paret finne ut hva som er behovet og veien videre.

Ofte er det nok med en time, men om det er ønskelig tilbyr vi oppfølgingstimer som også kan innebære kontroller i neste svangerskap.

Trykk her for å bestille time til oppfølging etter abort.

Kilder:

https://www.helsenorge.no/sykdom/svangerskap/spontanabort/