When there is no help from the maternity clinic or trauma occurs in the birthing room, Finnish mothers turn more on more towards private service providers for help. The widening of private support services is naturally a good thing, but at the same time it is an indicator of a serious societal problem.

Her due date is in early November. Kati Kaikkonen (37 years), is expecting her first baby. Mums usually need the most help during their first pregnancy, but Kaikkonen has not had a good experience in the public care system. "I've had a different nurse every single time I have visited the clinic". The so-called sf measurement, which measures the size of the entire uterus, has varied between all the visits, sometimes even supposedly reducing in size. According to the professionals, this is likely to be due to the different hand size between nurses. "Why on earth is it even measured in that case," Kaikkonen wonders.

In a sugar stress test, Kaikkonen was diagnosed with gestational diabetes. "I had to insist it myself that I start the medication and treatment. At the clinic, it would have only been monitored and treated with dietary instructions." Kaikkonen is a nurse by profession. "I said you can't just monitor this when your sugar levels are so badly off balance." Kaikkonen belongs to the risk group for pre-eclampsia, i.e. pregnancy poisoning, and this group is recommended to take mini aspirin for the final 16 weeks of pregnancy. They forgot to give her this recommendation at the maternity and child health clinic. "When I asked about it, the maternity nurse told me that it was still worth starting, even though the recommended weeks had already passed. This instruction was only sent to me electronically and not in person, and I did not even notice until a week later. It really feels like everything is in a state of flux."

Everything is in tatters in a country that should be the best place to become a mother. (Save the Children organisation made comparisons on the subject until 2015. In the last report, Finland fell to second place behind Norway.) As a nurse, Kaikkonen has a good knowledge of the healthcare system and what she can demand as a customer. "If I wasn't in this industry, I'd be pretty lost with my first child. I´d feel totally alone and neglected."

Kaikkonen isn't the only one who feels this way. The turnover of nurses is one of the main issues of public pregnancy monitoring, which drives mothers and families to pay for services out of their own pockets and go private. Kaikkonen has used her own money in early pregnancy to purchase ultrasound imaging, NIPT chromosome research, and the so-called 4D ultrasound. In addition, she has consulted private specialists regarding her ferritin and haemoglobin levels and received guidance on the intake of iron supplements and vitamins.

Kaikkonen and her spouse plan to take out private health insurance for the baby at birth and will continue to rely on private care. "If needed, we will seek private osteopathy or physiotherapy. I will seek breastfeeding guidance from a private lactation consultant if the baby happens to have a tongue tie."

In Finland, there is an ever-increasing supply of private service providers operating in the pregnancy and newborn sectors. Statistically, the increase is not significant, as private operators report incomplete information to the Finnish Institute for Health and Welfare.

Supply arises when there is demand. In 2020, the Finnish Institute for Health and Welfare conducted a survey to which nearly 15,000 parents of families with babies responded. "Prenatal coaching emerged as a matter in the survey, where the need for support could not be adequately met," says Reija Klemetti, Research Director of the Finnish Institute for Health and Welfare. After the birth of the baby, up to 37% of the mothers reported not receiving enough help with the baby crying or not sleeping. "I'm not surprised that we resort to private services if the parents' experience is this," Klemetti says. She believes that part of the explanation for the increase in demand is also the so called `new kind of parenting´. "Parents want to increasingly invest in parenting, also in monetary terms. "

Aura Pyykönen replies from her new home town, Äkäslompolo. She holds a doctorate in gynaecology and obstetrics and has had a career spanning about a decade in maternity hospitals in Helsinki, and a short time in Malmö in Sweden.

Pyykönen, together with her colleague Marjo Pant, founded the Isla Terveys remote GP service last spring. It offers expectant and newly postpartum mothers and their spouses consultations by phone or through a video link. Isla also provides psychologist, psychotherapist, physiotherapist and midwifery services remotely. One session is charged at 110 euros. “The company was born out of frustration," Pyykönen says. "I was exhausted because I couldn't do my work in a way I wanted to." She emphasizes that she is proud of Finnish medical care, where the physical problems of pregnant women are treated very well. On the other hand, a mother who does not have any diagnosed conditions in her pregnancy is systemically ignored. In Pyykönen´s opinion, a massive information gap exists between the public maternity clinics and maternity hospitals. "Women come unprepared for childbirth and are really alone after giving birth."

Finnish midwifes also feel that mothers are unprepared for birth. 79% of midwife respondents to a recent survey felt that mothers were not adequately prepared for birth. Many metrics point to an alarming direction. For example, caesarean sections, fear of childbirth and the popularity of home births have increased.

In the ´me too at childbirth´ campaign, Finnish women shared their traumatic or even violent birth experiences. Pyykönen believes that this is all partly due to the systematic ignorance of birthing mothers as individuals. Women have children at an older age these days. The average age of first-time mothers in Finland has risen by 1.6 years ten years and is now 30years. "There's more time and space to think about what could go wrong," Pyykönen describes. Birthing mothers need more time and a more individual approach at birth; they need to have their concerns heard.

When Laura McGrath's son was born, there was only one product for mums in the maternity package: a lubricant. "Is that really the only product that mums need after childbirth!” McGrath says and laughs. "A few others would come to mind."

In all honesty, the maternity boxes have included at least reusable nursing pads and nipple cream in the past, but McGrath´s observation is still apt. Why is the box called the ´maternity´ package when almost all of the contents are for the baby? "This also sends a message from society that only the baby matters".

According to Reija Klemetti of the Finnish Institute for Health and Welfare, Finland differs in its emphasis from many other countries. "Elsewhere, maternal care focuses more on the mother, but in Finland we take a family-centric approach and talk of an expecting family rather than an expecting mum", says Klemetti.

The WHO recommend three check-ups to monitor the health of mothers afterchildbirth. In Finland, two are recommended. The first of these is postpartum home visit or a clinic reception where the baby is also measured and examined. The second is the postpartum check for the mother.

In McGrath's first birth, a lot went wrong, and her life was in danger. She felt that the focus of the hospital shifted to the baby immediately after birth and that they were not interested in her condition at all. McGrath´s childhood friend, Kati Hovikari took three years to get her core to recover from childbirth, and it was difficult to find help or information.

So, the friends started a company that focuses on the mother. Lola&Lykke sells breastfeeding products and support bands for pregnancy and postpartum, but aims to become a holistic start-to-finish support collective for mums. "The maternity market is still quite fragmented. There is no single actor who would support you all the way. That's a huge opportunity," McGrath says.

On its website, Lola&Lykke offers free advice and answers to general questions from a panel of experts. Providing free assistance is part of the company's philosophy: it wants to provide mothers with reliable information at a low threshold so that no one must struggle with their questions alone.

Lola&Lykke operates as a wholesaler and online store in 16 countries. The largest market is the UK, before Finland. Its turnover almost tripled last year to EUR 684 000. According to McGrath, this year has been difficult due to the global crisis. Lola&Lykke is reportedly still on its way to good revenue growth in 2022.

Why does the baby cry? Why does she not eat? Why does he not sleep? When googling, you don’t run out of search results. You can't say that information isn't available.

However, online knowledge is a double-edged sword. A new parent gets precious peer support from baby forums on the Internet, social media groups, and blogs. On the other hand, they also get a lot of instructions that are either appropriate or at least unsuitable for their situation.

Certified sleep consultant Annukka Karttunen gives an example. "There are a lot of families who have read that a particular way has worked really well for a child to sleep. They have tried it and found that the situation is getting worse. "

Karttunen's sleep guidance service, Sleepy, offers help with sleeping problems for babies and young children both in person and remotely. I entered the industry a couple of years ago when my firstborn had trouble sleeping. Sleepy employs Karttunen and another part-time consultant. "I speak with families daily who feel like they have failed because they cannot get their child to sleep. When we start deconstructing the situation, it almost always appears that the sleep method they have read about is not suitable for their child. For example, if a child has a high density of wakefulness, the solution is not necessarily to put an end to night feeds. The solution can be found, for example, in daytime naps or bedtime," Karttunen says.

Almost all maternity and baby companies want to offer factual information to their customers. For some, like Sleepy, it's a product. Half an hour of telephone time costs 49 euros. For Lola&Lykke, it's the path to customer engagement and happiness. Pyykönen from Isla Terveys wonders if peer support could somehow be curated, i.e. to ensure that misinformation is not disseminated in the community. Karttunen also offers breastfeeding guidance, and the experience is the same: incorrect information or even the breastfeeding attitudes of a discussion forum can cause unnecessary concern for new parents. "There's been a huge increase in this, parents can be really stressed, and they feel inadequate at parenting. And if it's hard with the baby, then when does a mother get to focus on her own wellbeing?"

The separation of the abdominal muscles means that the straight abdominal muscles separate into different parts of the abdomen and there is excessive space between them. This is the case, for example, during pregnancy, but the problem is if the muscles do not recover after pregnancy. It may make it difficult for the entire core to function and cause other symptoms too. Abdominal separation can be healed through the right kind of rehabilitation, but exercising incorrectly may actually make the situation worse.

As a rule, the maternity clinics provide a handout of exercise instructions after childbirth. At the postpartum examination, the GP may instruct the mother whether she is allowed to start exercising and what types of exercises to do. After that, the mum is on her own. Riina Laaksonen founded a sports studio in Helsinki in 2014. Until then, sports coaching had only been a hobby as Laaksonen was working full-time in IT. In addition to coaching, she wanted to share information for example, through newsletters.

"Very quickly, the requested topics started to circle around maternity, abdominal separation and other related issues. Probably because I had small children at the time”, Laaksonen explains. The more Laaksonen spoke about the matter, the more there seemed to demand for it. "We started to get enquiries from all over the country. We thought about how to help these mums as we were based in Helsinki." Laaksonen and her partners invented a email course. They simply sent subscribers exercise instructions and information about postpartum recovery via email. And this is how Nordic Fit Mama was born.

Since 2019, the company has focused solely on digital coaching. Last year, the company generated a turnover of EUR 220,000 and a marginally positive operating result. It is opening its business in the UK, Italian and North American markets. Together with the City of Oulu, it has run a trial around postpartum core rehabilitation through online coaching. Laaksonen believes digitalisation will be the solution to many of the shortcomings of the health and social services sector.

"Resources are getting cut all the time, and this trend will certainly continue in the future. Then you just have to think about ways to help the big masses effectively." Nordic Fit Mama offers a monthly membership, starting at €16.60/month. This gives you access to the extensive library of online training.

However, since it normally does not take years to heal abdominal separation, Nordic Fit Mama has expanded its offering and will continue to do so going forward. Another course provided is covers emotions during maternity and a toddler stage training course has also been developed. "Our goal in the long term is to cover the entire life cycle of a woman. So that we can get clients already from puberty – when menstruation begins, there is a very strong need for information and peer support – and, on the other hand, for menopausal women.

Laaksonen says that all coaching has a hidden agenda. It is not emphasized since customers want to invest specifically in their physical health. "We take the mother in our arms and say that you are good enough. We get continuous feedback to say the way we speak to mothers is really encouraging. It may well be that mothers do not get this feedback from anywhere else"

The negligence of mothers may also have consequences private businesses cannot easily fix. The birth rate in Finland fell by a quarter between 2010 and 2019. After two slightly better years, between January and June 2022, the number of babies born was lower than ever before. This is a huge social problem. In Finland, not enough new taxpayers are born and there is insufficient labour force to maintain prosperity.

No one has been able to fully explain the steep decline in Finland’s birth rate. There are certainly many reasons. For example, over a quarter of women of childbearing age hesitate to have another baby due to a traumatic previous birth experience. In the 2018 Family Barometer survey, respondents who were not currently planning a pregnancy, or were not pregnant, were asked why not. 27% of 20-45-year-olds with at least one child replied that this was due to a negative experience of a previous pregnancy or childbirth. 16% of men of same age reported the same feelings. In 2006, only 1.8% of birthers were diagnosed with fear of childbirth. In 2021, the share had grown to 11.1%.

According to Aura Pyykönen, the increased fear of childbirth was one of the main reasons why she founded Isla Terveys. "The treatment of fear of childbirth has been developed a great deal and it is really good. But a lot of the industry veterans are exhausted and have resigned," Pyykönen says.

Some clients of Isla Health just want to ask if it is sensible to consider a new pregnancy when the previous one has been so traumatic. The birth rate has fallen in Finland in all age groups, but it has fallen most among less educated men and women. This is the accumulation of disadvantages: those who are less educated, have less employment possibilities and earn less, are more likely to end of childless.

The customers of private maternity care providers tend to be highly educated and those doing well financially. If and when the public healthcare system ignores the birth fears and traumas of mothers, it is not difficult to identify those who will be disproportionately affected.

”Women have always given birth and childbirth is the most natural thing in the world.”

Laura McGrath from Lola&Lykke says that she has come across this outdated mindset on a continuous basis since starting her business. In some markets, this is still a prevalent view. ”All other areas of health have experienced immense development and digitalisation. The more ways we can find to improve the experience of becoming a mother, we should use them,” McGrath emphasises. And besides: ”Childbirth is not a very natural experience for most women. None of us know what we are doing when we enter the birthing room.”

* this is an unofficial English translation of the recent Talouselämä-newspaper article about the state of motherhood in Finland.