Pregnancy and Childbirth

Many questions arise during pregnancy and after childbirth:

How do I take care of my own well-being during pregnancy?
How do I support my partner during pregnancy?
How can I be understanding and gentle about my own or my partner’s changing body and moods?
What will happen during childbirth and what are the choices involved?
How do the maternity and child health clinics work?
Where can I find everyday life support for families with a baby?

Information on family coaching classes organised for new parents:

The section ‘Pregnancy and childbirth’ contains information on

the services available during pregnancy and about pregnancy itself, as well as childbirth
the services available once your baby has arrived.

You can learn more about each topic by reading the articles and watching the videos. The links of each page contain a wealth of additional information.

I am pregnant, what happens now? Refer to the checklist.

All expectant mothers experience pregnancy-related changes differently. One might feel like she has never felt better, while another might go through a lot of discomforts.

The calendar below illustrates how pregnancy progresses and what you should take into consideration (source: National Institute for Health and Welfare, THL). More information on foetal dental development on the Finnish Dental Association’s website (in Finnish).

Pregnancy calendar

Weeks	Progress	Remember!
Conception	About two weeks after menstruation.	Read the instructions on a healthy diet. Quit smoking and consuming alcohol! Ask for advice at your maternity clinic to help with quitting.
Weeks 0–4	A two-week-old embryo is the size of a pinhead.	Do not use any medication during pregnancy without consulting a healthcare professional. Check first with your doctor, nurse or at the pharmacy that the medicine is safe to take.
Weeks 5–8	A two-week-old embryo is the size of a pinhead. The heart, nose and eyelids, nervous system, spine and umbilical cord begin to develop.	The mother’s well-being will also help the child: eat a healthy diet, get adequate rest and exercise outdoors as much as you can.
Weeks 9–12	A 10-week-old foetus is about 3 cm long and weighs approximately 20 g.	The heartbeats can already be heard. The foetus is floating in amniotic fluid inside a sac formed by foetal membranes and receives nutrients through the umbilical cord. The foetus already has an upper and a lower jaw, and a budding tongue. The first teeth begin to appear. The general early-pregnancy ultrasound examination is performed during week 10–14, usually transvaginally.
Weeks 13–16	A 14-week-old foetus is about 9 cm long and weighs approximately 100 g. The uterus is about the size of a clenched fist. The foetus has a large head, roughly half of its entire length. The facial features are beginning to develop. Ears and reproductive organs are developing. The foetus is practising breathing and swallowing motions. It is kicking, moving its toes and thumbs, and turning its head. However, the mother cannot yet feel these gentle movements.	To be eligible for a maternity grant you must have had a health check-up at a maternity and child health clinic or with a doctor before the end of week 16 of your pregnancy.
Weeks 17–20	An 18-week-old foetus is 25–27 cm long and weighs 250–300 g. The foetus has its own blood circulation, and its heart is beating twice as fast as an adult’s. Soft hair grows on the foetus’ skin, but this so-called lanugo hair will decrease as the pregnancy progresses. The foetus grows eyebrows. At this point, the placenta is almost as big as the foetus. It protects the foetus from harmful substances, but cannot filter out everything. The mother might already be able to feel the foetal movements if she has had a baby before.	Now it is time to arrange for family coaching with a public health nurse. Most pregnant women will have an ultrasound between weeks 18 and 21, performed through the abdomen.
Weeks 21–24	A 22-week-old foetus is about 30 cm long and weighs approximately 400–600 g. Its movements can be felt by a first-time mother as well. The heart sounds are clearly audible. At week 24, the base of the uterus is at the level of the navel. Faster growth of the uterus is often a sign of twins. The foetus is practising sucking, and will often place its thumb in its mouth. The foetus grows hair and nails. The protective membrane is beginning to develop into the skin. For most of the time, the foetus is asleep but can be woken up by external noises or vibration. A pregnancy that ends before week 22 is considered a miscarriage. A child born between weeks 23 and 24 can stay alive with intensive care, even though it is still very immature. Developmental risks remain great and the course of treatment must often be assessed.	At week 22, you can already apply for maternity, paternity and parental allowance, and a maternity grant (more information at: Avoid too much stress. Take contractions seriously.
Weeks 25–28	A 26-week-old foetus is about 35 cm long and weighs approximately one kilo. The foetus moves a lot, turning around and kicking, and the movements are also visible on top of the abdomen. The foetus is opening and closing its eyes, and has a strong grip. The uterus is at the level of the navel. The first contractions may be felt as hardening of the abdomen for a few seconds. The foetus already looks like the baby that will be born but is more fragile. Babies born before week 28 are considered very premature. They are still very immature, and their lungs and many other organs are not yet fully developed. With intensive care, these babies will often live, and their future prognosis has improved with developments in their treatment.	Remember to listen to your body and get enough rest. Avoid unnecessary stress, particularly if your uterus contracts easily.
Weeks 29–32	A 30-week-old foetus is about 40 cm long and weighs approximately 1.5 kg. The majority of babies born at this stage will survive with intensive care, and the risk of disabilities is already low.	Avoid work that you must do standing up, lifting heavy things, and doing other stressful work.
Weeks 33–36	A 34-week-old foetus is about 47 cm long and weighs approximately 2.7 kg. Its weight is increasing fast. The foetus is moving less than before because it is running out of room in the uterus. Most children will turn upside down at this point. A waxy layer of vernix is forming on the foetus’ skin. The uterus is at its highest, reaching the ribs. With preterm labour, the preference is to undergo childbirth near a neonatal unit. At week 35, ICU is rarely needed anymore. Babies born before week 37 are considered premature, so the baby and the mother may need support from the delivery ward for longer than usual.	It is best to get the baby’s things ready at this point. Many hospitals organise pre-arranged visits to their delivery wards.
Weeks 37–40	The uterus moves lower, and the child’s head engages with the pelvis. The number of contractions increases notably. The child is kicking in the womb so vigorously that they can cause a book placed on top of the mother’s tummy to fall off. Most children are 49–52 cm long and weigh 3,000–4,000 g when they are born. On average, children are born in week 40, but this can typically vary by about a week in either direction.	Leave for the hospital if your waters break, you experience pain or bleeding, or when your contractions are coming at regular intervals (see chapter Childbirth). If 10 days have passed since the expected date of delivery, the pregnant woman will visit a hospital’s maternity clinic for an overdue check-up.

Diet and oral health during pregnancy

Diet during pregnancy

Proper nutrition is important for the growth and development of the soon-to-be-born child as well as for the well-being of the expectant mother. Regular meals are the cornerstone of a healthy diet. A diverse diet includes plenty of different coloured vegetables, fruit and berries, wholegrains, regular portions of fish and vegetable oil, low-fat dairy products as well as a reasonable amount of chicken, meat or plant-based protein sources. You can also create diverse meals with the help of the plate model.

Vitamin D and folic acid supplements are recommended for all pregnant women. For more information, please see Special diet recommendations for pregnancy (pdf)

Regular and diverse meals are the cornerstone of a healthy diet during pregnancy.

Oral health during pregnancy

During the pregnancy, it is recommended to change the customs and routines of the whole family so that they support the good oral health of the future baby, too. Bad teeth are not hereditary, but eating habits and dental health care routines of parents and siblings are transmitted to the new baby. The dental caries bacteria that cause tooth decay can also be transmitted to the baby.

Pregnancy puts stress on the teeth

Importance of diet

Tooth decay is contagious

How to get to dental health care?

Diet and oral health during pregnancy

Diet during pregnancy

Vitamin D and folic acid supplements are recommended for all pregnant women. For more information, please see Special diet recommendations for pregnancy (pdf)

Regular and diverse meals are the cornerstone of a healthy diet during pregnancy.

Oral health during pregnancy

During the pregnancy it is recommended to change the customs and routines of the whole family so that they support the good oral health of the future baby, too. Bad teeth are not hereditary, but eating habits and dental health care routines of parents and siblings are transmitted to the new baby. The dental caries bacteria that cause tooth decay can also be transmitted to the baby.

Pregnancy puts stress on the teeth

Importance of diet

Tooth decay is contagious

How to get to dental health care?

During pregnancy, various examinations are performed to monitor the health of the mother and the foetus. This page lists the main examinations carried out at a maternity and child health clinic and maternity ward.

A pregnant mother and her partner are visiting a hospital for an ultrasound scan and a midwife checks on the development of the foetus.

The examinations carried out at a maternity clinic during your first visit:

A blood sample is taken to determine your blood group, Rhesus factor and haemoglobin, and to exclude syphilis. HIV antibodies and hepatitis will be checked for with the mother’s permission.

Levels of protein, glucose and, if necessary, bacteria will be checked from a urine sample. The mother’s height, weight and blood pressure are measured and her body mass index (BMI) is calculated.

More information about blood group antibodies (Finnish Red Cross Blood Service)

A glucose tolerance test is carried out to find out if the pregnant woman has gestational diabetes. The glucose tolerance test is typically performed during pregnancy weeks 24–28. If the expecting mother is estimated to have a high risk of becoming ill (BMI at least 35 kg/m2, the mother has suffered from gestational diabetes before or has polycystic ovary syndrome (PCOS), the presence of sugar has been detected during early pregnancy, or a close relative has type 2 diabetes), the test will be carried out during weeks 12–16, instead. If the result is normal during that test, the test will be performed again during week 24–28. An aberrant glucose tolerance result will not lead to re-testing.

More information about gestational diabetes

During pregnancy, the health check-ups at a maternity and child health clinic monitor:

your weight, blood pressure and the presence of glucose in your urine
haemoglobin level in your blood
weekly weight increases
possible swelling
position of the foetus
foetal heart sounds
foetal movements (Naistalo, in Finnish)

Ultrasounds and foetal screening

Normally, two ultrasound examinations are performed during pregnancy. The general ultrasound examination during early pregnancy is performed in weeks 11–13, which determines how far along your pregnancy is and the number of foetuses. A structural ultrasound scan is performed in weeks 19–21, checking the organs and for any severe structural abnormalities.

If a pregnant woman also wishes to have a screening for chromosomal abnormalities, a sample of her blood will be taken in weeks 9–11 and a nuchal translucency scan will be performed on the foetus in weeks 11–13.

More information on ultrasounds and foetal screening:

Naistalo (in Finnish)
HUS

Listening to the baby’s heartbeat

The baby’s heartbeat can be heard over the stomach by the 26th to 30th week of pregnancy. The sound is a quick knocking noise that resembles vibration. The normal fluctuation margin of baby’s heartbeat is 120–160 beats per minute. When the baby is sleeping and remains still, the heart rate is lower and more even.

An empty toilet paper roll is a good hearing aid for listening to the heartbeat. Before listening, gently press the stomach with a few fingers to feel where the baby’s back is. The back feels like a longish, hard area. The heartbeat can be best heard near the baby’s upper back.

Set the toilet roll on the mother’s stomach above the baby’s back, press your ear against the hole and make sure that your fingers do not touch the roll and cause a rustling sound. Push the roll into different positions with your head, focus and listen. Change ears, if you cannot hear properly. You can also practice listening at the appointments with the maternity and child health clinic. You can also listen without using the toilet roll, using just your ears.

Exercise and pelvic floor muscles

During pregnancy, healthy nutrition, daily exercise, refraining from intoxicants and oral health become increasingly important. These will directly affect the well-being and health of the foetus and mother. Pregnancy is a good time to evaluate your habits so that you can be the best possible growing environment for your baby. Your well-being will have an immediate impact on your baby’s health as well. Furthermore, the health choices of an expectant mother’s partner and other people close to her will reflect on her behaviour.

Two pregnant women walking in the woods for exercise.

Liikunta raskauden aikana (UKK-instituutti, in Finnish)

Raskaus- ja imetysajan liikkuminen (Neuvokas perhe, in Finnish)

The exercises and instructions on this website are intended for expectant mothers and in part also for their partners. The videos have been designed by the City of Helsinki’s physiotherapists. For more information, please contact the centralised physiotherapy booking number 09 3106 7000 from Monday to Friday at 8–15.

The pelvic floor has strong muscles, which support and carry the bladder, urethra, rectum and, for the women, the womb and the vagina. The purpose of these muscles is to react to the pressure from the abdomen, for example during coughing, sneezing, lifting heavy objects, running and jumping. In addition to this, the pelvic floor muscles bring pleasure to both women and men during sex. Stretched, lazy or unused pelvic floor muscles may cause incontinence, bladder and uterus prolapse and difficulties with intercourse. The pelvic floor muscles are voluntary muscles: they can and should be trained regularly, especially when pressure near the abdomen grows. Pregnancy and birth put a big strain on a woman’s pelvic floor muscles.

Finding your pelvic floor muscles

Intoxicants and medication

The use of intoxicants should be stopped as soon as you start planning a pregnancy. Women who smoke or consume a lot of alcohol will take longer to get pregnant and have a higher risk of miscarriage. This page contains information on different intoxicants and their effects on a child’s development.

Unnecessary use of medication should also be avoided during pregnancy and when planning a pregnancy. However, the foetus’ well-being depends on the mother’s well-being, so the use of important medication must not be discontinued. You should always tell your doctor if you are planning to become pregnant, so that your medication can be adjusted to be as safe as possible for the foetus, even before pregnancy. More detailed information on harmful medicinal substances at HUS’s website.

Tobacco

Tobacco is a stimulant that causes dependence either as a habit or through the even more severe nicotine addiction. Tobacco influences the central nervous system in two ways, both stimulating and calming it. Tobacco smoke contains around 4,000 substances, 50 of which cause cancer. Most of these chemical components travel through the placenta and umbilical cord to the baby growing in the womb. (More information)

Alcohol

It is difficult to determine safe limits for alcohol use during pregnancy. A small amount of alcohol does not cause a risk of deformity, but the limit for alcohol use causing malfunctions of the central nervous system is unknown. This is why alcohol should not be consumed during pregnancy. The alcohol use of the expectant mother and her spouse is assessed at the maternity clinic with the help of extended substance use survey (pdf), which you can read through at home (More information)

Narcotics

Various narcotics and drugs penetrate the placenta easily. The effects of smoked drugs on the mother and the child are similar to those of tobacco, although partly more severe. THC, i.e. tetrahydrocannabinol, which is the active substance in cannabis, carries over to breast milk. (More information)

Pregnancy and sex

The body of the future mother changes and moods can change quickly. These changes can be confusing; it may seem like the mother has no control over herself.

During the first term of pregnancy, nausea and exhaustion may be near-constant companions. Breasts can be sensitive to touch. Some moments, one may feel like crying even if everything is well. A pregnant woman may also interpret matters differently than before and feel insulted by others. If is often difficult for the spouse to understand these changes, as the pregnancy cannot yet be seen.

During the mid-term, many expectant mothers start to feel better and more sexual again. Things feel more normal after the surge of hormones during the beginning. An expectant woman may be surprised by her rising sexual desires. Awareness and enjoyment of one’s own body increase.

During the final term of pregnancy, both parents have a lot to think about. The expectant mother may question if she is still desirable the way she is. Her spouse or partner can be confused. How to feel about the growing stomach and changing body of the spouse? How can we make love? Can it harm the baby? During the final term, both women and men often feel the desire to stay close to their partner and be cherished, without any pressure for anything more. Although the sexual desire may vary, tenderness and intimacy can be maintained in many ways. These confusing matters should be discussed with the partner, without putting any blame on them. One could simply ask how the other feels about the matter. What would they want in the situation?

A pregnant woman and her partner are in each other's arms, enjoying sex and intimacy.

It is important that the partner of the expectant mother can also feel as part of the pregnancy and does not feel like an outsider. People often think that sex equals intercourse. During pregnancy, partners should use their imagination to create new forms of intimacy in the relationship. Making each other happy with sweet words and actions reinforces the feeling of belonging. When intimacy is maintained, the future parents can feel that they are important just as they are, even if they have changed. This helps to share the burden of confusion and worry.

Sex during pregnancy has its pros, too: Contraception is not needed and it is easier to just enjoy each other. The situation changes again after the baby is born. The daily rhythm is no longer the same; the new small person may cause many feelings. After the childbirth or a caesarean section, the thought of sex may feel distant.

It is important that the new parents treat each other as partners, not just as parents: mothers, fathers and diaper-changers. The feeling of being desired, even after having changed, is important to all. The birth of a child may deepen and improve the sexual bond between the couple and their feelings for each other: ‘together, we have created something unique and new’.

Travelling when pregnant

A pregnant woman travelling abroad draws a suitcase, with palm trees and a plane in the background.

You should think carefully about travelling already when planning a pregnancy. For the most part, the same travel-related problems apply to pregnant women as to other people. However, an expectant mother’s underlying disease, which can become aggravated during a holiday, or a high-risk pregnancy (e.g. twins) increase the risks of travel.

If these conditions apply to you, you should discuss your travel plans with a physician. In addition, pregnant women should pay special attention to certain things when travelling abroad and should check the terms and conditions of their travel insurance policies.

Sunbathing

Vaccinations

Flying

Eating abroad

Diseases transmitted by mosquito bites

Traveller’s diarrhoea

Pregnancy and travel insurance

Pregnancy checklist

1. Make your first appointment with a maternity and child health clinic by calling 09 310 555 30, Mon–Fri between 8 am and 2 pm, as soon as you get a positive pregnancy test result.

A couple is happy about a positive pregancy test. 2. Remember to mention any illnesses you might have or medication you are currently taking when making an appointment. With questions concerning your medication, contact the HUS Teratology Information Service at 09 4717 6500, weekdays from 9 am to noon, or your own physician.

3. If the pregnancy is unwanted, please contact your health station.

4. Once you have made an appointment with a maternity and child health clinic, fill out a History data for the maternal welfare clinic form. You can print out the form from the link below, and take with you on your first appointment with a maternity and child health clinic.

History data for the maternal welfare clinic (rtf)

Alternatively, you can fill out the form in Finnish at asiointi.hel.fi.

To use the maternity and child health clinic’s e-services, you will need to fill out a consent form at asiointi.hel.fi.

5. Check the recommendations on nutrition and vitamins during pregnancy can be found here or from the website of the National Institute for Health and Welfare in Finnish.

6. If you are a first-time mother, please read the information on pregnancy and childbirth provided on this website

Problems and concerns during pregnancy

Pregnancy may not always be carefree and can sometimes involve risks and concerns. Pregnancy is a natural state for a female, but it also poses a challenge to the body. Risks associated with pregnancy are carefully screened at the maternity clinics. It is important that a family expecting a baby receives reliable information on these risks, how to prevent the symptoms, and how to treat the illnesses.

Changes during pregnancy

The first change when you become pregnant is that you will no longer have your periods. At the same time, many women will also start feeling tenderness in their breasts. The most common breast changes during pregnancy include tenderness, increase in size, and occasional light lactation. During early pregnancy, a woman may experience lower abdomen pain resembling menstrual pain, and even light spotting. Also, vomiting and nausea are very common symptoms.

A pregant woman suffers from nausea while her partner is supporting her.

During early pregnancy, many expectant mothers feel tired. Sometimes women may feel fatigued, due for example to the considerable hormonal changes that their bodies are going through. You should keep an eye on how you feel and rest as necessary.

Rapid mood swings occur during pregnancy and breastfeeding. This is caused by hormonal changes and the fact that expecting and delivering a new baby is a life-altering experience. Mood swings can be confusing because they often come on quickly and cannot always be anticipated. Both the pregnant woman and her partner can find them bewildering. During these moments, the support of loved ones plays an important role. If your mood remains low or depressed for an extended period, you should talk about it during a maternity clinic appointment. Every expectant woman will fill in an EPDS questionnaire (pdf) assessing her mood and identifying signs of depression at the maternity and child health clinic during mid-pregnancy. Based on the questionnaire, any support required during pregnancy can be discussed.

During mid-pregnancy, most women feel energetic and well. The alternating feelings of joy and uncertainty of early pregnancy are left behind, and the pregnancy is becoming more concrete to the woman’s partner. First, the mother will begin to feel the baby’s movements, and later also, the father or partner will be able to sense them through the abdominal wall. During mid-pregnancy, you can begin imagining what the baby growing inside you will look like and reminisce about your own childhood. You will start thinking about the kind of parent you want to be to your baby.

Contractions resemble menstrual pain, but they can also be completely pain-free, and instead, you may feel your abdomen go tight, and your breathing may be momentarily harder. During early pregnancy, contractions are most likely to occur when your period was supposed to start. During mid- and late pregnancy, your uterus is preparing for the labour, but these contractions are often harmless. If, however, the contractions are strong or are stress-related, it is recommended that you avoid straining yourself.

Morning sickness

Many women feel nauseous during early pregnancy. It might manifest as mild queasiness or vomiting, especially in the mornings. Resting, small and frequent meals, cold drinks, a small breakfast before getting up and citrus fruits, among other things, can help ease morning sickness. A doctor may, after an assessment, prescribe an expectant mother with an anti-nausea drug. Usually morning sickness and excess fatigue decrease once the woman reaches her 12 week milestone. However, a small percentage of pregnant women will experience nausea throughout their pregnancy.

The Lopu jo! (‘Please, stop!’) website contains more information on this topic.

A pregnant woman is suffering from morning sickness and her partner offers her a cold drink.

Gestational diabetes

Gestational diabetes is a disruption in the body’s sugar metabolism that occurs for the first time during pregnancy. A two-hour glucose tolerance test is used to detect gestational diabetes. In gestational diabetes, the mother’s insulin production cannot cover the increased need during the pregnancy. Because of this, the mother’s blood sugar increases and the foetus may grow larger than normal. During pregnancy, the amount of pregnancy hormones in the blood and the level of body fat increase. Due to these changes, insulin may lose some of its effectiveness during pregnancy.

Risk factors for gestational diabetes include:

being overweight
diabetic family history
being over 40 years of age
having previously given birth to a baby weighing over 4.5 kg
previous history of gestational diabetes
sugar in the morning urine
polycystic ovary syndrome (PCO).

Read more on the Naistalo website (in Finnish).

During pregnancy, it is important to keep the mother’s blood sugar at a normal level and weight gain should remain reasonable. These objectives are usually achieved through diet, exercise and, if necessary, insulin treatment. Good treatment of gestational diabetes secures the natural progression of pregnancy and prevents the excessive growth of the foetus. Weight control after birth can prevent both the relapse of gestational diabetes and the onset of Diabetes mellitus type 2 (adult-onset diabetes).

Raskausdiabetes – Asiakaspolku Helsingissä (pdf, in Finnish)

The treatment of an expectant mother’s gestational diabetes

Nutrition

Familiarise yourself with the diet instructions you have received and pay special attention to a regular eating rhythm, small meals, fat quality and the content and quality of fibre and carbohydrates.

Good sources of carbohydrates include whole grain products, vegetables, potatoes, liquid dairy products, fruits and berries.

Poor sources of carbohydrates are sugars, food products with high sugar content and refined grain products (white wheat).

The blood sugar of a woman suffering from gestational diabetes increases easily in the morning and after breakfast. This is why the breakfast is smaller than normally. Blood sugar remains at a suitable level, when the mother eats small meals often and ensures that she eats plenty of fibres.

Exercise

Aim to exercise at least 30 minutes every day. The exercise can be divided into periods of ten minutes.

Monitoring blood sugar at home

A two-hour glucose tolerance test is carried out for nearly all expectant mothers between the 24th and 28th week of pregnancy. If the test result is abnormal, the public health nurse will guide the mother to participate in group guidance, which gives more information on gestational diabetes and the significance of diet and exercise, teaches the parents how to measure their blood sugar and gives them the blood sugar meter and instructions for monitoring blood sugar.

A pregnant woman is checking her bloodsugar.

The target value of blood sugar during home monitoring are below 5.5. mmol/l before breakfast or some other meal and below 7.8 mmol/l after a meal. If the value in the morning is ≥ 5.5 mmol/l twice in one week or the value after a meal is repeatedly ≥ 7.8 mmol/l, contact the maternity clinic.

Home monitoring

Every second week, measure the morning fasting value of your blood sugar on four mornings (fasting time no longer than 10 hours).
Every second week, make a daily monitoring of eight samples. The daily measuring graph can be produced by measuring blood sugar before breakfast, lunch, dinner and evening snack and an hour after every meal.
Note down the values into the blood sugar control notebook and take it with you, whenever you visit the maternity clinic or hospital.
If the two-hour glucose tolerance test shows three abnormal values or if the fasting blood sugar is ≥ 6.0 mmol/l, the maternity clinic refers the expectant mother to a maternity outpatient clinic and she will be contacted by the clinic’s midwife specialised in gestational diabetes.

The test strips and lancets for testing blood glucose levels you will get from the maternity health clinic nurse at the first guidance visit. If you should need an insulin pen, you will get it from the Koskela distribution of self-treatment product with a referral from a hospital diabetes midwife. Call and make an appointment.

You will receive 40 strips for 4 weeks or some other amount defined in the referral. If you wish to measure your blood sugar more often than the instructions recommend, you can buy more strips from Helsingin diabetesyhdistys diabetes association, for example.

If you should need an insulin pen, you will get it from the Koskela distribution of self-treatment product with a referral from a hospital diabetes midwife. Call in advance to make an appointment. You can find more information here: Distribution of self-care supplies.

Preeclampsia

What is preeclampsia?

Excess protein in urine and high blood pressure are symptoms of preeclampsia, i.e. toxaemia of pregnancy. The reasons behind preeclampsia are still unclear. There are possible immunological factors that cause changes to the smaller blood vessels of the placenta. The system is forced to increase the blood pressure so that the foetus can get enough blood through the placenta. The changes in the placenta’s blood vessels weaken the bloodstream. The baby may feel ill in the womb, and in the most difficult cases the foetus’ growth may slow down or even stop completely. The baby will usually gain the lost weight back after it is born.

The earlier the preeclampsia sets in, the greater the risk of premature birth is. With the help of blood pressure control and instructions for rest by the maternity clinic, it is possible to slow down the onset of preeclampsia or even prevent it completely.

High blood pressure

Blood pressure may be high even before the pregnancy or it may arise during the pregnancy. Blood pressure fluctuates during the pregnancy so that during the mid-term it is lower than usual and will then rise back to the normal level during the last trimester.

The urine protein content is measured in addition to measuring high blood pressure. It is important to keep an eye on other symptoms, too, including headaches, upper abdominal pains, swelling and disturbances with vision.

High blood pressure and excess protein in urine can be signs of the onset of preeclampsia.

How to measure your blood pressure:

Avoid any strenuous activity half an hour before the measurement. Do not drink any coffee, tea or cola and do not smoke half an hour before the measurement.
Sit next to the table and set the cuff around your upper right arm.
Wait for 5 minutes for your blood pressure to stabilise and to calm down.
Avoid talking during the measuring process.
Measure your blood pressure twice, keeping a 1-2 minute pause between the measurements.
Note down both results.
Give the measurement result to you public health nurse.

How to measure urine protein content using a strip:

Wash your private areas thoroughly with the handheld shower.
Release some of your urine into the toilet bowl.
After this, urinate into the cup to provide a urine sample.
Take one strip from the jar and dip the ‘pillows’ into the urine sample.
Set the strip in a horizontal position and wait for 60 seconds.
Examine the colour of the strip’s ‘pillow’ by comparing it to the colours presented on the side of the strip jar.
Estimate the protein content, using the colour, and set it on level at +, ++ or +++.
Tell your public health nurse the result or, in unclear situations, ask you nurse to check the test result.

Treating high blood pressure during pregnancy

High blood pressure is the most usual symptom during pregnancy that requires more frequent control. In most cases, the blood pressure increases only slightly and does not lead to serious complications. In some cases, however, the situation can get worse and threaten the well-being of the mother and the foetus. This is why more frequent and intense control may be necessary.

What constitutes as high blood pressure?

Blood pressure is high when it is 140/90 mmHg or more. A higher one-time result does not necessarily mean that blood pressure has risen. Blood pressure is always measured twice and the measurement is carried out again after some rest, if necessary.

Treating slightly increased blood pressure

The first method of treatment for high blood pressure is to rest more. Resting improves blood circulation so that the foetus can get as much nutrients necessary for its growth through the placenta as possible. The unnecessary strain is avoided. Increasing the amount of rest often stabilises the blood pressure, but sometimes medication for lowering the blood pressure is needed.

Notes on nourishment

Food with high salt content may increase swelling, put a strain on the kidneys and increase blood pressure. Recommended daily consumption of salt in a normal diet is a maximum of 5 grams.

The biggest sources of salt in a diet are:

salt used for cooking and salt added to meals
bread and other sources of grain
meat products (sausage, cold cuts)
cheeses
spice mixtures
snacks with high salt content.

Also, liquorice and salty liquorice increase blood pressure. In order to reduce swelling, at least 1.5 to 2 litres of liquid, preferably water, should be consumed daily.

Symptoms of escalating preeclampsia

The expectant mother may observe various symptoms, such as headache, disturbances with vision (for example floaters), general nausea or pain below the heart, a belt-like pressure. As the preeclampsia escalates, swelling of the hands and feet increases and the amount of urine may reduce notably. These symptoms need to be reported to the maternity clinic.

Miscarriage

Many women have light bleeding during early pregnancy, but their pregnancy still progresses well. Pain in the lower abdomen, resembling menstrual pain, is possible during early pregnancy, and it is caused by the growing uterus.

Approximately 15–25% of all clinically recognised pregnancies end in a miscarriage. The majority of miscarriages, roughly 75%, happen before the 13th week. The most common reason is a severe chromosome abnormality. A miscarriage that is about to begin or is already happening cannot be medically prevented.

Early miscarriage

When a pregnancy ends before 12 weeks of gestation, it is referred to as an early pregnancy loss. A very early miscarriage may go unnoticed if the woman’s period is only a few days late and her bleeding is only slightly heavier than her normal menstrual bleeding. An early miscarriage does not require any treatment.

The pain associated with an early pregnancy loss is caused by the contracting uterus and opening cervix. If the bleeding and pain continue, you should have a physician perform an ultrasound to check how your pregnancy is progressing and what is causing the bleeding. The examination will verify whether the size of the foetus matches the gestation week, if the pregnancy in question is anembryonic, or if the pregnancy has ended.

Late miscarriage

A late pregnancy loss refers to a miscarriage that happens after the 12th week mark but before the 22nd, and usually at this point the foetus will weigh under 500 grams.

A miscarriage typically begins with light bleeding that progressively becomes heavier. The bleeding may contain large clots. Pain resembling menstrual cramps in the lower abdomen and back is common. Sometimes the foetus may have perished several weeks earlier, and the miscarriage is detected when the uterus stops growing. A late pregnancy loss may also begin with the woman’s waters breaking.

Recurring miscarriages refer to a situation where a woman has had three consecutive early pregnancy miscarriages, or two consecutive early pregnancy miscarriages, one of which took place during the second trimester.

After a single miscarriage, the next pregnancy is likely to progress normally.

How do I seek treatment?

In all emergency situations, you should call the emergency clinic before leaving for the hospital. You can find the contact information via the links below. Normally, a pregnant woman will need a referral from a physician or nurse to be admitted to an emergency clinic. However, you may come to the Gynecological Emergency Clinic during early pregnancy without a referral if you are having vaginal bleeding and strong abdominal pain, and pain medication is not helping.

Miscarriages during early pregnancy are primarily verified and treated during office hours at the Gynecological Outpatient Clinic. Only miscarriage patients who are bleeding heavily will need emergency treatment. An ultrasound is performed to confirm the miscarriage, and sometimes pregnancy hormone levels are measured from the woman’s blood. If the uterus has emptied itself or is in the process of doing so and the bleeding is not heavy, the situation will be monitored without further treatment. If the uterus needs to be emptied, the options include medical treatment with medication that causes contractions, or dilation and curettage (D&C).

Read HUS’s instructions on seeking emergency services

Coping

Talking about your emotions and grieving are important for your psychological coping and a possible future pregnancy. An abruptly ending pregnancy may cause crying, grief or guilt. Sometimes it can be mentally challenging to cope with a miscarriage. If you feel like you need professional help, you should mention this to a nurse or a doctor. If necessary, you can talk to your own nurse at the maternity and child health clinic if you already had an appointment there, or contact your health station.

Read about the Selma self-help programme on the website of Mielenterveystalo (in Finnish).

Age is a risk factor for miscarriage. After the age of 35, a woman’s risk of miscarriage increases. The man’s age will also have an impact.

A couple hoping for a pregnancy should aim for a healthy lifestyle; excess weight, smoking and use of intoxicants should be avoided.
The woman should ensure that she is getting enough vitamin D and folic acid when trying to become pregnant.

Frequently asked questions about miscarriage

Did I do something that caused the miscarriage?

It is not possible that you caused the miscarriage yourself. The most common reason is a severe chromosome abnormality. That is why a miscarriage that is about to begin or is already happening cannot be medically prevented.

How long will the bleeding last?

The duration of the bleeding will vary. It depends on the treatment method. After medical treatment, the bleeding may last from six days up to six weeks. After dilation and curettage with suction, the bleeding will last for 3–10 days on average.

How heavy will the bleeding be?

During the very early pregnancy miscarriages, the bleeding is often only slightly heavier than normal menstrual bleeding. The further along the pregnancy had progressed, the heavier the bleeding will be, as well. When a miscarriage is medically treated, the bleeding will be heavier than menstrual bleeding for the first few days, and may include clots. After the initial days, the bleeding will become less heavy. After a D&C, the bleeding will usually be lighter in comparison to menstrual bleeding.

Pain? Which painkillers can I use?

Everyone experiences pain differently, and several factors affect this. It is completely normal to have only slight pain. You should also ensure sufficient pain relief during a miscarriage. At home, you can take both ibuprofen 600 mg – 800 mg (e.g. Burana®, Ibumax®, Ibuxin®) and paracetamol 1 g (e.g. Panadol®, Paratabs®, Paramax®) every eight hours. Your doctor may have prescribed you with some other painkiller. Take this painkiller according to the prescription.

In addition, you can try drugfree pain reduction methods, such as an oat-filled heat pack, a warm shower or light exercise. If these means are not sufficient, contact the Gynecological Outpatient Clinic.

Will I have another miscarriage?

After a single miscarriage, the next pregnancy is very likely to progress normally. Even after three consecutive miscarriages, the next pregnancy has a 60% likelihood of being normal.

Children with special needs

Each child develops at their own pace. Children with special needs have many different development and learning paths.

A child with special needs and their family is at the amusement park.

A child with special needs requires special support for development and learning. The needs for support may be due to a disability, an illness or a functional impairment.

When a parent finds out that their child has special needs, they will have many questions. Questions also arise as the child is growing and developing

These pages contain information and numerous links about many different kinds of special needs, disabilities and illnesses.

Lack of networks and support

The close relatives of many families living in Helsinki may live far away from the capital region or even in another country. This is why families may find it difficult to arrange child care assistance or find a babysitter. Families who have moved to the city from elsewhere may also find it difficult to build new networks when they are otherwise busy. It is not rare for people to lose contact with old friends when they become parents. However, parents may often find relief from the stress of daily life just by talking to another adult.

A mother takes her child to a temporary daycare.

Travelling when pregnant

A pregnant woman travelling abroad draws a suitcase, with palm trees and a plane in the background.

Sunbathing

Vaccinations

Flying

Eating abroad

Diseases transmitted by mosquito bites

Traveller’s diarrhoea

Pregnancy and travel insurance

Your image of your new baby

The child grows and develops in the womb for nine months. Growing into parenthood will take at least as long. Becoming a parent is an important transitional phase in life, which gives you the chance to consider and review your own thoughts and experiences and learn something new about yourself. Your future parenthood will be strongly influenced by two things: early childhood experiences and what kind of mental image you form of your baby during the pregnancy.

A pregnant woman imagines what her baby will be like.

Early experiences refer to the future parents’ memories and experiences of their own parents or other loved ones during childhood. Expectant parents will often remember the type of relationship they shared with their own carers. These may include both positive and negative ways in which their carers behaved in various situations. At the same time, the future parents will become aware of how the choices of their carers felt to them. They can look at the situation from a child’s perspective. This gives them the opportunity to also see things through the eyes of their new baby. An image of their own parenthood is created.

Studies have shown that people give the same kind of care as they have received. However, it is possible to grow and develop in parenting and make different choices from those experienced as a child.

Generally, people will be seeking answers to the following questions:

What kind of parents or carers did I have?
Am I going to be a good mother or father?
How can I protect my child?
What things should I do the same way or differently than my own carers did?

Parents often form a mental image of their future baby. They might wonder, for example, which relative the child will resemble and what characteristics they would like the child to have. It is also natural to speak to the child already during pregnancy. Studies have been conducted on the parents’ mental images of their future baby and the impact these have on growing into parenthood. Parents’ expectations are connected to the different phases of a baby’s growth and development. During early pregnancy, these images are often vague, and it is natural not to feel a strong attachment to the baby. The mental images will grow more substantial once you start feeling the baby’s first movements. This is the baby’s way of letting the parents know of their presence, and the thought of a future child will become more concrete.

The parents may develop very different images of their child. This does not matter, as the images will reinforce parenthood, regardless. Towards the end of pregnancy, as the birth comes nearer, the images will again become vaguer and less detailed. The parents will return their focus on facts and the upcoming birth.

With the help of mental images, parents can create an emotional bond to their baby during pregnancy. The images help them feel more connected with and attached to their child. When these images become vaguer towards the end of pregnancy, it will help the parents to let go of the imagined baby and interact with the real one.

Preparing for breastfeeding

You can and should prepare for breastfeeding. Your stay at the hospital will be short, and the main focus there A mother breastfeeding her baby. will be on practical matters. Information acquired in advance will help you learn and understand new things. You can prepare for breastfeeding by talking about it with your family and friends, reading the Family Support’s Breastfeeding and food section and the breastfeeding guides for mothers and families

All of these provide information on the first days of breastfeeding, proper latching, the baby’s hunger signs, hand expression and several other important topics. During pregnancy, you can also visit the City of Helsinki’s breastfeeding support group. There, you can receive tips on breastfeeding directly from other mothers.

Breastfeeding and your family’s plans on how you will be feeding your baby are natural topics to bring up at the maternity and child health clinic.

Breastfeeding instructions for expectant families

Maternity care during pregnancy provides information about the benefits of breastfeeding and how to prepare for it, as well as on the hospital’s treatment practices.

You can receive information from:

your own maternity and child health clinic
family coaching
maternity hospital

The Helsinki region has a breastfeeding card in use, which each family will receive together with their maternity clinic card. The breastfeeding card can be used to monitor what kind of information a family has received on breastfeeding and which topics should be reviewed before the baby is born.

Breastmilk is the most natural food for the child.

It is always ready to use, at the right temperature, pure and designed for the baby’s needs.
Breastmilk has the perfect content of fat, protein and carbohydrates for the baby’s digestive system as well as for the baby’s growth and development.
Aside from vitamin D, it has sufficient amounts of all vitamins and minerals in an easily absorbed format. The baby is given vitamin D in accordance with the maternity clinic’s instructions, starting from the age of two weeks.

For the father and partner

Fathers and partners are always welcome to the maternity and child health clinic. We would especially like you to join the first visit, as well as all of the extended health check-ups, which will map the health and well-being of your entire family. The extended health check-ups are performed once during pregnancy, and after the child is born at the ages of 4 months, 18 months and 4 years. Family coaching offered by the maternity and child health clinic is intended for all parents expecting their first child, so fathers and partners are welcome too!

Fathers-to-be and other expectant parents join the visits to maternity and child health clinics and the family coaching.

Pregnancy, a new baby, your relationship with your partner and parenthood are things you share. A child will need at least one adult who feels connected and attached to them to facilitate appropriate and safe growth, but the child will benefit more from having several close people around them from the first moments on. A child will learn different things from different adults. For example, one parent in a family may be more nurturing, whilst the other is more curious and playful. However, all people have their nurturing, curious, playful, caring and boisterous sides, but may prefer to do things differently, which is a wonderful thing from the child’s perspective.

What matters most to a child is spending time with other people. In addition to getting breastmilk, a newborn’s biggest needs include skin contact, eye contact, hearing affectionate speech, smiles and the sense of movement while being held. A father or a partner will have a lot to give and receive in this. In section Baby’s development, you can receive more information about babies’ development by reading or watching the videos.

All adults in a family have their own important roles when it comes to breastfeeding and ensuring a baby’s proper nutrition. Recognising the baby’s hunger signals and reacting to them appropriately are key in creating a calm breastfeeding environment. Support from the partner is vital to the success and continuation of breastfeeding. In section Breastfeeding and food, you can find more information about breastfeeding, its benefits and various tips.

The birth of a new baby is a life-altering experience that you can start preparing for already during pregnancy. Preparation may be easier for the mother than the father or partner, because she can feel the physical changes brought on by the pregnancy, as well as the growth and movements of the foetus, both in her body and mind. Therefore, it is important to talk to your spouse about the bodily changes, feelings and thoughts during pregnancy. Sharing these things will allow for the father or partner to begin their preparation too.

In section Preparing for a new baby, you can read more about becoming a parent.

Having a baby will have a significant impact on the parents’ relationship. The change for the parents will be considerable, particularly if the child is their first one, as the relationship of two now becomes a relationship of three, in which everyone has their own important role. However, a well-functioning relationship between the parents where the spouses are able to find the best possible way of sharing their lives in various situations bears special importance to the child’s development. Therefore, the parents should discuss the upcoming change before the baby is born. You can read more together in section Parenthood and parents’ relationship. Return to this site during pregnancy and after your baby has been born. Parents should work to maintain a good relationship, and the website can offer tips on how to strengthen your relationship when your child is still young.

Preparing for childbirth

The birth of their own child is a unique, emotional and tender experience for the parents. The memories and experiences of birth may have a strong impact on the life of the mother, in particular, for a long time afterwards.

It is impossible to know in advance how the birth will go, but one can be prepared for it and train for it. It is probable that the birth is easier and perhaps even shorter when the expectant mother and her partner both know which factors facilitate it.

It is possible to find support for the preparing process from various guides, prenatal classes and discussion groups as well as through trained birth companions, i.e. doulas. At the moment, there is no established municipal or governmental party that would provide these services, so most of them are subject to a charge.

If you are worried about the birth, it is also possible to visit the maternity hospital’s ‘fear clinic’ to discuss the matters. You can get a referral to the clinic from the maternity clinic.

Hormones of labour and birth and their effect on the birth

Relaxing during labour

The partner helps the mother to relax during labour.

The following section has some tips on how to relax. These methods are easy to apply during birth if you practice them in advance. By training in advance, you can also find out, which parts of your body you tend to tense, so you can relax them easier with some concentration. This helps you to stay comfortable, facilitates the delivery and eases the important work of contractions. Most people tend to tense their shoulders and chins by grinding their teeth together, so you should pay special attention to making these areas more relaxed. With the help of training, relaxation becomes quicker and more automatic. It has been proven that training has a positive effect on the experience of giving birth.

If you have some fears concerning the birth, you should process them and discuss them with others. Discussion partners are available, for example, through various forums, discussion evenings, family guidance, doula evenings, prenatal classes, the maternity clinic or a hospital’s fear clinic.

Stages of childbirth

Video source: HUS

Every childbirth will progress at its own pace, but mothers often become worried if the dilation stage is taking long and the delivery is therefore delayed. It is good to know that plenty of other things are taking place in your body besides the dilation, and the delivery may be progressing well even if the midwife tells you that your dilation is slow. That is why you should also ask about the other signs of progress. These include your cervix turning forward and becoming softer and shorter, and your baby turning and settling lower in your pelvis.

Childbirth does not always progress in a linear way. First, it may take hours for the cervix to dilate one centimetre, but later it can dilate several centimetres in a single hour.

Leaving for the hospital

When leaving for the hospital, a first-time mother should remember:

To always call the maternity hospital before leaving. The midwives will assess the urgency of the case and give necessary instructions. Due to lack of room, the mother may also be asked to go to another hospital.
Once the contractions have lasted for a few hours and are coming every five minutes, you should leave for the hospital, either by car or taxi.
If your waters break at home, but you are not yet having contractions, you must remain lying down. This is particularly important if the maternity clinic has told you that the baby’s head has not yet engaged.
If your labour pain is intense and does not pass on its own, or if you are bleeding heavily, you should call an ambulance instead of driving a car to the hospital. If, however, the bleeding is similar to menstrual bleeding, it is safe to use your own car.

Parents-to-be leave for the maternity hospital.

You should take your maternity clinic card, personal hygiene items and a pair of slippers with you. You can also pack some entertainment. You should choose clothes for your baby in advance for leaving the hospital, but you do not necessarily need to bring them with you to the delivery.

At the hospital, the midwives and doctors are there for the parents and the baby. They wish for your first meeting with your baby to be as safe, calm and happy as possible. The staff will do their best to honour your family’s wishes if you let them know about them openly.

Birth control

Health and well-being come from a balance between our physical, mental, social and sexual wellness. Sexual health is an integral part of our overall health.

You can talk about sexual and reproductive health, relationships, birth control, pregnancy plans and sexually transmitted diseases (STD) during a healthcare appointment.

Ensuring appropriate birth control is the responsible thing to do for yourself and your partner. A reliable birth control method will allow you to have more energy to enjoy life. Below you can find descriptions about a number of birth control methods, and together with a healthcare professional you and/or your partner can decide on the best option for your current situation. Condoms are the only means of birth control that protect against STDs. If you suspect an STD infection, you can get tested at your own health station.

Sexual and relationship guidance is available and worth utilising.

You can get help with choosing a birth control method during a visit to a maternity and child health clinic, at your own heath station, or at the centralised contraceptive advice service.

Birth control after childbirth

Childbirth is a huge and wonderful change to a woman, her body, her relationship with her partner and the entire family. You now have a new family member but also each other, a shared background, the present moment and the future, and these should be actively maintained.

Even if it has taken a long time to get pregnant, fertility may ultimately happen quickly for a couple who have been having trouble conceiving. With many women, the first ovulation (the release of the egg) will happen before their first period, and so the possibility of a pregnancy already exists. The parents should talk about their relationship and the type of birth control they intend to use after their baby is born, before the birth and the hectic life of a family with a newborn.

Birth control will be discussed during the follow-up examination after childbirth, and the parents will be provided with information about the various options during and after breastfeeding. You should bring up your wishes and questions concerning birth control during a visit to the maternity clinic or your health station, or by contacting the centralised birth control advice service.

Birth control options after childbirth

Condom

When used correctly, a condom is a good option to use before moving on to other methods or if there is no need for a long-term solution. Research shows that condoms offer the most effective protection against sexually transmitted diseases. Due to hormonal changes, the vaginal mucosa of a breastfeeding woman is thin and sensitive, and the use of a lubricant, or a vaginal oestrogen insert or gel, is recommended and safe.

Intrauterine birth control (coils)

A copper coil or a hormonal coil can be inserted after the follow-up examination. A copper device will increase the menstrual flow and may also increase the amount of menstrual pain. Women with a history of heavy, long or painful menstruation and tendency towards anaemia should carefully consider other birth control options.

A hormonal device releases progesterone into the uterus. Its strong local effect on the uterine mucosa will result in a reduction in menstrual flow. In addition to providing a form of birth control, hormonal coils are used as medical treatment for heavy or painful periods. The effect of the device in the body is weaker than that of other hormonal products, which significantly decreases the risk of adverse hormonal effects.

Combined contraceptives

Combined contraceptive products contain both oestrogen and progesterone. Combined contraceptives come in the form of pills, patches and vaginal rings. The general contraindications (e.g. migraine, tendency towards thrombosis, age and smoking, excess weight) to combined contraceptives must be taken into account when planning their use. Traditionally, breastfeeding women are recommended to wait for six months after giving birth until they start using a combination contraceptive. If the woman is not breastfeeding and no contraindications to combination contraceptives exist, she may begin using them three months after giving birth.

Progesterone-only contraception

Progesterone-only contraception (the so-called mini pill, birth control implant) is suitable for women who breastfeed or who have a contraindication to combined contraceptives. Unanticipated bleeding may occur, especially during initial use. During the follow-up examination after childbirth, the doctor may provide a prescription for mini pills.

Other options

If the woman is breastfeeding full-time (including nights), her period has not resumed, and her child is under 6 months of age, breastfeeding will provide protection that is as effective as from a condom. The acronym LAM (lactational amenorrhea method) is used for this method.

A breastfeeding mother may also use emergency contraception, if necessary. However, another form of birth control should be chosen for long-term use.

The pullout method or ‘safe days’ are not forms of birth control.

Sterilisation is intended as a permanent solution, and both women and men can undergo sterilisation. Sterilisation can be performed on a woman at the maternity hospital during childbirth, if she has made plans for it during pregnancy and delivers her baby by C-section. In all other cases, you can contact your own health station after the birth in order to apply for a sterilisation.