Future

In Sweden, A More Hands-On Approach To Premature Births

Swedish hospitals are a model for a more natural, less clinical approach to caring for newborn and premature babies.

Newborn at Stockholm's Karolinska Danderyd hospital
Newborn at Stockholm's Karolinska Danderyd hospital
Pauline Fréour

UPPSALA — Samira gently draws the sheet over her newborn's minuscule chest. The baby boy lies in a transparent cot at the intensive care unit of the Uppsala neonatal hospital, 70 kilometers north of Stockholm. The baby whimpers a little. His mother looks on with concern as his chest moves up and down. She adjusts the oxygen mask over his tiny little mouth. "He's nervous today," she says.

Amro was born more than three and a half months premature. He is a squirming little ball weighing a few hundred grams, kept alive by tubes that feed and help him breathe. Breathing is an ongoing struggle, though inside the highly controlled intensive care unit, Samira is allowed and even encouraged to take care of him. She washes and changes him and refills his feeding catheters; nurses would usually do this, but these are some of the tasks given her to help her settle into mothering.

Sweden insists on keeping parents close to prematurely born babies, whatever their level of vulnerability. Parents are invited into the medical routine as "privileged caring partners." At night, Samira sleeps on a bed close to Amro's cot. She will stay there for as long as her baby's state of health requires, be it weeks or even months. In Sweden, parents of a child with a serious illness are given unlimited parenting leave from work.

When the baby needs less supervision, he or she can share a room with the parents, where they can also cook and wash their clothes. The parent is "responsible for the child's health and nobody would understand their not being there," says Charlotte Casper, a neonatology professor at Toulouse University who completed part of her training in Sweden. "This is written in people's minds and in the law itself."

Dr. Pierre Kuhn of the Strasbourg University Hospital, an importer of the Swedish method into France, says that until the 1980s, the "hygiene-oriented" logic kept parents at a distance to protect the baby from exposure to germs. In many hospitals, he says, they "were shown their baby behind a window and were seen at times as "disrupting" the care process."

Skin-to-skin

The Karolinska Huddinge hospital in Stockholm pushed the new logic further when revamping its neonatology ward in 2009, seeking input from parents even at the design stage. In the intensive care service, every little room with a cot includes a parental suite with a bathroom, separated by a simple door.

This new service is the latest manifestation of a new idea in hospitals: that premature babies have affective as well as physiological needs. Hi-tech care, in other words, isn't enough — even if it has helped improve survival rates among premature babies, some of whom are born just five and a half months into pregnancy.

Professor Bjorn Westrup of the Karolinska Danderyd hospital in Stockholm is one of the first to have used this method in Europe. In 2010, after seven years of observation, he compared 183 families (couples with a baby) who had enjoyed a family room with 182 families that had received the classic-care model. On average, babies in the first group spent five fewer days in hospital than those in the second. Benefits were even greater for highly premature babies born between the 24th and 29th weeks of pregnancy, who left the hospital an average of 10 days earlier.

"They typically spend less time in intensive care, and have fewer breathing after-effects and infections," says Westrup. "The mother is less anxious and there is a better breastfeeding rate three months later."

The daily presence of parents increases opportunities for "skin to skin" contact — more than six and a half hours a day on average at the Uppsala Hospital. This involves slipping the baby naked under one of the parent's clothes against his or her chest. The baby "enjoys the warmth," says Westrup. "When against the mother, the infant breathes in her odor and hears her voice through bone resonance, like when it was inside her. That has an immediately soothing effect, evident on the heart beat."

The family-oriented care model is spreading, says Westrup. But there are also financial restraints to contend with. Many hospitals don't have the resources, for example, to offer the kind of space needed for parental involvement. The French neonatology society recommends 16-24 square meters. Doctors familiar with the Swedish model hope that will soon change.

"This is scientifically proven," says Dr. Kuhn of the Strasbourg University Hospital. "It's not just about being kind."

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