Nearly all expectant couples and families with small children use maternity and child health clinic services in Finland. The social and healthcare services reform at the turn of the year reassigned the responsibility for organising these services from municipalities to newly founded wellbeing services counties, and the services will undergo reorganisation.
Aalto University’s researchers are contributing to the creation of redesigned maternity and child health clinics and positive childbirth experiences in their research projects. The visions seize the potential of technology, such as childbirth simulation in a 3D-video conference using an avatar, a virtual character. On the other hand, the researchers would also like to hold on to the best practices from the past, such as the traditional child health clinic card, genuine human interaction and the rotina tradition, visits by family and close-ones to meet the newborn and bring foods as a gift.
Maternity and child health clinics started operating in Finland as early as 1922. Guided by cultural homogeneity, the clinics started to disseminate information that was previously passed on by the wise older women of the family. Added motivation for launching the activities was concern over child and maternal mortality. The clinics brought a clear improvement in the matter as the mortality rates are now among the lowest in the world.
In Finland, 1–7 maternal deaths occur annually. The infant mortality rate was 1.8 out of a thousand children born alive in 2020. The deaths of 1–14-year-olds have also become increasingly rare. In 2020, 58 children died in Finland, marking the lowest number in recorded history.
Doctoral student in computer science, doula entrepreneur and childbirth educator Marjaana Siivola says that maternity and child health clinics experienced a kind of heyday at the turn of the millennium.
‘The clinics offered face-to-face encounters, presence, familiar nurses and birth preparation classes that were based on peer support.’
After the high point, both clinic and childbirth services started to be centralised. Nowadays, the number of public health nurses and physicians at the clinics often falls short of the recommendations.
If there was still doubt before the COVID-19 pandemic that birth preparation classes could not be arranged online, the mindset has now changed. A webinar arranged during the COVID period could attract up to a thousand participants.
Marjaana Siivola and Professor of New Media design and learning Teemu Leinonen together with their colleagues have studied birth preparation classes arranged as so-called flipped classrooms.
‘The participants are welcome to explore the materials independently. They can watch videos online, read, take a tour in the delivery, section and family rooms through virtual 360° images, play a childbirth game or watch birth videos through virtual glasses. Virtual events provide peer support and answers to puzzling questions, and they also allow you to learn from other participants’ questions,’ Marjaana Siivola lists.
Maternity and child health clinic services, birth preparation classes included, have been a part of basic healthcare in Finland, while childbirth has been categorised as specialised medical care. This has led to problems with the continuity of the care. Maternity clinics have their own nurses, the delivery is handled by a midwife – and there can even be several if the delivery takes a lot of time – and after the delivery, there’s yet another nurse to be met.
In autumn 2022, researchers Hanna Castrén-Niemi and Annika Järvelin working in the Biodesign Finland programme observed everyday work at maternity and child health clinics for three weeks. They are now applying for funding for two projects that took shape during the period.
A project led by Castrén-Niemi aims to seek solutions to optimised labour induction and mothers’ improved childbirth experiences. Coordinated by Järvelin, another project examines possible ways to better identify and alleviate fear of childbirth.
According to the Finnish Institute for Health and Welfare (THL), the share of induced births has been on a clear rise for several years, and the same applies to the number of diagnosed cases of fear of childbirth.
‘The clinics are unable to adequately screen for customers who need help with depression or fear of childbirth, for example. If people are left to cope on their own, they lose their trust in the clinics,’ Järvelin notes.
Annika Järvelin says that scattered information is currently one of the challenges at maternity and child health clinics. This may also impact one’s experience of their own parenthood.
‘As the volume of information increases, parents’ trust in their own capabilities may deteriorate.’
The technological solutions used today do not convince the researchers: they may undermine the childbirth experience. For example, the outdated ultrasound scanners used at the clinics may even increase unnecessary hospital visits during pregnancy.
‘All the wires and other technology occupy a major role, which may limit the parturient’s movement during childbirth, for example. This, in turn, has a direct impact on the progress of the labour. Discreet, such as wireless, technology would respect the person in labour,’ Marjaana Siivola says.
Some clinics have already adopted electronic clinic cards, but Professor Teemu Leinonen is keen to keep the paper format.
‘The card and the notes made in it play a major role in the clinic experience. I would also not bring much technology into the child–adult interaction.’
In Annika Järvelin’s view, the child’s viewpoint should also be accounted for when planning maternity and child health clinic services. Weighing and taking measurements, being touched by a stranger, cold hands, lifting, unpleasant cushions, vaccination, masks and white coats could all be rethought from a child’s perspective.
Tailored services and their timely availability, combined with the right kind of expertise, will be key factors in tomorrow’s maternity and child health clinics.
‘I believe in multi-professional collaboration in which care paths are built systematically together. This allows combining medical, technical and business expertise,’ says Midwife and Research and Testing Manager at Metropolia University of Applied Sciences Eija Raussi-Lehto, who completed her doctorate in technology at Aalto in autumn 2022.
In a few decades, maternity and child health clinics may provide photorealistic 3D-video conferences alongside traditional face-to-face encounters. The future parturient and her spouse could meet the midwife as virtual characters in the space where the delivery will take place.
‘The pregnant avatar’s child would be born in a simulation, which would also allow practising for possible complications,’ Teemu Leinonen describes.
Today’s photorealistic environments are based on photo information. In the future, video footage could be used directly by adding a face from a video to the avatar.
‘The whole body could be modelled, and instead of moving the avatars with a mouse, the simulation could work with the person’s own body movement,’ Leinonen says.
Expressing empathy through video may be difficult, however, and emotions such as fear of childbirth are not only in the mind but also in the body, Leinonen reminds.
In her birth preparation classes, Marjaana Siivola emphasises not only the fundamentals of childbirth but also processing the childbirth experience, the puerperium and supporting the family through the rotina tradition, for example. Negative childbirth experiences often get a lot of publicity, but there is another brighter reality to counterbalance them.
‘Those who enjoy their own wonderful baby bubble tend to lead a quiet life.’
Text: Tiina Aulanko-Jokirinne
Illustration: Juuli Miettilä
This article has been published in the Aalto University Magazine issue 32, April 2023.
Researchers are now exploring how to meet the needs of the next century of maternity and child health clinics using Biodesign methods from Stanford University.
