Finnish “neuvola” system is a crucial part of the Finnish welfare model. In Finnish, the word “neuvo” means advice, and “neuvola” translates to “a place for advice”. These maternity and child health clinics form a specific branch of the Finnish public health care system for maternity, family and children’s health services. Finnish mothers usually visit neuvola between 8-10 times during a pregnancy. The visits are free, and include two ultrasounds. In addition to health care services, nurses in neuvola offer information and advice, organize family support groups, and help parents with the baby-parent interaction once the child has been born.
First check-up, 1-4 weeks
In the first check-up after the birth main emphasis is in the overall wellbeing of the new born and parents as well as in the guidance of baby care. The most important thing is to support the early interaction. If a prenatal home visit has not occurred the home should be observed with the prevention of accidents in mind.
This first check-up should be done when mom has settled at home with the baby and both parents are present. Specification of family’s life situation and especially the wellbeing of the mother are priorities. Additionally, the parents should be asked whether they feel any concerns about child’s wellbeing
Before the check-up
Parents fill a form that gives an overall picture of the family:
- Family structure
- Disease history and learning difficulties of the family and relatives
- Concerns and abnormities in the previous check-ups/birth etc.
- Background information for child’s growth and development collected from biological parents:
- Height of both parents
- Mom’s menarche age
- Father’s growth and maturation
The overall appearance and well-being of the child is evaluated throughout the first visit. Also the interaction between parents and child is monitored.
- Appearance and well-being
- Overall condition
- Interaction between child and parents
- Doctor’s evaluation if baby’s skin or eyes have turned yellow
- If yellowness have been present for longer than 2 week check for the bile duct troubles
- Head circumference
- Condition of eyes and reacting for light
- Reaction for sounds
- Nervous system and musculature
- Movements’ symmetry
- Sinew, traction experiment
- The asymmetrical tonic neck reflex (ATNR)
- Moro reflex
- Palmar grasp reflex
- Health routines
- Sleep and rest
- Eating routines
- Vitamin D supplement for babies of 2 weeks and older (10 g/day)
- Mom’s well-being
- Overall condition
- Postnatal depression
- Edinburgh Postnatal Depression Scale (EPDS)
- Possible perineal wounds and tears
- Vitamin D supplements for breastfeeding moms (10 g/day)
The emphasis is in the individual needs of each family.
- Parenting and family life
- Breastfeeding guidance
- The use of pacifier
- Outdoor activities
- Mom’s wellbeing
- Media parenting
At the end of the checkup
Nurse makes an overall evaluation of child’s and family’s health and wellbeing
- Nurse’s evaluation
- Family’s self-evaluation
The feedback from the evaluation of child’s and family’s overall condition is reviewed together with family and the nurse and possible discrepancies as well as health risks are covered.
If needed a wellbeing and health plan is constructed for the child, which includes follow-up checkups, support and further treatment needs, goals and appointed support:
- Health counseling and guidance
- Scheduling appointments according to further treatment needs
- Plan should also include monitoring of its fulfillment
The Health Booklet is filled and passed to the custodian. Next checkup time is determined, and parents are advised how to book it.
- Nurse’s contact information is passed to parents
Electronic form is filled with collected information, overall evaluation and possible wellbeing and health plan.