How the Swedish system supported me after my miscarriage at 18.5 weeks pregnant.

I feel nervous as I sit down to write this post.

Where to start? What to share?

And, the biggest question – Should I share at all?

I feel compelled to share for two reasons. The first is that pregnancy loss is incredibly common, yet rarely discussed. It has been the single most isolating and lonely experience of my life and if this post can help just one person feel less alone or de-stigmatize the topic of miscarriages even slightly, then it is worth sharing.

The second reason is to inform. I created Sweden and Me to help non-Swedes understand Sweden better. And, man, have I learned a thing or two about the Swedish healthcare system through this experience. I’ve experienced paramedics and ambulance rides, and hospital stays and bills. I can tell you the differences between three types of therapy providers and what it is like to go on sick leave from work. I know the process of getting a death certificate, how to secure a permit to scatter ashes, and what it is like to get autopsy results from a specialist at the hospital. And I will share as much as I can with you about everything I’ve learned.

That being said, my experience is deeply personal. The death of my unborn child is the single worst thing that has ever happened to me and I’m just not sure how much I want to share in this public forum.

It has been five months since my miscarriage (missfall) and, with the help of a lot of therapy, I feel ready to start sharing. But, for now, I am going to share the facts and keep the depths of my emotions private. And I ask you, reader, to please be kind. I am just a person trying to make sense of a horrible experience. I did the best I could at a time when I had no idea what to do. And I will try my best to share what I would have done differently, had a known what I know now.

I would also ask you to be gentle with yourself. This post talks about pregnancy loss, miscarriage, and death. It might not be suitable for all to read.

So, I guess I should start at the beginning. Or the end, depending on how you look at everything.

My partner and I became pregnant in September 2023 with a very desired baby. We celebrated the news together, with friends, and in person with family for Christmas in the US when I was 16 weeks pregnant. It was hard to keep the news secret from family for so long, but since it was the first grandchild on both sides, we really wanted to share the news in person rather than over FaceTime. Deciding when to share such big news when you are halfway across the world from your loved ones is one of the hardest parts of living abroad. But we were so happy to have been in person to laugh, cry, and hug each other when told our families we were expecting.

Flash forward two weeks. We are back in Sweden and it is my first day back at work after Christmas vacation. It was Monday January 8th, 2024 and I started to experience some mild cramping at 1PM in the afternoon. It wasn’t a normal symptom for my pregnancy, but it was very subtle and we had an ultrasound scheduled for the following Wednesday and I figured I could bring it up then. Plus, we’d only been back in Sweden for three full days and I was jet lagged and down with a cold. Overall, my system was totally off and I figured this was just a consequence of the travel and time change. Not to mention, I was eighteen weeks and four days pregnant and well into the “safe” zone.

I finished my work day from home, did an online pregnancy yoga class, and took a warm shower. I went to bed around 9:30PM feeling a little off but generally fine.

A few hours later, at 12:30AM, I was awoken by intense cramping. The pain was intense, but would come in waves. I woke my partner up and told him that I was feeling a pain that felt like labor, but without the desire to push. I began to time the waves on my phone and could see that they were coming about every two to five minutes and would last about 20 or 30 seconds each time. We frantically scoured the internet for help and tried to stay calm in the knowledge that a miscarriage was very unlikely so late into our pregnancy. But it soon became clear that something was wrong when the cramping – and what I later came to realize were actually contractions – turned into pushing. I started to bleed. The pain was extremely intense and I was faint, dizzy, and lightheaded. My partner packed a hospital bag for us and we called the paramedics via 112. They told me to lie on the floor with my feet elevated while waiting for the paramedics, which greatly helped with my dizziness.

The paramedics (two women, which was comforting to me) arrived at our apartment and stayed with us for an hour. They took my blood pressure (which was normal) and I was able to stand and have a full conversation with them. I told them I was 18 weeks and 4 days pregnant and thought I was having a miscarriage. They called the hospital and described my situation to the nurse at the maternity ward, as the paramedics were unsure what to do. They were most concerned with how much blood I had loss. It was, obviously, hard for me to quantify, but they told me that it would only be considered an emergency if I had lost 0.5 liters of blood or more in 10 minutes. I didn’t believe I had lost that much blood, but, again, how could I really know?

After an hour at our apartment, the paramedics and the nurse at the hospital on the phone told me that it was decidedly not considered an emergency and the bleeding was not a certain indication that anything was wrong with my pregnancy. They encouraged me to get some sleep and go to the hospital right when they opened at 8:00AM for an ultrasound. I was nothing but relieved to know that everything might be okay. I didn’t question the paramedics because I didn’t want to question them. I wanted everything to be OK and was only more than happy to hear what they were telling me…even if my body was telling me otherwise.

It was about 3:50AM when they left our apartment. Within ten minutes of the paramedics leaving, I had another contraction (I did not have any during the hour they were with us). This contraction, however, brought our baby into this world, head first and lifeless. We called the paramedics again and they returned instantly to our apartment, shocked to find our baby out, still trailing from my body via umbilical cord. Needless to say, my partner and I were in complete shock, too.

Looking back, I wish I had advocated more for myself in the time when the paramedics were first with us. I knew something was wrong, but I wanted to hold on to any ounce of hope I was given in the moment. I know nothing would have changed had I insisted it was an emergency and they take me to the hospital right then and there, but perhaps we wouldn’t have been alone when delivering our baby. Then again, perhaps the delivery would have just happened in the back of an ambulance. Or in a foreign and sterile room. Perhaps being at home with only my partner was the best thing. I’ll never know for sure, and I’m at peace with what happened. I share this one point because I want to emphasize the cultural differences at play. Sweden has a relaxed, stress-avoidant culture (at least to my American eyes). Should you find yourself in a situation that you deem to be an emergency, but the Swedish system does not, perhaps it is best to advocate for yourself harder than I did here.

I had delivered our baby, but not the placenta. The paramedics transported my partner and I to the hospital and cut the umbilical cord during the short ride there. Upon entering the hospital, a nurse immediately took our baby’s body. I became panicked, unsure what was going to happen to the body. The nurse was very firm and repeatedly told me I needed to follow a different nurse to a hospital room. I was ushered into a private bathroom connected to my hospital room and told I would need to deliver the placenta. I was very thirsty, as it was about four hours since my labor had started, but was told not to eat nor drink anything in case I needed surgery. The nurse then said to press the red button connected to the toilet when the placenta came out. She left and I was left alone in the bathroom.

I called my partner in, neither of us wanting to be alone. The entire thing was completely surreal. I had no idea what a placenta looked like nor what it would be like to deliver one. I was in complete shock. There was no pain, but I was bleeding and my body was releasing lots of tissue. Within thirty minutes of arriving to the hospital, my body pushed and the unmistakable placenta came out. I called the nurse using that big, red button and she took the placenta away to examine it. The placenta was whole and intact, a good sign that I would not need an operation nor medication to “complete” the miscarriage.

I was then told to use the bathroom at least every thirty minutes and to call a nurse every time I did so they could examine the tissue that was released. This again was because they wanted to be sure that my body was “completing” the miscarriage.

The nurse then asked if we would like to see our baby. We said yes and they brought the body in. We learned that we had had a boy. It was in this moment that things began to feel very, very real.

The nurse asked us what we would like to do with the body. We, of course, had never considered what we would do with the body of our dead child. The nurse presented us with a few options 1) we could do nothing and the hospital would dispose of the body, 2) we could have the baby buried in a cemetery of our choosing (at our expense), or 3) we could have the baby cremated (for free). The hospital also has a partnership with a local cemetery where we could have the ashes scattered in an anonymous minneslund for no charge. We were told we had one year to decide what we would like to do with the body. I’ll go into this more in a future post, but we ultimately selected option three.

The hospital also offered us the opportunity to have a free autopsy performed on our baby’s body. We agreed to this, hoping it would offer some clarity and peace. This too will be discussed in a future post.

After two hours at the hospital, I was discharged. I was told to expect bleeding for about 10 days and that mild cramping would be considered normal. I was told how much pain medication I could take and that I should call the hospital if my bleeding or pain intensified. I was also given a pregnancy test to take at least two weeks after the miscarriage, once my bleeding had stopped. If I still tested positive for pregnancy, then that meant fetal tissue was still in my body and would need to be removed medically. They also explained to me that I could take seven days of sick leave (including that day) from work without any need for a doctor’s note. Taking more than seven days would require a doctor’s note. I will go more into this in a future post. We were also given the numbers to therapists and the hospital mortuary (we would need to call with our decision about our son’s body within one year). The entire hospital stay felt very clinical. The nurses were attentive and polite, but the overall feeling was sterile and clinical and emotion-less.

And perhaps that is slightly how this post feels, too. When we see the worst life has to ofter, I suppose it dampens us. Likely in the same way water dampens stone: soaking it whole and softening its edges. Perhaps my story, as shared here, is a stone. Standing strong, despite its blunted and misshaped edges, against the torrent of emotions raging in my heart.

So, there it is: The beginning of my story. Or, the end, as it has felt to me.

• I have written a blog about the first 14 weeks of my pregnancy and what the process looks like in Sweden. When I feel ready, I’ll share that, too.
• The hospital called me each day for the following two days after I was discharged to check in on me.
• I was very tender and walking was hard for two days following the delivery.
• The cramping lasted for about seven days.
• My bleeding lasted 14 days.
• My pregnancy hormones dropped off rapidly every five days after the miscarriage.
• I tested negative for the pregnancy hormone hCG two weeks after the miscarriage.
• The total hospital bill – including the two paramedic visits, the ambulance ride, the private hospital room with attached bathroom, the autopsy, and the cremation of our baby – came to 400 SEK (~$38 USD).

• Naming him, and using his name when we speak about him, has helped us cope with his loss.
• Sharing our miscarriage experience has allowed others to share theirs with us. It has made us feel less alone in our experience.
• Writing has always been an outlet for me. I’ve began writing poetry since this experience.

• Miscarriages on 1177
• Bleeding During Pregnancy on 1177