Why We’re Running in Iceland Part II: An interview with Olöf Ásta Ólafsdóttir

Every Mother Counts is getting ready to run the Íslandsbanki Reykjavík Marathon on August 20th.

That means we’re excited to educate ourselves and others about their maternal heath system, Iceland’s positive birth outcomes, and how we can use their maternal healthcare model to highlight the various solutions we can invest in that can improve maternal health around the world.

We interviewed Olöf Ásta Ólafsdóttir, Director of Midwifery Studies at the University of Iceland. She began her midwifery career shortly after the 1975 demonstration and shared some thoughts on why Iceland delivers such good care.

Every Mother Counts: The 1975 demonstration made such a big impact on women’s rights and health in Iceland. What led up to that demonstration?

Olöf Ásta Ólafsdóttir: I was there that day. It started with a group of women who were very radical and thinking about women’s rights. They decided every woman would take a day off from their jobs and homes. At that time, society in Iceland was still old fashioned. Almost all women worked outside the home and took care of family and everything else, so we all thought this was a very good idea. That’s been the thing in Iceland for a very long time. We’re not so much just housewives. It is in our culture to have babies and families and still have a career. After that, everyone saw women’s work and contributions differently.

EMC: What kind of training do midwives get in Iceland?

Ólfsdóttir: It’s a two-year program on a master level after a BS degree in nursing. It’s a six-year hospital program before they get their license and every student has to attend at least 50 births before seeing clients.

EMC: Do they attend births both in hospital and at home?

Ólfsdóttir: Yes, we have a 2 percent home birth rate, which is higher than other Nordic countries and in the past twenty years it has been increasing. We think women should have a choice of giving birth at home if she’s healthy and wants to. Home birth is part of our public healthcare system and every midwife is licensed to practice at home and in hospitals. It’s not a problem to transfer a patient to a hospital if necessary, but we have careful guidelines, like the home should not be further than an hour from a high quality healthcare facility. Weather conditions are quite heavy in wintertime too so we think of all these factors when weighing that decision.

EMC: Most women deliver in hospitals though, right?

Ólfsdóttir: They do. Though with nearly all normal births, they go home quite early after birth. Then they get quite a lot of service at home. A midwife comes every day for a while and then every week. That’s different than what you do in the U.S., right?

EMC: Everything is different here in the U.S and you have much better outcomes.

Ólfsdóttir: It’s because we have a universal healthcare system and maternity care is free. Every woman has between six and ten midwife visits during pregnancy. The midwife is the professional leader of pregnancy care if everything is normal. If not or the mother is concerned, then the doctors come in. One midwife supervises all her care during pregnancy so there is consistency. For delivery, we don’t have continuity of care but that’s something we want to work towards so every woman can know her midwife. If complications arise, the midwife doesn’t leave. She continues to care for the woman along with the doctor.

EMC: How well do obstetricians and midwives collaborate in Iceland?

Ólfsdóttir: Honestly, we are in good cooperation though there is a little conflict because doctors tend to want to be in control. Because they have some power, especially in the biggest hospital in Reykjavík, they tend to influence care as well as we do. We all have the same goal to support every woman to have as normal a birth as possible. But obstetricians want to use interventions, sometimes unnecessary interventions more quickly. Women are influenced by the medicalization of society too and find it normal to have an epidural and other interventions. Our role is to honor the mother and what she wants. We support normal birth but also women’s independence to choose their own care. Our patients are our students and we have to give them information so they can make the right choices.

EMC: Is there anything about Iceland’s maternal healthcare system you’d like to change?

Ólfsdóttir: We still have a high rate of interventions and even though our 16 percent cesarean rate is quite low compared to other countries, it shouldn’t be so high. It should be lower than 15% like the EU standards say but 10% would be OK too. It’s not only cesareans you have to think about though. I think women can be so strong if they have the freedom to give birth using their own strength and their own body. I think it is a feminist issue in a way.

EMC: We agree with you 100%.

Team EMC is raising funds and awareness at the Íslandsbanki Reykjavík Marathon to help support our grants program and make pregnancy and childbirth safer for every mother everywhere. Contribute what you can to the team here, or donate here to support Every Mother Counts.

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