Obstetric care in Latviapregnancy care, midwives and where to give birth

Pregnancy care in Latvia is governed by Cabinet Regulation No. 611 on the provision of obstetric care. The clinical pathway published by the Centre for Disease Prevention and Control for low-risk pregnancy states that a visit may take place with a midwife, a gynaecologist and obstetrician, or a family doctor, each examining the pregnant woman according to those rules.

On registering the pregnancy, the woman is issued a mother's passport, which is worth carrying day to day.

If there was a pre-conception planning visit, earlier tests do not need repeating provided the pregnancy began less than six months after they were done.

Within her competence, the midwife issues referrals for blood and urine tests, listens to the fetal heart with a Doppler, performs cardiotocography, and refers for antenatal ultrasound screening.

The Centre for Disease Prevention and Control states that it does not matter which municipality the mother lives in or where she received antenatal care: she can give birth at any hospital maternity unit in Latvia.

Planned out-of-hospital birth is governed by point 8 of Cabinet Regulation No. 611. Public sources state that the main conditions are good health, confidence in one's ability to give birth, and a birth location no more than 30 minutes' drive from the nearest hospital maternity unit, along with specified equipment and a plan for transfer to hospital.

• Gynaecologist and obstetrician: six years of medical study, a doctor's degree and residency. That route is described on the gynaecology page.
• Midwife is a separate registered health profession with its own education route and entry in the practitioners register.
• A midwife's competence covers evidence-based, person-centred care, managing physiological pregnancy, birth and the postnatal period, caring for the healthy newborn and infant, and public education in sexual and reproductive health.
• If the midwife identifies a departure from physiological progress, she must inform the gynaecologist and obstetrician about the onward plan for the pregnancy.
• Entry in the practitioners register must be renewed every 5 years.

• Midwife or doctor. A low-risk pregnancy can be led by a midwife, and some women choose this for continuity. If risk factors appear, care passes to the gynaecologist and obstetrician.
• Distance. You may give birth at any maternity unit, so weigh the distance and the journey, particularly in winter.
• Tests on site. At some providers the midwife takes samples during the visit, saving a separate laboratory trip.
• Type of birth. If water birth or a contract birth interests you, ask whether the provider offers it and what contract is needed.
• Home birth. If you are considering a planned out-of-hospital birth, check the conditions in point 8 of Cabinet Regulation No. 611, including the distance to the nearest maternity unit.

• The first visit is with a gynaecologist to confirm the pregnancy, and carries the patient co-payment.
• Once the pregnancy is confirmed, subsequent pregnancy-related visits are state-funded.
• Bring the mother's passport if it has been issued, and previous test results.
• At the visit the midwife or doctor examines you in line with Cabinet Regulation No. 611, listens to the fetal heart, and performs cardiotocography where indicated.
• Questions about breastfeeding or the newborn's weight are handled at postnatal consultations, which are also state-funded.

To receive state-funded pregnancy care, you first see a gynaecologist to confirm the pregnancy, paying the patient co-payment. After that, gynaecologist and midwife consultations and the necessary tests during pregnancy and for up to 42 days postnatally are free. State-funded services unrelated to pregnancy, birth and the postnatal period still carry the patient co-payment.

• First visit to confirm pregnancyPrice EUR: patient co-paymentSource: Jelgava City Hospital
• Gynaecologist and midwife consultations during pregnancyPrice EUR: 0.00Source: Jelgava City Hospital
• Postnatal care up to 42 daysPrice EUR: 0.00Source: Jelgava City Hospital
• Outpatient services in pregnancy, birth and postnatallyPrice EUR: 0.00Source: Liepāja Regional Hospital
• Water birthPrice EUR: 0.00 with a midwife contractSource: Liepāja Regional Hospital
• Individual birth care with a gynaecologist or midwifePrice EUR: by contractSource: Jelgava City Hospital

On the medical side the field is represented by the Latvian Association of Gynaecologists and Obstetricians, registration number 40008061658, president Lāsma Līdaka.

Newborn care is represented by the Latvian Neonatology Society, registration number 40008103557, neonatologi.lv.

Certificates are issued by the Certification Council of the Latvian Medical Association. The sector regulator is the Health Inspectorate.

If you have doubts about the quality of care, raise them first with the institution's management, which must operate a complaints and suggestions system. If that does not resolve it, a written submission goes to the Health Inspectorate no later than two years after the alleged infringement, and is reviewed within 30 days, extendable to four months in complex cases. The procedure is set out on the Health Inspectorate site.