Maternity Support in Estonia Depends Too Much on a Mother’s Own Initiative

For families expecting a child, the months surrounding pregnancy, birth and the early postnatal period should be marked by a clear and reliable chain of care: antenatal check-ups with a midwife, professional support during labour, and follow-up examinations and counselling once the newborn is at home. In Estonia, however, a new doctoral study shows that this chain is often broken. Whether a family receives comprehensive support can depend less on any systematic guarantee and more on the mother’s own ability to navigate a fragmented system, or on the initiative of a single dedicated specialist who happens to be involved in her care.

The finding comes from Silja Mets-Oja, who defended her doctoral thesis at Tallinn University’s School of Governance, Law and Society on 18 September 2026 and who heads the Centre for Health Education at the Tallinn Health University of Applied Sciences. Her research examined how maternity care services function at the interface between healthcare and social care, and how the experiences of women and the cooperation habits of professionals shape the support families actually receive. Her central conclusion is deceptively simple but far-reaching: the existence of services is not the same as their accessibility, and neither guarantees that they form a coherent whole for the mother and her family.

“The necessary maternity care services should be provided to families consistently and seamlessly throughout the entire period of starting a family,” Mets-Oja argues. In an ideal model, a woman would move along a clearly defined pathway of care, from antenatal appointments through childbirth support to postnatal health checks and counselling that helps the family cope with everyday life and parenting. The study reveals that in practice, receiving this support frequently depends on the family’s capacity to organise the system for themselves, or on an individual professional’s willingness to arrange it. The gaps in consistency are most pronounced in the postnatal period, precisely when families are adjusting to a newborn and may be most vulnerable.

One of the study’s key insights is that maternity care cannot be reduced to healthcare services alone. A mother and her family may also need counselling to protect their mental wellbeing and to manage the practical demands of daily life with an infant. In Estonia, however, healthcare and social care are organised as separate systems, so the continuity of support hinges on cooperation between specialists working in these two fields. Mets-Oja notes that this intersection has been little studied in Estonia to date, leaving researchers and policymakers without a clear picture of how systemic changes, women’s lived experiences and collaboration between professionals are interlinked.

The regional dimension of the problem emerged vividly from the experiences of women living in rural areas. “The mere existence of a service in the nearest town does not always mean it is actually accessible,” Mets-Oja points out. A long distance to the maternity ward can force difficult and sometimes risky choices on pregnant women. One participant in the study described how, towards the end of her pregnancy and just before giving birth, she was asked to drive 120 kilometres back home from the hospital. She managed to stay with friends in the city, and the baby was born the very next day. The anecdote illustrates how logistical barriers can translate into real clinical and personal risk, even when services formally exist on paper.

Public debates over the closure of smaller maternity wards added another layer to the research. A survey of local residents showed that access to maternity care close to home matters not only as a practical service but also as a source of security, a marker of regional vitality and a signal of the state’s presence in the area. Communities demonstrated a clear willingness to play an active role in the reorganisation of maternity services. Mets-Oja’s conclusion is that when health authorities reorganise care, they must weigh not only clinical and service-management indicators but also the broader impact of such changes on the local population, including trust and the sense of being looked after.

Beyond geography, the study examined what happens when a family simultaneously needs physical health, mental health and social care support. Here the findings are sobering. Cooperation between the health and social care sectors is often arranged case by case in practice, and its success may hinge on the individual specialist: their previous experience of cross-sector work, their personal network of contacts, and their willingness to initiate collaboration with colleagues in other fields. Information about a family’s circumstances and need for support is not always shared consistently between healthcare and social care professionals, meaning that critical signals can be lost at the very points where continuity matters most.

The women who took part in the study were clear about what they lacked after childbirth: practical support tailored to their home situation, the kind of help that builds confidence in caring for a newborn. “Families shouldn’t have to organise a system themselves in order to receive support,” Mets-Oja explains. “Services should be seamless, and the support system should be easy to understand. Families may need practical guidance, emotional support and clear information on who to turn to if problems arise, especially after returning home from the hospital.” Her formulation captures a structural critique: a support system that only works for those resourceful enough to work it is not a system at all, but a lottery of personal capacity and luck.

Methodologically, the research is an observational study of people, combining the documented experiences of mothers with an analysis of how professionals across healthcare and social care interact. By mapping where the pathway of care breaks down, the thesis identifies concrete points at which women and families may be left without the support they need. These bottlenecks are not random; they cluster around transitions, such as the move from hospital to home, and around boundaries between institutional sectors, where responsibility for a family’s wellbeing becomes ambiguous and depends on informal goodwill rather than established procedure.

The study’s main message is that organising maternity care requires a more comprehensive approach in which individual services form a coherent whole for the family rather than a collection of disconnected offerings. “The aim is to ensure that the necessary support reaches families consistently throughout the entire journey, from pregnancy to the postnatal period, and that the need for support can be identified as early as possible,” Mets-Oja says. For Estonia, and for any country grappling with how to join up health and social services around new parents, the research offers a pointed reminder: comprehensive maternity support should be a structural guarantee, not a reward for the initiative of mothers or the persistence of a single specialist.

Subject of Research: Continuity and accessibility of maternity care services across healthcare and social care in Estonia

Article Title: Comprehensive maternity support for families often depends on the initiative of the mother herself or a single specialist

Article References: Comprehensive maternity support for families often depends on the initiative of the mother herself or a single specialist. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: maternity care, postnatal support, Estonia, healthcare and social care cooperation, rural access, doctoral thesis, Tallinn University, midwifery, maternity ward closures, family support services, service accessibility, Silja Mets-Oja