Swedish maternity care is often presented as safe and equitable for all. Yet behind this image lies a highly centralized and standardized system that, in practice, can strip women—especially those in Sápmi—of the right to give birth on their own terms and in connection with Sámi culture.

Sápmi is the traditional homeland of the Sámi, the Indigenous people of northern Europe, spanning parts of present-day Norway, Sweden, Finland, and Russia. For centuries, Sámi communities have faced colonization, forced assimilation, and the suppression of their spiritual and cultural practices. Christianization campaigns and witchcraft laws targeted traditional healing, ceremonies, and midwifery knowledge, disrupting practices that had long been central to Sámi maternity care.

These colonial dynamics did not disappear with history. Scholars describe today’s exploitation of Sámi lands and limitations on Sámi self-determination as a continuation of settler colonial policies in new forms. 

Through my work as a doula and birth support worker, as well as through my own birth experiences, I have seen how the structure of the maternity system shapes the experiences of birthing people—and how transformative it can be when women can follow their instincts, beliefs, and traditions. As a Sámi woman and chairwoman of the Sámi women’s organization Niejda (meaning “daughter/girl” in Sámi), I also see clearly how colonization and Christianization continue to affect Sámi women today.

My Body, My Child—But Not My Conditions

When I gave birth to my first child in 2009, I had wanted a home birth, but financial constraints led us to a hospital instead. Although the birth went well and without interventions, I often felt pressured to ignore my instincts and adapt to hospital routines. I was required to lie on my back for monitoring, staff repeatedly attached monitors to my baby’s head despite my feeling that she was fine, and her umbilical cord was cut immediately according to protocol.

By my second birth in 2014, also in a hospital, it became even clearer that medical staff trusted their assessments more than my own experience of my body. When I felt the urge to push, the medical staff told me I still had hours left before birth and left the room. Fifteen minutes later, my son was born into my own hands. That moment changed something in me. For the first time, I fully understood that my body knew how to receive my child.

Afterward, I asked to delay cutting the cord until it had turned white, but the doctor was in a hurry and cut it almost immediately. Soon after, my son began having trouble breathing.

By the time of my third birth, I knew I no longer wanted to compromise or feel controlled during labor. Since there were no home birth midwives available in our town, I decided to give birth at home on my own, in a way that felt fully undisturbed and true to my beliefs.

Although there were no home birth midwives available in our town, I received support from Agneta Bergenheim, one of Sweden’s most experienced home birth midwives, who encouraged me to trust myself and my decision. In February 2022, my daughter was born at home, witnessed only by her father and her two older siblings. For the first time, I felt I was giving birth exactly as I was created to do.

A Colonial System That Centralizes and Controls

In “Sweden” today, colonialism rarely appears as direct violence. Instead, it operates through institutions and systems that centralize power and decision-making away from Sámi communities. In maternity care, this means that services are increasingly concentrated in larger cities, while the specific cultural, geographical, and emotional needs of Sámi women are deprioritized. Women are often forced to leave their homes, languages, traditions, and support systems at one of the most vulnerable and transformative moments of their lives.

This process has deep historical roots. During the 1800s, traditional midwives in Sweden and Sápmi were gradually absorbed into state-controlled medical education systems, leading to the loss of traditional birthing knowledge. Home births nevertheless remained common well into the 1900s. After World War II, Sweden still had maternity units in most rural communities. But over time, care became increasingly centralized. In 1973, Sweden had 95 birthing units; by 2025, only 45 remained, with just six serving the entire northern half of the country, including Sápmi. Today, some women must travel up to 350 kilometers to reach the nearest hospital.

As a result, around a hundred women each year in Sweden give birth on the way to the hospital. One of them was Marie Rahkola, who lives in the Sápmi territory. In January 2019, while traveling the long road from Kiruna to the hospital in Gällivare—known locally as “The Road of Death”—her baby became stuck during birth. With only a midwife on the phone to guide them, her partner had to deliver the baby himself on the roadside. “He didn’t cry because the umbilical cord was around his neck,” Rahkola later told SVT, Sweden’s national public broadcaster. “Eventually, we got him breathing, but then I went into shock.

Revival of Home Birth

Although more women in Sweden are seeking home births or more home-like birthing environments, these options are becoming increasingly difficult to access. Maternity wards focused on personalized care are closing, and many midwives are leaving home birth practice due to growing legal and institutional pressure. Midwives who attend home births are often questioned by colleagues, restricted from bringing essential medications, and risk losing their licenses if they assist births classified by the medical system as “high-risk.”

This pressure became clear in the case of Agneta. In 2025, she was banned from attending home births after assisting a planned twin birth at home. Although the birth went well, the case was reported to IVO, the Swedish authority responsible for overseeing healthcare. Agneta continued supporting women who wanted to give birth at home, arguing that women deserve the right to give birth with dignity and on their own terms. As a result, she now faces legal prosecution.

For many women, especially Sámi women, the loss of midwives like Agneta has deep consequences. While not Sámi herself, Agneta has worked extensively in the Norwegian part of Sápmi and has learned from the Sámi women she has supported through birth. She understands the cultural and spiritual dimensions of childbirth that are often absent from institutional care. “Our society today has a mechanistic view of human beings, where women are forced to become units of production,” Agneta says. “We live in a strong culture of fear around birth and death, the most natural parts of life.”

A Dignified Birth

The Sámi book Čalbmeeadni (“Eyemother”) collects birth stories from across Sápmi. In Sámi, čalbmi means “eye” and eadni means “mother,” and the word can be understood as “a wise woman” or “one who sees and cares for others.” Traditionally, it referred to the woman who attended a birth, whether formally trained or not. The concept reflects a view of childbirth as something grounded in community, trust, and women’s knowledge.

For generations, childbirth and midwifery were part of everyday life in Sámi society, as in many Indigenous and traditional cultures. Today, many Sámi women are fighting to reclaim that connection. This includes the right to give birth close to home, to speak Sámi during labor, to avoid long and dangerous travel during active birth, and to access care that respects cultural traditions and women’s autonomy. International frameworks such as the International Labour Organization Convention No. 169 and the United Nations Declaration on the Rights of Indigenous Peoples affirm that Indigenous communities should be able to organize and provide healthcare in ways that reflect their own knowledge systems and needs.

Agneta encourages women to ask themselves: “What feels peaceful, pleasurable, and calm within me?” She believes change must begin by rebuilding trust in women’s bodies and restoring community-centered birth practices. The Sámi women’s organization Niejda has twice applied for government funding to preserve traditional Sámi women’s health knowledge, without success. In 2025, the organization launched the small-scale project Nissonolbmo eallin (“Life of Women in Sámi”) with support from the Swedish Sámi Parliament to continue preserving and sharing the knowledge of Sámi elders.

Decolonizing maternity care in Sápmi requires more than expanding medical services. It means redistributing power so that women’s experiences, Sámi perspectives, and traditional knowledge are respected within maternity care systems.