Doctoral thesis: comprehensive maternity support for families often depends on the initiative of the mother herself or a single specialist

“The necessary maternity care services should be provided to families consistently and seamlessly throughout the entire period of starting a family,” says Silja Mets-Oja. This means a clear pathway of care, ranging from antenatal care with a midwife and support during childbirth to postnatal health checks and counselling to support the family’s coping and parenting. However, the study reveals that, in reality, receiving the necessary support depends on the family’s own ability to organise a system or on a specialist’s initiative in arranging support. The bottlenecks in consistency are particularly evident in the postnatal period.

Silja Mets-Oja, who heads the Centre for Health Education at the Tallinn Health University of Applied Sciences, examined the development of maternity care services at the interface between healthcare and social care and how the experiences and cooperation of various parties influence the functioning of these services in her doctoral thesis. “The need to investigate this issue arose from the fact that maternity care is not limited solely to healthcare services,” explains Mets-Oja. “A mother and her family may also need counselling to support their mental wellbeing and help them cope with everyday life. As healthcare and social care in Estonia are organised under separate systems, the consistency of support depends on cooperation between specialists in these fields. This has been little studied in Estonia to date. We do not really know how systemic changes, women’s experiences and collaboration between specialists are interlinked.”

The existence of services does not guarantee their accessibility

The results show that, when it comes to maternity care, it is not just the existence of the necessary services that matters, but also their accessibility and their way of becoming a coherent whole for the mother. “The experiences of women living in rural areas show that the mere existence of a service in the nearest town does not always mean it is actually accessible,” Mets-Oja points out. For example, a long distance to the maternity ward can mean difficult choices for a woman. One woman who took part 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 was able to stay with friends living in the city – the baby was born the very next day.

The availability of help affects one’s sense of security

Discussions regarding the closure of maternity wards highlighted the willingness of local communities to play an active role in the reorganisation of maternity care services. A survey of local residents showed that access to maternity care close to home is important both as a service and for a sense of security, the vitality of the region and the perception of the state’s presence. Therefore, when reorganising services, it is important to take into account not only clinical and service management indicators, but also the impact of the changes on the local population as a whole.

Families should not have to organise a system for themselves

In addition to the regional availability of services, it is important to consider how cooperation works in situations where a family needs physical health, mental health or social care support all at the same time. The doctoral thesis reveals that cooperation between the health and social care sectors is often case-by-case in practice and may depend on the individual specialist – their previous experience of cooperation, their network of contacts, and their willingness to initiate cooperation with other specialists. Nor is information about a family’s circumstances and need for support always shared consistently between healthcare and social care specialists. The women who took part in the study highlighted that, following childbirth, they needed practical support tailored to their home situation to help them feel more confident about looking after their newborn.

“Families shouldn’t have to organise a system themselves in order to receive support. 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,” explains Mets-Oja.

Maternity care requires a more comprehensive approach

The doctoral thesis shows that, when organising maternity care, the mere existence of individual services is not sufficient. It is important that they form a coherent whole for the family. The results of the study help to identify places where women and families may be left without the support they need. “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,” says Mets-Oja, summarising the study’s main message.

 

Thesis defence

Silja Mets-Oja defended her doctoral thesis at Tallinn University’s School of Governance, Law and Society on 18 September 2026.

Her doctoral thesis is entitled Structure and Agency in the Design of Maternity Care Services: the Parties’ Experiences and Cooperation Practices at Points of Integration Between Health and Social Care.

The supervisors for the doctoral thesis are Anu Toots, Distinguished Professor of Social Policy at Tallinn University, Kadi Krinal, Senior Research Fellow at Tallinn University of Technology, and Ülle Ernits, Associate Professor at the Department of Nursing, Tallinn Health University of Applied Sciences.

The opponents are Judit Strömpl, Associate Professor of Social Work Studies at the University of Tartu, and Ruth Kalda, Professor of Family Medicine at the University of Tartu.

The doctoral thesis can be read in the ETERA digital environment of the Tallinn University Academic Library.

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Silja Mets-Oja completed her doctoral studies under a cooperation agreement between Tallinn University and the Tallinn Health University of Applied Sciences. This cooperation enables the Tallinn Health Care University of Applied Sciences to carry out the research necessary for the development of the healthcare sector.