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Midwives Explain What a Home Birth Really Means

By Lauren Valenti

The COVID-19 pandemic has presented a unique set of emotionally distressing challenges for pregnant women . From concerns about their health and that of their baby, to the prospect of having to go into labor and birth alone in hospitals, mothers-to-be are facing extreme fear and uncertainty in an already vulnerable time.

With many hospitals operating near or at capacity with limited resources as they take on the flood of Coronavirus patients, many expectant mothers are rethinking their birthing plans—and considering the option of a home birth which, typically, only about one percent of mothers do each year. Midwives are being inundated with home-birth requests . Here, the birthing experts speak on commonly asked questions about home birth, the benefits and potential risks of doing so, and why the decision to have one should be made with careful consideration.

What Is a Home Birth?

"A home birth is exactly what it sounds like—when someone decides to birth their baby in their own home!" explain licensed midwives Robina Khalid and Tanya Wills of New York City's Small Things Grow Midwifery in a shared interview. "People who have a planned home birth, in the absence of complications, will never need to go to the hospital." While someone can birth at home without a midwife, the vast majority of people who choose home birth will work with one. As for who else is present, it varies from family to family; oftentimes it’s just the birthing person, their support person, and a midwife. "In general, home birth is a quiet, intimate experience," explains Sara Howard, a Los Angeles-based midwife and educator at healthcare center LOOM. "Lights can remain dim, music can play in the background, and partners and doulas can provide support no matter where the birthing person wants to be physically, whether that's in a bed, tub, or somewhere else."

What Role Does a Midwife Play in a Home Birth?

The midwife is there to safeguard the health and safety of the birthing person and the baby. While many midwives vary in credentials in the U.S.—there are licensed midwives, certified professional midwives, certified nurse midwives, and traditional midwives, for example—practices are similar. "I’m licensed by the same medical board that licenses doctors," explains Howard. "I carry a doppler to listen to the baby’s heartbeat in labor, medications to stop bleeding after birth, oxygen, suturing equipment, IVs and antibiotics, and more. I’m certified in neonatal resuscitation and infant CPR, as well as trained in advanced fetal monitoring." A midwife may involve herself during birth by "catching the baby" or, during the immediate postpartum, ensuring the placenta is birthed safely, keeping a watchful eye on bleeding, giving stitches when needed, performing a head-to-toe newborn exam (including weight and measurement), and assisting with breastfeeding. "In the best case scenario a midwife is just there to remind the birthing person of their own strength and to help ensure the birthing person feels safe enough to do what only they can do—birth their baby."

What Are Some Benefits of a Home Birth?

"Home birth may be the best chance the average American person has at having a physiologic birth—a birth that occurs without intervention," explain Khalid and Wills. This method has been shown to carry benefits to parent and baby, including a better transition to breathing for the baby, less genital trauma for the birthing person, quicker recovery from birth, increased rates of breastfeeding, improved parent-infant attachment, and decreased incidence of postpartum depression. Planned home births attended by a registered midwife have been associated with reduced rates of obstetric interventions, such as C-sections, and other adverse perinatal outcomes. Plus, there is an inherent bond that's been formed between mother and midwife. "By the time we arrive at the birth, there is a deep understanding of the person, baby, and family we are caring for—there is trust," say Khalid and Wills. "People can birth anywhere they like on their own turf while listening to their bodies and allowing their own innate wisdom to guide them."

How Is Labor Pain Managed During a Home Birth?

"Epidurals are an amazing technology that many people choose to use in the U.S., but there are many other people who place value on the experience of labor and birth as it is," explain Khalid and Wills. "We have a belief in our culture that pain is always bad or wrong. And is labor painful? Yes. But pain is different than suffering, and pain is sometimes instructive." For example, the pair believe that having full sensation when pushing helps people know how to push—and when to back off—which helps people tear less than they would during guided pushing. Moreover, birthing at home gives the birthing person the opportunity to move more freely, as well as take advantage of multiple spaces, such as a bed and a pool of water. "Laboring in a big pool of water at body temperature is probably the most soothing tool we have at all to relieve pain at home," explains Howard. "Virtually all people who labor at home will utilize a birth pool for that very reason." Another way to relieve pain naturally is deep, focused breathing. "When you relax and breathe, your muscles get more oxygen, which reduces pain," she explains. "Whereas when people are scared and tense, their muscles constrict and they feel more pain."

What Are the Safety Concerns Around Home Birth?

In order to be a good candidate for home birth, a person and a pregnancy need to be “low-risk,” which generally means that there are no major medical problems present either before or during the pregnancy, says Howard. Generally, high-risk factors may include high maternal age or previous C-section delivery. The best way for an expectant mother to know for sure is to talk to their doctor, as well as consult a midwife about their specific history and situation. As for unexpected medical emergencies that could arise during an at-home birth, Howard says the most significant risk is the delay in getting from your home to a hospital, which is why many medical experts recommend that an at-home birth should take place within 15 minutes of a hospital. "The majority of problems that occur during labor and birth present warning signs, and midwives are extensively trained in recognizing these warning signs," explain Khalid and Wills. "Our intimate knowledge of our clients, as well as years of observing people's labor while sitting with them for hours on end, gives us the ability to interpret what’s going on, and decide whether staying at home is still appropriate." The pair also stresses that most transfers are not emergencies, and that the most common reason for going to the hospital during labor is exhaustion or a very long labor that might need some augmentation or pain relief.

How Can I Decide Between a Home Birth and a Hospital Birth?

In additional to consulting medical professionals, it's important to gauge your personal comfort level with the idea of a home birth. "Home birth can be an incredibly warm, sweet way to bring your baby into the world—but it isn’t for everybody," says Howard. "There are times when epidurals and surgical births are terrific, life-saving things that we can all be grateful for. Deciding where to birth is personal. Take the time to gather the information and resources you need to ensure that you’ve made the best choice for you and your family. You know best." As far as the timing of a mother-to-be's decision, the earlier the better, especially in the instance of home birthing. "Things get tricky when it’s very late in the pregnancy and folks want to have a home birth, especially because most midwives have small practices that fill up early," explain Khalid and Wills, who released an open letter to address increased interest in home birth during the COVID-19 pandemic. "Moreover, creating trust and familiarity between the midwife and the family over time is key to a safe and healthy experience." Ultimately, the decision to have a home birth is not one to be made out of fear and panic, even in unprecedented times—fundamentally trusting the location of one's birthing is the best way to ensure safety for the mother and child, they stress. "If after diligent and thoughtful research, the autonomy and safety of home birth remains appealing, pregnant people are always welcome to contact individual practices, with the understanding that most practices book up far in advance," Khalid and Wills note in their address.

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• Open access
• Published: 19 April 2023

“But at home, with the midwife, you are a person”: experiences and impact of a new early postpartum home-based midwifery care model in the view of women in vulnerable family situations

• Bettina Schwind 1 , 2 ,
• Elisabeth Zemp 1 , 2 ,
• Kristen Jafflin 1 , 2 ,
• Anna Späth 1 , 2 ,
• Monika Barth 3 ,
• Karen Maigetter 1 , 2 ,
• Sonja Merten 1 , 2 &
• Elisabeth Kurth 1 , 2 , 3  

BMC Health Services Research volume  23 , Article number:  375 ( 2023 ) Cite this article

1949 Accesses

Metrics details

Postpartum home-based midwifery care is covered by basic health insurance in Switzerland for all families with newborns but must be self-organized. To ensure access for all, Familystart, a network of self-employed midwives, launched a new care model in 2012 by ensuring the transition from hospital to home through cooperation with maternity hospitals in the Basel area. It has particularly improved the access to follow-up care for families in vulnerable situations needing support beyond basic services. In 2018, the SORGSAM (Support at the Start of Life) project was initiated by Familystart to enhance parental resources for better postpartum health outcomes for mothers and children through offering improved assistance to psychosocially and economically disadvantaged families. First, midwives have access to first-line telephone support to discuss challenging situations and required actions. Second, the SORGSAM hardship fund provides financial compensation to midwives for services not covered by basic health insurance. Third, women receive financial emergency support from the hardship fund.

The aim was to explore how women living in vulnerable family situations experienced the new early postpartum home-based midwifery care model provided in the context of the SORGSAM project, and how they experienced its impact.

Findings are reported from the qualitative part of the mixed-methods evaluation of the SORGSAM project. They are based on the results of seven semi-structured interviews with women who, due to a vulnerable family postpartum situation at home, received the SORGSAM support. Data were analyzed following thematic analysis.

Interviewed women experienced the early postpartum care at home, as “relieving and strengthening” in that midwives coordinated patient care that opened up access to appropriate community-based support services. The mothers expressed that they felt a reduction in stress, an increase in resilience, enhanced mothering skills, and greater parental resources. These were attributed to familiar and trusting relationships with their midwives where participants acknowledged deep gratitude.

The findings show the high acceptance of the new early postpartum midwifery care model. These indicate how such a care model can improve the well-being of women in vulnerable family situations and may prevent early chronic stress in children.

Peer Review reports

Based on evidence that lifelong health and human development are strongly influenced by experiences during the first years of life, early childhood interventions are increasingly the focus of research and policies [ 1 , 2 , 3 , 4 , 5 ]. Interventions during this period are found to be more effective and less costly than later efforts [ 3 ], and especially children in vulnerable family situations seem to profit from early interventions. Studies show in particular, that early chronic stress and its long-term consequences can be mitigated [ 6 ]. Evidence suggests that parents, caregivers, and families need support for providing responsive, nurturing care and protection for young children so that they may achieve their developmental potential [ 3 , 7 ]. Programs designed to meet the needs of families in difficult circumstances lead to enhanced parental resources and thereby better outcomes for children [ 8 , 9 , 10 , 11 , 12 , 13 ].

Positive effects on developmental outcomes have been documented for three types of family support and strengthening: quality services, support, and skills building [ 3 ]. However, studies [ 14 , 15 , 16 , 17 , 18 , 19 , 20 ] have shown that especially psychosocially and economically disadvantaged families have limited access to postpartum care at home and use the available services less frequently. Midwives, due to their immediate access to vulnerable families, may therefore be key actors for early prevention, i.e. the early assessment and support of families with, or expecting an infant whose living situations are overstraining their capacities to cope [ 19 , 21 ].

Only a few, mostly Scandinavian, studies have addressed the perspective of parents receiving postpartum home-based care by midwives, and research on the impact of such care on infants and their families is still scarce. A Swedish study on first-time parents’ experiences of home-based postpartum care after early hospital discharge showed that midwives took a supporting role and strengthened parents’ self-confidence [ 21 ]. In a Norwegian study on women’s experiences of home visits by midwives in the early postpartum period, three central themes, relational continuity, postpartum talk, and vulnerability emerged [ 22 ]. Specifically, relational continuity with a midwife appeared as a crucial part of care, as expressed by a cited quote “postpartum care provided by a named midwife”. The importance of relational continuity in care was supported by a study from the UK that linked care across pregnancy, birth, and new motherhood with improved health outcomes for women and babies in socially disadvantaged and diverse communities [ 23 ]. An Australian home visit program for vulnerable families in disadvantaged areas also improved clients’ parenting skills and well-being, increased participation in community networks, and access to support services [ 24 ]. In Sweden, parents in vulnerable situations who received extended home visits reported improved parenting skills and confidence in discussing problems with professionals [ 25 ], especially fathers with migration histories who benefited equally through home visiting programs [ 26 ]. Furthermore, a German study applying a longitudinal mixed-method design investigated the effects of family midwives in 734 vulnerable families in Sachsen-Anhalt [ 27 ]. Results showed an increase in mothers’ skills in three areas: childcare, self-help/organization of family life, and searching for and accepting external help.

Because the literature so far has largely focused on the context of extended home visiting programs and outcomes for families in vulnerable situations [ 25 , 26 ] and was less concerned with experiences of families in vulnerable situations with very early home-based midwifery care and its impact, these issues were addressed in a Swiss study.

In Switzerland, early home-based postpartum care is mainly provided by independent midwives and family nurses [ 18 ]. Organizing postpartum care at home before birth is usually the responsibility of the pregnant woman and/or her relatives. Basic insurance covers 10–16 regular home visits by an independent midwife over 56 days. Little is known about the practices that go beyond standard care. Several local midwifery networks guarantee a seamless transition for all mothers and newborns from the hospital to the home setting [ 28 , 29 ]. These networks coordinate a postpartum care pathway in collaboration with maternity hospitals, independent midwives, and other maternal and child health care providers [ 30 , 31 , 32 ]. They assure that all women who give birth in the collaborating hospitals receive standardized care in that a midwife comes to their homes after hospital discharge and ensures further care. A first evaluation study in Switzerland suggested a great value of organized, guaranteed postpartum outpatient care by a midwifery network, especially for socially disadvantaged families [ 16 ]. It appeared that the accessibility and reliability of the midwives were crucial to women. The midwife network not only eased the burden on families and reduced stress, and for many women, the midwife evolved into an important reference person and was recognized as a cultural mediator by women with migration history.

In the Basel area, a Familystart network model has been running since 2012. Due to the guaranteed access to postpartum home care, midwives regularly visit disadvantaged families who may have fewer resources to organize postpartum care themselves, yet need support beyond services covered through basic health insurance. Set up in late 2018, the project “SORGSAM – Support at the start of life” aimed to offer vulnerable families improved assistance in dealing with complex postpartum situations [ 33 ]. The SORGSAM project supports independent midwife care activities for families in situations of stress and risk in three ways: first, midwives have access to first-line telephone support (7 days a week) to discuss challenging situations and required actions with a midwife specialized in psychosocial care [ 33 ]; second, the SORGSAM hardship fund provides financial compensation to midwives for services not covered by basic health insurance, e.g. for their time and costs in emergencies or for coordinating inter-professional services; and third, women may receive financial emergency support from a hardship fund.

We specifically aimed to investigate how women in vulnerable family situations experienced early postpartum home-based care by independent midwives provided in the context of the SORGSAM project, and how they viewed the impact of obtained care.

The study and this report were conducted following the Consolidated Criteria for Reporting Qualitative Research (COREQ) [ 34 ]. The research team of the SORGSAM evaluation consisted of an interdisciplinary team dealing with society and health care in Switzerland anchored at the Swiss Tropical and Public Health Institute, University of Basel [ 35 ]. Ethical approval by the Northwest Switzerland Ethics Committee was obtained before the start of the study (BASEC 2019–02030), and in an amendment during the COVID pandemic concerning the conduction of zoom interviews and directly contacting the families through the caring midwife.

Research design

This article reports findings from the qualitative part of the mixed-methods evaluation of the SORGSAM project in the area of Basel, Switzerland [ 35 ]. It is based on the results of semi-structured interviews with women in a vulnerable family situation in the postpartum period who experienced home based support from a Familystart midwife. The midwife made use of the SORGSAM support, including coaching/counseling by a specialized midwife and financial support from the SORGSAM hardship fund.

Open-ended, narrative-generating interview questions were developed in consultation with the research team and included three thematic blocks: (1) perception of the postpartum situation, (2) perception of the midwife’s care, and (3) perception of the current situation. Towards the end of the interview, participants could talk freely about topics that were not previously addressed but were important to them. An additional document shows the interview guide in detail (additional file 1). For the purpose of publication the guide was translated from (Swiss) German into English.

Sampling and recruitment

Criterion-based maximum variety sampling was used to select participants based on two available SORGSAM routine documentations, namely: (1) reports of the SORGSAM reimbursement from the hardship fund and, (2) reports of provision of first-line telephone support provided by a specialized midwife for colleagues encountering complex family situations. The criteria consisted of poverty, migrant history, single parent, health, and/or psychosocial stressors to maximize the diversity of complex family situations. Women were eligible to participate if they received care from a Familystart midwife who requested SORGSAM support in 2019. Individuals with severe mental illness, and/or receiving support from a midwife who were not Familystart members, and/or having language barriers were excluded. The selection based on the sampling criteria was documented, discussed, and validated by the team.

Eligible participants were approached by their midwives and informed about the study. When they were interested, the informed consent packages were sent via mail. They had sufficient time to read through the documents, clarify questions and consider whether they wanted to participate in the study. Written informed consent was obtained from all participants before the interview.

Among 55 eligible participants, nine agreed on a contact date for an interview, whereas 32 refused to participate or did not react; four persons showed insufficient language skills for interviewing, and 10 could not be reached. Two participants did not attend the agreed appointment due to the illness of a family member. As they were no longer reachable afterwards, this was considered as a withdrawal from participation. Once seven interviews were completed, recruitment had to be suspended due to the financial constraints of the project.

Data collection

Between February and July 2020, a senior researcher with a background in health and social sciences conducted seven interviews in the area of Basel in the German language. Each participant was free to choose the place of the interview. The first interview was conducted in February 2020, face-to-face in a café. Due to the increasingly tense pandemic situation, all subsequent interviews were conducted virtually via Zoom. The virtual approach appeared to be convenient for participants, as they did not have to find childcare for their children. All interviews were audio-recorded and lasted approximately one hour. The semi-structured interview method with open-ended questions allowed delving into participants’ perspectives so that women could talk freely about their experiences. Observations on the research process including the pandemic situation were noted in a reflexive diary by the interviewer.

Data analysis

After transcription of the interviews data were analyzed following Braun and Clarke’s thematic analysis [ 36 , 37 ], a method designed for researching the views and experiences of research participants. The qualitative data analysis software package MAXQDA 2018 was used to support the analysis steps for coding following thematic analysis [ 36 , 37 ]. These included familiarization with the data (step 1), assignment of preliminary codes (step 2), search for preliminary themes (step 3), review and definition of themes (steps 4 and 5) and provide a written record (step 6). At a stakeholder workshop, consisting of 12 participants, the themes identified through the analysis were presented, revisited, discussed, and validated. No themes were corrected or determined to be missing. Based on the results of the analysis, a thematic model was jointly developed by the research team that formed the basis of the results section.

Participants

Of the seven participating women, five had a migration history (see Table  1 ). One participant was of Swiss nationality, and one woman was a cross-border commuter living in Germany. Their ages ranged from 23 to 44 years. Four women had a tertiary education and three had attended primary school. At the time of the interviews, only one woman was employed (100%), whereas two reported unemployment status and four reported not working and currently not seeking paid work. Four women were married; three were single or living alone. The partners of the four married women worked full-time.

Research findings

Three themes emerged from the analysis of the interviews, each containing several sub-themes and respective codes:

complex postpartum situation,

comprehensive postpartum care, and

psychosocial relief and empowerment.

The themes were grouped into a thematic model as shown in Fig.  1 , displaying midwife care and its perceived effects on women. They emerged from the accounts of the women, who found themselves in “complex postpartum situations” at home. Women described the “comprehensive postpartum care” by explaining “what it comprised” and “what it meant” to them. They indicated that the care received resulted in their “psychosocial relief and empowerment”. In the following, the three emergent themes are consecutively described:

Thematic model

Theme 1: complex postpartum situation

Women described challenging situations at home. Four sub-themes became apparent, including the aspects: “health situation”, “social situation”, “psychosocial situation” and “financial and material situations” (see Fig.  2 ).

Theme “Complex postpartum situation”

Specific to the present study, however, was that the postpartum situations were considered complex, due to the intersection of health challenges of mother and/or newborn, but also the precarious social and financial situation, partly with experience and/or fear of violence as the following example shows:

“At the beginning, it wasn’t easy,…after the birth I had problems with my leg, I could not walk properly…and I am overweight…and I am here alone, without family. I had problems with my boyfriend at that time and with my boyfriend’s father, yes, and I have another child…and she was kidnapped when she was one year old, and the problems plus my fear that my new child would also be kidnapped, that made my life quite difficult.“ (Interview 3).

Theme 2: “comprehensive postpartum care”

Women reported how they experienced the care provided by midwives as shown in Fig.  3 . Therewith, the sub-themes “what it comprised” and “what it meant” emerged from the data, each including different thematic aspects that added up to what was understood as “comprehensive postpartum care”.

Theme “Comprehensive postpartum care”

Sub-theme “what it comprised”

The sub-theme “what it comprised” is composed of the thematic aspects of “mother-child-care”, “midwife presence”, “coordination and networking”, and “material support”. “Mother-child-care” included ordinary aspects of midwifery care in the postpartum situation, such as bathing the newborn, checking wound sutures, breastfeeding support, assuring weight gain of the newborn, and checking for emotional distress and/or anxiety/depression. To focus on the three further thematic aspects that go beyond ordinary midwifery care, mother-child care was not elaborated on in more detail.

“Midwife presence” emerged as a very central element in the women’s narratives. Women described the feeling that midwives were always there for them and their families, and even in case of emergencies:

“She was always there when we needed her, always…” (Interview 1) . “When I need help, when I write, she always calls.“ (Interview 4) . “She really helped me and never minded, even if it was raining.“ (Interview 6) .

Thus, the reachability and availability of midwives appeared as a crucial aspect to ensure emotional, parental and material support to promote feelings of security - especially in case of uncertainties at home. This was the case for example, when women were worrying about how to deal with the newborn, how to feed the baby, or if there were no nappies due to financial constraints, but also if they were fearing violence. This kind of accessibility and reliability to medical, social, and emotional support appeared especially important for women who felt challenged having to navigate through the health system and therefore they were able to receive the help at the time they needed it:

“[Doctors] were often not available,…nobody came by…and I was…also not so well organized, but there was…a big gap…I somehow think that the midwifery care was a very personal, individual care.” (Interview 6) .

The low threshold of accessibility and reliability, e.g. to text midwives and receive an answer via SMS, appeared as a supportive cornerstone. However, it was not only the perceived reachability and availability of the midwife that was important for the women, but also that the midwife’s presence at home was felt to be without any apparent time pressure:

“I think it was important for us that she was simply there, that she always took her time, sometimes she was even there for two hours and didn’t look at the clock, … that she wasn’t in a hurry, but that she took her time and asked three more times, with, um, is it everything now, is there anything else?… Yes. That was good.“ (Interview 7) .

The quotes suggest that the women perceived an unconditionality in the midwifery care received, presumably creating feelings of trust and being taken seriously. The women also reported that the midwife was not only there as a contact and care person for them and the newborn, but also for the whole family, as evidenced in the next quote of a woman who experienced stillbirth:

“Yes, and I liked the fact that she looked after us as a family and not just after me as a woman, because there wasn’t much to control in terms of the baby…that the family was looked after, that the brother was looked after, asked how he was dealing with it, right? Things like that.“ (Interview 7) .

Furthermore, one woman described a situation of domestic violence, in which her midwife provided her with emergency help:

“Because once I was in a situation there, I couldn’t call the police or get help somehow, then I wrote to her and she got the police for me, you know?…I didn’t know what to do, I didn’t have a car, my baby was sick…so, or violence,…something happened to him,…I couldn’t go to the hospital right away, then she helped me, even though it wasn’t working time, or, so she came with her car, she helped me go to the hospital”. (Interview 6).

Overall, the thematic aspect of “midwife presence” indicates that the interviewed women appreciated the midwife’s accessibility, availability, and continuity of care without time pressure. They described midwives as “carers” for their families and as trusted confidants - especially for themselves, and who were called in during emergencies such as in cases of domestic violence.

Women interviewed reported on the different forms of “coordination and networking” functions of midwives. They described midwives’ work as mediating, organizing, and coordinating services and institutions to improve complex domestic situations. Midwives were reported to have organized parent-child counseling, breastfeeding counseling, social services, and home care services for domestic help (e.g. the Red Cross). Women also indicated that midwives contacted various doctors, police, and cantonal offices. The women interviewed described this central interface function:

“And, she gave me a lot of contacts…la Leche ligue, and now I’m a member and other mothers…that was very good.“ (Interview 1) . “So yes, so I was sad, so not good, since the birth and yes, the midwife, has found such a person…a therapist, and I had gone there with (child).“ (Interview 2) .

The range of this interface network function went from quick fixes to complex coordination activities as illustrated in the following example:

“At the beginning, she just put away the toys…and then afterward she…asked at Spitex [home care service for domestic help], can someone cook there? And, do a bit of housework and a bit of cleaning. And they said, no, they just do the flat a bit. And then she …first asked in Canton X because the children were born there and then,…but I live in Canton Y…then she had asked if she could organize someone from the Red Cross if they would take over something. Then they said, no, have to ask Canton Y. She called Canton Y, and then they understood my situation, then Canton Y just took over and also organized it further.“ (Interview 4) .

The midwifes’ networking activities included professional groups or organizations or institutions, and networking among mothers. Women with a migratory background who felt or were alone mentioned this positively and emphasized the important role of their home-country language in feeling understood:

“Because the [other mothers] speak Spanish and it was…my midwife was the midwife of this mother and my midwife, and [she said] I know other Spanish mothers - do you want their phone number? And she asked for the other mother too, and we made contact and we are friends.“ (Interview 1) .

Beyond midwife’s care and coordination support, women also described to have received material support, ranging from getting diapers to breast pumps to children’s clothes:

“If I need some clothes or something bed and things like that…if I need that…all the organizing…for cot or something, you know…I didn’t buy much and she also tried to get [this] organized. That was also…great, how do you say, yeah because everybody thinks only about one health side, the other side…she helped on both sides, yeah.“ (Interview 4) .

Women also received information and knowledge about where to obtain assistance in case of financial bottlenecks, e.g. where to get second-hand clothing and toys free.

Sub-theme “what it meant”

The sub-theme “what it meant” is composed of the thematic aspects of “filling the gap”, “people take center stage”, and “great responsibility”. The interviewed women described the overall postpartum care received not only as extensive, but also contrasted it with the care provided by medical doctors where they described midwives as “filling a gap” in the care system:

“With the doctors a bit like that…so, ‘I do that, that’s my problem…They don’t see a collective problem…and he just looks at the child. I find the medicine a bit separate…The midwife! it’s in the middle…she’s worked with both of us so far, so that’s so her job, she’s doing great.“ (Interview 2).

Women also described as being seen and treated by the midwife as a person, which also included much of their emotional situation.

“Because in hospital you are a patient with blood pressure, this and that and the values, but at home, with the midwife, you are a person with feelings and yes…that was a completely different approach. (Interview 7).

“I mean, it isn’t just the baby what the midwife works on…she helped me in other ways too.” (Interview 6).

Women also emphasized the great responsibility that this entails for the midwife:

“I felt that the midwife took more responsibility than she…had to.” (Interview 2) .

The quotes highlighted that women understood the care they received as comprehensive postpartum care that occurred at the interface between somatic and psychosocial care, and as interconnecting between professions and institutions. This meant for women that a gap in postpartum care was being filled, which they described as a great responsibility for midwives.

Theme 3: Psychosocial and emotional impact

The theme “psychosocial and emotional impact” developed from the data, covering the sub-themes “psychosocial relief”, “empowerment”, and “feeling grateful”, see Fig.  4 .

Theme “Psychosocial relief and empowerment”

Sub-theme “psychosocial relief”

What appeared as important for the interviewed women was that the received care was experienced as personal and emotional, and was labeled “human”. This aspect was particularly memorable for the interviewed women as they described the midwife’s care as supporting “physical, emotional recovery and relaxation” which helped them to relax:

“Helped me to relax a bit, because I was always very stressed and so (groans), and I…was breastfeeding (child),…so and she helped me to relax a little bit like that, and to breathe…and to get a little bit, yeah, calm, so that was…that was good”. (Interview 2).

“It all sounds like a commercial now…she couldn’t have done it better. She was also great interpersonally…That really supported me insanely.“ (Interview 4) .

The quotes indicated how women no longer felt alone due to the midwife’s presence and the interpersonal relationship, which supported women in dealing better with the new postpartum situation. They also stated how important it was for them to be able to “build and experience trust” with the midwife:

“I could trust her…that was important for me, that I could trust her, I could also talk so openly with her.” (Interview 6).

“She was actually my contact person number one and I think that was actually almost the most important thing.” (Interview 5).

The quotes underlined the importance of interpersonal closeness and trust so that women could open up and thereby feel relief and relaxation at the same time. They experienced a reduction of concerns and stress.

Sub-theme “empowerment”

From the different interview texts, it became manifest that the women not only felt relieved by the comprehensive midwifery care but that they also felt strengthened to survive the difficult life situations. The following quotes expressed how women felt to “become stronger and courageous”, also through “competence and knowledge enhancement” on where and how they could obtain help:

“That made me a bit strong,…um, I don’t know, is there this expression in Switzerland or German, that you can stand on your feet? [Yes. That was like that for me. So I know where, where I can go for help if anything happens…yeah…And that made it a bit easier, the situation made that, became a bit easier. It’s not easy, but it has become easier.“ (Interview 3).

“During the birth or after the birth a little bit so, just, like nice, so, just, so, just, um, agreeing with the situation or so a little bit braver, we can help, we can organize something, not worrying or so a little bit, yeah, so just with the others, just helping would be nice (laughs)” (Interview 4).

The midwifes’ presence provided security and confidence to better deal with and accept the current situation so that women described, “feeling good and safe”:

“So yeah, now it’s, um, now it’s really like, I hope, I don’t know, but like…right now I’m somewhere good with my baby” (Interview 6).”

Through these different forms of emotional and social self-empowerment, they described feeling “good and safe” again.

Sub-theme “feeling grateful”

Starting from the question about changes compared to the current situation, women made statements that indicated, in retrospect, a positive assessment and gratitude for the care and support they had received that still lasted at the time of the interview. This was exemplified in interview 6:

“She just…helped a lot, a lot, and I’m very grateful that she kind of saved my life, twice.“ (Interview 5) .

This gratitude was rooted in the comprehensive support, which was described as “coming from the heart”, as it was formulated in interview 5:

“She helped me in many ways, you know…in clothes, in healthy, in emotional, she was … a person…she did so many things with me, helped…she did it from the heart.“ (Interview 5) .

“She has been like a god when she asked like that and organized the help like that, that’s, yeah, that’s a big help, you know? I won’t forget that.“ (Interview 3) .

The quotes illustrated both the gratitude towards the midwife as well as her central role, possibly because the interviewed women have had little support in their vulnerable family situations.

Our study showed that women living in vulnerable family situations and who were cared for in the context of the SORGSAM project, evaluated the early postpartum home-based midwifery care as a relieving and strengthening experience. Midwives not only ensured the mother and child’s postpartum health but also coordinated further care and opened up access to appropriate community-based support services. Mothers described the received care as comprehensive, personal, and reliable, allowing them to better deal with complex family situations. They reported that it eased the burden of social isolation, made it easier to talk about challenges such as fears and violence, and led to de-escalation in situations of tension. They expressed how receiving care resulted in stress reduction, increased resilience, and empowerment and that it enhanced their mothering skills and parental resources.

Our study highlights that the benefits of early home-based midwifery care for women in precarious family situations are rooted in the close and trusting relationship with their midwife, resulting in deep gratitude for this experience. Participating women described their complex life situations and commented in detail on the supportive, comprehensive midwifery care they experienced. They reported that they felt strengthened by the continuous and easily accessible midwifery care during the uncertain phase of the early home transition, in terms of health, as well as social and emotional aspects.

”Midwife presence”, provided them with emotional and material equipment support, and supported them in accessing different community networks. This kind of supporting role by the midwife was described before, as in the study of Johansson in healthy families after early hospital discharge in Sweden [ 21 ], or in a recent Swedish study in families with low socioeconomic status, where the support of midwives was considered reassuring [ 25 ]. In our study, this aspect appeared to be very pronounced. Women expressed the impact of receiving midwifery care by memorable wordings such as “saved my life twice, somehow”, or “otherwise I would be dead”. Women included in the study used metaphors such as “angel” or even “God” to describe the midwives. Similar expressions by postpartum women have also been documented in a recent study in Zurich involving socially disadvantaged women [ 16 ]. These expressions may reflect, on the one hand, the hardships experienced in vulnerable situations and, on the other hand highlighted that support in such situations was perceived as particularly helpful. According to the Swiss study by Grylka-Baeschlin et al., midwives who provided postpartum care evolved into important support persons, and, among women with migration history, in that the midwives became cultural mediators [ 16 ]. Relational continuity has also been described as a crucial part of midwifery care in the review of Dahlberg [ 22 ], and it was linked to improved outcomes [ 23 ]. The high accessibility and reliability of the midwife appeared very central also in the other recent Swiss study [ 16 , 38 ]. The building of trust probably occurred fully only if midwives could be immediately present in the homes of new mothers, recognize situations of psychosocial and emotional emergency, and act as first professional responders. As the mothers in our study reported, bridging to further help systems was a further, crucial part of care, and networking helped prevent social isolation. These findings are in line with those of a Swedish and an Australian study, that reported an increased knowledge of societal and local resources for families [ 26 ], increased access to support services, and improved participation in community networks [ 24 ].

Our findings exemplify that stress in the very first phase of life can be mitigated by early midwifery home care even in very difficult social situations. Mothers described impacts on themselves in terms of calming down, de-escalation of situations, strain relief, and stress reduction. Grylka-Baeschlin et al. found that home-based postpartum care eased the burden on families and reduced stress [ 16 ]. This should, in turn, positively impact mothering skills, the mother-infant relationships, and the further development of the children, as it has been shown, that a high level of parenting stress is associated with a poor dyadic co-regulation between mother and child [ 39 ]. “Midwife presence” seems to be helpful for what is called a “co-regulation in therapeutic processes” resulting in mitigating high-stress levels in the mother [ 40 ], which can be seen as a key factor for preventing/decreasing early chronic stress in the child.

A key finding of our study relates as to how early midwifery home care strengthened self-confidence and resilience, including knowledge and assurance on access to further support services. Women described that they felt to be seen and treated as “a person”, how they became ‘stronger and more courageous’. They furthermore reported increased competencies and knowledge of where to get help, and impressively described increased resilience. These findings postpartum are in line with several studies reporting that home-based early midwifery care had positive effects on parenting and self-confidence [ 21 , 24 , 25 , 26 , 38 ]. The mothers in our study also reported to have more confidence in that they now knew where and how to get the help they needed. It may thus be understood as a prerequisite for the promotion and prevention of mother and child health, including mental health aspects.

Limitations and strengths

The positive picture given by postpartum women may be too optimistic due to a participation bias. Indeed, enormous efforts were needed for the recruitment of participants, and among the 55 eligible families, around half did not react to the study invitation or refused to participate. Ten women had no valid address, and four women had difficulty mastering the German language and this appeared to be too limited to participate in an interview. In particular, no woman could be recruited who was involved in a child welfare issue. Among the participants, six women had a migrant history, thus, migrant women were well represented.

Saturation is usually accepted as the criterion for the number of interviews conducted. Saturation is described to be reached - depending on the research questions and study population - at approximately 12 to 20 interviews, but the basic elements for a thematic ordination are reported to be already identified at six interviews [ 41 ]. Even though the sample was small by using a maximum variety sampling, we have succeeded in mapping the diversity and complexity of care for vulnerable postpartum family situations. The data collection was also quickly adapted to the pandemic measures and was carried out digitally. This actually was a simplified access for women in vulnerable family situations, as they were not burdened by the additionally needed childcare.

Furthermore, the information provided by the interviewed women was very congruent with the information in the midwives’ case documentation [ 35 ]. In these files, psychosocial problems were recorded in approximately 60% of cases, and midwives noted that they could contribute to a more stable situation, by lowering tension, exhaustion, and stress, and they notably documented a positive course in most of the cases. The thematic mapping was conducted by the research team and validated at the stakeholder workshop. Although there was no systematic assessment of the impact on children in our study, the findings suggested that SORGSAM care might influence favorably on children’s well-being as several of the interviewed mothers explicitly reported improved breastfeeding, and two out of the seven interviewed mothers mentioned a decrease in the crying of their children.

In conclusion, our findings are supportive of a potential beneficial effect of postpartum midwifery care for the improvement of resilience and well-being of women in vulnerable family situations. Midwives appear to be important players in early childhood interventions with a comprehensive biopsychosocial approach breaching the interface of medical and psychosocial care. To allow midwives to make full use of their potential, it is necessary to install programs such as SORGSAM, which reimburse midwives for their coordinative services and give them access to a hardship fund enabling them to provide short-term financial support to families in acute need. Investing in midwifery services may be understood as a direct investment in earliest childhood interventions as described by Magistretti Meier [ 42 ] to prevent early chronic stress at early onset. The findings are suggesting that midwifery home care was a “door opener” for interprofessional coordinated early childhood support, strengthened parenting skills and self-confidence, and might alleviate early adverse childhood experiences, potentially reducing health care disparities and improving health equity. However, more studies are needed to quantitatively assess associations of midwifery home care with positive outcomes in mothers, and in particular, to assess and quantify its longer-term effects on the well-being of families, women, and particularly the development of children.

Data Availability

The datasets produced and analyzed in this study are not publicly available due to the confidentiality of the information, especially in a small region like Basel, Switzerland, as this is the only way to ensure the non-identifiability of individuals. Upon reasonable request, the anonymized data are available from the authors.

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Acknowledgements

A thanks goes to Alessia Kiener for her valuable support in the realization of the evaluation. We would also like to thank the participants, especially for their trust despite their emotionally challenging and stressful family situations.

Open access funding provided by University of Basel.

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Bettina Schwind, Elisabeth Zemp, Kristen Jafflin, Anna Späth, Karen Maigetter, Sonja Merten & Elisabeth Kurth

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Contributions

Study conception and design were done by EZ, EK, and BS. MB recruited the participants. BS conducted the qualitative part of the mixed-methods-based SORGSAM evaluation. The results of the thematic analysis were jointly discussed and finalized by BS and EZ through the development of the thematic map. BS and EZ contributed to the subsequent draft. All authors read and approved the final manuscript.

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Correspondence to Bettina Schwind .

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Competing interests.

EK has a part-time position as the managing director and MB is a part-time co-worker of the Midwifery Association “Familystart” located in Basel. The authors BS, EZ, KJ, AS, KM, and SM declare that they have no competing interests. The Swiss Tropical and Public Health Institute was commissioned to evaluate the SORGSAM project.

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Ethical approval, including an amendment due to the COVID pandemic, was obtained by the Northwest Switzerland Ethics Committee (BASEC 2019–02030). All methods were carried out in accordance with relevant guidelines and regulations. Written informed consent was obtained from all participants of the study.

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: Interview guide with women experiencing vulnerable family situation postpartum at home

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Schwind, B., Zemp, E., Jafflin, K. et al. “But at home, with the midwife, you are a person”: experiences and impact of a new early postpartum home-based midwifery care model in the view of women in vulnerable family situations. BMC Health Serv Res 23 , 375 (2023). https://doi.org/10.1186/s12913-023-09352-4

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DOI : https://doi.org/10.1186/s12913-023-09352-4

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What does a midwife do and other FAQs

Read time 6 minutes

They’ll be one of the most important people in your life for nine months (and beyond). So here’s what you need to know about your midwife’s role.

What is a midwife?

A midwife is a health professional (male or female) who supports women through pregnancy, labour, birth and the early days of parenthood (MIDIRS, 2017) . They will see you through scans, tests and welcoming your baby into the world.

What does a midwife do?

A midwife can be based in hospital, in a community setting like a midwife-led unit or a doctor’s surgery, or they can visit you at home (MIDIRS, 2017) . Community midwives will monitor you during your pregnancy, give advice and arrange access to any medical care you need.

For the birth, a hospital midwife will support and guide you and help you to get medical support if you need it. After your baby is born, a community midwife will be around to help you feed and care for your baby. That is, until you’re ready to say goodbye to them and switch over to a health visitor.

Do I have to see my GP for a referral to a midwife?

No, it’s much simpler than that – you can go directly to a midwife for your antenatal care (NICE, 2008) . Your GP practice or health centre can give you contact details for an NHS midwife. Your local NHS Hospital Trust website might also contain NHS midwives’ contact details.

"You don’t have to see a GP or an obstetrician while you’re pregnant or giving birth if you’d prefer not to, as long there are no complications (NICE, 2008) ."

Can I choose a private midwife, rather than NHS?

Of course, if you’re happy to pay. Independent midwives work for themselves so they charge for their services (IMUK, 2014a) .

If you opt for this route the same midwife – possibly with a colleague – will care for you throughout. This can improve a woman’s chance of achieving the kind of birth she is aiming for (IMUK, 2014b) . Independent midwives are often very experienced in more complicated births, such as vaginal breech, twin, and after caesarean (VBAC ) births too (IMUK, 2014b) .

Many women who choose indpendent midwives plump for a home birth but it’s not restricted: you are still able to access NHS care if it’s needed (IMUK, 2014c) . Find out how to access an independent midwife at IMUK  or the Positive Birth Movement  or go for a personal recommendation from a friend.

Is a doula the same as a midwife?

No. You might have heard mention of doulas but have never been quite sure how they’re different from midwives. The main distinction is that they are not acting medically but as a person who supports you during labour, birth and postnatally (Doula UK, 2017) .

What happens at my midwife appointments?

If this is your first baby you’ll probably have 10 appointments, but if you already have children it will likely drop down to seven (NICE, 2008) . You might have extra appointments if you see a specialist; if so, this should be written in your maternity notes that you’ll get at your ‘booking’ (first) appointment (NICE, 2008) . Here’s what to expect:

• You’ll have your ‘booking’ appointment between eight to 12 weeks of pregnancy.
• At each appointment, you’ll have specific topics to talk through. This will include things like which screening and antenatal tests are available, your lifestyle or what type of birth you’d like. You’ll always be given the chance to ask questions.
• At every appointment, your midwife will ask permission to take your blood pressure and check your urine for glucose and protein.
• Your midwife will feel your tummy to see how your baby is growing, and listen to your baby’s heartbeat. Towards the end of your pregnancy, they’ll also ask about their activity and check which position your baby is in.

(NHS, 2015)

Do I call my midwife when I go into labour?

The process on the big day varies throughout the country, so talk to your midwife about what happens in your area. Your local NHS Hospital Trust  might also provide details. Some areas have a single telephone number to call when you’re in labour, where you speak to a midwife and discuss what to do.

Whether you’re having your baby at home, a midwife-led unit or an obstetric unit, the midwife will support you and liaise with medical staff if needed (NICE, 2014) . Straight after the birth, your midwife will check you both over and offer help with feeding and stitches if needed. They might also refer you on to further medical support if you need it (NICE, 2006, 2014) .

Will I see the midwife after my baby is born?

Technically, your midwife will continue to support you for six to eight weeks  after you welcome your baby into the world and will also make sure you’re both adjusting well (Raynor, 2017) . If you’re doing ok though, you’re more likely to move over to the care of a health visitor around day ten. Check your maternity notes or ask your midwife to find out how and when the transition works in your area.

This page was last reviewed in September 2017.

Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.

We also offer  antenatal courses  which are a great way to find out more about having a baby, labour and life with a new child.

For more information on everything that midwives do, check out the Nursing and Midwifery Council  or the Royal College of Midwives

Doula UK (2017) About doulas. Available at: https://doula.org.uk/about-doulas/ [Accessed 12th September 2017].

IMUK (2014a) FAQs. http://www.imuk.org.uk/professionals/faqs/#about [Accessed 6th September 2017].

IMUK (2014b) What we do. http://www.imuk.org.uk/families/what-we-do/ [Accessed 6th September 2017].

IMUK (2014c) Hospital birth and NHS care. http://www.imuk.org.uk/families/faqs/#hospital [Accessed 12th September 2017].

MIDIRS (2017) Definition of the midwife. https://www.midirs.org/how-to-become-a-midwife/definition-midwife/ [Accessed 10th August 2017].

NHS (2015) Your antenatal care. Available at: http://www.nhs.uk/Conditions/pregnancy-and-baby/pages/antenatal-midwife… [Accessed 10th August 2017].

NICE (2006) Postnatal care up to 8 weeks after birth CG37. https://www.nice.org.uk/guidance/cg37 [Accessed 6th September 2017].

NICE (2008) Antenatal care for uncomplicated pregnancies. https://www.nice.org.uk/guidance/cg62 [Accessed 10th August 2017].

NICE (2014) Intrapartum care for healthy women and babies CG 190 https://www.nice.org.uk/guidance/cg190 [Accessed 6th September 2017].

Raynor MD (2017) Myles survival guide to midwifery Ebook. Available at: https://books.google.co.uk/books [Accessed 12th September 2017].

Further reading

Department of Health (2014) Independent midwives: insurance options outlined. Available at: https://www.gov.uk/government/news/independent-midwives-insurance-optio… [Accessed 6th September 2017].

MIDIRS (2017) Midwifery education: academic and clinical course content. Available at: https://www.midirs.org/how-to-become-a-midwife/midwifery-education-acad… [Accessed 6th September 2017].

NMC (2015) The Code. Available at: https://www.nmc.org.uk/standards/code/ [Accessed 6th September 2017].

NMC (2017) Standards for competence for registered midwives. Available at: https://www.nmc.org.uk/globalassets/sitedocuments/standards/nmc-standar… 6th September 2017].

RCM (2018) Independent midwives FAQs. Available at: https://www.rcm.org.uk/content/independent-midwives-faqa [Accessed 5th March 2018].

Information you can trust from NCT

When it comes to content, our aim is simple: every parent should have access to information they can trust.

All of our articles have been thoroughly researched and are based on the latest evidence from reputable and robust sources. We create our articles with NCT antenatal teachers, postnatal leaders and breastfeeding counsellors, as well as academics and representatives from relevant organisations and charities.

Read more about our editorial review process .

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Your first midwife appointment

As soon as you find out you are pregnant, contact a GP or midwife and they will help you book your first appointment.

Your first midwife appointment (also called the booking appointment) should happen before you're 10 weeks pregnant. This is because you'll be offered some tests that should be done before 10 weeks.

If you're more than 10 weeks pregnant and have not seen a GP or midwife, contact a GP or midwife as soon as possible.

You'll still have your first midwife appointment and start your NHS pregnancy journey.

Where the first appointment happens

Your first appointment may take place in:

• a GP surgery
• a Children's Centre

Where the appointment happens depends on the pregnancy services in your area.

How long the appointment lasts

The appointment usually takes around an hour.

What your midwife may ask

Your midwife will ask some questions to help find out what care you need.

They may ask about:

• where you live and who you live with
• the baby's father
• any other pregnancies or children
• smoking, alcohol and drug use
• your physical and mental health, and any issues or treatment you've had
• any health issues in your family
• domestic abuse
• female genital mutilation (FGM)
• your job, if you have one
• whether you have people around to help and support you, for example a partner or family members

The first appointment is a chance to tell your midwife if you need help or are worried about anything that might affect your pregnancy. This could include domestic abuse or violence, sexual abuse, or female genital mutilation (FGM) .

FGM can cause problems during labour and birth. It's important you tell your midwife or doctor if this has happened to you.

Tests at your first appointment

Your midwife will ask if they can:

• measure your height and weight, and work out your body mass index (BMI)
• measure your blood pressure and test your urine for signs of pre-eclampsia
• take blood tests to check your general health and blood group, and to see if you have HIV, syphilis or hepatitis B

They'll also offer you a blood test for sickle cell and thalassaemia (blood disorders that can be passed on to the baby) if they think there's a high chance you might have them. They'll work out your chance by asking some questions.

Things your midwife may discuss with you

Your midwife may give you information about:

• how the baby develops during pregnancy
• a healthy pregnancy diet and foods to avoid in pregnancy
• pregnancy exercise and pelvic floor exercises
• your NHS pregnancy (antenatal) care
• breastfeeding
• antenatal classes
• benefits you can get when you're pregnant, such as free prescriptions and free dental care
• your options for where to have your baby
• the tests and scans you'll be offered in pregnancy

Ask questions if you want to know more or do not understand something.

Your maternity notes

At the end of the first appointment, your midwife will give you your maternity notes. The notes may be digital in an app or website or written down in a book or folder.

These notes are a record of your health, appointments and test results in pregnancy. They also have useful phone numbers, for example your maternity unit or midwife team.

You should have these notes with you all the time until you have your baby. This is so healthcare staff can read about your pregnancy health if you need urgent medical care.

Page last reviewed: 22 September 2022 Next review due: 22 September 2025

Women's experiences of home visits by midwives in the early postnatal period

Affiliations.

• 1 St. Olavs University Hospital, Department of Women's Health, Olav Kyrres gt. 17, 7006 Trondheim, Norway. Electronic address: [email protected].
• 2 Department of Nursing Science and Center for Health Promotion Research, Norwegian University of Science and Technology, Trondheim, Norway.
• 3 Department of Nursing Science, Midwifery Education, Faculty of Health and Social Science, Norwegian University of Science and Technology, Trondheim, Norway.
• PMID: 27321721
• DOI: 10.1016/j.midw.2016.05.003

Objective: The aim of the present study is to gain a deeper understanding of women's experiences of midwifery care in connection with home visits during the early postnatal period.

Research design/setting: A qualitative approach was chosen for data collection, and the data presented are based on six focus group interviews (n: 24). The women were both primiparous and multiparous, aged 22-37, and lived with their partners. All participants had given birth at a maternity unit responsible for about 4000 births a year. The transcribed interviews were analysed through systematic text condensation.

Findings: The findings are reflected in three main themes: 'The importance of relational continuity', 'The importance of a postpartum talk' and 'Vulnerability in the early postnatal period'. When the woman had a personal relationship with the midwife responsible for the home visit she experienced predictability, availability and confidence. The women wanted recognition and time to talk about their birth experience. They also felt vulnerable in their maternal role in the early postnatal period and the start of the breast-feeding process.

Conclusions: It is important to promote relational continuity models of midwifery care to address the emotional aspects of the postnatal period. Women generally wish to discuss their birth experience, preferably with the midwife who was present during the birth. Due to the short duration of postnatal care in hospitals, the visit from the midwife a few days after childbirth becomes all the more important.

Keywords: Continuity of care; Home visit; Postnatal care; Postpartum talk.

Copyright © 2016 Elsevier Ltd. All rights reserved.

• Focus Groups
• House Calls*
• Midwifery / standards*
• Mothers / psychology*
• Patient Satisfaction*
• Postnatal Care / standards*
• Qualitative Research

Ready Steady Baby

Home visits.

You should be visited several times by your midwife or family nurse at home during the first 10 days. Friends and family will want to visit to meet your baby too.

It’s OK to ask visitors to:

• call you first and to sometimes say no
• help with other things so you can have a rest or spend time with your baby

Extra support

Some new parents need more support than others. You’ll get extra support from your midwife, family nurse or other health professionals if your baby:

• was born early
• spent time in special or intensive care
• has additional needs

Tests and checks

During the first 10 days your midwife will:

• weigh your baby
• do a newborn blood spot test if you agree

You’ll also need to register your baby with a GP

More about newborn blood spot tests

Your health visitor

A health visitor’s a registered nurse or midwife who’s done further study in public health nursing.

Your health visitor will:

• take over from your midwife when your baby’s 11 days old
• get to know you and your baby
• ensure you get all the help and support you need as your baby grows

Your baby’s named person

In Scotland, the aim is that every child, young person and their parents have a `named person’ who is a clear and safe point of contact to seek support and advice about any aspect of your child’s wellbeing.

From when your child is born until they start school, your named person is your health visitor.

Your baby’s named person will:

• be a good person for you to ask for information or advice about being a parent
• talk to about any worries
• support you to look after yourself and your baby

They can also:

• put you in contact with other community professionals or services
• help you make the best choices for you and your family

The Red Book

You’ll be given a personal child health record called the Red Book. You can use it to record information about your baby’s growth, development, tests and immunisations.

Keep it safe and take it to any appointments you have with a healthcare professional.

The family nurse

Family nurses offer the Family Nurse Partnership (FNP) programme to young, first-time parents from early in their pregnancy until their child’s 2 years old. This program is available to first-time parents under the age of 20.

The programme includes home visits from a family nurse while you’re pregnant, and after your baby’s born. These visits help:

• to have a healthy pregnancy
• you and your baby grow and develop together
• you to be the best parent you can be.

Your health visitor will take over from your family nurse when your baby is two until they go to school.

The Scottish Government has more information about Family Nurse Partnership

Translations and alternative formats of this information are available from Public Health Scotland .

If you need a different language or format, please contact [email protected].

• Ready Steady Baby leaflet in Arabic, Polish, Simplified Chinese (Mandarin) and Ukrainian
• Ready Steady Baby leaflet in English (Easy Read)

Source: Public Health Scotland - Opens in new browser window

Last updated: 19 December 2023

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Pregnancy, birth and baby in Southern NSW

We provide various ways for you to receive maternity care, offering options for both before and after your baby is born.

Book your first appointment

To book your initial pregnancy care appointment with Southern NSW LHD Maternity Services fill out our online booking form or contact us  via telephone.

About our services

Pregnancy and birth are normal life events, and our aim is to promote a nurturing environment for all women and their families. Our focus is on providing women and their families a healthy and positive experience during the pregnancy, birth, and early parenting journey.

Each pregnancy is a unique experience, and we believe that women are the decision-makers in their care. We are committed to providing care that is tailored to your individual needs.

Some pregnant women may need to have additional specialised care in a larger health facility during their pregnancy, however, in most cases, the care can be shared with your local maternity service. It’s important to contact your local service so the midwives can get to know you and work with you so that you and your baby receive the best care in the right place and at the right time.

Pregnancy care

Begin your journey into pregnancy with comprehensive care, which includes assistance in scheduling, initial check-ups, thorough baby scans, and the chance to familiarise yourself with your chosen maternity service.

Southern NSW LHD Maternity Services are here to help you through your pregnancy, childbirth, and after giving birth.

We suggest that women come for their initial appointment before reaching 14 weeks of pregnancy. This allows us to plan and provide the best care for you and your baby/babies. Your partner or support person, midwife, and obstetric team will also be involved in planning your pregnancy care.

How to register and book an appointment

Once we receive your online booking form, we'll email you and get in touch to arrange your pregnancy care appointments. Feel free to attach any pathology results or ultrasounds to the online booking form, or you can bring them to your first pregnancy care appointment.

Most maternity services in Southern NSW LHD follow a shared model of care with midwives and GP obstetricians. Your local Maternity Service will be happy to talk about their care model and provide more information. 

All maternity services in Southern NSW LHD are  Level 3 maternity units (PDF 148.66KB) (PDF 148.66KB)  with  Level 2 nurseries (PDF 152.43KB) (PDF 152.43KB) .

If you live in the ACT, you can give birth in a Southern NSW LHD maternity service.

Your maternity service will get in touch with you to schedule your first antenatal (before birth) visit once they receive your registration.

During this visit, your Midwife will talk to you about your overall health and ask questions about your current and past pregnancies. Please bring any recent pathology or ultrasound reports with you.

Your Midwife will start your "hand-held" pregnancy record, go over routine antenatal tests and screenings, and discuss any potential risk factors. Together with you and your partner, they'll plan your antenatal care.

If needed, your Midwife will talk about referrals to other healthcare clinicians. In case any risk factors or complications arise, additional consultations may be required, and there might be a possibility of transferring to a higher-level facility for ongoing care. However, in general, most women should be able to receive the majority of their antenatal care at their chosen Maternity Service.

In the Southern NSW we provide all women with a screening ultrasound around 18 to 22 weeks into their pregnancy. This ultrasound takes a close look at your cervix, baby, and placenta to ensure your baby's proper development.

Understanding morphology ultrasound

This screening scan checks for the following:

• the number of babies
• the position of the placenta and the umbilical cord
• the amount of fluid around the baby
• the length of your cervix and whether it is closed
• the size of your baby – the sonographer will measure the baby's organs and body parts
• structural abnormalities of the baby, such as issues with the baby's bones or internal organs.

You can inquire about your baby's gender but note it may not be 100% accurate.

Abnormalities

While most pregnancies are normal, 2 to 3% may have issues. Ultrasound is effective for major problems but not for all abnormalities, such as cerebral palsy, autism, or some heart defects.

Preparation

Wear comfortable clothing, keep your bladder comfortably full, and bring previous scans. Your partner can attend.

During the scan

• takes 30 to 60 minutes
• lie on the examination bed with a warm gel applied
• sonographer uses a flat probe on your abdomen
• they may not talk continuously as they concentrate on scanning
• a doctor might review routine scans.

Internal scans

Usually, abdominal scans are sufficient. If needed, a transvaginal scan may be offered, and you can decline or take time to decide.

Abnormal findings

Discuss with the doctor. Additional scans may be needed. More significant findings may lead to a referral to the Fetal Medicine Unit.

Sent to your doctor and birthing hospital within 5 business days. Discuss results in person with your care team for clarity and questions.

Take a look at these video introductions for your local Maternity Service in Southern NSW LHD. You can contact each service directly if you have any questions or would like to come in and visit.

Virtual tour of the Queanbeyan maternity ward and antenatal clinic. 

Queanbeyan maternity guide

Batemans bay.

Virtual tour of the Batemans Bay antenatal clinic.

Batemans Bay maternity guide

Virtual tour of the Moruya Hospital Maternity ward.

Moruya maternity guide

Virtual tour of the Narooma Community Health Centre Antenatal clinic.

Narooma maternity guide

Community midwife.

Information on the Travelling Community Midwife program.

Travelling midwifery information

Next steps - batemans bay.

Advice on what you should do next if having a baby in Batemans Bay.

Pregnancy next steps Batemans Bay

Next steps - moruya.

Advice on what you should do next if having a baby in Moruya.

Pregnancy next steps Moruya

Health and wellness during pregnancy.

Take care of yourself during pregnancy. Learn when to contact maternity services, deal with nausea, including hyperemesis gravidarum, and discover how a doula can support you.

You should contact us immediately if you are experiencing the following in pregnancy:

• your baby stops moving or you are experiencing reduced movements
• trauma to the abdomen, assault, serious fall or car accident
• vaginal bleeding at any time
• sharp pains in the abdomen with or without vaginal bleeding
• your waters break or if you have a constant clear watery vaginal discharge
• fever or chills, temperature over 37.8 degrees
• severe nausea and persistent vomiting
• recurring and persistent headaches
• blurred vision or spots before your eyes
• pain or burning on passing urine
• contractions at any time before 37 weeks
• sudden swelling of the face, hands or feet
• persistently itchy skin, especially hands and feet
• labour has started and you feel it is time to come to hospital
• booked Caesarean birth and labour commences.

Have you ever experienced severe morning sickness during pregnancy?

Hyperemesis gravidarum (intense nausea and vomiting), can make it difficult for pregnant women to eat, drink, and manage daily tasks. Without treatment, it can lead to dehydration, weight loss, anxiety, depression, and other serious complications. It's more than typical morning sickness. Did you know it's the most common reason pregnant women are hospitalised early in pregnancy? Many are unaware of its impact on pregnant women, their babies, and families. It can be debilitating, isolating, and frightening.

You're not alone. We're here to help.

If you have questions or need more information, ask at your next pregnancy visit. We aim to provide consistent, integrated, and continuous care that's culturally appropriate, supportive, and respectful.

Learn more about hyperemesis gravidarum .

Labour and birth preparation

Prepare for labour and birth by discovering what to pack in your hospital bag, understanding how labour can begin, learning about special delivery procedures, and exploring various methods to manage pain during childbirth.

• antenatal card
• loose comfortable clothing
• maternity pads
• phone charger
• snacks for labour.
• formula, bottles, teats and sterilisation equipment if you are choosing to formula feed.

Hand hygiene

Help us prevent infection by following the hand hygiene rules:

• sanitise hands upon entering hospital
• sanitise hands upon entering rooms
• sanitise hands upon exiting rooms.

Safe environment

Ensuring a safe and friendly space for our patients, visitors, and staff is our top priority. We do not tolerate any actions that put the safety and well-being of mothers, babies, or staff at risk.

Understanding induction of labour

Labour usually starts naturally between 37 and 42 weeks of pregnancy when the uterus has regular strong contractions that open the cervix, letting the baby pass down the vagina for birth. Sometimes, this doesn't happen, or there's a need to bring on labour before it starts naturally, called Induction of Labour.

Inducing labour often involves using medication (oxytocin in an Intravenous drip) along with breaking the waters in front of the baby's head (artificial rupture of membranes or ARM). This happens in the Maternity Unit birth suite.

If your cervix is ready for birth, ARM/oxytocin might be enough to start labour.

However, in many cases, there's a need for treatment the day before the induction to soften and open the cervix. This process, known as Cervical Ripening, makes the induction more successful and shortens the labour.

The usual way to ripen the cervix is by inserting a small, soft Foley catheter balloon into your cervix, causing the release of a natural hormone called prostaglandin.

Another option is to use a synthetic prostaglandin like Prostin Gel or a prostaglandin pessary (Cervadil) inserted into your vagina. Your GP, Obstetrician, and Midwife will discuss with you which method is better for you and your baby.

Monitoring your baby

Before and after inserting the balloon catheter or Prostin Gel/pessary, we'll check your baby's heartbeat with a cardiotocograph (CTG) to ensure everything is okay.

Once oxytocin is started with an intravenous drip, your baby's heartbeat will be continuously monitored during labour with a CTG.

We have wireless CTG monitoring, allowing you to be upright and mobile during labour if you choose.

For more information on Induction of Labour, please speak to your Midwife and GP Obstetrician.

Planned caesarean – meeting with the anaesthetist before the operation

If your baby is going to be born through a planned caesarean section, you'll have an appointment to visit the hospital and talk to an anaesthetist. This usually happens a week or two before the operation, and the anaesthetist will discuss the choices for your anaesthetic.

During this visit, you can ask questions about the operation, your hospital care, and receive instructions on when to stop eating and drinking before the procedure.

For a planned caesarean, you'll be admitted to the hospital on the day of your operation, specifically to the Maternity Unit, where you'll get ready to go to the Operating Theatre.

Anaesthetic options for a planned caesarean

In the operating room, before the surgery begins, an intravenous drip will be placed in your arm if you don't already have one.

Epidural or spinal anaesthetic

This is a local anaesthetic inserted into your lower back to numb the pain during surgery, allowing you to be awake. It's the most common and generally the safest option. With this choice, one person (your partner or support person) can accompany you into the operating theatre.

General anaesthetic

General anaesthetic involves being in a deep sleep throughout the procedure. While less common for a caesarean, it might be the better option in some cases. For safety reasons, your partner or support person is not allowed in the operating room. Your baby will be taken to your partner, and your midwife will stay with them until you wake up to see your baby.

When baby is born with epidural or spinal anaesthetic

Once everything is ready, the obstetrician will start the operation. If you're awake, you might feel some mild pressure as your baby is lifted out of your uterus. Your baby will be dried off and usually brought to you. Occasionally, some babies may need a bit of help getting used to breathing in air, which could delay contact with you for a few minutes.

With a planned caesarean, we aim to keep you and your baby together during the rest of the operation and in the theatre recovery room afterward. This allows for skin-to-skin contact and, if you've chosen to breastfeed, the possibility of the first breastfeed soon after birth.

Your midwife will stay with you and your baby in the operating theatre and recovery room to assist with care and breastfeeding.

After the operation, you'll spend a brief time in the recovery room before returning to your room in Maternity.

If an emergency caesarean section is needed

In most cases of an unplanned or emergency caesarean section, it will still be done under an epidural or spinal anaesthetic, and your partner will be present in the operating theatre. Additional doctors may be present based on the reason for the emergency caesarean. Efforts will be made to keep you and your baby together, but if additional care is needed, your partner will be encouraged to stay with your baby in such situations.

At Southern NSW LHD, you can decide to go through labour and give birth in water if it's deemed safe for both you and your baby. Use the details below to chat with your midwife or doctor, aiming for a positive experience.

Benefits of water immersion

Using water during labour and birth can offer you added comfort, mobility, and privacy. Evidence suggests that in uncomplicated labours:

• less need for pain-relief drugs, especially epidural analgesia
• increased relaxation and lower perceived pain levels
• fewer medical interventions for slow progress in the first stage of labour
• greater sense of control during labour.

If you have questions or want to understand our procedure for water immersion during labour and birth, talk to your midwife or doctor.

We have water immersion at certain times

Maternity services in Southern NSW LHD consider the following criteria before offering water immersion during labour:

• healthy with no pregnancy complications
• only one baby in a head-down position (not twins)
• at least 37 weeks pregnant
• no infections that may affect your baby
• able to enter and leave the bath with minimal assistance
• no use of injected pain relief in the previous four hours
• pre-pregnancy Body mass index (BMI) less than 40 for safety reasons.

It's not advisable to have water immersion in certain situations

Your midwife or doctor may advise you to leave the bath during labour in certain circumstances, including:

• concerns for your well-being (bleeding, high temperature, feeling faint or unwell)
• concerns for your baby's well-being (changes to heart rate, meconium, or blood-stained amniotic fluid when waters break)
• abnormal progress in labour; a period out of the water with walking may help contractions strengthen and progress.

Considerations when choosing water

• have support with you at all times, and assistance when entering and leaving the bath to prevent injury
• bathwater should be free from additives like oils, gels, and soap
• water temperature can be adjusted for your comfort
• stay hydrated during labour
• ensure the water level is deep enough for your body to be fully submerged at breast level when seated or kneeling
• nitrous oxide gas can be used in the bath if you choose
• gently guide your baby to the water's surface
• you can leave the bath at any time.

More information

For more details or to review our procedure for water immersion during labour and birth, talk to your midwife or doctor.

Information about epidurals to help you decide if you want one for the birth of your baby

You don't have to make a decision now. When you're admitted to the hospital, a midwife or anaesthetist will be available if you want to discuss it further.

Pain relief in labour

Every labour and birth is unique, and everyone experiences pain differently. Until you're in the midst of childbirth, you may not know how you'll cope or what will work best for you.

Your ' Having a Baby ' book, especially pages 70 to 83, contains helpful information about labour and birth, given to you by your midwife. We suggest reading it to prepare for the birth and discussing any questions with your midwife or doctor.

Various methods can help you cope with pain in labour, including staying active, changing positions, breathing techniques, water immersion (bath or shower), complementary therapies like hypnotherapy, reflexology, massage, and aromatherapy, subcutaneous sterile water injections, TENS (transcutaneous electrical nerve stimulation), Nitrous Oxide (gas and air), opioid analgesia (morphine), and epidural analgesia.

This information focuses on epidural analgesia.

If you have questions, talk to your midwife or doctor, who can arrange for you to speak with an anaesthetist. You can also request to talk to the Maternity Unit Manager at your birthing hospital. You have the right to an interpreter; please ask staff to arrange this service for you.

Frequently asked questions

What is an epidural.

Epidurals are a common way to relieve pain during childbirth. They're administered by an anaesthetist, a doctor trained to manage pain and care for patients during surgery, including caesarean sections.

Facts about epidurals

Epidurals are the most effective pain relief during childbirth. The anaesthetist inserts a small plastic tube (epidural catheter) in your lower back near spine nerves, staying in place for continuous pain medication. This can include local anaesthetic to numb nerves, small opioid doses, or a mix.

An epidural shouldn't make you feel drowsy or sick. However, it increases the chance of needing tools like a ventouse or forceps during birth, raising the risk of perineal damage for the mother and injury for the baby.

You can top up an epidural for added pain relief during procedures like ventouse, forceps, or a caesarean section. If a caesarean is needed and you don't have an epidural, the anaesthetist typically uses a spinal anaesthetic, similar to an epidural feeling.

Can everyone have an epidural?

Most people can get an epidural, but some health issues (like spina bifida, prior back surgery, or clotting problems) may make it unsuitable. It's best to know this before labour. If your labour is complicated, your midwife or obstetrician might suggest an epidural for you or your baby's benefit.

If you're overweight, placing an epidural may be trickier and take longer.

Epidurals don't harm your baby or increase the chance of emergency caesarean section.

For pain relief during labour and birth, epidurals are more effective than tablets, Nitrous Oxide gas, or injections.

What is the procedure for putting in an epidural?

First, a plastic tube (cannula) goes into a vein in your hand or arm, and a 'drip' (intravenous fluid) usually runs. During labour, you might have a drip for medication or if you're feeling sick.

Your midwife will guide you to lie on your side or sit bending forward. The anaesthetist will clean your back with an antiseptic.

Local anaesthetic is injected into your skin to numb it before placing the epidural catheter near your spine nerves. The anaesthetist must be cautious to avoid piercing the fluid bag around your spinal cord to prevent headaches.

Stay still while the anaesthetist inserts the epidural, but after securing the catheter with tape, you can move freely.

Once the catheter is in place, medication is delivered through a pump from a fluid bag. You might receive a handset to request additional doses, giving you control over pain relief with a safety lockout to prevent accidental overuse.

How long does it usually take for an epidural to work?

Setting up the epidural typically takes around 20 minutes, and it provides pain relief after another 20 minutes.

While it's taking effect, your midwife will regularly check your blood pressure. The anaesthetist ensures the medication works on the right nerves by applying ice to your tummy and legs, asking you about the cold sensation.

In some cases (about 10 to 15%), the epidural might not work well, and adjustments or reinsertion of the catheter by the anaesthetist may be necessary.

Are there any problems associated with having an epidural?

Your blood pressure may drop, making you feel light-headed or nauseated. We'll monitor your blood pressure regularly.

You might need to stay in bed as your legs could feel heavy and numb. The epidural may also remove the urge to urinate, and a catheter will be used.

You may experience shivering, fever, or itching.

The epidural may not always fully relieve pain. If uncomfortable, the anaesthetist might use more local anaesthetic, and occasionally, the epidural may need replacement.

In rare cases (less than 1 in 100), severe headaches may follow an epidural, but they can be treated.

• hyperemesis gravidarum is the same as morning sickness
• you're exaggerating
• my mum had it and is fine
• it can't be that bad
• you're weak; toughen up.

Hyperemesis gravidarum significantly affects women's physical and mental well-being. If you take one thing from this, know you don't have to endure it alone. Your struggle is tough, and you deserve supportive care and treatment.

What are the risks of an epidural?

How could an epidural be used to keep me comfortable during a caesarean section.

If you require a caesarean section, an epidural is often chosen over a general anaesthetic.

A potent local anaesthetic is injected into the epidural catheter, numbing the lower half of your body for the operation. This is safer for you and your baby compared to a general anaesthetic.

In rare cases (1 in 20 people), the epidural may not work sufficiently for a caesarean section. In such instances, another anaesthetic like a spinal or general anaesthetic may be necessary.

Consent for an epidural

NSW Health requires written consent before inserting an epidural. Understanding your pain relief choices, weighing the benefits and risks of an epidural is crucial. Please read this information and ask questions early.

While there are occasions when an obstetrician may recommend an epidural, each woman can make her own decision. If you choose an epidural, you'll sign a consent form before having it. As you may be focused on labour, in pain, or have taken pain-relieving drugs, sign and date below to confirm you received and read this info.

The anaesthetist will repeat this information verbally if you opt for an epidural during labour. Remember, the anaesthetist can answer any remaining questions during consent, but you might be distracted by pain or sedating drugs.

If you need an interpreter

Professional interpreters are available if you need help to communicate with staff. Please ask our team who can make this booking for you. The service is free and confidential. 

This information is for women who choose to go home after assessment, especially when their waters break before labour, and they don't want or need to stay in the hospital.

About 70% of women will start labour within 24 hours after their waters break.

Before you go home and wait for labour, we need to make sure:

• your baby is positioned head down
• you show no signs of infection
• you have a reliable way to get back to the hospital quickly if needed.

When you're home, take some basic precautions and know when to call and come in:

• check your temperature every 4 hours during the day
• if your temperature is 37.5 degrees or higher, contact your midwife or maternity ward
• use a sanitary pad and change it at least every 4 hours during the day
• normally, the colour of the water (amniotic fluid) is clear. If it changes to green, yellow, or blood-stained, contact your midwife or maternity ward
• if your baby moves less than usual, contact your midwife or maternity ward
• if you have regular, painful contractions, contact your midwife or maternity ward
• if you feel concerned for any reason or unwell, contact your midwife or maternity ward.

In case any of these things happen, you'll be asked to come to the hospital for review.

How you can reduce the chance of infection and help your body prepare for labour

• rest, eat, and drink normally
• take a bath or shower if you want to
• wash your hands carefully before and after using the toilet or changing your pad
• change your pad regularly
• avoid sexual intercourse
• don't go swimming
• avoid using tampons.

The Southern NSW LHD recommends inducing your labour if it hasn't started within 24 hours of your waters breaking.

If you're concerned or have questions at any time, please contact your midwife or maternity ward.

Southern NSW LHD supports your decision to hire a doula for emotional and physical support during labour.

A doula is an experienced companion who understands the needs of a woman and her family during pregnancy, birth, and the postnatal period. They provide continuous, non-medical support.

Doulas are not regulated or registered health professionals. Anyone can use the title "doula".

Some doulas undergo a doula course. You can ask about their education and experience. Your doula should share their background, abilities, education, and feedback from previous families.

It's important to clarify the roles of midwives and doulas, especially if the doula has midwifery qualifications. However, a doula cannot act as a midwife, providing clinical advice or tasks.

To avoid confusion:

• bring your doula to antenatal care appointments for information sharing
• develop your birth plan with your midwife or doctor by 36 weeks
• call the hospital or midwife if you think you're in labour.

Your doula is one of your support people in labour but cannot speak for you or make decisions with your doctor or midwife. If you can't communicate in labour, the midwife or doctor will discuss your wishes with your partner or next of kin.

Your doula cannot provide clinical care or advice. For clinical concerns, talk to your midwife or doctor.

If you need a caesarean, only one person can be with you in the operating theatre. Decide beforehand who that person will be.

Your doula, like other visitors, may be asked to leave if the focus is on your safety.

Partners in the hospital

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Most maternity services offer postnatal home visits, but there may be travel limits, such as a 20-to-30-minute travel distance from the service. Discuss this with your midwife.

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• J Glob Health
• v.8(1); 2018 Jun

Postnatal home visitation: Lessons from country programs operating at scale

Robert mcpherson.

1 Save the Children, Washington, D.C., USA

Stephen Hodgins

2 School of Public Health, University of Alberta, Edmonton Clinic Health Academy, Edmonton, Canada

* At the time this paper was first submitted, Dr Hodgins was employed by Save the Children, USA

Associated Data

Newborn mortality remains unacceptably high in many countries. Postnatal home visits (PNHVs) have been endorsed as a strategy for delivery of postnatal care (PNC) to reduce newborn mortality as well as to improve maternal outcomes. This paper reports on a review of coverage-related performance of such programs implemented at scale through government health services in Bangladesh, Ethiopia, Ghana, India, Indonesia, Malawi, Myanmar, Nepal, Pakistan, Rwanda, Sri Lanka and Uganda.

We undertook a multi-country, mixed-method program review and used available survey and administrative data and key informant interviews to characterize performance of postnatal home visitation programs. In results presented in this paper, we have relied primarily on population-based surveys, notably Demographic and Health Surveys and Multi-Indicator Cluster Surveys. In addition, based on key informant interviews, we sought to understand the implementation challenges experienced delivering PNHVs, as well as responses to those challenges, in order to provide useful insights to countries to design home visitation programming when they can meet requirements for effective delivery at scale – and to identify other options when they cannot.

Contact coverage of PNC within 48 hours of birth following home birth (the group most prioritized in these programs) is below 10% in most of the countries reviewed; in no country does it exceed 20%. Most country programs have been unable to achieve PNHV contact coverage that would have any meaningful impact on newborn or maternal mortality. Country responses to disappointing performance have varied: some continued programming unchanged, some suspended attempts to provide PNHVs, and others modified their strategies for providing postnatal care (PNC).

Conclusions

Policymakers and program managers need to consider seriously context and local feasibility when determining whether and how to use a strategy like PNHVs. At the global level, we need more than evidence of effectiveness (as determined through proof-of-concept trials) as a basis for formulating recommendations for how governments should provide services. We must also give serious attention to what can be learned from experience implementing at scale and place greater importance on feasibility of implementation in the real world.

The early postnatal period, particularly over the first hours of life, extending into the first 2-3 days of life is a period of high risk for both mother and newborn. Household practices and care provided by health workers during this period can have an important influence on outcomes. This has always been understood by professionals working in this area and is now receiving increased attention in the global maternal-newborn health community, as reflected in recommendations released by WHO in 2014 [ 1 ].

Important though this period is, it is not straightforward how best to ensure optimal practices and outcomes, particularly in settings where the overwhelming majority of births occur at home, unattended by professional health workers. We are challenged by a question that has not always been adequately considered: what strategy or strategies are likely to be most effective for improving postnatal care, faced by such constraints? This paper focuses specifically on home visitation as a strategy for improving postnatal care, recognizing that over approximately the past decade this has been the approach that has received greatest programmatic effort.

In a series of field trials that began in the mid-1990s and extended over the following decade, investigators demonstrated that in low-income country settings with high newborn mortality, a strategy relying on postnatal home visits (PNHVs) by community health workers (CHW) delivered on specific days with defined content, supported by extensive inputs, could reduce newborn mortality [ 2 , 3 , 4 , 5 ]. On the strength of this evidence, in 2009, WHO and UNICEF issued a joint statement recommending PNHVs for delivery of postnatal care, where appropriate [ 6 ]. For home births, the statement called for visits on days 1 and 3 and a third visit by day 7, if possible. For facility births, the first visit was to take place as soon as possible after returning home. The Joint Statement recommends specific maternal and newborn content, suitable types of health workers, and that postnatal home care by CHWs should be linked to the health system and the full continuum of care to ensure timely and appropriate care for complications. These recommendations have been reaffirmed and further developed in subsequent WHO guidance [ 1 , 7 , 8 , 9 ]. The 2014 WHO recommendations for postnatal care [ 1 ] call for initial postnatal care within 24 hours of birth (whether institutional or home birth), followed by contacts on day 3, between days 7 and 14 and 6 weeks after birth (without specifying where these contacts occur). These recommendations also endorse the practice of home visits over the first week after birth.

Although various proof-of-concept trials have been published [ 2 , 3 , 4 , 5 ], the experience of countries attempting to implement a postnatal home visitation strategy at scale has been less well captured. This paper is intended to help fill that gap.

Subsequent to the 2009 Joint Statement, many countries adopted policies to deliver postnatal home visits. Among the 75 countries included in the Countdown to 2015 report [ 10 ], 59 have policies to deliver such home visits within one week of birth. However considerably fewer have rolled them out at scale. Anecdotal reports suggest that most governments attempting to deliver PNHVs at scale have encountered serious barriers and have not reached coverage levels needed to achieve meaningful reductions in mortality and there is documentation on problems of equitable reach [ 11 ]. These reported difficulties have raised concerns about the feasibility of providing PNHVs at scale under routine program conditions. Responding to this concern, a working group was formed in 2015, with participants from Save the Children’s Saving Newborn Lives program, WHO, UNICEF, USAID, and USAID’s Maternal Child Survival Program (MCSP) and has subsequently provided oversight to a process that was guided by the following objectives: 1) a review of country program experience implementing PNHVs at scale through government health services and 2) the development of guidance intended to inform country-level design decisions on home visitation programming as a component of a broader postnatal care strategy [ 12 ].

We sought to understand the structure of specific programs, their performance, and factors that influence effective implementation, drawing lessons across the various country programs. The methodology used could be characterized as a pragmatic, multi-country, mixed-methods program review. We began by using a structured process to identify study countries and then collected primary qualitative data considered together with secondary quantitative data to develop conclusions and recommendations.

Country programs were selected and studied in two phases. During phase I we consulted global experts to identify countries that have implemented postnatal home visitation programming at scale through government services. Based on their suggestions, we initially identified and screened 14 countries (6 low-income countries, 8 lower-middle-income countries) to confirm that they had implemented such programming. Respondents from each country, who included government policymakers and technical specialists from external development partners, completed a questionnaire (see Appendix 1 in Online Supplementary Document (Online Supplementary Document) ) to describe country implementation of PNHVs. We used this information, supplemented by follow-up phone interviews and document review, to prepare profiles for the eleven countries that had implemented PNHVs at scale: Ethiopia, Ghana, India, Indonesia, Malawi, Myanmar, Nepal, Pakistan, Rwanda, Sri Lanka and Uganda. We also included Bangladesh in our review even though it had not implemented PNHVs at scale and had only just begun a one-district learning project to deliver PNHVs through government health services. The rationale for including Bangladesh was that it had carefully considered issues of feasibility of implementation of PNHVs within the local context over the past decade and only then proceeded to develop and test a public-sector implementation model – an approach that we hoped to learn from.

These twelve countries were then considered for inclusion in phase II using criteria that included evidence of implementation at scale, maturity of implementation, availability of performance data, and diversity criteria (eg, geographic location, implementation models).

Based on these criteria and potential for learning, we selected Bangladesh, Ethiopia, India, Malawi, Nepal and Sri Lanka for inclusion in phase II. During phase II we reviewed their experience implementing PNHVs through country visits, key informant interviews and document review. The process that we followed in identifying, screening and selecting countries for inclusion in our review is described in Figure 1 .

Process for selecting and screening countries during phases I and II. Note: Bangladesh was included in the review in order to better understand how it has proceeded in development of postnatal care (PNC) programming over the past decade.

We collected qualitative data through phone and in-person interviews (see Appendix S2 in Online Supplementary Document (Online Supplementary Document) for an example of a questionnaire), written questionnaires (Appendix S1 in Online Supplementary Document (Online Supplementary Document) ) and document review to understand the development process and structure of home visitation programs and to identify key factors that influenced their performance. Authors of this paper conducted almost all interviews. We interviewed respondents that included policymakers, technical specialists from external development partners, national and district-level government health managers, health providers and clients. We took comprehensive computerized notes during interviews and then reviewed and edited within 24 hours of the interview to maximize accuracy and descriptiveness. Edited interview transcripts were then entered into a database using QDA Miner Lite V2.0 (Provalis Research, Montreal, Canada) where they were coded and analyzed.

Availability of suitable quantitative data describing performance of PNHV programming was an important challenge. Essentially all available data measuring performance at scale focused on estimating contact coverage and did not assess quality of care. The richest, most rigorously collected data were generally only available for comparatively small pilot efforts and therefore not representative of the situation as programs were progressively scaled up and institutionalized. Administrative data were generally problematic with regard to completeness and data quality. So, although we reviewed all such data, in making judgements on overall program performance, we relied most heavily on the most rigorous available secondary quantitative data to assess coverage of PNHVs for both mothers and neonates, including periodic population-based surveys, supplemented by administrative data, and special studies. Most useful were data available from Demographic and Health Surveys (DHS) and Multi-Indicator Cluster Surveys (MICS), although neither gives an altogether adequate picture of PNHV program performance. The most recent version of the DHS questionnaire (version 7) allows for disaggregated analysis of postnatal care by place, provider type and timing of PNC contact. However much less information is available in earlier surveys using version 6 and in the MICS surveys. For the countries included in this review, available DHS data are limited to studies done with version 6.

Data that governments collect on home visitation programs through routine health information systems have other limitations and can be misleading if viewed in isolation, especially when they are also used to calculate performance-based incentives for health workers who provide PNHVs. Given these constraints, to draw conclusions about overall program performance we relied primarily on data from rigorous nationally representative surveys (mainly DHS and MICS).

We used information gathered through methods described above to develop country profiles which were then shared with key stakeholders in each country for their inputs prior to finalization.

The work described in this paper did not involve any individual-level data, apart from interviews with respondents as described above. As a form of program review, it was judged by Save the Children not to be human-subjects research. The review, however, was conducted according to the principles of the Declaration of Helsinki and interviews were conducted after having obtained informed consent.

In addition to the original effectiveness trials cited earlier, the literature documents pilots of home visitation packages in Bangladesh, Malawi, Nepal and Uganda [ 13 , 14 ]. All were designed to deliver multiple home visits during pregnancy in addition to the postnatal period. Despite intensive support, these pilots achieved only low to moderate contact coverage for early postnatal visits. Higher contact coverage was achieved for home visits during pregnancy (see [ 12 ] for more detail on these pilots).

Countries have implemented PNHVs at scale using a variety of visit schedules. Bangladesh is currently testing a model that attempts to ensure a single visit delivered within 48 hours for home births only. In contrast, Accredited Social Health Activist workers (ASHAs) in India are to make home visits on day 1 (for home deliveries) and then on days 3, 7, 14, 21, 28, and 42. Malawi is attempting to provide additional home visits to low birthweight newborns by mandating PNHVs on days 1, 3, and 8 for normal babies and, in addition, days 2 and 14 for low-birthweight babies. Indonesia has a flexible schedule for timing and location of postnatal contacts, which can take place either at home or in a health facility on days 1-2, 3-7, and 8-28.

Contact coverage

In Table 1 and below we provide findings on program performance (in terms of contact coverage) in delivering postnatal care particularly over the first 2 days of life. We focus on home births and PNHVs and present data from countries included in our review for which nationally representative survey data of acceptable rigor were available. All countries except Bangladesh had programs that were attempting to provide PNHVs at scale at the time of the surveys, although intensity of effort and geographic reach varied among and within countries.

National, population-representative data relevant to PNHV coverage (past 2 years, unless otherwise specified)

TBA – traditional birth attendant, CHW – community health worker, PNC – post-natal care, MICS – Multi-Indicator Cluster Surveys, d – days, h – hours

For institutional births, opportunities already exist to provide postnatal care to mothers and newborns before discharge although in most of the settings considered for this review there have been no systematic efforts to take advantage of this contact at scale. For home births, some mothers and babies access early postnatal care through a visit to a health facility. However, many cannot or do not seek facility-based postnatal care following home deliveries, leaving home visitation as a potentially attractive way to make such care available. Postnatal home visitation programs reviewed here attempted to ensure that visits were delivered by CHWs, with emphasis on an initial visit within 48 hours of birth. To varying degrees these programs prioritized home births. Reliable, independent data measuring adherence of home visitation to country-specific visit schedules were unavailable. Likewise, no data were available on the content or quality of services provided during home visits though, clearly, to have impact on health outcomes more than a mere contact is required..

We judged that data from DHS and MICS surveys generally served as a sounder basis for drawing conclusions on home visitation contact coverage than do routine administrative data sources. With the exception of India, data presented in Table 1 are from DHS and MICS. While DHS data derived from the version 6 survey instrument cannot be disaggregated to assess PNC coverage by service site, they can be stratified by timing: within 4 hours and within 4-48 hours following birth. We assume that most PNC reported in DHS that occurred within 4 hours of birth refers to care during labor, delivery and/or immediately post-delivery (ie, part of care at childbirth), and thus does not represent a separate contact for provision of PNC. So from DHS survey data, we classify PNC provided within 4-48 hours following birth as ≤48hr PNC , some of which may be delivered through home visits. DHS data also allows for PNC to be disaggregated by place of birth. Assuming a baby born at home is at least as likely to receive a home visit as one born in a health facility, ≤48hr PNC rates for home births – as measured in DHS – can be considered to represent a maximum possible level of ≤48hr PN home visit contact coverage, although some reported ≤48hr PNC will have been received in a health facility. The MICS survey structures its questions and analysis in a way that allows for differentiation between care provided immediately following birth and PNC provided later in a separate contact. The MICS reporting format also allows for PNC rates to be disaggregated by service site.

From the data on postnatal care presented in Table 1 , we see that:

• In Ethiopia , according to the 2014 Mini-DHS, among the 84% of women who gave birth at home, 1% reported receiving PNC within 2 days of birth. More recent data from organizations supporting the rollout of the Community-Based Newborn Care (CBNC) program estimate PNC contact coverage for mothers within 2 days of birth (home and facility combined) at 10% and 16% in two sub-regions where CBNC has been introduced [ 25 , 26 ]. Coverage for postnatal home visitation within 2 days of birth is probably considerably lower than 16%.
• In Ghana , for the 27% of newborns born at home, PNC coverage within 4-48 hours of birth was 10%. Only 0.2% of newborns born at home were reported to have received ≤48hr PNC from community health officers or community health nurses, the two cadres primarily responsible for providing PNHVs. Most ≤48hr PNC is provided by traditional birth attendants (TBAs) – an untrained cadre in Ghana – or is facility-based. PNHV contact coverage within 48 hours of birth from a trained provider is clearly less than 10%.
• In India , where 1 in 5 births occur at home, 13% of newborns born at home are reported to receive PNC within 24 hours of birth. Available data do not allow for disaggregation between PNC provided within 4 hours (ie, associated with care at childbirth) and PNC provided between 4-48 hours after birth.
• In Indonesia , among the 37% of births occurring at home, 15% of newborns were reported to have received PNC within 4-48 hours of birth (home plus facility). Most care was provided by midwives, the cadre responsible for conducting home visits (although they also provide PNC in facilities). These data suggest that coverage of PNHVs within 48 hours of birth is no higher than 15% for home births.
• In Malawi , where 1 in 10 births occur at home, 14% of newborns born at home and 11% of all newborns received a PNC visit not associated with a health check following delivery within 2 days of birth. Most of this PNC was provided at a health facility. These data suggest a PNHV coverage rate within 48 hours of birth in the low single digits.
• In Myanmar , 63% of births occur at home. Among newborns born at home, 17% received PNC over the period 4-48 hours after birth. Much of this care appears to be provided by TBAs, some of whom may have been trained to provide PNHVs. These data suggest that coverage of PNHVs within 48 hours of birth for newborns born at home is no higher than 17%.
• In Nepal , the 2014 MICS estimated the institutional birth rate at 55% and found that 4% of newborns born at home received PNC within 2 days of birth. Among the 5% of all newborns reported to have received PNC within 1 week of birth, 28% received their first PNC at home. On the basis of these data it appears that a postnatal home visit within 48 hours of birth was a rare event.
• In Pakistan , half of newborns were born at home, only 3% of whom received PNC within 4-48 hours of birth (at any site). Lady health workers, the government cadre nominally responsible for conducting PNHVs, are not listed as providing PNC. Coverage of PNHVs within 48 hours of birth appears to be extremely low.
• In Rwanda , 9 in 10 births occurred in facilities. Only 6% and 4% of babies born at home and in a health facility, respectively, received PNC within 4-48 hours of birth; only 2% and 0.2% of babies born at home and all babies, respectively, received their first PNC within 2 days of birth from a CHW. These findings suggest that coverage of PNHVs within 48 hours of birth is very low.
• In Uganda , among the 43% of newborns born at home, only 4% received PNC within 4-48 hours of birth. Village health team (VHT) members are nominally responsible for making home visits, but only 0.1% of babies born at home received their first PNC within 2 days of birth from a VHT member. These findings suggest that coverage of PNHVs within 48 hours of birth among home births is no higher than 4% and is most likely lower.

Considering care specifically for the mother, Table 1 shows very similar results.

Implications of survey findings

As stated in the introduction, published evidence suggests that effectiveness of postnatal home visitation for reducing neonatal mortality risk depends to a considerable degree on ensuring PNC visits within the first 2 days of life for babies born at home [ 27 ] (note that the published studies that demonstrated the effectiveness of PNHVs [ 2 , 3 , 4 , 5 ] did not use maternal mortality as an outcome measure but the interventions tested did generally include maternal content). Our analysis provides some insight into program performance on this measure, within limitations imposed by available data.

PNC provided within the first two days of life (and one strategy for its provision: home visits made during this period) should be understood as programmatically distinct from care provided immediately following childbirth. As we have categorized available DHS data, we classify “ ≤48hr PNC” as care delivered over the interval 4-48 hours after birth. In most countries presented above, coverage of ≤48hr PNC to babies born at home is below 10%, and in no country does it exceed 20%. Coverage of ≤48hr PNHVs is, by definition, no higher than overall coverage of ≤48hr PNC (which also includes PNC provided in facilities).

There are no recent population-representative data that measure coverage of PNC in Sri Lanka, which has a renowned program for delivering PNHVs. According to routine health information system data, 78% of mothers received a postnatal home visit within 10 days of birth (using a denominator of total estimated births) [ 28 ]. Sri Lanka has an institutional birth rate of 99% [ 29 ], a well-adhered-to protocol requiring mother-newborn pairs to remain in the facility at least 24 hours following childbirth, and provides structured PNC before discharge. Sri Lanka is the only country in our review that appears to be achieving high coverage of PNHVs, although such contacts may not be very early.

In the data summarized above, most PNC within the first 48 hours is provided by professional health workers or health auxiliaries (and appears to occur primarily in health facilities). CHWs – the backbone of recent program efforts to provide PNHVs that were inspired by the 2009 Joint Statement – are not a significant provider of PNC in any of the reviewed surveys. Low coverage levels of home visits within 48 hours of birth provided by CHWs reinforce our finding that government efforts to deliver PNHVs reach very few mothers and newborns and therefore, as program mangers interviewed have noted, they cannot be expected to meaningfully affect newborn or maternal mortality rates.

Response to low performance

Countries have responded in various ways to low performance of PNHV program efforts. Some have made little or no change to their programming; for example, Malawi continues to mandate home visits on days 1, 3 and 8 and is experimenting with adding management of neonatal sepsis to the content of PNHVs. Other countries have suspended efforts to systematically provide PNHVs; in response to the disappointing results of a 2012 evaluation [ 30 ] Nepal decided that female community health volunteers will no longer be expected to conduct PNHVs. Finally, some countries have modified their strategies for providing PNHVs; Rwanda reduced the schedule from 4 visits (days 1, 7, 14 and 28) to 2 (days 3 and 7-14), while in India policymakers are poised to make changes based on recent findings on barriers to effective provision of PNHVs.

Factors influencing the performance of PNHV programs

We interviewed stakeholders from phase II countries to identify factors affecting performance of home visitation (focusing especially on contact coverage). Stakeholders noted a range of general health system issues, suggesting that a robust primary health care system may be a prerequisite for effective delivery of a PNHV strategy. Stakeholders also identified factors driving performance that are specific to PNHVs ( Table 2 ).

Factors that influence performance of postnatal home visits (from key informant interviews)

PNHV – postnatal home visits, PNC – postnatal care

We conducted a review of postnatal home visitation programs implemented at scale under government health services, with the intention of helping countries design and strengthen locally appropriate services, particularly addressing needs in the early postnatal period. Recommendations arising from our findings are presented in Box 1 .

Recommendations

Provide operational guidance to countries on designing context-appropriate delivery strategies: Countries require operational guidance to help them determine how PNHVs might best fit into their mix of services and whether they have the resources to effectively deliver such services at scale and at adequate coverage. We have developed operational guidance for PNHV programming separately, as a product of this review [ 29 ].

Encourage and facilitate local adaptation of recommendations: Building on actual country experience documented in this paper, countries should consider developing modified schedules and approaches to implementing PNHVs that are appropriate to context and should not interpret current global PNHV guidance as inflexible. For example, some countries that have not been successful in achieving adequate coverage of PNHVs have adapted approaches to providing PNC that include: 1) increased emphasis on community-level contacts during pregnancy to promote key PNC practices; and 2) targeting high-risk mothers and newborns for PNHVs.

Prioritize pre-discharge postnatal care: Given that in many low-income countries, in recent years there have been marked increases in institutional delivery rates, countries should prioritize the provision of high-quality pre-discharge PNC to all mothers and babies born in facilities. Many countries and facilities miss the opportunity to provide this critical service. Provision of pre-discharge PNC would reduce the need for very early PNHVs – visits that are very difficult to deliver at scale in most countries.

Our findings also have implications for the process involved in developing global recommendations. Certainly, when considering new interventions or approaches, it is appropriate to begin by assessing evidence from robust proof-of-principle trials designed to allow firm conclusions with regard to causal relationships between interventions and outcomes (ie, with high internal validity). However, we argue that in many instances this is an insufficient basis for governments to adopt policy, in the absence of adequate evidence on feasibility and lessons from program experience that are relevant to specific settings where services will be delivered. This is especially true for complex interventions or service delivery strategies such as PNHVs, which are dependent on local context and available inputs.

Recommendations on complex interventions or service delivery strategies need to allow considerable flexibility and encourage context-specific judgments of relevance and feasibility. Rather than standardized templates, countries need tools and methods to support development of locally appropriate approaches tailored to the opportunities and constraints of their settings [ 12 ].

Countries have introduced PNHVs through a variety of modalities and schedules. All countries that have implemented PNHVs at scale have made serious efforts to do so. However, given the low contact coverage of PNHVs in most programs operating at scale, especially during the crucial first days following childbirth, even if such visits are delivered with good quality it is unlikely that PNHVs are achieving meaningful impact on mortality in most countries. Among countries included in the review, only Sri Lanka has documented high, sustained coverage of PNHVs at scale, although in Sri Lanka PNC within the first 48 hours after birth is systematically provided in hospitals before discharge, with follow-up home visits beginning up to 5 days later.

Among countries that have been unable to achieve acceptable coverage, some ceased efforts to deliver PNHVs while others have continued despite low performance. Still other countries have responded by modifying strategies for providing postnatal care and home visitation, illustrating the importance of learning and adaptation.

We acknowledge that program performance may have improved since the surveys that we have analyzed were conducted. Furthermore, measures of PNC coverage in these surveys are based on two-year recall, which may affect data quality and validity. And the national-level data presented here may mask better performance at the subnational level in some cases.

To date, countries implementing PNHV programming have placed primary emphasis on the PNHV visit schedule. To the extent that performance has been tracked, focus has generally been limited to whether at least one contact occurs. Increased attention to quality would benefit mothers and newborns and align with WHO’s current focus on strengthening the quality of labor and childbirth care [ 31 ]. To date available data from nationally representative surveys include essentially no information on the content or quality of PNC. This has to some extent been remedied in DHS version 7, so future surveys will provide more insight into these issues.

Effective provision of PNHVs clearly requires the support of a strong health care system. Many of the factors that stakeholders identified as crucial for the effective delivery of PNHVs also represent characteristics of a well-run primary health care system. Any strategy selected to deliver PNC should take system capacity realistically into account.

Postnatal home visitation should be understood not as a singular, stand-alone intervention but as a service delivery strategy – one of a number of ways in which PNC can be provided. A country can provide excellent PNC without necessarily making use of home visitation. What is important is that health services provide high-quality, high-coverage PNC. Where the service is provided is secondary. The most efficient, effective, and feasible way to provide PNC will vary among (and even within) countries.

Acknowledgements

This paper reports on one portion of a larger effort that also included development of implementation guidelines. This work was undertaken by a group that also included: Severin von Xylander (WHO), Bernadette Daelmans (WHO), Helenlouise Taylor (WHO, at the time this work was done), Luwei Pearson (UNICEF), Lily Kak (USAID), Joseph de Graff Johnson (Save the Children), Neena Khadka (MCSP/Save the Children), Kate Kerber (Save the Children, at the time this work was done).

Disclaimer: The views expresses in this article are those of the authors and not an official position of Save the Children or its funders.

Funding: for the work reflected in this paper, SH was employed by Save the Children, US, under the Saving Newborn Lives project; RM was engaged as a consultant by Save the Children, Saving Newborn Lives.”

Authorship contributions: The authors contributed equally. SH conceived of the activity and provided overall direction. RM did almost all of the data collection, field work and analysis. Both authors contributed equally to writing the paper.

Competing interests: The authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare no conflict of interest.

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19 Unique And Fabulous Experiences In Moscow

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Thinking of visiting Russia? When visiting such a famous city, one must, of course, visit the iconic landmarks first. Moscow has plenty of those, most of them in the center of the city, which is very well-planned for tourists. Once you’ve seen the sights that are on most travelers’ lists, it’s time to branch out and visit some of the lesser-known sites, and there are some fascinating places to see and things to do.

I know this list is long, but I just couldn’t help myself. You probably won’t have the time to see them all. But that’s okay. Just scroll through the list and choose what sounds the most interesting to you. Where possible, make sure to book in advance, as things can get crowded, especially during high season.

1. The Red Square, Kremlin, And Surroundings

Red Square (Krasnya Ploshad) is the heart and soul of Russia, and where much of the country’s history has unfolded. This is the most famous landmark in Moscow and indeed the whole country, it’s an absolute must-do! The square is always full of people and has a rather festive atmosphere!

Saint Basil’s Cathedral

This is the famous church with the rainbow-colored, onion-domed roof. The cathedral was commissioned in the 1500s by Ivan the Terrible and according to legend, the Tsar thought it was so beautiful, that he ordered that the architect’s eyes be cut out afterward, so he could never build anything more beautiful! He wasn’t called Ivan the Terrible for no reason!

Lenin’s Mausoleum

The “love-it-or-hate-it” of tourist attractions in Russia. A glass sarcophagus containing the embalmed body of Russian revolutionary, Vladimir Lenin. It may seem a bit bizarre to display the mummy of a person, but it has been there for almost half a century and the 2.5 million visitors who come each year, clearly feel the queuing and thorough body search are worth it, to be in Lenin’s presence.

Pro Tip: no photos and no loud talking are allowed inside the Mausoleum.

Eternal Flame

There is an Eternal Flame in honor of an unknown soldier on the left side of Red Square. The hourly changing of the guards is worth seeing.

The Kremlin is the official residence of the Russian president. You can see it from the outside, or you can take an excursion to one of the museums located inside. This is the biggest active fortress in Europe, and holds a week’s worth of attractions! Once behind the 7,332-feet of walls, there are five squares, four cathedrals, 20 towers, various museums, and the world’s largest bell and cannon to see. Worth a special mention is the Armory Chamber that houses a collection of the famous Faberge Eggs.

Pro Tip: You can only go inside the Kremlin if you are part of a tourist group.

2. Bolshoi Theatre

Bolshoi Theatre translates to “The Big Theatre” in Russian, and the building is home to both the Bolshoi Ballet and Bolshoi Opera — among the oldest and most famous ballet and opera companies in the world.

Pro Tip: It’s hard to get an inexpensive ticket, so if you’re reading well in advance of going to Moscow then try buying tickets on the official website . Last-minute tickets cost around $250 per person. If this is out of your budget, about an hour before a performance, you can try buying a ticket at the entrance from a reseller. Most can speak enough English to negotiate the price.

Tour the Bolshoi Theatre: You can take a group guided tour of the Bolshoi Theatre which focuses on the history and architecture of the theatre and behind the scenes. There’s an English language tour that lasts 2 hours and costs around $300 for a group of up to six.

3. Luxury Shopping At GUM And TSUM

Russia’s main department store, GUM, has a stunning interior that is home to over 100 high-end boutiques, selling a variety of brands: from luxurious Dior to the more affordable Zara. Even if shopping is not on your Moscow to-do list GUM is still worth a visit; the glass-roofed arcade faces Red Square and offers a variety of classy eateries. TSUM, one of the biggest luxury malls in town, is right behind the Bolshoi and GUM. It’s an imposing building with lots of history, and worth a visit just for its design and its glass roof.

4. Christ The Savior Cathedral

This is one of Russia’s most visited cathedrals and is a newer addition to the gorgeous array of Muscovite cathedrals, but don’t let its young age fool you. After perestroika, in the early 90s, the revived Russian Orthodox Church was given permission to build a cathedral on this site. It did the location honors and built the largest temple of the Christian Orthodox Church. The façade is as grand as you’d expect, but it’s the inside that will mesmerize you, with its domes, gold, gorgeous paintings, and decor!

The cathedral is located just a few hundred feet away from the Kremlin and was the site of the infamous Pussy Riot protest against Putin back in 2012.

Pro Tip: Bring a shawl to cover your hair as is the local custom.

5. Gorky Park

Moscow’s premier green space, Gorky Park (Park Gor’kogo) is the city’s biggest and most famous park. There is entertainment on offer here for every taste, from outdoor dancing sessions to yoga classes, volleyball, ping-pong, rollerblading, and bike and boat rental in summer. In winter, half the park turns into a huge ice skating rink. Gorky Park is also home to an open-air movie theater and the Garage Museum of Contemporary Art. There is also Muzeon Art Park, a dynamic contemporary space with a unique collection of 700 sculptures. It is located right in front of Gorky Park.

6. Sparrow Hills Park

If you take a walk from Gorky Park, along the Moscow River embankment, you’ll end up in the city’s other legendary park, Sparrow Hills. Although the park doesn’t offer as many activities as its hip neighbor, it has a great panoramic view of the city

Pro Tip: You can take a free walking tour to all of the above attractions with an English-speaking guide.

7. River Cruising

One of the best ways to experience Moscow, and see all the famous landmarks, but from a different angle, is from the Moscow River. Take a river cruise. Avoid the tourist crowds. There are little nameless old boats that do the cruise, but if you are looking for a more luxurious experience take the Radisson Blu cruise and enjoy the sights with some good food and a glass of wine.

8. Metro Hopping

Inaugurated in the 1930s, the Moscow Metro system is one of the oldest and most beautiful in the world. Started in Stalinist times, each station is a work of art in its own right. I’d recommend touring the stations between 11 a.m. and 4 p.m. This way, you’ll be able to properly see it without the crowds. Ideally, I’d recommend taking a tour with a knowledgeable guide with GuruWalk, who will tell you stories of forgotten stations and how the history of the country is interconnected with the metro development. If going by yourself, then I definitely recommend checking out: Mayakovskaya, Ploschad Revolutsii, Kievskaya, Kropotkinskaya, Kurskaya, and Novoslobodskaya stations.

Visit the free Moscow Metro Museum: For real train enthusiasts, located in the southern vestibule of Sportivnaya station is a small free museum. Here you can take a peek into the driver’s cabin, see a collection of metro tokens from different cities, and see different models of a turnstile, traffic lights, escalator, and more.

9. Moscow State University View

In his effort to create a grander Moscow, Stalin had seven skyscrapers built in different parts of town; they’re called the Seven Sisters. The largest of these buildings and the one with the best view is the main building of the Moscow State University. Although this is a little outside the city center, the view is more than worth it.

10. Izmailovsky Market

Mostly known for the city’s largest flea market, the district of Izmaylovo is home to a maze of shops where you can get just about anything, from artisan crafts to traditional fur hats, handcrafted jewelry, fascinating Soviet memorabilia, and antiquities. It’s also one of Moscow’s largest green spaces. There are often no price tags, so be prepared to haggle a bit. Head to one of the market cafes for a warming mulled wine before continuing your shopping spree.

The History of Vodka Museum is found here, and the museum’s restaurant is the perfect place to sample various brands of the national drink.

Once you’ve covered the more touristy spots, Moscow still has plenty to offer, and the places below will also be full of locals! So for some local vibes, I would strongly recommend the spots below!

11. Moscow City

With a completely different vibe, Moscow City (also referred to as Moscow International Business Center) is like a mini Dubai, with lots of impressive tall glass buildings. Here is where you’ll find the best rooftops in towns, like Ruski Restaurant, the highest restaurant both in Moscow City and in Europe. Moscow City is great for crowd-free shopping and the best panoramic views of the city.

12. Tretyakov Gallery

Tretyakov Gallery started as the private collection of the Tretyakov brothers, who were 19th-century philanthropists. They gave their private collection to the government after their deaths. If there is just one museum you visit in Moscow, I recommend this one!

13. Tsaritsyno Museum-Reserve

Tsaritsyno was a residence of Catherine the Great more than two centuries ago. It became derelict during the Soviet era but has now been fully renovated. With its opulently decorated buildings, gardens, meadows, and forests, Tsaritsyno Park is the perfect place for a green respite in Moscow.

14. Kolomenskoye

A 10-minute metro ride from the city center is Kolomenskoe Museum-Reserve, where you can get an idea of what Russia looked like 200 years ago. You’ll find ancient churches (one dating back to the 16th century), the oldest garden in Moscow, and the wonderful fairytale wooden palace of Tsar Alexey Mikhailovich, father of Peter the Great.

15. Ostankino TV Tower

Built in 1967, Ostankino TV Tower was the tallest free-standing construction in the world at the time, it’s still the 8th tallest building in the world and the highest in Europe. It’s also the best observation deck, with a glass floor and 360-degree views. The speedy elevators take you 1,105 feet in next to no time.

Pro Tip: You need to book in advance; entrance is based on specific ticket times and the capacity is limited and only a certain number of tourists are allowed per day. Don’t forget your passport, you’ll need it to get through security.

16. Zaryadye Park

Zaryadye is a newly opened, landscaped urban park so new you won’t find it in a lot of tour guides. The park is near Red Square and is divided into four climatic zones: forest, steppe, tundra, and floodplains, depicting the variety of climatic zones in Russia.

These last three suggestions are a little quirky, but all are really worth checking out.

17. Museum Of Soviet Arcade Games

Release your inner child playing on 66 arcade machines from the Soviet era! What a great way to spend a couple of hours when tired of visiting museums and palaces. The staff speaks excellent English and are happy to explain how the games work.

18. Moscow Rooftop Tour

Take a 1-hour private Moscow rooftop tour with an experienced roofer. I can just about guarantee none of your friends will be able to say they’ve done it! For your comfort, I recommend wearing comfortable shoes. Take your camera, there are some amazing photo opportunities out there!

19. Sanduny Banya

This classical Russian bathhouse opened its doors in 1808 and is famous for combining traditional Russian banya services with luxurious interiors and service. If you enjoy spas and saunas, then you should experience a Russian bathhouse at least once in your life! Go with an open mind and hire a specialist to steam you as it’s meant to be done — by being beaten repeatedly with a besom (a leafy branch)! This is said to improve circulation, but is best done by a professional!

So there you have my list of things to do in Moscow. I could have gone on and on and on, but I didn’t want to try your patience! There are so many things to do in this vibrant city that you’ll definitely need to allocate several days for exploring.

Here are some other reasons to visit Moscow and Russia:

• 7 Reasons To Put Moscow On Your Travel Bucket List
• Russia 30 Years (And 30 Pounds) Ago
• Massive Mysterious Craters Appearing Again In Siberia

Born and raised in Sydney, Australia, before moving to Africa at the age of 21, Sarah Kingdom is a mountain climber and guide, traveler, yoga teacher, trail runner, and mother of two. When she is not climbing or traveling she lives on a cattle ranch in central Zambia. She guides and runs trips regularly in India, Nepal, Tibet, Russia, and Ethiopia, taking climbers up Tanzania’s Mount Kilimanjaro numerous times a year.

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Moscow Travel Guide: Best Things to Do + More [2023]

· everything to know about visiting moscow, including the best things to do and how to get around. ·.

Moscow is Russia’s vibrant capital city, and it also happens to be the largest city in all of Europe. The city’s long and infamous history makes it one of the most unique places we have ever visited.

The architecture ranges from centuries-old palaces to uniform, gray concrete buildings. The people range from cold and private to warm and welcoming. Moscow is a city is strong juxtapositions, and we learned a lot during our time there.

This post will break down all you need to know about visiting Moscow, including the best things to do, how to get there, how to get around, and more.

The Best Things to Do in Moscow

1. explore the red square.

The Red Square is the heart of Moscow. Most of the city’s top attractions can be found here, including just about everything on this list. The Kremlin, St. Basil’s Cathedral, and Lenin’s Mausoleum are all located here, and the State Historical Museum and GUM are not far from here, either.

The Red Square is a common home for parades, protests, and seasonal celebrations. There are massive Christmas celebrations here, with food vendors and carnival rides set up in numbers.

2. Check Out the Ziferblat

The Ziferblat is a café in Moscow that is unlike any café we have ever been to. While most cafes charge you for your drinks and food, the Ziferblat charges you for your time.

Upon arrival, you are given a clock. When you leave, the barista calculates how much time you spent in the café and charges you accordingly. This concept was created to help visitors to be more intentional with their time, and the cafe itself is incredibly charming.

For a detailed look at everything you need to know before you visit, make sure you read my post about visiting the Ziferblat Cafe in Moscow .

3. Marvel at St. Basil’s Cathedral

St. Basil’s Cathedral is one of the most iconic churches in the world, and it was the single thing we were most excited to see while in Moscow. Built almost 500 years ago, St. Basil’s Cathedral is recognized by its colorful domes and whimsical style. The church is of the Russian Orthodox faith, and the inside is just as wondrous as the outside.

St. Basil’s Cathedral is located on the edge of the Red Square, making it incredibly convenient to visit. Entrance for non-worshippers costs 800 rubles, and tickets can be bought at the church

4. Explore the Kremlin

The Kremlin is the largest active fortress in Europe, and it is the site of most of Russia’s government affairs. In addition to government buildings, the Kremlin Complex is filled with courtyards, towers, and museums that are open to the public. If you have the time, you could spend a couple of days fully exploring all that there is to see in the Kremlin.

5. Walk Through Lenin’s Mausoleum

Vladimir Lenin is one of the most important figures in Russian history, and his body is located perfectly embalmed in a mausoleum in the Red Square. The Mausoleum is open to the public to visit, and as long as you are willing to go through a few security checks, it is easily one of the best things to do in Moscow. Its convenient location in the Red Square makes it a can’t miss attraction.

There is absolutely no photography allowed inside the Mausoleum. Do not test this rule.

6. Wander Along Arbat Street

The Arbat is a very popular street in Moscow that is lined with stores, cafes, and other touristy attractions. It is one of the oldest streets in the city, dating back to the 1400s. This street is both quaint and trendy, and there are many walking tours that introduce tourists to the neighborhood’s wonders and highlights.

7. Catch a Show at the Bolshoi Theatre

As a lover of the arts, it is hard to think of Moscow and not think of ballet. Russia has always been a top dog in the world of fine arts, and Bolshoi Theater is one of the best places to catch a performance. We were lucky enough to attend an Opera here, and it is a venue that you don’t want to miss out on if you enjoy opera, ballet, or orchestral performances.

8. Visit the State Historical Museum

The State Historical Museum is one of the most respected museums in Moscow. Despite its name, it is not really focused on the history of Russia as a nation. Rather, it contains a collection of artifacts from all throughout Russia’s history.

The museum’s collection is very broad in nature. It houses some items from indigenous tribes that used to occupy the region, pieces collected by the Romanov family, and more.

9. Wander Around GUM

GUM is an absolutely massive mall within walking distance of the Red Square. It isn’t just the size that draws visitors here; it’s the sense of luxury. The mall is so beautiful inside, much like the metro stations.

While visiting a mall might not sound like it belongs on a bucket list, this mall does. You will not want to miss out on visiting GUM while in Moscow.

10. Admire the Cathedral of Christ the Saviour

While St. Basil’s Cathedral is the most iconic church in Moscow, it isn’t the only one. The Cathedral of Christ the Saviour is absolutely stunning, with massive golden domes. It is the tallest Orthodox church in the world, and it is the seat of the Orthodox Patriarch of Moscow.

It is located just about a mile from the Red Square, just south of the Kremlin Complex. You can walk to it from the Red Square in about 20 minutes.

How to Get to Moscow

Flying to moscow.

Moscow has three major international airports: Sheremetyevo (SVO) , Domodedovo (DMO) , and Vnukovo (VKO) . All three of them are directly connected to downtown Moscow by the Aeroexpress trains, which leave every 30 minutes throughout the day. By Aeroexpress train, you can expect to get to the city center in 25-45 minutes depending on the airport that you fly into.

Sheremetyevo is the biggest and busiest of the three airports, and it is the one you are most likely to fly into – especially if you are coming from outside of Europe or the Caucus region. We flew into Sheremetyevo on a direct flight from New York City.

I usually provide backup airport options, because flying right into the city isn’t always the cheapest way to get where you’re going. Unfortunately, when it comes to Moscow, don’t really have a choice other than to fly right into Moscow. It is a very remote city, and it is usually the cheapest place to fly into in Russia as a whole.

Since Sheremetyevo is so busy, you will probably find a great flight option anyway. I wrote in  my post about finding cheap flights  that using hub airports will lead to more affordable airfare, and the same logic applies here. Even though Russia’s national airline, Aeroflot, is no longer a member of the SkyTeam Alliance, Moscow is still a major hub connecting passengers from all over the world.

READ OUR CHEAT SHEET

Train or Bus to Moscow

Trains and buses are one of the most popular ways to get around Europe. However, they’re of very little use when you’re trying to get to Moscow.

Moscow is hundreds of miles from the nearest major cities. The only major European city that can even be reached within 8 hours on the ground is St. Petersburg, and even the Baltic capitals of Riga, Vilnius, and Tallinn are over 12 hours away.

If you want to get to Moscow, the best option is almost always to fly. While the train routes to Moscow are scenic, they simply take forever.

How to Get Around Moscow

METRO | TROLLEYS | TRAMS | BUSES

Moscow has one of the most memorable metro systems in the world. Its metro lines are very deep underground, and the stations are absolutely stunning. Each station has its own unique style, but all of them contain escalators that seem to go on forever.

The system was built in an effort to showcase the power of the Soviet Union and its bright future. The plans were a form of propaganda, but they resulted in what is still one of the most visually appealing subway systems on earth.

Moscow’s metro system isn’t just pretty. It is also very useful and accessible. The system has 17 lines that connect the city and its surrounding area.

But wait; there’s more!

The Moscow metro system is also incredibly affordable, with each ride costing less than a dollar. The metro is by far the best way to get around Moscow, as it is almost impossible to beat the connection times and the low cost to ride.

Tickets can be bought at electronic, English-speaking kiosks in stations, or directly from ticket counters at certain larger stations. There are also day passes available, which are a very solid option if you plan on riding the metro several times per day.

The metro is by far the best way to get around Moscow.

In addition to the metro system, Moscow also has a network of buses, trams, and trolleys. This system is nowhere near as convenient or well-connected as the metro, though, and is likely of little use to you during your trip. There is no Uber in Moscow, but a similar app named Yandex is available if you need a ride in a pinch.

How Many Days Do You Need in Moscow?

Moscow is the biggest city in all of Europe, and it is absolutely loaded with things to do. You could spend weeks in Moscow and still find new things to do. Of course, most travelers don’t have that kind of time to spend in one place!

I recommend spending no less than three full days in Moscow, and ideally closer to five or seven.

Moscow is very spread out, and it can take some time to get from one major point to another. There are also so many places that are nice to just sit back and relax, which is hard to do when you’re in a hurry trying to cram activities into just a few days.

If you only have a week to visit Russia, I’d advise spending all of the time in one city. If you decide to split your time between Moscow and St. Petersburg, I recommend not trying to squeeze in any day trips beyond those two cities.

When Is the Best Time of the Year to Visit Moscow?

There are two different ways to approach this question. Personally, I think the best time to visit Moscow is around Christmas and New Year’s Day. While the weather will be absolutely freezing, Moscow is a surreal winter wonderland in December and January.

We were in Moscow right before Christmas. While it was very cold, you can always bundle up. Exploring the Christmas markets and pop-up ice skating rinks throughout Moscow is one of my favorite memories from anywhere I’ve traveled, and I dream of going back to do it again.

If you aren’t fond of the cold, Moscow is beautiful in the summer. It tends to get pretty cold in the shoulder seasons, so if you want warm weather, you should plan to visit in the summer. Moscow actually gets pretty warm in July and August, and there are a bunch of fantastic places to soak up the sun within the city.

The best time to visit Moscow is either around Christmas or from late May to August.

Is Moscow Safe to Visit?

While Moscow is a truly wonderful city, there’s no denying that visiting Russia comes with risks. As the country is run by an infamous communist dictator, concerns about visiting are valid. While we didn’t experience any sort of threat or negative treatment during our time in Moscow, we visited in a peaceful time.

In our experience, Russia doesn’t seem to detain normal Americans or Westerners to use as pawns. As a regular person, as long as you don’t commit any crimes, there is a slim chance you will run into any issues. However, Russia will not hesitate to enforce its laws against foreigners, and illegal behaviors will likely land you in a very compromising position.

Russia will not hesitate to enforce its laws against foreigners, and illegal behaviors will likely land you in a very compromising position.

To make matters worse, Russia has a bad reputation for gang violence. While the Russian mafia has very little interest in normal Western tourists, they won’t hesitate to pick a fight with anyone who ventures into their sphere of influence. If you seek out illegal substances or activities, you could be a target of the mafia.

If you seek out illegal substances or activities, you could be a target of the mafia.

Finally, since Russia’s invasion of Ukraine, things are all very different. Russia is currently at war, and there are battles raging within 8 hours of Moscow. While it is still relatively safe to visit, that could change at any time as the war with Ukraine continues.

Is Moscow Worth Visiting?

Without a doubt, Moscow is worth visiting. It is one of the most unique major cities we have ever visited, and we hope to make it back one day. The Russian Orthodox churches are stunning, the city’s history is unlike any other, and the food is to die for.

While many visitors prefer St. Petersburg to Moscow, I think Moscow deserves a lot of hype of its own. Moscow is the beating heart of Russian culture and history, and it’s a place I highly recommend checking out if you have the chance.

That’s all we have for you about Moscow! I hope this post was helpful as you plan your trip to Russia’s capital.

Have you been to Moscow? Or is this your first time visiting? Comment below if you have anything to add to our travel guide!

Hi, I'm Greg. I'm an avid traveler who has traveled to over 50 countries all around the world with my wife and kids. I've lived in Italy, Mexico, China, and the United States, and I dream of moving abroad again in the future. With this blog, I provide my audience with detailed destination guides to my favorite places and pro-tips to make travel as stress-free as possible.

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The best things to do and places to visit in Moscow, Russia

Updated On 14th October, 2021

While Moscow isn’t always at the top of everyone’s Europe bucket list , it’s certainly one of the best places to visit in Europe if you’re looking for a more alternative adventure! In this blog post I plan on sharing some of the free things to do in Moscow, as well as the best places to visit in Moscow, so that you can enjoy some of the best things to do in Russia! 

Moscow, the capital of Russia, sits in the European part of the country. It’s an incredibly beautiful city, which I personally found to be more beautiful than Saint Petersburg (which is often people’s preference). The capital is certainly a lot busier, and less laid back than Saint Petersburg , but it’s a much more colourful and vibrant city, full of stunning and unique architecture.

Visiting famous landmarks such as The Kremlin and St Basil’s Cathedral, enjoying some of the green space in Gorky Park, watching a ballet in the Bolshoi Theatre… these are just a few reasons that you should visit Moscow! On top of that, because of visa restrictions (we’ll get onto that later), it’s also one of the most unique destinations in Europe. 

There is a common misconception that Moscow is a dangerous city, but now that I’ve visited, I don’t believe this to be true. I would say the same rules apply here as to other large cities: avoid walking in dark areas alone at night, keep an eye on your belongings on public transport, and be streetwise. There’s no reason to avoid visiting this energetic city and miss out on these amazing things to do in Moscow! 

It would take months if you wanted to truly explore Moscow because it’s a huge city, but I’m going to share some of my favourite things to do in Moscow and places to visit in Moscow so that you can prepare for your upcoming adventure! Even if you’re only there for a few days, you should be able to fit in these highlights from my trip. 

Other blog posts you might be interested in...

• The best things to do in St Petersburg
• A 2-week Norway road trip
• A complete guide to Helsinki
• A complete guide to Tallinn
• Europe: the ultimate travel guide
• The best capital cities to visit in Europe
• The best things to do in Europe: the ultimate Europe bucket list

Where is Moscow?

If you’re wondering ‘Where is Moscow, Russia?’ then you’ve come to the right place! Moscow in in west Russia, the European part, and it’s the capital city. 

How do you get to Moscow?

Getting a visa for moscow:.

To get into Russia, you need to get a visa. The processing time is approximately 20 days, and you’ll need to have your fingerprints taken at a visa centre in London , Edinburgh or Manchester. You can find out more about getting a visa for Russia here.  

Getting to Moscow:

Once you’ve got your visa, the easiest way to get to Moscow from the UK is by flying. Direct flights between London and Moscow take just under four hours, and with an airport layover you’re looking at a 6-7 hour trip. You can also fly in from many other major European and international cities. 

Top tip: Check out flights to and from Copenhagen on  Skyscanner here.

Check out how to pack a weekend away in a carry-on suitcase here.

16 best places to visit in Moscow...

1. st basil’s cathedral.

The most iconic building in Russia and one of the most iconic buildings in the world. St Basil’s Cathedral is one of the best places to visit in Moscow, if not the best! 

St Basil’s is situated on Red Square, where you’ll also find many other popular places to visit in Moscow. In my opinion this still stands out against them all. There’s something about the multi coloured domes against the Moscow skyline that I found quite spectacular. 

Although I’d already been in Russia for several days, it wasn’t until I was at this amazing piece of architecture that I really felt I was in Russia.

The cathedral was built by order of Ivan the Terrible, and apparently after the architect completed it, Ivan blinded him so that he could never build anything more beautiful. Whether or not this story is true, it certainly adds a bittersweet feeling as you stand admiring the beauty of St Basil’s Cathedral.

Inside is a museum displaying many historic items once used at the cathedral, which costs 700 rubles to enter. In my opinion it’s worth the entry fee, as simply seeing the ornate interior walls is a spectacle in itself.

2. The Kremlin

This historic fortress that sits on Red Square is probably the largest landmark and one of the most popular places to visit in Moscow. It’s the official residence of the President, although he doesn’t actually live there. It’s been rebuilt many times since it was first constructed in 1147 out of wood, before Ivan III the Great ordered it to be made from stone, which is the Kremlin you’ll recognise today. 

This place is huge, and there’s quite a lot to see. The first problem I had was finding where the entrance was. Even though I had a pre-booked ticket, I was then told I still had to visit the ticket office to exchange it for another ticket. I also needed my passport, so make sure you have yours if you plan to visit the Kremlin. After a lengthy queue I finally had a ticket I could use to enter the Kremlin, and had to go through security. The security here is thorough, so make sure you don’t take too much in with you. I had my pockets full, and it was a nightmare emptying them and explaining each item, before I was finally allowed in. Once inside you can pay for extra tickets to visit the various museums, however there’s also quite a lot to see simply on the grounds if you don’t want to spend too much. 

See more tips for travelling on a budget here. 

There’s so much to see here, including The Assumption Cathedral, Ivan the Great Bell Tower Complex, the Grand Kremlin Palace, the Armoury Chamber and Diamond Fund. There is also the Tsar Cannon (a huge artillery cannon), and the Tsar Bell. The Tsar Bell is the largest bell in the world. An incident with a fire and water being poured over the bell caused it to crack and for a slab to break off from it, which can now be seen propped up next to it.

As you walk around the grounds you’ll hear the sound of whistles. The guards patrolling the area will blow a whistle at anyone walking where they shouldn’t. Even if it’s just on the grass, or towards more restricted areas. This can sometimes be funny to watch, as often the tourists will be in a world of their own whilst a guard is blowing a whistle at them. Sometimes a guard will be stood face to face with a tourist angrily blowing their whistle before the tourist realises they need to get back onto the main path.

This is perhaps one of the more unusual places to visit in Moscow! Gum is a huge department store situated on Red Square. It’s an interesting department store to walk around, with several levels, although the shops inside are certainly quite pricey. It’s a beautiful building when it’s lit up at night, and it seems to fit in nicely amongst the other famous sights on Red Square. Even if you don’t plan to buy anything here, one of the best things to do in Moscow is to take a quick look inside, although bear in mind there are usually security checks before entering.

4. State Historical Museum

The large crimson building on Red Square is now the State Historical Museum. It was originally the first pharmacy in Russia, and later a University before finally becoming the museum it is today.

Unfortunately I didn’t go inside as my time was limited and there was so much else I wanted to see, but if you have the time I think it would be one of the best things to do in Moscow. There are items dating back to the 6th century, and maybe even further. There’s also a library inside storing many ancient manuscripts and the largest coin collection in Russia. 

5. Bolshoi Theatre

Bolshoi means big in Russian, so it roughly translates to large theatre. The Bolshoi Theatre is one of the foremost ballet companies in the world. The exterior of the building is an impressive sight, one of the most beautiful places to visit in Moscow, and it’s certainly worth admiring from the outside. There are guided tours of the interior, but if you really want to experience the theatre, one of the best things to do in Moscow is to watch a ballet here.

I was torn between booking a seat, but the ballets were very expensive. I’d have liked to have seen “Swan Lake”, (as at least I may have recognised some of the music). Unfortunately there were no performances on the days I was in Moscow, so I decided to pass. But if I return to Russia, then watching a ballet will be on my list of things to do.

6. Sparrow Hills

If you want a good view of the city, then Sparrow Hills is one of the best places to visit in Moscow. It’s a bit of a trek outside of the centre, but if you have the time then it offers an escape from the hustle and bustle of the busy city. There’s a viewing platform here which gives you fantastic panoramic views of Moscow.

Nearby you’ll see the magnificent Moscow State University building, which is one of the seven sisters of Moscow.

7. Seven Sisters

Whilst in Moscow, you’ll no doubt notice these magnificent soviet skyscrapers dotted around the city. At the time of construction they were the tallest buildings in Europe, Moscow State University being so until 1997. There are, as the name suggests, seven in total, which are: Hotel Ukraina, Kotelnicheskaya Embankment Apartments, the Kudrinskaya Square Building, the Hilton Moscow Leningradskaya Hotel, the Ministry of Foreign Affairs, Moscow State University, and the Red Gates Administrative Building.

If you visit Sparrow Hills, then you’ll come across Moscow State University, but I’m certain as you explore the city, you’ll see more of these giants against the Moscow skyline. One of the best things to do in Moscow is to see if you can locate all seven as you wander round the city! 

8. Nikolskaya Street

The start of this street is found by Red Square. It’s one of the most prominent pedestrianised streets in Moscow, filled with shops, restaurants and bars, so one of the best places to visit in Moscow if you’re looking for a bite to eat or some souvenirs!

What makes this street extra special are the thousands of bright lights in the sky above. After dark it looks simply magical with the many colourful lights overhead as you walk beneath them. One of the best things to do in Moscow is to visit Nikolskaya Street after dark and see them for yourself. It almost feels like Christmas in London!

There is another street nearby which also features similar lights, “Kuznetskiy Most”, which is also quite beautiful, but I thought “Nikolskaya Street” was ever slightly more impressive.

9. Izmailovo Kremlin and Izmaylovskiy Bazar

Did you know that The Kremlin in Red Square is not the only Kremlin in Moscow? Kremlin actually means a type of fortress, so there are many in Russia.

The Izmailovo Kremlin is a fairly new addition to the city, having been built in 2007 as a cultural centre. With its multitude of colours and historic style, it has a real fairytale feel to it. There are several small museums here for you to explore, devoted to subjects such as Russian folk art, vodka and bread (yes, bread). Visiting these is definitely one of the more unique things to do in Moscow! 

It’s a little way out of the centre, but it’s an interesting place to visit in Moscow to see something a little bit different, and it won’t be as overcrowded with tourists. 

Next to the Izmailovo Kremlin is the best market in Moscow for souvenirs. You’ll find good and poor quality items, but you’ll certainly pick up a bargain if you take your time and haggle for a good price. Many of the items here you’ll get for half the price you would in souvenir shops in the city centre. It’s here that I picked up several Matryoshka dolls for a very good price. I think I’d have paid more than double, or possibly even triple if I’d have bought them elsewhere.

10. Izmailovsky Park

Not too far from Izmailovo Kremlin you’ll find this huge park, one of the prettiest places to visit in Moscow. It’s easy to get lost here, so try to make sure you keep track of where you entered if you plan to go back the same way. There’s a lot to see in this park, a round pond, ferris wheel, playgrounds and sports grounds, shooting galleries, cinemas and a skate park.

There are often festivals, concerts and exhibitions at the park, on top of firework displays and dance parties.

The main reason I chose to visit the park was to find the painted trees. A local artist “Yevgenia Khlynina” has been painting on trees in this park, and one of the best things to do in Moscow is to explore the park looking for them. One of the most famous pieces of hers is the “Hedgehog in the Fog” from a famous soviet cartoon.

11. Gorky Park

The most famous park in Moscow is named after the writer “Maxim Gorky”. Although it’s likely you’ve heard it mentioned in the song “Wind of Change” by “The Scorpions”. 

There’s lots to do and see in the park with sports facilities and exhibitions. During the summer months this is one of the best places to visit if you’re looking for things to do in Moscow; there are often open air concerts and an open air cinema. There are many statues and sculptures in the park, including a small sculpture park area which features many interesting pieces.

One piece of advice: don’t visit Gorky Park or any other parks on 2nd August if you’re in Russia. 2nd August is Paratrooper day, which usually encourages a lot of drinking in the park, which is not always very welcoming.

12. Arbat Street

One of the oldest and busiest streets in Moscow, and the most famous pedestrian street in the city. Arbat is one of the most popular places to visit in Moscow. There are several shops including many dedicated to souvenirs, but although these will have a good range of goods, they will be quite expensive . You may see street performers and buskers, and there are often poets reciting famous works, if not their own works.

It’s within walking distance from the Kremlin, which should only take around 10 minutes.

There are actually two streets with this name, Old Arbat Street and New Arbat Street. Old Arbat Street is where you’ll find the pedestrianised area. New Arbat Street is a separate street which runs alongside a main road, filled with many bars and restaurants.

13. Metro station art

The best way to get around Moscow is by using the metro, and the metro is a tourist attraction in itself.

Although I obviously didn’t visit every metro station, I believe that every single station is unique in its own beautiful way. Many of the stations I passed through were impressive, quirky or simply jaw dropping. You’ll more than likely pass through many of them on the way to other sights, but I’d recommend the following:  Komsomolskaya, Novoslobodskaya, Mayakovskaya, Teatralnaya, Arbatskaya, Prospekt Mira and Ploschad Revolutsii (be sure to pet the dog statue for good luck).

There are of course many others for you to explore, but these are the ones I considered to be some of the most impressive places to visit in Moscow (even if they’re only metro stations!).

VDNKh is an exhibition centre with many monuments and museums. Now that it’s combined with the Botanical Garden and Ostankino Park, one of the best things to do in Moscow is to spend the day at this recreational centre enjoying a mix of nature and culture. The most popular museum in the complex which you shouldn’t miss on your trip to Moscow is the Museum of Cosmonautics.

15. Lenin's Mausoleum

Despite requesting to be buried with his mum in St Petersburg, it is at the foot of the Kremlin on Red Sqaure that you will find Lenin’s Mausoleum, where Vladimir Ilych Lenin has been frozen in time since 1924. It’s only open for a few hours a few times per week. Photography is not allowed, and you should line up on the western corner of the square (near Alexander Garden) to wait you turn to see the embalmed body. 

16. Novodevichy Convent

Novodevichy Convent, on the UNESCO World Heritage List, is one of the most beautiful places to visit in Moscow. Located south west of the centre you’ll find this stunning monastery. Inside you’ll find a cathedral and several churches, surrounded by high walls and 12 towers.

Where are your favourite places to visit in Moscow?

What about the best things to do in Moscow? Anything you’d add?

Love as always and happy adventuring…

I’m Spike! Solo traveller, cultural explorer and world adventurer! With 57 countries under my belt, I live and breathe travel. I never plan to stop exploring new destinations and experiencing new cultures.

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Travel Itinerary For One Week in Moscow: The Best of Moscow!

I just got back from one week in Moscow. And, as you might have already guessed, it was a mind-boggling experience. It was not my first trip to the Russian capital. But I hardly ever got enough time to explore this sprawling city. Visiting places for business rarely leaves enough time for sightseeing. I think that if you’ve got one week in Russia, you can also consider splitting your time between its largest cities (i.e. Saint Petersburg ) to get the most out of your trip. Seven days will let you see the majority of the main sights and go beyond just scratching the surface. In this post, I’m going to share with you my idea of the perfect travel itinerary for one week in Moscow.

Moscow is perhaps both the business and cultural hub of Russia. There is a lot more to see here than just the Kremlin and Saint Basil’s Cathedral. Centuries-old churches with onion-shaped domes dotted around the city are in stark contrast with newly completed impressive skyscrapers of Moscow City dominating the skyline. I spent a lot of time thinking about my Moscow itinerary before I left. And this city lived up to all of my expectations.

Travel Itinerary For One Week in Moscow

Day 1 – red square and the kremlin.

Metro Station: Okhotny Ryad on Red Line.

No trip to Moscow would be complete without seeing its main attraction. The Red Square is just a stone’s throw away from several metro stations. It is home to some of the most impressive architectural masterpieces in the city. The first thing you’ll probably notice after entering it and passing vendors selling weird fur hats is the fairytale-like looking Saint Basil’s Cathedral. It was built to commemorate one of the major victories of Ivan the Terrible. I once spent 20 minutes gazing at it, trying to find the perfect angle to snap it. It was easier said than done because of the hordes of locals and tourists.

As you continue strolling around Red Square, there’s no way you can miss Gum. It was widely known as the main department store during the Soviet Era. Now this large (yet historic) shopping mall is filled with expensive boutiques, pricey eateries, etc. During my trip to Moscow, I was on a tight budget. So I only took a retro-style stroll in Gum to get a rare glimpse of a place where Soviet leaders used to grocery shop and buy their stuff. In case you want some modern shopping experience, head to the Okhotny Ryad Shopping Center with stores like New Yorker, Zara, and Adidas.

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To continue this Moscow itinerary, next you may want to go inside the Kremlin walls. This is the center of Russian political power and the president’s official residence. If you’re planning to pay Kremlin a visit do your best to visit Ivan the Great Bell Tower as well. Go there as early as possible to avoid crowds and get an incredible bird’s-eye view. There are a couple of museums that are available during designated visiting hours. Make sure to book your ticket online and avoid lines.

Day 2 – Cathedral of Christ the Saviour, the Tretyakov Gallery, and the Arbat Street

Metro Station: Kropotkinskaya on Red Line

As soon as you start creating a Moscow itinerary for your second day, you’ll discover that there are plenty of metro stations that are much closer to certain sites. Depending on your route, take a closer look at the metro map to pick the closest.

The white marble walls of Christ the Saviour Cathedral are awe-inspiring. As you approach this tallest Orthodox Christian church, you may notice the bronze sculptures, magnificent arches, and cupolas that were created to commemorate Russia’s victory against Napoleon.

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Unfortunately, the current Cathedral is a replica, since original was blown to bits in 1931 by the Soviet government. The new cathedral basically follows the original design, but they have added some new elements such as marble high reliefs.

Home to some precious collection of artworks, in Tretyakov Gallery you can find more than 150,000 of works spanning centuries of artistic endeavor. Originally a privately owned gallery, it now has become one of the largest museums in Russia. The Gallery is often considered essential to visit. But I have encountered a lot of locals who have never been there.

Famous for its souvenirs, musicians, and theaters, Arbat street is among the few in Moscow that were turned into pedestrian zones. Arbat street is usually very busy with tourists and locals alike. My local friend once called it the oldest street in Moscow dating back to 1493. It is a kilometer long walking street filled with fancy gift shops, small cozy restaurants, lots of cute cafes, and street artists. It is closed to any vehicular traffic, so you can easily stroll it with kids.

Day 3 – Moscow River Boat Ride, Poklonnaya Hill Victory Park, the Moscow City

Metro Station: Kievskaya and Park Pobedy on Dark Blue Line / Vystavochnaya on Light Blue Line

Voyaging along the Moscow River is definitely one of the best ways to catch a glimpse of the city and see the attractions from a bit different perspective. Depending on your Moscow itinerary, travel budget and the time of the year, there are various types of boats available. In the summer there is no shortage of boats, and you’ll be spoiled for choice.

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If you find yourself in Moscow during the winter months, I’d recommend going with Radisson boat cruise. These are often more expensive (yet comfy). They offer refreshments like tea, coffee, hot chocolate, and, of course, alcoholic drinks. Prices may vary but mostly depend on your food and drink selection. Find their main pier near the opulent Ukraine hotel . The hotel is one of the “Seven Sisters”, so if you’re into the charm of Stalinist architecture don’t miss a chance to stay there.

The area near Poklonnaya Hill has the closest relation to the country’s recent past. The memorial complex was completed in the mid-1990s to commemorate the Victory and WW2 casualties. Also known as the Great Patriotic War Museum, activities here include indoor attractions while the grounds around host an open-air museum with old tanks and other vehicles used on the battlefield.

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The hallmark of the memorial complex and the first thing you see as you exit metro is the statue of Nike mounted to its column. This is a very impressive Obelisk with a statue of Saint George slaying the dragon at its base.

Maybe not as impressive as Shanghai’s Oriental Pearl Tower , the skyscrapers of the Moscow City (otherwise known as Moscow International Business Center) are so drastically different from dull Soviet architecture. With 239 meters and 60 floors, the Empire Tower is the seventh highest building in the business district.

The observation deck occupies 56 floor from where you have some panoramic views of the city. I loved the view in the direction of Moscow State University and Luzhniki stadium as well to the other side with residential quarters. The entrance fee is pricey, but if you’re want to get a bird’s eye view, the skyscraper is one of the best places for doing just that.

Day 4 – VDNKh, Worker and Collective Farm Woman Monument, The Ostankino TV Tower

Metro Station: VDNKh on Orange Line

VDNKh is one of my favorite attractions in Moscow. The weird abbreviation actually stands for Russian vystavka dostizheniy narodnogo khozyaystva (Exhibition of Achievements of the National Economy). With more than 200 buildings and 30 pavilions on the grounds, VDNKh serves as an open-air museum. You can easily spend a full day here since the park occupies a very large area.

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First, there are pavilions that used to showcase different cultures the USSR was made of. Additionally, there is a number of shopping pavilions, as well as Moskvarium (an Oceanarium) that features a variety of marine species. VDNKh is a popular venue for events and fairs. There is always something going on, so I’d recommend checking their website if you want to see some particular exhibition.

A stone’s throw away from VDNKh there is a very distinctive 25-meters high monument. Originally built in 1937 for the world fair in Paris, the hulking figures of men and women holding a hammer and a sickle represent the Soviet idea of united workers and farmers. It doesn’t take much time to see the monument, but visiting it gives some idea of the Soviet Union’s grandiose aspirations.

I have a thing for tall buildings. So to continue my travel itinerary for one week in Moscow I decided to climb the fourth highest TV tower in the world. This iconic 540m tower is a fixture of the skyline. You can see it virtually from everywhere in Moscow, and this is where you can get the best panoramic views (yep, even better than Empire skyscraper).

Parts of the floor are made of tempered glass, so it can be quite scary to exit the elevator. But trust me, as you start observing buildings and cars below, you won’t want to leave. There is only a limited number of tickets per day, so you may want to book online. Insider tip: the first tour is cheaper, you can save up to $10 if go there early.

Day 5 – A Tour To Moscow Manor Houses

Metro Station: Kolomenskoye, Tsaritsyno on Dark Green Line / Kuskovo on Purple Line

I love visiting the manor houses and palaces in Moscow. These opulent buildings were generally built to house Russian aristocratic families and monarchs. Houses tend to be rather grand affairs with impressive architecture. And, depending on the whims of the owners, some form of a landscaped garden.

During the early part of the 20th century though, many of Russia’s aristocratic families (including the family of the last emperor) ended up being killed or moving abroad . Their manor houses were nationalized. Some time later (after the fall of the USSR) these were open to the public. It means that today a great many of Moscow’s finest manor houses and palaces are open for touring.

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There are 20 manor houses scattered throughout the city and more than 25 in the area around. But not all of them easily accessible and exploring them often takes a lot of time. I’d recommend focusing on three most popular estates in Moscow that are some 30-minute metro ride away from Kremlin.

Sandwiched between the Moscow River and the Andropov Avenue, Kolomenskoye is a UNESCO site that became a public park in the 1920’s. Once a former royal estate, now it is one of the most tranquil parks in the city with gorgeous views. The Ascension Church, The White Column, and the grounds are a truly grand place to visit.

You could easily spend a full day here, exploring a traditional Russian village (that is, in fact, a market), picnicking by the river, enjoying the Eastern Orthodox church architecture, hiking the grounds as well as and wandering the park and gardens with wildflower meadows, apple orchards, and birch and maple groves. The estate museum showcases Russian nature at its finest year-round.

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If my travel itinerary for one week in Moscow was a family tree, Tsaritsyno Park would probably be the crazy uncle that no-one talks about. It’s a large park in the south of the city of mind-boggling proportions, unbelievable in so many ways, and yet most travelers have never heard of it.

The palace was supposed to be a summer home for Empress Catherine the Great. But since the construction didn’t meet with her approval the palace was abandoned. Since the early 1990’s the palace, the pond, and the grounds have been undergoing renovations. The entire complex is now looking brighter and more elaborately decorated than at possibly any other time during its history. Like most parks in Moscow, you can visit Tsaritsyno free of charge, but there is a small fee if you want to visit the palace.

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Last, but by no means least on my Moscow itinerary is Kuskovo Park . This is definitely an off-the-beaten-path place. While it is not easily accessible, you will be rewarded with a lack of crowds. This 18th-century summer country house of the Sheremetev family was one of the first summer country estates of the Russian nobility. And when you visit you’ll quickly realize why locals love this park.

Like many other estates, Kuskovo has just been renovated. So there are lovely French formal garden, a grotto, and the Dutch house to explore. Make sure to plan your itinerary well because the estate is some way from a metro station.

Day 6 – Explore the Golden Ring

Creating the Moscow itinerary may keep you busy for days with the seemingly endless amount of things to do. Visiting the so-called Golden Ring is like stepping back in time. Golden Ring is a “theme route” devised by promotion-minded journalist and writer Yuri Bychkov.

Having started in Moscow the route will take you through a number of historical cities. It now includes Suzdal, Vladimir, Kostroma, Yaroslavl and Sergiev Posad. All these awe-inspiring towns have their own smaller kremlins and feature dramatic churches with onion-shaped domes, tranquil residential areas, and other architectural landmarks.

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I only visited two out of eight cities included on the route. It is a no-brainer that Sergiev Posad is the nearest and the easiest city to see on a day trip from Moscow. That being said, you can explore its main attractions in just one day. Located some 70 km north-east of the Russian capital, this tiny and overlooked town is home to Trinity Lavra of St. Sergius, UNESCO Site.

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Sergiev Posad is often described as being at the heart of Russian spiritual life. So it is uncommon to see the crowds of Russian pilgrims showing a deep reverence for their religion. If you’re traveling independently and using public transport, you can reach Sergiev Posad by bus (departs from VDNKh) or by suburban commuter train from Yaroslavskaya Railway Station (Bahnhof). It takes about one and a half hours to reach the town.

Trinity Lavra of St. Sergius is a great place to get a glimpse of filling and warming Russian lunch, specifically at the “ Gostevaya Izba ” restaurant. Try the duck breast, hearty potato and vegetables, and the awesome Napoleon cake.

Day 7 – Gorky Park, Izmailovo Kremlin, Patriarch’s Ponds

Metro Station: Park Kultury or Oktyabrskaya on Circle Line / Partizanskaya on Dark Blue Line / Pushkinskaya on Dark Green Line

Gorky Park is in the heart of Moscow. It offers many different types of outdoor activities, such as dancing, cycling, skateboarding, walking, jogging, and anything else you can do in a park. Named after Maxim Gorky, this sprawling and lovely park is where locals go on a picnic, relax and enjoy free yoga classes. It’s a popular place to bike around, and there is a Muzeon Art Park not far from here. A dynamic location with a younger vibe. There is also a pier, so you can take a cruise along the river too.

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The Kremlin in Izmailovo is by no means like the one you can find near the Red Square. Originally built for decorative purposes, it now features the Vernissage flea market and a number of frequent fairs, exhibitions, and conferences. Every weekend, there’s a giant flea market in Izmailovo, where dozens of stalls sell Soviet propaganda crap, Russian nesting dolls, vinyl records, jewelry and just about any object you can imagine. Go early in the morning if you want to beat the crowds.

All the Bulgakov’s fans should pay a visit to Patriarch’s Ponds (yup, that is plural). With a lovely small city park and the only one (!) pond in the middle, the location is where the opening scene of Bulgakov’s novel Master and Margarita was set. The novel is centered around a visit by Devil to the atheistic Soviet Union is considered by many critics to be one of the best novels of the 20th century. I spent great two hours strolling the nearby streets and having lunch in the hipster cafe.

Conclusion and Recommendations

To conclude, Moscow is a safe city to visit. I have never had a problem with getting around and most locals are really friendly once they know you’re a foreigner. Moscow has undergone some serious reconstruction over the last few years. So you can expect some places to be completely different. I hope my one week Moscow itinerary was helpful! If you have less time, say 4 days or 5 days, I would cut out day 6 and day 7. You could save the Golden Ring for a separate trip entirely as there’s lots to see!

What are your thoughts on this one week Moscow itinerary? Are you excited about your first time in the city? Let me know in the comments below!

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24 comments.

Ann Snook-Moreau

Moscow looks so beautiful and historic! Thanks for including public transit information for those of us who don’t like to rent cars.

MindTheTravel

Yup, that is me 🙂 Rarely rent + stick to the metro = Full wallet!

Mariella Blago

Looks like you had loads of fun! Well done. Also great value post for travel lovers.

Thanks, Mariella!

I have always wanted to go to Russia, especially Moscow. These sights look absolutely beautiful to see and there is so much history there!

Agree! Moscow is a thousand-year-old city and there is definitely something for everyone.

Tara Pittman

Those are amazing buildings. Looks like a place that would be amazing to visit.

Adriana Lopez

Never been to Moscow or Russia but my family has. Many great spots and a lot of culture. Your itinerary sounds fantastic and covers a lot despite it is only a short period of time.

What was their favourite thing about Russia?

Gladys Parker

I know very little about Moscow or Russia for the\at matter. I do know I would have to see the Red Square and all of its exquisite architectural masterpieces. Also the CATHEDRAL OF CHRIST THE SAVIOUR. Thanks for shedding some light on visiting Moscow.

Thanks for swinging by! The Red Square is a great starting point, but there way too many places and things to discover aside from it!

Ruthy @ Percolate Kitchen

You are making me so jealous!! I’ve always wanted to see Russia.

Moscow is in my bucket list, I don’t know when I can visit there, your post is really useful. As a culture rich place we need to spend at least week.

DANA GUTKOWSKI

Looks like you had a great trip! Thanks for all the great info! I’ve never been in to Russia, but this post makes me wanna go now!

Wow this is amazing! Moscow is on my bucket list – such an amazing place to visit I can imagine! I can’t wait to go there one day!

The building on the second picture looks familiar. I keep seeing that on TV.

Reesa Lewandowski

What beautiful moments! I always wish I had the personality to travel more like this!

Perfect itinerary for spending a week in Moscow! So many places to visit and it looks like you had a wonderful time. I would love to climb that tower. The views I am sure must have been amazing!

I was lucky enough to see the skyline of Moscow from this TV Tower and it is definitely mind-blowing.

Chelsea Pearl

Moscow is definitely up there on my travel bucket list. So much history and iconic architecture!

Thumbs up! 🙂

Blair Villanueva

OMG I dream to visit Moscow someday! Hope the visa processing would be okay (and become more affordable) so I could pursue my dream trip!

Yup, visa processing is the major downside! Agree! Time and the money consuming process…

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