So how does pregnancy and birth work when living in such a remote part of Scotland?

The geography

Strikingly, Scotland has over 790 offshore islands. Of which only around 100 are inhabited. This equates to a total population of 103,000-105,000. Some Islands such as Skye are seeing a fast rise in their population.

This rise could be merited to several different factors: the surge in Skye’s popularity on social media since Covid, the tourism boom driven by shows like Outlander, or simply people seeking a quieter, more peaceful way of life surrounded by some of the most beautiful scenery in the world.

For all their beauty, Scotland's islands can be genuinely isolated places - surrounded by open water, at the mercy of the weather, and often hours from the nearest hospital.

The History

For most of Scottish history, births on the islands were attended not by doctors but by a local howdie - an untrained but deeply trusted community midwife. On remote islands, they were often the only person for miles with any real experience of birth. They were trained from the community Howdie’s and from observation. Howdie’s were especially important on the remote islands, where harsh weather could mean help could not arrive.

One such Howdie was Elizabeth Balfour from Shetland, born in 1832. She was known for her immense skill and ability to deal with high risk birth with very little resources, often traveling miles across harsh seas. On one such instance she travelled to Muckle Roe Island to help a difficult labour during a fierce storm. She improvised and assisted the delivery with a pair of forceps, made by her husband who was a blacksmith, saving the life of both the baby and mother.

Midwifery only became a regulated profession in 1915, and the NHS’s arrival in 1948 shifted birth from home to hospital, at this time slowly women began to move to the larger islands or the mainland for birth.

Does anyone remember the 2019 Call the Midwife special that focussed on the remote nature of maternity care in the Outer Hebrides.

Antenatal Care

Community midwives exist throughout all the Islands and NHS Scotland has done a great job of ensuring antenatal care is accessible to all - regardless of how remote they live. Community midwives will set up hubs in local GPs or perform home visits to pregnant women.

Routine scans (such as the 12 week dating and 20 week anomaly scan) can only be performed in certain places and women in the more remote islands will need to travel off the Islands for these.

The Birth

There are only four maternity units on the islands themselves that can facilitate births.

Isle of Lewis

Western Isles Hospital - Stornoway.

Obstetric consultant led unit

No of births per year: 200

Shetland

Gilbert Bain Hospital - Lerwick, Shetland

Midwife Led Unit

No of births per year: 100-150

Orkney

The Balfour Hospital - Orkney

Integrated unit

No of births per year: 100

Isle of Skye

Broadford Hospital - Broadford, Isle of Skye

Community midwife led

No of births per year: 35

Women who live on any of the other islands or have a higher risk pregnancy, need to relocate to either one of the above islands or to the mainland to places such as Inverness, Aberdeen or Glasgow.

If there’s a chance their baby will be born preterm, mainland transfer becomes essential: Orkney, Shetland, and the Western Isles don’t have neonatal intensive care units, so the smallest and sickest babies must be born (or urgently transferred) to one of Scotland’s three specialist NICUs, in Aberdeen, Edinburgh, or Glasgow.

Travel

Most women if they know they need to relocate to give birth will do so in plenty time of the birth. Common methods include flying via plane or ferry.

Caledonian MacBrayne (CalMac) offer the main services alongside NorthLink ferries servicing Orkney and Shetland.

Scotland’s airline LoganAir allows women to fly up to 40 weeks pregnant (with a doctors note).

However in emergency situations this is not possible. The Scottish Ambulance Service operates two helicopters (based at Glasgow and Inverness airports) and two fixed-wing planes (Glasgow and Aberdeen), all available 24/7 for medical transfers. At Orkney’s Balfour Hospital specifically, air ambulance (fixed-wing or helicopter) transports pregnant women to Aberdeen, and inter-island transfers happen for women already in labour.

Eilidh, a teacher from North Uist expecting her third child, was airlifted off the island at 34 weeks after a routine check revealed dangerously high blood pressure from preeclampsia. She safely delivered her son shortly after arriving on the mainland.

From the howdies who rowed between islands to reach labouring women, to the air ambulances that still do something similar today, one thing hasn’t changed across centuries of Scottish island life: giving birth here has always meant navigating distance.

The geography hasn’t moved, the islands are still incredibly remote. What’s changed is the system built around it: community midwives reaching every corner of the isles, four active maternity units, specialist care centralised on the mainland, and a genuinely impressive emergency network ready for the moments they are needed most.

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What is it?

The Finnish baby box is a package of baby clothing and essential items given to all expectant mothers. The box itself is designed to double as a safe first bed, with a firm mattress fitted to the base and sturdy cardboard walls -genuinely the first place many Finnish babies ever sleep. The whole concept is to ensure all babies have the best possible start to life.

Why was it introduced?

The scheme wasn’t born from charm but it came from crisis and genuine need. In the early 20th century, Finland faced strikingly high infant and maternal mortality, driven by poverty, poor sanitation, and a harsh climate, at a time when the country was a relatively poor agrarian state. The Maternity Grants Act of 1937 was designed to address this directly, giving mothers baby clothes and care items to ease the financial burden of a new baby and support infant health.

Who is Eligible?

Initially, the grant was only available to low-income mothers. It wasn’t until 1949 - over a decade later, that it became a truly universal benefit, available to every mother in Finland regardless of income. It remains this way today.

What is inside?

The contents have evolved constantly since 1938. Today’s box contains around 50 items of clothing and care essentials for both baby and mother, including ready-made clothes, a thermometer, blankets, bibs, and a picture book. A baby book was added in 1982, and since 2018, children born in Finland receive a new book every month throughout their first year. The box has occasionally sparked debate too - condoms and lubricant were added in the 1970s, framed as support for women’s wellbeing. They were dropped in 2025 due to supplier issues.

Newborn Clothing

6 x bodysuits

3 x trousers

1 x hood

1 x cap

Mittens and socks

1 x wool blend onesie

1 x snowsuit

Insulated booties and mittens

Sleep

1 x sleeping bag

1 x duvet cover

1 x sheet

2 x blanket

1 x mattress

Baby Cares

1 x Muslin

1 x feeding bib

1 x towel

1 x hairbrush

1 x themometer

Nappies

1 x scissors

1 x toothbrush

1 x book

For Mum

Sanitary Towels

Nipple Cream

Breast pads

The box as a bed

One of the most well-known details about the Finnish box is that it isn’t just packaging - it’s designed to double as the baby’s first bed. The box has a firm-fitting mattress at its base, and the cardboard walls are sturdy enough to create a genuinely safe sleep space. Many Finnish babies have their very first naps in the box itself, before moving to a cot.

This is also part of why the idea has been picked up internationally, some countries and organisations adapted the concept specifically to promote safer infant sleep, since a firm, separate sleep surface (rather than sharing a bed with a parent) is one of the clearest ways to reduce the risk of sudden infant death (SIDS).

What other countries offer this?

Several other countries have been inspired by Finland’s baby box initiative.

In 2017, Scotland introduced a very similar scheme, in which every expecting parent receives a box. The initiative has been a huge success and has meant every newborn in Scotland is given the best possible start in life.

As of 2026, all you need to be eligible is living in Scotland and registered with a midwife. Your midwife will then register you for your box, and it should arrive around 4 weeks before your due date.

Since 2017 Scotland has offered ‘Scotland’s baby box’ to all parents.

Wales launched “Baby Bundles” in February 2026, though it’s currently targeted rather than universal for families with particular need, registered by a midwife around 16 weeks.

The United States tried a similar model from 2017 (New Jersey, Ohio, Alabama, Texas, Colorado), but in 2022 new federal safety rules meant the cardboard box design no longer qualified, and most of these programmes have since unfortunately been closed.

Australia offers “baby bundles” in New South Wales and Victoria since 2019, though there’s no single national scheme.

South Africa’s Thula Baba Box takes a different approach - it’s given as an incentive for attending antenatal classes and clinic check-ups, run by community organisations, and has been shown to meaningfully improve how often mothers attend care.

Nearly ninety years on, Finland’s baby box remains a rare example of a wartime-era policy that never disappeared but simply evolved. Its influence has spread far beyond Finland, inspiring versions in Scotland, Wales, Australia, South Africa, and beyond, each adapted to fit very different needs and circumstances.

Whether or not your own country offers something similar, it’s a good reminder of just how differently the world approaches the first days of a baby’s life.