• Childbirth while moving across cultures

    Posted by Dannielle Noonan

    Maternity - woman.jpg


     Thinking about having a baby abroad?

    For most women, pregnancy involves significant amounts of stress. For most expats, moving or living abroad involves significant amounts of stress. So, it is easy to imagine that moving abroad while pregnant or becoming pregnant in a foreign country may be one of the most stressful situations you will ever encounter in your life. Not only will you need to navigate a new health system for prenatal care and childbirth but you may also face cultural, language and physical barriers to accessing care. Fortunately, the path has been paved and many women have not only bravely ventured down this path but are also willing to share their journeys down the roads less traveled.


    I am currently writing a book about what life is like for 22 different women who have experienced pregnancy and birth in 20 different countries, called Knocked Up Abroad: A collection of lighthearted stories of pregnancy, birth and raising a family in a foreign country. Throughout this process, I have learned that cultural practices of the country largely influence the medical practices.


     As I mentioned, there are good stressors and bad stressors in life and undoubtedly, pregnancy is full of both. Pregnancy is full of hopes, dreams and hormones. Those tricky hormones add emphasis to whatever you are currently experiencing, which make the highs very high and the lows very low. Moving internationally is also full of good and bad stressors. There is excitement about the unknown, the thrill of a new adventure and the grief experienced when leaving support networks of friends and family.


    Childbirth practices, customs and beliefs vary widely by culture. In some cultures, it is customary for a mother to receive little to no intervention and is allowed to progress on her own - attended to only sparingly by midwives or non-medical attendants. In other cultures, only certified doctors (OB/GYNs) are legally allowed to deliver a baby. The definition of “best practices” for childbirth depends entirely on the cultural perspective of the person doing the defining. Some mothers feel reassured by multiple ultrasound scans, frequent urine sample testing and blood tests whereas others view these as unnecessary medical intrusions during a normal and healthy pregnancy journey. There is no one formula for each woman’s pregnancy.


    Despite technological advances, pregnancy remains one of the more enigmatic phases of the female body. Due dates remain only as estimations and no number of ultrasounds can accurately predict your baby’s final weight at birth. It is no wonder then, that mothers have anxiety about the unknown during pregnancy. Not even doctors with the most advanced instruments can answer certain questions with any modicum of accuracy. All of these things are frustrating enough when you are in your “home” country but many women must also juggle learning foreign medical systems, doctors and hospitals whenever they move abroad while pregnant.


    Some countries do not have medical facilities that are certified to perform Cesarean sections. Rural hospitals in Borneo, for instance, may not meet the quality certifications and you may need to travel abroad (again) to find a suitable hospital. Kuala Lumpur, Malaysia has state-of-the-art hospital facilities and is very accommodating to foreign mothers.


    Other countries have strict laws around pregnancy and childbirth. Dubai, United Arab Emirates, for example, will not issue a birth certificate until the parents’ marriage certificate is produced and the dates line up accordingly (i.e., married before conception), so be sure to bring copies of your marriage certificate along with you. Dubai also has high(er) rates of Cesarean sections (25%) due to financial incentives (surgery costs more money) and doctors advising patients with high BMIs and gestational diabetes that vaginal deliveries are not as safe for the mother and baby.


    By contrast, in Germany, the medical community embraces holistic approaches. You may have some language barriers to overcome between you and the midwives but you may find yourself receiving acupuncture, acupressure or massage therapies during labor. Antibiotics are provided sparingly in favor or herbal teas and homeopathic medicines. There are excellent resources online that provide guidance for what to ask your doctor during prenatal check ups and checklists of what to bring to a German hospital for your birth.


    The Nordic countries – Denmark, Finland, Iceland, Sweden, and Norway – also embrace holistic approaches to childbirth. It is not that an epidural is impossible to receive but many mothers have had their requests for epidurals ignored by the midwives or the epidurals were placed in such a way that did not numb the entire lower body. If an epidural is something you were counting on for pain relief, you might want to think of a back up plan just in case.


    Japan boasts some of the lowest infant and maternal mortality rates in the world. Perhaps indirectly related, in Japan epidurals cannot be offered outside of working hours if there is no anesthetist on call. However, after childbirth, mothers are pampered with a five-day stay in the hospital, massages, hot rock treatments and delicious food. It will all be worth it, I promise!


    While technology may not be able to tell us everything we want to know about our unborn babies, it does connect us with tremendous resources online. Before you move, conduct as much research as possible and connect with other mothers who birthed babies in that country to learn about their experiences. The more you know, the more empowered you will be to give birth in a foreign culture. Even if the foreign cultural norms of childbirth are at odds with the type of birth you imagined for yourself, know that it is always your birthing experience and you remain in control. Embrace the cultural differences that will add dimension and color to your new lives as you welcome your baby into the world.




    Lisa Ferland is a U.S. Citizen currently living in Sweden. She has birthed one child in her “home country” and one while living abroad. She is currently compiling an anthology featuring the different cultural challenges and unexpected joys that women experience when giving birth and raising a family in a foreign country at www.knockedupabroadbook.com.

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