Prenatal Care Away from Home

A few years ago we performed a survey of over nine hundred women who had been expatriates when they were pregnant.  This revealed that they were on average older than their stay-at-home counterparts and often, as a result, suffered from more complications.  Prevention of these complications requires careful attention to prenatal care.

What “prenatal care” consists of varies greatly from one location to another, depending on what diseases and complications are common in the local population, as well as what resources are available.  Patients from North America, for instance, have a relatively high risk of gestational diabetes, group B streptococcus and Rh negative blood; all conditions that are rare in some other cultures.  If you are North American, therefore, you may need to specifically request these tests from your provider.  In addition, Rh negative blood and Rh immune globulin (Rhogam®) are virtually non-existent in many parts of the world and may need to be brought in from another country.

Essentials to look for in prenatal care include clean facilities, adequate equipment, accessibility, an adequate nearby delivery facility and staff that is trained to provide basic obstetrical services.  They should also be able to identify and refer complications.

Initial prenatal care should include a detailed medical history and a complete and thorough physical examination, including a pelvic exam.  The primary goal of early prenatal visits is to establish a reliable due date, for if anything goes wrong later, what needs to be done about it will depend on how far along you are in the pregnancy.  The secondary goal is to identify any potential high risk factors and make allowances for them.

Initial laboratory studies should include a complete blood count to look for anemia or infection, your blood type, blood and vaginal tests for any ongoing infectious diseases, urinalysis to look for kidney disease or infection, and a Pap smear if you haven’t had one recently.  Wherever possible, we recommend an early ultrasound to establish a due date and rule out any pending problems such as twins, placenta previa or a tubal pregnancy.  Later in the pregnancy we also recommend tests for diabetes and, as mentioned above, for streptococcal infection in the vagina.

Nutrition is often a problem for pregnant expatriates, especially in underdeveloped countries.  The soil and the food may not contain adequate nutrients, and vitamin supplements may simply not be available.  Prenatal vitamins (i.e. supplements containing vitamins, minerals and at least one milligram of folic acid) may need to be brought in from abroad.

In order to identify problems before they become major, we recommend a prenatal visit at least every four weeks until twenty-eight weeks, every two weeks until thirty-six weeks, and then weekly thereafter.  These check-ups do not necessarily need to be performed by an obstetrician, but they should include an accurate assessment of your weight and blood pressure, measuring your abdomen for growth of the baby, and checking your urine for protein and glucose.  Any problem that is identified should be addressed earlier rather than later as it may necessitate a change in your delivery plans.

Remember that if you are planning to return to your home country for delivery, most airlines forbid international travel after thirty-two weeks and some as early as twenty-eight weeks.

Finally, what comes as a shock to many expatriates is what all of this costs!  After all, many expats live in countries where the overall cost of living is much below what they experience at home.  And it is true that many laboratory tests, medicines and medical procedures are a lot less expensive in other countries than they are, for instance, in the United States.  But if you live in a remote area, then you need to factor in the cost of transportation to and from your prenatal visits and perhaps even overnight hotel stays.  You may also need to consider the cost of buying your own medical supplies and the expense of an emergency medical evacuation or the insurance to cover it.