Delivery Away from Home

Other chapters talk about the issues of how to find an obstetrician in a strange country, and what is important in prenatal care.  Here we would like to address the issues pertaining to the delivery itself.

The first and most important thing we have to say is how important it is that you choose a facility that is adequate for a complicated delivery or cesarean section.  Our research on almost a thousand pregnant expatriates showed that they are, on average, older than women who stay in their own countries to deliver.  Also, they tend to have more complications.  Some of this is simply due to the fact of being older, but other factors enter in as well.

Expatriates, in our experience, tend to be risk takers.  And this is no less true of expatriates who happen to be pregnant.  But having a baby is not a good time to take unnecessary risks.  Our data showed time after time that having a baby at home or in some other rustic setting was fraught with severe hazards to both mother and baby.

While it may be appropriate, therefore, to have most of your prenatal visits in a remote setting, that is not the place to plan your delivery—unless it happens to be also equipped with the equipment and personnel necessary for a complicated event.  The laboratory should be adequate for emergency blood transfusion and the nursery prepared to handle sick and premature newborns at least until transfer can be arranged.

In some remote areas, it is often the case that even basic supplies such as bandages, surgical suture and medications are the responsibility of the patient and may need to be located and bought at the last moment.  These possibilities should be investigated well in advance.

It doesn’t matter what part of the world you are from, it is most likely that normal obstetrical practices will be different in your host country than at home.  And you will find it impossible to convince anyone that your ways are any better than theirs.

These cultural and language barriers have the potential of turning a normally joyful event into a nightmare.  In the United States, for instance, it has become commonplace for your husband or partner to be present and even participatory during labor.  This is not the custom in most other cultures.  Careful communication with your obstetrical provider ahead of time can help you avoid much confusion and frustration. 

Many expatriates have found it helpful to have with them someone to function as a duola.  A Spanish word, this represents a woman who functions as your advocate, coach and intermediary during labor.  She may be native or expatriate, but she should be fluent in the language, familiar with the medical setting and able to act as a liaison between you and the medical staff.

In-hospital nursing care in other countries is often radically different than what you are used to.  In many instances, care of the mother and baby after delivery is expected to be largely the job of family members.  Whenever possible, we recommend that you be prepared for this to be the case.

We would like to close by saying that we are not insisting that obstetrical care be hi-tech and highly invasive.  There’s often way too much of that and it can amount to nothing more than “meddlesome midwifery”.   But sad experience has taught us that, at least for expatiates, “going natural” isn’t the answer either.  The key is not necessarily a major medical center with lots of gadgets.  It is simply careful planning for one of the biggest events in your life and, like the Boy Scouts, "being prepared" if problems occur.