This section will cover birth practices of the world and related topics. Some of these writings had appeared on the Online Birth Center News run by Midwifery Today, US.
Australia
Waiting period before the initial visit
You may not get your appointment with your obgys soon after you find out you are pregnant. In Australia, they make your initial appointment with the doctor after 12 weeks of your pregnancy. This is to make sure that the baby is well. It is common that you may have miscarriage in the first part of your pregnancy.
Interpreters are available
Many Japanese are concerned about communication with doctors and midwives, but here in Australia, they have a system that guarantees patient to have interpreters. You may need to book in advance, but you will be able to communicate with the doctor through interpreters. In case of emergency, they have telephone interpreters standing by all the time.
Birth Centers
Birth centers are quite popular and in demand. There is no doctors but just midwives at the birth center. They will not do pelvic examination during pregnancy, they will not give you epidural, they will not over medicate you, they will not perform episiotomy. They allow you to have as natural a birth as possible. But in case of any emergency or if any complication happens, you will be sent to the hospital which is usually on the same grounds as the birth centers.
Discharged within 24 hours
If you give birth at the birth center, they will allow you to return home after 24 hours. If you have birth in the hospital, you will be in the hospital for about 3 days. So you may worry whether you may be OK with so short stay, but for one whole week after you are discharged from the birth center, the midwife will visit your home every day to check you and your baby, so you will not have to worry.
Who attends birth
In Japan and still in many parts of Asia, husbands are not allowed in the delivery room. In the old days birth was considered a women乫s thing in these regions and as hospital birth grew in number, the delivery room was only for the medical staff.
However, now, more and more women are becoming aware that when husbands attend birth, they are more likely to help on child rearing. Thus they now try to choose the hospitals that will allow husbands to attend birth. Yet it is still difficult to find such hospitals.
When we look around the world, husbands attending birth is a normal thing. Maybe it has been around for more than 30 years in some places. In some birth centers they even allow children to be at the scene. If it is home birth, there is no restriction as to who will be there, friends, sister, mother, whomever. It will be totally up to the choice of the birth mother.
I believe the women乫s choice of who she wants to be at her side when she has her baby does have an effect on the satisfaction of her birth. If she gets the support from the people whom she trusts and feels comfortable with, this will certainly help her to relax and thus lead to an easy delivery.
China
There is a big difference in the way
the local people are treated and the way the foreigners living in China are
treated. The difference is so great that it even determines life and death
of a newborn child. In this section I will be introducing how the local
people experience birth.
Birth
means having a boy
In China, the people expect to have boys so much that it even sounds like when you give birth it means you have to have a boy. Therefore, the Chinese would eat sunflower seeds and watermelon seeds so that they will have boys. There are couple of things the Chinese eat during pregnancy and before pregnancy such as dumpling, so that you can have a boy, prunes, so that you will have early delivery, peanuts, so that one can have an easy delivery.
No Privacy
Even
when you are looking at your own ultrasound, there is someone overlooking
your baby. There are patients who would not stay in line and they are even
standing at the side of the doctor乫s desk as they wait. Of course, one has
no privacy during pelvic examination.
Ob-gyns are all women doctors, no men
allowed
In
China, all the ob-gyns are female. Men are not allowed in the delivery room.
Even when you wish your husband to help you as an interpreter, the nurses
will tell you to leave the labor room. In one hospital, they had a camera
set in the labor room and the husband was only able to talk with his wife
over the screen with a phone conversation.
The
reason they have this system is because in the past one of the husband got
so emotional over seeing his wife suffer from labor, he had punched the
doctor. And that is the reason that the hospital staff feels that the
Chinese husbands are not ready to be in the delivery room to give support to
their wives. I find the Chinese husbands to be very loving and caring
towards their wives and this is so sad that they cannot be there for the
wives at the delivery.
More
surprisingly, in one of the hospitals, the visitors are able to see the
actual delivery over the glass window of the delivery room. It is surprising
to see the delivery table lined up in a row like the beauty salon seats.
Caesarean Section
Birth date
Here is my bi-monthly article on birth around the world. Today I would like to take up the topic of birth year, month, day and time. As the year 2000 approaches, I am receiving letters from clients, wishing their babies to be born in the year 2000, and that means that they have tried to conceive so that the baby will be carried through to the year 2000. Well I think that is great. It will be a mark of the century.
But did you know that around the globe, there are some countries that actually allow you to change the birth year, date and time?
Well after all, if you have home birth, the details are known only to the midwife and the parents. There is no explicit proof or evidence that the baby was actually born on that particular time, day and the year, and if the parents have a valid reason to relax the rules of objective truth, why not? Is it really a matter of ethics and morals?
Besides in some developing countries, they don乫t even have a clock to check what time the baby was actually born. Imagine being able to choose your baby乫s birthday.
In some countries, a particular birth date, time, and year may mean more than just numbers. It can mean a blessing, a prayer for the baby乫s future.
In Singapore, the year 1988.8.8. was one of the best dates to be born for the Chinese. 8 represented everlasting fortune. The parents wished their children to be prosperous and wealthy in the future. 1988 was also the year of the dragon. The year of the dragon represented strength and dignity. If you had a boy, you couldn乫t wish for more. But now the classrooms of children born in the year 1988 is packed full (smiling).
In Taiwan, the best birth date around the due date is decided by the fortune teller. When the day is decided, some even opt for a planned birth by either inducing labor or having a Caesarean section.
Certainly from the view point of the pro-natural birth advocates, I know that any artificail birth is unacceptable, but in some cultures, they may value these customs and beliefs over naturalness.
Netherlands
Home birth
What surprised me the most about birth in the Netherlands was the high percentage of home birth. As high as nearly 40%. This was possible since the midwives were very skilled and knowledgeable and highly qualified for assist normal birth. The obstetricians worked as a team backing up the midwives.
Doctor's role
Once you find out that you are pregnant, most mothers visit their home doctor, but as soon as they seem to follow the normal course of pregnancy, the home doctor will refer her to one of the midwife clinics. Thereafter, the midwife takes over. The frequency of the visit to the midwife clinic is the world standard, but the care seems to be more personal.
Choice of birth place
The choice is up to the mothers to decide whether they want to have home birth or a hospital birth. However, many have heard stories of the good home birth experience, they seem to opt for home birth more. They have mentioned that home birth is most relaxing and many opt for home birth especially if its their second or third child. At home birth, you progress at your own pace. The husband cuts the umbilical cord and the baby is with you all the time.
Home visit by the midwife
It is very reassuring to know that the midwife who delivered one's baby visit you for nearly 10 days after birth. You also have the choice of having a well-trained postnatal nurse for 3, 5, 8 hours a day. She will take care of the woman as she recovers as well as looking after the baby and the older children, the house and attend to the guests.
Waiting rooms
I have looked into several waiting rooms of ob-gyn clinics and have noticed who is there besides the patient, yes, the mothers-to-be and women.
In Japan, to start off with, in the past, ob-gyn clinics were totally for women and men never entered the clinic since they felt ashamed to be there. But nowadays things are slowly changing. The husbands began to go along with the women to the clinic, yet the number is still small compared to the west. The midwifery clinics on the other hand encouraged husbands to come with their wives and there are more men in midwifery clinics than in hospitals.
In Singapore, I have noticed that the husbands always come to the ob-gyn clinics with the women. Moreover, when they are to go to the pediatrician, they will also accompany their maid, to look after the baby and their grandmother to look after the sick child. This was also seen in Hong Kong as well. There, the husbands went along to the clinic with the expectant mothers.
In Korea, it was more like the mother of the women who came along to the clinic. In China, I have also noticed that mothers of the women go along to the clinic. I guess in these Asian countries where Western cultural influence is not so much at a stake, has a strong tie between the mother and the expectant women. Of course South Korea, places like Seoul is a bit different, yet still the change is slow.
Of course in Europe, and in the United States, prenatal check ups are to be attended as a couple. I believe in near future, the concept of family will become so strong that the ob-gyn clinics will not only be places for women but to see as a whole, women and men.
Philippines
In the Philippines, babies are born as part of an every day life event. Because they are Catholics, they tend to have many children. In the rural clinics, they discourage women to bear more than 4 children. Today, there has been more medical intervention done than it was of the past where natural birth was common.
Especially
in Manila, epidurals and even Caesarean birth is popular for foreign
expatriats.
Pregnant
women are a blessing
There
are many folklores related to birth. Pregnant women are considered to be a
blessing and they are told to bring luck in the family.
Also, children are considered to bring wealth in the family.
D
There
are many restrictions during pregnancy: do not step over a rope since the
baby will fall and become bleech, do not put anything around your neck or
over your shoulder because the baby may be born with his/her umbilical cord
wrapped around its neck, wear a hat when you go out in the evening when a
full moon is seen because that will have bad influence, do not buy anything
for the baby until past 8th months of pregnancy, drink young
coconut juice during the last trimester of pregnancy for easy delivery,
apply coconut oil over the breast to massage. Well, there are some things we
can agree on. Which ones would you try?
Husband乫s
role is to bring food
Home
birth was a common thing in the rural area, however, even in the rural areas
nowadays, hospital birth has become a popular event. In these rural
hospitals, the mother of the woman is considered to be the assistant to
birth and the father乫s role is to bring food. The midwife is called the
乪comadorona乫 and her role is to massage the woman from labor till
afterbirth.
Herbs
used after episiotomy
The Philippinas will
immerse where
they had the stitches soak into warm water and they will burn incense to
soothe the atmosphere. They also put char coal and herb
indirectly on the perineum for quick recovery.
Bargaining
on delivery fees
I was most surprised to hear that one must bargain even for the hospital charges. Sounds a bit like the U.S. where the health insurance companies negotiate with hospitals on our behalf, but in Philippines, the success lies on the patient him/herself.
Birth away from home, a trend?
It is not easy to mention about people taking advantages over another country and often the US being the target. This may sound harsh, but true. Over the past 30 years, many people of insecure countries had looked into giving birth in the US, simply to gain the right of citizenship of the country. The advantages of being that if the child was a US citizen, then the family has a high chance of getting a permanent visa or to become a US citizen in the future. Still many people believe in the American dream come true.
From the stand point of a consultant who support birth away from home for the expatriots (those who have gone overseas for business but returning back to their home country eventually.), I had to encounter those who were planning to give birth in order to gain citizenship for the child. Most popular spot for the Japanese is Hawaii.
The tourist visa only allows 3months stay, so they take the risk of flying nearly 10 hours on plane at nearly the end of trimester stage. The insurance does not cover the delivery nor the hospital stay, so they spend a tremendous amount of money. Some people make business out of supporting these families who come to Hawaii for delivering babies. Staying in hotels or condominiums is not the same as home. They would have to fly back with the tiny newborn.
Now, for what reason would they ever choose to take such risk? Just to gain citizenship? Taking so much risk? If midwives are to support natural birth, this kind of birth is just not natural to my eyes. When I think about the babies who would have to endure unnecessary stress, I am just not for it. Babies should not be victimized.
Hospital meals
You may not think hospital meals are that important, but for some mothers they are. The meals may even influence their impression of the medical facility as well as the medical staff within.
Naturally, most people prefer to have meals that they are used to eating at home. But it is not usually the case when you have your babies away from your home country.
I have looked into various hospital meals in different countries and found out that the hospital meals do represent the country. In Korea, you are expected to have Korean food served. In India, yes very spicy food. What was more interesting was at the hospitals where there are many foreigners admitted, they gave choices such as western food and the local food.
In underdeveloped countries, meals are not served at the hospital. The family has to bring food from the house. In countries like Thai, they even allow you to cater meals from outside the hospital. The restaurant staff comes to take your order? Wow, what a luxury.
In countries where there were mixed ethnic group, they had many choices, such as in Singapore, you have the choice of Chinese food, Western food, Muslim food or Vegetarian. Muslim food is mainly for the Malaysian Singaporean, and Vegetarian food was for the Indian Singaporean.
I myself had the opportunity to challenge all and tried Chinese one day and Muslim another day. I thought it was part of experiencing the dynamics of having your baby in the exotic South East Asia.
Umbilical cord
The umbilical cord connects the mother and the child in the uterus. What do you do with the cord? Clamp it and cut it as soon as the baby is born? Do you just leave it for a while until the cord has stopped pulsating? Do you wait until the placenta is delivered? Do you advice the husbands to do the snipping of the cord? Well one of the midwife I knew allowed the child who was attending the birth to feel the pulse, the blood that was flowing through the cord. 乬Feel the pulse?乭 she said, and I saw the child with a surprising look, and I thought that was beautiful.
The cord may mean nothing to many, but for some it symbolizes the strong bond of LOVE between the mother and the child. In Japan it has long been practiced to keep the umbilical stub that got dried and fell off from the navel. Since the length of hospital stay is an average of 5 to 7 days, the probability of having the stub off before you leave the hospital is very high. So, the nurse may place it in a wooden box. Many hospitals in Japan nowadays do not pass the umbilical stub for hygienic reasons. The mother usually keeps it along with the first crop of hair, but some give it back to their daughter when she leaves the house to get married.
I know one lady who had kept a long strand of cord and dried it out in the air and kept it. While many of her friends only get to keep the umbilical stub, she kept almost the entire length of the cord. Some may say 乬yuck, it is unhygienic!乭 but in some cultures, or even some people, they value the cord in such way that was the connection of the two entities. So, maybe next time you cut the cord, you may want to ask the ladies how they feel about the cord.
Mother and Child Health booklet
For the past 14 years I have been collecting mother and child health booklets around the world. You might wonder what this is. Well, this is a booklet where all the records of the mother during pregnancy, birth, and afterbirth are kept as well as all the records of the child's physical developments including immunization records.
Unfortunately in most countries I have found that the booklet is not combined with the mother's. In some countries the mother's record which she carries with her only includes her weight gaining records which she can record herself. In general the mother's pregnancy record is very simple but the child's development record is with more detail in most countries.
Perhaps the only country which has the two combined is Japan. Germany came close with the mother's record quite in detail and the child's record also in detail, but the booklets were separate. In some developing countries including Mexico have adapted Japan's mother and child health booklet thus combining the two.
I believe the reason that Japan has the mother's record in detail is because many still return to their home province to have birth and the doctor or the midwife needs to know how she was progressing through her pregnancy. In Japan it is not our custom to ask for a copy of the medical records hence this booklet does become handy. The record includes the tests the mother had done including weight gain, blood pressure, results of the urine tests, blood tests, and so forth.
If you consider the child's life beginning from the time of conception, I think it is natural that the record be kept from pregnancy stage. My mother had handed my health booklet to me when I got married and I was able to see how she carried me through her pregnancy and it made me feel I was really loved.
Breast-massage in Japan
When I was asked by Donna whether I would write something related to customs of various countries surrounding birth, I spontaneously answered yes, because I found the differences to be very interesting. But then I realized if I get questions from the experts, I wasn乫t sure if I could answer them all. I am not a midwife, obstetrician nor a nurse. I am just an international social worker who just happens to have done research on birth of various countries. So, upon this understanding, I hope you will enjoy my article.
Well, there can乫t be a better place to start than to start where I live, yes the exotic Asia. So today I am picking up the topic of breast-massage in Japan.
One of the complaints my Japanese clients raise when they have birth overseas is, 乬I didn乫t get any breast massage.乭. In Japan, there is a belief that massaging the breast will promote the milk flow. I believe it comes from good blood circulation. There are even books on how to massage one乫s breast with illustrated guide lines. There are even schools of thoughts in this area. In one school, Oketani, they believe in removing the base off the chest and pushing it on sideways and up and down.
At the hospitals, the midwife will place a hot towel over your breast and massage your breast. Remember how your milk drips after taking a hot shower? I believe it is almost like that, a hot compress brings the good circulation of the blood and thus the milk. She will squeeze the nipple to make the milk come. It is a 5-minute procedure, but you surely feel good.
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