2 October 2014

Expecting abroad - Pregnancy in a strange land

When you find out you are expecting most couples will run the gamut of emotions from ecstasy (if planned) to terror.  Your mind then turns to ‘what next?’.  In your home country it is fairly simple – you know how processes tend to work so will go to your doctor and be guided by them.  You will probably have family – parents, in laws, aunts, cousins and friends who have been through the system and can give advice if you want it.

When you are abroad things get a little more complicated – expectations are different and sometimes the language can be a hurdle.  I had our first two children in the UK – I had lived there for some years and was quite accultured but no one in my family had been through the system there before.  My mother and I were shocked when we found out how unmedicalised it was and it made us both feel very uncomfortable.  Being au fait with the language and cultural expectations, however, meant that I could advocate for what I wanted.  Interestingly a friend has just had this experience in reverse – she is from UK and currently expecting in Australia – she finds the process there far too medicalised for her taste. 

We were still in Kazakhstan (but due to move to Malaysia in the third trimester) when we found out about our third child and I had to negotiate a complex web of Kazakh hospitals, general clinic, insurance and the potential contacts in Malaysia as well as speaking to my lovely UK OB and arranging for her to speak to and send my operative notes on to my new consultant in Malaysia.

Because I was not going to complete the pregnancy in Kazakhstan it was decided not to book me in to the Kazakh system but to have ad hoc appointments every few weeks.  My general clinic would attend appointments with me to translate for the sonographers and OB.  This was a great idea until it transpired that the representative had no knowledge of obstetrics in either Russian or English – I ended up doing most of the translation/speaking myself including making sure we understood the results of the anomaly scans.  Because I refused an amniocentesis I was not permitted to have any maternal blood risk checks in Kazakhstan although this had been permitted in the UK.   It was not until we arrived in Malaysia that I was able to understand with 100% certainty what my OB was saying to me. He had to rely on my translations of the Kazakh notes for background and ended up doing a from scratch work up.

Advice and expectations differ greatly from country to country as well.  In the UK dietary advice for expectant mothers is very strict and extremely restrictive.  Both Kazakhstan and Malaysia seem to be far more easy going, at least as far as food is concerned.  My Kazakhstani friends were, however, horrified that I would wear high heels when expecting as it was ‘dangerous’.  I was seen as cavalier for lifting and moving a dining chair and one told me, in all seriousness, her husband had been warned not to drink beer while she was expecting as it might harm the baby!  In the UK I was allowed to take paracetamol for a cold or headache and antibiotics for tonsillitis.  In Kazakhstan I was told I could not have antibiotics or painkillers at all (though I managed to sneak some paracetamol from a pharmacy saying they were for my husband) Conversely it is not unusual to see expectant mothers in saunas and jacuzzis in Kazakhstan – something completely beyond the pale in the UK. 

In the UK you are given a firm estimated day of delivery – (our first child is the only one we know who actually arrived on that day) and everything is calculated in the number of weeks and days.  In Kazakhstan I asked when this date would be and was told – ‘some point in September – when the baby feels like coming’.  In Malaysia the system is similar to the UK and the doctor and I spent some time working out when we could safely schedule the operation. In the UK women are rarely weighed but sugar and bloods are checked assiduously – in Kazakhstan and Malaysia I was weighed at every appointment – I did not, however, have as many blood or sugar checks. 

UK visitors to hospital tend to be restricted in number and time. Even fathers are thrown out at the end of visiting time to allow mothers and babies to ‘rest’  a strange rationale as I know I would have rested more had my husband been able to help look after the babies.  I recall my parents and sister being barred from coming in (with our breakfasts) to meet our first baby, it took us a long time to convince the nurses to let them in.  Here in Miri I was told I could have the whole family to stay over and sleep in my room if I want (for a small surcharge).  They were most apologetic that our children would not be allowed in the operating theatre!  The mind boggles as to the requests they must have for that pre-emptive statement to be made with apology!  

My babies have all been operative deliveries. In the UK, as  long as a local anaesthetic is being used the baby (if healthy) is given to the father and stays with the parents in the Operating Theatre.  Here in Malaysia I was allowed a quick sight of the baby before she was whisked away to the Nursery my Husband rushing behind to get out of scrubs and back into his clothes so he could keep her in view the whole time.  I spent another hour and a bit rather bored and wishing I had a book to read as the operation was concluded, with recovery checks etc it was about two hours before I got to meet the baby properly.  The nurses kept trying to take the baby back to the nursery for her checks and to ‘give me a break’.  As soon as I was allowed to walk I followed them everywhere – they were quite surprised that I did not want to be away from her and concerned that the walk (all of 200m) and standing around might be too much.

Top tips
  1. Find out how things work in your host country and see how it differs from your expectations.
  2. Speak with friends and family at home to find out what their experiences were.
  3. Decide with your husband/partner where you want to have the baby – is your host country safe or should you go home?  This will depend on the host country and whether you have any complications, be aware that a text book pregnancy does not guarantee a text book, problem free birth.
  4. Try and find a health care professional who will support you in your wishes for care and delivery.  Be prepared to research options and advocate for what you want.
  5. Be realistic about care – in some countries you will not be allowed whale music, dim lights and a water birth.  In others this will be encouraged, if you have your heart set on a particular type of birth you may need to arrange for a doctor who agrees with your ideas or (at the extreme) move to a country that will allow it.
  6. Take ‘advice’ with a pinch of salt – it varies from country to country, try to find out the reasons for the advice and weigh your own risks.
  7. Be aware that cultural expectations can be very different – in some countries your baby will stay with you at all times – in others it will be removed.  If you do not want this speak to the hospital staff and explain why.  We found staff happy to accommodate our ‘strange’ requests and allowed us into the nursery when our daughter was brought down.
  8. Remember that the doctors are professionals and, at the end of the day, want only the best outcome for you and your baby.  

Click on the picture for more information on the challenges of expat life.

Ersatz Expat


  1. Useful tips here!! I had our son in the Seychelles and while there were of course challenges I thought it was fantastic!!