For the past few years, my husband and I have unknowingly and totally unconsciously started a new tradition: each time we moved as expats, we combined our international move with an international pregnancy. As a result I kept starting a pregnancy in one country and finishing in another.

I have been pregnant and received pre-natal care in 3 different countries – Denmark, Singapore and in the UAE. I have also traveled extensively during both of my pregnancies and received additional care and undergone appointments and tests in two of our home countries of Germany and Pakistan.

My international experiences have shown me how different cultures approach pregnancy and childbirth. Here’s, what I’ve learned so far:

  1. Attitudes to pregnant women and pregnancy do’s and don’ts vary greatly around the world:

 It is a fact that as soon as you fall pregnant, (no matter where you are in the world), those around you will offer you a lot of advice. But the advice you get, may depend very much on which country you find yourself pregnant in.

The first thing my Danish midwife said to me was “Don’t worry; you can still bike to work!” This was so, because in Denmark, pregnancy is not viewed as an illness and women are encouraged to go on about their lives. The Danes have a very practical, matter-of-fact approach to pregnancy and childbirth and being pregnant does not mean being any less active outdoors, for instance.  In Singapore, the Chinese are extremely superstitious and cautious when dealing with pregnant women as they are seen as delicate. When we were moving into our new Singapore apartment and I was 5 months pregnant, our landlady (a local Chinese woman in her 50’s) kept making me sit down, bringing me a glass of water and insisting that I hire someone to setup the apartment because I “shouldn’t be moving too much” especially “in my condition.”

Decaf coffee or no coffee, yes to sushi or a complete no to raw fish – pregnancy do’s and don’t vary so much around the world, which brings me to my next point.

2. Listen to your body and follow your own instincts:

Different people would offer different advice, especially dietary advice was outright contradictory in the countries I was pregnant in. Something that was okay or even encouraged in one culture (like eating spicy food in Pakistani culture), was a complete no-go in another one (in Singapore and both Denmark, spicy food was only to be eaten to help induce labor!). It is important to recognize the cultural differences and figure out what works best for yourself, and to not stress out about expectations that are thrown at you. Amidst the differing opinions and advice out there; you have to trust yourself and your instincts. Only you can decide what’s best for yourself and your baby.

As for me, I decided to politely acknowledge any advice given, while quietly being amused by all the contradictions and also developing a keen interest in understanding the cultural roots behind certain ideas or practices.

3. Standards for the appropriate amount of weight gain depend on which country you are pregnant in:

In my first pregnancy, my Copenhagen hospital handed out the weight guidelines to me very clearly stating I didn’t need to “eat for two” – just about 300 extra calories per day, starting from my second trimester would be sufficient. The recommended weight gain was perhaps about a kilo a month and my weight was not constantly checked. In contrast, in Singapore and in Dubai, I got weighed at the start of every prenatal appointment. And I knew women in Singapore who prided themselves on only gaining the recommended 10 kilos.

I have been on the receiving end of both spectrums – not gaining enough weight initially in my 1st pregnancy and constantly being told the baby measured little, and gaining a lot in my 2nd pregnancy and being told the baby was too big already at 32 weeks!

In the end, I tried not to focus too much on the weight and the differing international standards. Each baby is different and so is each pregnancy.

4. Medical tests and protocol for pregnant women vary from country to country:

In some countries they scan you too much – like in Singapore, I was scanned at every single appointment. In other countries, like in Denmark you only go through the medically necessary 2 ultrasound scans throughout your entire pregnancy, which are deemed sufficient.

In Singapore, I did not have to undergo the glucose test, but in Dubai it was mandatory and quite thankfully so – since I tested borderline positive for gestational diabetes.

Medical protocol varies greatly between countries. It’s best to be as informed as possible about the local medical culture and know what to expect beforehand.

5. It’s important to have trust and full faith in your doctor/midwife/hospital:

In some countries, you choose the hospital you want to give birth in and then look at the doctors who sit there and choose among them. In others, you don’t get to choose a doctor at all, you are registered at the public hospital closest to you, or a midwife is assigned to you.

Regardless of the process and which system you give birth in, there is one most important thing – to have trust, confidence and full faith in your doctor/midwife/hospital. This is the single most important factor that will help you throughout your pregnancy. And when you have to make tough decisions under pressure, your medical team will help you through it.

6. Understand the level of prenatal intervention in the local culture:

Soon after arriving in Singapore, I realized that the level of prenatal intervention was exceedingly high there. Superstition and local culture play a huge part, with many local women choosing a planned C-section to ensure their child is born on an auspicious day. This is why I deliberately set out to choose a pro-natural birth doctor there; someone who would support me in my efforts to have a natural/vaginal birth and not push me or rush me into a C-section (especially if there was no need for it medically!). I asked around on expat forums, and got several good recommendations and advice this way, which helped me choose a doctor I was comfortable with.

In Dubai, I found a high level of interventionism as well – membrane sweeps at 38 weeks as part of a normal check-up, recommended induction at 39 weeks and so on.

The level of pre-natal intervention varies throughout the world, so it’s important to understand the local culture in which you give birth and speak up about your choices.

7. No matter where you are, you need to be your own best advocate:

This can be hard to do, even in your home country, but it’s so important to state your wishes and be your own best advocate.

When my Dubai doctor wanted to induce me at 39 weeks, I asked for 40 weeks instead. If I hadn’t gone into labor naturally by then, I was willing to be induced because of some previous risk factors.

Being an advocate also means doing your own research, making informed choices and drawing your own conclusions. This includes knowing things like your options for pain management, how late can you ask for an epidural, whether an anesthesiologist is always on call, what factors could increase your chance for an emergency C-section and hospital procedures and tests conducted on your newborn.

8. Post-natal care is extremely underrated but should be a vital component of your birth plan:

Never underestimate the importance of post-natal care, especially in the days right after you give birth.

In Denmark, it is possible that if you’ve had a natural birth in the morning, that you are home in the evening, making pizza for dinner with your family by 6pm.

In Singapore, they like to keep you at the hospital for 2-3 days (and definitely more if you’ve given birth via C-section). Especially if you’re a first time mum, those extra few days in Singaporean hospitals were to show you the ropes – provide breastfeeding and lactation support, show you how to feed, bathe and swaddle your baby etc. In Dubai, the after-care also included a visit to my home by a midwife to check on how I and the baby were doing. All these measures are so important in helping a new mother feel supported in her new culture, after giving birth.

My brush with pre-eclampsia after I gave birth to my daughter, highlighted the need for excellent post-natal care. Scary seizures, high blood pressure, dangerously low iron levels, one blood transfusion and 10 days of re-hospitalization later, I was able to return home to my newborn, but my after-care extended up to 6 months in Singapore including regular visits with a cardiologist and blood pressure medication. I was extremely grateful for the thoroughness and efficiency of the postnatal care I received even after giving birth.

9. Embrace the importance of the first 40 days in the post-partum culture:

In many cultures around the world, (including my own Pakistani culture), the first 40 days after you give birth are of great significance for both mother and child in terms of rest, recuperation, food and diet. The same was incidentally true of the local Singaporean Chinese culture – where Moms enjoy a period of “confinement”. Practices and traditions vary but the idea in essence is the same – to recover from the stress of childbirth, a woman is helped and encouraged to eat certain energy-rich foods, to be supported by friends and family (or a confinement nanny in Singapore) and to generally limit her movement and activity until she is slowly back on her feet again and can cope with the demands of a new born.

In other countries and cultures like Denmark, Germany (where my husband is from) and in the United States (where I have spent many years) – this is a foreign concept. There and in many other Western countries, women are expected to bounce back immediately from childbirth and the lack of a socially-accepted post-partum culture means women are often putting themselves under pressure to adjust to their new role as mothers and keep on top of the ironing and vacuuming.

Regardless of which culture you give birth in, take care of yourself for the first month or 40 days. Accept offers of help to cook and clean, and don’t expect to be fitting back in your pre-pregnancy jeans right away. Give yourself and your body time to rest and recover after the stress of childbirth.

10. Keep on top of the international pregnancy paperwork:

My international pregnancies in Singapore and Dubai meant that armed with birth certificates in Chinese and Arabic, we had a limited number of days after the birth of each child to get our child registered in our local country, apply for resident permits and appropriate visas and get the birth registered in the embassies of our home countries, have birth certificates translated to German, Italian etc. and apply for 3 passports.

Phew! That’s a lot of paperwork and if possible it’s best to delegate the responsibility to your significant other so that you can focus on yourself and baby.

International pregnancies mean an increase in international paperwork, be aware of that in advance and plan accordingly due to local timelines and procedures.

 

Have you been pregnant or received pre-natal care in more than one country? What has your biggest learning been from your international pregnancy?

 

About the Author:

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Mariam is an eternal expat who 15 years, 7 countries and 3 continents later, is embarrassingly a seasoned expert at getting lost in every new city she calls home, and butchering words in every new foreign language she picks up along the way. She is the founder and writer of the blog ‘And Then We Moved To’ and writes mostly about life as an expat, trying to raise her multilingual and multicultural children in her East-meets-West marriage and of course traveling the world. Her work has been published on the Huffington Post, Expat Living Singapore, Expat Living Hong Kong, Expat Connect Dubai and Sassy Mama Dubai. You can connect with her on Facebook and follow her on Instagram @andthenwemovedto.

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