I wanted to write today's post as a thorough answer to this reader's question. But I simply don't have the answers! So instead I'm just posting the question and hoping that the rest of you can help us out!

Question:

Hi!  My husband and I have begun talking about starting a family, but we're overwhelmed just thinking about how we will plan for childbirth.  I've heard stories of women going back to their passport country for childbirth, and I've also heard stories from women who give birth in their assignment countries.  What are the factors we should consider when making this decision?  What about traveling before and after birth, family help, or separation from my husband if I need to travel and he needs to stay and "hold down the fort"?  I'd love to hear the wisdom your readers have on this topic, especially about what some needs may be that a new mom might not expect!  Thank you!

Please help us! What kinds of things need to be considered here, ladies? If you gave birth overseas, what was your expereince, and how did you make that choice? If you traveled back to your passport country for childbirth, how did you plan, what factors did you have to consider? How long were you away from your assignment country? Have any of our readers been seperated from their husbands for childbirth? What kinds of questions should this potential new mom be asking right now?

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  • My own experience giving birth overseas was amazing. It was our second son. Our first, in the States, was an emergency C-section after 15 hours of labor with a baby in the wrong position. So my second was a VBAC. We had two options - 1) travel 350 miles to the capitol city, where we would have access to decent medical care and well-trained African doctors; or 2) travel 80 miles to a mission hospital out in the bush, where we would have an excellent American OBGYN but very limited emergency equipment. We were hands-down more comfortable with the second option, but many people thought we were crazy trying a VBAC in the bush of Africa. There are other organizations working in our area who require their workers to fly out of the country for childbirth because they don't feel the medical care is good enough. Here are some factors that affected our decision:

    1) We had been planning a home-birth in the States with our first child, until circumstances required that we labor in the hospital. So we were already "into" the idea of natural birth and didn't feel that it was necessary to have a team of doctors by my bedside. On the other hand, we were definitely NOT ready to give birth at home in Africa, wanting to be in a hospital in case of something going wrong. (Transfer from home to hospital in Africa is not the same as transfer from home to hospital in America!!)

    2) I had done a LOT of research about pregnancy and childbirth with my first baby, devouring everything I could get my hands on, including a book on midwifery. So I felt comfortable with what to expect, what was normal, and what could go wrong. This made me more confident in making decisions for our second birth.

    3) Although the actual care in case of emergency would probably be no better (and likely more limited) in the bush hospital, we both felt much, much more comfortable working with an American doctor. Not because of the level or quality of training, but simply because of the language barrier and cultural expectations. I wanted someone with me who could understand me when I was screaming, who would allow my husband to take me to the bathroom, etc. :-)

    And we had the most amazing experience ever! We overlooked the stark room (not even a chair for hubby!) and lack of privacy (big windows open into hallway) and just focused on having a baby. My labor was fast and smooth, relatively easy (is labor ever "easy"?) and he was born a big, beautiful baby. An hour later we were headed back to our little guest house to recover in comfort. It could not have been a better experience!

    A few bits of advice -

    **Ask around. Do you know any expats in your area? What do they do for childbirth? What hospitals have the best reputation in your area? Is there a missionary doctor or a clinic run by expats somewhere that you might feel more comfortable in? Consider that traveling a distance within your host country will still be a lot cheaper and a much shorter trip than traveling back to your home country.

    **If you do give birth in a local hospital, be sure to ask lots of questions about expectations. Are husbands allowed with their wives when laboring? Can you have a private room? Are any pain medications available for laboring women? What supplies are you expected to bring? In our country, the laboring mother is expected to bring her own bed-sheets, supplies for baby's first bath, and other things that we consider the hospital's responsibility in the States.

    **Do lots of research. Know what's happening with your body. Know what to expect for childbirth. Knowledge will give you confidence in whatever situation you chose for yourselves. It will also help you make the decision!

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  • I had our second child overseas, and had a very good experience....I believe the reason it was so good was because we prayed a lot about it, and trusted God for all the unknowns. We looked into what our options were as far as hospitals were concerned, and we weren't impressed with the care they had to offer. One major draw back was that my husband would not be allowed in the maternity ward, and I really wanted him to be there through the labor and delivery. We looked and asked around some more, and were blessed to find a German midwife not far away that was willing to do our delivery at home!

    My encouragement to you is first of all, to pray A LOT about it. God knows all about your future children, your pregnancies, and how your deliveries will go. He will guide you. You will have to be willing to trust Him as He makes the way clear, even if some of it looks a little scary. Personally, I experienced some pre-term labor, and had to be on partial bedrest. It was scary to know that if my baby would be born early there was no hospital anywhere close to us capable of handling a preemie. I had to trust God that He loved my baby even more than I did, and whatever happened was okay. My hemoglobin was also very low, and I was at risk for hemorrhaging after the delivery. The midwife was prepared to give me shots to help stop the bleeding, but I had to trust God that He would keep me from hemorrhaging, as there wasn't much I could do about it. Our baby was born 2 1/2 weeks early, but she was healthy. Although there was more blood loss than we would have liked, it wasn't dangerous. The reason I shared those stories is just to testify that God loves it when His children cast themselves on Him, and trust Him. He answers prayers!

    Find out what kind of options you have near you for the birth. Are there any Doctors from another country with good medical knowledge? Would there perhaps be a midwife that could do it? Tour the maternity ward and see if you feel comfortable with it.

    Just a couple more practical thoughts...I have no idea what kinds of things are available near you, but I would encourage you to start taking prenatal vitamins as soon as you're pregnant. (It wouldn't hurt to start now either if you're wanting to conceive.) If there is a way to get some things from your home country have some sent over. Depending on how good of a diet you have, you may want to have some protein powder sent over for you. Pregnant women need lots of protein, and overseas that can be hard to get sometimes. If you're in a hot, tropical climate you may appreciate some Gatorade powder as well. During my pregnancy I would get so thirsty, and I'd drink and drink, but then being water-logged would make me feel sick, and yet my thirst was still not quenched. Gatorade helped me. You may also like to have some liquid chlorophyll to take after the birth, to give you extra iron.

    This is by no means a deciding factor, but one sweet blessing of having your child in the country you're working in is how it will strengthen the bond you have with the people you are working among. The people we lived among were amazed that I didn't go back to my home for the birth, and just loved it that my daughter was born there. They called her one of them. She had dark hair, and they loved it. They said it was because she was born there, and was like them. They were sorely disappointed that we were giving her an American citizenship. :)

    Blessings to you as you face these decisions! May God give you wisdom and confirm it with His peace.

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  • Good advice! Childbirth really is a walk of faith, whether overseas OR in the States!

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  • Guest - Michelle

    If healthcare is free and reliable in your home country or you are high risk those are good reasons to go home. However, for us our child's birth was completely covered by insurance overseas. At the time we lived in a country that didn't have proper healthcare but we came out to a neighboring country that does have good, reliable healthcare. I had a great OBGYN, an excellent midwife and I even had a water birth! I wouldn't recommend being separate from your husband at least for the first child. I needed his support more than other family. We are fortunate that my parents could come out to help just after the birth. Other things to consider... can you get things you feel you need for your baby i.e. car seat, formula (you might not want to need this but it could happen, it did with us), diapers (cloth or disposable), pack-n-play (or in our case a baby sleeper tent), baby carrier, etc. If not and someone can't bring the items you feel necessary out for you then you may want to consider delivering in your passport country. Also if you are over the top nervous about your first child, I would go to your passport country. After your first one you know more what to expect and the idea of delivering in a foreign place isn't as daunting. Remember if you choose to leave your country of service you will probably need leave at least a month before the due date and plan to be gone 3 months after your baby's birth in order to get all the proper paperwork like birth certificate, passport, etc.

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  • Great thoughts, thanks for sharing!

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  • Our second son was born in our host country. I had an easy pregnancy and wonderful birth experience. However, I had a major health crash after he was born, from which I am still recovering, almost 6 yr. later. There were many factors involved, but looking back, I realize that one mistake I made after giving birth in our host country, was that I didn't allow myself enough time to lay low and heal from childbirth. We lived in a remote area, and life was tough. I pushed myself too hard too soon after he was born. So one word of encouragement I would have , if you give birth in your host country, be wise and make sure you have the help you need to give yourself enough of time to just focus on your baby and recover from childbirth. Don't feel guilty if you can't immediately jump back into the life and work and ministry you were involved in before your baby was born. You may need more time then you think, especially if you live in a remoter area, harsh climate or primitive conditions.

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  • Oh, such a good point! Thanks for bringing that up!

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  • Guest - Katie

    We had both of our children in the states. Our first was born 5 months before we left. She was a three day labor with a vacuum delivery that was quite intense and rough. This led us to seriously weigh out our option for baby #2. We decided our current city was out of the question due to sanitation issues and my local friends telling me rough stories of their births and their friends. We also felt like a home birth wasn't a good option due to our first experience.
    My other options were the capitol, a neighboring country, and America. These are the things we did to weigh it out.

    1. Ask management what our options were to see how long Aaron could be away from the program. This opened the door to an early furlough option and a birth stateside. This actually seemed to work well since we would have to be away anyways. Why not raise support while you are at it?

    2. Weigh out the costs financially. We looked at the actual birth, cost of living arrangements in each area, and what it would cost to fly someone out to help us (such as grandma/friend). Since our org budgets the tickets for furlough, this was not a cost we had to consider for this birth.

    3. I called both US doctors and local doctors in our capitol and other provinces to see what they advised. I have RH negative blood, and if I had another rough birth and hemorrhaged, my blood type is not kept in stock. Both local doctors from the capitol and expat doctors confirmed that. We looked into blood banking, but it felt complicated. We also looked into the rhogam shots that I needed for RH- blood.

    4. I considered birth culture in each location. Could I birth as I wished (positions, walking, etc)? Would I feel emotionally comfortable or safe? Could Aaron be with me? Would I have privacy? How do they perform c-sections? Is it sterile?

    4. I considered my emotional support in each of the areas. Who lives in each city that can emotionally support me?

    5. I considered physical support. After the birth of my first daughter, I could not use my legs for days due to nerve inflammation. At the time I didn't have house help and was striking out in finding anyone. I knew I potentially needed someone who could wait on me and help me for a few weeks.

    6. I considered how long I would be separated from my husband.

    7. We considered how close we were to our previously scheduled furlough. We were very close. If we were just starting out our term, this might have changed our decision.

    In the end we chose to do an early furlough which management encouraged. It financially was super minimal since we lived in a friends furnished basement apartment and were brought lots of food post birth. We were also lent a car for our time and my doctor bill was shockingly cheap. The birth went really well the second time around which was a huge answer to prayer and gives me more confidence to try it in another location. We had a lot of emotional and physical support stateside which was nice as well.
    I thought doing a furlough would potentially be rough, but it has been really relaxing and rejuvenating. Most people understand that you have had a baby. We made a video to send to people we could not see which helped a lot. I also have let my husband handle most of the admin stuff.
    I left at 33 weeks pregnant I think, and my husband came at 37 weeks I believe. The details are fuzzy but it was a month of being apart. It was hard, but I had my mom and friends help me out a ton. I lived with my mom for two of those weeks and then set up our place before my husband joined me. In any other location I would also have had to leave somewhat early and live apart from my husband, so it felt easier to do that with family.

    We are still stateside and plan to go back in April which will be about 5 months after having the baby.

    Recommendations:
    1. Take lots of vitamins and eat lots of protein. I came back deficient in calcium, protein, and iron. Our baby was super healthy, but I was wiped out!

    2. Check out the medical facilities ahead of time. Ask for a tour. I did that in a few places. I also had medical care in our local city, the capitol, and neighboring country, so I got to feel out each of those medical environments. I had a few rough experiences in my host country with OB which caused some red flags to pop up. Exploring the system or interfacing with doctors will give you a good idea of what it is like. The same goes for our passport country right?

    3. Ask other nationals and expats. Both will give you great insight. My national friends gave me way more insight than I expected. They even got down to the details of how their c-sections were stitched differently by different doctors. Many of them had traveled to the capitol or other areas to give birth so it was interesting to hear each of them compare. And women will talk! All I had to do was throw out a few questions to some moms hanging out and all sorts of stuff came up. Some of my expat friends had given birth locally and some in a neighboring country and each had an experience to tell.

    4. Go where grandma is or ship her out to you :) This is the exact advice an expat doctor gave me. Having that extra set of hands is awesome! If family can't come to you ask some of your expat friends if they would help out. It is true that not letting your body recover will lead to problems. I also find that I need loads of support in the first two weeks while I am figuring out nursing. Both of my kids needed tongue tie surgeries so nursing took a lot of work.

    5. Go where God leads. Just because you give birth in a certain place doesn't mean you will give birth there for every kid. Each kid is different and so is each situation. Weigh out the factors and pray about the overall situation. Each place will have pros and cons. God will lead you.

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  • A reader emailed the following response to this post -

    Your birth plan is going to be unique to you and your husband. I can't say," oh, you should definitely. .........." Your needs might be different than mine.
    All my 4 children were born overseas. At home or in a temporary home in the city. I don't regret that for one minute. Was it a step of faith? Yes. Was it scary sometimes? Yes. I would do it over again the same way. (The only reason that I would like to have a birth in my home country is cause I'd love to experience a comfortable states-side birthing center :) God knows if that will ever happen.
    I would really caution the thing of on purpose planning that you are separated from your husband for the birth. This is an experience that God intended to draw us closer as a couple. To help you understand each other. This is OUR birth, not MY birth.
    Another thing you might want to consider and check into is paperwork. If your baby is born abroad some countries will allow the child to have dual citizenship which can be a big blessing to that child as an adult. Since my children are dual citizens they will be able to enter and serve as missionaries in a wider range of countries without all the immigration stress that many of us have had to deal with. -Joyce

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  • Guest - Miller

    The topic of this post is very interesting for all of us which is about Planning for Childbirth Overseas. This is very impressive for all of those parents who are living overseas with their kids. I will must share this informative post with others.
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