Happy healthy maman: Facilitating pregnancy in a different culture





I have had the pleasure of living abroad for the past seven years. In this period, I’ve worked in and experienced distinct cultures and immersed myself in unique and different lifestyle choices. For me, life is a continuum, and living as an expat means life goes on, meaning love, marriage, and family happen.

Regarding family, I had a special experience of pregnancy and birth in a different country and culture: in Italy. Yes, my son was ‘Made in Italy’. The journey to motherhood is already a mix of emotions and feelings. There are so many questions, unknowns and uncertainty, where do you seek guidance?

In the pre-internet days, we shared our experiences in our communities, with our families and neighbours, passing down advice from mother to daughter. Nowadays, you can Google search and find diverse types of advice and tips on pregnancy and birth. In a recent conversation, a new mother friend of mine mentioned, “Yeh, my mom said to contact my cousin Jane, but she is in a different time zone, so it would take too long for a quick answer. I recommended we Google it. My mom had an ‘ah-ha’ moment.” The nerve-wrecking part is finding the complete opposite advice under the same search. What to do?

Pregnancy and birth can be magical, exciting, and daunting all at the same time, so doing it in a culture or country that is not your own, can be thrilling but can also add to the anxiety.

During my days abroad, I’ve had the honor of meeting and living with women who have facilitated their pregnancy experience in a culture different from their own. Aside from cultural differences, and language obstacles, there are legal aspects that are often unknown as well as ideas and thoughts that are taboo and controversial.   

As we kick off the “Belly Beautiful” blog series, I share below 16 recommendations from the World Health Organization’s on maternal health care for all mothers to be informed and feel empowered. Related to each recommendation is a brief quote shedding insight on a real-life momma’s experience.

*Of note: The mothers mentioned below mainly come from the USA, UK, Europe and Latin America and have given birth in a culture different from their own.

1.       The whole community should be informed about the various procedures in birth care, to enable each woman to choose the type of birth care she prefers.

“With my husband, I created a birth plan, shared it with my doctor and with the team that was on duty. It was not honored, and barely looked at.”

 2.       The training of professional midwives or birth attendants should be promoted. Care during normal pregnancy and birth and following birth should be the duty of this profession.

“I met mostly with midwives during my second pregnancy and the delivery was with a midwife. I felt confident with their approach and experience.”

 3.       Information about birth practices in hospitals (rates of cesarean sections, etc.) should be given to the public served by the hospitals.

“As I was researching where I wanted to give birth, many hospitals and clinics refused or never provided birth practice information to me to help make an informed decision on where to deliver.”

 4.       There is no justification in any specific geographic region to have more than 10-15% cesarean section births (the current US c-section rate is estimated to be about 32% according to a recent 2017 CDC Report; 2015 BBC report on Europe rates).

“Amongst my friends, family and community most women opt for caesarean so they can ‘book’ the birth and plan accordingly. I felt the pressure to do the same.”

5.       There is no evidence that a cesarean section is required after a previous transverse low segment cesarean section birth. Vaginal deliveries after a cesarean should normally be encouraged wherever emergency surgical capacity is available.

“I had a successful VBAC! I’m grateful to the medical team as well as the family and friend support in this decision.”

6.       There is no evidence that routine electronic fetal monitoring during labor has a positive effect on the outcome of pregnancy.

I escaped the labor room because the team on duty was adamant on hooking me up to the monitors and all I wanted to do was walk around and be free. So, my husband and I snuck away to the hospital garden for a bit so I could walk, dance and feel free.”

 7.       There is no indication for pubic shaving or a pre-delivery enema.

“They shaved me pre-delivery, no questions asked. They said it was just a part of their normal routine before the birth. I asked no questions.”

 8.       Pregnant women should not be put in a lithotomy (flat on the back) position during labor or delivery. They should be encouraged to walk during labor and each woman must freely decide which position to adopt during delivery.

“It was my first baby. During pregnancy, the routine care had been good and exceeded what I would have had in my home country. For the birth they strapped me down, on my back, so that I wouldn’t get up during the delivery.”

9.       The systematic use of episiotomy (incision to enlarge the vaginal opening) is not justified.

I was adamant against episiotomy. Although I tore and required stitches, but everything healed perfectly afterwards.

“I was completely against an episiotomy. Although I tore and required a few stitches, I healed rapidly and everything was fine.”

10.   Birth should not be induced (started artificially) for convenience and the induction of labor should be reserved for specific medical indications. No geographic region should have rates of induced labor over 10%.

“I was induced since I was ‘over-term’. The labor went from 0 to 100 and was a complete shock to my body and the baby due to the increase in rapid, strong contractions over a short period of time. In the end, a caesarean was advised for the safety of the baby.”

 11.   During delivery, the routine administration of analgesic or anesthetic drugs, that are not specifically required to correct or prevent a complication in delivery, should be avoided.

“They gave me too much anaesthesia, and I was really out of it for the first 24 hours after my baby’s arrival.”

12.   Artificial early rupture of the membranes, as a routine process, is not scientifically justified.

“My water was artificially broken by a nurse who went up and pinched, squeezed and punctured me. It was painful. I yelped and my baby, due to fear, I presume, went back up, despite all the work I’d already done during the labor. In the end, I was sent to have a cesearean.”

13.   The healthy newborn must remain with the mother whenever both their conditions permit it. No process of observation of the healthy newborn justifies a separation from the mother.

“I waited nearly 48 hours after birth for the nurses to bring me my baby boy. He was in ‘observation’ and there was only a vague explication as to why. I was unable to breastfeed in this period.”

14.   The immediate beginning of breastfeeding should be promoted, even before the mother leaves the delivery room.

“My baby was taken away immediately after the caesarean birth and kept in observation because he was breathing quickly. The nurse team made the decision to give him formula. I was uninformed and uninvolved in the decision.”

15.   Obstetric care services that have critical attitudes towards technology and that have adopted an attitude of respect for the emotional, psychological and social aspects of birth should be identified. Such services should be encouraged and the processes that have led them to their position must be studied so that they can be used as models to foster similar attitudes in other centers and to influence obstetrical views nationwide.

“I chose a home birth. Simple, no technology, just the courage and strength of my baby and I, with the support of my husband and two midwives.”

 16.   Governments should consider developing regulations to permit the use of new birth technology only after adequate evaluation.

“I decided to not have any ultrasounds during each of my pregnancies. As a health care professional, I have never seen any scientific evidence anywhere indicating the benefits/ effects of doing routine ultrasounds.

Were you aware of these WHO recommendations? Are any of these particularly relevant to you or anyone you know? Do any of the recommendations surprise you? Agree or disagree strongly with any of the above?