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Posts Tagged ‘Giving birth in Korea’

I took Dragon to the zoo on Thursday. It was a lovely sunny day. The birds were chirping. A fresh warm breeze drove the clouds out of the sky. I wore a t-shirt. He wore giraffe pjs and a frog hat. We wore sunscreen. The animals were out and about in fine form. Dragon watched the monkeys frolic in their cages with interest, but reality, we were the ones on display.

At one point, a woman sat across from me and yelled at me from her bench. Then she yelled at other random women who were walking by to come and tell me off. At another point, four grandmothers surrounded me on my bench. They touched me. They told me I was cold. Yes I was. Really, I might not know it, but I was cold. My baby was also cold. Really. Yes, they know better than me about my child. My baby was cold. There is wind. Yes, the wind is dangerous. Yes, the wind is going to damage my son and myself because I am a mother. I am cold. Yes, I am whether I know it or not. Why am I out? I should be inside. I am cold. Stupid foreigner. Don’t I know that mothers don’t dress in t-shirts in sunny 18 degree weather?

On Friday I was sans Dragon at an open air concert with 40,000 other people. The concert started at 8 pm. It went until 10:30 pm. The air was cool and crisp in a late April evening sort of way. I was surrounded by couples in matching polo t-shirts and Gangnam girls in micro minis or long shirts and no minis at all. Several women were sipping cold drinks in cool weather. Some of them might have been mothers. Nobody said anything to anyone. Nobody said anything to me.

Sometimes it’s easier to not be seen as a mother.

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Dear Dragon

The first gift I wanted to give you was your birth: a peaceful birth, a birth that let nature not interventions guide it, an un-medicated birth where you would emerge with clear eyes and a calm heartbeat, a birth where we could bond as a family immediately. That’s not what I thought birth could be for most of my life. That’s not what I saw in the movies or heard as we women recounted the battle scars our bodies have taken in our journeys as women. I spent most of my life fearing birth and, as I grew older, it’s eventuality in my life. But then, through friendships, chance encounters on the Internet, and a growing desire to find an alternative to the traumatic tales I had heard, I started to learn about the midwifery model of birth, hypnobirthing, and the amazing ways women’s bodies are designed to birth. And then pregnancy, birth, and the process of labour became fascinating to me, and I wanted my first gift to be one without cutting, drugs, separation, and trauma if possible.

And so we trained. I carefully chose liturgical and inspirational songs to sing during labour and practiced them every day. We took hypnobirthing and practiced breathing and calming techniques regularly. I read positive birth stories and tried to educate myself about my options here in Seoul and saved money to get that kind of birth. The initial result was that I was so happy during my pregnancy. Me, your pessimistic, cynical mother, was no longer afraid of the changes her body would be going through during those ten months or the impending day of your birth. In the end, that might have been the first gift I gave you, that while in utero, I was happy and fascinated by the weird and wonderful ways my body was changing in order to accommodate you. I enjoyed sharing space with you. I hope that positivity during that period somehow influenced your character in a positive way.

Things were not to proceed so smoothly though. At 38 weeks 2 days, part of my membranes released un-expectantly without any signs of contractions starting. Of all the scenarios I had practiced for, this was not one of them because even though the birth centre was much less ready to intervene than almost any other birthing place in Korea, I was still only given 48-72 hours to start contractions naturally because of the risk of infection to you. If I could not start contractions naturally, I was going to have to be induced, and if I have a critique of the natural birth movement, it is that it doesn’t always do as good of a job of helping people to prepare peacefully for births which do actually require interventions. In between the constant trips to the birth centre to get antibiotics, check your heart rate, and monitor our health, I tried to research how I could use my training if I did have to be induced. However, again and again I found that discussions focused on the to avoid being induced instead of how to be induced and still birth peacefully. Obviously I was trying very hard to start my contractions naturally, but the hour glass sands were falling fast which was causing me more stress and preventing progress even more. And so, as I was walking, going up and down the stairs of our building, bouncing on my exercise ball, eating spicy food, and doing all the other proscribed actions to induce contractions naturally, I also had a lot of fear in my heart that I was not going to be able to give you the birth I wanted for you.

And that’s where your 아빠 stepped in. And that’s when I began to realize that this was not just my gift to give but was going to be a collective gift made possible through the actions and beliefs of many. Your 아빠, a man initially very sceptical of natural birth, a man who had to stop telling coworkers and friends about hypnobirthing because of the negative reactions he received, this 아빠, he hugged me and calmed me down, and told me that I did not have absolute control over the process my body was going through, but that I had trained to at least be at peace. And I had absolute control over that part. As we spoke, and as he consoled me, I felt my confidence returning. I felt that I had the tools that I needed to get me through the rest of the day.

By that evening’s doctor visit, after a day of releasing fear, bouncing on my ball, prayers, and believing it could be so, I was in labour, 3 cm dilated, and effacing. We decided to go home to continue labouring, and our doula, Casey, made the trip into Seoul to be with us at home. When we arrived at home, I got into bed, turned on Sigur Ros, and focused solely on calm breathing and surge breathing. Throughout my pregnancy I had practiced to Sigur Ros, preferring Icelandic and atmospheric rock to the hypnobirthing cd we were supposed to use. Again and again I had listened to Glosoli and Hoppipolla in my training, and these songs were instrumental during early labour. I continually visualized the ending of Glosoli where the children jump off the cliff only to fly/swim though the air in absolute freedom, and the bad assness of elderly puddle jumpers with pirate eye patches and wooden swords. They gave me strength and joy.

In retrospect, that long period of labour was beautiful. Many people prefer to call contractions “surges,” and that is what my feelings were. My body was surging. Your body was surging. We were surging together, but we accepted the force with peace. I slept between the surges and awoke to my body moving to the ethereal sounds like some kind of primitive cosmic dance. Then Casey arrived, and she massaged me and gave me a heat pack for my back while I continued to sleep and surge. The whole process was more pleasurable than I could have hoped for.

When my back began to hurt, I got up and spent time on my ball and walking around the house – moving slowly from talkative during rest periods to a more trans-like state as my body deepened into labour. Finally, I decided to go back to bed to labour there, but around 4 am during an deep surge, you suddenly dropped, fully bursting my membranes in the process, and sending me into intense surges every couple of minutes. It was at that point that we decided a rather swift ride to the birth centre was in order. Your 아빠 skilfully – and probably in his heart terrifyingly – drove through the empty streets of Seoul as Casey kept me breathing and kept me from flinging myself out of the car with each massive surge.

When we finally reached the centre, I was deep in heavy labour. It had come on so hard and so fast that I was completely unprepared for the transition. I was breathing the baby down with each surge, but that process was the most painful and intense feeling I had ever experienced. But then they told me I was 5 cm dilated. My midwife and doula told me that I had made excellent progress and that 1-5 cm usually took the longest, but I couldn’t fathom how 8 hours had resulted in only 2 cm. And once again, your mother faltered and was weak: I pleaded for drugs, for someone to cut me open, for it all to stop. I lost faith. I didn’t believe anymore. I didn’t think my body or your body were capable anymore. I spent the surges on hands and knees on the bed moving my body down with each wave and breathing down, and then I would collapse in the chair beside the bed feeling defeated and wearied. I felt I had lost everything I had practiced for, and I thought all was lost. I could not complete this process. I could not.

Again, your 아빠 and our doula were there for me – reminding me of the reasons I had chosen to birth like this: reminding me of my progress, reminding me of the techniques I had learned, reminding me that my body was designed to do this and there were no complications preventing me from doing this act. Our doula brought me cool towels sprayed with something delicious and refreshing, and I smothered myself in it. They gave me blankets and water and juice and massages. Again I was reminded of this truth; they took care of me so that I could take care of you. They supported me so that I could birth you naturally. And then I decided, if I did not have the strength to sing, I could chant. And I started to chant the words I had practiced the most:

Come, come, ye saints, no toil nor labor fear;
But with joy wend your way.
Though hard to you this journey may appear,
Grace shall be as your day.
Tis better far for us to strive
Our useless cares from us to drive;
Do this, and joy your hearts will swell –
All is well! All is well!

Why should we mourn or think our lot is hard?
‘Tis not so; all is right.
Why should we think to earn a great reward
If we now shun the fight?
Gird up your loins; fresh courage take.
Our God will never us forsake;
And soon we’ll have this tale to tell-
All is well! All is well!

Then, as dawn broke and the sun came up, I repeated over and over again “grace shall be as your day.” Maybe I had always known that you would be born in the morning; maybe I always knew that the dark soul of the night would bring you as my dawn and my grace.

There was something about this point where everything clicked, and after one final torturous surge, something changed, and there was an intense feeling of pressure that never ceased but was devoid of the previous surges. At that moment, the midwife came in and proclaimed I had reached 10 cm and was ready to push. I didn’t believe my doula when she said that pushing was a relief earlier in the night, but it was true. Pushing was on my terms. The surges weren’t directing my actions anymore. I was using the surges to direct the action. I was in control of my own body again, and by default, I was in charge of your body. Pushing was labourious. Pushing sometimes felt useless at the beginning. And again I lost some of my confidence until I reached down and felt your head and knew that you really were there; you really were on your way.

I laboured on the birthing stool but didn’t like it. I pushed on my hands and knees and loved it, but my arms and body were growing weak, and I couldn’t maintain that position. I ended pushing on my back, but as I had been allowed to move for the rest of the labour and pushing, it was actually a relief not a burden to be in that position as I had feared.

And then, with one final push, you slid out, and there was a feeling of freedom and relief that I’ve never experienced in my life before. Then you were lifted up onto my chest with your cord still attached – the piece which tethered you and me – and I gazed at you as the last of the blood flowed from me to you. I saw your full head of dark hair, your clear eyes, your adorably moulded cone head, your tiny feet and hands with their perfectly formed nails, and you were perfect. The only intervention had been antibiotics. Neither of us were hooked up to machines. No stiches were needed. We laid unencumbered for several minutes skin to skin. After ten months of carrying you, of imagining you, of feeling you from the inside, I was finally seeing you from the outside. It was both surreal and thrilling.

Birth was harder than I had expected in both a physical and emotional way. I wanted to be strong throughout the whole process. I wanted to be the calm zened out woman in the birthing videos. I wanted to be in control at all times. But I wasn’t and initially my perceived failures saddened me. But what I had failed to realize before I went into labour is that while perhaps some women have it in them to go through this process alone, I very much needed a support system to get me through. And thankfully I had that support system in place, and they rose to the occasion. We all had roles in bringing you into the world, and we all had a part in giving you as natural as possible birth. Collectively you were welcomed, and together we worked to strengthen each other and ensure the best possible birth for you.

That was your birth little Dragon. It was peaceful and painful and powerful all at once, and maybe, if we are talking about something as awe-inspiring as the creation and delivery of a new human being, it is as it should be.

Love Mum

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First of all, thanks for all those who left lovely comments over the past few days, and for those who have linked his birth on their sites. Dragon much appreciates your thoughtfulness!

And now…a few pics. Baby’s first iPhone pic. An important milestone in any child’s life.  He’s about 2 minutes old here and still sporting his vernix.

My Korean baby’s first ‘hwaiting!.’

Despite the odds of having a curly hair baby, Dragon is a spiky hair baby! I’d always hoped that I would have a spiky hair child, and like my friend R says, sometimes dreams DO come true…..

His favourite thing to do after hanging out at the boob.

But he’s selca savy enough to know when 아빠 is taking pictures. Must put on my handsome face.

And even a tiny smile.

Full swaddling is a mama’s best friend in the first week.

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This year we decided to skip the usual same old same old family stuff and I pushed out a baby instead. Well, maybe it was Dragon deciding he desperately wanted to show off his dragonness and make sure he was born early. But anyway, a little different holiday for us this year. Pictures, birth story, and all manner of baby nonsense coming up as soon as I can drag myself away from cuddling my sleeping son…

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I thought I would share my birth plan here simply because it might help others to build their own bilingual plan.

But first, my doula asked me to write my ideal birth plan. Yes…obviously, this is the ideal, but everyone should have an ideal in their mind, and this really is what I’m working toward.

I sing. I stay calm. People intervene only to keep me and baby calm and safe. I sing. I stay calm. I push. He comes out. All is well.

This is the ‘proper’ birth plan I’m giving to my doctor. Feel free to copy and paste or get inspired as you see fit.

We __________ have chosen to give birth to our child at _____________ under the care of Dr. ______________. We prefer a natural, vaginal, and un-medicated birth with Mr. Lee being involved in all procedures and stages of labour.

우리__________는 _____________에서 닥터 ________ 선생님의 돌봄 아래 우리 아기를 출산 하기로 하였습니다. 우리는 철저한 자연분만을 원하며 남편이 출산에 모든 과정에 함께 하기를 원합니다.

Labour and Delivery 진통 및 분만

Unless absolutely necessary for medical reasons, we would like to avoid:
의학적으로 아주 명확한 필요성이 있기 전까지는, 우리는 아래와 같은 것은 피하길 원합니다.

-induction before 42 weeks
42주 이전의 유도 분만
-IV fluid lines
링겔주사
-pain medication (epidural, Demerol)
진통제 (에피두럴, 데메롤)
-enemas, catheters, shaving of the pubic area, episiotomy
관장, 카테터(소변 배출용 삽관), 음모 면도, 회음 절개
-lying flat
고정된 자세로 등을 대고 평평하게 누운 상태에서의 분만
-having membranes ruptured medically
의학적인 방법으로의 양막 파열

Unless there is a medical emergency, we would prefer:
의학적으로 위급성이 있지 않다면, 우리는 아래와 같은 것을 선호 합니다.

-soft lighting
부드러운 (강하지 않은) 조명
-the ability to eat and drink during labour
진통 중 먹거나 마실 수 있는 여건
-Heparin lock in lieu of IV if necessary
링겔주사가 필요하다고 하면 헤파린락 시술
-intermittent monitoring of the baby’s heartbeat
아기의 심장박동에 대한 간헐적 모니터링
-minimal vaginal exams (and only with consent)
가능한 최소화된 질 검사 (그리고 반드시 산모의 동의 하에 시행될 것)
-the ability to move freely and labour in any position
진통 중 자유롭게 움직이고 어떠한 자세도 취할 수 있는 여건
-the ability to vocalize, including singing, while laboring
진통 중 말하거나 노래할 수 있는 여건
-the ability to shower or use the birthing pool as necessary
원하면 샤워나 분만용 욕조를 사용할 수 있는 여건
-to be free of time limits
각종 시간 제한으로부터의 자유로움
-the ability to push instinctively
본능에 의해 푸시(push)할 수 있는 여건

-natural forms of pain relief (self hypnosis, massage, yoga, positions, hot/cold therapy etc)
자연적인 형태의 고통 저감 (자기취면, 마사지, 요가, 자세전환, 냉/온 요법 등)
-perineum massage or other natural measures taken to protect the perineum
회음부 보호를 위한 회음부 마사지 또는 다른 자연적인 방법들

After Birth 분만 후

Unless there is a medical emergency, we would prefer:
의학적으로 위급성이 있지 않다면, 우리는 아래와 같은 것을 선호 합니다.

-to have immediate skin to skin contact on the mother’s chest
분만 후 즉각적으로 산모의 가슴 위에서 아기와 산모와의 피부 대 피부간 접촉시키기
-to place warming blankets if necessary over mother and child
필요하다면 산모와 아기 위에 보온 담요를 덮어주기
-to wait until the umbilical cord stops pulsating before clamping and cutting
탯줄의 맥동이 멈추기를 기다린 후, 클램핑 및 커팅 하기
-to have Mr. Lee cut the cord
남편이 탯줄을 자르게 하기
-to breastfeed immediately after birth and wait for stitches and newborn procedures until after breastfeeding
분만 후 즉각적으로 모유수유를 하게 하기
(파열 부위 스티치 시술이나 신생아 처치는 모유수유 후에 하기)
-to avoid pacifiers, artificial nipples, formula, glucose, and water
아기에게 공갈젖꼭지, 분유, 포도당, 물 등을 주지 않기
-to naturally deliver the placenta without medication or pressing down on the abdomen
복부를 누르거나 약물에 의하지 않은, 자연스러운 태반 배출
-to room in with the baby
아기와 한 방에 있게 하기
-to have unrestricted access to the baby at all times
산모가 아기에게 언제라도 접근할 수 있도록 허용하기
-to use vitamin K syrup instead of injection
주사보다는 비타민 K 시럽을 이용하기

And finally, this is the birth plan to take to the hospital in case of an emergency C-section. Again, copy if you want.

Medical Emergency
의학적 긴급 상황 시

In the case of a medical emergency, every medical effort should be taken to ensure the health and wellbeing of mother and child. However, if medically possible, we would also prefer:

의학적 긴급 상황일 경우, 산모와 아기의 건강과 웰빙을 위해 모든 의학적 처치가 이루어 져야 할 것입니다. 그렇다 하더라도, 만약 의학적으로 문제가 없다면, 우리는 아래와 같은 것을 선호 합니다.

-to not have a chest X-ray
가슴 엑스레이 사진 찍지 않기
-to have Mr. Lee present during all procedures including the C-section surgery
제왕절개를 비롯한 모든 의학적 처치과정에 남편이 참관하기
-to have an epidural anesthesia
제왕절개를 해야 할 경우, 경막외 마취를 하기
-to have immediate skin to skin contact on the mother’s chest
분만 후 즉각적으로 산모의 가슴 위에서 아기와 산모와의 피부 대 피부간 접촉시키기
-to place warming blankets if necessary over mother and child
필요하다면 산모와 아기 위에 보온 담요를 덮어주기
-to wait until the umbilical cord stops pulsating before clamping and cutting
탯줄의 맥동이 멈추기를 기다린 후, 클램핑 및 커팅 하기
-to breastfeed immediately after birth and wait for stitches and newborn procedures until after breastfeeding
분만 후 즉각적으로 모유수유를 하게 하기
(파열 부위 스티치 시술이나 신생아 처치는 모유수유 후에 하기)
-to avoid pacifiers, artificial nipples, formula, glucose, and water
아기에게 공갈젖꼭지, 분유, 포도당, 물 등을 주지 않기
-to naturally deliver the placenta without medication or pressing down on the abdomen
복부를 누르거나 약물에 의하지 않은, 자연스러운 태반 배출
-to delay bathing the baby in order to leave the vernix in place
아기 태지(vernix)가 남아서 자연스럽게 피부에 흡수될 때까지 아기 목욕을 늦추기
-to room in with the baby
아기와 한 방에 있게 하기
-to have Mr. Lee present for all procedures done to the baby after birth
분만 후 아기에게 행해지는 모든 처치과정에 남편이 참관하기
-to have unrestricted access to the baby at all times
산모가 아기에게 언제라도 접근할 수 있도록 허용하기
-to use vitamin K syrup instead of injection
주사보다는 비타민 K 시럽을 이용하기

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So we’ve been through the good and the bad of getting prenatal care in Seoul, but I don’t want to leave this topic on a negative note. Therefore, here’s my own personal ways to deal with ‘the bad.’

Do your research

But you were doing this anyway right? Honestly, I feel like I am more informed because I am an expat than if I were living in Canada. If I were back home, I would probably do whatever everyone else around me back home was doing and not even realize there were different options out there when it comes to birthing. But everyone should be researching different options and different ways health care providers deal with birth. And most importantly…something I’ve had to learn over and over again here…just because something is often one way in my home country does not mean it is the same way in this country. For instance, my friend told her doctor she did not want an episiotomy. The doctor smiled, nodded, and gave her pamphlets on vaginal reconstruction surgery and told her that her husband would never ‘want her’ again if she didn’t have an episiotomy. I shit you not. And I’m telling you this not to horrify you but so you can be prepared for such possibilities.

You need to know what your provider’s policies are regarding post 40 week deliveries, routine medical procedures, movement during labour, breast feeding, rooming-in after birth, and postpartum care. They may be very different from your assumptions regarding birth – or they may not be different. But you should still know what to expect. And most importantly, if you do know what you want, and your birth preferences in any way deviate from standard medical practice in Korean hospitals (no episiotomy, waiting til 42 weeks to be induced, birthing in any position not lying down, wanting to vaginally birth breech babies or multiples, wanting to breastfeed immediately/delay cord cutting/room-in after labour/breast feed a smaller or larger baby than what is considered ‘normal’ etc….), then you need to know this. Many doctors will use the ‘bait and switch’ approach. In other words, they will tell you ‘yes yes, everything will be okay, you can do what you want,’ and then when you are in labour they will tell your husband or you (when you are most vulnerable) that X must be done for dubious medical/policy/whatever reasons.

So what do you do about this bait and switch? Not only should you be researching and thinking about what kind of birth you want, but you should search out first-hand accounts of other women’s experiences at different hospitals or birthing centres. If you do not know many people who have birthed here, I highly suggest joining the Expat Parents Forum which is full of people who have birthed and are raising kids here. The people on this forum can tell you their stories and you can decide based on their experiences, your research, and your discussions with various health care providers what you are most comfortable with. Your other option is to hire a doula (a birthing companion). There are so many options in the Seoul/Gyeonggi-do area (Belly Bliss Doula, Journey Doula, Birthing in Korea, Morning Calm Doulas). There are fewer options outside of the metropolitan area, but one woman I know is having a Suwon doula travel all the way down to Mokpo for her birth, and there are doulas in other areas including a lovely woman I have never met but count as an online friend (Jeju Doula). I also highly recommend the Korea Doula Network for birthing information and additional information on some of the doulas listed previously. There are many benefits of doulas, but for the purpose of this section, one of the greatest benefits for expat women is that doulas have been involved at births in many different locations, and they can also give you first-hand information about what each provider really does when it comes to labour and postpartum care. If you do not want to commit to a companion during births, many doulas also offer birth classes or consultations where they can offer helpful advice about birthing options.

Keep the jeong

Ok, so I’ve just told you that you need to do your research and choose your provider wisely. However, as a balance to this advice, I want to say that, like everything in Korea, keeping a good relationship with a person perceived to be in a higher position than you is important. My first part of this advice is that you should pick your battles wisely. Again, just like everything in life here, there has to be a balance between your home culture and Korean culture – between doing what you feel strongly about and what is reasonably possible in your present circumstances. If you fight over every single thing, it’s probably best to change providers, compromise, or….smile, nod, and ignore everything your provider has said once you leave the office.

Now, this last piece of advice does not always work when it comes to being in labour for example. However, when my current doctor told me to go on the no-carb diet, I instinctually did what I do with most advice given to me by older people. I smiled, I nodded, and I said I ‘understood’ (in my mind ‘comprehended’ not ‘assented.’) Now, I did go on the no-carb diet for a week, but when I realized it caused me more problems, I disregarded the advice. Actually, I should have gone with my first instincts and disregarded his advice from the get-go. I’ve also done this in terms of my doctor’s advice on the brand of prenatals I should take (I had been taking my prenatals months before my doctor recommended the ones he was selling through his office), and my previous doctor’s advice to think about amniocentesis when I had decided before I even got pregnant never to do amnio because of the risks. The reality is, often older people/people in higher positions in Korea do not always expect you to fully follow their advice. Often, they just feel it is their ‘duty’ to give advice and so they do. And even when they do mean for you to follow the advice, many younger people deal with the situation by smiling, nodding, and disregarding. My husband confirmed that smiling/nodding/disregarding was in fact the proper way to deal with the diet comment. In this way, we can keep the jeong (relationship and good feeling) with the person in a higher position while still doing what we want/think is necessary.

In Canada, I feel like when I ‘agree’ to something I should actually follow through because I have assented. However, I have had to learn a very different mode of interaction which is based on helping the person in a higher position maintain face while still kind of doing what I think is right. Now, of course this can go too far, and I’m not saying that you should disregard all of your health provider’s advice. And obviously, as I’ve already said, this advice depends on the situation. You probably won’t be smiling and nodding and disregarding while in active labour as they hook you up to machines you don’t want to be hooked up to. However, I do think that Western expats often have a very different concept of how to deal with disagreements (directly verses indirectly) and in certain cases it is better to try to avoid the conflict by nodding in understanding but not agreement.

Conclusion

Again, I will reiterate that these are simply my views based on my experiences and conversations with others who have birthed (or helped others birth here) before me. I have yet to actually birth my baby, so perhaps I will have additional thoughts in my postpartum period, but for now what I can say is that research is the most important thing you can do for yourself. Research will help you to determine what you want and balance that with what is available on your area of the peninsula. Thankfully, the ability to change health providers quickly and easily (at least within the greater Seoul region) means that if you are unhappy with one person, you can switch to someone else. But for smaller issues, you can also learn to choose your battles and assent without assenting. The combination, or maybe the balance of all of these methods means that you can probably have the birth you want…or maybe even a better birth than you had first imagined…even when you are far from home.

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(This is part of a 3 part series. If you haven’t already, please read part 1 first).

The Bad
1. Pay-for Service = Pressure
With all things good comes the bad, and the negative part of having options and the ability to demand more services is the fact that doctors will push you to have more procedures in order to make money. When I started to go to my first doctor, I was just preparing to get pregnant. I needed my yearly PAP. In addition, I decided that if I was going to get pregnant, I wanted to know if there was anything wrong with me so I could fix the problem before I got pregnant, so I got the tests that would normally be done in the first trimester before getting pregnant. I wrote on my intake form that I was trying to get pregnant as soon as I received clear tests, but I also said that I had never received the HPV shot. Now, I’m a pro-vaccine person, and I am an especially pro-HPV vaccine person…but….at the time I was 30, married, had been in a monogamous relationship for many years and…very importantly…was trying to get pregnant. It takes 4-6 months to receive all the necessary HPV shots. I was not the prime candidate for the HPV vaccine to say the least. But goodness. I heard about that shot from 3 different people in that office on two different visits, and they were insistent that I was putting myself in grave danger by not having that shot at that moment.

In terms of prenatal care, if you are an ‘I only want two sonograms per pregnancy’ sort of person, it isn’t really easy to keep refusing your care provider’s insistence that you need one every time. In actual fact, you will probably not even be told you have the option to decline a sonogram or a test. In addition, the ‘safe’ zones for screening tests like the Quad Test (to look for Down’s, neural tube defects, etc) are much lower than in countries with universal health care like Canada.

For instance, a woman I know was told her baby likely had a neural tube defect, but in reality, her tests results just missed the cutoff for the safe zone in Korea. However, she would have easily registered as ‘negative’ had she been in Canada because of the different levels of acceptable test results. Another friend was carrying twins (and then lost one twin), and was told that her baby had a problem because the lab didn’t take into account that multiples have higher AFP levels. White and black women have slightly higher levels than Asian women, and the mother’s weight also plays a factor in the results. However, many doctors and labs do not take these differences into account (see point 2 in this section), and thus expat women sometimes receive positive test results because other factors are not taken into account. Of course, the reason for different negative and positive zones is that amniocentesis, a very expensive and invasive test is the next step that doctors will recommend, and a wider positive zone ensures more women will go onto the next step (and pay!).

2. All Women, All Cases, All the Same

When I first arrived in Korea, the only shoe sizes available in most stores were 235, 240, 245. Thankfully, my feet are a 240-245, but for 90% of my friends who were not, they were told that no other sizes exist in Korea because all Korean women wear the same size. Now this of course is bull shit – all you have to do is look around you on the street to see that (and look at what is offered on online shopping malls which provides a much larger selection of goods), but there is a view that everyone is (or should be the same) in Korea, and thus there is often a one-size fits all both literally and figuratively here. So if you are an expat with a different body type or a different view of medical care, then you are not going to fit the mould very well are you?

Case in point. My friend J, a very petite woman with a very obviously (and perfectly positioned) pregnant belly is due a few weeks before me. She had to get her yearly medical done for her university, and was told, by the doctor who knew that she was pregnant, that she had higher than normal cholesterol levels (normal for a pregnant woman), needed to lose weight, exercise more, and eat less fatty food. There is a script – higher than usual cholesterol results always equal actually high cholesterol. A larger stomach always means people need to exercise. Etc. etc. And even if the doctor understands that you don’t fit the profile, for all intents and purposes you must fit into the profile.

Or take another friend who posted about her experience being a unruly patient (for Korea) after stomach surgery. Anything that goes against the norm is going to cause problems here, and your body alone, if it does not confirm to Korean standards of ‘normal,’ is going to be a problem.

I’ve had a really amazing pregnancy thus far. No morning sickness, no problems with blood pressure, no problems with tests of any sorts. I’ve been eating based on my instincts…when I crave lentils, it’s because…well, the digestive track gets a bit sloooow when you are pregnant, and lentils help with that. When I’ve craved veggies, I’ve made myself a big salad. When I’ve been tired, I’ve listened to my body and responded, and this has made me a much healthier person overall than before I got pregnant and pushed myself to my limits. So when I started craving rice all the time, I went with it, not really knowing why my body was asking for carbs other than the fact that it was. I did gain a bit more between my 21st and 26th week appointment, but I was shocked to hear my doctor – well known for work with expats and being natural birth friendly – telling me I HAD to go on a diet. My baby was going to be too big (he’s EXACTLY mid-sized in weight and measurements at the moment). My body was going to be unable to function. I was going to get diabetes. All was going to go to hell unless I went on this diet. Specifically – I was not allowed to eat carbs anymore…kind of hard for a veggie trying to get extra protein from beans and lentils. So I tried that for a week, and you know what happened? Horrible horrible horrible acid reflux. It was only then that I learned from other mums that carbs is one of the best ways to avert acid reflux. And as my mother had had horrible problems with this when she was pregnant with me, I realized that the only thing stopping me from experiencing this problem was that I had been listening to my body’s cravings for rice. Smart body.

Later, I met another woman who had been given the same advice and left said doctor. In my birthing class, another (very petite) woman had been told to go on this diet, and I found out that this is very common advice given to expat women at this clinic. I knew from experience and other people’s stories that it was common for expat women to be told they were too fat when pregnant in Korea (one friend had a client put on fat blockers), but I was not expecting it from this doctor. Supposedly most physicians think that the maximum weight gain a woman is allowed per pregnancy is 12kg. And since I am close to that mark now, it’s going to be a fun last few months! But anyway, if you are not super tiny, if you gain at a different speed than you are supposed to, if your baby is measuring at a different size because you are not Korean size and the doctor is only using Korean size averages, or if you want to deviate from the usual tests and procedures done by that health care provider, you are going to encounter some problems.

And it is best if you know this in advance.

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