Sooner or later many of you out there will be faced with
the decision of where to birth your child. This is where I
really get on my soapbox, as I am both a Midwife and a Mother.
For those that have a choice, my advice will always be to
leave the Island and go home, or to neighboring countries
like Australia, Singapore, or Thailand. Indonesia really has
been left behind in everything to do with bringing a baby
into this world safely and with grace. Couples will come up
with all sorts of excuses like “I can’t afford
it”, “I can’t get time off work”,
“my in laws won’t like it” etc. etc. But
hey wait a minute here, how often to we do this “baby
making” thing?….once, twice or maybe three times
in an entire lifetime? Take some time out. This is a pretty
special event, and you certainly don’t want to mess
it up for the sake of some lame excuses.
I have enough of those nightmare child birth stories under
my pillow, to curdle your blood. All the horror stories aside,
lets look at a few cold hard facts that need to be seriously
considered, if and when you make the choice of where to pop
your baby. One of the most frequent arguments that I hear
from women trying to convince me (or themselves) that they
will be fine delivering in Bali goes something like this:
“Thousands of women deliver babies here every year,
it can’t be that bad. All my relatives/friends have
had children here, and they are all fine”. Look again.
Ask any woman here over about 35 years of age, and most of
them have lost at least one child at or soon after birth.
It’s “Biasa”. The neonatal mortality statistics
(babies that die at birth) here are the third highest in the
world; to say nothing of the mothers that lose their lives
in childbirth. To lose a baby is very sad. To lose the mother
is a tragedy. You see, if a baby is born normally and without
complication, a monkey could deliver it behind the nearest
bush in the rice paddy, but should an emergency arise and
you need urgent surgery, or urgent anything for that matter,
you are in real trouble.
I remember 20 years ago as a midwife in a small private hospital
in South Australia. The wee small hours of 2 a.m. and my patient
was in trouble. The baby’s heartbeat was failing, and
she was not even close to delivering. Even though none of
the staff were resident at the hospital, that woman was in
theatre, with a full team of doctors in less than 5 minutes.
The baby’s life was saved. Compare this to a dear friend
of mine who lay waiting on a gurney outside the operating
theatres of a Denpasar hospital. In heavy labor, with the
baby’s heartbeat failing, all the theatres were full.
The baby’s life slipped quietly away before the next
operating theatre became available. Given the “CHOICE”,
where would you rather be?
Let’s not be too hard on the local facilities here.
Vast improvements have been made over the past decade or so.
The one factor that most people forget when weighing up the
level of medical care available here is that this is a third
world country. Despite the 5 star hotels, the fashionable
malls, and the gourmet restaurants on this Island, you are
still part of a much bigger, and much poorer picture. Medical
facilities are poorly funded, understaffed, over worked and
over crowded. On average a specialist Obstetrician here would
see about 50 – 80patients each evening compared to an
average 10 a day in the West. How can any one man (or woman)
give quality care to so many, in such a short time? It’s
just not possible. I stand in awe of the men and women who
dedicate their lives to medicine in this country. I am bequizzled
as to when they actually sleep, let alone satisfy their family
and cultural commitments.
Still not convinced that you need to go “somewhere
else” for the big event? Or perhaps like too many of
us you don’t have the “choice”. What about
delivering in Bali? Let me give you a few pointers as to how
to get around this as safely and as comfortably as possible.
v Choose your Obstetrician carefully. (I am more than willing
to drop names for those that wish to contact me). Make sure
that he will listen to your concerns and will answer all your
questions. If he doesn’t want to listen to you now,
he never will. Change your doctor until you find one with
a compassionate ear! Make sure that you write down all your
questions before your visit. Keep the questions brief and
to the point. Remember that this guy does not have a lot of
time to spend with any one patient, probably ten minutes at
the most.
v Keep yourself informed. There is enough information on the
net, or even at the local bookstore, to educate yourself about
your pregnancy.
v Remember that you have the right to refuse any treatment.
If your doctor suggests giving medications (other than vitamins)
during the pregnancy, find out what they are for, and if they
are safe for pregnancy. (I am more than happy to give information
on safety of medications during pregnancy).
v You do not need an Ultrasound scan at every visit. This
is just helping the doctor to pay for his machine! Some studies
have suggested that the ultrasonic waves may be harmful to
the babies hearing apparatus if used too frequently. One scan
at 16 weeks and another at 28 weeks is standard practice.
There may be specific reasons why your doctor feels that he
needs to scan you more than this, but he should give you a
good explanation as to why……and beware, ultrasound
scanners do not give a 100% correct reading on the sex of
the baby!
v Choose a birthing partner that will be strong and firm (not
angry) with the doctor/ hospital staff. Your birthing partner
should be someone other than your husband, that is either
qualified or very experienced in childbirth. Let the team
know what you want, and that you may do things a little differently
to what they are used to. Some of these things may be:
l You DO want to walk around during early labor.
l You DO want your husband / partner to be present at the
birth.
l You DO NOT want an episiotomy (perineal cut) unless it is
absolutely necessary.
l You DO want to hold and breast feed your baby as soon as
it is born.
l You DO NOT want your baby to have any drugs (vaccines, antibiotics,
steroids etc) without your consent, unless it is an emergency
situation.
l You DO NOT want your baby to be formula fed by the nursing
staff, if you are planning to breast-feed.
Most people are alarmed at the high rate of caesarian sections
here. Quotes such as “Everyone I know that has delivered
here had the chop” are common. I am sure there are the
occasional hasty decisions to reach for the scalpel, perhaps
with the increased financial revenue as an extra-added bonus,
but on the whole, I tend to think that safety is probably
the doctors main concern. Factors that would be considered
in the decision to deliver surgically would be:
l The woman wants a caesarian section! It has become quite
a trend, and even a status symbol amongst the wealthy to have
a neat and tidy delivery. No huffing, no puffing, no pain
and no waiting around.
l A caesarian section is medically warranted. In developed
countries we are spoiled for the choice to “wait and
see” if a labor looks dicey, or the baby is in early
distress. We have state of the art monitoring equipment, rescucitation
equipment, and intensive care units. In this country the decision
to operate would be made before a situation developed rather
than waiting to see if it did.
l PAIN! There is little or no pain relief available to a laboring
lady here. If a woman is unable to cope with the pain, she
may as well have a general anaesthetic and get it over with.
What about delivering at home? As I said before, any one
can deliver a baby. Taxi drivers do it, airline stewards do
it, even husbands have been known to catch the odd hasty babe!
It’s only when things go awry that you really need the
professionals. Never assume that yours will be the perfect
birth, even if you’ve already had 4 normal births. You
can never predict the outcome of a delivery, so don’t
gamble on the consequences….get a professional. If you
choose a home delivery with a midwife, make sure that she
comes well recommended. Ask to see her qualifications. Make
sure that she has an agreement with a doctor should surgery
be needed. If you are planning to use a midwife from overseas
be aware that she is practicing illegally in this country.
She cannot sign the baby’s birth certificate, and you
will have no recourse if things go wrong.
So think carefully on the baby making plans, and until next
edition stay happy, stay healthy and stay young.
“ Kim Patra is a qualified Registered Nurse / Midwife,
and mother of three, who has been living and working in Bali
for past 15 years. She has assisted many traveller (... and
others) either as a flying medical escort or just a voice
on the end of the phone! Kim is happy to discuss any health
concerns that your may have. Her e-mail contact is info@chcbali.com
