Birthing In Bali

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

Copyright © 2002 Kim Patra