What “prenatal care” consists of varies greatly from one location to another, depending on what diseases and complications are common in the local population, as well as what resources are available. Patients from North America, for instance, have a relatively high risk of gestational diabetes, group B streptococcus and Rh negative blood; all conditions that are rare in some other cultures. Essentials to look for in prenatal care include clean facilities, adequate equipment, accessibility, and staff that is trained to provide basic obstetrical services. They should also be able to identify and refer complications.

The primary goal of early prenatal visits is to establish a reliable due date, for if anything goes wrong later, what needs to be done about it will depend on how far along you are in the pregnancy. The secondary goal is to identify any potential high risk factors and make allowances for them.

There are laboratory studies and sometimes imaging studies that are usually recommended.

Nutrition is often a problem for pregnant expatriates, especially in underdeveloped countries. Prenatal vitamins may need to be brought in from abroad.

These check-ups do not necessarily need to be performed by an obstetrician. Any problem that is identified should be addressed earlier rather than later as it may necessitate a change in your delivery plans.

Delivery Away From Home

The first and most important thing we have to say is how important it is that you choose a facility that is adequate for a complicated delivery or cesarean section. The laboratory should be adequate for emergency blood transfusion and the nursery prepared to handle sick and premature newborns at least until transfer can be arranged. In some remote areas, it is often the case that even basic supplies such as bandages, surgical suture and medications are the responsibility of the patient and may need to be located and bought at the last moment. These possibilities should be investigated well in advance.

Pregnant expatriates are, on average, older than women who stay in their own countries to deliver. Also, they tend to have more complications. And they tend to be more risk taking. But having a baby is not a good time to take unnecessary risks. Our data showed time after time that having a baby at home or in some other rustic setting was fraught with severe hazards to both mother and baby.

It is most likely that normal obstetrical practices will be different in your host country than at home. And you will find it impossible to convince anyone that your ways are any better than theirs. Cultural and language barriers have the potential of turning a normally joyful event into a nightmare.

In many instances, care of the mother and baby after delivery is expected to be largely the job of family members.

After the Baby Comes

There are many cultural variations regarding what is considered appropriate care for the new mother and her baby. Expatriates often find this quite distressing.

Post-partum complications for the mother or the problems of a sick newborn are fortunately rare. What is used to treat common after-birth pains much more often have to do with local social patterns.

Citizenship is one of those major issues. And a surprising issue for many is the matter of breast feeding, especially in third world countries.

Another concern for some is the matter of circumcision of a male infant.

When and how you return home from the hospital may require a lot of forethought, especially if you live in a remote area.

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