Musings of a Midwife: Birth in the Age of Fear
Published on: April 28, 2019
In this month’s Bumps and Babies article, midwife Emma McNerlin reflects on the challenges of choosing a care provider for pregnancy and birth in Bangkok, and how what should be a happy time of anticipation for any pregnant woman can instead be one of worry and second-guessing.
By Emma McNerlin
Whether it’s a longed-for baby, a total surprise or a downright shock, the appearance of the little blue lines on the pregnancy test launches a woman into a journey taken by generations of women before her. Yet, for each woman it is still special and unique; and all too soon her attentions turn to how her baby is going to get out!
On top of the agenda will be finding the right care provider for her pregnancy and birth. Expecting a baby in a foreign country adds a layer of complexity to the process.
Thailand’s approach to birth
At this point, Thailand’s approach to birth comes into sharp focus and deep contrast to what one might expect if birthing in their home country.
Birth is not the same worldwide. There is no autonomous midwifery practice in Thailand. Midwives here are general nurses with approximately six months of obstetric training. Thailand has a high C-section rate, as high as 80% in some of the private international hospitals. It should be pointed out that the majority of those C-sections are planned and requested rather than emergency. Choice of doctor for natural birth is limited.
Don’t go outside the healthcare system
Navigating this system to find the right doctor for you can be daunting, and there is a lot of fear and negativity being peddled around about birthing in Bangkok. For some women, this fear may drive them to make decisions to birth outside of the healthcare system with practitioners not licensed or registered to conduct birth in Thailand. This practice is illegal and not backed up by any medical professionals should complications arise in the birth.
Values and healthcare
Everyone has a different value system when engaging with health care. Culturally in Thailand, there is a lot of reverence towards the medical community and a doctor is seen as an expert not to be argued with.
In contrast, expats birthing in Bangkok may expect more consultation, collaboration and choice in their care, to allow them to ultimately make the decisions that are right for them and their baby.
Both approaches are available in Bangkok if you know how to find them. It’s also important to note that, there is no right or wrong in this regard. Whatever gives you the most confidence to birth and parent your baby is what is best for you.
Start by speaking to other mums
The first thing you can do in navigating the birth system here is to speak to other mums. Be careful not to ask for “who is the best doctor”. Birth is very subjective.
When a doctor is recommended to you, be sure to ask what type of birth they wanted, what did they have, did they feel listened to, informed and included in any decision about the care for them and their baby, was it a humanizing experience in which they felt safe and well cared for. No one should tell you which doctor to birth with; that should be a choice you make carefully with your partner.
Get informed about birth and the type of birth you want
Expecting parents will also feel more empowered to work in partnership with their doctor if they are informed about birth and the type of birth they want.
There is nothing wrong with opting for a C-section if that is what you really want, and you are well informed of the risks, benefits and consequences of a C-section on future pregnancies. Many doctors in Thailand will say why suffer to have a natural birth?
If you want to have your baby naturally, you need to inform the doctor that all pain is not suffering, and you will take pain relief when you ask for it. This lets them know that your expectation is not for them to fix it, rather just to go with the process as nature intended.
Meet with several doctors before deciding
You should meet with several doctors before deciding on who to birth with, choose the one that you feel most comfortable with, and trust your intuition.
It is never too early to talk about your overall plan for birth, to gauge how well aligned your birth philosophies are. You don’t need to go into chapter and verse on inductions, skin to skin and delayed cord clamping, but stating that you want a natural unmedicated birth or a vaginal birth with epidural and asking them whether they support it. That is a good start. You can follow up by asking what percentage of their births in the past year were natural.
These are all valid questions and if framed correctly and asked in a culturally sensitive way, they will be well received, and if not, then perhaps this is also useful in you making your choice of a care provider.
Set the tone
Once you have chosen your doctor, try to set the tone in how you engage with them. Ensure that they do not assume your consent, ask questions, demonstrate that you expect to be fully consulted on everything.
It’s always ok to ask why something is medically indicated. If you are passive in your approach, the doctor will assume your consent.
In the second half of pregnancy, at each clinic appointment, consider asking a question about the birth or take the opportunity to remind the doctor about what you want. For example, you can ask what their policy is on induction, or on breaking waters, or on freedom of movement and then state your expectations. This can help to reinforce your expectations and open discussion with your doctor.
When you come to presenting your birth plan at around 34 weeks, nothing in it should be a surprise to your doctor. Remember, do not wait for them to ask for your plan, in the absence of anything from you they will assume that you are happy to go along with whatever plan they decide and that may not be communicated to you until late in the pregnancy.
Don’t underestimate the power of a second opinion
Never underestimate the power of a second opinion. If you discover late in your pregnancy that your doctor has had a change of heart about supporting your plan, seek clarification from them on clinical grounds. If you are unhappy with their advice, speak to another doctor.
You can change doctors here right up to the end of pregnancy.
You can have a positive birth experience in Bangkok
Pregnancy and birth are transformative for a woman, and she deserves to feel supported and central to all decisions made regarding her care. It is very possible to have a positive birth experience in Bangkok, whatever you perceive that to be, when you find a care provider whose philosophy of birth matches yours. If you need help or advice, you can contact the BAMBI Bumps Team.
Photos by John Looy and Luma Pimentel on Unsplash.
About the Author
Originally from Ireland, Emma is a UK-trained midwife who worked in the maternity unit at a busy NHS hospital just outside London. Emma moved to Bangkok with her husband in 2014; they have an 11-year-old son, Toby. Volunteering with BAMBI Bumps and Babies since August 2015, Emma regularly conducts sessions on pregnancy, birth, breastfeeding and Infant First Aid. In her spare time, she enjoys baking and Muay Thai, and is an active member of her son’s parent group at school.
The views expressed in the articles in this magazine are not necessarily those of BAMBI committee members and we assume no responsibility for them or their effects.
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