Having Babies in Tajikistan and the U.S.A.
With a precious, healthy (tfoo, tfoo, tfoo) baby to call our own, I think my husband and I consider ourselves the most blessed people on the planet. Compared to this, nothing else seems remotely lucky. However, if anything is to seem fortunate again, I’d start with having had the chance to get prenatal care in three different countries. That was interesting.
I’ll skip France, though I was quite happy there, and focus on the differences between the Soviet-Eurasian model of OB-Gyn care and the American one. Leaving aside the enormous need for funding, exodus of professionals to the West, and other post-perestroika / shock-therapy problems, which are obviously not a planned or integral part of their system, I prefer the former more.
I had planned to have my baby in France because of their excellent health care system. It might not seem so to the people living there, but in fact, they have some of the best health statistics in the world on nearly all counts. It’s also possible to pay cash for health services and to buy insurance for one year. However, because I was travelling, I failed to register at a hospital in time and later found out I needed to be present in person with my declaration of pregnancy, which I couldn’t do until far too late.
I didn’t want to have my baby in Tajikistan, with its dearth of emergency services (though prenatal care in the city can be quite good). I wanted to be around family, too, but knew it would be hard for my mother to come to Tajikistan.
When I decided I was going to have to have my baby in the U.S., my first thoughts were of cesarean sections (the rate of which is around 25% nationwide and even higher in some areas), drugs, and labour accelerants / inducers, which are used in abundance. I hate taking processed drugs and foods and I hate hospitals and doctors’ offices even more, so this sounded terrible to me.
There is a small but dedicated tribe of people that use homeopathic medicine, eat organic, and have their babies at home or in birth houses. According to the only source I could find, this is about 1% of the population. My husband, who is very supportive and open-minded, agreed to a homebirth he found out that we could get real medical care at home (”your health is the priority”), and that my mother also thought a home birth would be a good idea. So we went for it.
In Tajikistan, babies are born in “maternity homes”, as in the rest of the former USSR and many other European and Asian countries. They are rarely born in hospitals- this is only the case if the mother or baby is already ill. A maternity home is like a birth house, which is solely dedicated to mothers having babies and recovering. Babies are delivered by akusherki (from the French “accoucher“) or midwives, but OBGyns are present in the building and there are facilities available for medical interventions such as vacuum deliveries and c-sections, just in case. The rate of c-sections, however, is lower than the U.S.’s in nearly every other country in the whole world, and the same goes for Tajikistan.
My OBGyn in Tajikistan advised me to have two ultrasounds- one at 12 weeks and one at 25 weeks. She said the ultrasound was still a relatively new procedure (like in the U.S. it’s only been used for healthy pregnancies for about 20 years) and that there could be unknown, though obviously subtle, risks. We discussed my diet, avoiding stress, and each visit she weighed me, measured my abdomen and uterus using a tape measure and her hands, and determined the baby’s position through asking me about it’s kicks (in North America this is called “baby mapping”). She used a special wooden stethoscope to listen to my baby’s heartbeat and took my blood pressure, asked about swelling, bowel movements, and discomforts. If all was going well, she sent me off happily. Though I measured small in the abdomen throughout my pregnancy, she said this was common among smaller, first time mothers. “Your uterus doesn’t stretch as fast,” she explained, “but for future babies you’ll get bigger.”
We met once per month, and would have met once every two weeks from 30 weeks on and then once per week for the last month, had I not left the country.
For our last appointment, when I was 28 weeks pregnant, she recommended a general checkup with a terapevt (”therapeutic specialist”, or general practitioner whose job it is to do put together information from all the specialists) and with two other specialists, the eye doctor and a last ultrasound. After they gave me a clean bill of health, she signed off that I was in good health to fly as of that date.
Had I delivered in Tajikistan, I would have gone to the central or second maternity house and been offered pain medication. Had I refused, they would not have given me any. I might have been given oxytocin to speed up labour if I’d been behind (as it turns out in my case this is not likely to have happened because by the time it got strong enough to go to the hospital, the baby was already halfway down the birth canal). Forceps and c-sections are rarely used.
Most women in Tajikistan no longer receive this standard of care, because they are so poor and the socialist programmes are too underfunded. It remains, however, the maternity care standard on paper, and what the tiny middle class does get when they pay a bit more for it. Nearly all women in the cities get some form of follow-up.
It seems to me typical that here in the U.S. we should be polarized into two extremes- the overly medical, litigation-driven model of care in which a doctor specializing in surgery (c-sections) and pathology delivers the baby, and a small movement of very independent people who chose to have their babies at home without immediate access to pain medication, and without doctors nearby, in which a woman with only two or three years’ medical training (but much more experience) is delivering the baby.
Whereas in the former USSR they managed to keep some balance- birth is considered healthy, a woman’s rite of passage and a joy to be facilitated by another experienced woman. But they also made sure that the latest medical advances were available to women. Since experienced midwives and accouchers were in charge, these were taken advantage of only when all the other techniques, developed over centuries across Asia, didn’t work.
In the U.S., we have to choose: 25% chance of surgery, or your home.
Ah, the joys of living in the richest country in the world.
Yay! I was waiting for your post, glad to hear that you and your family are doing well, shukur. It sounds like the Tajik model is the best, if only they had enough funding (this seems to be my mantra these days). Many of my friends have gone through this decision-making process and it seems so complicated.
do the midwives provide the real medical care that you mentioned or is it someone else? I’ve always wondered how the birth process with midwives worked.
Oh, and we have a mutual friend. I don’t know if he wants his name in the blog but his initials are J.G., he said he’d mention it to you.
Comment by Asiyah — 07.11.2006 @ 06.0.26
Wow, thanks for sharing! I once asked one of my colleagues, who’d worked extensively in sub-Saharan Africa, how she found life in Macedonia. (This was in 2000.) She said the biggest adjustment was the medical care, which surprised me given how much more “developed” E. Europe/ex-USSR countries are. She said that in Africa, when you go to a doctor, either the doctor is a foreigner or a national who trained overseas, so the medical care (at least for expats) is up to Western standars. Whereas in Macedonia and other places, there is no one like that, everyone was trained in the crappy state system, and the care reflected that.
Comment by Sylvia — 07.11.2006 @ 13.0.32
Asiyah- I have a number of friends and the initials don’t ring a bell- is he Afghan? As for the midwives, in our state they are allowed to provide responsive (as opposed to preventative / proactive) medical care in the form of oxygen, oxytocin (a labour stimulant that also helps stop excessive uterine bleeding after birth), forceps, etc. Surgery (like a c-section) or other riskier procedures (like vacuum extraction) require hospital settings because of the risks involved. I think some midwives use vacuums but generally midwives consider their expertise in getting babies out the natural way, so they generally use other ways of getting babies unstuck. Usually that means changing the woman’s position, or pressing on her hips, or using counselling to help women relax and/or push correctly so that baby can come out.
Sylvia- Unfortunately in the formerly communist countries, many of the best doctors have left. The state system was not always crappy, and in fact is not so horrible at present. If I could get good care in Tajikistan from a Tajik (not Russian) doctor, and Tajikistan is the poorest country of all the formerly communist countries, I’m sure reasonably good regular care can be obtained in most others.
Surgery, however, is another question.
Comment by Administrator — 09.11.2006 @ 03.0.59
Dear Elizabeth, thank you for taking the time to write that, when you could be with your baby!
I can add in something to your comparisons of global OB-GYN practives, for Italy: there too, like in the US, the C-section rate is high (but not as high), and most people opt for masses of painkillers. However, most (regular, state-run) hospitals do offer an alternative ‘natural birth’ set up, which is what I chose for my baby. Although my son was born in a hospital, he was born in a cozy, serene room with a double bed and no hopital trimmings, where I was assisted only by a midwife who knocked on the door before entering. I was admitted into that room - which also had a tub for water births, on the understanding that no artificial medication would be available to me. If anything went wrong, I could move to a ’standard’ western delivery room - a terrifying place to me. Luckily no need for that! I left believing midwives to be among the most amazing people on earth. And, the whole experience was completely free: all the check ups, the pre-natal classes, the birth, the followup, regardless of nationality, residency or visa status. Brava Italia!
Comment by Flora — 10.11.2006 @ 01.0.03
Flora- Oh, brava Italia indeed. Here I paid about $1,000 including all tests, but that doesn’t include my health insurance payments. To have the baby in the hospital is about $10,000.
Comment by Administrator — 10.11.2006 @ 04.0.25
For years I’ve heard horror stories about giving birth in hospitals, from young mothers (like 19) being prevented from breastfeeding and being too young and insecure to advocate for themselves to a baby of a co-worker’s sister dying because the doctors delayed in giving her medical attention as the baby strangled on its umbilical cord. I’m so glad that there is an alternative out there! I read that here in Vegas one of the private hospitals is starting an alternative birthing center. Hopefully, this is one step closer to reaching that balance between a natural, joyous birth and medical attentiveness.
Comment by Shannon — 10.11.2006 @ 17.0.30
I’ll ask him to email you, he’s not Afghan - he’s Anglo-American. I don’t want to out him w/o his permission. Shannon’s story sounds very frightening.
Thanks for the info re midwives, it sounds like a more appealing solution though I worry about complicatons. Flora’s solution sounds the most comfortable. Of course, in an Afghan case, there’s a waiting room full of Afghans waiting outside and drinking tea..
Comment by Asiyah — 11.11.2006 @ 08.0.29
I am little wistful reading your comparison of childbirth experiences. Our first was a footling breach presentation who was delivered in the USA by C-section, and we opted for a C-section for the second to minimize the risk of a ruptured uterus. I am happy that your experience was rewarding and apparently straightforward (never easy!), but I am not sorry that the surgeons were there when we needed them.
Comment by Bill Day — 18.11.2006 @ 02.0.35