Having a baby in China: 38-week appointment

This would be our 12th and most likely final appointment. It was a Sunday afternoon, the sun was shining and Mr T and I were enjoying a lovely day together. We thought it was funny when our translator greeted us by saying; “You’re in a great mood today!” I just laughed out loud, amused by what she must think of me.

It was a simple appointment, vitals, urinalysis and fetal heart monitoring. We did have a bit of a scare when the monitor stopped recording, the nurse had to come in and replace the cord but all was fine from there, though the new cord only recorded heart beat but not fetal movement. I could still feel the baby moving so I wasn’t concerned, we were just hoping we wouldn’t have to sit through another 20-minute session of monitoring.

In with the doctor she said my stats were good and she did a physical exam, not surprised to find baby still in breech position. The doctor said she would like to preform a cesarean birth between the 9th and the 16th of June (39-40 weeks). We expected this and said we would schedule for the 16th, still leaving some time for birth to start naturally but accepting the doctor’s wishes not to go past 40 weeks. It was amazing how quickly they were ready to process us in for the surgery, forms were filled out in no time and I had confirmation text messages before we had even left the building!

Although we had succumbed to scheduling the cesarean, I still came with two lists of points that are important to us whether it is a cesarean or natural birth and as much as they were probably annoyed with me, I took the time to go through each one. It was a kind exchange this time and Mr T and I feel that we understand what the hospitals procedures are and that they understand our wishes. I have since typed up my own birth plan and had a friend translate each point so we can have a clear quick reference on hand, just in case.

So that’s it, next installment should be about the birth of our baby!!

-Mrs T

Having a baby in China: 37-week appointment

As it often happens in the small world of expat living we by chance met a couple that had recently (one year ago) had their baby at AmCare. It was just after our last appointment and we were still feeling a bit negative. They had had a great experience at the hospital, I think this was because of two factors: the woman was Chinese, so there was less of a dependency on the translators and the man was very up front and asked for (and got) what he wanted. Before committing to the hospital he wanted to meet with the president of the hospital and would settle only for the lead doctor in the hospital to care for his wife. It was nice to speak to another couple who had used our hospital and hear some positive things. The woman has continued a personal relationship with her doctor and made a few calls and got us an appointment with her. We were unsure what this appointment would be like. Our translator canceled with our original doctor and scheduled us with the new doctor. We didn’t know what type of dialogue (if any) had occurred between the doctors or the translator about us. Had she been warned to watch out for the moody, demanding westerners or were we just another patient to her… This appointment was a very simple one with just vitals, urinalysis, fetal heart monitoring and then a visit with the doctor. It did seem as though the translator was being a bit kinder toward us, and I as well had vowed to come in and stay calm and accepting. The new doctor took great care to explain everything to us, starting with the fetal heart monitoring report, describing what each line meant (contractions, heart rate, and fetal activity) and told us all was normal. Upon her examination she found the baby to still be in breech position and she took the same stance as our previous doctor, but with a bit more sensitivity in her delivery of information. She also did not recommend acupuncture to attempt to turn the baby. She is willing for us to wait to go into natural labor, but would not feel comfortable going past the 40 week mark. We made it clear that we were not expecting anyone to try to vaginally deliver a breech baby, because we think that they think that is what we want, (from what we can tell it is just not done in China), but we would like to give the baby as much chance as possible to turn or let us know it is ready to be born by labour beginning. She explained how the hospital would define cesarean and emergency cesarean and the costs that accompany it. We asked how many days in advance did they need to schedule a cesarean (they can do it the next day). We left the appointment feeling secure in the care we were being given. We know we have done what we can to help the baby move and if it sticks in breech there is a reason for it. What is most important is not how the baby is born but that the baby and mum are safe and healthy. -Mrs T

Having a baby in China: 36-week appointment

Another intense appointment…

We were squeezing in our appointment around what is called a birth rehearsal class. We arrived to first have a fair amount of blood taken for several different tests, which I had to be fasting for. And for the first time we remembered to bring our own breakfast as boiled egg and prepackaged cake is not my favourite thing to eat. We then had our 20 minutes of fetal heart monitoring, heartbeat was strong and steady, though the monitor itself seemed to jump from very low to very high and there was nothing being recorded on the sheet. At this point we had to go for our class so we would return for more monitoring later.

Birth rehearsal class consisted of about 8 other couples, all Chinese. We of course had our translator with us, though I am sure I did not get all the info. Luckily I do feel quite prepared for birth based on my own reading and support of our doula. The important bits of the class were to know when to call the hospital (when contractions are 5-1-1, or when your water breaks), what phone number to call and whether or not to go in the main entrance or into the emergency entrance. We had another tour of the room we will labour in and stay in after the birth and then we were brought up to see the delivery room. We were pleasantly surprised to see the room looking very similar to the labour room, wood paneled walls, and soft colours. The difference from the labour room was the size (a bit smaller), and the bed (designed specifically for delivery). The teacher spent a lot of time talking here about the stages of labour. We were also informed that the operating rooms are just across the hall in case of any emergency.

At one point in the delivery room they asked all the men to go stand in either the bathroom or the closet so each of us women could have a go at sitting in the pushing position. It was quite funny seeing Mr T ushered into a tiny room with a bunch of men he wouldn’t even be able to talk to! I gave the teacher a bit of a scare when I asked if I could push in any other position, and demonstrated by turning around, getting on my knees and facing the back of the bed. I thought she would have a heart attack. The answer to my question was that I would have to speak to my own doctor.

That was the end of the class and we were back down stairs to finish the rest of our appointment. We had 20 more minutes of fetal heart monitoring, which was more successful this time. We were a bit confused about this as the nurse said they couldn’t get an accurate read if the baby was not active, but surely we thought the baby should have a heart rate whether active or not… just another thing we had to trust them on without understanding exactly the meaning. I then went in for an ultra sound as doctor wanted to check the baby’s position. Mr T stayed with me for a few minutes and then our doula joined me in the room (she had come along for the class and wanted to have a look at the baby’s position as well). The most important bit was that the baby is healthy and has a strong heartbeat, but seeing the confirmation of the baby’s head cuddled up against my upper right ribs, really hit me emotionally. I tried my best to not let anyone see, but I couldn’t stop the tears from flowing. Coming out of the ultrasound room I had to sit for a minute and have a good cry. It is just that I know my body was built to give birth naturally and I felt upset that I might not be able to do it. This compounded with having no support or encouragement from the doctor. I knew in a few minutes we would walk into her office and she would be ready to schedule my cesarean.

The visit with the doctor was quite grim. All the same comments about the baby’s position and the way forward remained the same. I asked if I could get acupuncture as I have read and spoke to several women who it has helped to turn the baby and the doctor flat out said no, don’t do it. We continued to hold our position of wanting to go into labour naturally and then proceed to cesarean if necessary, she seemed to accept this though not agree with us. In the midst of this my pulse was rising due to the fact that the translator in the room was proving to be very weak. She could not articulate acupuncture, and had to be corrected by a doctor’s assistant in the room when reporting results of our blood tests (she said your kidney results are normal, when actually it was liver, not the biggest concern of mine however it made us wonder about other inaccuracies she may be reporting back to us). At this point I was adamant that the other translator return to help us.

So there we were sitting with four stone faced Chinese women in front of us and things turned even worse when I returned to the questions from last week’s birth plan discussion. The first point was Could our doula be with us for labour and delivery? flat out answer: no. This completely devastated us, it is something we had been clear about since the very beginning, she had attended an appointment with us and never had the doctor said she wouldn’t be allowed. At this point we both just felt so disappointed and felt there was no sense of trust. The only sympathy we received was a tissue passed to me by the doctor’s assistant (who we had only seen for the first time today) to dry my crying eyes. Our translator went through the remainder of the questions though I don’t really recall what she said as I was so upset. I had asked last week for her to prepare a list of procedures that are normally carried out on the newborn baby and she had not prepared it, so the doctor sat and wrote it as we watched, and the translator begin to rewrite it in English but I said don’t bother and took the doctors notes.

We arrived home that afternoon feeling the gravity of the choice we have made to have our baby overseas. I found myself thinking maybe having an optimistic, adventurous outlook may not suit all of life’s important decisions. It took a few days and many discussions and explorations of our options for us to calm down and accept our situation. I did clarify that our doula could be with us in the labour room and must wait outside the door of the delivery room, which did mean something, albeit it would have been nice for someone to say that in the appointment.

We will be sticking with our hospital, but with a very clear view that we need clear communication and know that what we want or expect may not be what they will do.

-Mrs T

Having a baby in China: 34 week appointment

This was an interesting and intense appointment. It included vitals as normal including urinalysis, also ECG and pelvic examination. We had our first non-stress test, which was me sat in a comfy armchair for 20 minutes of fetal heart monitoring. It was relaxing and reassuring to just sit there and listen to the baby’s heart beat, also so interesting to watch the rate change and wonder what was the cause. The doctor’s examination confirmed our thoughts that the baby has yet to turn, seems to be lying transverse across the middle of my belly. Cesarean was brought up again. After a bit of conversation we were able to get across we do not intend to plan a cesarean and would like to give this little one as much chance as possible to turn. If we get to a point that labour has begun and there is no sign of baby moving into the right position we will of course take the safest route to have a healthy baby and mum, which here in China is a cesarean. The doctor seemed agreeable to this.

It all got interesting when we began to discuss the birth plan. The hospital provides a booklet with different options (written in both English and Chinese) regarding your time in the hospital through the birth. The sections include:

Environment (Accompaniment/During labor/Mobility and positioning/pain relief) Labour (Episiotomy/Placenta/Patient transport from the delivery room to the patients room)

Newborn Care (Immediately after delivery/Umbilical cord/Newborn’s vernix)

Cesarean Section Delivery (Cesarean Section Planning/Anesthesia during the cesarean section/ Medication after the cesarean section/Company during the cesarean section)

Postpartum (Breastfeeding/Nursing interventions and newborn care/Meals/Visitors.

Within each section there are several options to choose from and an area for remarks. Mr T and I had spent considerable time going through it, as well as going through it with our doula. We handed it to the doctor, and she slipped it into the file and continued on with the rest of the appointment, from that moment we knew we had a bit of a battle ahead of us. We had to ask to go through it, and each time after we discussed a point, she began to close it up to put it away, whilst I had to say, next point please.

From the very first point, accompaniment, there was a problem. I had selected partner and friend (doula), and was told only one person is allowed. I found this frustrating, as we have been very clear since we started visiting the hospital (34 weeks ago) that we had a doula and she would be attending the birth with us, which up until today had not been an issue. The long discussion over the whole birth plan ended with a very red faced mama-to-be and a list of things that the doctor would be applying to get approval for. We will have to wait and see what types of accommodations the hospital will be able to make at our next appointment.

As you may know from previous posts we are looking to have a natural birth. I believe that a woman’s body is made to give birth and knows exactly what to do. I would like all opportunities to allow my body to do what it needs to do to birth this baby. I have read many positive natural birth stories and have the support of a doula that has given birth naturally and attended many natural births. If I were giving birth in America or the UK I would be opting for a home birth or going to a birth center. (I of course will accept interventions when medically necessary to ensure baby and myself stay safe.)

That being said we know we may face some challenges delivering in a hospital, in China. But we remain hopeful that with good communication and clear information we will have a happy healthy baby before we know it.

-Mrs T

Having a baby in China: 28/30/32 week appointments

I am grouping these three appointments together as they have all been very straight-forward and similar. At 28-weeks we began visits on a two-week cycle rather than four-weeks, this will last up until 36-weeks and then appointments will be every week until birth.

At each of the last three there have been vitals, uterine fundal height, abdominal perimeter, fetal heart Doppler and urinalysis. Two of the three appointments included a blood test and one had an ultrasound. We have continued to receive ‘normal’ results in all testing, and baby’s heart rate has remained at a similar rate all through pregnancy which is great.

The ultrasound at the 30-week appointment was a bit long and uneventful (I nearly fell asleep a few times). They again struggled to get the measurements they were after as baby wasn’t in the ideal position for them. We did get one nice silhouette of the head but just for our viewing in the room, the images they sent home with us were of the spine and some unidentifiable (to our eyes) body parts.

The 30-week ultrasound did start with the Dr informing us that the baby was in breech position and if it doesn’t move they will schedule a C-section. This was again repeated at our 32-week appointment upon Dr’s palpations. As we are planning for a natural birth these are not the most encouraging words, however I have had lots of great ideas from my doula and books and we are doing what we can to make room for baby to move around. I will say though I have been a disappointed in the hospital/Dr to not have even suggested anything to turn baby, or let us know there is still plenty of time. At least we know the position and can give proper effort to share our position with them. (Of course I will do whatever is medically necessary to ensure baby and mother are safe and healthy, but I strongly believe in the nature of labor and birth, our bodies know exactly what to do!)

Additionally, comments about my weight (gain) have decreased significantly since I spoke to the translator about being a bit more sensitive. At our last appointment we were even told that my weight was perfect! Mr T and I had a big giggle then and saw a bit of a laugh from the Dr, we thought there was even a hint of sarcasm!!

This week I will begin to scale back on my workload just a bit. Still feeling lots of energy but the heat and demands of a class of six-year olds is beginning to get challenging. I will begin my maternity leave at 36-weeks.

We are looking forward to next week’s appointment where we can check baby’s position, go over our ‘birth plan’ and organise a delivery room tour.

-Mrs T

Perfect Pancakes

This morning we ventured out to try a new spot which we found on one of our favourite parts of Tianjin (Wu Da Dao). After a quick look we thought we had finally found somewhere to get a good western breakfast in Tianjin. Despite the challenge of ordering food with no English menu and pictures we were quite impressed. The pancakes were tasty and we were even able to get butter and maple syrup on the side. Two meals and two hot drinks for 119 rmb ($19/£13), we will go back for sure!

-Mr & Mrs T

Having a baby in China: 24-week appointment

We were expecting this to be a quite a big appointment, I had read a bit about the glucose test I would be having and we had another ultrasound which we were very excited about. To make it more enjoyable our new baby friends were there for their appointment as well so we had someone to chat with whilst waiting.

We checked in, my blood pressure and weight were measured. They took my first of three blood samples and I was then given a sugary drink and instructed to drink it all within five minutes. They then let me know that I needed to go for blood again after one hour and then two hours. We had no idea we would be at the hospital for over three hours!

While waiting for the second blood draw we went in for our ultra sound and again the technician was not pleased with the baby’s position and not able to get all of her required measurements. We were sent out to walk and hope the baby would change position.

Blood draw number two, (which I had to remind the nurses it was time) was my first experience with a bad technician. I could feel that the needle was not in the vein though she still attached the tube and acted surprised that no blood came out. On her second go she had to call in for help whilst the needle was sticking out of my arm! Help arrived and blood was drawn.

We went back in the ultrasound room, this time the technician was getting a little more aggressive trying to move the baby who was still not in the right position. We were sent out again and this time I made a bit more of an effort to move around to try and get the baby moving.

Blood draw number three went well on the first try and it was finally time to eat. Hot soymilk and chocolate marble cake was the breakfast provided, it made us think why did we not bring our own snacks?? Next time…

Third time in the ultra sound room and baby was still not cooperating, though with me on my side she was able to get the measurements as well as a picture for us.

By this time it was noon and we then had to wait to see the doctor as she was out for lunch. We heard the heart beat on the Doppler and all of the days test results were normal. The doctor did say that I had gained too much weight since my last visit and I should work to not gain too much weight.

I heard the weight comments but didn’t really listen to them. I have been feeling fantastic and really healthy throughout this whole pregnancy and I am often told I look great. My doula has been really happy with how things have been progressing. Despite knowing all of this the comments did start to get to me. Whilst waiting for our taxi I decided to have a quick chat with the translator.

As kindly as I could I tried to let her know that this subject of weight gain can feel quite sensitive to a (pregnant) woman. I can appreciate some sensitivity may be lost in translation but bluntly saying “You’ve gained too much weight” is not really the best way to give this information. If the doctor has a medical concern about the amount of weight gained that should given to the patient. Additionally I said that she should maybe recognize that western women’s bodies do differ from Chinese women’s bodies. We take on weight and fat a bit differently. This point she quickly argued against and said no we are the same (western and Chinese women). I emphasized to her that I was comfortable with the weight I have gained, as was my doula, however I thought she should know how the doctors comments (given through her) may seem quite negative to the person receiving it.

I think she was very surprised by my comments but I had to do it. 16 weeks to go….

-Mrs T

Having a baby in China: It’s a small world

On every visit to the hospital we always wonder if we will see any other expats. We’ve asked our translator and have been told there is only about four other western patients at this time. For a few appointments we did see another non-Chinese couple but were never brave enough to go up and say hello.

Of all places I met this other mummy-to-be at the monthly gathering of the Sauvignon Club. (Once a month we expat ladies gather for good food and wine at the St Regis Hotel.) The chairwoman had mentioned to me that she had another woman wanting to attend but not drink any wine (which is kind of the point of the club). I was so surprised to see the woman from the hospital appear and even more surprised when she said, “I know” after I introduced myself. It turns out that for about an hour into one of her appointments they thought she was me and kept calling her by my name!

It was really lovely to meet another pregnant woman and we have stayed in touch since. She has met up with our doula to go over a few things and we were able to have a birthing class together with her and her husband. I feel extra lucky to have met her as her due date is about 11 weeks before mine so she will be able to give us the low-down on labor and birth at AmCare.

-Mrs T

 

Having a baby in China: 20-week appointment

We had been looking forward to this appointment, as we knew it was the time when we could find out the baby’s gender and so we expected a good view on the ultrasound.

It was a very standard appointment: vital signs, blood draw, ultrasound, Dr. consultation and FH Doppler. We had a bit of a hold up with the ultrasound as baby was not in the correct position and they could not see all the organs and get all the measurements. They asked me to go out and walk and eat to see if we could get the baby to change position. During this time we took the opportunity to have another tour of the hospital as our doula had joined us for this visit. It was nice to have a second look, knowing this time that we would actually be having a baby here. She was very interested to see what the facilities were like and was impressed with what she saw.

The funniest moment of the afternoon was after asking their policy of eating during labor (its the mother’s choice) we were told that a tray of snacks would be available including cake, biscuits and red bull. We just could not believe our ears, when we asked about the red bull the translators reply is that mum’s get tired in labor and need the energy! Not sure if red bull (especially not Chinese red bull) would be top of my list whilst in labor.

Back to the ultrasound room and after a bit of prodding baby did a little flip, which we got to see on screen (pretty amazing) and all the needed information was retrieved. In the end we decided NOT to find out the baby’s gender. It was something we had been going back and forth on since the start and we finally decided that we would like to be surprised.

Since our doula was with us we took this time to go through a long list of questions about labor and birth and were pleasantly surprised with the responses. In general they seem very supportive of natural birth and patients making decisions for themselves (taking into account that mother and baby are safe). At our 34-week appointment we will go through a detailed birth plan and tick our choices.

Four weeks until the glucose test…

-Mrs T