Saturday, April 29, 2017

an expat childbirth: why I am electing to have a c-section

A lot of people are very surprised (and rather opinionated) when they find out that I am electing to have my c-section, meaning my doctor is not the one telling me I must do it.

I am a-okay with their surprise (and disapproval) though.

One thing I have learned over my 30 years on this planet is that I am the one who has to live with my choices, and this is most definitely my choice to make -- not my colleague's choice or relative's choice or friend's choice or random stranger's choice. 

Still, the reasons why I am choosing to have a c-section are due to the fact that I am an American expat living in Taiwan, so I am going to share them here on my blog. After all, the whole point of this blog is to share our expat experience both for our future selves and for others who may find themselves in our shoes.

I have already raved about experiencing pregnancy in Taiwan, and while I have nothing to personally compare it to, I know I am being absolutely spoiled in comparison to what many of my girl friends in America experience as pregnant ladies.

For example:

I have received thorough and excellent health care over the past eight months. We have spent less than $100 USD for all of it: the numerous doctor appointments, the numerous blood and urine tests, and the numerous ultrasounds.

Further, I am 37+ weeks pregnant, on my fully paid maternity leave, and have been since the end of my 35th week. I will continue to receive full payment until August. Then, I will receive partial compensation until I return to work in late February 2018.

Further, my employers have to hang on to my position for me for up to two to three years. Between Sean and I, we are entitled to that much parental leave. Even more, Sean has one full week of paid paternity leave to spend with Ruby and me and then the option to use sick and personal leave to extend that time.

However, there is one catch to my experience with pregnancy in Taiwan: it is my opinion (and the opinion of many others too-- just poke around lightly on the Internet and you will see what I mean) that Taiwanese birthing practices are decades behind those of the developed world, which is why I am electing to have a c-section. 

Women essentially have two options for birthing regardless of where they live on this planet: have a vaginal birth or a c-section. The more I learned about what having a vaginal birth here in Taiwan would entail, the more I knew I just couldn't.

First, women in Taiwan (at my hospital) labor in a shared room. It's not the cozy birthing suites I visited after my girl friends gave birth in America. There is a lack of privacy and little room for family. That was the first red flag for me. I am a very private person especially when it comes to certain things like my body or vulnerable moments. Truthfully, even the idea of my mother seeing me breastfeed wigs me out. It's not because I am ashamed of my body or puritanical; it's just the way I have always been, and I accept that. While many people may not understand this, knowing I would not have privacy was a huge deal to me. It stressed me out beyond belief to know that I would be forced to share those hours (or days) with strangers-- and I do not mean the nurses and doctors-- I mean with the other laboring women and their relatives.

Second, there is a shared delivery room. In Taiwan (at my hospital), women labor in one room and deliver in another. That means that during the worst part of labor, you are wheeled through a hallway to get to the delivery room. Again, the whole privacy thing. Further, if more than one woman is delivering, no relatives at all are allowed in the delivery room. Guys, pushing out a baby is not something that happens in five minutes. Sure, it can, but it also can't. The idea that I would be in the delivery room without Sean was the icing on the cake. I knew I could not handle that. Further, I have no interest in being separated by only a curtain from another woman in the midst of pushing out a baby. I know what some of you are thinking: but it's possible no other woman will be delivering at the same time. True. That is true. However, Hsinchu has the highest birth rate in all of Taiwan and that is not a gamble I can live with.

Third, Taiwan has a near 100% rate of performing episiotomies. When I asked my doctor about this, he all but said it was mandatory. However, the definition of the word episiotomty is: "a surgical cut made at the opening of the vagina during childbirth, to aid a difficult delivery and prevent rupture of tissues." Essentially, what my doctor was saying was that they treat every single birth as though it is a difficult one. I have my theories about this, but as they are just theories, I won't share them here. It may sound crazy to someone else, but I am far more comfortable having someone cut my abdomen than my lady bits, especially knowing that regardless of the birthing method I choose, I will be cut.

Fourth, it is still common here for nurses or doctors to apply fundal pressure during labor, which means pushing on a laboring woman's stomach to "aid" the baby in coming out. Um, the only other places that seem to still do this are third world countries in which c-sections and other birthing emergency care is not available.

Fifth, I think it is hard for my American friends and family to understand that in Taiwan, there are not a lot (if any, actually) of choices regarding how one gives birth. Here, there is socialized healthcare. The policy at one hospital tends to be the policy at most, if not all, hospitals. We did copious amounts of research to understand our options in Hsinchu. Really, there were three: my hospital or two others. However, especially after encountering complications in the second trimester, we only felt confident staying with mine because it has the best NICU in Hsinchu, and we were seriously concerned about a premature birth. There is one clinic in all of Taiwan that we could find-- once again, this was after massive amounts of searching -- that does anything close to an American version of a "home birth" with a doula and tub, but it's a birthing clinic in Taipei, which is a two hour drive away -- and we don't even have a car!

All of these factors made it easy for me to come to my conclusion and ask for an elective c-section, which, luckily in Taiwan, is something doctors will perform with minimal shaming and guilt.

While I felt very confident in my decision, I knew I made the right choice last Thursday morning when we ended up at the hospital from 1am - 4am due to some happenings in the night (of which I will spare you the gory details). While everything turned out to be fine in the end and we were eventually sent home, the three hours we experienced on the maternity floor of my hospital reaffirmed everything I know about myself.

I was lying on my back for three hours hooked up to all of these machines stressed out beyond belief. I broke out into a nervous sweat and ended up puking because I was so uncomfortable and nauseous lying in that position for so long (which, by the way, is how hospitals want women to labor here: on their backs-- a friend was told she could not get up and go to the bathroom because how would they leave the monitors strapped to her, so they gave her a bed pan instead). I cannot begin to express how uncomfortable it is to be on your back for that long with a heavy baby pressing on you; for the past two months, the only way I can relax is on my side. I literally feel like I cannot breathe when on my back, and now I know that it also makes me vomit. Sounds like a lovely situation for hours of labor, right?

Further, my high blood pressure is a real concern moving forward regardless of how I choose to give birth. Hypertension in pregnancy is no joke, and I have been grappling with it since 26 weeks of pregnancy when I was diagnosed with mild preeclampsia. When I was just contemplating what a vaginal birth would be like in Taiwan, I could feel my blood pressure rise. However, when I was actually at the hospital lying down on that bed with all those machines and wires strapped to me for just three hours, I could literally see my blood pressure rise-- I am talking readings of 150/115 when normally I hover around 120/95 (which is still quite high).

I can only imagine what would happen during actual labor with all of the factors I mentioned-- likely, my blood pressure would hit such a level that I would end up with an emergency c-section regardless, which is what happens when a woman's blood pressure gets dangerously high in the midst of labor.

To me, all of it sounded way too traumatic and being legitimately traumatized sounded like a really poor way of entering motherhood.

So what does all of this mean?

On May 5th, I will check myself into the hospital so I can have my c-section the next day. Within a 45 minute to 1 hour span of time, I will be wheeled in and out of the OR. I will get a private recovery room afterwards, and Ruby, as long as everything is good, will be with us the whole time afterwards.

Why May 6th and 38 weeks?

All of the literature says it is safer for hypertensive women to deliver once they reach 37 weeks. Due to my family history of severe preeclampsia, which is something that happened to both my aunt and cousin and made both terribly and dangerously ill, I am not willing to take the risk of seizures, coma, permanent kidney or liver damage, or death.

To me, that sounds pretty reasonable.

In the end, being an expat in a foreign country that is remarkably different from your own can make childbirth a more daunting concept than it is to begin with.

For me, there are far too many practices surrounding childbirth in Taiwan that just don't sit well with me at all. In the end, I chose the option I could best live with, even if it's not the option I would have chosen if I was home in America, which would have just been an early induction to deal with my pregnancy induced hypertension.

Many people warned me that having a baby would entitle all kinds of people to offer their unsolicited opinions about my pregnancy and parenting choices, but I cannot think of a more personal choice for a woman to make than how to give birth, which luckily, I was able to do.

And for that, despite the fact that Taiwan and I don't see eye to eye on many matters regarding birth, I am grateful.


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