Induction in Thailand - Kristin's Story
Kristin has really kindly allowed me to share her blog post about her pregnancy and birth experience in Thailand. If you'd like to check our Kristen's blog to see more of her content, give this link a cheeky click: https://www.familyseesworld.com/ and she can be found on Instagram at @familyseesworld.
WOW! Just wow! My baby boy is 1 year old. I think with the addition of every child to a family, time speeds up. I can’t believe a year has gone by. So, in celebration of his first birthday, I wanted to share some highlights of being pregnant abroad, and what it was like delivering in a foreign country (please read to the end if you want all the details). The decision to fly home to deliver vs staying and delivering abroad is not always an easy decision to make. I hope this post can make you laugh, and also shed some light on the questions to ask in the decision-making process. For our family, with having 3 young children, it would not have been good for any of us if I traveled back to America 2 months before the due date and remain there for 2+ months after. So we knew I would be delivering in Thailand.
My first appointment with an OBGYN was quite humorous. When I sat down with my her and discussed how I had 3 children already her questions to me were: “Does your husband know you’re pregnant?!” and “Do all of your children live with you??” both were honest questions full of surprise and shock! It was funny, and it was not the last time she would say things that I just have to laugh about. Such as the multiple times at my later ultrasound appointments she would laugh about how big my baby’s nose was! She would then tell the nurse in the room to come look, and they would both laugh!! They were in no way trying to be rude, and I laughed along with them. Overall, the doctors’ appointments are very similar to those back in America. They would do ultrasounds every appointment if you asked (which is not true in the States), but in general the monitoring, lab tests, vitals are all on par with the timing of things with my previous pregnancies. The biggest concern I heard from foreigners about delivering babies in Thailand is the push towards a planned C-section. Since only a FEW hospitals in all of Thailand offer epidurals, and for other reasons culturally it is very normal to plan C-sections even if there is not a medical reason to do so. Because of this, any slightly atypical presentation of the baby at delivery practically requires a C-section because vaginal deliveries are just not as common. Since I developed gestational hypertension with my 3rd baby which required her to be delivered 4 weeks early (perfectly healthy!) I was acutely aware of the risks and wanted to make sure I fully trusted my OB to tell me if I required a C-section only if there was a risk to me or the baby and not just because. Therefore, I continued researching other hospitals to ensure I had that trust in my OB.
Eventually, I found a wonderful doctor in Bangkok who had delivered over 10,000 babies by the time I met her. The hospital was beautifully decorated and the labour ward had a room for a water birth and it was one of the few hospitals that offered epidurals. If there was any complication during delivery, the operating room for C-sections was literally across the hall from the delivery rooms. Even though we live 2.5 hours away from the hospital, I was willing to make the drive for my appointments and for delivery. Thankfully, since many women travel to Bangkok at the end of their pregnancies from surrounding cities and countries, it is not uncommon to show up for the last month of pregnancy for monitoring and delivery. My delivering OBGYN offered the possibility to follow my OB in Pattaya until 36 weeks and then switch to her. I LOVED that idea, and it saved me a lot of time in the car. When my parents found out we were pregnant (on their first trip to visit us!) they decided to come stay with us for 7 weeks, spending about 3.5 weeks before and after the due date since they were retired! It was AMAZING on so many levels.
Because of the 2.5 hour drive to the hospital, and since it was my 4th baby, I put together a “delivery in the car” bag of supplies just in case! Did you know, cutting the umbilical cord is a sterile procedure? YOU do NOT cut it… you wait until you’ve arrived to the hospital so it’s done by a midwife or OB. Do not do that yourself. Have lots of towels & trash bags to put down (or a shower curtain), gloves, water, nose suction, infant hat & blanket to wrap the baby. I did lots of reading and ensured my husband and mother were well informed on how to deliver a baby in a vehicle! My mom is a nurse practitioner, so her medical expertise is very helpful, but she worked with the elderly population, so just a tad different! I figured if we were prepared then it wouldn’t be necessary, and my husband looked at me crazy anytime I was trying to “teach” him something about delivering a baby, lol. I had an appointment 3 days before my due date on a Saturday. My mom and husband came along and I was planning to ask to be induced because of the length of time it would take to get to the hospital. Oh, I forgot to mention we have one vehicle and a driver since the company my husband works for does not allow us to drive for liability reasons. So, we share one vehicle and he works over 45 minutes away from home, and not on the way to Bangkok. Theoretically, if I went into labor in the middle of the night, or when my husband was at work it would take well over 3.5+ hours to get to the hospital. The typical expectation when delivering in Bangkok is to move there the last few weeks of your pregnancy for this reason. But having 3 other children to care for while my husband was still working full time it wasn’t possible for me. Because of those reasons we thought it best to just be induced and not risk a delivery on the road! My OBGYN 100% agreed with this plan and at about 11:15am on Saturday May 11, 2019 she gave me cytotec to soften my cervix. We soon moved into the room for a water birth because that is what I wanted. My previous 3 deliveries I had an epidural – WHICH I LOVED!!! – but I figured for my last baby I wanted to try it natural. A while later they started a low dose of Pitocin. I generally felt pretty good. We watched movies and only a few hours later was I feeling a little uncomfortable with the contractions.
About that time the doctor came back to check how dilated I was and it was 5 cm. She advised breaking my water so at 3:00pm she did. I IMMEDIATELY started having very severe contractions and pain. She left go to back to her office and would be back to check on me after a while. The next bit seemed like forever, but in reality it was not very long. I really thought I was going to die. I asked if I could get into the birthing tub to help with pain relief. However, the hospital policy is you can only be in for a maximum of 2 hours, and if you want a water birth you have to wait until your fully dilated to get in. I understand some people it takes a long time to go from fully dilated until the baby is born, but even with my first she was out about 15 minutes and a few pushes later. Since the nurses here don’t check for dilation, and I had just been dilated to a 5cm only, it all seemed hopeless and I told my husband I needed an epidural because in my mind this was going to last a while.
My husband looked at me like… “is this the crazy talking?” not exactly sure what to do about my epidural request. I told him that I NEEDED it. So he chatted with the nurses, who said I could have one but it would take about 30 minutes. At that point I was desperate and didn’t care! I needed the idea that I would soon have relief. Well, because I was in the delivery room for the water birth, it did not have a typical hospital bed to deliver in, so we needed to move rooms. The nurse asked me to walk to the next room over. I had a contraction while walking, and then when we arrived she asked me to use the toilet before the epidural. So, I go to sit on the toilet and suddenly the baby is coming!!!
It all happened so fast. I start yelling “the baby is coming!!!” You can hear the nurses scrambling and yelling. One of the nurses is telling me to scream to let the pressure out from wanting to push, my husband comes running in (because he was moving our stuff between rooms). My mom is seeming like she’s about to pass out, and in no time Silas was born. Over the toilet. The nurse caught him, and then in the most un-glamorous way I had to walk to the bed.
He was born at 3:13pm. A whole 13 minutes after the doctor broke my water (no wonder I felt like I was dying). About 10 minutes after the delivery the doctor arrives, apologizing profusely as she had just gotten back to her office when she was called that I was in labor! One of the many things I loved about this hospital though, was that they strongly encouraged skin to skin and breastfeeding immediately after delivery. We were able to do skin to skin for an hour before moving rooms and doing a physical for baby.
They fulfilled all my wishes – delayed cord clamping, 24-hour delay for bath, no formula, no hepatitis B vaccine at birth because he is not high risk and it can be given at a later date. I trusted the doctors and nurses to not do anything against my wishes. I know that sounds strange, but I had heard stories about other hospitals doing things against the parents’ wishes such as giving babies formula when you want to be exclusively breastfeeding and more. So, I was very pleased with the care both of us received after delivery.
My parents brought our other 3 children up to visit the following day. What sweet moments those were, watching them see their baby brother for the first time. We stayed in the hospital 3 nights and were welcomed home by some very happy kids and grandparents. So, there you have it. I am so happy we went to Bangkok, and I highly recommend the Hospital. It was so easy being pregnant in Thailand as well – other than the heat! – but people are so kind and helpful and love, love, love babies!!
Here are some photos from our Big 1 Year Old’s birthday weekend! Carrot cake is our traditional first birthday cake! So, this was a labor of love made-from-scratch carrot cake and cream cheese frosting. Buddy boy is our “Wild One” who has the most hair of any of our kids at their first birthday’s… and the most teeth (8)! He also started walking earlier than any other kids on the day he turned 11 months. He seems to be wanting to grow up even faster than his older siblings, and this momma’s heart can’t handle it.
So if you're a man, you probably want to stop reading now. The following are discussions of the complicated questions that all pregnant ladies ask, and want to know answers to. So you've been warned. 1) The hospitals give you the price for delivery ahead of time. If you are cash-paying you need to agree to this prior to delivery. Afterwards, while still hospitalized, if you ask for something that is not included in the price, they will inform you prior to giving it, one example - an ice pack. The total must be paid prior to discharge. The prices are insanely cheaper than they are in the America (even with insurance), but it can still cost a few thousand dollars. Once again this is not hidden information, so ask the hospitals up front.
2) Most hospitals offer an enema prior to delivery – some require it. Ask your OB what the pre-delivery treatment entails.
3) Have a birth plan typed up and translated to Thai (or whatever the local language is) and print lots of copies. Review your birth plan with the physician and make sure they understand what your wishes are, and that they will follow it to the best of their ability.
4) Ask if you will be allowed skin-to-skin after delivery. Many friends here have had their babies taken to the nursery for anywhere from 2 hours to 6 hours immediately following delivery for monitoring. Even with C-sections, it is beneficial for the baby to do skin to skin with the daddy while you are being stitched up, so ask if that would be possible. At some hospitals you have to be adamant about skin to skin following delivery. Do not be shy in voicing the wishes that are best for baby and you, and do your research ahead of time.
5) If you want to exclusively breastfeed, do it! And do not feel like you have to allow the nurses to give the baby formula before to your milk has come in (typically it takes up to 2 days) as you are producing colostrum. Another friend here who wanted to exclusively breastfeed was just too nice about it. The nurses would come in with a bottle of formula every so many hours and say it was time to give the baby a bottle (even waking the baby up for the bottle). I know it is sometimes hard to speak up for yourself or your baby, especially with there is a language barrier and as a first time mom. But know that you can do it respectfully, and it will be okay. I will share that with my first baby, it took 5 days (maybe 6, I can’t remember exactly) for my milk to finally come in. I didn’t know that it hadn’t “come in” yet, and after voicing the concerns to our paediatrician about how she was waking frequently and crying a lot at night around day 4, he recommended to breastfeed (as she was still getting colostrum) and then offer a bottle of formula until the mature milk was produced. It only took a day or 2 more, but she was so much happier with a full tummy, and it wasn’t a detriment to exclusively breastfeeding after that either.
6) If you’ve had a baby before, perhaps you have experienced the mesh, stretchy underwear you are given after delivering a baby. Although completely unattractive, they work… they’re nice and big and hold things in. It is an elastic band that goes around your waist with a hook in the front and a hook in the back that connects to a pad. Yup. That’s what you’re given. You definitely feel a LOT exposed.
7) I do have to sing praises about the hospital gowns! First, in your normal exams, you are given pants to wear, that have a drape over an opening. You feel very respected and covered. After delivery you are given a gown of a thick material that essentially looks like a dress, with a nursing wrap-bra built in for easy breastfeeding while still remaining covered. The gowns were amazingly better than the thin hospital “gowns” that open in the back and provide very little coverage which you receive in America.
8) Part of the post-partum care that is included is the use of an infrared lamp. Twice a day the nurse comes in and sets up the sheets over your legs/lap to be like a tent, and at the base of your bed place the lamp to shine towards you for about 15 minutes. It is to help promote healing.
9) I got better sleep at the hospital here than ever following the birth of my previous children. If you are asleep, the nurse lets you sleep. They check your vitals about 2-3 times a day, and the latest is at 9pm at night. You are mostly given privacy unless you ask for help with something. I can’t speak for other hospitals, but Samitivej was amazing about this. 10) I was happy with the food selection on room service as they have many international patients and a good international food menu. There were a few cafes to pick up food or coffee within the hospital. My husband could also order from the room service as well. 11) Common practice in Thailand is removing your shoes prior to entering a home. So, at my delivering hospital, before entering the delivery ward, you remove your shoes and are given slippers. This is true for nurses, patients and visitors. And every time the staff enters your room they will take off their shoes/slippers as well.
12) If you’re considering giving birth abroad, you’ll need to do the research about what paperwork is required to file for citizenship in your home country. Samitivej Sukhumvit had a paid service to get the birth certificate translated to English or French, and also to take and print the passport photos of your infant. Those were such helpful services so we did not have to find a translator for official documents on our own. In regards to reporting a birth abroad in Thailand, here is the Thailand US Embassy & Consulate website which gives the instructions and details on how to “Report the Overseas Birth of a U.S. Citizen Child”. It sounds complicated but it’s not too bad if you just follow the instructions. From the time we had the appointment at the Embassy until we received his citizenship paper and passport was about 3 weeks. Depending on your country of citizenship, this may be different, so you must read up on your own country’s laws on birth abroad.
If you are considering giving birth in Thailand and have specific questions you’d like to ask, I’d love to connect with you, just message me on Facebook at Family Sees World or on IG @familyseesworld .