This week we go to Qatar as part of the series on The Global Differences of Baby-Making. Dr. Rajka Milanovic Galbraith is a family physician who had her second child in Doha, Qatar.  Having had her first baby, her son Liam, in the USA she shares her experience of having a baby in the USA and Qatar as both a mother and a doctor. Here is her story:

Tell me a bit about yourself? Where are you from? How old are your children and where did you have them?
I am originally from Cleveland, Ohio.  We moved to Qatar in 2005. Aside from about 9 months in 2009, we have been in Qatar ever since.  My son Liam is now 7.  I delivered him in Chicago, Illinois. And my daughter Liv is almost 3.  I delivered her in 2008 at Al Ahli Hospital (a private hospital) in Qatar.

Why did you have your children abroad?
We really wanted to move back to the USA when I got pregnant with our daughter in 2007.  However, as we did not have health insurance which covered deliveries abroad prior to getting pregnant, there was no way to get health insurance to cover the delivery in the United States.  Health care is expensive in the USA, heaven forbid anything went wrong.

Liv and Liam

What do you feel were the benefits to having children abroad?
There are so many!  To begin with, the cost of the delivery and hospitalization for me and baby was less than our co-payment when we delivered our son in Chicago.  The delivery cost less than $2,500 USD here in Qatar.

My delivery in Qatar went smooth.  I was treated with the utmost respect here in Qatar unlike with my delivery in Chicago at Northwestern.  Unfortunately, I had to have a forceps delivery with my son in Chicago.  The pain afterward was excruciating as the forceps caused a lot of trauma to the perineum.  The pain after was worse than during labor.  It was if someone had repeatedly beat my perineum with a baseball bat.  Yet, I was treated like a “drug seeker” off the street instead of with respect.  I have never been so humiliated in my life.

The lactation consultant was overworked in Chicago.  My son would not latch but she didn’t show up until after 24 hours.  Unfortunately, when she arrived, I had developed urinary retention and literally on her arrival, I sat up screaming of intense abdominal pain because I had 2 liters of urine retained in my bladder.  She barked out orders on what I was to do to try and get him to latch. Then she said that it was near 3 pm and her shift was over.  As you can imagine, I couldn’t focus on what she was saying because of the pain.  This story is even shocking to me now.

My doctor in Qatar did a fantastic job with the delivery and the repair.  She spent an hour filling out our cord blood paperwork and drew the blood free of charge.  Drawing cord blood takes less 10 seconds and I used to do this for free for all my patients when I did deliveries.  Yet, we were charged $300 USD for this in the United States and the doctor did not do any of the paperwork.

We had the luxury of having hired help after the delivery.  Our nanny had been with us for 4 years at this point.  She is excellent with infants and children.  Having hired help is beneficial to all expats as most of us do not have extended family abroad.  Having a nanny let me get rest in-between feeds and allowed me 1:1 time with our son which helped his transition with having a sibling

Liam and Liv in New Zealand on holiday

As an expectant mother abroad how did you feel?
I felt like I was in good hands medically speaking.  Second babies deliver easily most of the time.  To me this fact alone was reassurance enough.   I was also fortunate that one of my good friends is an Obstetrician so when I got nervous i.e. when it looked like our daughter would be over 4 kg (which she wasn’t) and they were suggesting a C-Section.   It was good to have her to bounce things off of back in the USA. 

Emotionally, I had a lot of support as we had been in the country for 4 years and had a large circle of friends by then.  There is a very large expat community here.  3 of my girlfriends were “on call” in case I went into labor when my husband went out of town for 3 days near my due date.

Did you encounter any opinions that would have been different in your home country with regards to your pregnancy or parenting choices?
There is a difference in use of episiotomy, in recommending C-sections, in timing of post dates induction and how long to wait before induce when a women’s “water” has broken and she hasn’t gone into labor. 

Some of the doctors here are of the opinion that every first time mum should have an episiotomy.   I would say in my clinical experience the majority of 1^st time mums do need one/benefit from one but you can make that decision last minute as the head is crowning not beforehand.  In fact the American College of Obstetricians now recommends against routine episiotomy!

There is a bigger push for C-Sections here in Qatar.

For post dates delivery, in the USA, the standard of care has become to induce at 41ish weeks.  The doctors here tend to wait until 42 weeks to induce.  This is an acceptable alternative if you do the appropriate monitoring.  After 41 weeks the amniotic fluid decreases, the placenta is not as efficient in supplying oxygen to the fetus.  I think it is a set up for complications to wait until 42 weeks to induce.

One friend of mine was not induced until 24 hours after her water broke (at the government hospital) as he did not go into labor on her own.  In the USA we don’t wait 24 hours because of the risk of infection to both mom and fetus.

One doctor postpartum changed my grip from Cross Cradle to Cradle when I was breastfeeding.  I just chuckled as it makes no difference.  You should be comfortable and the baby should be latching properly.

On the parenting, I didn’t feel like my choices in parenting and breastfeeding were imposed upon.

What advice would you give other mothers in your situation?
Consult with a few OB/GYN’s.  Most westerners will feel more comfortable at Al Ahli, one of the private hospitals as your partner is not allowed into the delivery room  in the government hospital (Hamad).
I get this question a lot: Where should I deliver, here in Qatar or back home?   You have to weigh the pros and cons.  On the pro side, you may have extended family at home; you may feel more comfortable and less anxious.  On the con side, it will separate your family if you are away and will your spouse be able to make it back in time for the delivery.  For this last item,  How would you feel if he didn’t make it back?  It is a tough decision.  If you are not comfortable with the care you perceive you will received abroad then I would recommend delivering in your home country.  There is nothing like added anxiety during your pregnancy.

Join Doha mums (www.dohamums.com).  It is an excellent source for expecting mums.  There is private forum you can post questions to.  I have found the mums to be an excellent source of information: Which doctor to choose? What to do if you’re having trouble breastfeeding? Etc.  This is in addition to the countless play groups and activities which are organized by the mums.

Dr. Rajka Milanovic Galbraith is an American Board certified family physician, a mother of two and a wife.  She has over 14 years of clinical experience and is regarded highly by her patients, colleagues and staff.  Recently she added entrepreneur to her list of titles when she launched her website: www.expatdoctormom.com, an informational blog offering free health care advice and guidance to anyone anywhere!  She says:  “Going through the experience of launching a website from scratch inspires me to inspire others and that in this day and age of technology the sky’s the limit.  Never limit yourself!”

Connect with Rajka on Twitter and Facebook as well as her awesome www.expatdoctormom.com !

Want to share your story? Get in touch: ameena@mummyinprovence.com