BirthCustomsAroundtheWorld

Whenitcomestohavingbabies,everycountryhasitscustoms.
ByLaraSchalkenfromAmericanBaby

How Does the U.S. Compare?

Childbirthisaneventthat,despiteitsextraordinarynature,occursdailythroughouttheworld.Butthe
circumstancesunderwhichthismiracleoccursvarydramatically,eveninplacesthatdon'tseemthat
dramaticallydifferent.Icanpersonallyattesttothis:ThreeyearsagomyDutchhusbandandImovedfrom
TexastotheNetherlands,whereIgavebirthtoourson,Bram.Iwassurprisedbymanydifferencesthere,
andIhavefriendsfromothercountrieswithstoriesjustasinteresting.SoIputtogetheraroundupof
birthingpracticesaroundtheworld,basedonmyownexperienceandaccountsfromfriends.

The Netherlands
MostexpectantmomsinHollanddon'tseeanobstetrician,butareinsteadreferredbytheirfamilydoctorto
alocalmidwifepractice.Doctorsonlyinterveneinhighriskcasesorifcomplicationsariseduringdelivery.
Dutchwomendecidewhethertheywantahomeorhospitaldelivery.Iwassurprisedtolearnthatmorethan
halfofthewomenatmymidwife'spracticedeliverathome.Infact,allexpectantmothersinHollandare
requiredtopickupakraampakketthatincludesallofthemedicalsuppliesnecessaryforahomebirth.If
youchoosenottodeliverathome,yourmidwifewillmakeahousecalltocheckontheprogressofyour
laboranddeterminetheidealtimeforyoutogotothehospital.
Evenifyouoptforahospitalbirth,it'sunlikelythatyou'llgetanepidural.Epiduralsareusuallyonlygiven
ifit'sconvenientfortheanesthesiologist'sschedule(peopleoftenjokeabouttheDutch9to5epidural)orif
anobstetriciandeterminesitisnecessary.Givingbirthnaturallyremainstheidealforthevastmajorityof
Dutchwomen.Asmyduedateapproached,Ibecamemoreopentotheidea,andintheend,noonewas
moresurprisedthanIwastorealizeIhadgivenbirthtooursonwithoutanypainkillers.
Ifamothergivesbirthearlyinthedaywithoutcomplications,sheandthebabymaygohomeinaslittleas
twohours.ThentheuniqueDutchsystemofkraamhulp(maternityhomecare)issetintomotion.Forseven
dayswehadanursecometoourhome,abenefitcoveredbyinsurance.Notonlydidsheprovidemedical
care,butshealsocleanedourapartment,cooked,andinstructedusinbasicparentingskills.
Localcustom:Anotherimportantdutyofthenurseistomanagetheflowofvisitorsandmakethe
traditionalsnacktocelebrateabirth:beschuitmetmuisjes,whichliterallytranslatesas"biscuitswithmice."
The"mice"areactuallyminiaturelicoricebitswithblueandwhitecoatingforboys,pinkandwhitefor
girls.

Germany
AsinHolland,inGermanywomenseemidwivesfortheirprenatalcare.Infact,midwivesaresorespected
thatbylawamidwifemustbepresentateverybirth,andadoctorisoptional.
MalinHaugwitz,aBerlinresidentwhoisoriginallyfromBethesda,Maryland,saysthatGermanwomen
focusontheeventofgivingbirthalmostmorethantheoutcome.Followinghersecondcsection,sheheard
manywordsofpityfromfriendsandevenfromhermidwife,whoasked,"Doyouseeitasafailure?"

Germanwomenwhoholdfulltimejobscanfeelsecureknowingtheirpositionwillbewaitingforthem
whenandiftheydecidetoreturntowork.Assoonasawomantellsanemployershe'spregnant,shecannot
befired.Thus,duringeconomicdownturns,beingpregnantcanessentiallysaveyourjob.Womenmaystop
workingsixweeksbeforetheirduedateandareforbiddenfromworkingforeightweeksaftergivingbirth,
allwithfullpay.Mothersmayeventakeuptothreeyearsofunpaidleave,thethirdbeingafloatingyear
thatcanbetakenatanytimeandbyeitherparent.
Localcustom:AnotherpracticethatHaugwitzrecountsisthatgovernmentofficeskeepalistof"accepted
names"thatparentsmustadheretowhenregisteringthenameoftheirchild.Inthecaseofanunusual
name,theymustgiveacompellingreasonwhyanexceptionshouldbemade.Thegovernmentpolicyis
intendedtoactinthebestinterestofthechild,inanefforttothwartpotentialridiculeofachildwitha
namethat'stoodifferent.

Japan
LikeDutchandGermanwomen,themajorityofJapanesewomenstrivetogivebirthwithouttheuseof
painkillers.AccordingtoAiAzuma,aTokyonative,thispreferencerelatestotheBuddhistperceptionof
suffering:ThereisabeliefamongJapanesethatlaborpainsactasakindoftestthatawomanmustendure
inpreparationforthechallengingroleofmotherhood.Thiscenturiesoldbeliefenduresdespitethefactthat
agrowingnumberofdoctorsinJapanarerecommendingepiduralsfortheirpatients,suggestingthatthey
createamorepeacefulbirthexperience.Althoughmorewomenarebeginningtoexercisethisoption,
centuriesoftraditionstillkeepmanyothersfromconsideringtheprocedure.
Japanesewomendeliverinhospitals,butit'snotagiventhatthebaby'sfatherwillactasthelaborcoachor
evenbeintheroom.Fathersarepermittedtobepresentatthebirthonlyiftheyhavetakenprenatalclasses
withthemothertobe;ifacsectionisperformed,theymustgotothewaitingroom.Ingeneral,hospital
staysinJapantendtobelongerthanintheU.S.;motherscanexpectaminimumofafivedaystayfora
vaginalbirthand10daysormoreforacesareandelivery.
Localcustom:Afterleavingthehospital,motherandbabyoftenstayatthemother'sparents'homefora
monthorsometimeslongeritisaculturaltraditionthatwomenstayinbedwiththeirbabyfor21days.
Duringthistimefriendsmaydropbytogreetthenewbabyandjointhefamilyineatingthecelebratory
foodosekihan(redricewithredbeans).

Brazil
InthisSouthAmericancountry,electivecsectionshavebecomealmostcommonplace,accordingto
MasumiMelloeSilva,whorecentlyimmigratedtotheU.S.fromSaoPaolo.Theoverallcsectionratein
Brazilis40percent,accordingtotheInternationalCesareanAwarenessNetwork.Andifyoulookatonly
privatehospitals,therateisevenhigher.
Therearesomewithcesareanbirthratesof100percent,accordingtoMarsdenWagner,MD,aperinatal
epidemiologistwhoworksfortheWorldHealthOrganization.Privatehospitalsarethechoiceforroughly
onequarterofexpectantBrazilianwomen,andthesewomenhailmostlyfromthemiddleandupper
classes.Tryingtoexplainthereasonsfortheoverwhelmingnumberofcesareans,MelloeSilvaspeculates
thatmanydoctorsperformtheprocedureinordertoreceivehigherpaymentsfrominsurancecompanies.
Privatehospitalslikewisereapthebenefitsofhigherpaymentsforthelongerhospitalstaysthatcesarean
proceduresrequire.Also,theconvenienceofperforminga60minutecesareanprocedureversusattending
toalonglaboranddeliverymayleadmanydoctorstoseethetimesavedasvitaltotheirpractice.InBrazil,
thedoctorpatientrelationshipisverystrongwomenreceivenearlyalloftheirinformationabout
childbirthfromtheirdoctor,ratherthanfromprenatalclasses.Ifawoman'sdoctorisadvocatingac
section,shemaywellbeswayedbyhisopinion.

Thetideisbeginningtoturn,atleastinpublichospitals,wheretheBraziliangovernmenthasinstituted
procedurestoreducethenumberofcsections.In1998thegovernmentsetagoaltoreducethepublic
hospitalcesareanrateto25percentorlowerby2007.Toachievethisgoal,thegovernmentstipulatedthat
publichospitalswithcsectionratesover30percentwouldnolongerbecompensatedforproceduresthey
performedabovethatnumber.In1999theaveragecesareanrateinBrazil'spublichospitalsdroppedto24
percent,from32.4percentin1995.
Localcustom:AccordingtoMelloeSilva,pregnantwomenaretreatedlikeprincessesforexample,they
areusheredtothefrontofanylinesotheydon'thavetowait.Oncemotherandbabyleavethehospital,
visitorsflocktotheirhome.Theygiveagifttothebabyandreceiveoneinreturn.Traditionally,it's
somethingsmall,suchasabottleofperfumeorcandy,withamessagefromthebabyattachedthanking
friendsandfamilyforthevisit.

Turkey
ThisEuropeancountryhasrecentlychangeditsapproachtochildbirth,accordingtoTulinSevil,who
comesfromthecapitalcityofAnkara.Asrecentlyas20or30yearsago,midwivessupervisedmostofthe
birthsinTurkey,especiallyinruralareas.Doctorswereinshortsupplyandmosttendedtopracticein
metropolitanareas,suchasAnkaraandIstanbul.Butasmoreuniversitymedicalschoolswerefoundedand
thenumberofdoctorsincreased,careshiftedawayfrommidwivesinfavorofobgyns.
TheshifttowarddoctorshasalsobroughtaboutagrowingpreferenceforelectivecsectionsamongTurkish
women.Inarecentsurvey,overallcsectionratesforprivatehospitalsinTurkeywerenearingastaggering
75percent,accordingtoKybele,aU.S.nonprofitgroupthatpromotessafechildbirthpracticesin
developingcountries.Onereasonforthistrend,accordingtoKybele,isthatonlyafewTurkish
anesthesiologistshavespecializedtraininginobstetricanesthesia.Manywomenknowtheywillnothave
theoptionofanepidural,sotheyinsteadoptforacsectionwithgeneralanesthetic.Kybelereportsthatthis
useofgeneralanesthesiamaybeacontributingfactorinTurkey'shavingoneofthehighestmaternal
mortalityratesinEurope.Kybelecoordinatesprogramstotraindoctorsinadministeringepidurals(the
groupmaintainsadatabaseofU.S.doctorswillingtogotoTurkeytosharetheirknowledge);thedoctors
thenteachtheirfellowphysicians.Turkeyhasbeenveryreceptivetotheprogram,sothehopeisthat
epiduralswillbemorewidelyadministeredinthefuture.
Localcustoms:UnlikeintheU.S.,babyshowersarenotgiveninTurkeyallcelebrationispostponed
untilafterthebabyisborn.AccordingtoAhuTerzi,whoemigratedfromTurkeytoNewYorkCity,
motherandbabystayhomeforthefirst20daysafterthebirth.Friendsdropbyanddrinkaspecial
beveragecalledlohusaserbeti.Afterthisperiod,themotherandchildmakereturnvisitstogiftgivers'
homes,wheretheyreceiveahandkerchieffilledwithasingleegg(forahealthybaby)andcandy(fora
goodnaturedbaby).Theyalsorubflouronthebaby'seyebrowsandhairline,whichissupposedtogrant
himalonglife.
WomenintheU.S.knowtheyarefortunatetohaveaccesstoarguablythebestmedicalcareintheworld.
AftermyverypositivebirthingexperienceintheNetherlandsandhearingstoriesofotherpeople'sbirths,I
realizeweAmericanshavemuchtolearn,aswellasmuchtobethankfulfor.Nowthatwe'vemovedfrom
HollandbacktoTexas,I'mwonderinghowI'mevergoingtosurvivethenexttimewithoutmykraamhulp
nurse!
LaraSchalkenliveswithherhusbandandson,Bram,inFrisco,Texas.Allcontenthere,includingadvice
fromdoctorsandotherhealthprofessionals,shouldbeconsideredasopiniononly.Alwaysseekthedirect
adviceofyourowndoctorinconnectionwithanyquestionsorissuesyoumayhaveregardingyourown
healthorthehealthofothers.