I have received prenatal care on three continents in four countries — China, the United States, Italy, and the Netherlands.
My son was conceived in China, and I spent my first trimester working in Shanghai, followed by a summer in New York City, before moving to Milan, where he was born.
I am now halfway through my second pregnancy and, assuming all goes as planned, my daughter will be born in Amsterdam, where my Dutch husband and I recently moved.
I wish I could say that my transcontinental experiences have allowed me to glean the most essential wisdom necessary for a healthy pregnancy. But here’s what I have learned:
1. There is no one right way to handle pregnancy.
This is a universal truth: As soon as you are pregnant, no matter where you are in the world, everyone will offer some well-intentioned (and often unsolicited) advice. This advice is often conflicting.
In China, most women try to move as little as possible when expecting — pregnant women are seen as delicate; in contrast, my Dutch midwife emphasizes the importance of regular exercise, saying I can continue to run as long as I'm comfortable and encouraging me to do prenatal yoga.
In the U.S., pregnant women are told to avoid sushi; in Japan, I hear you’d be hard-pressed to find someone who doesn't think raw fish is good for a fetus. In Italy, I was told drinking espresso is fine, whereas in the US, I was told to switch to decaf.
2. Trust yourself, but you don’t need to defend yourself.
What worked best for me amid all these conflicting ideas was to go with the flow and to not make a big deal about my opinions. I found this made it easier to open space for a conversation, and it also took the focus off my choices, which I found more comfortable.
So, for example, I won’t take a small sip of my husband’s wine in public in certain countries, even if I might do so at a private family celebration. If someone says, “Oh, you’re pregnant, you can’t eat this cheese!” I go with it rather than starting a debate.
At the end of the day, I know which decisions work best for me. And that’s a lesson that’s been true on every continent: amid the noise, you have to trust yourself.
3. Not all Europeans are relaxed about drinking during pregnancy.
My mother-in-law's French physician had prescribed a glass of red wine a day when she was pregnant in Paris, so I figured my third trimester in Italy would be a glorious sunset of mindfully consuming red wine and gorging myself on pasta.
I was dead wrong. While I hear things may be different in Southern Italy, in Milan expectant mothers are told to abstain entirely from alcohol. And my visions of devouring pasta were squashed by my Italian doctor, who chastised me for gaining too much weight. (I’d put on 17 pounds in seven months, which had been fine according to my American doctor.) He raised one eyebrow as he told me I might want to be careful moving forward.
Even in Amsterdam I was recently surprised at a dinner party when the host informed us that the fish would be specially prepared without white wine for me and another pregnant guest. I had never worried about wine in cooking before. Because this was a request from the other pregnant lady, I didn’t want to appear disrespectful and went along with it for the night.
4. Standards for the appropriate amount of weight gain vary widely around the world.
The rule I heard from Italian doctors about gaining weight in pregnancy was one kilo per month, which works out to about 20 pounds during an entire pregnancy. In the US, the recommended weight gain is between 25 and 35 pounds. In China, the theory was that bigger is better (and overindulging in dumplings was encouraged). In Holland, they don't weigh you at all. Ever.
Women in Italy spoke with pride about having only gained the recommended nine kilos. And I knew women in China who seemed equally pleased to have gained 50 pounds or more when pregnant.
I tried to not focus too much on weight, but sometimes it was hard. Like when an Italian friend told me she’d given up pizza while pregnant and exclusively ate fruit and fish. Of course she told me this while I was happily indulging in a delicious and decadent Italian meal.
5. People have very different ideas about timelines.
When we finally accepted that our breech baby boy was not turning and we had to schedule a cesarean section, my husband and I were surprised to discover that the standard in Italy for C-sections is 38 weeks. In the U.S. and the Netherlands, our respective countries, the standard is 39 weeks.
Without wanting to offend my doctor or her medical culture, I gently tried to push back the date. Thankfully, she first wanted to schedule the delivery on Halloween, which I explained was a sacred day in my culture and so I couldn't possibly do it then.
The next possible date was November 2, the Day of the Dead in Italy, so she couldn't in good conscience bring a child into the world then.
Finally we settled on November 6. At which point, the anesthesiologist turned to me and said, "But now you have to gain an extra week of weight!"
I just smiled weakly and thought, But now my son's lungs have another week to develop!
6. The level of prenatal intervention varies widely around the world yet healthy babies are born everywhere.
My weight is not mentioned or measured in Holland. I’m sure if I were gaining too much or too little, there would be some swift and efficient response, but so far it’s been a non-issue.
This seems to be the way things are done here, allowing the pregnancy to progress naturally unless there is a problem. I was initially taken aback by this — I was always weighed at every check-up in China, the US, and Italy.
At my first meeting with my midwife (it’s standard to see a midwife rather than a doctor) I kept waiting to be asked to step on a scale or to give blood. In Italy and China, I’d had so many blood tests done I never knew what was being tested.
She explained that they believe childbirth is a natural process and they try not to disturb me or the baby except as needed. During one visit, she declined to listen to the baby’s heartbeat because I'd had an ultrasound done earlier that day and so the baby had already been disturbed enough and we knew everything was fine.
At my most recent check-up, I learned that the Dutch also do not require a pregnant woman to do the glucose screening test for gestational diabetes unless there is some reason to think she may be at risk. I was pleasantly surprised.
The glucose screening test, required in the U.S. where I did it, was distinctly unpleasant. I had to consume a high concentration of glucose in five minutes and try not to vomit as I waited for an hour to have my blood taken. After I narrowly failed the first test, I had to do a second test, which was even worse; drinking the glucose was just as nauseating and I had to have blood taken every hour for three hours. And I didn’t have gestational diabetes!
About two to five percent of expectant mothers will develop gestational diabetes, so in the US, we all get tested. In Holland, you only do so if your midwife or doctor believes you’re at risk.
7. In any medical culture, you need to advocate for yourself.
It can be a challenge in any culture, even your own, to express your wishes and advocate for yourself. But it’s important.
When my first Italian doctor wanted to schedule a cesarean section for my breech baby 10 weeks before my due date, I pushed back and ended up finding a new doctor. (I should have known I wasn’t comfortable with him when he harped on my weight.) But it wasn’t until he tried to schedule a surgery far in advance to help him better plan his vacation that I realized I needed someone more willing to listen to me.
My next doctor agreed not to schedule the surgery until I was 36 weeks pregnant and also to immediately cancel it if our son turned before the scheduled date.
Being an advocate also means being informed. I didn’t know that my Italian hospital wouldn’t allow my husband into the delivery room with me until I was being wheeled into the operating room and he was told to wait in another room. It all happened very fast and we never even had a chance to properly say goodbye.
I wish I had known the policy in advance. Then I would have been prepared to be in the operating room without my husband and saved myself quite a bit of stress.
I now try to be well-informed. Although the Dutch system allows expectant mothers to choose where to give birth — in a birthing center, at home, or in a hospital — I need to deliver in a hospital since my last delivery was via C-section. This is fine by me, but I'm glad I was informed at the outset.
So far my experience in Amsterdam has been very agreeable. I've heard that the natural approach means that you basically need to have a nervous breakdown before you can get an epidural, but I'll cross that bridge when I come to it. I don’t know if I’ll want an epidural. But I know now that you simply cannot be afraid to speak up and ask (or shout) for what you need.
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