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6 Things I've Learned From Being Pregnant In 4 Countries

Mattie Johnstone Bekink
Updated on March 15, 2020
Last updated on March 15, 2020

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.

My transcontinental experiences have opened my eyes to what other women go through in their pregnancies. Overall, it's important to stay educated, learn as much as you can about the culture around you, find a doctor you trust, and listen to their advice.

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There's often conflicting cultural advice—so I just listened to the research and my trusted medical practitioners.

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. And 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 U.S., I was told to switch to decaf.

Instead of feeling confused or conflicted about cultural differences, listen to your doctor and their medical advice.


I trusted myself but didn't feel the need to defend myself.

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, if someone says, "Oh, you're pregnant; you can't eat this particular food or drink," I go with it rather than starting a debate. At the end of the day, I know which decisions are approved by my medical practitioner. And that's a lesson that's been true on every continent: Amid the noise, you have to trust yourself.

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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 1 kilo per month, which works out to about 20 pounds during an entire pregnancy. In the U.S., the recommended weight gain is between 25 and 35 pounds. In China, the theory was that bigger is better. In Holland, they hardly weigh you at all. I tried to not focus too much on weight, and as long as my doctor thought I was healthy, I was happy.


Even medical communities can 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, and we worked with the doctor to find a date that made both of us comfortable.

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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 nonissue. 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, as I was always weighed at every checkup in China, the U.S., 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.


I found the best thing to do is simply stay informed.

It can be a challenge in any culture, even your own, to express your wishes and advocate for yourself. But it's important. Being an advocate also means being informed. For example, 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. For example, 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. I know now that you simply cannot be afraid to speak up and ask (or shout) for what you need.

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Mattie Johnstone Bekink author page.
Mattie Johnstone Bekink

Mattie Johnstone Bekink is a writer and consultant living in the Netherlands. She blogged about her son's first year in Italy here.