Maternity Care In Indonesia: What The Options Are And How To Decide On A Birth Plan

If you become pregnant while you are living in Indonesia, you can either access the public healthcare system and pay upfront, or you can give birth in a private clinic. Most expats choose to take out private health insurance cover that has a maternity clause and give birth in the private sector. Please read on to learn more about your options.

How to decide on a birth plan

A birth plan is a list of what you would like to have happen during labour and immediately afterwards. You may want to write one, so that your doctor knows what your wishes and expectations are. There are a number of things you may want to consider when writing your birth plan:

• Where do you want to give birth?
• Who do you want to have with you (e.g. your partner)?
• What kind of birth do you want (e.g. vaginal birth or a Caesarian)?
• Do you need any birthing aids?
• Do you want pain relief, and if so, what kind?
• What kind of birthing environment would you prefer?

Home births are an option in Indonesia. A World Health Organisation (WHO) study found that Indonesian women give birth at home, in health centres and in hospitals, and most do so with the assistance of a health professional, unlike those in most lower and middle income countries. However, the WHO’s findings in regards to the safety of home birthing in India were inconclusive. If you are pregnant and want to include the option of a home birth in your birth plan, then you need to discuss this carefully with your GP, obstetrician, and/or midwife.

You may want to consider using the services of a doula when you give birth. As well as this, you could think about whether you’d like an epidural, or another type of pain relief, and discuss the viability of different birthing positions.

You may want to write a birth plan, so that your doctor knows what your wishes and expectations are during labour.
Indonesian maternity care

As an expat, you will not be eligible for the national healthcare insurance scheme, so must either pay upfront for public sector care, or give birth in the private sector. Most expats do not recommend using the public healthcare system outside of an emergency, as it is overcrowded, overstretched and standards are low. In saying this, the Indonesian government has recently embarked on an overhaul of the system.

The WHO reports that Indonesia is unusual in that it has developed its maternity system to include skilled birth care in communities and homes. The village midwife programme (bidan di desa) was begun in 1989 by the government, with the support of international aid agencies. Up to this point, most women gave birth at home with the help of traditional birth attendants (dukun bayi) with limited training. The country saw an increase from 13,000 midwives to over 50,000 at the end of 1997.

In many other countries, skilled birth care is restricted to hospitals and health centres. The WHO says that the backbone of the Indonesian maternity system now consists of thousands of village-based midwives who provide reproductive, maternal and child health services, in the home or in maternity units.

Midwives work alongside community-level health care facilities called puskesmas (daily clinic or inpatient clinic with basic surgery), pustu (village health centre with a daily clinic) and posyandu (usually once-a-month health services delivered in small and/or remote villages). Authorities note, however, that these community clinics are often understaffed and may have erratic opening hours.

Public hospitals support the clinics as referral facilities. A large number of midwives have their own practice or work elsewhere in the private sector – this is common among Indonesian healthcare professionals.

The disparity between public maternity care and that in the private sector is considerable. Private healthcare is a rapidly expanding market in Indonesia, with both local and overseas investment. Indian and Malaysian private hospital chains are moving into the region. If you choose to give birth in a private hospital, therefore, you should find that you have plenty of choice, particularly if you are based in Jakarta.

The disparity between public maternity care and that in the private sector is considerable in Indonesia.

There are a number of specialist maternity clinics and hospitals, for instance, the YPK Maternity and Children Hospital, Mother and Child Hospital Grand Family, RSIA BUNDA and the Rumah Sakit Ibu dan Anak Harapan Kita. In addition to providing maternity care, the latter also has clinics specialising in infertility, nutrition, heart diseases, and child health problems, as well as pediatric neurosurgery services. The hospital also has an NICU room, which offers new babies critical or specialist care if necessary.

Expats report that their appointments and scans were with their obstetrician-gynecologist (OBGYN), rather than a nurse, and that their care was of an excellent standard, and included entry into a private birthing lounge as soon as contractions began (which is not standard practice even in some Western nations). Your partner can be with you during and after the birth, and one expat reports that she was offered a postnatal massage scheme at her maternity clinic, in addition to breastfeeding advice.

Costs have been quoted at:

• Regular birth: US$250 to $1650
• C-section: US$4,150 to $7300

Some high tech maternity care is also in place. Dutch technology company Philips introduced an app in 2016 consisting of mobile obstetrics monitoring – it was aptly named MOM. The app connects rural midwives in rural communities with gynecologists, so that they can monitor patient’s vital signs and identify risk factors throughout a pregnancy. This may be something that you can take advantage of.

After you leave the hospital, you will need to get a local birth certificate before you can apply for a passport for your baby. You must also apply for a limited stay permit (ITAS visa) for your baby, which will be tied into the visa of the working parent.

You will need to negotiate maternity leave with your employer. However, the law is supposed to cover expats and local citizens equally, so you should be eligible for paid maternity leave for 1.5 months before and 1.5 months after the birth.

Will the baby be an Indonesian citizen?

The child will assume the citizenship of the mother, unless the mother is married to an Indonesian citizen, in which case the child will be granted Indonesian citizenship too, as long as the marriage is legally registered. Indonesian citizenship is gained through descent.

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