Carlie: Welcome to another episode of the Expat Focus podcast. I’m your host Carlie, and on today’s show, we’re going to be talking to a virtual midwife.
It’s information overload when you’re pregnant, and if you’re having a baby while living in another country, there can be even more layers of complexity, not just potentially in language, but in birth practices too. Your expectations versus the local reality might be quite different. Of course, you can find out almost anything online these days, but googling stuff about pregnancy and childbirth – well, it’s a bit of a minefield. And that’s where midwife Karen Wilmot is here to help.
Karen, can I ask you, first up, why did you start The Virtual Midwife?
Karen: Because I am an expat myself, and I ended up working with a lot of expat families and seeing the challenges that they face, and not just being far from home and away from their loved ones, but also just not understanding the healthcare system, how to go about finding a doctor, were the same tests and investigations available, and just feeling a little bit lost. Being pregnant makes you feel lost anyway, but it’s even worse when you’re in a foreign country.
Carlie: I’m curious about that, and how birth culture and birth practices can differ around the world. What have you seen, in your experience, working with your clients?
Karen: I think the biggest thing is the way birth is treated in different countries. Because a lot of the women I work with, in fact, everybody, wants … if it’s your baby and it’s your pregnancy, especially if it’s the first one, you want it to be regarded as something special. It’s such a miraculous event. But in many hospitals today, you’re just a number, and so they don’t give … they don’t honor it with the same reverence that it deserves.
So, that’s a huge thing, and I think that happens globally, but it’s more relevant when you’re in a foreign country, because you blame it on the country and the culture. And then, I’ve also noticed that in some hospitals, they don’t allow the husbands to be present. They don’t think that it is … it’s not part of the culture, or not even accepted there, so that’s another big thing. And in African countries, the numbers of pregnant ladies are so high, and you’re in such a huge system, once again, it’s not treated with the reverence that it deserves, and there’s no personalized attention, which is something that you really want when you’re pregnant.
Carlie: If you’ve given birth in your home country before, you’ve got an idea of how you expect it to go. You have some standards, you have some expectations. If you’re pregnant and abroad, and you’re pregnant for the first time, do you find it’s easier for people to accept how things are going to happen with their birth in the country they’re in, or do they still have some reservations about how things are done locally?
Karen: I think that I agree with you that there’s no point of reference, which can be the scary bit initially, but the advantage to that, in my experience, is that it almost forces you to do a lot more research and get more informed than you would have if you were in your home country. And very often, you end up having an excellent birth experience, a very positive birth experience, because of the amount of work and preparation that you put into being pregnant because you were in a foreign environment.
Because I do know some people, expats that I’ve worked with as an expat midwife, who don’t come to the classes, don’t do the due diligence that is required, because they say, “Oh, it’s okay, we’re going back to the UK or to the States to have our baby, and we’re sure of the system there.” And then end up having a not-so-positive birth experience because they didn’t do the due diligence.
Because the fact is that nothing about childbirth has changed over the years. Nothing about the way babies are born has changed, but the way that birth is treated in hospitals and how medicalized it’s become has changed. So, women have to be a lot more proactive in their care these days if they want it to be a positive experience, because of that, because it is so highly medicalized. And I know women have been doing this for millions of years, but they really didn’t have to navigate a system that supports policy and procedure over their choice, and choice isn’t always respected, no matter where you are in the world.
And I know that, because I left the hospital system myself, way back in 2009. Because at least 80% of the women that I met in the labor room weren’t prepared for the challenges of pregnancy and birth. And it’s too late for me to do all of that teaching and learning and preparing when you’re already in labor.
Carlie: You do mention in one of your videos, I noticed, that it’s really important to be birth-fit. What does that birth-fitness involve and how should you be preparing for your labor?
Karen: For me, birth-fitness encompasses physical fitness – so not necessarily being like fit for a marathon, just having done some form of exercise to support the changes that are happening physically. You’re putting on weight, your body is changing, you’ve got a baby growing inside of you. It puts excess strain on your ligaments and your joints and your lower back, so you’ve already got a lot of physical changes that sometimes cause discomfort and dis-ease – ‘dis-ease’ as in not disease, but dis-ease, unease. So, you want to accommodate those by walking, swimming, doing prenatal yoga. And those all give you an opportunity to really connect with the changes and become more accepting of them.
And then, it also means becoming emotionally prepared – so, birth-fit is not just about being physically fit, but emotionally and mentally prepared for the changes that are happening, not just in your body, but also with the changes that are going to happen in your family and to your finances. Having a baby is a huge, big life event that changes your entire family dynamic, going from a couple to being a family.
So, thinking of all … I bring all of those aspects into my birth preparation classes – physical, mental, emotional, and even spiritual, whether or not you’ve got any form of spiritual practice. I think people are kind of drawn to start thinking more deeply about life and relationships with their mothers and how they were brought up and everything. So, it’s a big change, it’s a transformation, and pregnancy opens you up to that.
Carlie: One of our previous podcast guests, Bec, in describing her experience having babies in the Netherlands mentioned that she decided to hire a doula in her first birth experience. How do people like doulas and yourself, as a virtual midwife, fit into the picture of somebody’s birth journey, and how do you provide support, particularly yourself virtually, in this case?
Karen: To answer the question about doulas first: doulas I think are incredibly important at just giving you that extra bit of emotional support that women really, really need. The reality is that there’s a worldwide shortage of midwifes and birth workers. So, you don’t always get the ones that who [07:16] especially when you’re in labor and giving birth. And having a trained doula or a trained birth professional with you during labor makes a huge [experience] to your … to your birth experience, and how you remember it and how you experience it, and the decisions that you make leading up to the birth, and helping you with the first weeks at home with your baby.
And the way that I work as a virtual midwife is I really provide continuity of care for, particularly, expats. I mean, most of my clients are expats and I work with women from around the world, and I’m giving them that support throughout pregnancy, and even if I’m not with them physically, because I have such a large network of birth professionals around the world, very often, I can connect them to either a doula or somebody in the community, and then I will work together with those birth professionals and with the couple themselves, just making sure that they get the right information at the right time, and that when they’ve got a question, they just pop it in a WhatsApp or an email, and instead of going online and getting the worst-case scenario, I can take their situation into account.
Because every question, you have to look at the big picture. And unfortunately, Google doesn’t give you the answers that are specific to your situation. And whatever’s happening in your pregnancy … are you low-risk, are you high-risk, where can you get the help, depending on where you are in the country … so, I can take all of those factors into consideration and either give you the answers that you need or give you the guidance as to what you need to do in your specific situation.
So, I support women around the world and I do it in various ways, whether it’s with the classes, whether it’s one-to-one supports, and [fly-in placements]. It just really depends what their needs are, create those packages around them. But ultimately, it’s about making sure that they have a positive pregnancy and birth experience.
Carlie: Karen, in your experience working with your clients around the world, where do you see as the easier and more difficult countries to be pregnant and to be having a baby?
Karen: Well, the best birth practices at the moment are in New Zealand and Canada, purely because … I’m not sure if you know that there’s two care models that are practiced worldwide, and one is the midwife model of care, which is where midwives like myself, who are trained to guide women through pregnancy and be present at the birth and help them after the birth … so, they work in conjunction with obstetricians and gynecologists, but we take on all the low-risk cases. And 70% of women are actually low-risk. So, it takes a huge load off obstetricians, who are really trained in the pathophysiology of pregnancy and birth, so all the stuff, the high risk and the complications.
And Canada and New Zealand both work on the midwife model of care and are very well supported by the governments and that, so that the load of high-risk cases falls on the people who need and who are trained to do that.
And then, the rest of the world really does work on the medical model, where women, all women, are seen by obstetricians and gynecologists, so very often, low-risk women get treated as high-risk. And that’s why there’s such an increase … and why birth is so medicalized and why there are so many unnecessary caesarean sections. Because the World Health Organization recommends that only 20% of women would require a c-section for various reasons that … because you know, a c-section is a life-saving procedure for either mum or baby. And about 20% of pregnancies will require that. But most countries are running at between 50% and 70%.
So, at the moment, I’m in South Africa, and the percentage is over 75. I’ve just come from the Middle East, where the c-section rate is over 60. And in Brazil, it is over 90%. And a lot of those are elective, and that’s purely because of misinformation.[crosstalk]
Carlie: I was going to ask what was driving or what is driving such high rates of c-sections, if the recommendation is so much lower? Is it just because women choose to have them or is there something else going on there?
Karen: A lot of it is financially driven, but it’s also because, as I say, obstetricians are trained in high-risk births. They don’t have the time to … labor sometimes takes a long time. And that’s what we, as midwives, do. We are there and we can be there for hours, assisting the woman and guiding them. An obstetrician doesn’t want to be doing that. They really want to come in, and they’re trained to deal with c-sections and high-risk births. So, they don’t have the time or the patience really, because there’s so many other things going on that they’re dealing with, and then there’s also the medico-legal hazard … the insurance on obstetricians and all birth workers is incredibly high because of the risks associated.
So, it’s better for them, from a medico-legal perspective, to cut out all of those risks and just go straight to c-section, where things might still happen, but you can always justify it by saying, “Oh well, we did the c-section for this reason. Yes, something happened with the c-section, but we prevented something else happening.” And then it’s okay.
So, it’s financial, it’s medico-legal, and also very much misinformation. Certainly, in Brazil, it is seen as “Why would you go through childbirth, when you could just go for a c-section?” And I think that it’s about preserving good bodies and maintaining sexuality and healthy pelvic floors. So, a lot of that is all misinformation.
Carlie: And I guess a lot of that is what people like doulas and yourself are there, ahead of the birth, to actually help educate women and their partners about too.
Karen: Very much so. I very much support women’s choice. I know that there are some women who choose to have a c-section, and many women who come to me do think that in the beginning. And I respect that, but I also think that it’s important that they get informed, because very often, they come to me thinking they want a c-section because they think it’s easier and better for the baby, but they don’t know anything about the process of birth and why a natural birth can be advantageous to the baby and to them, or what’s involved.
And very often, it’s fear-driven. There’s a lot of fear-mongering online, there’s a lot of stuff out there that makes birth seem dangerous and not something that you aspire to doing. It depends what you’re looking at. But there’s a lot of radicalization of both ways. So, it’s finding the middle ground, and it’s very difficult, with so much information available, to find that middle ground and know what’s right. And it’s a very weighted decision. Because obviously, you want a healthy outcome for mum and baby. And depending on where you’re looking, you may think that that would be going for a c-section. Or you may think it’s having a baby at home, with absolutely no attendants whatsoever.
So, those are the two opposite ends of the scale, and you want to find, well, what are the other options? And there are so many! And I think that’s the confusing bit, is that there are so many more options available to women these days.
Carlie: I have an expat friend who recently gave birth here in France, had to attend all of her appoints alone, never gave … the appointments in local language. Her partner was in the army and away for most of the pregnancy. And she faced a huge challenge in requesting a c-section for health reasons. She was met with a lot of resistance, to the point where, a few days before her birth, she still wasn’t certain that they would do it, and they were saying no, and it put so much stress on her. She tried to get supporters in to talk to the midwife and the obstetrician on her behalf, to argue her case. When should you be sticking to your guns on things like that and when should you just trust the local system and what they’re telling you locally?
Karen: I always trust the woman’s instinct, unfortunately, because I really believe a woman knows what’s right for her in her situation. Not knowing the circumstances and why they were refusing to do it … I find it insane that they are, because in every other country I’ve worked in and most of the women that I know, they’re encouraged to, so it’s quite strange that she was being encouraged not to. But I really believe that women’s choice should be respected. Because she was clearly informed and she clearly had her reasons.
Yes, you should trust … I mean, trust is an essential element of all births. And that means trusting your body, trusting your instinct, trusting your partner, trusting your doctor and the birth team that you’ve chosen, so that you’re able to sit down and have an open discussion and talk about everything. So, a huge decision like that … why were they pushing her in one direction? And then, what you want to do is really talk about what is the benefit of doing what you’re suggesting to me and my baby, what are the risks associated? Because there’s always a risk/benefit ratio. So, what are the risks associated, to me and my baby, of doing what you’re suggesting? Are there any alternatives, and if there are, why can’t we consider those alternatives? And what is the timing of this decision?
Like you say, she got to 37 weeks, and she was still negotiating that. At some point there’s a cut-off date. So, how long are you going to give me before saying this is what I need to do? And if that’s how long they’re giving, is it maybe an indication that I need to change my care provider? If I’m still not agreeing, after we’ve gone through that entire process of discussing benefits, risks, alternatives, and timing, and I still really feel strongly that what you’re suggesting is not right for me, perhaps that an indication to change your care provider, to go somewhere else and get a second opinion, go through that exact same process, and then work out what it is that is making them suggest that line of action when it essentially seems to be going against what it is that you feel is right for you. And what are your reasons for doing that as well.
Carlie: There must be so much confusion and self-doubt when it comes to navigating medical appointments and preparing to give birth in another country, and knowing when your instinct is correct, and when it’s a cultural issue and you’re trying to understand each other.
Karen: Absolutely. And one of the things that, when I’m working with clients one-to-one … it gives us the time to establish that relationship of trust and me getting to know their full history and what it is that they want, and the culture and the environment that they’re working in. And then, together, we practice weighing up their sense of intuition and their trust in [18:44] intuition with what they’re being told and with what we know is scientifically proven.
Because that’s what you’re doing in every decision that you face, is weighing up your instincts with the facts, and which way are you going to go. Because sometimes our instincts are correct – why do we have it? In pregnancy, your sixth sense or that sense of inner knowing is heightened so much. You start … but it’s about learning and practicing, trusting that, but not necessarily ignoring what you’re being told, but working together with that, and once again, finding the middle ground. But also knowing what questions to ask, and what is important in every decision and discussion that you’re having.
And once again, that’s another thing that I really help couples with – if they’re going for an appointment, what’s important at this appointment? What are you going to discuss with the doctor? How are you going to navigate those choices? If you’re given a choice, what questions are you going to ask? Because you don’t know what you don’t know. It’s like me, when I go and have my car serviced – I don’t know what I don’t know, I don’t know what to ask. If they say to me I need the oil changed or the brakes checked or whatever, I just say, “Yeah, go ahead.” I don’t ask any other questions.
And it’s the same when you’re pregnant. They make suggestions, and you trust that they are the care provider, they’re giving you the right information, and you go with it. But you’d like to be able to have some questions to ask, and say, “Well, is that common practice? And if I don’t do it, what will the consequences be? What information will you get from this test or investigation that you’re suggesting?” And learning to ask open-ended questions, as opposed to just your yes/no, yes/no, and then walking out and wondering afterwards, “Oh wow, why did I have that?” Or “Why was that suggested? Is it the right thing?”
Because as soon as you get home, you’ll go and google, and you’ll see a thousand people who’ve been offered the same thing and didn’t do it, or did it and then regretted, or didn’t do it and regretted it. And then, that throws you into complete panic and confusion.
Carlie: And on Google, you can definitely always find someone that agrees with your opinion or fear too, which is not always a great thing. [laughs]
Karen: Always. And Google can be very helpful or very detrimental. It’s a double-edged sword. And in fact, many reasons … that’s very much part of why I started The Virtual Midwife, was as a point of reference to help people move through the overwhelm of online, and come straight to source. I do the homework, I read all of that stuff, good and bad, but I have the experience and expertise to be discerning with what I share, and to take what is relevant to your situation. And I will guide my clients to find the right resources for them, but not stuff that’s going to send them into panic. I’m giving you facts, and then let’s make this decision together. But here are the facts, and let’s read through this. So, it’s just helping people to navigate the overwhelm.
Carlie: It would give such piece of mind, as you said, to be able to go to your appointment, come home with questions, be able to jump on a session with yourself, and talk through what your doctor has told you, what it means, what questions you should be asking next, or what you need to clarify.
Karen: Absolutely. It allows you to navigate your pregnancy or enjoy your pregnancy with confidence, because as I say, trust is an essential element. If you don’t trust, then the immediate response is fear. And fear produces cortisol, and cortisol is not a great hormone to be released into your system when you’re pregnant. It does pass directly to the baby, so your baby is born stressed as well. We don’t want that. We want a happy mum, we want a happy baby. So, we want to keep stress and fear levels to a minimum. And yes, there’s going to be life events that occur, and there will be stress hormone release. That’s normal, that’s part of everyday life, but we don’t want you to be in a constant state of stress or worry. Because it impacts you as well, and it impacts your health and your ability to enjoy your pregnancy.
Carlie: Karen, you’ve written a book especially for expats, Embarking on the Journey of Having a Baby While Abroad. And you have some essential pieces of advice. Can you tell me what they are?
Karen: Sure. I think that there are five things that you need to do if you want your pregnancy abroad to be a positive experience. And the first is not to allow fear to steal your joy. You want to replace fear with curiosity, and allow curiosity to guide you to find people to help you throughout the process.
To take full responsibility for your health and well-being. So, don’t put your power into the hands of the care providers that you don’t know, that you don’t trust. Take responsibility for finding people that will support you and knowing what you want and helping you to get it.
To connect with like-minded people and new parents in your local community – so that means through social media, through chatting and meeting with local groups.
To research and educate yourself, so that you know what to expect and how to get it.
And then, last but not least, especially for expats, is to really embrace the differences, and prepare yourself for cultural misunderstandings, because they will happen. And if you’re prepared for them and you know that they’re going to happen, and you have the tools to work with them, then it really does just make for that big adventure that one day you can look back, with fondness, and say, “Oh, remember that time where I asked for this and actually got that, but I knew what the difference was.”
I think those are the five points that I would encourage or that I use, that are the essence of the courses and packages [that I offer] as The Virtual Midwife.
Carlie: That’s it for this episode. If you have any questions for Karen or want to share your own experience of having a baby abroad, head over to expatfocus.com, follow the links to our forums and Facebook groups. If you’re an expat in the Netherlands, be sure to take a listen to our interview with Bec Holmes – she shares her Dutch birth experiences. If you like what we do, please leave us a review on Apple Podcasts or however you listen to the show. And I’ll catch you next time.