Monday, July 28, 2008

Pregnant in Korea, Part I

Updated on March 12, 2010: If you are pregnant in Korea and came upon this post through Google, please feel free to contact me at mamseoul at gmail dot com or join the Expat Parents Forum.
Be sure to check out Birthing in Korea as well.

Back to the original post:

My first delivery was by scheduled cesarean due to breech. Ian was breech the last three months of my pregnancy and never had any big movements. My due date was somewhere between September 8 and 14 and we took him out on September 6, so he was 39 or 40 weeks and in very good shape. It was an easy surgery and recovery. Still, it was not what I imagined. I didn't really have the birth experience. My surgeon separated my muscles instead of cutting them and double stitched me. With the type of incision, stitching and reason for cesarean, I am an ideal candidate for VBAC (Vaginal Birth After Cesarean). Unfortunately, it is often hard to find doctors who will let you try, even though the research shows that VBAC is safer than a repeat cesarean for mother and baby in most cases.

I have two choices for delivery in Korea: at a Korean hospital or at the American Army hospital. The American Army hospital won't see you until you are 12 weeks, so I have started with a Korean doctor. Between the two options, I have to pay with insurance for both because my husband is a civilian. The advantage of the military hospital is that they will submit the paperwork so we don't have to pay upfront. Also, everyone speaks English. The disadvantages are that they are not reputed to be open to alternative birthing positions or natural birth. The hospital is small and old and you do not have private rooms.

My first appointment with Dr. Sung in Hannam-dong (the doctor all the expats go to) was when I was 5 weeks along. They weighed me, the doctor talked to me and the did a sonogram. The technician showed me my sonogram, identified the parts and showed me photos of good 5 week sonos and bad 5 week sonos. Mine matched the good sono. Dr. Sung does not deliver anymore, but she does prenatal care to 25 weeks and then transfers you to another doctor. She also gives a labor class in conjunction with a doula and the Hypnobirthing instructor. That seemed like a good sign, but then she gave me the VBAC talk. There are no VBACs in Korea for Koreans (Update: I have learned this not true, some English-speaking doctors will do VBAC and Women & Children's Hospitals will do VBAC. The Women and Chikdren's hospitals may not be ideal for expats because most of the doctors/staff don't speak much English, but there are options and a doula who speaks English and Korean can help). They are all repeat cesareans. Of all the hospitals in the area, there are two that allow VBAC, but one is not recommended for English-speaking patients. There is one doctor that will worked with expats for VBAC and the Hypnobirthing instructor knows of a recent Hypnobirthing VBAC with that doctor. Also the cesarean rate in Korea is 40%. They separate the muscles with their hands and do double stitching so I am sure my cesarean would go well, but since I am looking to VBAC, it doesn't bode well. What if that one doctor or hospital changes policy before I deliver?

Disappointing to say the least.

My next steps. I have an appointment with Dr. Sung on Thursday. I am meeting with the Hypnobirthing instructor on August 13 to discuss birth culture in Korea and talk about my options. I start Hypnobirthing class the this week of August.

I also go to the Army hospital's OB Orientation on August 4. I plan to explore this option even though I think I will find my current impressions are correct. Everyone who has delivered there says,"It's ok". No resounding endorsements.

The other options are to go back to Erie and work with a doctor or go back to Erie and work with a midwife for a homebirth. My friend, Heather, has already agreed to let me have the birth at her house. She is very close to the hospital if something goes wrong. Labor can be long and is much more comfortable done in a house rather than a hospital room. With a skilled midwife to check on me and the baby I feel confident that I could give birth safely. It just seems like the most appealing option. My parents could watch Ian and I would have a lot of support.

The downside to the Erie plan:

1. Separation from Curt: He has a lot of built up leave, but I would probably be gone for at least 3 months

2. Expenses: My trip to the US would be on us. Roxxy (the dog) would need to come back because Curt isn't home enough for her, that is both an expense and a trauma for her. Homebirth would probably not be covered by insurance.

3. Stuff: All my baby stuff is here in Korea. Of course, I wouldn't need much, just a carseat and some clothes, but my breast pump is here and all of my stuff.

No decisions have been made, but my gut feeling is that an Erie homebirth is my best shot for a VBAC. I guess we will just see how things go. Of course, the baby could be breech again or I could have some trouble that would lead me to a repeat scheduled cesarean, but I have a good feeling this time....


Katharine Graves said...

Go with your instinctive feeling. If you look at the statistics in Ina May Gaskin's book from The Farm between the years 1970 and 2000, of 106 VBACs attempted, 104 were successful, and only 2 had to have a repeat caesarean. Good luck!


Katharine Graves is a hypnobirthing teacher in London

Cairo Mama said...

Thanks, Katharine. I am really looking forward to starting Hypnobirthing.