Topics of the World
This section will cover topics related to birth, childcare, and medicine around the world. It may give you incentives to think about the topic and how it may relate to you and your family.
Free Medical for children
As I research through the medical system of over 60 countries, I have realized that those countries in which the government place value on social welfare, have free medical for children. When I say children, they are children usually under the age of 18. Countries such as Denmark, England, Canada, and some other countries in northern Europe have free medical for children.?
In these countries, pregnancy, birth is also covered by insurance and that parents do not need to pay a cent towards medical professionals nor the medical facilities. It covers their prenatal check ups, various tests during pregnancy, and delivery. In some generous countries, they also provide parents with monetary allowances so that they will not feel overwhelmed in spending a lot of money on raising children.
The financial support from the government is important in order to prevent the decrease of child birth cases of developing countries. It is often told in Japan that people cannot afford to have babies anymore because children are expensive. In Japan, even though they have universal medical plan, it does not fully cover the entire cost of medicine. Especially, since pregnancy and birth is not considered an illness, the insurance does not cover for pregnancy and birth. Although claims can be made to insurance companies, their underlying perspective has not changed.
I believe in order to give rise to more birth, free medical, free education up to high school will contribute a great deal.
Who attends birth
In Japan and still in many parts of Asia, husbands are not allowed in the delivery room. In the old days birth was considered a womenq・ thing in these regions and as hospital birth grew in number, the delivery room was only for the medical staff.
However, now, more and more women are becoming aware that when husbands attend birth, they are more likely to help on child rearing. Thus they now try to choose the hospitals that will allow husbands to attend birth. Yet it is still difficult to find such hospitals.
When we look around the world, husbands attending birth is a normal thing. Maybe it has been around for more than 30 years in some places. In some birth centers they even allow children to be at the scene. If it is home birth, there is no restriction as to who will be there, friends, sister, mother, whomever. It will be totally up to the choice of the birth mother.
I believe the womenq・ choice of who she wants to be at her side when she has her baby does have an effect on the satisfaction of her birth. If she gets the support from the people whom she trusts and feels comfortable with, this will certainly help her to relax and thus lead to an easy delivery.
Hospital meals
You may not think hospital meals are that important, but for some mothers they are. The meals may even influence their impression of the medical facility as well as the medical staff within.
Naturally, most people prefer to have meals that they are used to eating at home. But it is not usually the case when you have your babies away from your home country.
I have looked into various hospital meals in different countries and found out that the hospital meals do represent the country. In Korea, you are expected to have Korean food served. In India, yes very spicy food. What was more interesting was at the hospitals where there are many foreigners admitted, they gave choices such as western food and the local food.
In underdeveloped countries, meals are not served at the hospital. The family has to bring food from the house. In countries like Thai, they even allow you to cater meals from outside the hospital. The restaurant staff comes to take your order? Wow, what a luxury.
In countries where there were mixed ethnic group, they had many choices, such as in Singapore, you have the choice of Chinese food, Western food, Muslim food or Vegetarian. Muslim food is mainly for the Malaysian Singaporean, and Vegetarian food was for the Indian Singaporean.
I myself had the opportunity to challenge all and tried Chinese one day and Muslim another day. I thought it was part of experiencing the dynamics of having your baby in the exotic South East Asia.
Umbilical cord
The umbilical cord connects the mother and the child in the uterus. What do you do with the cord? Clamp it and cut it as soon as the baby is born? Do you just leave it for a while until the cord has stopped pulsating? Do you wait until the placenta is delivered? Do you advice the husbands to do the snipping of the cord? Well one of the midwife I knew allowed the child who was attending the birth to feel the pulse, the blood that was flowing through the cord. q⑦eel the pulse?q・she said, and I saw the child with a surprising look, and I thought that was beautiful.
The cord may mean nothing to many, but for some it symbolizes the strong bond of LOVE between the mother and the child. In Japan it has long been practiced to keep the umbilical stub that got dried and fell off from the navel. Since the length of hospital stay is an average of 5 to 7 days, the probability of having the stub off before you leave the hospital is very high. So, the nurse may place it in a wooden box. Many hospitals in Japan nowadays do not pass the umbilical stub for hygienic reasons. The mother usually keeps it along with the first crop of hair, but some give it back to their daughter when she leaves the house to get married.
I know one lady who had kept a long strand of cord and dried it out in the air and kept it. While many of her friends only get to keep the umbilical stub, she kept almost the entire length of the cord. Some may say q・uck, it is unhygienic!q・but in some cultures, or even some people, they value the cord in such way that was the connection of the two entities. So, maybe next time you cut the cord, you may want to ask the ladies how they feel about the cord.
Mother and Child Health book
For the past 14 years I have been collecting mother and child health book around the world. You might wonder what this is. Well, this is a booklet where all the records of the mother during pregnancy, birth, and afterbirth are kept as well as all the records of the child's physical developments including immunization records.
Unfortunately in most countries I have found that the booklet is not combined with the mother's. In some countries the mother's record which she carries with her only includes her weight gaining records which she can record herself. In general the mother's pregnancy record is very simple but the child's development record is with more detail in most countries.
Perhaps the only country which has the two combined is Japan. Germany came close with the mother's record quite in detail and the child's record also in detail, but the booklets were separate. In some developing countries including Mexico have adapted Japan's mother and child health booklet thus combining the two.
I believe the reason that Japan has the mother's record in detail is because many still return to their home province to have birth and the doctor or the midwife needs to know how she was progressing through her pregnancy. In Japan it is not our custom to ask for a copy of the medical records hence this booklet does become handy. The record includes the tests the mother had done including weight gain, blood pressure, results of the urine tests, blood tests, and so forth.
If you consider the child's life beginning from the time of conception, I think it is natural that the record be kept from pregnancy stage. My mother had handed my health booklet to me when I got married and I was able to see how she carried me through her pregnancy and it made me feel I was really loved.
Breast-massage in Japan
When I was asked by Donna whether I would write something related to customs of various countries surrounding birth, I spontaneously answered yes, because I found the differences to be very interesting. But then I realized if I get questions from the experts, I wasnq・ sure if I could answer them all. I am not a midwife, obstetrician nor a nurse. I am just an international social worker who just happens to have done research on birth of various countries. So, upon this understanding, I hope you will enjoy my article.
Well, there canq・ be a better place to start than to start where I live, yes the exotic Asia. So today I am picking up the topic of breast-massage in Japan.
One of the complaints my Japanese clients raise when they have birth overseas is, q⑩ didnq・ get any breast massage.q・ In Japan, there is a belief that massaging the breast will promote the milk flow. I believe it comes from good blood circulation. There are even books on how to massage oneq・ breast with illustrated guide lines. There are even schools of thoughts in this area. In one school, Oketani, they believe in removing the base off the chest and pushing it on sideways and up and down.
At the hospitals, the midwife will place a hot towel over your breast and massage your breast. Remember how your milk drips after taking a hot shower? I believe it is almost like that, a hot compress brings the good circulation of the blood and thus the milk. She will squeeze the nipple to make the milk come. It is a 5-minute procedure, but you surely feel good.q_
Birth away from home, a trend?
It is not easy to mention about people taking advantages over another country and often the US being the target. This may sound harsh, but true. Over the past 30 years, many people of insecure countries had looked into giving birth in the US, simply to gain the right of citizenship of the country. The advantages of being that if the child was a US citizen, then the family has a high chance of getting a permanent visa or to become a US citizen in the future. Still many people believe in the American dream come true.
From the stand point of a consultant who support birth away from home for the expatriots (those who have gone overseas for business but returning back to their home country eventually.), I had to encounter those who were planning to give birth in order to gain citizenship for the child. Most popular spot for the Japanese is Hawaii.
The tourist visa only allows 3months stay, so they take the risk of flying nearly 10 hours on plane at nearly the end of trimester stage. The insurance does not cover the delivery nor the hospital stay, so they spend a tremendous amount of money. Some people make business out of supporting these families who come to Hawaii for delivering babies. Staying in hotels or condominiums is not the same as home. They would have to fly back with the tiny newborn.
Now, for what reason would they ever choose to take such risk? Just to gain citizenship? Taking so much risk? If midwives are to support natural birth, this kind of birth is just not natural to my eyes. When I think about the babies who would have to endure unnecessary stress, I am just not for it. Babies should not be victimized.
Waiting rooms
I have looked into several waiting rooms of ob-gyn clinics and have noticed who is there besides the patient, yes, the mothers-to-be and women.
In Japan, to start off with, in the past, ob-gyn clinics were totally for women and men never entered the clinic since they felt ashamed to be there. But nowadays things are slowly changing. The husbands began to go along with the women to the clinic, yet the number is still small compared to the west. The midwifery clinics on the other hand encouraged husbands to come with their wives and there are more men in midwifery clinics than in hospitals.
In Singapore, I have noticed that the husbands always come to the ob-gyn clinics with the women. Moreover, when they are to go to the pediatrician, they will also accompany their maid, to look after the baby and their grandmother to look after the sick child. This was also seen in Hong Kong as well. There, the husbands went along to the clinic with the expectant mothers.
In Korea, it was more like the mother of the women who came along to the clinic. In China, I have also noticed that mothers of the women go along to the clinic. I guess in these Asian countries where Western cultural influence is not so much at a stake, has a strong tie between the mother and the expectant women. Of course South Korea, places like Seoul is a bit different, yet still the change is slow.
Of course in Europe, and in the United States, prenatal check ups are to be attended as a couple. I believe in near future, the concept of family will become so strong that the ob-gyn clinics will not only be places for women but to see as a whole, women and men.
Birth date
Here is my bi-monthly article on birth around the world. Today I would like to take up the topic of birth year, month, day and time. As the year 2000 approaches, I am receiving letters from clients, wishing their babies to be born in the year 2000, and that means that they have tried to conceive so that the baby will be carried through to the year 2000. Well I think that is great. It will be a mark of the century.
But did you know that around the globe, there are some countries that actually allow you to change the birth year, date and time?
Well after all, if you have home birth, the details are known only to the midwife and the parents. There is no explicit proof or evidence that the baby was actually born on that particular time, day and the year, and if the parents have a valid reason to relax the rules of objective truth, why not? Is it really a matter of ethics and morals?
Besides in some developing countries, they donq・ even have a clock to check what time the baby was actually born. Imagine being able to choose your babyq・ birthday.
In some countries, a particular birth date, time, and year may mean more than just numbers. It can mean a blessing, a prayer for the babyq・ future.
In Singapore, the year 1988.8.8. was one of the best dates to be born for the Chinese. 8 represented everlasting fortune. The parents wished their children to be prosperous and wealthy in the future. 1988 was also the year of the dragon. The year of the dragon represented strength and dignity. If you had a boy, you couldnq・ wish for more. But now the classrooms of children born in the year 1988 is packed full (smiling).
In Taiwan, the best birth date around the due date is decided by the fortune teller. When the day is decided, some even opt for a planned birth by either inducing labor or having a Caesarean section.
Certainly from the view point of the pro-natural birth advocates, I know that any artificail birth is unacceptable, but in some cultures, they may value these customs and beliefs over naturalness.
Blythedale Children's Hospital?
Many babies were in a sitting position. q臼hotoqeBlythedale H)
Blythedale Children's Hospital is situated in Westchester, a suburban area of New York. It is a rehabilitation hospital where children who had major surgery prepare to go home. It also has a school where kids from age 5 to 21 attend. I was surprised to see a blind child pushing the wheelchair. Here, everybody helps out.
In the U.S., the definition of a child is up to 18 years old, however, those in special education can attend school until age 21, where they are given the chance to stay longer in the educational system.
Connecting the family
Unfortunately some children may never go home. They may require intensive medical intervention. Nurses are required on a 24 hour shift and they often become mothers to these children. However, nothing replaces their true parents. Therefore, parents are encouraged not just to visit the children but to be involved in taking care of the child as much as they can. Nurses teach parents how to change the NG tube which the child needs to be fed. There is a house for these families for short stay.
Early Intervention
I had heard that earlier the better, but I had not expected therapies to begin as early as few weeks old. But I was convinced that for these babies, therapy is training themselves to eat, or to reach for objects.
Therapy, a fun time
Children at this hospital receive 45-minute therapy each day. For these children, therapy is an important factor for their survival, so the therapy gym is a fun place for them. They have exam rooms that are just like play house.
Hear no cry
What surprised me was that even though there were 4 babies in one room, not one baby was crying. The hospital makes sure that babies are not in pain. There are professionals called pain managing staff. Also I was surprised to see that there were no children in most of the rooms. The healthy kids are required to attend the school. But most of all, I was impressed by the staff who are devoted and have pride in working at this hospital.
Genetic Counselor?
At the Inherited Metabolic Disorder clinic where I am working as an intern, we have a genetic counselor in training. I had the chance to interview Ms. Cynthia Livingston. She explained to me about what genetic counselors do and how important they are. I hope this section will help you to think of the need you may have to seeing a genetic counselor.?
How did it begin?
It began around the late 60s in the United States. First, the doctors who were specializing in genetics were talking to families. However, they found the need to have a specialist who can just focus on explaining about the genetics to the family, but at the same time to be able to counsel. Doctors had their role to treat patient with genetic disorders.
How do you become a genetic counselor?
In the United States, you will go through four years of undergraduate in any areas that may prepare you to become a genetic counselor, such as biology, pre-med, etc. Then you would apply for two years of masters at any colleges that have department in Human Genetics. You will graduate with Master of Science degree. Graduates would have to work a year before they can take the test by the American Board of Genetic Counseling, to get a certificate to work as a genetic counselor in the States. It is a national certificate.
What do they do?
Genetic counselors work with the health care team, provide information and support to families that have members with birth defects or genetic disorders, or who may be at risk for inherited conditions. They identify families at risk, interpret information about the disorder, analyze inheritance patterns and risks of recurrence, discuss the risks, benefits, and limitations of genetic testing, review available options with families and provide supportive counseling. They also serve as patient advocates, educators, administrators, researchers and resource people for health care professionals and the public.
The Human Genetics program gives students a comprehensive understanding of the medical, scientific and counseling aspects of human genetics, placing equal emphasis on medical genetics and psychological approaches to working with patients. The interdisciplinary curriculum enables students to integrate both theoretical and practical knowledge while developing research, analytical and communication skills. Course work is conducted in seminars, tutorials and workshops, and practicums emphasizing student participation and individualized evaluations. Extensive library work and carefully supervised fieldwork at ABGC-accredited training hospitals is required.