Our Prenatal Adventure in China: Part VII

This is Part VII of a series.  Click here to read from the beginning.

With this baby due any time now, here are the rest of the entries on our prenatal adventures in China in one long marathon update!

32 Weeks

We had our 32 week prenatal visit at the Shanghai hospital because they like to do a third trimester ultrasound here, so it was deemed one of the “important” visits.  We had our ultrasound first and then were to meet with the doctor.  The ultrasound tech was much less talkative than the one at the anatomy ultrasound and she didn’t even print a photo for us.  She did confirm that it was a boy though.

Following the ultrasound we went to meet with the OB, who was already waiting for us.  We had not yet met this particular OB and he did nothing to impress us.  When we walk in to meet him, the first thing he says is, “You gained 6kg.”  What a nice way to introduce yourself to a new patient…  We weren’t even sure what time period he was referring to (I had gained more than 6kg in the first 32 weeks) and if he was telling us I gained too little or too much. After four more tries it was conveyed that he thought it was too much weight gain since my previous Shanghai appointment.

I actually have a spreadsheet of my weight gain that I track weekly and compare it to my weight gain from when I was pregnant with LiLi.  The spreadsheet is for interest sake… not an obsession with weight.  I have gained the same total weight this pregnancy with the same spikes and plateaus.  To quantify that for you, I had gained a total of 28 pounds so far and, with LiLi, gained an additional 4 pounds before her birth.  I never did the half-pound a week gain the last few weeks like is often purported.

Doc, can you please specify what you mean
by I need to "start exercising"?  I don't know
what else to do if 7 hour rides aren't
exercise... Oh, wait.  YOU don't even know
what I do because you never asked!  

Then his OB-ness really came out.  Instead of asking good questions, he then tells me I “need to start eating healthy and exercising.”  I think I am in at least the 95th percentile of active pregnant women.  We still are riding our tandem bicycle (recently did a 70 mile, 7 hour ride with 3600’ of climbing – with a toddler in tow), going on hiking trips, etc. and my eating habits are quite healthy.  He also specifically stated that my weight gain has already put the baby on track to be too big since the ultrasound measured him at 1.9kg.  He never mentioned the accuracy of weight estimates via ultrasound though, which are often wrong.  In retrospect, we should have asked him for the confidence interval on that weight estimate.  Although we know birth weights of babies born to the same mother can vary greatly, LiLi was still only 6lbs 10 oz. and she was six days late.  It’s kind of funny to have this Chinese trained doctor say the baby is too big now when the previous Chinese doctors established him as too small.

                                   

This OB also told us “a couple hundred grams can have a drastic impact on your birth outcome” and indicated I would need a c-section.  At this point, Mark starts asking if it is really the weight of the baby or head circumference that is the problem.  We know lots of women who have had normal vaginal deliveries with ‘big’ babies.  Interestingly, some journal articles I read after we got home only find significant correlations between the doctor’s expectations of a big baby and the probability of a c-section and not with the actual birth weight of babies (or even head circumference).

We already had low expectations for this doctor before meeting him because one of Mark’s co-workers recently delivered his first baby with him.  When they met with him at their 36 week visit they were told they could schedule an induction for anytime after 39 weeks.  We told Mark’s co-worker that  a non-medically indicated induction for a first baby is silly and that if they did that they would probably be induced, be allowed to labor for 12 hours, and then be deemed ‘failure to progress’ and have a c-section.  The day after their due date they had an elective induction, she labored for just over 12 hours, the baby was deemed ‘too big,’ and they had a c-section.  Their baby only weighed 7lbs 5oz, yet the ultrasound had estimated a pound heavier, which the doctor considered ‘very large’ for a small Vietnamese woman.

Our arguing with the OB finally cued him that we didn’t really appreciate his “medical” advice and he started climbing out of the hole he had dug quite a bit.  He then started talking about how pregnancy isn’t a medical condition, etc.  He even went from telling us that we would need a c-section to saying that we could do a normal vaginal delivery for a breech baby (though this one is supposedly already vertex)!

We left that appointment rather disappointed though.  At our first visit, the head OB had indicated we would have no problem achieving the birth experience we desired at this hospital.  This OB left us feeling like we would rather have the baby in a taxi than at the hospital with this particular OB!

Finally¸ this OB told us we didn’t have to move to Shanghai until 10 days before our due date instead of two weeks, which gives us four extra days to possibly have a home birth instead of having a birth experience with him!  More so, it means four less days spent living in a hotel room with a toddler.

34 Weeks

For my 34 week prenatal visit, only a routine checkup was required so I went to the local Sanmen hospital, as the Ningbo hospital had suggested.  However, since the Sanmen hospital doesn’t have a VIP clinic to help foreigners navigate the hospital, the local site doctor accompanied me.  The site doctor is an ISOS (http://www.internationalsos.com/en/)  doctor who can speak English (though is Chinese and Chinese-trained) who is on call for the expats 24/7.  There is a small medical clinic on site, but it doesn’t have a fetal Doppler, urinalysis capability, etc. so we still had to go to the Sanmen hospital.  The site has two of these doctors who rotate every 30 days.

Anyway, in advance of the need for this appointment I had sent an e-mail to the site doctor explaining what I needed and also forwarded him the note the Shanghai doctor had written clearly specifying what care I have already received and what care I needed at the 34 week visit (urinalysis, fetal Doppler, blood pressure).  While often the site doctors seem under qualified (at best), this one did take the initiative to call the Shanghai doctor to make sure he understood what I needed, etc. before taking me into Sanmen.

Another expat needed to have some routine blood work done, so the doctor took both of us to the hospital at the same time.  It is a 30 minute drive to the local hospital.  When we got there, the site doctor (George) asked us to sit down while he registered us.  I had some blood work done at the hospital in the fall, so I had a Sanmen hospital card (registered under my Chinese name 惠丽) that I passed off to him.  George returned a few minutes later to retrieve the other expat for his blood work.  When they finished, the returned to retrieve me and said that we had to go to a different hospital in Sanmen for prenatal care – the Sanmen Traditional Medicine Hospital as opposed to the Sanmen People’s Hospital.

We took a taxi over to the other hospital (5 min. away) and George registered me at the front desk and then we went upstairs to wait.  The hospital doesn’t have appointments, so you just get in line once you are there (that was one perk of the VIP clinic in Ningbo – I could schedule an appointment).  We only waited about 30 minutes (I think only because George asked the head nurse every 5 min. how long until they could take me). 

Even though he is a doctor, George didn’t think he would be allowed to go back with me to see the OB since men aren’t generally allowed, so he wrote a note with his phone number for me to give the OB when I got to her so she could call him and he could tell her why I was there.  Thankfully, they didn’t actually care and George was able to join me and he explained to the (young) OB what I needed and that my main care was in Shanghai.  The OB was great.  She didn’t try to send me for additional blood work or anything (which happened every time I went to Ningbo).  She just did my blood pressure, fundal height measurement, and the fetal heart rate.

After meeting with the OB we then went downstairs to do the urinalysis.  I was handed the little plastic open cup on a stick and directed to a bathroom – which was several hallways away!  Again, no clean catch concept exists.  George advised me to only pee a little in the cup to make carrying it easier.  When I carried it back to the nurses’ station, they then directed ME to pour it into a glass vial, which was lined up in a grid of glass vials.  Let’s just say that splashing into other vials is not only a possibility with this method, it is probable!  We then had to wait about 15 minutes for them to print off my urinalysis results (which were all normal).

I really wasn’t surprised about anything during this visit since the procedures really weren’t that much different than in Ningbo.  However, the other expat who was with us hadn’t been to a Chinese hospital before and he was blown away by everything he was seeing, particularly the parents walking around holding an IV bag on a stick that is inserted in their child’s head.  If a child gets even a little sick here, they take them to the hospital to be rehydrated and receive a round of antibiotics.  They are going to have major issues here in a few years with super-bugs and antibiotic resistance.  At 2 years old, LiLi has never received any antibiotics…  However, I hardly noticed any of these oddities.  I guess I am becoming desensitized…

36 Weeks

The 36 week prenatal appointment was in Shanghai because it was one of the “important” visits.  At this visit they did the Strep. B culture.  We met with Dr. Ji again this time.  She is the head of the OB department at the Shanghai hospital and we were impressed with her during our initial visit to the hospital.

After our previous (disappointing) visit with a Shanghai OB, I wrote down several direct questions to ask (like how they operationalize “progress” in labor, their c-section/induction/epidural rates, birthing supplies that would be available (birthing ball, bathtub, etc.)) so we wouldn’t be surprised in labor.  She answered all of the questions well (giving the book definition of “progress” though it was pretty obvious that in labor it tends to be operationalized by whether the parents feel progress is being made fast enough… which, I guess, would be to the benefit of a relaxed patient).

We also brought along our three page birth plan and asked the doctor to review it and tell us if the hospital wouldn’t be able to accommodate any portions of it or if we should modify sections.  She finished reviewing it and goes “We don’t do PKU testing until 72 hours here in China.”  This genetic testing is done at 24 hours in MA and was the reason we had to stay at the hospital a min. of 24 hours post LiLi’s birth.  We had assumed it would be done in the same timeframe so it was included in the birth plan that we wished to have the option to leave after 24 hours (i.e. after PKU test).  We were a bit distraught about having to wait 72 hours to leave the hospital (though Ningbo told us 10-14 days!) when the doctor clarified that the testing was after at least 72 hours.  Since it was our second baby, we could actually check out after six hours and just return for the PKU testing. 

Her willingness to accommodate all parts of our birth plan and let us leave at 6 hours gave us warm fuzzy feeling again about this hospital.  Unfortunately, knowing that we could end up with the OB we had met with the previous time tempered the excitement a bit.  At 32 weeks he was already practically recommending a c-section be scheduled!  Having the head of the department tell us none of the birth plan violated hospital rules though is critical – if we have to fight for anything (which hopefully won’t happen), we have the head OB on our side.

37 Weeks

The 37 week prenatal checkup was done at the local Sanmen hospital.  The site SOS doctor had rotated, so I had to explain what I needed again.  This doctor, Gabriel, was already aware of our need to go to the ‘other’ hospital in Sanmen for the prenatal checkup.  He was very apologetic that we couldn’t make an appointment, which I was already aware of.

We left the site at 9AM and had registered me by 9:30AM.  We then went upstairs to submit my registration card into the stack and begin the wait.  There were about forty other women already waiting ahead of me.  I’m not sure if the crowd was bigger because it was a Monday or because it was post-Qingming Festival and people were trying to get their missed appointments in now.  Gabriel told me to find a seat and hope I got to see an OB before their lunch break (11:30AM-1:30PM).  At 11:15AM Gabriel called me over – he convinced the head nurse to bump me up to be taken before the lunch break.

However, since Gabriel was with me (i.e. a male) and I needed him for translation purposes, we had to wait in the hallway since the OBs see several patients at one time (yeah, no privacy of medical information here!) and he didn’t feel comfortable being around the other female patients.  Mind you, they are all fully clothed.  The most skin you might see is a belly during a fetal heart rate check!

We finally saw an OB who was really confused about why me prenatal records had differing due dates.  I finally got Gabriel to convince her to just move on and use the Shanghai date – I was only there for basic care anyway!  She did my blood pressure and then decided I didn’t need a urinalysis (even though the Shanghai doctor said to have it done… I didn’t argue this one though because mine have always been normal).  After the fetal heart rate check and fundal height measurement Gabriel said we could go but would have to return at 1:30PM.

I knew I had done everything the Shanghai doctor had requested (except for the urinalysis), so I was confused why we would have to return in two hours after the lunch break.  He said the OB wanted me to have an ultrasound.  I asked if the OB thought something was wrong, and he assured me everything was fine and that they just do these routine ultrasounds (as I already knew from Ningbo).  However, I insisted that he instead call my Shanghai doctor and check.  I knew I didn’t need this unnecessary test and it was going to be a pain to return in two hours – particularly since I would then have to arrange additional childcare for LiLi or bring her with me.  Gabriel called the Shanghai doctor who confirmed I didn’t need the ultrasound, but the Sanmen OB saw it as an elective (i.e. obstinate) decision on my part and made me sign a statement that I was refusing her recommended treatment.

Just as a point of interest… the total cost for this visit was Y2.50.  That is 40 cents.  It did take a lot of my time though.  I don’t understand how this local Chinese hospital can have electronic medical records but fail to be able to schedule appointments.  So many man hours are lost to patients (and their families) unnecessarily sitting at hospitals waiting to see a doctor.

With our scheduled temporary move to Shanghai for this baby’s birth just around the corner (April 20th), I probably won’t be spending much more time at the local hospitals.  This journey through some local Chinese hospitals has certainly been eye opening though.  The actual cost of medical service here is so very low that it has led to the overuse of the medical system by both patients seeking antibiotics unnecessarily and doctors keeping patients for longer than necessary and prescribing unneeded tests (blood work, ultrasounds, etc.).  Hopefully our kids continue to be healthy so we have no need to frequent these places again!