How to get the birthing experience you want (in Bangkok)

I haven't been able to find much time to start writing again, but then I realised that life simply isn't going to give me a few spare hours a day anymore, pa ha ha. So I've promised myself that I will focus on short (and hopefully sweet) posts for a little while. Hope you like them and find them useful...

Here are my top five tips on how to get the birthing experience you want. This is from my experience at Bumrungrad earlier this year.

Ensure you have discussed your wishes with your Doctor

Emergencies happen,

and its important to listen to the professionals when they do,

but at the very least your Doctor should know your basic wishes

before you get into the labour room

Use your partner to be your voice

(they listen to dads more)

Hire a Doula

She will empower you to have a voice when it matters most to you
Article: Doulas - a friend in an hour of need
Article: Doulas Do More

Attend an Antenatal Class

Article: Knocked up.....Now What? Private Antenatal Classes in Bangkok

Politely insist on anything and everything you want

You will ultimately get it if you stick to your guns

We insisted on skin to skin, which admittedly was more of a long awkward cuddle but we got some ✅

We insisted that dad went with bubba to the nursery for her basic checks, and that it was as quick as possible ✅ (they had her back to me before I’d even left the labour room) 

We insisted that bubba came back to me for her eye drops and vitamin k injection ✅ (as above, this was done in the labour room) 

We insisted that she stayed with us ✅ (in fact she stayed with us so much that they almost forgot to do her hearing test and BCG) 

We insisted that I was with her for her hearing test and BCG ✅ (we threatened to not pay if they didn’t allow me to have physical contact with her for her BCG)

So, other than a very quick trip to the nursery with dad, I was with her for everything. We had to be politely forceful, but it’s your child, and no one should/can dictate to you.

You've got this mama!

GET INFORMED, GIVE TRUE CONSENT!

My stork arrived early...

Just a quick post to say that I am very pleased to announce that on the 1st May 2017 our baby girl was delivered safely, and happily, at Bumrungrad Hospital with the aid of Dr Somsri and team, my doula, Rasee Govindani, and of course my wonderful husband.

I went into early labour 9 days early whilst eating our favourite food in our favourite restaurant - xiao long bao in Din Tai Fung - and 17 hours later I delivered our bundle of joy.

I am very pleased to say that, whilst I won't lie - labour friggin hurts! - I asked, and was given, an epidural at 10cms dilated - the team were very respectful of our birth plan, and we got everything we asked for.

Our baby girl was never out of our sight post delivery, and eye drops and vitamin K were administered, after checks were done, in the room with us, whilst Hep B and BCG was administered a couple of days later in the nursery, again with us by her side and immediate cuddles and kisses.

I will write more about how we managed to get the birth we wanted just as soon as I can...but for now I have some very important cuddles to give!

Please don't hesitate to message me if you have any questions, I have already mastered the art of one handed typing, but I might not be blogging for a few weeks.

Big hugs and kisses to everyone out there that is TTC, pregnant or just starting their family. 

It's all such a precious time, be gentle to yourselves!

Baby Blue in Bangkok is not so blue :-)

xxx

Knocked up.....Now What? Hospital Antenatal Classes in Bangkok

My 'offline' pregnancy bible throughout this journey has been the book by Lesley Regan called "your Pregnancy week by week", it has been my friend and confidant on many nights ...

As I hit the Third Trimester section Lesley writes "you will probably be starting your antenatal classes now - most hospital-run classes have start dates every four weeks and recommend women start their course between 30 and 32 weeks".

Panic! Where do I find Antenatal classes, in English, in Bangkok???

Knocked up.....Now What? Basic labour packages in Bangkok

UPDATED at 30th July 2017

There is a lot to think about when you are growing a baby, and cost might not be at the forefront of your mind, but it is worth thinking about sooner, rather than later, as it may affect your decision of hospital (and Doctor).

If you do not have medical insurance that is covering the cost of your labour then the hospitals try to make it easier for you by advertising Birthing Packages, but you really do need to look into the small print.

Knocked up….now what? More tests…am I Diabetic?

Before I talk about diabetes (more precisely the gestational variety) I have to have a huge moan about the Thai Healthcare system AGAIN! Sometimes I think they are purely in this business for the money, I mean purely, no Hippocratic oath, no caring for the patients, no ethics, just plain wealth and extortion!

Knocked up....now what? Vaccinations - Whooping Cough

Things are getting serious now, I'm 19 weeks pregnant and last week my Doc dropped into conversation that she should give me a vaccination next month. This would be mostly to help prevent whooping cough, and also diphtheria and something else beginning with P that I couldn't quite catch. 

Knocked up...now what? Am I Incompetent?

Or to be more precise is my cervix incompetent?

Just over a month ago, when I was 14 weeks pregnant, my doctor dropped into conversation that she wanted to test if my cervix was ok, it might be opening, and she might need to put some stitches in it.

That was pretty much what she said, no more explanation, very matter of fact, and she made it sound perfectly normal. 

Miscarriages - How to cope in Thailand

This post was the main reason for me starting this blog but its taken me a while to build up the courage to write this.

Knocked up...now what? Chromosomal Testing

Having lost 3 babies, one of which we know was due to Trisomy 21 we knew we  wanted to have Non Invasive Prenatal Testing (NIPT). From the moment we found out we were expecting again we were counting down until we got these results and were treading on eggshells until we got to the 11-13 weeks window.

Knocked up...now what? Chillin

Maybe the Thai's have got something right about this pregnancy lark.

I find myself once again in the early weeks of pregnancy. This is the 4th time and of course there is a lot of trepidation. But this time I am doing things a little differently, I'm doing it Thai style.

My doctor, at the moment, is Dr Somsri (Bumrungrad). She specialises in high risk pregnancies, she is very chilled (for a doctor), she smiles and laughs and talks about her family (even when you would prefer to be talking about your expanding family) but she is lovely and her English is excellent, and she even has a dose of empathy and cultural understanding.

But Thai doctors, and therefore Thai people, can be a bit worrisome and tend to air on the side of caution, with basic advice amounting to "don't move", 'don't think' and forget about having anymore fun.

As with the previous non viable pregnancies I was planning on toughing it out as I meant to go on...this baby has to fit into my regime, not the other way around, and it might as well start now. Especially after having our first scan (6 weeks and 1 day) and finding a good heartbeat, and that for the first time I had some mild morning sickness which is the one thing that has probably made me the happiest for months and months...at last, maybe, hopefully, I am having a normal, healthy pregnancy.

But then it happened.....

That dreaded little drop of blood on the toilet paper (that toilet paper that all us TTC women are now so accustomed to studying in more detail than a mother looking for lice after an outbreak at nursery school). We were about to fly to Singapore the same day for a fun filled (now sober) weekend with friends and I didn't know what to do, less than 24 hours earlier I had seen my babies heartbeat, could it have gone so horribly wrong so quickly????

I called Dr Somsri and her advice was effectively "don't move", 'don't think' and forget about having anymore fun. She doubled my dose of Progesterone, but told me not to worry and scheduled me for a scan in 7 days, she also told me not to fly and that I should move as little as possible and have bed rest, I guess in this type of situation gravity definitely isn't your friend.

I have been finding it hard to focus on work, and to be honest my boss is a prick, plus the nausea and cramping had been genuinely getting a little worse, so for the first time ever it was easy for me to follow doctors orders, and I am currently on a full weeks sick leave doing nothing but lying down and watching TV box sets.

For the first few days I was genuinely worried. I don't know if it was mind over matter but my cramps and nausea were getting much worse, and the cramping was really worrying me. 3 days in and I tried to sit up to type some emails and 30 mins finished me off and gave me every justification I needed to lie back down and finish Season 6 of Game of Thrones. 

I'm now 6 days in to doing not much at all (with 2 days until our next scan) and I am starting to feel less worried, although even a walk to the toilet seems to set off unexpected cramps and once again provides me with all of the justification I need to sit back down on my arse and stretch out with a warm hot water bottle.

I still feel like a fraud though. I've watched most of my friends battle their way through early pregnancy as if it was nothing more than a hangover, seeing them prep themselves for the real shit that happens after 9 months, when they will have no excuses or time to think about themselves. And here I am, lying on the sofa, now working my way through every episode of The Wire (because I missed the hype the first time round).

But, this is my 4th chance, and I don't want to mess this one up. I do want to be able to look back and think that I did anything wrong, I want to start putting my baby first, to get used to the idea that life is no longer about me and instead is about protecting something innocent.

So here I am, being and thinking like a mum for the first time ever. Work is almost out of my mind, the condo is tidier, dinner is prepared on time and I've even made ice cream and baked a cake...this shit is getting real and I want it to keep getting "real".

I want as much "real" as humanly possible, so I'm gonna chill and I'm gonna chill and I'm gonna chill some more, because I'm in Thailand, because I am lucky, because I have worked hard up until now to make some of that luck, and because I can....and because it's how the Thai's do it.

Knocked up...now what? Choosing a Doctor

So you've confirmed in your own mind that you are pregnant, but how do you find a doctor that you can trust and that speaks enough English to communicate with you effectively, and with some empathy?

Getting Prepared...POAS

At this stage I had been to the hospital for some stern words about relaxing and taking folic acid but Thailand hadn't really helped me to prepare for anything or given me any real advice of "how to" get pregnant.

So I started to download app after app, full of calendars, hints, tips, recipes, positions, recommendations and statistics and this is where I learnt about Ovulation Tests. It became apparent that one could only get pregnant on a very small handful of days each month and as I didn't have any time to waste I couldn't afford to be second guessing this. I'd spent most of my life thinking that if I missed a bus there was always another one coming along in 5 mins, but I couldn't afford to be so lackadaisical about my dwindling egg supplies...this planning shit had to get real.

If you are TTC then you may already be well ahead of me here, but I once again found myself in a quandary...where could I get Ovulation Tests in Bangkok that I could trust? Given that the pharmaceutical industry here is about as trustworthy and genuine as buying a Mulberry handbag in MBK, I once again headed back to Boots to attempt to buy a brand of Ovulation Test that may be sophisticated enough to tell this old hen when she was laying an egg.

Firstly, it doesn't seem to matter how you pronounce the word "Ovulation" you will find yourself in an awkward and rather public display of pointing, shoulder hunching, graphic gesticulation and embarrasment. 

"Ov..u..lay..tion test ka?"

"Ov..ooo..ay...tion test ka?" 

"O..woo..ay..tion test ka?" ahhhh yes ka "o..woo..ay..tion test, chai ka, have ka". 

Success, at least for a brief moment.

The box they produce from behind the counter looks about as sophisticated as a toddlers doodle pad. It was called 'Baby Sure', was made in Thailand and gave me absolutely no comfort that this would be able to tell me anything more about my eggs than if I was using a divining rod to find them. But there were some English instructions on the back the box and it was the only option they had so I decided to persevere and POATS (Pee on a 'Thai' stick) and hope for the best.

As it happened they are easier to use and understand than a Boots UK branded ovulation test, which was a huge surprise to me, and I'll be honest that I think they are actually better. They have now guided me through many months of egg production, with a few successes, and by comparison my UK sticks just cause me more confusion than certainty whenever I use them.

But are there any other options in Thailand? A friend swears by another, very cheap, Thai Brand called "Check Tru". These are strip style, also contain a pregnancy test, and are about one third of the cost. 

After another false start last month, and our third miscarriage, I have decided to try "Check Tru" for my next ovulation cycle. I plan to test it along with "Baby Sure" and I'll let you know a pee by pee comparison, but for now here is a summary of the only two tests I am aware of in Thailand.

Brand	THB	Type	Style	Ovulation Tests	Pregnancy Tests	Sensitivity of Pregnancy Test
Check Tru	฿270	Ovulation and Pregnancy	Strip	5	1	20ml/U/ml
Baby Sure	฿725	Ovulation	Stick	5	0

Both brands seem to be readily available. "Baby Sure" seems to be the mainstream (excuse the pun) test available in larger outlets like Boots and pharmacies in Central etc, whilst "Check Tru"is available in places more frequented by Thai's, smaller more local pharmacies.

You may find on occasions that pharmacies have run out of tests, but do not despair, there will always be one available in a pharmacy you can get to, just keep asking, persevering and remembering that "v's" are pronounced as "w's" and don't get too embarrassed when you realise you have started shouting the word "owoolation" to the pharmacist.

Happy POASing

Getting Prepared...Popping Pills

After my health check the Doc had solved one problem for me, as she'd prescribed me with Folic Acid, which I picked up as part of my overall costs that day at Bumrungrad hospital (THB1,080 for 6 months of 5mg Foliamin Tablets). So I knew I was covered for Folic Acid, but I didn't know what, or where, I could get overall pre-natal (or pregnancy) vitamins.

Looking in Boots, which was the most obvious place for me to go being a Brit, and also the easiest as the pharmacists normally speak English, I found that they simply do not have pre-natal, or pregnancy, vitamins as we do back home.

So what are the options?

• Multivitamins plus Iron
• Multivitamins Minerals plus Ginseng
• Vitamin C
• Ginkgo
• Evening Primrose Oil
• Calcium D
• Calcium D plus Collagen
• Calcium plus Vitamin D plus Minerals
• Fish Oil
• Fish Oil plus Evening Primrose Oil
• Cod Liver Oil
• Gingko plus Fish Oil
• Garlic
• Zinc

They also have Blackmore's readily available in Thailand, but they follow similar themes to above, although you can get standalone Folic Acid as well.

I didn't really want to be popping more than one vitamin tablet a day, along with the Foliamin, and I didn't want to to take too much Iron as a supplement either, so what could I do?

Assuming you live in Thailand you may have already found that it isn't always easy to get a balanced diet in the sense we are used to. Getting a variety of vegetables into your diet, for example, is difficult if you don't cook at home every day and live next to a Gourmet Supermarket. So it was all the more important at this point in my life that I really should be taking some extra vitamins, that I knew I could trust, and would provide me with the right quantities for pre-natal preparation.

But i'm afraid ladies that I simply didn't find a Thai solution for this. Even the Doctor's look blank at you when you try to ask about an alternative to Vitabiotics Pregnacare.

My solution...I did a huge Boots shop when I was back in the UK and bought 6-12 months of Pre-natal and Pregnancy Supplements. On the plus side you will earn your friend/mum a lot of Boots Advantage points (my last "TTC" Boots shopping trip in the UK earned my mother in law GBP18 of points!)

One extra thing I have recently learnt, and I will pass on to you, is that there are sometimes concerns with taking Vitamin K with anticoagulants. Following my first miscarriage I was immediately put onto "baby aspirin" for my second pregnancy. Doctor's here seem very quick to put you on medication that they think might help (and will certainly not harm). As aspirin is an anticoagulant I now pay more attention to content of the Pregnancy vitamins I choose, and for now my doctor advises to only take pure Folic Acid for the first trimester. But that is just based on my medical history and you should always listen to your healthcare provider.

Getting Prepared...am I healthy? (a costly business)

There are some things in Bangkok that you can easily throw money at, and medical tests are big business here.

I'll be honest that I've been lazy and I've had all my TTC tests done at Bumrungrad hospital. I probably should have shopped around but ease of transport, location, guaranteed spoken English, and reputation has meant that I have only ever used either Bumrungrad or Samitivej for my TTC needs (although I have used medical clinics for Visa medicals and basic pregnancy tests).

My first visit to Bumrungrad was just after we were married. As I was 36 I wanted to ensure that I had a general TTC overhaul to check there were no obvious roadblocks.

I made an appointment online with Bumrungrad. I booked a basic appointment to see a Doctor in OB/Gyn. Here's the link: https://www.bumrungrad.com/en/contact-us/request-an-appointment

Before I go on, just a word of warning for the emotional sorts (like myself). I choose to go to the hospital on my own as I figured this was a routine appointment. But as I sat in the waiting room I realised then and there that I might find out that I couldn't have children...it hit me like a wet fish and I burst into tears. I suddenly felt incredibly vulnerable and in need of a hand squeeze. As an expat, your mum or best friend cannot always be by your side, or even at end of the phone, when you need them, hubby was also unfortunately at work and I knew this was only the start of crazy arse emotions taking me hostage at inopportune moments, so I made the decision to sniff and brave it out - but you may wish to arrange to have a hand squeezer by your side.

So, I had an appointment with Dr. Suleewan Ratanachai. Her English is ok and she seemed to be a very nice lady, but this was my first experience of a doctor in Thailand and I have now come to the conclusion that they can come across as disingenuous. I don't know if the problem is that they are perfectly fluent in technical english, but lacking in colloquial english or just plain culture, but they can often come across as dismissive and uncaring, which I am sure they do not mean to be.

Dr. Suleewan assured me that my age was not a worry and that many women get pregnant at my time of life. I should not assume any problems and should start TTC naturally. But you have to press Doctors here for real information and I kept pressing for information about what could, but hopefully wouldn't, be problems in the future. At this point she suggested that I could have a Pap smear and blood tests. She explained that there are various blood tests, but that detailed analysis of my hormones etc would be expensive and she recommended just a general blood overhaul.

So here is what they tested me for:

I had a Transvaginal Ultrasound to check the size, shape, endometrial echoes and appearance of my uterus, a Pap Smear and they took blood to check for:

Hemotology/Serology:

Non Panel Items:

• VDRL

Hemoglobin Typing:

• Hemoglobin Type
• Hb A
• Hb A 2
• Hb E
• Hb F
• Hemoglobin (Hb.)
• Hematocrit (Hct.)
• MCV
• Osmotic Fragility Test

CBC:

• WBC
• Neutrophil
• Lymphocyte
• Monocyte
• Eosinophil
• Basophil
• Neutrophilic Band form
• Atypical Lymphocyte
• NRBC
• RBC
• Hemoglobin (Hb.)
• Hematocrit (Hct.)
• MCV
• MCH
• MCHC
• RDW
• Anisocytosis
• Macrocyte
• Microcyte
• Poikilocytosis
• Target cells
• Fragmented cells
• Ovalocyte
• Hypochromia
• Polychromasia
• Platelet Count

Hormones/Tumor Markers:

Non Panel Items:

• Free T3
• Free T4
• TSH
• Estradiol (E2)
• FSH
• Prolactin

Blood Bank: (note that you should already know this as part of your Visa medical)

Non Panel Items:

• ABO Group
• Rh Grouping

Immunology/Infectious Diseases:

Non Panel Items:

• HIV Ag/Ab
• HBsAg
• HBsAb
• Anti HCV
• Rubella IgG

They had the test results back the very next day and Dr Suleewan gave me a priority appointment to see her quickly to explain them to me. They aren't very good in Thailand at giving you detailed explanations in words and phrases that you actually understand, they speak in clinical English and lack sensitivity and cultural awareness (cultural awareness of our needs and expectations as an English woman anyway) but she quickly told me that all of my results were fine (thankfully) and then bid me farewell, under advice to try naturally for 6 months and with a prescription for 6 months Folic Acid.

Now, the cost of peace of mind in Thailand does not come cheap. This is breakdown of costs:

THB 6,500   Health Screening Program

THB  1,000  Doctor's Fee

THB     100   Nursing Service

THB     200   Lab - pathologist's fee

THB  1,480   Lab - Pathology

THB  3,760   Laboratory - Clinical

THB  2,525   Ultrasound

THB     675   Ultrasound - Radiologist's fee

THB  1,080  Medicine

THB17,320  TOTAL

Do I think it is worth it, for peace of mind, absolutely, but I didn't really learn as much about myself as I was hoping for, as Thai Doctor's simply don't explain things to us in a way that we are used to in the UK. It was all clinical jargon to me and the only thing I could hold on to was the concluding phrase - no obvious signs of problems.

So, I have made a vow to translate as much of the above in the Glossary section of this blog to help all TTC women in Thailand for the future. You will note that some the test names are in italics, this is because I noticed that they checked for these items more than once. It can be common to be overcharged by medical establishments for non essential tests or doctor's time. I haven't questioned Bumrungrad about this yet, but as time goes on I will keep my eye on this happening again and let you know if there is anything we can do to save ourselves some unnecessary costs.

But for now, don't despair, if you are worried about your chances of getting pregnant and have the money, I would recommend getting these tests done for peace of mind. Of course they are not essential, we wouldn't get this service with the NHS back home, but why not avail yourself of modern technology and your highly prized position as an expat woman.