Knocked up abroad: prenatal care and pregnancy advice in a foreign country

See part 1 of Knocked up abroad: getting pregnant in a foreign country here.

One of the best parts of my experience so far with pregnancy in a foreign country has been the excellent medical care I have in Istanbul. Like many other expats before me, as soon as I took a positive pregnancy test, I called up the American Hospital for an appointment. The hospital treats many foreigners each year, is renowned for infertility treatment as well as other quality medical care, and is popular as part of Turkey’s growing medical tourism (the cow pictured at right is in the hospital lobby; you can tell how serious he is because of the glasses).

My first prenatal appointment was scheduled for Thanksgiving Day, and while many Americans were getting up to stuff the turkey, I confirmed I was six weeks’ pregnant (you’re welcome for sparing the “bun in the oven” puns). My very charming and English-speaking Turkish doctor gave me the usual pregnancy advice/warnings*, all peppered with only-in-Turkey bits:

  • Eat lots of dairy like ayran (yogurt drink Westerners often hate because it’s not sweet), yogurt, and cheese. While pregnant women should avoid unpasteurized milk and soft cheeses, you won’t find many of either in Turkey (or in the U.S.) unless you are looking for them.
  • No undercooked or raw meat like çiğ köfte, a popular raw meat and bulger-wheat snack served all over Istanbul (I first tried it outside a trannie bar here). I’ve discovered that the primary concern with sushi is an elevated risk for food poisoning; there is no additional or specific risk to the fetus. Sushi fish is often flash-frozen when caught, therefore it contains lower levels of bacteria. Use your judgment when ordering raw sushi, or stick to California rolls.
  • It would “be a crime to not eat fish in Turkey,” according to my doctor, but stay away from the big ones like shark which have high mercury levels. 1-2 servings of salmon or tuna per week is fine.
  • Sadly, especially in a country with excellent produce, eating unpeeled vegetables or salads in restaurants is a no-no, due to the hepatitis risk. While most restaurants are very clean in Turkey, when you are in a country with some traditional “natural-position” (aka squat) toilets still in use, you run the risk of some food contamination that’s riskier for expectant women than the general public.
  • Like many Europeans, I was told that 1 or 2 alcoholic drinks a week is okay, such as a glass of wine with dinner. Moderation and common sense are key, and it’s always best to err on the side of caution.
  • Caffeine is also fine in moderation: 1-2 cups of coffee, tea, or sodas are allowed per day, though I’m not convinced that a piping hot, two-sugars-no-milk glass of Turkish çay isn’t higher in caffeine than your average cup of tea.
  • Light exercise like yoga, pilates, and swimming are fine, but no “jumping exercises.”

My other concern was, of course, travel, but that was given the green light as long as I have no complications. Most airlines allow travel up to 28 weeks without a doctor’s note and up to 35 weeks with medical clearance. Whether your flight is short or long-haul, it’s advised to get up and move around every hour or so (good advice even for non-preggos) and choose the aisle seat. As I get bigger, I find puffing out my stomach as much as possible helps to get baggage assistance, and seats on the subway is good too.

The costs of prenatal care in Turkey are low: each of my appointments to a top-end private hospital cost just over $100 USD even with NO insurance (my U.S. insurance treats all international care as out-of-network and thus, out-of-pocket), even with ultrasounds at every visit–most American women get only a few over the course of the pregnancy. I’ll pay less for childbirth with a private room and catered meals for the family than I would for a shared room in a New York hospital. I rarely wait more than a few minutes to see the doctor, and the facilities and equipment are new and clean.

So far, Turkey has proved fairly easy to navigate as a pregnant person. I’ve never had a doctor who I could easily email with problems (such as which cold medicines were okay to take when I was sick in Russia), and everyone I meet is helpful with my concerns and questions. Istanbul is built on hills, so walking to the store can mean a fairly strenuous hike, but modern Turkey accommodates with online food and grocery delivery. Organic food is cheaper than at home, and nearly all of my cravings have been satisfied so far (though I could go for some American mac-and-cheese). I’m not yet halfway through the pregnancy but wouldn’t hesitate to reassure another expat that Turkey is a fine place to have a baby.

*Note: none of this is intended to be taken as medical advice, but rather my personal experience and anecdotal evidence. Talk to your own doctor about warnings and concerns before traveling to a foreign country, pregnant or otherwise.

Stay tuned for more on pregnancy travel, including Turkish superstitions and customs, where to travel in each trimester, what to eat when pregnant abroad, where to do pre-baby shopping, and more on having a baby in a foreign country. Check here for further updates.

Knocked up abroad: getting pregnant in a foreign country

My first clue that something was different came when I woke up one night on vacation in Kiev at 3am, proceeded to eat 3 slices of toast with caviar spread, went back to bed and woke up a few hours later wondering if they made blueberry muffins in Ukraine (tragicially, they do not). That “time of the month” hadn’t happened but flying tends to always mess with your body, so I didn’t give it much of a thought. Since moving to Istanbul from New York in May 2010 for a work project, my husband and I take frequent trips around Eastern Europe (see my Weekending posts) and that week we spent exploring Kiev and Warsaw while Turkey celebrated Kurban Bayramı (the Muslim festival of sacrifice).

When we arrived back home in Istanbul a few days later, I dug out the Turkish pregnancy test I had purchased a few months earlier after a previous false alarm. Though the instructions were in Turkish, peeing on a stick is fairly universal, and the “POZITIF” results were hard to misinterpret. Excited and nervous to be pregnant in a foreign country, my husband and I wondered what a mountain of paperwork we’d have to provide U.S. Customs in 9 months, what the medical system in Istanbul would be like, and if we could get away with having a baby in Turkey not named in some way for Mustafa Kemal Ataturk, father of modern Turkey and namesake for millions of Turks. Being pregnant in a foreign country is the ultimate way of “going native,” the most “authentic” travel experience you can have. It’s also challenging, sometimes scary, and limits where you can travel, but can be a great way to discover a culture, their hospitality, and traditions.Once I confirmed that I was in fact hamile with bebek, I noticed how child-friendly Turkey is, though not without challenges for the expecting expat. I could only find one English-language pregnancy book (co-written by Oprah’s fave, Dr. Oz, who is of Turkish descent), I’ve heard C-sections are pushed on many women as the only option for childbirth, and I’ve found maternity clothes are mostly limited to childish t-shirts and denim overalls. Turkey’s also a dream for the pregnant traveler: fresh fruit juice is cheap and easy to find at most cafes, vaccinations aren’t needed to visit, and Turks treat pregnant women with the utmost respect and care.

Having a baby, especially a first, in a foreign country isn’t for everyone. My family and support system is far away and I don’t know where to go for things I can find easily in my hometown. My doctor speaks excellent English but many of the nurses and hospital staff do not, and my Turkish is hardly fluent enough to cover every situation. Though the cost of domestic help is low, I’m not sure I want a lady with whom I can’t fully communicate telling me how to raise a baby.

Pregnancy also changes how you look at travel, both where you go and how you do it. I’ve been fortunate not to have morning sickness, but I’m just as at risk for disease as other pregnant women and have to weigh the risks of visiting countries with suggested vaccinations or food- and water-borne illnesses. Growing a baby is tiring work, and it’s hard to reconcile my usual travel self (lots of walking, few breaks) with my pregnant self (tired and hungry almost all the time). The best part about pregnancy travel is learning how each culture values pregnant women and mothers, hearing childbirth experiences from locals and foreigners, and seeing how kind strangers really can be. And all the food cravings help you discover the local cuisine, too.

Stay tuned for more on pregnancy travel, including Turkish superstitions and customs, the lowdown on prenatal medical care in Istanbul, where to travel in each trimester, what to eat when pregnant abroad, and more on having a baby in a foreign country. Check here for further updates.