To deliver DC1 in Zim, SA or UK... what would you do?

[bushprincess]

Hi! Just using this as a sounding board - please help if you have any thoughts!

currently living in Harare and expecting DC 1 in 13 weeks time! Went to look around the 'best' maternity unity in Harare and was really upset by the standards there... I'm not worried for my/beans saftey, but it is not a nice environment, busy, inattentive staff, not well cleaned, very run down (chipping paint on cots/beds etc) and v.small twin rooms where you're practically breast feeding on your room-mates lap. Oh, and currently no gas and air available...

Fine if everything goes to plan (i.e. go in as late as poss, push out baby, get out pronto!!) but my worry is if things aren't so smooth and I@m in there for a while - I really don't feel comfortable about being there (maybe I sound precious, but thats my gut).

Trying to think about options; I could go down to SA - probably cape town as I have some family there and would be more relaxed than jo'burgh

OR I go to the UK (cornwall) to stay with my parents.

Pros of staying in Zim;
Get to be in my home, with DH around and no big upheaval and travel.

cons; not great options for giving birth

SA;

Pros;
Great facilities
shorter flight than UK (and can fly regionally at 37 wks)
DH could pop down for weekends
some friends and family around so not completely on my own

cons;
need to find a Dr/decide on somewhere to deliver with only 2nd hand info
would need to stay in elderly relatives annex/rent somewhere to stay
on my own without DH for a large amount of time
hassle of getting passport for bean before I go back to Zim


UK;
Pros; can stay with parents - which would be great (we get on wonderfuly) at home, generally lovely
as safe as anywhere to give birth
power - all the time!!
water - out of the tap!!!


cons;
DH can't just pop over
long flight etc (24hrs door-to-door harare to cornwall)
would have to fly at 36 wks (that'll be fun!)
cant fly back until passport ready - but probably easier than SA
Being in my parents house (I know that was a pro- but it's also a con as not 'my' space!)
No private maternity services available in cornwall*


*please, I am a HUGE fan of the NHS - I feel so so lucky to come from a country with free at point of access health care, (even more so after 8yrs+ of living in developing nations) I think it is one of the most wonderful things about the UK and I'm not slagging it off.

its just that we're in the lucky situation of having private medical insurance and I'm looking at making a big move to access the best place to have my first baby (which I'm understandably nervous about)... there ARE some issues in the NHS and so if you have a choice of anywhere... would you fly 24hrs to choose an NHS maternity ward??


Ummmmm... anyhow, maybe I'm just writing this down to help get my thoughts clear but if you have any help/suggestions to add or have been in a similar situation please let me know - I'm feeling a bit overwhelmed!

Thanks in advance!

[bushprincess]

just to add; Did consider Nairobi for a while too (as lived there for 3 yrs, have friends there and Aga Khan is a good hospital) but reckon care is probably better in SA and the flights south are shorter and cheaper than NBO) so think I've crossed that off the list

[Backofburke]

I think that you will not be entitled to free NHS care having lived out of the country for 8 yrs. In the hospital where I work one of the first people that you would see is the overseas healthcare officer who would detail the costs for you. I think they will only provide care free in case of emergency. However I work in a big London hospital where healthcare tourism costs the trust a lot of money , might not be such a problem in Cornwall.
Secondly I would fly half way around the world to have a baby in a NHS hospital. Though I am sure that the private hospitals in SA are fine , some things to think of when choosing a private hospital other than nice food and rooms with good views are, how many deliveries per year happen in the hospital, if very low the staff may be deskilled. Do they have access to a neonatologist and an anaesthetist 24hrs a day. do they have a NICU or would your baby need to be moved if they require a NICU. Would a consultant obstetrician be present at the birth, how many deliveries does he do every year and how many major haemorrhages and other emergencies has he attended. Does the hospital have a robust policy to deal with emergencies such as major haemorrhage and do they have access to enough O neg and other blood. Also what is the C section rate and why are they being done. This is particularly important if you would prefer to have a vaginal delivery if possible.
All of these things and the infection risk are why I would be reluctant to have the baby in Zimbabwe. A friend of mine flew back from Africa to have have her babies in UK as she felt it was safer. She was working for an NGO and had continued to pay tax in the UK so was entitled to free healthcare here so perhaps the same applies to you.
My children were not born in the UK but were born whilst we were living overseas. I choose a local state hospital (lucky to be in a country where I could do this) as I felt that the local private hospitals had high C section rates, some as high as 50%, and did not feel as safe as the local state hospital(i had full private health cover at the time)
Sorry to ramble on . Also I don't mean to scare you with thoughts of a complicated delivery, the vast majority of deliveries go very smoothly , however the healthcare professional in me feels it is very important to have checked out the skills of the people who will be providing your care.

[DXBMermaid]

In your case I would go for Cape Town. Lots of great private hospitals to choose from and plenty of babies being born everyday.

Just as a side note. If you or your DH were born in the UK you're baby will be able to receive a UK passport. However his or her children will not be able to receive one unless they are born in the UK.

Good luck!!

[Saltedcaramellavacake]

I've had two babies in NHS hospitals in London and one in a swanky private one in Singapore and I would definitely fly 24 hours to use an NHS maternity ward! I'm not saying you should fly in all your circumstances, but my experience of the care in the NHS was fantastic. There is also a huge amount of comfort in knowing that everything and everyone is on hand in case of complications, just like backofburke explained so well. Private hospitals may look nicer but in a lot of cases you will be put in an ambulance and sent to a public maternity hospital if things go wrong - I'd rather deliver where I need to be in the worst case scenario. Just my 2p worth, though.

[JanePurdy]

You wouldn't be entitled to NHS care, as you are not a resident in the UK (although in practice you might well be able to fudge it if you present as "British").

In your choice I would go for Cape Town. I can recommend Vincent Palotti hospital.

[bushprincess]

thanks all of you so much for your comments,

I've submitted UK tax returns the whole time I've been away and remained registered with my 'local' GP so accessing NHS care should be fine. (have debated on and off becoming 'non-domiciled' but rather glad not to have at the moment!)

backofburke your comments on things to look for in a private hospital are really useful and will help me form a checklist for what to look for.

To be honest the hospital here in Zim actually ticks most of your boxes - I have an experienced obstetrician who I have been seeing throughout my pregnancy who would be present throughout, he performs his own epidurals but there are also anesthetists on call if needed. There is NICU onsite and a 'well' equipped surgical suite. Blood is apparently available (though I have heard that this is not always the case).

So on paper it's fine - BUT there was definately a feeling that I didn't like about the clinic here and despite the skill of the Drs available it seems that the midwifery care is sub-par at times.

I am inclined to believe (and thanks mermaid for your comment on this) is that the standard of care in cape town would be excellent.

I worry that I'm just being a bit 'precious' and worrying about how the hospital seemed superficially (though I'm inclined to believe that the cleanliness of public and state of equipment that we can see does reflect on how the place is managed as a whole). But at the same time I don't want to reject my gut feeling that all is not right...

However, making a long journey, without my husband isn't an easy decision to make either... though at this moment I'm veering towards NHS for the safety factor disregarding everything else...

Sorry I think I'm just baffled at the moment and don't have a clear idea of what is best! Sorry for waffling! thanks for taking the time to give your opinions.

[bushprincess]

Passport wise, as both DH and I were born in the UK there isn't any issue for little one to get a UK passport - but as mermaid mentioned it would be an issue for their children in the future (if they were born outside the UK, if born in the UK then no problems)

and if for any reason it was found I don't qualify for NHS care then our medical insurance would cover any costs (as you say natasha we'd have to pay in Zim or SA anyway)

[C0smos]

I'm in SA and had 2 babies here and the care was brilliant - bloody expensive though and you might struggle to get a gynae at short notice as you've not long to go.

My daughters birth certificate was ready 4 days after she was born, they gave me the forms when I was in hospital and the home affairs lady delivered the certificate to the hospital. I got an SA passport within 3 weeks I think. UK passport was more hassle as you can't visit home affairs in person anymore you have to courier everything and it's very expensive.

Your hospital sounds fine to me, what country would you prefer to give birth in, I have heard in Zim it's a bit of a hassle getting copies of birth certificates etc if you are not in the country. SA is probably just as bad though.

[Lavenderhoney]

I know lots of long term expats who flew to the UK to give birth, and also some dual passport holders who just wanted to give birth in the UK with the advantages that has for the baby.

I haven't heard of anyone being asked about their residency. Pick one with the best facilities should their be problems with the baby, and you. Also pick one and ensure you know you will be in safe hands should you need a cs, and they won't do a general anaesthetic and your dh can be there throughout.

If you don't want your baby taken straight to the nursery and you want to bf, make sure they know. And make sure your dh is prepared to argue about it when you give birth. If you want the baby in the room with you, make sure they know that as well!

You probably need to do a birth plan with all scenarios and talk it through with the hospital, and find out their policies - you might be pleasantly surprised or shocked. Don't leave it too late!

[JanePurdy]

TBH from your account of the hospital in Zim it doesn't sound that bad of an option considering the massive pros (being in your own home, DH being around). Doesn't sound medically risky which is what I assumed from your initial post?

[bushprincess]

cosmos great to hear you have had great experiences in SA...

the hospital here is fine 'on paper' BUT I did burst into tears after I'd been around it (not a good sign). Its very run down and the public areas at least are not well cleaned. maybe this is all superficial but I worry that if I don't listen to my gut reaction and find that these little things overly a bigger problem with the place then I'll be stuck.

So I think I've probably answered my own question regarding staying in Zim - great thing is I get to be at home with my husband and don't have a big flight to cope with, but I really, really, really, really don't want to give birth in that clinic!!!!

so then it's

SA- great care, shorter flight, DH can easily pop up and down to see me.
BUT getting passport to fly back might be an issue (I believe the embassy there doesn't issue passports now so would need to be sent form UK...)

UK - safe, care should be great (but wouldn't get the one-to-one care that I would get from a private OBGYN, at least not if I went to cornwall). support from parents and plenty of friends around. no hassles with paperwork/passports etc

BUT long flight (plus cost, which wouldn't be covered on insurance), longer away from DH (though he will take leave to be with me for the birth, but would be unlikely to be with me for the full 2 months I'm likely to be there).

lavender thanks so much for the suggestions - will make sure I have my wishes clearly stated - DH is pretty much aware of what I want so should be able to 'fight my corner'

Really, thank you everyone for your help - I'm grateful for the chance to try and work through my thoughts and try and work out what things are important or not!

[bushprincess]

jane the thing is I just don't know.... my gut reaction is that it probably isn't medically risky, but I hated it... yes, because of superficial things, but how deep do those deficiencies go?

The majority of expats I know here (and a fair number of Zimbos) leave the country to give birth... my OBGYN and his nurse have asked me several times now if I was going to leave the country (which is what prompted a proper look at the options here - ok I was too blase earlier on in my pregnancy)... the general feeling is 'why would you stay here if you don't have to'

However, that doesn't really mean its risky, just people don't like it/are worried.....

You're right - there are huge advantages of staying, it's just my initial reaction that puts me off...

Maybe I just need to put it aside for a few days, at the moment I can't make up my mind AT ALL!!

Sorry guys - this is why I posted - I suppose I'm just wanting someone to tell me 'do this and it'll be fine' - which of course is something only I can decide! But it does help to have a sounding board!

[Lavenderhoney]

Its your first dc so you don't know what will happen or what to expect. Be aware procedures outside the UK may be different. Make sure your dh is extremely well informed and can speak for you.

The nationality of your doctor and nurses can be important and their view on childbirth. Overseas, the doctor may have the final say and Mw not exist, which is what happened to me. Nurses aren't nurses as in advice and care in the UK. Luckily I already had a dc so knew what to say and what to insist on.

Why don't you look for a British doula if you want to give birth in SA? Insist they are there throughout. It would be money well spent. Or if you have a relative who is capable ( not emotional!) to come over.

Personally if I was you, I would come back to Cornwall- does your dh have time off after the birth? Mine had a day, and I had a cs. Home would have been better.

See the doctor and ask him to talk you through every single step. Or call a British midwife in Cornwall and ask her to talk you through it all and then compare.

Don't wing it.

[PlainBrownEnvelope]

Tbh if I had medical insurance I'd go to Cape Town and go private.

If you've never declared yourself non-resident, then NHS care shouldn't be an issue. However, submitting tax returns doesn't mean you're a resident. I'm non-resident and still submit tax returns.

However, totally cynically, you're resident from the minute you move back, so you could just play that card.

[Forester]

I don't think you are being precious about not being keen to have the baby in Zim - your concerns aren't about peeling paint but about in-attentive staff and poor cleanliness.

If your choice is down to SA and UK then I think you should give serious consideration to who you are staying with. If your DH isn't with you for the duration (which he wouldn't be) then you may feel much more comfortable staying with your parents once the baby arrives than friends. The last thing you want to be worrying about is whether a crying baby is keeping someone awake. For this reason I also don't think you should necessarily rule out Kenya.

Also you should check the precise policy for when you can fly with each of the airlines that you would plan to use.

Tough decision.

[bushprincess]

Thank you all so so much for all your advice.... I'm feeling much calmer today and current feeling is that I'll go to cornwall, being with my parents will be more relaxing than elderly relatives (grandfathers brother!) In cape town, even though they are lovely. I think at the end if the day something can go wring anywhere in the world, but if it's in the UK then hopefully i wouldn't spend the rest of my life wondering if I'd made the wrong decision.
I'm approaching the private patient department at treliske, think I'd be treated pretty much like an nhs patient but would rather just declare our hand and sort it on insurance than try and get in hoping they won't question my residency and then come up against problems.
Thanks again everyone... I'll check in and let you know if anything changes, otherwise when we hopefully have our happy healthy little boy!

[bushprincess]

Oh and thanks for reminding me to check iforester Kim says up to 36wks, so I'll plan to fly early that week, I'm really lucky that have had no complications so far so sure my Dr will be happy to give me permission to fly then

Thanks all!

[bushprincess]

Damn autocorrect! That's KLM not Kim obviously!

[diplodocus]

I would be really cautious about giving birth in Zim, mostly due to issues with constant availability of fully screened blood. If all goes well it will be fine, but I don't think they consistently have the infrastructure to deal with emergencies 24/7.

[breatheslowly]

A busy NHS has some characteristics in common with your description of Zim facilities - rushed staff and understaffing, wards of 8 women with very little room or privacy. I won't be going back to an NHS maternity ward if at all possible.

[ZamMummyInGabs]

Please don't stay in Zim if you don't have to. A friend of a friend of mine stayed in Gabs two years ago, had postpartum hemorrhage, and died because there was no blood in the country. Needless to say when DC3 (who turned out to be DD1) was born just over a year ago, I went home. As I did from Lusaka with DS1 & DS2. Have done NHS & private, flown at 36 weeks, got the passport & back in Africa 2 weeks later. PM me if you need any details - been there, done that :-)

[ZamMummyInGabs]

PS BA & Virgin allow you to fly up to 36 weeks, but how will you get to Joburg? Think SAA limit is 32 weeks....

[bunnyfrance]

I wouldn't wait until 36 weeks to fly 12 hours...what if the baby's born before then? I'd go at 32 weeks max!

[bushprincess]

thanks again for all the help with this...

diplodocus and ZamMummy I do worry a bit about the blood situation, a friend here also hemorrhaged last year (not life threateningly luckily) and had no blood available. My Dr assures me there are no problem with blood supplies at the moment, but it is a concern. I'm seeing him again on wednesday to chat about my options and that will a key question.

ZamMummy I'm going to PM you as you seem to have been in v.similar situation so would be great to hear more about your experiences - thanks!

Everyone - I do really appreciate your time in responding to this post, it is very useful to have your opinions while I make this decision.

as I mentioned I'm seeing my Dr here in Zim again on weds and he knows I'm seriously considering my options, DH and I have decided that we will make a decision one way or another after that so I'll let you all know what that is.

hope everyone has had a good weekend and lovely valentines