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!

[MarlenaGru]

I would avoid SA unless you want a section. Not a single friend of mine other than one having a home birth which she had to fight for has managed a natural delivery. Even if they aren't scheduled for an ELCS which most are they get told after labouring for a ridiculously short time that they need a section.
I agree that the Zim hospital sounds very like my local NHS London hospital (which coincidentally has signs up everywhere warning if you are non resident you can't use the maternity services). A bit dirty, a bit shabby and ridiculously overworked staff.
I am choosing a home birth and can't fault my nhs midwife care last time whilst in labour... Afterwards was a whole other matter!

[Christelle2207]

In your position I would return to the UK. Another benefit would be your parents would presumably love to be around and help with the newborn that they may not meet for a while after. Regarding passport, my baby's came within a week recently and I could have got it quicker. You would obviously just need to get him registered very soon after birth. I definitely dont think you'll regret coming home to give birth, assuming your dh is ok with it?

[WorkingBling]

I agree Cape Town. I recommend dr Barry Rousseau out of Constantiaberg hospital. Have been seeing him for years and only regret about having dc in London is that he deliver them.

[Bue]

While it would be ideal to stay in your own home and overall the care sounds safe, the blood situation would put me off staying in Zimbabwe (yikes). Second best to being at home is being at home with your parents, in a familiar environment. I don't think I'd feel comfortable staying with distant-ish relatives in a foreign country immediately after having a baby! Also you will have the widest choice of birth options in the UK as you'll be able to go to down the natural/active/possibly waterbirth route or the epidural route as you choose. Things will be much more medically regimented elsewhere, so it depends if this is important to you.

[homeaway]

I would go for the place that offers the best care for you and the best paedriatric care should you need it. If everything goes well and you have a healthly baby that does not need any care then it does not matter where you are ,but if you need that extra specialist care then it does become important.
Good luck op with your decsion.

[thanksamillion]

You will need to be organised about registering the baby and getting the passport photos/forms done if you want to return from the UK quickly. It's possible though - we flew when DC3 was 5 weeks old but she was born on Saturday afternoon and we were at the Post Office getting the photos done on Monday morning! Not sure I would have been that capable with DC1

You do also need a contingency plan about returning with baby if you need a CS as you may need to wait a bit longer before you feel up to flying.

[thanksamillion]

I meant to say that your 2 months is a bit optimistic IMO. I flew back to the UK at the end of 35 weeks, went 1 week overdue and flew back with DD when she was 5 weeks so it was getting on for 3 months. I felt like I was cutting it a bit fine both ways and I was certainly relieved to get to the UK and feel like it was safe if I went into labour.

[Caterpillar2001]

In this case I would say it is better to play it safe, so please, please just rule out Zim! A place that cannot guarantee properly screened blood nor offers an acceptable level of neonatal care is just not a place where anyone that has choice should give birth.
When I was pregnant with my children I worked in African countries and flew back to Germany to give birth. I did consider opting for South Africa for the birth of DC1 as our regional medical officers consider the private medical sector to be outstanding in SA, something that I can second as I had an operation there and later on travelled there for gynae appointments. In the end, having neither friends nor family in SA and knowing that I would have to stay longer due to planned c/s put me off that idea.
If I had to decide between NHS UK and SA with private insurance I would definitely opt for the latter, and that is not because SA is closer to Zim.

[Genesis2000]

I am from there and while it is true things are bad, generally giving birth there is very safe. I have not known anyone give birth in the main city hospital die like Avenues etc die on their death bed due to complications. Surely if you can live there - which for me is more risky because if you are ill properly your are in serious trouble, I don't see how giving birth there is such a risk.

The blood issue really isn't as bad as made up here. I had one child in Zim, one in UK and my best delivery was in Zim because I had a good gyna. The only thing is they gave me pain relief a bit too late so when it was time to push they did vbac which was a bit unnecessary. The other thing is even with a good gyna, they aren't always present when you deliver. You could be pushing at midnight. I had a good team but I feel had my gyna been there, I wouldn't have been given the pain relief that late.

You will be fine there honestly. Cases of complication and death arising from childbirth are rare at the private clinics. It really is the poor folks who can't afford these places who have to go through what I can only describe as dire and inhuman condition that no living person should ever be put through.

I also think you have a romanticized view of the NHS. My local trust where I gave birth to my son was very dirty. The labour place where I delivered was fine, I was by myself but when I got wheeled to the wards it was shock horror especially the bathroom. We were six in our wards and I hardly slept with kids crying non stop. In Zim I had my own room and don't even recall hearing noise.

[Genesis2000]

"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... "

Your quote above shows it's not the safety of your baby but the nice environment. I just wanted to say, I experienced worse on the NHS. You are talking about twin rooms. Hmmmm on NHS???

At least you will be breastfeeding on your room mate. I was literary forced to give my baby formula milk the night I stayed in hospital yet I breastfeed my baby exclusively after because that's what the nurses told me to do that night. The staff are so overworked and my baby was crying. I was tired from pushing and the solution was to give bottle, there was no support or any help with establishing breastfeeding. They just didn't have time to attend to my baby or even me. . I would have just loved to give birth and go home same day. The ward was just dirty but my local trust has been in the news for that anyway and they also have one of the highest rates of c sections. Oh and I had to wait the entire day the next day till 6pm doing nothing because I was waiting for a Paed to see my baby before being released. Apparently she was busy is the children's ward and those get higher priority.


The grass always looks greener, hopefully your local NHS you are thinking of is better than mine. I am not saying this to put the NHS down but just give another perspective so if you decide to come here, you have the right expectations. I have family and friends working in the NHS and most are very disgruntled as they work very hard. If you are expecting smiling stuff coo-ing over you and your baby forget it.

[mbabanemummy]

Lots of people here recommend the Genesis clinic in Jo'burg for natural births... it's true the CS rates in SA are the highest in the world. Medical care in SA is excellent so from that point of view you'd be fine.

We managed to leave the UK 10 days after DD2 was born (we were moving here for the first time, so I didn't travel back and forth) but I was lucky with a good natural birth with no complications, and we were very organised and had everything ready to go passport wise. I'm not sure I'd have managed that after DD1.

Definitely pros and cons on all sides, and ones we'll have to consider if we have another one.

[bushprincess]

Hi All, Thank you again for all your input on this - I really appreciate it, and have found it useful to take on the differing points of view.

I just wanted to let you know that after much deliberation I am going to fly to the UK to have the baby... it's probably completely over-cautious, but various things have left us thinking more and more that if we stay and anything goes wrong we'll never quite forgive ourselves when I had the choice to leave.

I'm completely aware that things can go wrong anywhere in the world and it is probably only a very, very small proportion that couldn't be dealt with in Zim and could be in the UK, so its possibly more of a perception than anything more, I think a couple of things have lead to this decision (Until 3 weeks ago I was adamant that I was staying here).

Firstly were the facilities, Genesis, you are completely right that most of my initial worries with the avenues were 'cosmetic', however it leaves a worry in my mind about 'what lies beneath'.... I find it a little poor that it should be so run down, being a private clinic with a US$ income, as although things are expensive here in Zim, things are available and I've seen far better in other countries. BUT I do agree that it has a good record - this is a decision that I've come to and NOT in any way suggesting that other people should feel the same - I think anyone who is considering it should just go on the tour and see how they feel.

The second is my dissatisfaction with my OBGYN (and admittedly if I was feeling more adamant now about staying I could obviously change Dr, however the lady I've had strong recommendations for would not take on a new patient when I tried to change to her and after that I fully admit I sort of gave up...)

my OBGYN is very out of date and keeps telling me things that I know are complete B**shit! (for what its worth I'm a vet by training with a PhD in epidemiology so I tend to go straight to the most recent literature to check facts if I'm not convinved by them.. and feel that although not a MD I have a fair amount of medical literacy)... anyhow, thats by-the-by really as if I was staying I would find a different Dr.

I have ruled out SA purely due to the need to stay with elderly relatives rather than home with my parents.

I've talked to various friends who have either delivered or worked (and in one case both!) in my 'local' NHS unit and the consensus is very positive, yes there are some issues with the NHS, but the opinion is that the standard of care is brilliant and the lead consultant there is one of the best in the UK (by hear-say... )

Having made the decision I'm feeling so so much happier - its crazy how much it had been weighing on my mind - I feel positively lighter now!!

I will be getting a flexible ticket with the 'plan' to fly back 1 month post due date, but with the option to stay longer should there be need (eg post c-section).

Thank you all again for putting in your opinions and for being very non-judgmental, I hope you (and anyone else who comes along this thread) realise that just because I made this decision does not in anyway mean that it would be the right decision for everyone (or even that there really is any 'right' or 'wrong' decision to make really). I will check in after the little one arrives and let you know my experience, for reference of anyone else considering a similar decision if nothing more.

Thanks once again

[mbabanemummy]

All the best for the delivery and getting back!

[mummytime]

I hope it all goes well for you! My neighbour's daughter has flown to the UK for both her births, for very similar reasons to you.