Childbirth is one of the most all-encompassing experiences in terms of the range of emotion you will experience going through it. You can expect everything from joy to pain and back again, and, of course, that will sometimes include fear. Of course, a bit of fear when you’re giving birth to a human being (I mean – WOW!) is to be expected. For some, nervous might be a better word. You’re about to undergo a drastic medical and emotional process no matter what your birthing plan looks like. Whether you’re giving birth in your house, in a hospital, in a forest, or in the back of a taxi, what you’re doing is incredible. It’s incredibly wonderful, and it can be extremely scary, too.
While childbirth practices may look very different from country to country, the basic process is the same. One way or another, a baby is going to come out of you. If you live in a first-world country, your biggest fear about childbirth may be the pain you will experience. For women in countries that are less developed and do not have access to the same resources as developed countries, your fears might cover ALL areas of childbirth, right down to having sterile water nearby.
One reason infant mortality rates are so low in developed countries is that world-class medical care for both mother and baby before, during, and after birth is usually available. While there is still a long way to go, the good news is infant mortality worldwide has decreased from 63 deaths in 1000 births in 1990 to 34 deaths per 1000 births in 2013 (http://www.who.int/gho/child_health/mortality/neon... Of course, that is just an average, so in some countries it is much lower, and sadly, in some countries it grows as high as 187.5 deaths to 1000 births. Not only do the general practices surrounding childbirth have an impact on these numbers, but the availability of life-saving medicine and technology play a huge role as well.
Here is a collection of customs and traditions that surround childbirth in these seven countries, all of which differ significantly. Some of these examples might make you cringe while others just might give you some good ideas for when you give birth.
Sadly, Afghanistan has the highest infant mortality rate in the world. A lack of doctors and medical supplies/care play a great role in this. Expectant mothers in Afghanistan can experience complications that would be handled quickly in first-world countries, but in Afghanistan, they often prove fatal for both mother and baby. Over 60% of births in Afghanistan happen without a medical professional in attendance. This sounds pretty scary to women who gave birth surrounded by knowledgeable medical professionals, but for women in Afghanistan, they often don’t know any different.
The landscape in Afghanistan makes it difficult to travel, which does not help women get to hospitals, and cultural practices play a role in this as well. Many Afghani women do not want to seek medical care for their pregnancy and delivery because it is a public acknowledgment that they are sexually active. For mothers who do manage to make it to hospitals, facilities are often so poorly stocked with supplies that doctors will send mothers to get prescriptions and supplies from street vendors. Unfortunately, these medicines are often labeled incorrectly or are not dosed properly, which leads to further complications.
There are midwives in Afghanistan who travel to villages to try and help mothers give birth. The problem is, the pregnant women are often reluctant to accept help, so the midwives will have to convince the expectant mothers to let them help. While having a midwife in attendance certainly increases both the mother and the baby’s survival, giving birth on a dirt floor without sanitized equipment, or any equipment and supplies at all, proves difficult and dangerous.
There is added fear for many Afghani women about the gender of their baby. There have been reports of women being killed for giving birth to baby girls. There is also an incredibly high birth rate in Afghanistan (6-7 babies per woman, on average), which is not only trying on a mother’s physical and emotional resources, but on an already struggling country’s resources as well.
6 The Netherlands
Birthing practices in the Netherlands look quite different than the traditional Western medicine model. These differences have led to the Netherlands having one of the lowest infant mortality rates in the world, even lower than both Canada and the United States. Dutch women rarely see obstetricians (unless there are serious complications) and their family doctor will instead refer them to a local midwifery practice. Dutch women also get to choose whether they would like a home or hospital birth, and home births are usually encouraged.
Interestingly, expectant mothers in Holland are required to pick up a “kraampakket” which contains all the supplies one needs for a home birth. Evidently, home births are favored, and more than half of Dutch women choose them. If you choose to give birth at a hospital, the midwife will still play a significant role. They will check in on you throughout your labor and tell you when to go to the hospital.
Women who give birth in the hospital without complication will often be sent home in as little as two hours. For women who do give birth in the hospital, an epidural is unlikely. More than anything else, epidurals in the Netherlands depend on the anesthesiologist’s schedule, rather than the mother’s pain. So much so, what’s known as the “Dutch 9-5 epidural” is often the subject of jokes.
One of the best-sounding parts of the Dutch model for childbirth and aftercare is the use of “kraamhulp” or maternity home care. For seven days after giving birth, a nurse will come to your home to provide medical care, cook, clean, control the flow of guests, and help with other parenting skills. Kraamhulp is usually covered by insurance, and most new mothers can attest to how helpful it would be to have that added support in the days following childbirth.
Childbirth in Japan is often seen as a test of a woman’s endurance, and there is a common belief in Japan that labor acts as a test for the challenges a mother will endure during motherhood, and not just during birth. For centuries, Japanese women would tend to opt out of any painkillers, but there is a growing trend of Japanese doctors recommending epidurals as it tends to make for a more peaceful birth overall.
One of the most interesting aspects of childbirth in Japan is the father’s role or lack thereof. Japanese fathers are not permitted to be in the delivery room UNLESS they have taken pre-natal classes with the mother. If a C-section is necessary, the father is not allowed in the operating room at all. Unlike in the Netherlands, hospital stays in Japan after giving birth are relatively long. For a caesarean, a mother can expect to remain in the hospital for at least ten days, and at least five days after a vaginal birth.
After a woman is released from the hospital, it is a Japanese custom that she stays in bed with her baby for 21 days. This often takes place at her parents’ house and during that time, they welcome visitors, and the family will eat a celebratory meal of red rice and red beans together.
While most people are accustomed to a nine-month pregnancy, in Japan, women are pregnant for ten months. No, they don’t keep the babies in longer, but Japanese calendar months are a short 28 days. So, ten 28-day months is the average pregnancy length in Japan. When those ten months have passed and you’re heading to the hospital to give birth, you will be instructed to bring your own towels, a fruit knife, straws, cups, and often, your own bedding. You can rent pajamas from the hospital, but they’ll cost you about 70 yen per day.
Expectant mothers in Brazil are treated almost like royalty. They’ll be ushered to the front of any line they’re in, and both the mother and baby will be showered with lavish gifts and many visitors after the birth. Sounds pretty good, doesn’t it?
An expectant mother in Brazil must find a doctor she really likes and trusts because she will be spending a lot of time with her doctor throughout her pregnancy, ever more than most other countries that use western medicine practices. The doctor/patient relationship during pregnancy is incredibly important as the doctor’s word is law in Brazil, and their recommendations are often more like rules. While there aren’t laws around home births, they’re often discouraged. And for the few Brazilian women who opt for a water birth, they often have to travel long distances to a facility that has birthing tubs.
Traditionally, C-section rates in Brazil have been very high. Births in private hospitals have even had C-section rates as high as 99% and this is likely because of all the time these procedures save (compared to labor and vaginal delivery), and because doctors will get higher payouts from insurance companies. It is also because women will often schedule a C-section long before they go into labor, ensuring there is no chance of a vaginal delivery. Brazil set out to lower these numbers in 1998 by declaring that they would not compensate for procedures above the 30% mark, and C-section rates did indeed decrease from 32.4% in 1995 to 24% in 1999. The C-section rate in private hospitals remains about 80%, compared to roughly 30% in public hospitals. For many women who do not live in urban areas close to hospitals, they will give birth at home with the help of a midwife and have minimal after-birth care.
Unicef lists Nigeria as the second largest contributor to the under-five and maternal mortality rate in the world. Sadly, the majority of these deaths are due to preventable and treatable illnesses and infections like tetanus, pneumonia, diarrhea, HIV/AIDS and other conditions. A lack of resources, education, and money make it very difficult for Nigeria to reduce these numbers. Only 20% of emergency health care centers offer obstetric services, which is especially problematic considering Nigeria is now Africa’s most populated country with a high birth rate.
For women who do make it to primary health centers, there are almost never doctors there to help. Mothers rely on the assistance of nurses, and virtually no equipment or supplies, to birth their babies. Often, facilities that do have equipment and staff can’t afford to have electricity to light the building, let alone to run the life-saving equipment. Because of cultural practices, many women who are too young and small to birth babies naturally will die as a result of internal injuries or for bleeding too much after giving birth.
Birth attendants often have little to no training, and will use dangerous methods like trying to force the baby out by pushing a stick into the mother’s stomach, or giving them a hack episiotomy with a knife. Abortion is illegal in Nigeria unless the mother’s life is in danger, so many women resort to back-room abortions that result in serious and life-threatening complications.
Laboring women in Nigerian hospitals are often scolded, yelled at, and neglected by staff. These stories may make women even less likely to try to give birth anywhere other than their home, for fear of mistreatment by healthcare workers. There are groups working to better the quality and amount of care for expectant mothers and their babies, but there is a very long way to go and a lot of work to be done.
While there are minorities of all kinds in Nepal, the primary influences on Nepalese culture come from Buddhism and Hinduism. While birth in hospitals and other medical facilities is on the rise, most women still give birth at home, as many of them live in remote villages. Studies have found that tradition and spirituality play the largest role in a woman’s thoughts and feelings toward childbirth.
Many Nepalese women will give birth in what is called a Goth. A Goth is a small building near the home, or on the lowest level of the home, and usually reserved for animals. The purpose of giving birth in the Goth rather than the home is so that the spirit in the home is not harmed. A woman will give birth on layers of straw, and her arms and legs are often restrained while she gives birth.
After birth, mother and baby stay in the Goth for 22 days, and after 30 days, the woman is permitted to touch water again. Before the woman leaves the Goth, a holy man must spray holy water on her and her baby. Women must be careful not to “pollute” their homes and anger God by doing things such as entering their kitchen within a few weeks of giving birth, or their baby may not survive.
Some Nepalese women give birth with the assistance of a “suduni” or pregnancy expert, but social and cultural taboos often limit or interfere how much medical intervention a woman will allow. Women are isolated during childbirth and even during menstruation, and an unwillingness to challenge cultural traditions often overpowers the desire for a healthy pregnancy and baby. High infant and maternal mortality rates in Nepalese villages are not considered to be a result of a lack of medical care, but rather the result of the pregnant woman angering the gods. When women are considered untouchable, (i.e. Pregnant, post-natal, or menstruating) it is illegal to mistreat her, however, there is often an unspoken law of silence in villages, which prevents women from coming forward about it.
Sweden is regarded by many as the best place in the world to give birth, and studies have even found it to be the safest. It also ranks number one for the best countries for a mother and baby to live, compared to the United States’ position of 27. In Sweden, the role of a midwife (barnmorskor) is critical. They guide the mother before, during, and after labor, even though almost all babies are born in a hospital with dedicated medical professionals standing by should they need to intervene. Sweden’s C-section rate is also lower than most industrialized countries (17%, compared to over 30% in the United States).
Well-staffed health services buildings mean that premature babies who are placed in incubators will have two, yes TWO- nurses assigned to them. There is also a family unit attached to NICU rooms so the parents can always be very close to their baby. For any parent who’s had a premature baby, they will understand the comfort that would bring. Birthing suites tend to be large and modern, ensuring the families who stay in them are comfortable. Another thing that makes Sweden stand out above other countries when it comes to childbirth is their treatment and support of the fathers.
Rooms are equipped with beds specifically for the fathers to encourage family bonding. Parental leave is also quite generous in Sweden. The mother gets 18 months, plus there is an extra two months either parent may use, and that time is valid until the child is eight years old. Women are also entitled to paid leave during the last months of their pregnancy. Wow!
The role of the child is a sacred and protected thing in Sweden, and their values and customs reflect that. Parents can take up to 60 days a year off to care for a sick child, and they are also entitled to reducing their workload by 25% until the child is eight years old. Those visiting Sweden will also notice how restaurants (or any other public gathering place) are designed to accommodate children and families, so they are equipped with play stations and supplies. Women can breastfeed freely in public, and it is quite common for the baby and parents to co-sleep. Other countries: take note!