Tuesday, August 06, 2013

Maternity care in the UAE

(To those of you who don't care to read much about the experience of being pregnant in the UAE, I apologize in advance. I have 7.5 months' worth of stuff to say and only a few weeks in which to post it.)

To set the stage for future posts about Sasha 3.0, I'll tell you a little bit about prenatal care and birth culture in the UAE. The joke is, it is almost impossible to define a single mainstream birth culture in the UAE, just as it is impossible to define a single culture, period. There are as many nationalities of OBs, and kinds of hospitals, and approaches toward pregnancy as you can imagine. What I'm going to write here is based on my own experience and my own research (from disparate and sometimes anecdotal sources, which is sometimes all you can find).

Midwives exist in the UAE, but as far as I understand, they operate more like glorified, maternity-specialist nurses rather than birth professionals. Midwives cannot attend a birth on their own. They may only assist an OB.

Home birth is illegal in the UAE. This is largely (if not entirely) because pregnancy/giving birth outside of wedlock is a crime in the UAE. If you have a baby at home, planned or unplanned, then there is no way for the authorities to know if it was a legitimate or illegitimate birth, because they can't be sure who the certified mom of the baby should be. For example, an unmarried, pregnant woman could try to pass off her baby as the legitimate child of her sister and her sister's husband. This leads to really dodgy things like a police investigation being launched within hours of an unplanned home birth and an actual examination of a woman's birth canal to see if it was recently used or not. Yeah.

I researched water birth in the UAE extensively in the early months of this pregnancy not because I am intent on having one, but because I knew that a facility/doctors who supported water birth would probably support my style of giving birth - fewer interventions, etc. - and also have a lovely tub for me to labor in. Unfortunately, water birth is not generally done in the UAE. There is one hospital in Al Ain that offers water births, but that's a stressful, 90-minute drive away from us. I have heard other stories of women purchasing their own birthing tubs and bringing them to hospitals in Dubai and setting them up there, but results were mixed - sometimes they weren't allowed to, etc., and I never read of anyone doing that in Sharjah.

All this is to say that I am seeing a female, Palestinian OB at the hospital nearest my house. It's a 7-minute drive from my front door to the hospital entrance. I am so pleased to have the chance to go somewhere close. In general, hospitals in Dubai/Sharjah tend to want to manage birth more than I like, but I think I've found a good balance at this hospital. They don't have a tub in the birthing rooms (sigh), but there is a shower. There is a chart on the wall with lots of suggestions for birthing positions and the nurse and supervisor there told me that they generally allow the woman to be in charge of her labor. However, they both told me that I would at least need to have a hep lock, which I am not happy about.

I hesitate to write this part, but here goes: I have heard three negative stories about the anesthesiologist(s) at this hospital. They are all from over a year ago, when the hospital was first opened, but I really need to look into this more and ask the hospital about it. One woman told me she could totally feel her C-section. Yikes. She made a formal complaint to the hospital. The other two women complained of poorly administered epidurals. I don't plan on needing an anesthesiologist, but dear goodness, I would like to have the comfort of knowing that if it comes to a C-section, I won't have to feel it!

Otherwise, it's business as usual being pregnant in the Middle East. Just like in Syria, I get a sonogram at every visit, administered by the doctor herself. We have insurance here, since I am a married female of childbearing age (you can't get maternity insurance if you are unmarried). Each visit to the doctor costs me 70dhs ($19).

That's the business of being pregnant in the UAE so far, from a medical care perspective (more perspectives to come). If you have questions, please ask.


Crys said...

Examination of the birth canal...yikes!

Nemesis said...

Are those $19 payments each visit considered equivalent to your copay or is that what the actual visit + sonogram costs? And how much is it to deliver at your hospital? Am fascinated by the numbers & how they compare since there's so much in the news about maternal care in the US is the most expensive in the world.

Liz Johnson said...

Yeah, "examination of the birth canal" made me cross my legs and wrinkle my nose. Ick.

Are you allowed to have a friend or doula there with you?

Did you consider going back to the US to give birth (I'm mostly asking because I've known a lot of ex-pat wives to do that)?

Curious - what happens to unwed mothers?

I presume abortion is illegal?

Do you know their policy regarding being overdue and induction?

(do you need me to stop asking questions? because I could go on forever. :)

Liz Johnson said...

AND! In the case of an unwed woman giving birth, do they aggressively seek out and/or prosecute the father of said baby?

Bridget said...

I know, sorry, I couldn't think of a less gross way to put it, because that's what it is! Shudder.

Bridget said...

The 19$ is a co-pay, but I've never seen documentation showing what the visit actually costs.

One huge difference between the UAE and the US is that you can actually shop around on hospital websites and see the costs up front. For example, check out this website - it has extremely detailed information on prices and what procedures are included. The exchange rate is 3.65 dhs per dollar, so if you deliver vaginally at that hospital without the services of an anesthesiologist, it will cost you about $2k. A c-section would be $4600. Etc.

Bridget said...

Yes, you can have a doula, and many women do to help them have an advocate in cases where culture or language barriers might interfere with her wishes being understood.

I did not really consider going to the US to give birth. Many British women go back to the UK because it is free for them there, whereas in the UAE they have to pay. Some US women go back, too, but it's personal preference.

Unwed mothers are thrown in jail, with their babies. The fathers can also be prosecuted...if they are still around. :/

Abortion is illegal, yes. I had a friend go to Lebanon to get one because she couldn't get one in the UAE, even though her reasons were medical.

Note to self: ask doctor about going overdue next time I see her.

Liz Johnson said...

SO... what if you get married when you're like 2 months pregnant, and then give birth 7 months after your wedding? Is that still a problem?

Are you excited to give birth there? Nervous? Confident?

Does the baby get Emirati citizenship?

Crys said...

I can answer that last one, NO! They are natorioidly stingy with citizenship in the gulf countries. We knew a family that live in Kuwait for 25 years. Had six kids there. Gulf war came. His service were no longer needed, whole family kicked home to Jordan within the month.

Crys said...

Haha notoriously...my fat fingers and my iPhone do not get along :)

Crys said...

Could you borrow a married persons identity or do they make it exceptional difficult? Do you have any idea how many woman are put in jail for adultery exposed by child birth? How long are they locked up? What eventually happens to the baby? Crazy bones! Well my friend I'm glad you are a married knocked up lady ;-)

Bridget said...

Yes, notoriously stingy. UAE citizenship is one of the hardest to obtain in the world, to the point that if you are an Emirati female and you marry a non-Emirati male, your kids will not be Emirati citizens. It is only passed down through males.

Bridget said...

Also, you would still be in trouble if you gave birth 7 months after your wedding, assuming someone with authority found out. It's extramarital sex that is illegal, whether or not it results in pregnancy. Does that make sense?

This is the reason why there are stories in the Gulf News/The National every day about some woman in the UAE giving birth in a toilet or abandoning a baby or killing a baby after it's born, all to avoid a hospital record that will show that she is unmarried and thus expose her to the risk of prosecution. Obviously, this is a problem. These women need help and support, not imprisonment. In my opinion.

Myrna said...

Citizenship comment: US citizenship was only passed down through males until that was challenged in court. So, my mother's brothers who were born in Canada when their father was a US citizen were US citizens, but she who was born after their dad became a Canadian citizen was NOT a US citizen, even though their mother was a US citizen her entire life. My mom finally got her US citizenship (which she should have always had, if there was gender equality) given to her in 1999. Just saying--people seem to always think the US is SOOOO enlightened.

Nancy said...

Super interesting. I'm looking forward to the birth story! :) Fortunately I won't have to wait long because you kept us all in the dark (how did you manage with Skype? I guess you just sit closer to the screen than we do; I don't think we could pull something like that off).

I keep trying to think of a response to say about the unwed mother thing, but all that comes to mind is, "Yup, yup. That's a problem that needs to be fixed." It's kind of a mess. Like, the whole rape case thing you posted about. Women's rights are a huge issue there. With all these issues flooding my mind, this article was stirred up.

Cait said...

Fascinating! Maternity care around the world is interesting. My Arabic tutor and I had a long chat about childbirth in Morocco (in Arabic, woop!) and she was pretty horrified by the idea of my birthing Tallulah in the tub (almost).

Bridget said...

Videochats were hard. I just sat myself close to the computer and stayed there, no matter what. What was harder was keeping the kids from saying anything. :)

Muhebb said...

Hi: You talk about insurance. My daughter is US citizen who will be in dubai for a while, quite probably at the time of her delivery. She is not employed, however, and would just be here visiting me (she is married, but her husband is not employed in the UAE either). So, my question is, can she buy some type of insurance in dubai to cover her expenses for the pre-natal visits, delivery, sonos, etc.? Or would she need to be employed and on an employer's insurance to be able to be covered? Thanks!

Muhebb said...

Hi: My daughter is a US citizen, married, pregnant, and will be visiting me in dubai. She is considering delivering here if she can get some kind of insurance. Neither she nor her husband have insurance coverage from an employer. Is it possible to buy insurance while in Dubai even if one is not affiliated with a UAE employer? Thanks

Bridget said...

Congratulations to your daughter! My guess is that she will not be able to purchase an insurance plan. However, she can pay out-of-pocket, no problem. Most hospitals are very up-front about their maternity costs, and they often sell a "package" that includes all associated charges for visits. sonograms, delivery, etc. in one price. Good luck!


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