Are you giving birth in Singapore?

Fair warning–lots of birth and medical talk here.  If that sort of thing makes you squirmish (especially if you’re a male) you might want to skip this entry.

When people learn that I’m pregnant, the first question is how far along are you/when are you due?  The second most commonly asked question is “Where will you give birth?”

I don’t know.

If I were a low-risk/normal pregnancy, I’d be giving birth in Singapore, no question.  While not quite up to the standard of what I’m used to (Boston hospitals are among the best in the world, and the NICU’s there are wings, not singular rooms as they are here), hospitals here are perfectly nice.  The embassies are set up to do a quick turn-around on your newborns’ passport and the SG government will issue them a dependent pass in a snap as well (once your paperwork is in order.)  Babies born in Singapore to foreign parents aren’t eligible for citizenship.

From a normal/low-risk perspective, prenatal care here might be superior to that which you receive in the US.  You can see your ob as often as you like, get as many ultrasounds as you like, and agree to/decline many of the “standard” pre-natal tests and assessments that you’d have no choice about in the US.  The OB will spend more time with you here than I hear is common in “normal” pregnancies in the US.

However, I am not a “normal” or low-risk pregnancy.  I am diabetic (with pregnancy, but not Gestational Diabetes…I’m a type 2 and I”m insulin dependent during pregnancy), and that carries many risks–abnormal fetal development, macrosomia (too large a baby), and at the end of pregnancy too little fluid and or the placenta not supporting baby’s growth, putting the baby at higher risk for in-utero death, especially after 40 weeks of gestation.  Here in Singapore, the climate (or whatever) seems to also have given me high blood pressure.  Not high enough to need medical intervention at this point, but high enough to require additional monitoring.  Coupled with soaring blood pressure at 38 weeks (after 38 weeks of normal-low blood pressure) and a high probability of late-term pre-eclampsia, I’m something of a problem child.

Something I haven’t talked about here in depth is Elanor’s early illness.  She had an infection that turned septic (became a blood infection) at a week of age.  No one knows what caused it.  The doctors were a bit too busy giving her life-saving antibiotics (she was in organ failure when we got to the hospital) to do a blood draw to find out what it was that was killing her.  Her life was saved, but she also suffered a stroke and lost function in one of her kidneys.  There are many possible causes for the infection, but since we weren’t able to find out what it was, it does raise some additional issues with #2’s birth.  Things like pro-active antibiotics for me have been discussed, as has the option of electing a C-section (to avoid exposure to bacteria in the vaginal canal as we don’t know if the cause was that I turned group B strep positive after testing negative or had a less common bacteria present).

My US doctor feels pretty strongly that I should go back to the US and deliver there. She wants me to fly home around 32/34 weeks (end of September).  It’s tempting as I know I’d have the best care in the world (pretty much literally–not counting the top rated NICU in the hospital I’d deliver in, there’s Mass General Hospital-which saved E’s life, and Boston Children’s among other world class hospitals only feet or blocks away).  But it would mean leaving Elanor in Singapore with her dad and B for several months.  I’d be unlikely to be able to secure a passport for the newborn immediately.  If I did elect a C, that would push my going home almost to the new year.  Ravi would either miss the birth or miss some chunk of #2’s early days (which is especially poignant as we effectively missed Elanor’s first month of life as she spent a large chunk of it on a ventilator with us unable to do anything but read to her and touch her hand/leg that didn’t have IV’s in them).

My SG doctor feels that outcomes are very good for preemies and such, once you reach 32/34 weeks.  We haven’t had a chance to discuss my US OB’s recommendations, but I know I’d have no problem getting a C here if that’s what I want.  I wouldn’t need to leave my family.  The baby’s passport and dependent pass would easily be sorted out.  I could recover from the C at home in my own bed, with B standing in to help as much as I need.  However, as a plus-sized mom, there are guidelines about stent placement that are different and in a country like Singapore, I don’t know that my OB would be familiar with them.

I’m spending the next two months doing my homework, and I’ll make a choice at the end of July.

I’m sharing this because it’s the sort of perspective that isn’t common.  Like I said, if I didn’t have my history, I wouldn’t think twice about delivering here.  But because I do…I will be giving it second, third, and fourth thoughts.

Because this *is* intensely personal, I’m closing comments.

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