What’s different about having a baby in China, you ask?

OK, so maybe you didn’t ask, but the beautiful thing about Blogs and Facebook notes is you don’t have to read them if you are not interested!

Steph and I were taking mental notes throughout our time in the hospital about everything that was different between our delivery in China and our delivery in the US. So this post will review some of our ‘birth story’ in a means to highlight some of the crazy (and mundane) differences between the two. For my male friends who saw ‘birth story’ and quickly closed out the window on their PC – rest assured, this was written by a man – there will be no details which you’ll find uncomfortable!

Chinese ‘Privacy’ Expectations
We had a regularly scheduled doctor appointment on Friday morning. The location of the birthing unit is directly connected to the doctor’s office. The operating room that they use for C sections is upstairs. We are sitting in the waiting room before our appointment, and a couple of orderlies come off the elevator, pushing a woman that is unconscious or asleep or embarrassed enough to act asleep, out of the elevator, through the waiting room and into the birthing center. This would not normally be that big a deal, except that they have a blanket over her that only covers up her topside from neck to feet, not her completely naked sides. Privacy has its own application here in PRC – even in western clinics! We’ve become desensitized to these things, because all we did was look at each other and shake our heads… TIC (This Is China).

The Oddest Paper I Have Ever Had to Sign
This might be the only part of the birth story that the guys I referenced earlier might want to skip over. But now that I have said that, I expect it’s like a car wreck – they really don’t want to look (read, in this case), but they can’t help themselves. As the mom’s (and women) reading this know, after mom gives birth to the baby, she delivers the placenta. Along with some admissions paperwork (that I had to fill out for both the mom and the yet to arrive baby) I had to sign a piece of paper that allowed the hospital to take some of our ‘personal property’. It seems that in China, the woman’s placenta is considered ‘personal property’ and many of the woman choose to have it bagged up/bottled up (honestly, I don’t know how the hell you would transport it) for them to take with them. Evidently it’s popular (if that’s the right word) for the family (especially grandparents) to eat a bite of the placenta after the birth. The placenta being so rich in nutrients for the baby it is thought to be good luck for the family to partake in at least a bite. Needless to say, we signed away our right to leave with the placenta… just the baby thanks!

The Room
We checked into the hospital about 10:30pm on Friday the 13th. Steph was hooked up to all the appropriate monitors, and while ‘the monitoring’ progressed we were struck by the size of the room we were in. There weren’t many people in the Labor and Delivery section that night, so I know we got one of the larger rooms as opposed to the smaller rooms, but this room as at least 30-40% larger than the delivery room in the US. And in the US we were moved from the delivery room to the ‘post partum’ room very quickly. Here we stayed in the same room for the entire delivery and it was at least 2x the size of the US post partum room. Of specific note to Stephanie was the size of the bathroom – which was larger than at least 2 of the bathrooms in our home in Portland!

The other nice thing about the room, due in large part to its size, was that the couch was actually a hide a bed. This meant that although sleep would be in short bursts, it would be more comfortable for dad than the ‘plastic couches’ that were in the rooms in Portland. That being said, I would have preferred the plastic cushions from a cleanliness perspective.

Speaking of cleanliness of the room – it was more clean than the rest of the office. However, it was still not as clean or kept as clean (like maintenance – i.e. removing meal trays, etc) as what we experience in the US.

The Lie and the Medical Chart
The doctor that was going to deliver us was not our primary OB. We had a regular scheduled appointment earlier in the day with our primary OB and she explained how she had pretty much been awake all night with a couple other deliveries. So when we checked in and it became clear this would be the second straight all-nighter for the doctor, we just let the OB on call (who Steph had seen previously) manage the delivery.

While ‘the monitoring’ continued, the nurse came in and explained that they wanted to take some blood from Steph to test for coagulation for the epidural. We explained that this was not necessary, that since an epidural was a part of the birth plan from the start (as it was with Olivia and Genevieve) and our doctor had already taken blood a week or two earlier, so this was done, and to check the chart. That’s when the nurse said ‘well, we can’t find your chart’. To say the least, we were a little uneasy about this. It seemed that they had all the nurses (4-5 of them) as well as the doctor searching for the chart. We explained that we had just been here earlier in the day for an appointment. It seemed to make no difference; the chart was nowhere to be found. I told the nurse that she needed to find the chart, and that she needed to call and wake up our doctor to find it.

Then the on call doctor came in to explain why the blood test was needed – not the real reason: they lost the chart – but the medical reason: the coagulation test. We explained that we knew what the test was for, that is was already done, and that she needed to find our chart – the test results only being a part of the issue we had! I said ‘I told the nurse to call Dr. Ferguson (our doctor) and find out where the chart is’. This is when the doctor looked me straight in the eye and said ‘We did. She doesn’t know where it is either.’

We acquiesced to the blood test – which of course we knew we were going to do from the start, as the epidural has always been a central part of the birth plan. When they left the room, Steph and I looked at each other and knew they had not called Doctor Ferguson. The next morning when Doctor Ferguson came to see us she said ‘I was surprised when I got here this morning and they told me you delivered last night! You did not call me.’ Our suspicions were confirmed. We didn’t tattle at this point, but we would do so later, since Dr. Ferguson is the head of OB, we thought it important for her to know.

While Steph and I have become accustom to a lot of differences between the US and China, this new one – the fact that they would progress with a major medical procedure, that was not emergency related without a medical chart – did actually surprise us greatly, and concern us a little.

Steph gave them a quick verbal medical history to get them up to speed on what she thought were the most important items from previous pregnancies, and that was that. Now it’s important to note that Amelia did not show herself until nearly 8 hours later, and still no chart was ever produced. Finally, after the delivery, I saw the doctor updating the chart, so it was found at some point.

The Epidural
The interesting thing about the epidural here in PRC was that it is considered ‘a walking epidural’. This seems to have two differences from our previous experiences. One, it is not as strong, and as can be assumed from the name, theoretically the woman could get up and walk to the bathroom if needed. With Olivia, Steph remembers not being able to feel ‘from her boobs to her toes’. With Genevieve it was not that strong, but still she could not walk. The second interesting thing is that it is ‘self administered’. This means there is a very small constant dose of medicine being delivered, but that the patient can press a button and get an ‘extra shot’ of medicine every 15 minutes. They have determined through studies that women actually use less medicine this way.

Now, the epidural worked as advertised for almost the entire pregnancy… almost. About 20 minutes prior to delivery – it wore off. Needless to say, no one in the Welsh family was happy about this, primarily mom. I think even Olivia and Genevieve were in a bad mood when they woke up, but didn’t know why! Steph did a little screaming/yelling during delivery, but luckily, this being the third baby, there were only 2 pushes required. One small funny story about the yelling was that the couple in the room next to us were in for their first child and were a little uneasy about the upcoming delivery based on what they heard from our room. They ended up in a C Section after nearly 24 hours of pushing, so I think they got passed the concern about our yelling very quickly.

The Food
Hospital food in the US has a certain reputation… and it’s not good. The interesting thing about the birthing center was that the meals were ordered in from local restaurants: one western and one Chinese. Every day Steph was offered a western and Chinese choice for each meal and the hospital ordered in. So the food was not great, but it wasn’t terrible either. One weird thing was that the first meal Steph had, we had missed the standard order time based on when we arrived, so they gave her the delivery menu from the local western restaurant (Element Fresh – a place we actually enjoy eating). Steph picked something basic, a club sandwich maybe. They then returned to explain that they only paid up to 40 RMB for the meal, and since Steph picked an item that was 58 RMB we would have to pay them the 18 RMB before we checked out!

In the US hospital we delivered in, there were a lot of snacks (popsicles I remember distinctly and maybe ice cream?) and drinks for mom and dad. Not so here in China. There was a small ‘dorm sized’ refrigerator in the room, but it was empty. Apple and/or orange juice could be requested and brought from a locked up room on the floor. There was nothing in the way of snacks. Luckily Steph had, in the way she does, thought way ahead and had snacks already packed in her hospital bag. One of the surprising things was that they offered ‘cold’ water – which was just slightly below room temperature. This is very ‘not Chinese’… evidently childbirth is the one activity that allows ‘cool water’ is childbirth!

Staffing and Staff Actions
First of all, it’s important to note that at no time did we feel like the education or the skills of the people in the birthing center were inadequate. I can’t say the same for the English skills (which I’ll get to later), but the medical skills were just fine. Here are some of our observations about staffing.

The parade of nurses… In the US it seemed that the nurses were always coming into the room – constantly. It was annoying, especially on the first night, the only night in the hospital everyone (mom and baby and dad) seem to be able to sleep. We remember lots of blood pressure checks for mom, and lots of general ‘in and out’ throughout the stay in the hospital. Our recollection of this was generally negative. China is the other end of the spectrum. Unless you call them – especially a family like us with 2 other kids at home – they generally leave you alone. We feel like we know what the happy medium is – at least for us. Being left alone on night 1 was great; no one in and out all the time to check on things. However, as the stay continued, it would have been nice to be checked on a little more frequently. Especially since Amelia was having trouble being woken up. We had to set the alarm to get up to do the feedings every few hours, as she was content to sleep. Even after we spent 30+ minutes waking her up, she would easily fall asleep while nursing. This was not the experience we had with either of the first two girls. It would have been nice to have someone checking a little more frequently then.

The shift change… When we did see nurses we tended to see a lot of them at one time. It seems that the standard operating procedure for ‘shift change’ is that every nurse on duty, including those leaving shift and those coming on shift – even if they seemed to be assigned to other patients, was required to come into the room together, one of the nurses announcing ‘shift change’, ogle over the baby momentarily (not actually check anything) and then leave. This shift change was very strange to us, being used, in the US, to our assigned nurse coming in and actually introducing the newly assigned nurse personally and then the two of them leaving the room.

The non-English speaking neonatologist… I am sure this woman was completely competent, but her English skills were extremely poor. It was the only person on the staff that we really had communication issues with. Everyone else’s English was good to very good. The issue we had was with Amelia sleeping so much, we were concerned about what that meant… surely there must be something wrong with a sleeping baby (it’s almost absurd to write it down now). I was specifically concerned about the weight loss… it’s normal for babies to lose weight after birth and before they go home, but they don’t want them losing more than 10%. We tried to talk to the neonatologist about both the sleeping and the weight, but weren’t getting anywhere, so we had to call in a nurse to translate. This was a frustrating point for us. As long as things seemed to be going according to plan, we were OK with her, but when it took a longer conversation, specifically about some concerns, and we couldn’t do it, we were easily upset. It all worked out in the end!

Chubby is a good thing… I am a little sensitive about this, but growing up, I had to wear ‘Husky’ jeans. You might not know this if you weren’t a chubby kid, but they had sizes when I was a kid that were meant to be easier on a kid’s ego. Instead of ‘fat pants’ or ‘large’ they called them ‘Husky’. Amelia was 8 pounds, 10 ounces at birth (3935 grams) – which is big by Chinese standards. When the midwife asked what her name was and we said ‘Amelia’ she just started calling her ‘chubby baby’ and ‘chubby’, which she did for the remainder of our stay. As it turns out, this is just a ‘pet name’ for the Chinese, and meant to be a kind thing to say… being ‘chubby baby’ is a good thing. Man, could I have used this story when I was a kid! The other funny story is that our OB (who is the head of OB for the hospital) was in talking with us, and we were telling a story about the midwife, and she said ‘oh, you mean the chubby one?’ Wow, were we surprised. The first thing we both tried to say as soon as the doctor left was, ‘you’d never get away with that in the US!’

Chinese inefficiency… There have been plenty of stories on my and Stephanie’s blogs about Chinese inefficiency. How could we have imagined having a baby in China and not find another example? This one revolves around the testing that is or is not done in China and the vaccinations that can and cannot be completed. Every person we talked to gave us different answers. One of the standard tests in the US at birth is the ‘PKU’ or commonly known as ‘the heel prick’, where they take a small amount of blood and put it on a card for testing – this is done almost immediately after birth in the US. We were told by the pediatrician that we met with a few weeks ago that this was not done in China. Steph went to a prenatal class to ‘brush up’ and to learn what to expect differently here. The class was given by a couple of midwives who said that the test was done here. Then during the hospital stay we asked about the visit that was supposed to be made by the pediatrician. It was explained that the pediatrician was on medical leave (and again with the privacy issues in PRC) for a heart disease. When we asked about seeing another pediatrician we were told there was not another one on duty. The in hospital visit by the pediatrician is a standard part of US births (based on what we are familiar with), but here, evidently optional.

We had a question about the vaccinations (since there are both Chinese made vaccinations as well as imported vaccinations from the UK). They asked a family doctor to come in and talk to us, since there was no pediatrician available. He did a good job of talking through the vaccination options with us (we ordered ours in from the UK). We asked again about the ‘heal prick’ test. He said ‘they don’t do that in China’. Shortly after he left our room, he returned and said, ‘well, actually, they do the ‘heal prick’ test here in PRC, I just don’t normally work OB, so I didn’t know’. What amazes us is that it’s not clear if we would have had this done had we not asked again… or would we have been ready to leave and have them rushing to complete this at the last minute? Either way, it got done – that’s good news.

Visitors
In the US there seems to be a steady stream of visitors when you are in the hospital. Being an expat in PRC is different. Maybe it’s that we have a smaller group of close friends, maybe it’s the complexity in some of friends lives right now, maybe it’s the difficulty of getting to the hospital for what is going to be a very short visit, but for sure it’s the lack of real family in China. It’s not good or bad, just an observation – and by no means were we concerned or did we feel slighted or offended – we don’t want our Shanghai friends to feel judged, nor is the intention for US friends to feel sorry for us – we didn’t expect many visitors.

Almost everyone plans on visiting once we get settled in at home. I think they believe (and correctly to some extent) that managing the international delivery experience is complicated enough without the additional stress of visitors.

The funny thing is the one set of friends that did come visit are a couple that we used to joke about if we had moved beyond acquaintances to friends, and now tease us that we are ‘dead to them’ since we are repatriating…

The Departure
Communication… In the US it seems to be very cut and dried about when you leave the hospital. Vaginal delivery = 2 days; C Section = 5 days. We were estimating our departure date as Monday, since we delivered on Saturday morning at 6:18am. When the on call OB came in on Monday morning (a different on call OB than the one that delivered us) she asked us ‘if we wanted to leave today’. It was weird. Not sure if it was the Chinese lack of being direct… not sure if it was just translation issues, as her primary language is Chinese. But the lack of clear direction and communication was weird.

Chinese Birth Certificate… OK, there’s no real story here, but it’s weird to look at our child’s first birth certificate and see that it’s an official Chinese government document. Note: there is no dual citizenship with China. They give us the birth certificate only so we can get US birth abroad documentation to get a passport. Amelia is a ‘natural born citizen’ as defined by the Supreme Court since she was born to American citizens, even if it was in China – so she can run for President one day… at least this is my understanding!

Goody Bag… They give us a goody bag of thing when we left the hospital, similar to the US. The primary difference is the make-up of the items in the good bag. In the US you leave with reams of paperwork. Paperwork on the baby blues, breast feeding, resource numbers, organizations you can contact, and the ‘this side up’ onesie and the hat. In China the relationship of ‘stuff’ to paperwork is the opposite. The goody bag had a very nice Gymboree onesie… I looked at it and was surprised they handed out Gymboree, since it’s so expensive… then Steph pointed out and I realized this was closer to Jim-Boree than Gymboree. There was also a Disney baby clothes hamper, closer to Diz-Nee than Disney. They also sent home the remainder of the Pampers (actual pampers) and Johnson’s Baby wipes, along with the first thermometer they used on her. Which will only ever be used for her, considering it is a rectal thermometer, and she deposited meconium all over it during its first use!

Car Seat Check… In the US they insure that no baby leaves the hospital without a proper car seat check. Not so here in PRC. So many people take taxi’s home, or walk that car seats are not common practice. Also, in PRC in general, they don’t get used, even if you do have a car. There was a question about it in Steph’s pre-natal class and the official communication from the hospital was ‘hold the baby in the car/taxi on the way home’. Steph and the other folks from Europe all cringed.

Held Up for Cash… The very last item was checking out at the business office, which should have been a piece of cake. Our insurance covers labor and delivery 100%. The business office, however, indicated they needed a 10% co-payment to settle the bill. We had been paying 10% of all our bills to this point, but I and checked in advance and confirmed the 100% coverage. I knew if I parted with my $800 USD and had to try to get it back from either a Chinese hospital or an US insurance company, it would happen sometime between a really long time and never!

So we’re home now. It’s day 2 and things are going well. Amelia is easier to wake up, Steph’s milk is in, and she’s fussy and does not want to be put down at night (Amelia, not Steph)… sounds like a normal baby to me!

Hope this finds you all well!
Cheers,
Joe

21st Century Birth Announcement - Amelia Jane Welsh

All,
A dinner party was cut short Friday night when Stephanie asked me to stop drinking wine and start timing contractions. About 30 minutes later, after timing contractions separated by anywhere from 4 to 10 minutes, we were on the phone with the doctor. Upon learning that this was our third baby, not our first, the doctor advised that we come directly to the hospital.

This addressed my greatest fear about having a baby in China – the speed with which third babies are reputed to arrive and the prospect of delivering in part or in whole in a taxi or minivan. We checked into the hospital at 10:30pm and proceeded to wait for the baby to arrive. Stephanie was having productive contractions moving toward delivery, but at a much slower pace than one might expect with a third baby. Finally at ~4:00am they administered oxytocin to ‘move things along’.

And at 6:18am, Amelia joined the family! After getting settled in to some extent, I went and picked up Olivia and Genevieve to bring them to the hospital and see Mom and meet their new little sister. Everyone got along famously!

We expect to be in the hospital here in Shanghai until Monday morning.

Here are the pertinent details about Amelia upon her arrival:

Name: Amelia Jane Welsh
Date: March 14, 2009
Time: 6:18am
Weight: 8 lbs, 10.5 oz (3.935 Kg)
Length: 20 inches (51cm)

We have attached a couple of pictures and will post more when we get a chance.

Hope this finds you all well.

Joe, Stephanie, Olivia, Genevieve and Amelia

Lots of stuff getting real!

I use iGoogle for one of my home pages in Chrome (Google's browser, which I have been using almost exclusively lately). One of the widgets I have been able to add is a countdown timer. As most of you know, there are 3 significant things the Welsh family is counting down to... These things are really how we define our life at this point, so I thought I would give an update on each.

1 - Baby Welsh #3: 11 Days, 1 Hour, 42 Minutes, 57 Seconds (Estimate)
Steph continues to grow, although she doesn't see how there is any room left for this child to grow for 11 more days! So far, so good. We are into the weekly doctor appointments. At our 36 week ultrasound a couple weeks ago, the doctor was muttering over the chart while the ultrasound tech was taking pictures... When we asked her about it, she was estimating the size... she was projecting a 9 lb, 12 ounce baby! Steph was a little concerned, for obvious reason. Then I reminded her that I was a 10 lb, 10 oz baby... Probably not the best thing to remind her! She has since heard from some folks that those estimates are very inaccurate - we're hoping that's true! The biggest concern at this point is the speed with which third babies arrive... We're anywhere from 30 minutes to an hour away from the hospital depending on traffic. It's one thing for this baby to be able to say they were born in China, but we'd like the excitement to stop there and not extend to being born in a car or taxi!

2 - Repatriation: 110 Days, 1 Hour, 46 Minutes, 40 Seconds
Steph said it finally seems real now since we have tickets booked. 4 tickets booked out of PVG to PDX on 28 June 2009. I used a bunch of my system wide upgrades to move the family into business class... That should be nicer with the 2 kids and the baby. We'll get a ticket for the baby once he/she is born, and see if we can't upgrade that one as well. I discounted the rent for the people in our house to get them out a little early so they'll be out on 25 June. Then we have a cleaning crew coming in on the 26th and carpets being cleaned on the 27th. We land on the 28th and will only have to spend a couple days in a hotel, as our things in storage will be delivered on the 30th. So if all goes according to plan, we'll be sleeping in our own beds (and crib) on the night of the 30th of June. Then hopefully we're mostly unloaded and settled in by the 4th of July. We won't be able to get to Lake of the Woods for the 4th of July this summer, as we'll just have arrived home. The upside of it is that we'll get to actually enjoy the Oak Hills 4th of July celebration, which we hear is very nice - including a neighborhood parade and our own fireworks display!

Returning to the US is really bittersweet. While we are looking forward to seeing our friends and family, we have come to really enjoy China and the Chinese people. We have come to enjoy our friends and 'expat family' here in Shanghai. We would have preferred to stay, but understand the reality of the economic situation that is bringing us home.

3 - Sabbatical: 137 Days, 20 Hours, 47 Minutes, 1 Second
So my Sabbatical will actually start sooner than that. It starts shortly after we arrive back in the US, on July 6th (actually the 3rd, since the 3rd is a US holiday). But for the purposes of the countdown, I am using 26 July, 2009 @ 7:55am. That is the day and time I leave for Scotland. Before Scotland we'll have about 3 weeks as a family in Oregon in the summer. This will be great. We'll spend time settling into the house, we'll spend time at the pool in our neighborhood, we'll spend time at the Lake of the Woods, and Olivia and I will spend time doing some volunteer work before I leave. The trip itself has been well covered in another post (27 Rounds of Golf in 31 Days), so I'll skip over that. When I get back the 25th of August, the hope is maybe one more trip to the Lake of the Woods before getting back to Portland to start the preparations for my return to work and Olivia's first day of first grade at Oak Hills Elementary School. We should both start those new adventures on the same day, I believe - the day after Labor Day.

People keep asking about my job situation... And it's still fairly unclear. What I am confident of is that I will have a job! There are some layoffs happening within my division in the next few days, and I am assured that I will not be affected... I am assured of a role, and have had some very general conversations about what that role will be, but until the legal and organizational announcements are made, everything is very fluid. In the mean time, I have been staying busy in China helping to shut down the business we were developing here, teaching class to some of our Chinese leaders and managers and working with our training department on how to adapt the class I teach for a different delivery timeline. Lastly, I have continued to mentor some of the local Chinese employees.

So that's the update on the Chinese Contingent of the Welsh/Kratochvil/Merryman Family. Steph is spending her last days of pregnancy driving all over town trying to cross off her list the things that we want to buy before heading home - and that are easier to take care of before we have a 'wiggler' to take along. Some pottery for her, stone lions for me, some clothes being made for all of us... taking advantage of the deals China has to offer while we can.