20 March 2018

My Experience with Prenatal Care in Malaysia

It must be noted that the comments in this post reflect my perspective: as an American expat in Malaysia. Though I haven't had any babies in America, I've heard plenty of tales of prenatal care in my birth country from family and friends, so that was the main reference point that I came into pregnancy with. Now I'm reflecting on what seemed interesting or different about the care I received here in Malaysia.

Malaysia has both public (government) hospitals and private hospitals. Where we are, doctor's offices are located in the hospital itself, and I went to a private hospital for all of my prenatal appointments. We chose our doctor based on the fact that she was the only female OB/GYN who had an open appointment on the first day we wanted to get in to see the doctor {super scientific method}.

Insurance: Malaysian private health insurance does not typically cover wellness care for expectant moms, at all. I was surprised by this when we were looking into switching providers and buying local health insurance and meeting with insurance consultants last year. We ended up buying our health insurance through an international provider, but there is still no coverage for prenatal care, which means that the total cost of doctor's visits, tests, treatment, and birth is completely out of pocket. One reason that we chose the international insurance provider, though, was that they did offer an option to cover complications of childbirth and newborn care--that's what we want to have insurance for, the extreme situations that you can't plan for, and we're glad we opted for that insurance choice, and also glad that we didn't need to use it.

Appointments: We have always found it very easy to make or change an appointment with our doctor, usually with only a few days' notice. No need to get my name in many weeks in advance. For my doctor, you do need an appointment, but an appointment is just for a certain day, not for a certain time. It took us a while to figure out the system, but patients are seen based on who arrived at the hospital first and registered and took a number. We finally figured out that the way to get an early number, so that you don't have to wait hours to be seen, is to send Angel to the hospital, arriving at 6:30 a.m. when registration opens, so that he can get one of the first few numbers, and then he'll return home and we'll have breakfast and then come back at about 9, which is the earliest my doctor might arrive. She might not be in her office till 10...or 11, but this strategy cut down wait times from about 3-4 hours if we arrived at 9 in the morning to take a number, to about 1-2 hours with the 6:30 a.m. strategy. On several occasions, the doctor rushed out of her office, and the nurses would come out and tell everyone in the waiting room that we could leave and come back in an hour, because the doctor had left to do an emergency surgery. So, we quickly learned to plan on doctor's appointments taking a good half of the day. We started seeing the doctor early because of my history, had 3 appointments during the first trimester, and after that, once a month appointments up until the 3rd trimester, when appointments shifted to every 2 or 3 weeks.

Testing: I got the impression that there are far fewer routine tests in prenatal care here as compared to in the USA. My doctor seemed quick to provide treatment without needing lots of testing first. I suspect that this may be related to the insurance factor--when patients are paying for every aspect of the visit out of pocket, there may be less feeling of a need for multiple tests or exams unless it actually appears likely that the results of the tests will be crucial. Actually, there were multiple times when our doctor advised on what she thought was/wasn't financially worthwhile as far as medical care (Angel asked if the hospital offered water birth, and she said they did, but that she didn't think it was worth the high fees charged for it)--for some of the medications I needed to take, she advised that we go buy them ourselves at a local pharmacy instead of sourcing them from the hospital pharmacy because it would be cheaper. I had my blood taken only once during my pregnancy and never had the infamous gestational diabetes test with the sugary drink. I think the standard testing protocol is not as intensive as it is in the USA, because there were a number of tests that I'd heard of as "required" in the USA that were never even mentioned to me. The only three things that were consistently checked at every appointment were my weight, my blood pressure, and the baby, via ultrasound. My actual appointments probably took 10 minutes each.

Ultrasounds: In Malaysia, you get a lot of ultrasounds. I had an abdominal ultrasound at every appointment and we were able to see the baby on an abdominal ultrasound from our very first appointment at about 5 and a half weeks. For me, the ultrasounds were very quick, probably 5 minutes or less most of the time, and performed right away by the doctor in her little office. Sometimes she printed photos to give us, sometimes she didn't. No 3D ultrasounds. We found out baby boy's gender when I was about 17 weeks along.

Interventions: I felt like my experience with prenatal care was minimally invasive and generally intervention-free. My doctor was proactive with prescriptions to help support and prolong my pregnancy during scary moments in the early weeks and the possibility of early labor in the beginning of the third trimester, but other than that, tended to be hands-off. We established early on that I was a good candidate for natural birth, and the doctor told me at one point she'd be comfortable letting me go to 10 days overdue without thinking about induction if baby was doing fine and in the mood to stay inside, although she suspected he wouldn't stay put nearly that long (he arrived several days before his due date, though, so no stress there!).

Communication: This is partially my own personality and preference, and also partially just the nature of busy doctors, but there was not much in the way of unnecessary talking or communication at appointments. And perhaps slightly lacking in necessary communication. We were surprised at my 34 week appointment when the doctor asked if we were planning on returning to America for the birth. When we said no, we weren't, we were staying here, then she handed us a birth plan form with lists of boxes to check or leave unchecked as far as preferences, and told us that if we went to patient services, we could ask to be shown the hospital's labor and delivery ward and a delivery room. At some point we asked where we were supposed to go if I went into labor and she told us to go to the Emergency Room, so that was good information to know. I was given steroid shots at the emergency room and it was rather confusing because it seems like all entrances to the waiting room say "Not An Entrance," but since we couldn't figure out how to get in, we just broke the rules and walked in through a not-entrance. I would say that our birth plan was mostly, though not exactly, followed--seeing as the plan was generally leave me alone as much as possible.


There are quite a few big differences in post-birth traditions when it comes to comparing Malaysia and the USA, but I don't plan to post about that since I pretty much made up my own "hybrid" tradition. The baby and I are pretty much staying home alone and not taking visitors for our first month, which is acceptable as far as the confinement tradition goes in this country, but that's where the similarity stops. Many, though not all, moms either hire a "confinement lady" to live with them for the first month post-birth, or else move into a "confinement rest home" with their baby for that month. Multiple people asked before Cyrus was born if I were planning on either of those two options, but I did not opt for either. I'm not eating any of the traditional foods that new moms are supposed to eat and I'm drinking iced water and wearing shorts and t-shirts and generally acting very American indeed--except that instead of bouncing right back into going on errands and getting back to the normal pace of life, I'm taking it as easy as possible and keeping the calendar empty while giving my body time to recover and Cyrus time to get a little bit bigger and stronger before facing the big outside world. Expat life often means taking a little bit of the best parts of different regions of the world and finding what suits your own lifestyle best.
Bailey said...

This post is SO interesting! I can't imagine having to wait hours to see your doctor!

AnneMarie said...

Oh wow, the doctor appointments not being for a certain time is fascinating! That would probably drive me (and many Americans I know who are in love with schedules and lining up multiple events on the same day) crazy lol. I also find the concept of a "confinement rest home" really fascinating! That sounds so different from here in America.

Amanda Bumgarner said...

So interesting that you get so many ultrasounds but don't do as much of the testing. That stood out to me as being the biggest change: here you do more tests but (at least for me) only 2 ultrasounds--the first one when you're just a few weeks along and the gender one, and then maybe one more if the baby is measuring big/little, etc. I also think that's interesting the different post-birth traditions. Thanks for sharing!

Beka @ Sunshine to the Square Inch said...

This is interesting! I kind of like that they do less testing in Asia. I think they go overboard here. When I worked at that group home with pregnant teens, they had so many tests and appointments.

Sarah said...

It's neat that you got ultrasounds so often! They can be kind of controversial in the US. I had to get a few extras for various reasons and they were by far my favorite part of being pregnant. I didn't enjoy much else!

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