My Ukrainian Maternity Experience, So Far…

Folks, we’re gettin’ close. Only 5 more weeks and we’ll have another little Johnson in the house! OMG. At 34+ weeks I’m at the stage in pregnancy when you are just ready to be DONE. My body is done. But, I’m also not quite ready for the baby to be out. Right now he/she is very easy to take care of and demands zero amount of my time. That’s convenient when I have six others that demand all my time and attention. So, as much as I’m ready to be done, I’m also not quite ready for a newborn. Make sense?

Lots of people have asked what the medical care has been like here in Ukraine, so far during this pregnancy, so I thought I’d share. It has been one gigantic learning curve that’s about to become reeeeeeeal steep here in a few weeks. I’ll start out right now by saying that nothing I’m writing here is meant to bash Ukrainian healthcare. I have felt very well taken care of over the past several months. I have zero doubt about the skill of the doctor I have been seeing. It’s not about that. This is all about the differences between my experiences in the US and my experiences here.  I’m not speaking to others’ experiences, only my own. I’ve birthed three biological kiddos in the US and am also an RN with many years of experience in postpartum and infant care and 13 years of hospital work experience. We’ve also been foster parents in the US to 10 newborns/young infants with special needs. In other words, I’ve been around this mountain before and am quite a nerd about it. I also have loads of opinions about it all…but I’ll try to spare you some of that. The differences between the cultures and medical systems here in Ukraine and the US are vast and the topic interests me endlessly. So, yeah, there is no bashing at the heart of this post- only interest combined with  some amusement, confusion and fascination. 🙂

In Ukraine the public healthcare is provided by the government. There are many free public clinics in our city. There are two free public maternity hospitals. The care is meant to be free, but the funding is sparse and the doctors are paid so little, it is expected that patients should tip as they are able. You also need to purchase many of your own supplies. I have a big ol’ list of supplies to buy and bring to he hospital for delivery. There are also private clinics here in our city, but no private hospitals.

The difference between private clinics and public clinics are vast. In a private clinic you make an appointment, come at the stated time, and with little wait you see the doctor you were meant to see, or get the test you were meant to receive. In the public clinic you just show up, ask who is the last in line, and then take your place behind them.  There are no appointments. So….as you can imagine, you can end up waiting a long time…but such is life. The waiting rooms are not what you would imagine if you have only been in US clinics. They are simply chairs in a hallway- bare minimum (or zero) lighting, concrete floors, no tv, no music, no magazines, no coffee machine, no nothing. Just people waiting. Fun times.

When I first discovered I was pregnant (Holy moly. The shock was intense.) I called a dear friend in our town who speaks great English and asked her to help me. I knew the system had to be so different and I had no idea even where to begin! Bless her heart, she said yes, and has been a big help to me ever since! Thank you, dear Olya! We first went to a private clinic for an early U/S, just to confirm the pregnancy because I’ve had a tubal pregnancy in the past and wanted to make sure we weren’t going to have a repeat of that sadness. That was a great experience and very similar to what you would experience in the US.

After that, around 10 weeks or so I needed to register with a doctor at a public clinic here in town. I decided to go with the doctor who Olya had seen during her pregnancy. In Ukraine you see one doctor throughout the pregnancy, and then when you near delivery (around 36/37 weeks) you choose where you will deliver and register at the hospital. A different doctor delivers the baby- not the doctor you have seen for the pregnancy.

The doctor has been very kind and pretty much laid back. At each appointment she weighs me, measures my belly, and listens to the baby’s heartbeat. Just like in the US. Major difference: the doctors here use Pinard Horns (a wooden horn thing) to listen to the baby’s heartbeat. I’d never even seen one of those in real life!  Think “Call the Midwife” and you’ll be spot on. Can you believe I’ve never heard my baby’s heartbeat? Only the person with the horn can hear the heartbeat. Old school. In fact, I’ve been watching a lot of Call the Midwife lately and feel like there are many similarities to the resources here and there.

I had an U/S at 12 weeks and then again at 19 weeks. I think that’s pretty similar to my experiences in the US. The 19 week U/S was much more brief here. It lasted maybe 10 minutes? I didn’t get to watch, but Jed did. 🙂 We requested to keep the gender a secret, so we’re still waiting on that big surprise! My doctor doesn’t do any ultrasounds but they’re done in an office right next to hers.

One massive difference between Ukraine and the US during pregnancy is the PAPERWORK and TESTING. Holy smokes! So much paperwork and so many blood tests! Wow. I feel like I’ve been poked more times here than in all of my previous pregnancies combined! Basically every 3 weeks, before my appointment, I need to have some sort of test done. At my appointment my doctor will give me little slips of paper that are for the next round of tests. She writes my name on it, her name on it, the hours you can go for testing (normally like M-F 07:30-09:00) and the room number where the test is done. Before my next appointment I need to show up at the different little rooms, stand in line, and go in to do my test. It’s customary to give a few griven (Ukrainian money) to the lab person, along with the little orders slip. For some tests I need to buy my own syringe and needle and bring that along, but most blood tests have been finger sticks. The finger stick tests are done in one room and the blood draws from the vein are done in a different room. I have more than 3 kids, so technically, I don’t have to pay for any of the tests.

The next round of tests I need to do before my upcoming appointment.

In the room where you get your finger sticks there are several different women sitting at desks with a bunch of little glass vials sitting in front of them. They take a metal, almost needle thing, out of a manila envelope and prick the end of my finger. Then they use a glass pipet to collect the blood and smear it on a microscope slide. When I look in front of them at the rows and rows of collected blood in different vials I can’t understand their system at all. There are no patient labels, no lids, no plastic (all is glass)…how do they keep it all straight? How do they separate dirty from clean? How do they not always mess up people’s blood work? I have no idea. It’s so fascinating to me.

I also need to bring a urine sample from home every time I have an appointment. You can bring your urine in a jar of any kind, or you can buy little plastic specimen containers from the pharmacy. Urine needs to be dropped off the day before the appointment, so Jed usually does that for me, bless his heart. 🙂

Another MAJOR difference between here and the US is that everything is done on paper and there is not a computer to be seen (hence the lack of patient labels in the lab). Private clinics have computers, but public do not- at least not in our town. Everything is written on paper. My doctor has a shelf of active patient records in her office. Because there are no computer systems linked between different clinics and hospitals, and you have no electronic chart following you, your patient record literally needs to stay with you. Everything needs to be written twice. My doctor writes notes in her chart for me (like a notebook) and then writes them again in my own personal chart/notebook that I take home and bring back and forth to appointments. There are two copies of every lab result and one copy is stapled into her chart and one into mine. That way, when I change to the delivery doctor, I have my chart in my hands. At this point in pregnancy my little notebook is just jam packed with notes and results and such. The lab where they do blood draws has a big binder where they write patient information- just like the Call the Midwife logbook. 🙂 It’s really interesting.

My personal patient chart and one of the lists of things I need to buy at a pharmacy to bring to the hospital for delivery.

For me, the big looming decision was where to deliver the baby. I have to have a c-section (huge bummer) because I’ve had three previous c-sections. My babies all love to position themselves bottom or feet first. Grrr. Anyway, because of that, I felt really nervous about where the surgery would be done. My options were delivering here in our town, at one of the public maternity hospitals, or in Kyiv, at a private maternity hospital. It would cost about $4,000 to deliver at a private hospital. The main question wasn’t money, but where we felt safest and most comfortable.

Again, I’m not saying I think Ukrainian doctors lack skill. C-sections are done here every day and everything goes just fine. It’s not like my situation is so unique (except 4 c-sections is actually considered very unique here in Ukraine!) that I need some special treatment. It’s not that at all, it’s just that when you are in a situation where the system is totally new, you don’t understand everything (medical terminology and such in Russian and Ukrainian), and you know you’re already going to be stressed, you want to feel like you made the best decision for you and your baby. It was a difficult decision for us! I would say I understand 85-90% of what my doctor says to me. She speaks great Ukrainian and I’m super thankful for that. But, that is rare in our city. Most of the lab techs and others I encounter speak Russian to me and I don’t always understand them as well. I know when I’m stressed and in surgery my mind is not going to want to think in Ukrainian or Russian. I will need to be able to trust and know that I’m in good hands.

In the end, we decided to deliver at the public hospital here in our town. It’s 10 minutes from our house, as opposed to 2.5-3 hours away in Kyiv. Especially with having Boris home now, it’s important that we stay close to home. It’s convenient, for sure, but the biggest deciding factor was the doctor. One of our closest friend’s mom is one of the head doctors of labor and delivery at the maternity hospital near our house. She has over 20 years of experience and has agreed to do the c-section for us. I feel great about this decision. She knows us, she knows our family. We matter to her- we aren’t just random people. She speaks no English, but I know that she will do her best to make sure I understand what’s going on and that means the world to me. Also, she is very skilled at her job. I know she’ll watch over me closely and I need that reassurance, being so far away from everything that seems normal to me.

I’ll for sure write about our delivery and hospital experience after the baby comes, but I can tell you now some things that I already know will be very different. I’m slowly coming to grips with these differences, even though I don’t like them one bit! For one, Jed doesn’t get to be in the operating room. This one absolutely kills me. He’s always been present for the births of our babies and I can’t imagine being in the OR without him! I know I’ll be an emotional wreck. But, we have no choice in the matter. They told me that he’ll be in a room next door and as soon as the baby is born and they show him/her to me they’ll take him/her straight to Jed and he will have the baby with him while they finish me up and take me to the recovery room. I can’t believe we won’t be together when we find out if it’s a boy or girl! I’m so sad about it. 🙁

The doctor told me it will be about two hours before the baby gets to be with me again, and during those two hours, he/she will be with Jed. The first day and night I will stay in a special post-op area with the baby and Jed doesn’t get to stay. But the next morning, if everything is going well, they will transfer me to a regular room, and then Jed will stay with me the rest of the time. We will pay for a private room so we can be by ourselves, as opposed to a ward room. No thanks!  Eek! The doctor reassured me that the baby will be with either me or Jed 100% of the time. At no point will they take him/her away. I’m really glad about that. They do a TB vaccination here while the baby is still in the hospital, so we need to decide if we will do that or not. I’m not big on newborn vaccinations, but I also know that TB is a real threat here and I want to be wise. We need to do our homework on that one.

The maternity hospital

Another big difference here is that the kids will not be able to visit us in the hospital.  They don’t allow children to visit at all. I have to stay for 5 days, so that will be brutal. Thank goodness for FaceTime! I’m certain the hospital has no wifi, but we recently got 3G in our fine city (woohoo!), so I should be able to connect, at least briefly. And Jed will be able to go back and forth and check on everyone. My in-laws are coming from Montana to stay with us and help out when the baby comes, so they can be at home with the kids. I’m so thankful they’ll be here. I don’t know what we would do if they couldn’t come! I’d probably be even more of an emotional wreck. Ha!

That’s my experience so far. It’s been different, for sure, but definitely fine. I’m blessed to have very straightforward pregnancies, so far so good. I’ve enjoyed learning another part of Ukrainian culture- especially as a nurse. We are getting so very excited to meet our little treasure in less than 5 weeks. We sure do appreciate your prayers for a safe and speedy delivery and recovery. Thank you, Friends! 🙂