Hello! I have had several people mention to me that they are interested in knowing what my experience of being pregnant abroad has been like, especially to hear how the health care systems are in different places. I thought I would begin this “Pregnancy Abroad” series of blog posts to chronicle this journey and provide a look into the health care systems I experienced in Albertville, France as well as here in Dakar, Senegal.
A little background so you can better understand my frame of reference going into all of this:
This is my third pregnancy. At this point Mia is nearly 5 years old and Desmond is nearly 3 years old. For both of my previous pregnancies I went through the same midwife group in my home town. Each pregnancy was smooth and uncomplicated.
Mia came 4 days after her due date after a long labor. I was admitted for my water breaking, but was not in active labor so I was given Pitocin to encourage contractions, but still had trouble progressing. After many hours of labor I had an epidural in order to rest for a couple of hours before pushing for 2.5 hours! Mia had slight complications at birth and spent some time in the nursery for extra care before coming back to me. I experienced 3rd degree tearing as well as an episiotomy. She was 8lbs 12 oz.
Desmond came exactly on his due date. I had my membranes swept that morning and begin having contractions that afternoon (comically these contractions began while on our very first introductory Zoom call with our teammates here in Senegal). They progressed as the night went on until I decided to go in. Shortly after being admitted I had a partial epidural. Soon after that I pushed for about 30 minutes before Desmond arrived! He had no complications and I had no tearing or an episiotomy. He was 9lbs even.
I found out I was pregnant this time partway through language school in France, on August 15th 2022. This pregnancy has been very similar to my previous two overall. I was thankful to have had several friends who had given birth in Albertville earlier that year as well as one friend who was nearing the end of her pregnancy at that time so it was easy to get connected with a good midwife there.
My midwife in Albertville, Madame Dubois, spoke very little English so I was grateful to have already had a couple of semesters of classes under my belt. Still, it was so interesting to navigate a new health system with a language barrier. At our first appointment we were asked to give a full family history for both sides of our family—we were not prepared for that! Overall the care I received in France was very good, albeit different than my experiences in the States. Most striking was the fact that Madame Dubois operated out of a little office alone, so all scheduling and payment occurred in her office with her directly. And she would only take cash so that was quite the adjustment! There was also a much greater emphasis on bloodwork so I felt like I was visiting the lab near our home almost as much as I was seeing the midwife! In particular there is a great concern for toxoplasmosis (which I’ve found to be true here in Senegal as well).
The other experience that was very different for me were our ultrasounds. This was done by a different midwife/ultrasound technician, Madame Pinheiro, out of her own little office. Similarly, the scheduling and payment were with her directly and of course, all in cash. Also, at least with our international insurance, we had to make all payments in full at the time of service and then submit for reimbursement. This was true for all pregnancy appointments, vaccine appointments and ER visits.
Madame Pinhero knew both English and French, but we asked her to stay in French, mostly to aid our learning. When things got very technical with the ultrasound she would switch to English, which we were grateful for.
We found that French culture in general, though certainly not every person, was much less warm than what we were used to in mid-Michigan. This definitely came through in our ultrasound, although these feelings were probably heightened by the fact that it was done in French and by the fact that the ultrasound technician we had in the States for every single one of our ultrasounds was SO amazing and warm. Still, I remember crying after the first ultrasound and wishing I was back in Michigan!
Our second ultrasound around 22 weeks was much better, probably because my expectations had been adjusted and because it was at that appointment that we found out we were pregnant with a little girl!
We left France when I was almost 24 weeks along. My final appointment was another interesting look into the differences between American and French culture in healthcare. Up to that point all my visits had included vitals checks, my midwife measuring my stomach and using a doppler to listen to baby’s heartbeat, but nothing more invasive. At this appointment, after the typical checks, I sat up to get off the table, assuming the appointment was about done (aside from handing her the cash I owed of course). Instead she said something else to me, but I didn’t understand.
One interesting thing I’ve found with language learning is that it is super easy to be thrown off and not understand what is being said when it doesn’t line up with what I’m expecting to be said in any given scenario. So in this case, when I thought the appointment was moving into the payment portion of the visit, I was very confused by this new request. Anyway, my midwife was very gracious and patiently continued to express what she was trying to say until I did understand. Eventually I realized that she wanted me to take my pants off so that she could do a cervical check to ensure everything was normal since this was my final visit before a big international flight. This made a lot of sense and I appreciated the care to ensure all was as it should be.
However, cue yet again the confusion that comes from your expectations clashing with what is actually happening. You see in all my experiences in the States with my midwives and other doctors I was used to the following: the practitioner needs to do some sort of vaginal exam; the practitioner gives me a gown or sheet then leaves the room; I undress and cover with the gown or sheet; the practitioner knocks to ensure I’m prepared then comes back in; the vaginal exams takes place; the practitioner leaves so I can redress.
So even after I finally understood what she was requesting I was confused on what to do next because there were no sheets or gowns in sight and she made no indication of leaving. She probably was thinking to herself, “What’s the problem here? ‘Take your pants off’ isn’t that complicated of a command”, but this was the difference in our cultures. There just isn’t as much concern put into discretion or patient privacy in this setting. Whereas I remember in nursing school that it was heavily emphasized to me to protect the patient’s privacy as much as possible, in France that isn’t a priority.
All of that to say, I eventually caught on and undressed, she did the exam then I redressed (again, with her sitting right there). It really wasn’t a huge deal, but still was off putting, simply because my background and culture is different. From talking to my other American friends who delivered babies in France this was their experience as well and was definitely an adjustment for all of us.
Hopefully this post, and the kind of humorous (in hindsight) final story, give a small glimpse into what my personal pregnancy experience was like in France. Part 2 will include my initial experiences in Dakar!
-Selina
