Shanghai Mamas was approached by Felicity, the author of this article, who asked us to share so that other moms in a similar position may learn something from her experience. This is the story of what happened to Felicity in 2011, when her baby was born prematurely in Shanghai.
Going into premature labor is a very stressful situation to find yourself in. However, there are ways to increase your chance of having a positive experience: do your homework early. Here are some of the things you need to think about:
- Find out the resuscitation cutoff dates in the different local hospitals, as they may be very different from each other. The hospital I was in in 2011 treated babies over 28 weeks and over 1,000g, and luckily my baby was born on the morning of 28 weeks and weighed 1,000g exactly! This first decision is important – if, like me, you have a placenta abruption while alone in the middle of Shanghai you need to know where you want to go. If you go into premature labor at 25 weeks, you do not want to turn up at a hospital which may consider the birth a miscarriage.
- Read up on your insurance policy and know what is covered. You may find that your international insurance policy won’t cover a lengthy stay in an international hospital or international wing of a local hospital while you are trying to prevent a pre-term labor. If this is the case you may want to go to the international hospital first, but if you need to be admitted for weeks or even months, it is highly unlikely those costs will be covered, so my advice is to have a plan B local hospital on your list.
- What are the NICU facilities like at the different hospitals? From how many weeks will they accept a baby? My hospital resuscitated babies from 28 weeks, but could only provide NICU support to those over 32 weeks. If you find yourself in a similar situation, your baby will travel by ambulance to a different hospital immediately after birth. Depending on the situation, your hospital will try to wait for the incubator and doctor to arrive from the third party hospital before starting an emergency c-section.
- If you find yourself in the situation above then you have another choice to make. Which hospital do you want your baby transferred to? Your choice will depend largely on these factors: urgency, distance, and facilities. Once you have made that choice, it’s not easy to transfer a second time. In my situation we decided on the nearest hospital instead of the hospital with the best facilities, and it was a difficult decision to make. The traffic in China can be very unforgiving to ambulances and having been in one I know just how bumpy the ride can be.
- Does the hospital you are giving birth in have surfactant? This can help prevent your premature baby’s lungs collapsing. The hospital I was in didn’t store surfactant so my baby had to wait until she arrived at her NICU in the third party hospital.
- Do you have international health insurance and will baby be in an international NICU? If your baby won’t be in an international hospital then you will need the person (your husband or friend) who travels in the ambulance with your baby to have at least 10,000 RMB to hand. They will need this to pay as the initial deposit to the children’s hospital, and this figure will just cover the cost of this one important drug (surfactant). I recommend carrying cash as the hospital may wait for the payment before they give your baby the medication, and may not be equipped to handle payments from international credit cards. My baby was forced to wait as she was not in a private hospital and my international health insurance failed us but that’s another story.
- If your baby is in the local hospital be especially friendly to all the staff. You may have very limited access to your child, with your baby behind closed doors for the majority of the time. It will be a highly stressful time but openly getting annoyed at any of the staff and their methods is best avoided. In our experience they really are doing the best they can within the limitations of their facilities. If being friendly to them means they smile at your baby one extra time when you aren’t there, it’s totally worth it. (Just to clarify, we never gave bribes to the staff and that’s not what I’m suggesting.)
- If you have international health insurance you may need to look at how premature your baby is as to where they will stay. The international hospital may not be the right choice not only medically but financially. Your baby’s care for just the basics will come to around 30,000 RMB per day. A normal hospital’s care for a 28 week gestation baby without any major problems will be about 150,000 in total. You will need to get out the calculator and make a very difficult decision.
- International hospital NICU versus a local hospital NICU. My baby was in the local hospital for the first 6 weeks before we secured a transfer to the international hospital. In 2011, the local hospital visits were twice a week for ten minutes each time, and we were not allowed to touch her during visits. Visitors were not provided with hand sanitizing lotion, and old gowns and slippers were passed from one visitor to the next. We were told that sometimes they were so busy that babies had to share incubators although I didn’t see this when we visited. An international hospital is much more likely to give you 24 hour access, and better hygiene practices. They are also more likely to allow you to give kangaroo care (they even brought me the only rocking chair in the whole hospital for my sole use). They can store breast milk and help you with getting baby to breast.
- Will your baby transferred to the hospital that is able to store breast milk? It is possible to make a special arrangement with the hospital; however, for us this meant delivering fresh milk every three hours including throughout the night. Somehow we managed and our baby’s health improved significantly as soon as the breast milk started (we plotted her weight on a graph).
- In 2011, China didn’t have fortifier. This is a powder that is prescription-only and is added to breast milk before feeding the baby. Breast milk alone may not be enough for a premature baby, and we weren’t allowed to give breast milk until we got access to some fortifier. Knowing that it’s prescription-only, buying it from an online unregulated pharmacy was not something we were willing to risk. With the help of SOS we managed to get some out from the back door of a hospital in Hong Kong then had it couriered up to Shanghai. I was later also given the left over supply from an expat. If fortifier is still not readily available in China, you will need to brainstorm your contact list.
- If you do decide to transfer your baby to a different NICU, do it as quietly as possible. When we arranged the transfer to the international hospital, everyone was sworn to secrecy. The local hospital were doing the best they could but we were worried that if they found out early about the transfer then they may not prioritize her level of care. Frustratingly someone let slip and told the local hospital about the transfer sooner than I would have liked. I would have liked to have told them myself. When we visited her, we found she had been transferred into a cheaper incubator. We were told she had improved but it felt like too much of a coincidence.
- Finally, what if you go into premature labor outside of a first tier city? Here you may find yourself with a nightmarishly difficult decision. Where is it safest for you to give birth and where is the best place for a premature baby? I started off in Suzhou and was there in hospital for 2 weeks before I was transferred by ambulance to Shanghai. I was dying and it was obvious the hospital wasn’t coping; my insurance company’s medical assessment labeled me as critical. In 2011, Suzhou only had ONE ambulance that could travel to Shanghai. Before I entered the ambulance I had been hemorrhaging every day, and I had to sign a form accepting that I may die on route as there were no blood transfusion facilities between Suzhou and Shanghai at that time. Know your local hospitals and be aware of your other options. Not all hospitals have a helicopter pad.
- If you do need an emergency transfer don’t rely on your insurance company. My insurance company lied. They said they were busy arranging my transfer but in actual fact had decided it was night time in China so they would wait until the morning! Once the hospital in Shanghai had finally been arranged, they also messed up my ambulance transfer (another story). I could have arranged it much faster myself.
- Reach out to the local expat community and LLL breast feeding group. If like me you are new to the city you find yourself in, reaching out to the local expat associations can find you help in unexpected places. I have so many people to thank. For example, we had offers of: chauffeur driven cars (especially of great help to my mum who came over); visitors who brought DVDs/books/magazines; visitors who brought fruit; visitors who brought home bakes and one lady who read to me; visitors who brought advice about local food delivery services (literally saved my life!); a visitor who lived near the children’s hospital and offered me access to her home; and a visitor who gave doula support. From the LLL group, I met an amazing lady who gave me many items of baby essentials for which I am eternally grateful. These people and their visits gave me something to look forward to on days that seemed would never end.
I wish you never have to experience a premature labor. But if you do, being prepared and knowing what your options are will significantly improve your experience, and help you make the best choices for your individual situation.
Shanghai Mamas is very grateful to Felicity for sharing her experience. For further insights into parts of Chinese culture that expats may not typically get to see, please check out Felicity’s blog at www.wwambam.com.