Thursday, October 25, 2012

Being a pregnant foreigner in South Korea

I've been pregnant in 3 different countries (the US, Mexico, and now Korea), and I can say that by far, the experience in this one has been the best. Why is that? Let's see...

Of course, my view is skewed by the fact that the last time, we were in the middle of our first attempt at the US immigration process, I was stressed out beyond all belief, I was unsure of whether to continue in Mexico or the US, ended up bouncing between both countries, and ultimately giving birth in the US while Carlos watched on Skype.

Obviously it's much more ideal to be in one country and together full-time with my husband. During my last pregnancy, I guess I just rolled with it and survived, but now I realize how much I missed out on. For example, this time, I'll only have had to fly pregnant once (already done)! Instead of...four-plus times like I did last time. This time, I actually got to have Carlos there at the ultrasound where they checked the baby's anatomy and told us she's (probably) a girl. That was amazing. Instead of an anti-climactic attempt to reveal the gender over Skype like last time. This time, he's been there to support me through the constant morning sickness that lasted for nearly 3 months, he's been there to slowly adapt to my wildly-changing body (instead of being shocked every couple months), and he's been there to dream with and envision our lives with the baby (mostly we freak out about that, but we'll be OK).  But let's get to the actual specifics.

OK, step one, pregnancy test. Just like last time, we were pretty confident, Carlos more than I, that we were expecting, but just to be sure, I went to the pharmacy, asked for an 임신테스트 기 주세요 ("im-shin-test kit juseyo" = "Pregnancy test kit, please"), then decided to get two (never hurts to be extra positive!) and for about 8,000 won (maybe $7.20) I walked out with the kits and went home to test. The positive line showed up instantly. For both pregnancies, those test kits practically jumped out screaming "Positive!" For anyone reading this who may be contemplating or experiencing pregnancy in Korea, I've heard there are some brands that are better than others and to avoid "the green one" because of false negatives. Incidentally, the green box is the one I ended up with. Also, if you are unfamiliar with pregnancy tests in your native language, it can be slightly confusing to decipher the instructions in Korean, so see if someone can help you interpret before you test. In general, one line is the control to show it worked, a second line is the test line that only appears if positive, and no lines means either it didn't work or you haven't waited long enough. Normally you have to wait like 3 minutes before reading the test (the kit will say, so another reason to have some help or get to work with your online/smartphone dictionary before testing if you can). Probably best to wait the full amount of time before making any conclusions, unless you're like me and the positive result is immediate.

Telling the Boss!
We were a few months ahead of our planned "start trying" date, so finding out I was pregnant in April was a bit of a surprise and then fairly frightening. I knew we would be set through September when my contract at school ran out, but with a December due date, this isn't enough. I decided to tell my employer almost immediately, basically as soon as the morning sickness set in. Probably wouldn't have been able to hide it much longer anyway, as my nausea was aggravated by the smell of food; in particular soy sauce, sesame anything, rice, garlic, red pepper paste, fish, fried anything, and basically I've just described the central features of Korean cuisine, so as you can imagine, teaching in the English classroom directly above the school kitchen was madness for my stomach. It's a serious miracle I got through that whole part of pregnancy without any vomiting incidents at school.

I was prepared that they may not want to renew my contract past September because I've heard many public schools find it too much hassle to support a foreign teacher through maternity leave and all the other legal and contractual obligations that come with it. In all honesty, there are a lot of perks given to native English teachers when compared against the usual qualifications and job obligations and those of the Korean teachers in the school, so I can understand why maternity provisions really tip the balance against the teacher's favor. And yes, my principal was hesitant at first, but she was assured by the other English teachers that my work here is valued, and she was also soothed by the fact that my maternity leave will coincide almost precisely with Winter Break when there are no classes anyway. If you're a native English teacher in Korea and you're pregnant, dealing with the employment end of things is perhaps the most delicate part of the whole entire pregnancy in Korea. It's a good idea to read through your current contract, the upcoming one if you're in the public school system and can access it, and be really informed before jumping into an official discussion at work. The first person I told was a co-worker who I felt I could trust to support me (she was beside herself with glee when I made the announcement), and then she accompanied me to tell the principal.

I worked really hard during the first trimester to not let my condition affect classes. Yeah, I was exhausted, nauseated, felt terrible all the time, and wanted nothing to do with food. But I didn't want the school changing its mind for any reason, especially until I had a signed contract in hand, and 40 weeks is a long time so I had to make it clear I was up to the challenge from the start. The one modification I had to ask for was that during one particularly awful week of nausea, I moved all English classes to the students' homerooms instead of using the fabulous English Zone, just so I could be away from the kitchen smells. My fellow teachers were more than fine with this, thankfully.

Visiting the Doctor
I need to preface this with a short description of the medical system here in Korea because it's vastly different from that in the US and also from the Mexican system. In short, it's a single-payer nationalized system, legal workers pay a small percentage of our paycheck into the system and our employers pay a matching percentage. This is in exchange for broad coverage of pretty much any necessary and non-elective medical needs, and our experience with it here matches the expectation: ridiculously low costs, fast, accessible care, and overall satisfaction. My job/contract covers my dependents under the system, so Carlos and Lucas are taken care of, too. For an fascinating, more in-depth look in layperson's terms, you can see this blog.

Prior to my pregnancy care, we had one hand injury (Carlos) and one ear infection (Lucas). In Carlos' case, a consult, X-ray, and a special brace for recovery all came out under $12 as a walk-in patient who was in and out in under 45 minutes. In Lucas' case, we didn't even take him to the doctor (or, really, hospital), it was his teacher at school who ran him in during lunch time because he was complaining that his ear hurt. Another vast difference from the US - no HIPAA regulations here. Again, less than $10 got him a consult, a cough syrup and antibiotic, and he was apparently back at school in time for class to resume.

When it comes to pregnancy, things get even better. Because South Korea has one of the lowest fertility rates in the world, the government is scrambling to incentivise pregnancy, childbirth, and child-rearing. So there are even further perks which I'll get to below.

Alright, finding a doctor. My co-worker called a local OB/Gyn center in the neighborhood and checked if the doctor spoke any English. Most doctors here know at least some essentials because they have to complete a lot of their medical study in English. For my first appointment, she happily accompanied me (nearly cried upon seeing the baby on the ultrasound), but after that I've always gone by myself or with Carlos and we've been just fine. The staff doesn't really speak English but we get by just fine with minimal English/Korean and a lot of gesturing, and the doctor is able to communicate just fine in English, at least about medical matters. He strains to attempt small talk during the consults but I try to let him know it's OK, we are fine keeping it down to medical business and a lexicon he's much more familiar with, I know he's on a time crunch.

By my first appointment I was already about 10 weeks (I have a bad habit of waiting a long time to get care), so I did the usual initial testing (pap smear, blood, urine checks) and the doctor performed an ultrasound to confirm the pregnancy, get the size/estimated due date, and check that things were alright overall. I was offered a DVD for 10,000 won (less than $10) that I could bring to every appointment and get all my ultrasounds recorded on video. I agreed because for that low of a price, why not? Going home and watching the ultrasound videos again has become a favorite activity of mine.

For those interested in prenatal care in Korea, especially more sophisticated or non-conventional options and doula services, and especially for English-speakers, there are TONS of resources out there. I think I'll get into those more in a separate post because this one is long enough, but an excellent starting place is the Birthing in Korea website, which features plenty of resources targeted to pregnant foreigners in Korea.

Paying for Care
Because I waited so long, I basically had two prenatal appointments rolled into one, tons of testing and procedures, and my expense was about 80,000 won. Keep in mind this is just a lowly, humble clinic in my neighborhood, not a big huge maternity hospital or one of the centers that caters to foreigners, both of which would cost a more. After this first visit confirmed the pregnancy, I was given paperwork to take to the bank (KB, Shinhan, or Post Office bank) to apply for the GoEunMom card. This is a debit card that comes preloaded with 500,000 won (as of April 2012), about $450, which can only be used on prenatal visits in 60,000 won increments at a time, and occasionally some other baby-related expenses like diapers and such at certain locations. This card is available to anyone enrolled in the National Health Insurance system, foreigners included, and the government funds it.

The beauty of using this card and getting prenatal care at a normal little clinic like I'm doing is that since that first visit, I've never had to pay anything out of pocket. Each visit is somewhere between 30,000 won and 55,000 won or so ($25-50) always under the 60,000 total paid by the card. And I should mention that every single visit features an ultrasound, included in the cost of the visit. So at 31 weeks, I've only paid the cost of the initial consultation, and I still have about 300,000 won left on my GoEunMom card. The experience of those getting prenatal care from a pricier institution is different, but I feel like especially for a second pregnancy and no history of risk, there's no need for the fancy stuff. My doctor checks me and the baby all the same.

Kor 538
Korean citizen babies and foreign babies
For foreign moms married to Koreans, there are a whole lot of perks after the birth as well, as they are giving birth to Korean citizens. I believe such moms in certain sectors with especially low birth rates get cash rewards and tax benefits for having more than one child, and there are more benefits as the child grows, even if you only have one, including stipends for child care, preschool, and further education. However, these are not available to children born to two foreigners, because these children are not Korean citizens.

Important fact: Korea, like many major countries, bestows citizenship based exclusively on parentage (jus sanguinis), so a child born in this country is only Korean if he or she has a Korean parent. That means our child will need to obtain one or both of our citizenships, and we'll actually have to do this pretty quickly to register her with immigration authorities and get her covered under the National Health Insurance. For those who are curious, our baby is eligible for both US and Mexican citizenship at birth because both of our countries grant citizenship by parentage as well as birth inside the territory (jus soli). The process of establishing her US citizenship is done by filing a Consular Report of Birth Abroad at the US Embassy, after which we are given a certificate that acts as a US birth certificate, and we can also get her US passport once that's approved. The process for Mexico is the same in concept, although we'll see in practice how it goes. Mexican registries are usually a bit of a fiasco.

For those who are curious, here are links:
US Consular Report of Birth Abroad
US CRBA instructions specific to Seoul
Mexico - Registro de nacimiento en el extranjero (highly specific to the embassy in Seoul, this varies a lot from the process in the US or anywhere else for that matter)

Pregnant woman2
Differences at the Doctor
I didn't do much prenatal care in Mexico, but my initial prenatal visit there was about US $50 and included just a sit-down consult and a pap smear at a tiny, non-fancy clinic. I was given a prescription to go out and get the rest of the testing, including the ultrasound and blood testing, at a separate lab. It was at that point that I got overwhelmed and ended up looking at care in the US instead, so most of my frame of reference comes from experiences in suburban Chicago.

Anyway, based on the experience in the US, besides the cost factor, there are a lot of other differences. Here, I'm not expected to make appointments. I'm just supposed to walk in whenever is convenient, and I generally get seen within about 20 minutes. I usually ask my co-worker to call ahead first just to make sure it's OK but she seems kind of perplexed by this. I can't break my American-ness on that aspect.

Also, the clinic is open until 7 pm and I always see the same doctor (I think he's the only OB), so I don't have to re-arrange my work schedule around prenatal visits or anything. Generally my OB in the States could only do daytime appointments.

The prenatal care schedule matches the standard US one pretty closely - General testing and dating ultrasound first, Dual Marker testing sometime around 12-14 weeks, Quad Screening around 16-18 weeks, full anatomy ultrasound sometime after that, glucose testing (YICK!) at the start of third trimester, non-stress-tests and the like as you're monitored up to the birth. The biggest difference in the care schedule is the use of ultrasounds at every single appointment. At first this freaked me out because I imagined spending piles of money on all those ultrasounds, especially considering that in the US, insurance often refuses to cover more than two over the whole pregnancy. But no, those ultrasounds cost me nothing over the usual limit of what my GoEunMom card covers. So I have no complaints about all the extra chances to see the baby! The office staff at my clinic gave me a prenatal visit schedule at the first appointment and wrote in the approximate cost of each visit, too, which is how I felt confident from early on that I wouldn't spend much more than what my Mom card covers, if any at all.

Cultural Differences in Care
For the most part, the traditional Korean model of prenatal care matches the conventional model in the US. Generally it's focused on spotting potential health complications for mom and baby. Many would say that in Korea, there's more of a sense of the doctor as all-knowing and the mom as simply a medical subject to be worked on. Rarely does Mom get to have any input during consultations and the assumption is that the doctor knows exactly what's going on.

Another thing that most foreigners seem to experience here: most doctors are overly concerned with both the size of the baby and the weight of the mom, almost across the board for any non-Koreans. Most of us have a slightly different physical makeup from that of a typical Korean mom and thus our measurements and baby's often vary from the norm of what doctors are used to seeing here. So expecting foreign moms are often told to cut out all carbs and exercise more (regardless of whether they're already following such a lifestyle).They're also frequently told by the conventional doctors that the baby is probably too big to deliver without a C-section. Korea's C-section rate, something between 30-35%, is often cited as one of the world's highest, especially among OECD countries, so if a foreign mom with a different kind of body shows up, many doctors are going to default to their simplest option, which is surgical removal of the baby, rather than the unknown of letting the mom labor and deliver naturally.

While a lot of the Western world is slowly starting to seek more natural birthing experiences, thanks in part to contributions like The Business of Being Born and an overall cultural normalization of natural birth, these trends have really not reached Korea. Many of the families seeking these experiences in Korea are the Westerners living here who find home and/or water birth and intervention-free labors more appealing. There are a handful of midwives and OBs who favor natural approaches, mainly in and around Seoul, and a majority of them can speak English. Again, the Birthing in Korea site is a great place to start looking at these options.

Delivery and Post-Partum
This is a topic for another post. Suffice it to say that I've been more than happy with my local clinic's checkups along the way, and if I delivered there, the cost would be insanely low. But as a mom who prefers natural, non-intervention approaches to childbirth, and would also prefer to have practitioners comfortable in English during the delivery, I am planning to deliver elsewhere, at great additional expense. I'll try to detail all that later.

A South Korean school lunch
The lunch portions my co-workers would like me to eat

Out in Public
I've probably mentioned that foreigners generally stand out a lot in Korea, and are often the subject of lots of staring. Then add a big, pregnant belly and you've got the attention of just about everybody on the bus/train you're riding. This isn't all bad. Pregnant moms are queens here. Just like in the States, subways and buses have designated "pregnant mom" seats and unlike in the States, people actually jump up and offer these seats. At least in my experience, as a person whose pregnant belly popped out during 1st trimester and who usually is carting around a preschooler as well as a shopping bag.

At school, I'm almost daily greeted with looks of pity and inquiries of, "Tired?" from students and other teachers. Out of obligation, I sigh, "Yeah, a little," because apparently expecting moms are supposed to be VERY tired all the time, especially at this point in pregnancy. Most of my co-workers constantly compliment my energy level, which I honestly thought was par for the course. My students have a hard time believing I'm not carrying twins because my belly really sticks out like crazy nowadays. My principal did have to make a stop at my table at lunch the other day to confirm that I am, in fact, due in December and not, say, next week.

I also get lots of commentary in the lunch room over what/how much I eat. Let's just say that in general, expecting Korean moms are able to consume amazing amounts of food (rice in particular). They also manage to maintain tiny figures and tiny baby bellies, but I digress. I am no longer able to eat that much even if I wanted to because real estate in my abdomen is at a premium right now. Plus, I discovered early into my Korean experience that daily rice consumption was making me gain weight, so I usually only have about a spoonful of it with my lunch and this causes extreme concern among my coworkers. Also, if miyeok guk soup (seaweed soup) is served that day, everyone scrambles to make sure I'm eating it, as this is the prime food of early motherhood. In fact, it's the only food you get to eat for the first month after having a baby in traditional Korean households.

In summary, pregnancy in Korea has been really low-key, and so much easier. It actually feels more natural but maybe that's also because it's the second time, I generally know what's going on, and because I'm actually firmly settled in one place with my husband at my side. We've still got about 2 months until we meet the baby (maybe less?), so we'll see how I'm feeling about it in December!


Mom and Dad said...

Happy for you that all seems to be going well! We can't wait to "see" our healthy, little granddaughter. What a great picture that will be to see all 4 of you TOGETHER!!!

ArmyMustang said...

Thanks for the informative post. As a Westerner, it's so easy to assume how you would handle a birth but I am amazed by the care they provide with such great coverage! My belly popped out too with my 2nd and 3rd so I know the feeling when everyone thinks you're overdue and you still have weeks to go.

Hang in there!

Flavio and Allison Rodrigues said...

I'm so glad to hear it's going well and I'm SO excited for you guys!

One Small Voz said...

I could not stand most Mexican food while pregnant. Anything spicy was out of the question and in general any ethnic food. I wanted American food, could have lived on ham, green beans and potatoes. I loved the frequent ultrasounds while in the Mexico for the first half of my pregnancy! But they got pricey real fast. I had a high risk condition which made it impossible for me to stay past 20 weeks, and my hubs watched our bub be born in the US via skype too. At least you are all together for this one! We will be too for the next! I look forward to having my hubs be there for the FULL 40 weeks. :)

Since our visa approval I have thought a lot about folks who are stuck such as yourselves. I just have a feeling things are eventually going to change for you guys. Let's hope for fair reform.

Anonymous said...

Loved your post! I am so happy for you that it.has gone smooth!

Laura L. said...

Thanks for the update Amy! I'm glad to hear that things are going pretty smoothly so far :) Sending lots of love your way!!

Andrea Wilson said...

Excellent, informative, thorough post

Emily Cruz said...

Great post Amy. I am so happy you are having a smooth experience with your pregnancy and wish you and your family all the best!

Anonymous said...

Thanks for the great information here. We're Korean Americans having our first child here, and it's great to hear your perspectives. Hope you're having a wonderful time with your second child.

LovelyRenae said...

Thank you so much for this post! I'm married to a Korean man and we would like to start a family soon in Seoul.

Erika Hong said...

Thank you so much for your detailed post! I'm pregnant with my third, but had the first in the US (hospital) and the second in the US (home). We'll be having this one here in Korea as I don't want my hubby to miss this one. I'm really nervous about it as I much prefer going completely natural, preferably in the comfort of my own home. I look forward to looking through any other blogs you did on your experience with pregnancy and child-birth in Korea. Thanks so much!

Anonymous said...

Thanks for the information. .
I wanted to know what are the benefits of giving a birth to baby in Korea. I am a foreigner and living in Seoul Korea.

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