DIY Delivery: Part I

I knew it would be a different experience. I knew—22 years later—it would be harder. I knew, at my advanced maternal age, I would be picked and pored over by perinatal specialists with their genetic tests and nuchal translucency ultrasounds. But I never, in a million years, knew I would become a problem patient at the mercy of the South Korean medical system. 

I’m reading Pearl S. Buck’s The Good Earth for the third time. In fact, by the end of my first month in South Korea, I will have read every Buck book available in PDF online:The Good Earth, Sons, A House Divided, East Wind, West Wind, and The Mother. I imagine the scene where Wang Lung’s wife labors alone—locking herself in their tiny bedroom, pulling out the birthing stool, leaning hard into the packed earth floor. She’d wipe the sweat off her brow, bite into a strip of leather to stifle her screams, and catch her own baby. If it had been a morning delivery--and her second or third child--she might’ve returned to the fields by mid-afternoon. And so our emergency birth plan becomes a running joke as the weeks tick by: the proverbial squatting down in a rice paddy.

The joke has merit. 22 years ago, I delivered my second son in less than four hours. My OB-GYN back then had quipped my third child would probably be delivered in the backseat of a cab. I think of my third child now. Who knew her “back seat of a cab” would mean a birth abroad? In August, the rice fields are a waving green sea and our humor is high. The grasses seem soft, small cabbages crown like baby heads, and fig trees are heavy with fruit. But by late fall—as we move closer to our December due date and I start to worry about a fast delivery—the fields lie fallow, and the barren, brown rows depress me. 

We keep a running list titled, “Funny Things About South Korea.” For example, public trash cans on the street are rare, toilet paper is often on the outside of the toilet stalls (God help you if you forget to grab a handful on the way in and are already well underway before realizing it), and delivery drivers on scooters are near homicidal as they run red lights and side swipe you on the sidewalk. But second to scooter scares, I am most shocked by this one funny thing: any small piece of earth is fair game for a garden. Scallions, leeks, and lettuces sprout up in the most unlikely places—an empty lot next door to a 7-Eleven, the periphery of a trash pile, the blank spaces between old railroad ties. Highway medians, easements . . . even the foundation of an abandoned house is seemingly tilled, turned, and terraced overnight. Nature’s tenacity gives me great comfort though. As my baby unfurls in my womb, I imagine my little girl must have found a tiny patch of healthy tissue to burrow into and grow. And just like sunflowers turning their heads towards sunshine, nature is just doing what nature does best: following its instincts. 

The South Korean medical system’s convenience is a pleasant surprise. Appointments are rarely set. “Just come back,” is always front desk’s answer when I ask about making one. Cost is also surprising. A prenatal appointment runs anywhere between $20-60 and includes any routine blood tests, glucose screens, or ultrasounds. As we have global insurance, we always pay cash up front and submit our receipts later for reimbursement. Initially, we are nervous about the pay up front delivery cost, but hospitals quote us anywhere between $2-5K, depending on natural or caesarean birth (a fraction of the cost in the US). In the states, and even with good insurance, my office co-pays alone were $40, my first trimester perinatal appointments totaled over 10K, and my genetic panels ran 2K. So, at first, we are pleased with our new care. I walk two miles to my doctor appointments and look forward to them. My OB-GYN, Dr. Um, is a tiny man with a smile like the sun coming out. I walk into his office and he cries out, “Jennifer Nance(ee)!” (Koreans always pronounce an extra “ee” sound on words ending in “e.”) Between his broken English and my Papago App Hangul, we discuss my condition of “old age(ee).” He is happy with my progress. From my weight gain to the baby’s development, everything is fine.

Fall turns and Koreans honor their ancestors and equinox with a three-day holiday weekend called Chuseok. Burial mounds are visited and tended. Harvest season is celebrated. Rice wine is drunk. On Monday, a Korean co-worker, Mr. Won, returns bearing gifts for our family: fresh persimmons, dried seaweed, and Asian Pears as big as softballs. Koreans encourage me to eat fresh fruits and vegetables and to look only at beautiful things: an old wives tale that promises a pleasant child. Our baby is now as big as a head of cauliflower and weighs almost 4 pounds in utero. And this is the first time my doctor expresses concern. Despite my reassurance that my previous two children were big babies, that both my husband and I were big babies, that I—standing at almost 6 feet tall—am still a big baby, my doctor shakes his head. He’s concerned about gestational diabetes, shoulder dystocia, and the possible need for a caesarean delivery if the baby exceeds 9 pounds. He says he will try to induce me first at 40 weeks. The limit. I’m due December 8^th, but I have a secret wish this baby will come early on Thanksgiving, my late grandmother’s birthday. So I am not worried. Yet. 

In South Korea 45% of all deliveries are by caesarean section. With the lowest birth rate among OECD countries in the world, this high C-section statistic is due in part to litigation fear, mother preference, and doctor recommendation. Korea’s National Healthcare system has also made vaginal deliveries so cheap that OB-GYNS are encouraging the more profitable surgical delivery just to financially tread water. And because the South Korean medical system is largely paternalistic, a doctor’s directive, “Because I said so,” is usually heeded. Female patients rarely question their doctors, and their husbands—who could speak up for their wives—are rarely allowed in the delivery room, especially for C-sections. These overprescribed C-sections have become, according to an article in the Korean Medical Review, a "cesarean epidemic."  While medically necessary in high-risk pregnancies and complicated deliveries, South Korea has seen an uptick in elective C-section deliveries among young women in their 20s and 30s. This data alarms me. While I know I'm not young, I also know I'm not a high risk patient. My doctors in the US assured me I could attempt a natural delivery if there were no complications, so I'm nervous about being pushed into an unnecessary surgery. However, I'm not reckless. I realize that even though my first two birth experiences were uncomplicated, natural deliveries, they were also lifetimes ago. I know I need to mentally prepare for this scenario; I just don't want it to be a foregone conclusion. Why not give my body a chance first? But when I  propose a birth plan very different from my doctor's, the conversation doesn’t go as planned. 

Thanksgiving passes by like a stranger. We cook the special meal for a mixed gathering of Koreans and servicemen, and while the room is cinnamon warm and friendly, one guest is conspicuously absent. Our baby marches toward her deadline, thickening daily like a cover crop of rye wheat in winter.