Pregnancy and Childbirth in Turkey

My little traveler has just turned two, and it seems like yesterday I was staring out at the Bosphorus after more than 24 hours in labor, while my Turkish doctor sang along to Eric Clapton’s Unplugged (true story), and I met my daughter. Recently, I’ve been contacted by a few ladies contemplating a move to Istanbul, a baby abroad, or both, and the New York Times published an eye-opening read about having a baby in the US which made me feel fortunate to have such a great (and affordable) experience. I thought I’d put together the numbers and the info so it might be of use to other women wondering about having a baby in Turkey.

NOTE: I was pregnant from November 2010 – July 2011, and all pediatrician or follow up visits took place between July 2011 and 2012, so prices may have changed.

Hospital and insurance

I went to the private Amerikan Hastanesi (American Hospital) in Nisantasi, because it was walking distance from our apartment and known to provide quality care. All of the doctors we have seen speak excellent English and there is an easy hotline to call for appointments in English, though you might find many nurses and other hospital staff do not speak much English. (This led to a few embarrassing incidents like my second pre-natal visit, where I needlessly completely stripped clothing, only to learn I only had to pull up my shirt for the sonogram. D’oh.)  As we were living in Istanbul for my husband’s work, his employer provided the excellent CIGNA Envoy expat insurance, which covered us all over the world, outside of the US.  Our expat insurance paid for ALL of my pre-natal, birth, and pediatrician appointments in FULL, but I did have to pay initially and submit the bills for reimbursement.  While there was a lot of confusion last year over Turkey’s national insurance SGK, I can’t help with that as my husband and I are both American citizens, and not entitled to SGK.

Pre-natal care and costs

Each and every visit included an ultrasound, something I have heard is only included a few times during pregnancy in the US. Each visit cost around 215 (about $120 USD), with tests ranging from 83 (glucose screening) to 155 (Down syndrome screening). My post-natal exam and pap tests were 370 (and 417 one year later, just before we left Turkey). We had a detailed 4D ultrasound at around six months for 510, it was rather boring since she hid her face, but still wicked cool. My doctor was kind and unflappable, always available by cell phone or email when I had questions (this is pretty standard in Turkey, but blew my mind), and was happy to work with me on having a “natural” birth (in Istanbul, elective c-sections are common and sometimes pushed on women, and natural birth just means vaginal).

I wrote a bit about pre-natal care and advice for Gadling, and remember my doctor giving me the most comforting advice on my first visit: in the first three months, a healthy baby will grow pretty much no matter what, but if something isn’t developing right, there’s nothing you could do about losing it. Indeed, other than a minor scare which put me in bed for a few days in the early second trimester, my pregnancy was pretty routine. The only thing I feel that I missed out on (in addition to decent maternity clothing, having a baby shower, and family and friends nearby during the pregnancy) was childbirth classes. My mother is a huge proponent of Lamaze, and had both me and my sister without any drugs (which was pretty novel in 1970s -’80s America). There is now a natural childbirth center in Istanbul that has several classes to help prepare for birth, but at the time of my pregnancy, nothing was particularly convenient for us. When I had asked my doctor about such classes, he didn’t really feel they were necessary, but if I had it to do over again, I would have liked a class or maybe a midwife to help me get through the pain of birth.

Birth

Vera was born in the morning of Tuesday, July 12, 2011. I give you the full story here (no gory details, though, don’t worry) in the interest of illustrating what it’s like to have a baby in Turkey. The Thursday prior to her birth, I went for my usual check-up, which included a fetal monitor “stress test” after 35 weeks, basically like a little lie detector test they put on your belly. After this test, my doctor informed me that I was in labor, but it was hard to know if the baby would come in a few hours or days or even weeks. My doctor was planning a weekend trip to the coast, but assured me he could hop on a flight back at any time if my labor progressed, and I gave him the go-ahead to go to the beach (I wanted a well-rested doctor for the delivery!)

I remember walking home that afternoon past fabric and wholesale clothing shops, where the “sales” men (they are nearly all men) sit outside drinking tea and smoking and arguing about politics, and wondering what would happen if my water broke right there. Would they flag down a motorbike delivering water bottles to take me to the hospital? Would I be offered some tea (of course I would, one is always offered tea in Turkey)? I ended up going to the movies, as I did often in the pre-Vera days. I saw Insidious, a decent scary movie, and each time I felt a contraction, I’d look around at the audience of mostly Turkish teens, and wonder what they might do if I went into labor, and what I might do if my water broke in the theater. Nothing happened, of course, and nothing happened all weekend, in fact. We went out that night to our weekly expat happy hour, and the next night to a long and raucous dinner with friends, culminating in me sitting on a stool outside a crowded nightspot, sipping orange juice at 2am, about 26 hours before I would wake up in “real” labor.

I hoped July 11 would be Vera’s birthday, easy to remember because of 7-Eleven, and also because it was the day I went to the hospital in labor. My doctor had said to come in any time, and while I’d been up since dawn with some major contractions, we waited until around 4pm to go to the hospital. We walked there, nearly 1 kilometer, which shocks some people, but I didn’t want to sit in the back of a hot taxi during rush hour traffic, and it was downhill. My doctor did a quick exam to confirm I was in active labor and sent us toward the maternity ward. This was one part I thought was distinctly un-American: no one put me in a wheelchair or rushed me anywhere, we had to wander around ourselves to find the right desk to check in and deal with a language barrier with the nurses who checked us in. My husband went to the payment office and signed some papers to agree to pay, while I got settled in my room.

I had a nice private room with a foldout chair for A to sleep in, a TV with all the international channels, and wifi. I have heard rumors that American Hospital will provide beauty services such as manicures and hair styling, but this never came up  for me, sad to say. I spent the first few hours in our room or wandering the halls, watching TV (I discovered that Gordon Ramsey is not bleeped out in English on Turkish TV, but they don’t translate his swearing exactly), and looking at the bizarre door decorations. Turkish families will decorate the hospital doors with elaborate tulle and plastic baby decor, as well as full family portrait layouts professionally done incredibly quickly after birth. (I assume those ladies did avail themselves of the beauty services.)

I had originally wanted to go “natural” with the birth, and not have pain medication. But after six hours of intense labor at the hospital (and about 10 hours before that), I was exhausted and seriously hurting. I tweeted to ask the internet to send me some distraction and/or animal videos, and they delivered with lots of fun links and encouragement. Finally, I gave in and had an epidural, which was less scary than I thought (my mother, who used to be terrified of needles, cited that as part of the reason for her natural births), and gave me a major break — for a bit. The epidural worked only for me for about an hour, though they kept replenishing the medication, it seemed to only take the edge off temporarily. For this, I would call my birth natural, with a pause, a sort of “ladies’ intermission“.

My primary doctor went home for the night at some point, leaving me in the capable but less charming hands of another doctor, and promising to return for the delivery.  I would eventually come to LOATHE the second doctor (let’s call him Dr. Z), but in the end, he was great. The problem was, that over the course of the night, he would come in, brusquely examine me, say something in Turkish to the nurse, and walk out. I was desperate to get it done with, and frustrated that he wouldn’t tell me anything, but I later learned that V was positioned in such a way (face up) that it delayed delivery, and if it had gone on further, they might have had to do an emergency C-section. He didn’t tell me because he didn’t want to worry me, which I found a good but also questionable thing.

Finally, in the early morning (now 24+ hours after labor began), I was suddenly taken to the delivery room. My husband did not come along, as no one invited him and he didn’t ask, but I was fine with it. I know many other couples who have had babies at the same hospital and the husbands were in the delivery room, but I think you need to make that known. I had random thoughts going into the delivery room:  I noticed a pill dispenser and thought of Nurse Jackie and how she hates that machine. The delivery room was full of doctors and nurses, and had a cool table with handles like a gymnastics horse, so one could hold onto something during the big push (another reason I didn’t miss my husband too much). As alluded to before, my doctor put on his iPod while we were in the delivery room, set to Eric Clapton’s Unplugged, and I remember thinking how Layla is really a perfect song.

Sparing gory details, Vera was born around 8am on a Tuesday, about 26 hours after I woke with serious labor pains. Dr. Z redeemed himself by turning Vera so she would come out smoothly, and I was in the delivery room for a relatively short amount of time. I won’t lie, it was pretty brutal, but I was fortunate to have an easy pregnancy (no morning sickness or stretch marks!), and I’d rather have one bad day than nine bad months. We spent only one more night in the hospital, but I could have stayed longer if I had wanted. The hospital food was quite good, and they sent up a nice fruit punch of sorts — lohusa serbeti is traditionally served to new mothers to help bring on the milk, and also served to visitors. The neighbors in the next room offered whiskey to my husband and custom cookies to me (the auntie runs a nearby cookie and baby store).

We also had a baby nurse help us to learn about nursing, diaper changing, etc. As the primary baby nurse didn’t speak English, she had a young helper to translate. My favorite bit: I told her that “poop” was the word for, uh, solid elimination, and she later asked me if the baby had “popped” yet. Heh. I sent A home to get the car seat (we would take a taxi *up* the hill home), though no one seemed to care much about that, while they seemed horrified that I had only a onesie for Vera to wear home. (Even in the sweltering July heat, Turks wouldn’t dream of taking a new baby out without being trussed up and fully covered.

Total birth cost: 3000 epidural + 3,600 “surgery” fees + 1000 2 nights “baby package”

Pediatrician

The first pediatrician we saw at American Hospital (assigned to us after the birth and seen again a few days later) we didn’t really jibe with: he told us no swimming pools, malls, or TV until she turns two. After we finished laughing about that, we switched doctors and never had an issue. Turkish pediatricians follow the same vaccine schedule as Americans, and our doctor had a comforting and pragmatic way. Instead of telling me any absolutes, he’d tell me what was going on developmentally at each age so I could make informed decisions and not worry about specific milestones. Again, I could reach him by email or cell phone, and could drop in if I had a problem. Babies are so adored in Turkey that everyone at the hospital was excellent at dealing with kids, while I’ve found many nurses and techs in America to be quite cold and unhelpful. (I understand there are liability issues here, but I think if you work in a pediatrician’s office, you should be *gifted* with children.)

Cost of “well baby” visits:  generally 300 each including shots and tests. Our few visits for illness were generally free.

One last note: on our last visit to Istanbul in February, V was bit by a cat in a shop after some aggressive petting. A friend helped us to the German Hospital in Beyoglu, but they were unable to give the rabies vaccine and told us to visit a public hospital, which are known to have long waits and lots of crowds. (The German Hospital ER was like a movie set, spotless and with no patients waiting unattended.) We tried the American Hospital, but were told the same thing. Finally, we called her old pediatrician, who happened to be at the hospital, and he gave her a quick exam and told us not to bother with the complicated and difficult rabies course of shots. The doctor determined that we would be able to *see* signs of a rabid animal, and since the cat was “known” to the shop and neighborhood, and had not attacked randomly, we were probably fine. We paid nothing for any of these ER visits since no treatment was given, other than a washing, bandage, and kiss on the forehead for the “princess.”

Any other questions about having a baby in Istanbul, please ask!