Knocked-Up Abroad: Macedonia Edition – 10 Weeks And The First Prenatal Visit


If you missed last week’s post with the big announcement, you can read it here.

I’m excited about this new series (and I hope you are, too!). I’m not committing to write posts for this series on any form of a regular schedule. I’ll probably post after each visit with my doctor, so about once a month for sure but I will also write whenever there’s something share-worthy. I’m already a bit behind because my first doctor’s appointment was already 3 weeks ago! Oh well.

Also: I’m quitting my kids’ pseudonyms. They’re just annoying. My daughter is Audrey, not Eleanor, and my son is Alistair, not Edward (though his middle name is Edwards, so it’s close). Bear with me as I get old posts updated.

When I found out I was pregnant with Audrey we had lived in Hungary for over a year and though I had basically no experience with the medical system there I felt comfortable having my first child there because we had an amazing community who immediately surrounded us with support. I also had complete medical coverage through my work and if we returned to the US we would have paid out of pocket for everything. It was an easy decision to have her there.

While we never considered having this baby in the US, it’s different this time around. I came into Macedonia 6 weeks pregnant, our only contact was Ryan’s supervisor whom he had only emailed with, I not only didn’t speak the language I didn’t even understand the alphabet. I wasn’t sure how we were going to find a doctor or how much it would all cost.

But we knew this was where we were supposed to be.

A few days after arriving Ryan was on the phone with his supervisor and he told Ryan that his wife is a non-practicing family doctor so if we ever needed any help with getting medical attention, she was available. I think my jaw literally hit the floor. We told both of them a few days later and she made an appointment for me with her OB/GYN, whom she really likes.

I was already past 8 weeks, when the first prenatal visit usually happens, and then the appointment was pushed back another week making me 10 weeks when I first saw my doctor.

Our friend drove the four of us to the hospital, which is so new part of it is still under construction. It started out as a specialty OB/GNY hospital but is branching out into other areas. She told us it’s part of a ‘Turkish system’ and I’m not 100% sure what that means (maybe it’s like a chain hospital?). The name does sound Turkish. I’ll probably eventually figure it out.

The facility was modern and the waiting room was full of women sitting on red IKEA-esk couches. We checked in with the receptionists and waited. When I was called in our friend came in long enough to introduce us to the doctor and make sure we were all comfortable with the situation.

The room was large and modern but what stood out were the semi-erotic sketches of nude women on the walls. I’m 100% fine with celebrating the female body, especially in a pregnant or breastfeeding state, but I have to admit these pictures were kind of weird, given that real-life women are semi-naked in the same room and the women in the pictures were neither pregnant nor breastfeeding. It’s moments like this that I just remember that Europeans have a very different view of the body (for good and bad) and most would consider my American sensitivities to naked bodies as ‘prude’. I shake my head, smile, accept it as a cultural difference and move on.

My doctor, Dr. B (I’m not using his full name for privacy’s sake), was nice, engaged the kids with a twinkle in his eye and didn’t speak the greatest English. I knew I was spoiled with my doctor in Hungary: he spoke English very well, was up-to-date on research coming out of the US and had attended conferences there.

Even with the less-than-ideal English, I did like my doctor (all the nurses spoke English so if we do run into language issues, one of them can probably translate). He’s been practicing since before I was born and only has 3 or 4 OB patients at a time, which I appreciate because he’s more likely to be available when I’m in labor.

Dr. B asked about my previous pregnancies and births in general terms and made sure I thought this pregnancy was going well. It was a lot different than giving my complete family medical history, detailed pregnancy and birth info and general ‘get to know you’ stuff with my midwife in Canada.

Then came the internal exam. I figured this was coming because I had one in Hungary. I was directed to a corner of the room where I could drop my pants before walking to the other side of the room, uncovered, to the exam chair.

It confirmed that, yes, I am 100%-for-sure pregnant.


Now onto the ultrasound.

The screen faced away from me so it was probably the most disappointing ultrasound I’ve ever had. At least Ryan and the kids got a good look at the little one. Dr. B did turn the screen so I could see for a bit but it was too short for a mama who wants to admire the 3cm long child growing inside her womb. Because it was an ultrasound we heard the baby’s heart beating strong. Audrey got a kick out of hearing it.

Dr. B told me I ovulated from the left side, so it’s a girl. He then looked at me with the same twinkle in his eye he had given the kids and winked. That made me really start to like him.

We then went back to the desk to wrap up the appointment.

11 weeks – This is seriously the closest thing I have to a baby bump photo. Sorry, child #3.

For weeks I had been trying to figure out how to ask about his views on c-sections, VBACs, natural deliveries and what I could expect during labor and delivery. But because from what I had experienced in Hungary, and I assume it’s the same here, most of that is dictated by hospital policy. As the expecting mother you don’t have a whole lot of say in what goes on – it’s all predetermined. So how do I non-confrontationally and respectfully address these issues that I assume we have different views on (I would expect to have different views from an OB in the States, as well)? How do I begin the process of making it known what I want my care to look like and that I plan on being in charge, not him or hospital policy? How do I not alienate or irritate him during my first visit?

This is when I am beyond thankful for my sensitive, intelligent and tactful husband.

Ryan explained to Dr. B how it’s important to me to deliver vaginally and not have another c-section and asked what his thoughts were on that happening.

Oh, it’s no problem, replied Dr. B. He prefers vaginal births and has the lowest c-section rate in the hospital. He lets labor take it’s time and he doesn’t order c-sections because he’s impatient. And he has no problem with a VBAC, especially since I’ve have a successful one. I’ve since found out that most doctor’s don’t do VBACs; I might be very fortunate to be with Dr. B.

We finished the appointment and headed downstairs to do something we’ve never done in two pregnancies worth of prenatal care: pay.

In Hungary I had 100% coverage through my insurance from work, though we did slip my doctor a hefty amount after Audrey was born as a ‘thank you’ for seeing us privately and we paid for a private room, a total of $420. In Canada I had 100% coverage as well, though because we had to make so many trips to the hospital before Alistair decided he was actually ready to be born (and not just faking us out) and because I had to spend several days, rather than hours, in the hospital after the birth we paid through the nose for parking, over $100.

We looked into insurance for our time in Macedonia but the only plans we could find cost thousands of dollars up front, have massive deductibles we would never meet unless we have cancer, and don’t cover any sort of maternity care until I’d been on the plan for 10 months. We figured that even with paying out of pocket for pre-and-postnatal care and labor and delivery it will be less than getting insurance. Ironically, if we were in Oregon I would have 100% coverage again.

I was really nervous as the receptionist prepared our bill. We figured it would cost less in Macedonia but  we didn’t know for sure. While we do have money set aside for medical expenses, let’s just say we don’t have much wiggle room in our budget. When we first walked in to the nice, new, modern building Ryan and I exchanged glances, knowing we’d be paying for the chance to have stainless steel doors, pretty decorations, and lots of staff. I had wondered if we should just go to a public hospital and not pretend like we can pay for something that’s up to our American standards.

The total for the exam and ultrasound was $80.

Okay, I think we can do this.

While there’s a lot that could happen between this first appointment and my precious baby being born, I feel good about continuing to pursue giving birth in Macedonia. I still have questions and I’m still trying to figure out how to ask them but we are headed in a good direction and unless things change (which in this crazy, unpredictable life we lead it’s not unlikely) I am confident in having our baby here.