Having A Baby In Estonia

As soon as we decided to have a third baby I started googling "Where In The World To Have A Baby". Apparently this not a normal search query and didn't return too many answers. I know people have babies outside of their home countries all the time but perhaps they just aren't writing about it. So, for that soon to be mama frantically consulting google about having a baby abroad (and to all of you who are just curious) here is what I experienced in Estonia.


WARNING: This is a super long post and may include way more details than you care to know.

Here's the abbreviated version: He's here. It took forever for him to arrive. He's healthy. Giving birth in Estonia very different from the US but I think I actually preferred it overall.


Prenatal Care

Comparatively to my other two pregnancies I actually didn't have too much prenatal care this time around. I spent the entire first trimester in the US but because we had been out of the country and planned to be out of the country again we didn't have US health insurance and would be paying out of pocket. I waited until I was three months along to go to my first appointment then I went to one more check up in the US before we headed to Estonia.

Once in Estonia my first order of business was to find a place to live but THEN it was to figure out how the Estonian medical system works. Luckily we found a church right off the bat that had an excellent moms group - these ladies were so helpful. I learned a few things pretty quickly, home births are very popular, midwives run the show here (even if you're in the hospital). I was given names of doulas, midwives and hospitals to check out but still hadn't really figured out how the prenatal care worked.

Really what I was most concerned about was arriving at the hospital ready to have a baby and A.) having to wait forever at reception because they don't really know what sort of paperwork to do for a foreign patient and B.) getting into the room and not being able to communicate if I needed something. So I messaged all sorts of doulas and midwives but I'm pretty sure there must have been a snowstorm or something in October because everyone was fully booked with clients all due the same week. Eventually I decided to just find an English speaking doctor and let her tell me what to do from there. I ended up at a private clinic called Qvalitas with Dr Katrin Seidelburg. 

My first appointment with Dr Seidelburg was at 30 weeks and she was shocked to find out that I had no pregnancy passport. A pregnancy passport is a smart little thing they give you when you start having babies. You bring it to every appointment and all the important information is recorded in it as you go along. You keep it with you just in case you need to have an emergency delivery or need to visit another doctor, in which case they will have all of the information about you, your pregnancy and any previous pregnancies. Simple but smart. Because Estonia is a very tech savvy place they also have a digital version of this but since I'm not in their system I just had the paper one.

Because the records sent from my American doctor were almost useless (didn't say which tests they had done, what the results were or anything that might be good to know other than the dates I had appointments) Dr Seidelburg did all of the necessary blood work, urinalysis and ultrasounds. The next appointment (34 weeks) was similar and all looked good with myself and the baby.

  I spent the weeks between appointments asking the ladies of the Moms in Tallinn Facebook group who had delivered at ITK what to expect, what to bring to the hospital, etc so I could feel as prepared as possible even if I wasn't able to bring someone along with me. If you're going to have a baby somewhere new, groups like this are invaluable resources. And I brought an Estonian speaking friend with me to register at the hospital I would deliver at so they would at least have me on file there when I needed to check in later.

Somewhere between 35 and 36 weeks I left the girls home with Johnny for the morning and headed over to see Dr Seidelburg. She did the normal tests. Then she did a couple again. She let me know that the baby wasn't happy and that all of my test results were not what they should be. She wrote a note for the hospital staff and sent me directly there to confirm that I had a case of Pre-Eclampsia.


The Hospital

I got a taxi to the hospital Ida-Tallinna Keskhaigla and immediately started panic mode. I texted a friend to come to the hospital to help translate just in case they didn't speak english. Then I started to worry about the real problem...I hadn't eaten breakfast. You must understand that I have a very close relationship with food. With my first daughter she was 5 days late and my parents were in town so we had planned to go to breakfast together after a quick check up at the OB/GYN. Almost exactly the same thing happened and because I would need to be induced at the hospital I was told I would not be allowed to eat until the baby arrived (more than 48 hours later). So here we are, reliving history (see if I ever go to the Dr again without breakfast).

I walk inside the hospital and the same girl was at reception who I had pre-registered with. She remembered I didn't speak Estonian so she kindly drew me a little map of where I needed to go. When I arrived, I was greeted enthusiastically in Estonian. I asked if she spoke English and with an almost Southern accent she replied "Aww honey you speak English? Well lets get you taken care of." I could've cried I was so relieved. The nurse who did the preliminary check up also spoke English and the Dr who came in after her saw that my name was Vasquez and offered to speak in Spanish (this is truly amazing as I have literally never met an Estonian who speaks Spanish). Turns out, I did in fact have pre-eclampsia and needed to be admitted to the hospital (around 1 pm on Monday). 

Having been through something similar with Aurora I assumed the treatment would follow along the same lines - get baby out ASAP. But because I was only 36 weeks along they wanted to try to lower my blood pressure and see if they could buy baby some extra time inside then induce when I got to 37 weeks. They sent me to a sunny room with 4 beds, a table and not much else. My friend I waited until around 6 pm and as she was leaving I had her ask someone what was going on/what the plan was. They told her I'd be there at least that night maybe the next night depending on how things went. It was then that I started to notice some cultural differences in how the hospital is run. The first being - if you need something, you'll probably have to ask for it. This holds true for everything from information about what is happening to pain killers after giving birth. They will happily give it if asked, but are very unlikely to offer it. 

One of the first things I noticed about the room where I was staying was that there was no medical equipment or electronics of any sort. It was quiet. Restful even. It was a far cry from my hospital room in Newport Beach that was packed full of every medical device that could possibly be needed and where I was immediately and continuously connected to a CTG machine. On that first evening I got to see the much more efficient way their prenatal wing of the hospital was run when I was taken to the CTG room to check on baby. There were three beds in there and all of the women on the floor would cycle through at various times of the day reducing their need from one machine for every bed to three machines for the entire floor...smart. Similarly they had one exam room, one procedure room (where blood was taken and medicines were administered) and an ultrasound room.

Possibly my favorite thing about my whole hospital stay is the amount of responsibility they gave you in your own care. Each evening they would leave the medicines I would need to take that night, along with the ones I would take in the morning and for the first few days they also left a container for urinalysis along with instructions for what time to take it and where to leave it. Then, most of the staff would leave for the night. If you should need anything you could go to the midwife station and if she couldn't help you she would call the doctor on duty. I can't imagine any of that happening back in the States but I certainly enjoyed being treated like an adult and left alone for the most part. 

The first couple days were veeeeerry slow and I mostly just sat there working on a paint by number I had asked Johnny to bring (remember the no electronics in the room thing? No TV either...totally fine by me ). A couple days of that was actually pretty nice, it was almost like a little painting retreat but after the second day I started to go a little stir crazy. That's when one of the midwives told me I was allowed to go outside. What?! Well sure, why not? I wasn't really hooked up to anything so I took full advantage of my freedom and had a couple picnics outside when the girls would come visit and took a few walks to the grocery store to supplement my very nutritious (but not always the best tasting) diet of hospital food. 

By day three they still hadn't had any success getting my blood pressure to come down so they started to induce using Misoprostol which is a much milder way to go about getting things moving than the Pitocin I was given with Aurora. They would give me three doses a day and would allow up to three days for it to work (so much for get the baby out ASAP but ok). Later I found out that in normal inductions they will do three days of medicine, one day off and repeat the whole sequence up to three times before trying something harsher. It was then that I learned another difference in the Estonian medical culture. In America if something isn't working you just add more drugs until it does, in Estonia you just add more time. 

Day one of induction didn't get me anywhere. Day two there were at least some decent contractions but at the end of the day I was still only at dilated to 1cm (you need to be at 3cm to be sent upstairs to Labor & Delivery). Day 3 started off slowly but things started to pick up just after receiving my last dose of Misoprostol around 3:40. At 5ish, Johnny and the girls came for a picnic and we walked around collecting leaves and checking out the fountain. By that point I was needing to breathe through contractions so I was hopeful that something was finally happening. They left at 5:30 and I went inside to have another CTG. I think they had the sensor in the wrong place because my contractions weren't showing up on the screen. They told me to go back to my room and let them know when I was very uncomfortable. I was already quite uncomfortable but I went back to my room and packed up my things. At 6:30 I headed to the midwife because I was having 1 minute long contractions less than two minutes apart. She had the doctor come check me out and I was at 4cm so I finally got to head upstairs to Labor and Delivery! I texted Johnny and my mom on the way upstairs.


Labor & Delivery

I got upstairs and into my new room at 6:40. It was super nice and outfitted with all sorts of cool things to help labor progress naturally. They have seven delivery rooms at ITK and I think four of them have birthing tubs, I had thought that would be nice to use but it turned out mine was not one of the four rooms. With that in mind, I was more than happy to agree to an epidural when told the anesthesiologist happened to be right outside. I was thinking that I was in a lot of pain but perhaps I was just being a baby about it because I had epidurals the first two times around. I got on the bed and the anesthesiologist told me how to lay and not to move. Ha! I did my best but on the very next contraction my water broke. Then as he's trying to do the second part of the procedure I felt like I needed to push. The midwife is telling me to wait. Anesthesiologist finishes putting in the epidural line. Midwife says actually you can push because I see his head. Anesthesiologist starts to say that I'll feel better 15 minutes after he puts the liquid in. I push. Baby is born at 7:07. 27 minutes after getting to my room. They didn't even have a chance to finish the epidural.

It was pretty insane.

I texted Johnny that he was here. By the time he got the girls home, our babysitter over and back to the hospital everything was cleaned up and baby Johnny was already weighed, measured, dressed and eating like a champ.  

He weighed 4lb 13oz (2kg 200g) and was 18.1in (46cm) long. We named him John William Orion Vasquez after two of his Great-Grandpas (one on each side of the family).

After delivery you have two hours in the room before being moved to a recovery room. Now, I was pretty excited because I had heard really good things about their recovery rooms. BUT like I mentioned before, pretty much every other woman in Estonia was also at the hospital having a baby that week so we ended up staying in the ICU along with 7 other mamas and new babies. Johnny was allowed to stay for another hour or so before being sent home (they aren't joking about their visiting hours) 

Johnny meets baby Johnny - he finally got a little boy!

Johnny meets baby Johnny - he finally got a little boy!


Recovery

The midwives were concerned that baby Johnny would be cold so they gave him a heated little water bed to sleep on and tons of little tiny knitted clothes. We were given another checkup along with a small stack of diapers, things for cleaning his eyes and a couple aftercare items for me (that was it for me, beyond that first day you are expected to provide your own but luckily someone had told me beforehand so I came prepared). 

The next day after the girls came and met their new little brother I was moved to a smaller room with only 3 other ladies that was much more serene than the ICU was. I was pretty much ready to go home the minute he was born because I had already spent 5 days in the hospital by that point but the staff was feeling extra cautious because baby Johnny had been born so early and was quite small.  They checked his height and blood sugar quite frequently. We ended up staying in the hospital 3 days after he was born making a total of 8 days in the hospital.

I would have actually been there longer but I had a toothache and needed to see a dentist so I checked both of us out of the hospital (much to the chagrin of the Dr on duty) on the condition that I would have a midwife come to our house the next day and sign a note saying I understood the risk I was taking.

I took Johnny for his first check up a few days later. They were hoping he would have gained 40g by then and he gained 70g so I'm not too worried. The only things that have been noticeably different is their much slower and much less immunization schedule (big fan so far) and the fact that every baby is given vitamin D drops each day from one week old to two years old. I had never even heard of this but it makes so much sense! You need vitamin D to absorb calcium and magnesium and if you are doubling in size every 6 months you need a lot of both of those things. 

Johnny is two weeks old now and still does not officially have a legal name or a birth certificate but I will be getting both at the office of vital statistics this week. Then we can head to the American embassy to declare his American citizenship and get a consular birth abroad certificate & passport. Whew. 


Huge shout out to our wonderful friends that prayed for us, brought me food (and knitting needles), watched our kids (and sent me pictures so I would know they were fine and happy), fixed our stroller, played translator, gave us tiny baby clothes and were all around awesome blessings to us during this crazy time! Raquel, Melody, Eike, Shawna, Shannon, Maris, Jessica and everyone else who played a part - thank you so much! 

So that's our story. If you have any questions about having a baby in Estonia specifically or are just planning on having a baby abroad and want someone to talk to about it please don't hesitate to contact me, I 'd love to chat. hello@thecosmopolitanmom.com


Cost Comparison

Some of you had asked about the cost of having a baby in Estonia versus the United States so here you go.

For Aurora and Aria born at Hoag Hospital in Newport Beach we spent two days in the hospital for each of their births. The total cost was $22,000 for each baby. This was paid by our insurance which we paid something like $250/month for. For prenatal care we paid a $40 co-pay for each appointment and additional fees for glucose testing, blood tests and ultrasounds.

For baby Johnny we paid in cash for the preliminary blood tests ($350) and one appointment ($112) as well as one additional blood test ($119) in the States before picking up care in Estonia.

Interestingly, most Estonians (and even the woman doing the billing at the hospital) were shocked that anyone would have to pay for something so basic as childbirth. Estonia has a 10% flat tax that covers a socialized medical system which covers the entire pregnancy. However, I am not an official resident yet so I did have to pay. For prenatal care at a private clinic each appointment cost 42 Euros plus a total of about 60 Euros in blood tests and urinalysis. For my 8 day stay at the hospital the bill was 1,095 Euros. Rather unexpectedly, I found out that our travel insurance will cover the total hospitalization amount because I was admitted to the hospital under emergency conditions. So, for all of the care I received in Estonia I will have paid less out of pocket than I paid for the one initial blood test in the US.