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Baring all at the OB/GYN

Sabine Devins · 2 Jun 2010, 16:52

Published: 02 Jun 2010 16:52 GMT+02:00

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Discovering how a foreign country ticks differently than your own can be fun part of living overseas, but doing it while naked certainly raises the bar a bit.

Back home in Canada, it took awhile to get used to the annual check-up that was required by my doctor for a birth control prescription. You lie under a paper sheet, look at the ceiling and five minutes later, you're done. Then I moved to Germany.

A "routine" check-up in a foreign land can be anything but routine. All of a sudden, you're dealing with a different culture and its particular quirks. I'm fortunate to at least speak German, since both of my parents are originally from Cologne. They moved to Canada two years before I was born and now my husband and I have done the reverse — even down to the having a baby two years after coming to Berlin.

Going to any doctor's office in Germany starts off with a stop in waiting room, where I've noticed every new person walking into the room greets the patients already waiting. If it's your first visit, you'll want to bring along a German-English dictionary for the medical history questionnaire. Even if you've found a doctor that speaks English, this questionnaire will be in German and the nurses might not be able to help you out. Once you get called into the doctor's office, you'll start with a quick consultation regarding what you're there for — whether its for birth control (Geburtenbeschränkung or the awful-sounding Antibabypille) or because — congratulations! — you've had a positive pregnancy test (Schwangerschaft).

When you move into the examination room, there is probably some sort of screen for you to undress behind, but don't expect it to be private. If you've lived in Germany for awhile you'll know Germans aren't particularly shy about nudity. After disrobing, you walk over to the doctor's chair in all your glory. This can disturb some expats on their first trip to a German obstetrician. Unlike a visit at home, I was not shielded from the sight of the examination by a paper towel. I sat in a chair and the exam began. Oh right. The chair.

While there is an examination table in most offices, for some visits you're in a chair specially designed for gynaecological purposes. You sit down and recline, but you're still face-to-face with the doctor, while all of those medical instruments remain in plain view. As is what he or she is doing down there. Oh — and German doctors seem to like to make conversation.

In North America, a normal pregnancy only gets the first ultrasound (Ultraschall) between 18 to 20 weeks, unless there's some risk. But at 14 weeks pregnant, I've already seen Baby Devins twice. The ultrasound is used in Germany as a diagnostic tool. Even with your bi-annual check up, you can expect to get a vaginal ultrasound to check for growths in the uterus. The first time to confirm the pregnancy at six weeks while the second was to make sure all is going well.

As a result, I know we're expecting just one baby and he or she is just fine. It's very reassuring — especially in your first weeks of pregnancy when all you have for "proof" is a positive pregnancy test and that odd feeling you can't shake. It's not uncomfortable (a pap smear causes more discomfort) and totally worth being able to see your little one for the first time — or, God forbid, get an early cancer diagnosis.

There is also a difference in care between private and public insurance holders. While doctors will obviously see patients holding either card, those with private insurance will have more ultrasounds as well as other tests that are covered by their insurance.

Story continues below…

Regardless of your insurance, during the first months of your pregnancy, the OB/GYN, or (Frauenärtzt/in), will expect to see you every four weeks. In the latter weeks, you'll see each other every two. But don't expect your doctor to be a familiar face in the delivery room. Most will take care of you throughout your pregnancy, but on delivery day, you'll be in the hands of the doctor at whatever hospital you choose and your midwife (Hebamme), whom you'll meet around week 30.

While North Americans such as myself might be a little shocked by the casual attitude toward waist-level nudity and vaginal ultrasounds, living abroad is about making adjustments to the local culture. Fiona Kamps, a German living in Vancouver, Canada, found herself equally flabbergasted when she had to visit the OB/GYN for the first time there. "It's so primitive," she said of her Canadian experience.

But those cultural differences are exactly what this regular column hopes to address. That way you can focus on the important things during your pregnancy in Germany - like whether you'll have to name your kid Karl-Heinz or Dagmar.

Sabine Devins (news@thelocal.de)

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Your comments about this article

18:31 June 2, 2010 by kbrauneis
From many articles I have read, and experiences I have had, pregnancy care in the US tends to be a little less involved or lackluster compared to other countries, my wife and I had our son in south america and well the Dr and his team were excellent with all the updates, and check ups and even took care of delivery , note he was her ob/gyn and a specialized surgeon. I think alot of it has to do with costs, and fear of lawsuits if anything goes wrong.
18:58 June 2, 2010 by hansestaat
The first time i went to OB/GYN after coming to germany for a general check up,i too had the same awkward exp. It was really embarassing. I never thought for a general check up i need to undress. I guess i wll just have to get used to the procedure :)
21:04 June 2, 2010 by dbert4
Maybe you should have arranged for the stork to deliver and saved your North American self the embaressment of doing it the old fashion way.
23:33 June 2, 2010 by MaKo
Dbert, maybe you should come back and comment on this story after you've done something as terrifying as giving birth in another culture.
23:39 June 2, 2010 by The-ex-pat
OBGYN.............can anyone say gynaecologist any more?
09:29 June 3, 2010 by DoubleDTown
What's "primitive" is the German fascination with psuedomedical "birth houses" and home delivery. After all, help is only an ambualance ride away.... (sarcasm) In my experience, women can find a soft, "homey" atmosphere in a hospital's delivery area and still be only a short run from the operating room and neonatal specialists/equipment.
09:35 June 3, 2010 by freechoice
my wife said she is not embarrased at all, and she is from Asia. German healthcare is awesome!!

anyway it's better to be safe than sorry...:D
09:38 June 3, 2010 by Arlete Soffiatti
I am 42 now and living in Germany with my husband and 5 year old daughter that was born in Brazil. My shock here is related to how cold a gynaecologist can be. When I decided to get pregnant again at the age of 40, she did a suposedly routine blood test. One week later , I received a letter urging for an appointment. She told me that based on an index (just one, despite the fact that there were others) in my test I would not be able to get pregnant naturally and If I really wanted to get pregnant "at this age", I should look for a hormon treatment. I hadn´t even had the chance to "try" getting pregnant because that was my first period after stopping taking the pill!!! I got so upset. However, I called my doctor in Brazil (who happened to be my surgeon for an endometriosis problem, my OB and my adviser, even being here in Germany). He told me to relax. My other hormon results were OK and there was no index that was definite on saying that a woman cannot get pregnant. 14 months later, here I am in my 10th week pregnancy!

Went back to the same doctor and it seemed that she wasn´t happy to know that I was able to get pregnant without any help (apart from my husband´s) .She then told me that my age was a concern and I should think of doing an Amniocentesis to detect Down´s Syndrome. I am not ignorant and know that there are other less invasive exams that can be done before this one takes place . I moved to another doctor and this new one seems to be nicer. Let´s see.
12:06 June 3, 2010 by snorge
I have been to a few Gen preacticioner doctors here in Germany a number of times. It seems to me some of these doctors are more intent on scaring the crap out of you than actually telling you what you really and CURRENTLY may be suffering from.

One in particular I visited was more interested in overcharging for tests (which (I found out later, were not really needed)and then explain to you how to bill your insurance company so it gets paid. She ran a normal blood test which cost me 1200 euro in the end. Never saying it is an expensive procedure - moste blood tests run between 50-100 euro. Having a second and thgrird opinion, I found the blood test was not needed for what I went to see the doctor about.

I reported her to the base authorities and had her removed from all base lists refering people to local doctors. I am also looking at how to report her to the German authorities, but that takes some time and effort not speaking german.

In short, don't put up with Doctors or nurses that want you to do what they tell you. Always ask for the cost up front and if it sounds far fetched or you don't feel it's right, get a second opinion. Not all German doctors are out to rip one off. But when they know you are American, some take advantage of that knowing. They do like to scare the crap out of you as well, so be sure to keep the conversation on the topic and not what the end result is as the subject of the story explained.
20:59 June 3, 2010 by Ayna
@Arlete Soffiatti. 42 is pretty late to be wanting a baby, so in the matter of

the doctor wanting to warn you about possible problems. e.g.Downs Syndrome

you cant blame her. She might have been rather tactless about it but lets face it, it

is truthful. You are going to be 62 when your child is 20. Thats a lot of stress for

a kid to have such a senior mother. You will be old when your kid is a teenager. I wish you the best. Teenagers hate their normal age parents.God help you.! and I mean

that sincerely.

To Snorge. Having been a victim of ER procedures in the USA I can tell you that you

are being still treated a lot better here in Germany than EVER in the US. Its up to your

Base Authorities to give you good listings. So dont blame the doctor who is on the list.

My tip. Learn the language. That is what I did.

And to DoubleDTown.Germans do not treat pregnant women as if they were sick. Having a baby here is a natural thing. If your pregnancy is proceeding normally there is no reason to have to go to a sterile clinic environment to give birth. I was born

at home on the kitchen table, and I was a healthy baby from the beginning.
21:04 June 3, 2010 by dluckygurl8
Just like freechoice's wife, I myself am Asian but I didn't find it embarrassing to bare it all at the OB/GYN (Frauenärztin). While it was a bit awkward during my first check-up at 6 weeks, I just thought that my doctor was just doing her job.

I agree with freechoice, German healthcare is indeed awesome! I've only been in Germany for a year and a half and I don't speak German very well (yet - i'm working on it!) but this (language and other cultural differences) did not hinder my relationship with my Frauenärztin (you build a relationship somehow as a result of the monthly visits and her concern for you and your unborn child - not including in-between visits when I had some complications with my pregnancy), my Hebamme (I attended pregnancy and birth preparation classes and she looked after my needs as well as my baby's even after birth!), the doctor who helped me deliver my baby as well as the hospital nurses.

Last July 2009, I delivered a healthy baby boy at 34 weeks. Despite the complications during pregnancy, the pre-term birth and my premature baby's 3-week stay at the Kinderintersivstation (neo-natal intensive care center), I never felt alone in this foreign land. My experience in terms of healthcare here in Germany is just amazing that it actually felt like 'home'.
21:59 June 3, 2010 by oliverh
Coming from Australia, my wife and I were amazed at how good the pregnancy care and birth planning/routine are here. There is a healthy lean towards home births and birthing houses. I strongly encourage anyone who thinks the US trend towards more and more C-sections is healthy to watch "The Business of Being Born" - there is nothing natural about it.

In fact, the US has one of the highest death rates during birth of mothers and babies. Compare that to the countries that actively encourage more natural methods away from hospitals - they have some of the lowest rates.
14:46 June 4, 2010 by dbert4
@MaKo - My wife and I have a 20 month old little boy, who was born in HSK Hospital in Wiesbaden. Just because you're from the US or even Canada your "kitty" isn't any different than any other womens. Just your mentality is different.

I can tell you lot's about OB/GYN care in a number of countries. The German care is excellent and the "Hebamme" system is awesome. Generally, there isn't anything like it in the US.

Or are you so terrified by the "giving birth in another culture" thing that you haven't been able to notice?
17:23 June 4, 2010 by mjm792
I noticed a dearth of comments from women and Americans but many complaints about these groups, so I am pushed to comment.

Sabine Devlin detailed the process for the many women who are curious. It is not a critique of the German system of health care. I am sure a German woman may be a little confused when left alone to undress at her American doctor's office, just as an American may be a bit confused when not left alone when asked to undress in her German doctor's office. Preparing for and giving birth is a very individual experience and women want to experience it in myriad ways. No method is better than another.

Also, there seem to be more stereotype than fact. The rate of C-Section is low. According to the New England Journal of Medicine, about 15% of births are voluntary C-Section and 15% are doctor-required C-section.

Also, the United States does not universal health care. Unfortunately, uninsured have poor pre-natal care and high rates of complications and deaths. Americans with health care have excellent survival rates and low rates of complications.

The United States has many options for pre-natal, delivery and post-natal care, including midwives and traditional hospital labor and delivery.

I warn against discouraging an able-bodied and responsible person from having a baby, even if that person is, GASP, 42.

I would suggest that people who have nothing to learn from these series of articles stop reading, instead of attacking the writer and the health care systems in the U.S. and Canada.
18:43 June 4, 2010 by ninebine123
I moved to Canada at the age of 23 and had my two children in Surrey, B.C. at age 26 and 29 with no relatives there to support me other than my husband. He was present the first time around. The second time around he stayed at home with our 2-year-old son, because there was no family to leave him with and we didn't want to impose on friends as I was giving birth on New Year's Eve. From what my two cousins, who were having babies (both times) the same time I was, told me and what I experienced in Canada, I would have gladly liked to be pregnant in Germany. I found the health care system over there very strange. I never saw a gynecologist until my 30th week of pregnancy and then again at 36 weeks, fully expecting him to deliver my son. As it happened, I had to be induced at 38 weeks but he was off duty and somebody else delivered our child (so much for Sabine Devins' comment "don't expect him to be a familiar face in the delivery room"). This exact same thing happened when our daughter was born three years later. But the most astonishing thing then was that I was basically "kicked out" of the hospital on day 2 after giving birth and day 1 after having a tubal ligation. Reason given by the nurse: it's your second child so you know what to do. The tubal ligation was done under general anaesthesia and anyone delivering a child at 7.30 pm and undergoing surgery at 8 a.m. the following morning under general anaesthesia would love to be pampered just a tiny little bit by German hospital staff! And the next-to-nothing aftercare.... I would have preferred having my babies here at home and for medical reasons I'm glad I could convince my husband to return to our native Germany. Having said that I must say that I loved living in Canada for a whole lot of other reasons, namely the friendliness of the general population, the easy-going and service-oriented shop assistants and of course the great outdoors. I'm sure we will move back there when the kids have completed their education and are able to support themselves whereever. By then I won't be having any more children and other than that the B.C. healthcare system is not bad.
20:58 June 6, 2010 by Arlete Soffiatti
@Ayna I am the youngest kid of a mother that was 36 when I was born and I am married to a man who still has his 84yo mother who gave birth to him when she was 42. We are all alive and well. By the way, really well in life and happy to have had the mothers we (still) do. To consider that a woman should not get pregnant because she is going to be old to deal with her adolescent children is sexism as well. There are many old men that are married to young women. Are there problems at this as well? This is just prejudice, mainly considering that it is worse not to have the possibility to give a good life to a child independently of the parent´s age. I know so many parents/women (even in Germany) that are young, can barely make ends meet, have a bunch of children who they can´t even feed and live off the social security system! That is a problem that people should be worried about, because we don´t know what kind of adult will come out of this situation. And as from diseases, they can happen to anyone, young, old, rich, poor. The risks can be greater (and I am aware of that), but this doesn´t give the right to a doctor to scare a patient. Their duty is to clarify in a way that doesn´t take the poetry of such a special time in a woman´s life . As I said, I am not ignorant. I know there are at least two other exams that can be done to detect Down´s Syndrome prior to the Amniocentesis. Our decision to have another child at this age was in order to not leave my first child as an only child.This would be a problem. At least for me because my husband and I come from two huge families and we know the joy of it.

Oh, I don´t have any complaints about the private and public health system in Germany, I just don´t like the experience I had with this doctor in particular. So I changed.
10:09 June 8, 2010 by MaKo
Dbert, please don't imagine that your assumptions give you any knowledge as to my "mentality." And I'll thank you not to make references to my business, either. That's just tacky.

I didn't say that I am presently terrified, but that giving birth in a foreign place is terrifying. That's something I know lots about, having had two children here.

My babies and I enjoyed great prenatal, delivery and postpartum/infant care here, and two miraculous and very safe, drug-free births (which I know is very, very lucky). Having received some prenatal care on Long Island, I appreciated my German doctor's directness. I had wonderful, supportive midwives both at home and at the hospital. Now, I can't imagine going through the entire process anywhere else. Nor would I want to.

But, the vocabulary for childbirth was never covered in my German education. So, yes, it is scary to come here and be at the mercy of good friends who are willing to lend you books and answer questions some might consider embarassing. I mean, "Mutterkuchen," for crying out loud! That's quite a linguistic difference, to say the very least.
10:20 June 8, 2010 by meandyou
@ Ayna

You obvious know what you say, but let me share with you my point of view:

1st regarding Arlette comment, and if i was this child she is caring, in 20 years time i would prefer to be 20 years old and have a mum with 62 but know i was wished and leave in a love and caring family then have 20 years old and have a mum with 40 that the only reason i exist was the fact that 20 years before none of my parents had a condom in the pocket.

2sd its clear that you adapt to this country (that is the way it should be!) and certain got the german attitude about telling all the others how bad they are and how good you and your life is.

I'm not english native, so please forgive any mistakes, and by the way I'm european, lived in 4 different EU countries and can tell you german doctors are certain NOT GOOD! The first thing they do when you call to set an appointment is asking if you have a public or a private insurance, what does this mean? Do you get a different treatment? That you will have your appointment quicker we already know!

And as you learn german, its a pity that you miss a big TV report about this subject last summer on the TV where all the german people i know and asked their opinion where ashamed with the system, obvious not all is bad, they do have the top equipment, but the problem most of the times is the attitude, they treat you as if you don't know anything (even know it's your body for i don't know how many years) and they are a superhuman that knows all, they are just a professional that studied the human body like i studied maths and they should realize that!

Last but not least, don't forget every pregnancy is different, like every person is different and we are all entitle to an opinion based on our own experiences and you should respect that!
11:30 June 9, 2010 by dbert4
@meandyou - You find the German doctors are "not good" because their office enquires about your insurance? I recommend that you don't EVER go to the States, where their only interest is in your ability to pay.

Unlike the NHS which you appear to be used to dealing with, the German public insurance pays a flat quarterly payment for services provided to their subscribers. The German Docs depend on private patients to subsidize the others.

So yes they are interested in your type of insurance, but that is rather common sense isn't it.
13:03 June 9, 2010 by meandyou

For your information i did use the german public insurance for 2 years and change for private after going to the hospital and get no one to explain to me the problem that my 9 month old baby had because my public insurance would not cover the doctors that would speak english....how about that

Don't worry if i ever go to the States i'm one of the lucky ones that will have a private insurance but everybody knows the US system, here we are talking about EU and what i believe is that everyone should have the same treatment and rights, no matter the social level.
16:02 June 9, 2010 by Arlete Soffiatti

I have both private and public insurance here in Germany, but I use the public for all the appointments and treatments I have, leaving to the international private one just what is not covered by the public. It is my option because I pay more for the public than for the private. I don´t know if doctors here receive less from public insurance. I know that the payment is not immediate. However, the greater number of patients is public. So, it is not correct to think that the private ones will pay for the public ones. Doctors are free to attend only private patients. If the public is not profitable, why do they keep on attending? Because is the greater source of income (of course is more work for less). So, they should not treat them worse. They depend on them as well.

I don´t complain at all about the public service I get in other doctors I visit, but at the doctor´s office I mentioned, she just ruled out a Toxoplasmosis exam because she said my plan did not cover it. I said: What is the problem? I can pay for it. And before doing it I was told three times that I must pay for it. And being pregnant, I saw three other patients that weren´t, being attended before me. I waited for more than two hours at lunch time. This is disrespectful. So, I moved to another doctor who respects me as a patient and not for how much she will get in her pocket.

@ Ayna

@Ayna You said :"Teenagers hate their normal age parents". Sorry, in which planet do you live in to generalize things like this? This is not a fact. Have you got a teenage child that hates you? What did you do or not do for him/her to hate you? Relationships have nothing to do with age but rather with education. And what is a normal age? And a normal person? Can you say that a disabled woman for example shouldn´t have a child? Don´t you know any person that at 62 is perfectly healthy and fit? And by the way 20 is not teenage anymore.

And, here in Germany, "teenagers" leave their parents home at 18 or less (even depending monetarily on them, what for me is nonsense). Oh, Celine Dion and Kelly Preston, who can have children in whichever country they choose and surely not on their kitchen table, are pregnant at 42 and 47!!! Remembering that one of them lost her 16y.o.child . Who can say they shouldn´t be pregnant at these ages?

You said: "I was born at home on the kitchen table, and I was a healthy baby from the beginning." Are you sure you didn´t bungeejump, the umbilical cord was too long and you hit the head on the kitchen floor?

Why do I care about these kinds of comments? Oh, yes, the hormons! Oh. I am pregnant at 42 and enjoying life as never! Sorry to disappoint you. I mean it and wish you all the best from the bottom of my womb.
16:59 June 9, 2010 by curlyhoward
What is the justification for the frequent ultrasounds during the pregnancy? No where has it been shown that such use of technology improves the outcome of a pregnancy. This brings up the question of overutilization of costly medical technology that cannot be justified in this economic environment. Furthermore, is the question of how a developing fetus is effected by being pounded by frequent powerful ultrasound signals. Does anyone know the possible long term effects of this practice? Sometimes, less is more and better!
17:31 June 9, 2010 by Arlete Soffiatti

18:07 June 9, 2010 by curlyhoward
To Altete Soffiatti

Thanks for the link. But the question remains unanswered. While an ultrasound or two during a pregnancy can be helpful, is it really necessary to have one every two weeks. Does this offer any additional benefit to the developing fetus, or is it used just because the technology is available and generates additional charges.
19:02 June 9, 2010 by Arlete Soffiatti
I know about 1 every month. When I was pregnant with my first baby, in the eighth month it was diagnosed that the umbilical cord was around her neck. So the doctor suggested one US and doppler every two weeks to check the vital signs and to see if the situation had changed. I thank him for this decision because otherwise I could have had a terrible surprise at the end, considering that some months earlier a friend of mine lost her baby in the operation table for the same reason.

The doctors nowadays are really worried about being sued for malpractice. Maybe the US are a way for them to be feel secure or it is just a money issue.
11:04 July 6, 2010 by bonner2010
Hi sorry not in line with the above topics, but does anyone know of child birth classes/Lamaze etc..in English in Bonn? or at the most Cologne ?..

Thanks a ton..:)
21:24 December 6, 2010 by Canuckgirl
I can completely understand where the author is coming from. I have had one child in Canada and one in Germany. The differences are immense. I think Canada's approach to pregnancy is that a pregnant woman is not sick. She is simply pregnant. They listen to the mother-to-be and if she has any concerns or unusual symptoms then they follow up. They do the necessary tests but it 's not over the top which I found was the case in Germany. There is definitely a feeling that something could go wrong any second and we better check your cervix and your blood EVERY single visit. I felt like a science experiment and finally decided to question some of the procedures. For instance, why do you need your blood checked every visit? It's to check your hemoglobin, which in fact is to check your iron levels. They were very pushy about having this done. I mean, the staff would chase me down and tell me I had to have it done. We don't do this in Canada every visit. You would feel symptoms of iron deficiency and then mention it to your doctor. Also, it is not proven that ultrasound is safe. We would do one in Canada at 18 weeks only. If they suspects something wrong then they would do another. I had at least 5 and in retrospect wish I had of refused some of them.

Someone had written that Americans have a lot of c-sections but I would also think that Germans do to. After 30 weeks you are put on the fetal heart rate monitor for a half hour every visit. How many unnecessary c-sections are done because of this?

And the chair.....OMG! It's very convenient for the doctor but how is a woman suppose to feel spread legged going up in the air above waist level whilst the doctor is talking away to you. Very uncomfortable. I guess this is where we differ culturally.

I was also very surprised at the midwives misconception of me because I was North American. They all thought I was American and I guess most of the American opt for c-sections and at the least, epidurals. That's what they told me. They didn't want me to have a labour and deliver room with tub or the birthing chair because they assumed I would get an epidural. That upset me. They are also not used to having patients involved in the decision making process of your own health care. They wanted to things like give me an enima which I refused. This actually made them mad and they started being rude to me. I'm in labour and they are being kurt with me. Needless to say, I am pregnant again and I have decided to have this baby in the Netherlands. They are on par with how Canada treats pregnancy.

I do not doubt that if there were complications that the Physicians would have been fantastic but if you having a normal pregnancy why all the hoopla?
02:17 December 7, 2010 by fairfaxco
@Arlete Soffiatti,


Congratulations! I am happy for you and your family and I hope you can ignore and forgive ignorant people that write or say comments that have absolutely no solid, rational ground.

We had a baby girl at 40 (in the USA) and she was (and is...) very wanted, loved and healthy. We are now expecting again, a few years later, and this baby will be born here in Germany - my husband is German.

The system IS different here - mostly positive - but for me, some negative experiences as well.

I too, changed Dr's in the beginning due to the callous attitude and treatment of the first Dr (mostly due to my maternal age).

I know that not all Dr's are like this and so I began my search again and did indeed find a friendly Dr who was willing to respect and accept some of my requests and also my choice to decline Amnio (I requested a diagnostic ultra sound instead).

And in my 5th month, I chose to have all my care done by a home midwife - very nice and understanding :)

Now, feeling very good (although VERY pregnant) 8 weeks from my delivery date, I am still folllowing up with midwife care and will deliver in a birthhouse or at home.

Thanks Arlete, for stating logic and truth ­ Wish you all the best on the upcoming birth of your baby!
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