Posted by: monsonmadness | October 17, 2012

Pre-natal care on a tiny Pacific island

I have been getting a lot of questions about the prenatal care down here and my plans for delivery. I have been in preparation mode for months but my posts always seem so long, that I will write about that in a separate post.

For now, here are some details about the hospital and the prenatal care that I am currently receiving.

* In all of the books that I have been reading to prep for my natural childbirth, the first chapters always talk about the importance of carefully choosing who will help you in labor and who will deliver your baby. Ironic really since you cannot choose an OBGYN here. I believe that there are five OBGYN’s here at the hospital. There are so many because this island is so “fertile” and delivering babies is the most common thing done at the hospital (other than treating dog bites!)

* If you sign up while in your first trimester, you can be put on the hospital’s prenatal program. This means that for a grand total of $20, you will be covered for all of your prenatal visits, and any ultrasounds, tests, lab work, and medication that you are lucky enough to receive. It also covers your delivery and stay at the hospital after the baby is born as well as the baby’s expenses. (Exceptions for this are a $100 fee if you have a Cesarean and extra fees if you or the baby stays longer than 24 hours). If you choose not to go with the program (many on the island choose not to have prenatal care because either they can’t be bothered going in for all the appointments, can’t get time off work or whatever), then the cost for appointments is $20 each time, same for ultrasounds, tests, and then $50 delivery fee. This will be the cheapest baby we’ve ever had, that’s for sure!

* Getting registered in the program was not as easy as filling out paperwork. You can only register for a couple of hours on a certain day of the week. My registration was hilarious. I had all my kids with me and didn’t know what to expect. It took several hours of getting blood work done, waiting to fill out forms, and being asked questions, and wasn’t fun at all. The best was when I was trying to tell the triage nurse about my medical history and previous pregnancies. I was telling her about my current medications and about having Hashimoto’s Disease. She had never heard of it. I tried to tell her what is was and she said, “What’s a thyroid?” Awesome. Instills a lot of confidence in the medical professionals here. NOT!

* The appointments are not really appointments. Basically, they tell you what day to come in, and then you sit there for several hours waiting for your turn in a small waiting room. You see whichever OBGYN is there on the day, and you’re out in a matter of minutes. Because of the inconvenience of this with home schooling my kids, I was fortunate enough to be able to choose another option…there is someone who I know who is a nurse practitioner here. She was willing to see me after hours to check on things, so I’ve been going in to see her. I’m in and out in 5-10 minutes which is much better than the alternative.

* If I was having my first baby here, I would be a hysterical mess (or on a plane out of here!) Luckily I know my own body and symptoms pretty well by now and I’ve been taking very careful steps to make sure I am doing what I need to. For example…obviously no endocrinologist here, and although Hashimoto’s is quite a common disease in the US and easily controlled with daily medication, there can be problems as thyroid levels change in pregnancy. My NP friend agreed to call in blood work for me every month, and so I have turned into my own endocrinologist and have been keeping track myself of what my levels are and whether they are getting close to the danger levels (they’re not, and if they were it would just mean a dosage adjustment)

* I also have to keep track of other important things that the rest of you may take for granted. For example, routine tests like the glucose test and Group B strep test are not done routinely here because they don’t have funds to test everyone and because it would overrun their lab, but since I have been positive for both of those in the past, I am keeping track of what week I’m on, and then when it’s time, I will “request/demand” those tests! I have not been weighed or had my blood pressure taken. Appointments involve measuring my tummy, and then listening for the baby’s heartbeat.

* At an early appointment, I was told that my blood results showed that I was positive for Hep B. Sounded weird because I knew that was something my kids had all been immunized for, and I thought I was up to date with my immunizations too. I was told I would need three shots before the baby was born. When I came home and checked my immunization record, sure enough I was not immunized. I googled Hep B and started to freak out at the seriousness of the disease that I supposedly had and the prognosis of it. SCARY! I got a copy of my lab results, got a friend to give me a second opinion, and guess what? I don’t have Hep B! Fancy that!

* I was really disappointed at my last appointment when I asked about the “standard” 26 week ultrasound that I had heard about. I was told there was no such thing, and I wouldn’t be getting an ultrasound at all. We really want to find out this time what we’re having since we don’t have ANYTHING here for a baby and would like to buy things online, get them shipped, and be prepared, so I”ll have to see if I can “request/demand” one somehow…

* That pretty much sums up my pre-natal care. Here is some information on the delivery and the hospital…

* A lot of my knowledge comes from two American women who have delivered their babies both on the mainland and here. I can trust their opinions because they have experienced it. One described delivering here as “brutal”, the other commented on it being like delivering in a barn, you can hear the roosters, see cats running around, mosquitoes, rat wire on the windows etc. However, they have both delivered more than one baby here, so it  can’t be THAT bad!

* They (and many others) have told me that the smartest thing to do is to labor at home, and then come into the hospital only when you’re ready to push. Ok….not sure I know exactly when that would be, don’t want to leave it too late. I live a 20 minute drive from the hospital and delivering in the car on the way to the hospital makes me nervous, but apparently the nurses are mean and yell at you if you scream, and they don’t give you painkillers anyway, so you might as well be more comfortable at home.

* Just like the clinic, you come in to deliver and just get whichever OBGYN is on call that day. No choice. No doulas, nothing, just you and one guest getting yelled at for crying like a baby! The doctors are also very c-section happy and almost 50% of births here are Cesarean. That is one of my biggest worries, that I take a long time pushing or don’t progress as fast as they think I should and they want to do a Cesarean for convenience!

* At the hospital here, you need to bring your own pillow, blankets, towels etc. The “newly remodeled” maternity ward has one shower to share, but you have to take all of your own things. Maternity rooms have three beds in each room (very different from the private suites I am used to with my own shower and a call button to get room delivery whenever I want! Michael and I even got a candlelight dinner in our room at our hospital in Utah)

* Oh yeah, the food. I used to love being in the maternity wards in California and Utah. I got whatever food I choose delivered to my room whenever I wanted. I took real advantage of that (hello? Considering what you pay for the hospital services in the US, I don’t think there’s anything wrong with ordering 6 or 7 meals a day!) I also stayed in the hospital as long as my insurance would let me (48 hours usually) because I had so many other “babies” at home, that I knew this would be the only chance I’d have to get some good rest before my real life set it! Not here! I plan on leaving as soon as I can walk! I’m not looking forward to being served Koko rice, vegetables and banana mush when THEY want me to eat, so I’m going to have to stock up on some snacks to take with me!

*OK, another novel, sorry. I’ll sign off with some pictures of the hospital and some information that I thought you might like that came directly from their website (and I was surprised that they had one, you can check it out here)

“The LBJ Tropical Medical Center, a 128-bed general acute care hospital, is the only hospital in the territory. The Medical Center provides a reasonable scope of general inpatient and outpatient services covering: medicine, surgery, obstetrics and gynecology, ear, nose and throat (ENT), eye, pediatrics, and renal dialysis. The LBJ hospital is the only clinical laboratory, diagnostic imaging, and outpatient pharmacy services in American Samoa.”

“Television and radio are allowed as a cost of $5.00 a day. Earphones should be used, and the volume turned very low. The security guards will make rounds at 9pm to assure that all TV’s have been turned off.”

“The hospital will provide three meals a day. We ask your assistance in keeping your bed clean and clear of food at all times to control pests in the hospital. Care-takers are asked to have their meals in the cafeteria or waiting areas outside on the benches provided. There is refrigeration in the patients’ wards for beverages, but storing of food in the room is discouraged.”


  1. Wow, that must have taken a while to type out. Very interesting and I’m sure your friends in Utah will be squirming at the thought of the conditions in American Samoa. As you say, cheap baby but I’m sure you’d rather have a few more mod cons, like painkillers! X x

    Sent from my iPad

  2. Oh wow. What a…different..experience you are, and will, have!! I know you will read and research and be very well prepared, so I hope that everything goes along with your well laid out plans!! You will do great!

  3. Wow! It would be hard not to have a choice as to the level of care you receive. I am ALL for no interventions for a normal pregnancy, but I always require an ultrasound–hopefully you can get one soon. Good for you for keeping an eye on your levels and recognizing what you need. Too bad your NP friend can’t just deliver the baby at home–sounds like it would be less stress. Hopefully the rest of your pregnancy goes without a hitch!!

  4. Have you considered a home birth? With the conditions at the hospital and unfriendly staff, maybe it would be a better option? It doesn’t sound like you will get painkillers anyway and you know how to give birth. A 50% c-section rate scares the holy-moly out of me! Unsanitary hospital and a “convenience” major abdominal surgery! Scary!

  5. I am all for ultrasounds!!!!! It is so much more than finding out the sex of the baby. It was an ultrasound that allowed us to find out what was wrong with Robyn so she could be monitored during my pregnancy and have the neonatal unit on call for when I delivered. It could have been fatal for her to have been born without the doctors knowing what was wrong.

    With Kaiser Permanente who ever is on call is who delivers your baby. I was fortunate that I was a scheduled induction so I scheduled it when my doctor was on call. Turned out to be a huge blessing!

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