Angloinfo Text_Having a Baby in Indonesia
Having a Baby in Indonesia
Maternity Healthcare in Indonesia
The Public System
Prior to the 1980’s, Indonesia’s professional maternity health care system was extremely limited. Women gave birth as they always had, sometimes with the aid of a midwife but very rarely with any access to a doctor, health facilities, or a hospital. This also applied to prenatal, perinatal, and post-natal care of infants. Immunization programs didn’t exist in many parts of the country. Vaccine stocks were insufficient. Rural Indonesia was almost totally underserved. The result was that maternal and infant mortality rates were both very high, as well as child mortality for children up to age five.
In the last thirty years the Ministry of Health has committed steady planning and funding for the establishment of professional medical help to pregnant mothers as well as infants. The country’s MCH, or Maternal & Child Health Care system is referred to as: Kesehatan Ibu dan Anak/Keluarga Berencana (KIA/KB).
Aside from building and equipping medical facilities, the emphasis on professional care for the KIA/KB has been on the regional training of midwives to help assist pregnant women from early pregnancy on through to post-natal care. This is organized at the village level and successful implementation requires community volunteers.
The public health system has seen great progress. As poverty and underdevelopment still mars Indonesia’s future prospects, much more remains to be done to provide minimal service for the population as a whole. Professional staffing continues to be a major impediment. The country has yet to train enough doctors or pay them a decent wage. Their numbers are inadequate to provide for Indonesia’s fast growing population that is now fourth highest in the world. Attracting doctors into remote areas continues to be difficult. The doctor-per-population ratio is six times greater in metropolitan areas as in rural. The government has yet to be able to train and place medical professionals in all the tens of thousands of remote locations that make up greater Indonesia.
All factors taken into account, human resource issues affect the health of mothers and their babies most.
MCH- The Major Public Program Providers
Indonesia’s public health system is structured and functions differently in rural areas versus urban.
RURAL AREAS
The goal is to develop health centers at the village, sub-district, and district levels, as well as in the metropolitan areas. General care is provided in the villages, and more specialized or emergency care at the sub-district or district levels. Sometimes those systems of care overlap when a village serves as the district seat. Seats of governments always offer more public services, including medical.
The following public programs, health centers, clinics, and hospitals provide MCH care:
In an urban center, the Rumah Bersalin takes the form of the maternity ward in a general hospital.
MIDWIFERY
Midwifes and midwifery have been central to the birthing process in Indonesia for centuries. That tradition has been readily adopted into the government program as perhaps the cornerstone of maternal care for millions of pregnant women living in rural Indonesia.
Many Indonesian women still use midwives and prefer home births. Midwifes also work in clinical settings. They must be licensed (SIB-Surat Izin Bidan) in order to work legally. When the mother is in labor, the midwife needs to make sure that the woman’s doctor is apprised of the situation and can be reached if a problem arises. They must also make sure there is a way to transport the mother to an emergency or examination room is needed.
The quality of midwives as trained and licensed by government programs is uneven. Their numbers as distributed across Indonesia are uneven as well.
URBAN AREAS
Delivery of urban public health care is much more centralized than in the villages. Multiple-services are found grouped together in the general hospitals. Lab work, clinics, doctors, midwives, maternity wards, pharmacies, in-patient, out-patient, intensive and emergency care are often all located in one complex. The number of public hospitals in any given city varies across Indonesia. Developed areas such as Bali and Jakarta have many to choose from, but outside of major metropolitan areas, that is rarely the case.
SURGERY
Common procedures such as Caesarian section are routinely performed in a rural setting. In case of serious surgery, it will likely be referred to an urban hospital.
VACCINATIONS
Both rural and urban areas are generally well-stocked with vaccines. Vaccination programs are long standing and most babies born today in Indonesia are administered a full schedule of vaccinations according to national health standards. (See below for more information).
HEALTH CARE EDUCATION
Biology, health, anatomy, and nutrition are under-developed curricula in Indonesia’s school system. KIA/KB does provide prospective mothers and fathers with a MCH book as available for free at designated health centers. Better developed district health programs sometimes offer information and classes for prospective parents.
MCH- PRIVATE CARE
Private maternal and child health care is rarely found in rural areas, but can be prevalent in urban settings. All the services listed above as found in public hospitals are available in the private sector, though sometimes not under one roof. Labs, clinics, and private doctors’ practices are numerous in big cities. Private maternity hospitals are found in the most developed and populated areas. This includes maternity clinics that work in conjunction with private hospitals which are used only at birthing time or if an emergency crops up.
MCH and the Foreign Resident
First of all, if a foreign resident chooses to have a baby in a rural setting, then the services outlined above as serves Indonesian women will be available to the foreigner as well. The only difference may come in the cost of care.
The balance of this paper will focus on what is the overriding norm: Foreign women seek maternal care in developed areas with an established track record of safe and high quality options.
WEIGHING FACTORS FOR BIRTH INSIDE OR OUTSIDE OF INDONESIA
Statistically, the larger percentage of foreign women who are living in Indonesia while pregnant choose to either return home for the birth, or travel to ASEAN hospitals outside the country. Singapore is the preferred destination as it is close and the quality of medical care rated highly. (See more below) Thailand is known for its good medical care, too.
Many pregnant women, their husbands and families are not satisfied with Indonesia’s health care standards and express fear concerning the consequences of choosing to have a baby in Indonesia. Lacking standards are an important part. This includes the perception that Indonesia has poorly trained medical practitioners, ill-quipped hospitals, scant specialized treatment, and inadequate emergency services. Hospital nursing staff, too, is sometimes criticized for less than personalized care.
But selective choice can overcome many of these concerns. External factors, though, carry equal weight in making this critical decision.
MEDEVAC
For instance, if a new born needs medevac out of Indonesia, it is not always possible. If available it can be dangerous. There can be bureaucratic complications. Immigration authorities might deny a request because the baby has no passport. As for the mother, it is reported that mothers in labor are denied medevac services. It is considered too dangerous.
BLOOD TYPE
Foreigners with blood that is Rh negative are at a disadvantage. Their baby will carry type negative and if a blood transfusion is required, it might be difficult finding any available in Indonesia’s blood banks.
PRENATAL TESTS
During the first trimester of pregnancy, women commonly have a series of pre-natal tests taken to determine whether their baby has any problems or carries a disease such as Down syndrome. The quality of these tests as well as their interpretation is questionable in Indonesia. Many women have complained of Indonesian doctors finding both false positives and negatives. For that reason, some women will fly to Singapore to have these tests taken.
TRAFFIC
Traffic is so bad in Jakarta that one must consider the liabilities of getting a mother in labor to the hospital in time, or transporting a sick mother or baby to specialized treatment facilities in case of an emergency. Traffic in Bali is reaching crisis proportions as well.
MAKING THE CHOICE FOR AN INDONESIAN BIRTH
Despite these drawbacks, there are a significant number of mothers and fathers who decide to have their baby born in Indonesia.
Most foreign women choose Jakarta as the preferred setting. The perception is that Jakarta offers the best in Indonesian MCH. Certainly it offers the most choice. Jakarta also provides the widest range of specialized medicine and medical treatments available in the country. If there were to be an emergency for either baby or mother, Jakarta would offer the best chance at getting the proper care.
Maternity Leave
One piece of good news for foreign workers in Indonesia: Indonesian law mandates businesses give three month paid maternity leave to female workers. This does not extend to fathers. Is this paid maternity leave, do you have a choice of when to take it? For example do you have to take 2 weeks before and 10 after or can you take it all after the birth?
SEE: http://www.asianfoodworker.net/maternity/mp-law-seasia.htm
Making the Right Choice
Word-of-mouth is the time-honored tool for choosing the right doctor and hospital. The expat community in places like Jakarta and Bali are in close communication when it comes to important matters such as maternal care. Pregnant women who are foreign residents reach out to others in the same position and ask for advice. Social networking on the internet is becoming increasingly important, too. Expat forums may not give expert advice, but they are a good starting point for many.
Home versus Hospital Birth
Home birth is perfectly legal in Indonesia, and as mentioned many women choose this traditional method. This applies to both urban and rural areas. A foreign woman would likely need to find a good midwife and make proper arrangements with a doctor in case emergencies arise.
If you choose to have a hospital birth
Which comes first- choosing a doctor or a hospital?
The general rule in Indonesia is the following: if you choose a doctor, the choice for the hospital will already be made for you. As in many countries, Indonesian doctors are associated with one hospital. If you contract a doctor’s services, that doctor’s hospital will become the place of birth.
But this is not always the progression in Indonesia. Often foreign residents who are prospective parents choose the hospital first, and search for a recommended doctor working there. A lot of the concern with giving birth to a baby in Indonesia rests with the quality of hospital care, so questions about the best hospital are more frequent than about the best doctor.
Greater flexibility comes with doctors who work in clinics that are able to contract out birthing services in several hospitals. Due to this as well as other considerations, international private clinics are popular choices. Most are foreign owned and their services cater to an international clientele. Since only Indonesian nationals can practice medicine in Indonesia, such clinics also offer foreign doctors as on-staff consultants. Telemedicine appointments provide another option for consulting with foreign doctors. Private clinics are dedicated to monitoring the pregnancy closely and will help guide the mother along if decisions pertaining to specialized care becomes an issue.
As for the choice between public and private, in Jakarta there are a both highly recommended public and private hospitals. Some are general hospitals, and others are specialized for maternal and child care. (See below for Jakarta and Bali listings)
More about Choosing a Doctor
Many foreigners naturally seek out an English-speaking obstetric-gynecologist with a quality reputation. Finding a clearing house for such kinds of information is extremely difficult. Word-of-mouth is how it is most often done in Jakarta and Bali. For foreign workers, they will network for referrals at the work place. There is always the possibility of picking up a referral from a foreign embassy or consulate in either Jakarta or Bali. As mentioned, expat internet forums are increasingly useful.
Many married couples go directly to a hospital they are considering and ask to meet with doctors on staff who speak English. For the private international clinics, the Indonesian doctors there must be able to speak English. This is one of their selling points.
Good English-speaking obstetric-gynecologists are rarities in Indonesia, even in larger cities. It is only in Jakarta and Bali that a real choice exists.
More about Hospitals
Visiting a Hospital- What to ask for
Married couples looking for a birthing hospital [you refer to married couple a lot – are there any problems that may be encountered by unmarried couples or even single mums?]
An astute and apt observation, Catherine- maybe the use of married couple was a bit subliminal- but it was more in an effort to be inclusive of both “father and mother”. “Prospective parents” is an inclusive term, and maybe we should choose that. To answer your question, a foreign woman who was giving birth out of wedlock would most likely not encounter problems in terms of receiving equal medical care- especially in developed, metropolitan areas. Most foreign women have the means to buy quality care, and if you pay a premium, you get what you pay for, regardless. The other option is to have the baby out of the country- and that might well be the decision taken.
In a rural area a single, foreign mom might be socially ostracized, especially if the father was an Indonesian living in that same village. I shudder to think, really. That might be considered an extreme case scenario. Again, I think most women in that situation would simply find safe haven somewhere. Birth out of wedlock often brings great shame not only to the parents but to the extended family’s involved. It’s scandalous. Mixed couples find themselves involved in this kind of situation- absolutely. Often times they are forced to either marry or flee. In fact I met one American woman today at the immigration office who left with her Indonesian boyfriend to have their baby in Malaysia. Her story happens to be a good case in point.
should ask to meet medical staff- doctors and nurses, both. Ask specifically to meet a doctor who can speak English. Also ask for a tour of the facilities: including the nursery, maternity ward, and delivery room. Check to see if emergency units are available such as neo-natal intensive care. This is enough to gain a tangible sense of the hospital’s comparative quality. Personalized care varies sometimes drastically from hospital-to-hospital. Pay close attention to the nursing staff and their interaction with patients.
Ask specific questions about hospital protocol surrounding birth. Who are how many are allowed to attend a live birth? Will the father be allowed? Will a pediatrician be attending the delivery to immediately check on the health of the new born? Are anaesthesiologists on call 24 hours a day if a Caesarian section, epidural, or episiotomy is required?
Find out what the routine procedures are during preparation for the birth. For instance, some hospitals perform a routine pubic shave. Some procedures are not up for negotiation- the patient has to accept them. Find out what those non-negotiables are.
Chances are many of the details won’t be enumerated and handed over to you upon request in the form of a list. You will have to create your own list and ask your own questions.
After birth, most hospitals routinely have the mother and baby stay in the hospital for two or three days.
Tradition of After-Birth
Many foreign women and their husbands are surprised to see that the after-birth is preserved and given to the couple after the baby is born. It is traditional for the parents of a new born to bury the after-birth as part of a ritual. As a source of nutrition for the baby, the placenta is considered the baby’s guardian and is buried in proximity to the baby as it helps insure the child’s safety. A ritualized burial is also a sign of respect given to the after-birth, which is considered a living thing. The burial usually takes places in the garden next to the family’s home.
Registering your baby’s birth
After the baby is born, one of the parents will have to register the baby’s birth with Indonesian immigration. Foreign residents with KITAS will need to apply for the baby’s KITAS while simultaneously processing its passport in the embassy or consulate of the home country.
Primary to both these procedures is the birth certificate. The hospital will issue the parents one after the birth. For a fee, the records department of a good hospital will help clients with immigration processing. It is very important to ask the records department for two birth certificates- one in Bahasa Indonesia (which is provided by default), and one in your own language. The home country embassy will request an authorized copy in translation.
Report the baby’s birth to immigration within fourteen days after. Here are the documents needed: (originals + two or more copies of all) Who can report the birth?
One or both of the parents, but paid brokers/agents could just as well. Agents are ubiquitous in many immigration offices. It is not true of all- but many. Sometimes employers will do the immigration processing for employees. Bigger companies especially extend those courtesies to valued employees.
Yes- good point- this could be a big problem. If the parents were both Indonesian, they would experience trouble getting a birth certificate for their baby. Having a baby outside of marriage is very, very frowned upon in Indonesia. Under the circumstances, immigration would put a lot of pressure on a foreign or mixed couple to marry. Without a marriage, no birth certificate. Without a birth certificate, maybe no visa, and possibly problems with the home country as per getting a passport. In any case, a foreign couple who were residents but not married might be forced to leave the country because of their inability to get a residential visa for their baby.
With the baby’s birth certificate in hand, apply for the baby’s passport. This should be done immediately after the baby’s birth.
Once you have possession of the baby’s passport, report back to Indonesian immigration and apply for the baby’s KITAS. This must be done within a 60 day period after the baby’s birth.
Are there any rules on surnames? Can the newborn have the surname of either parent or both surnames? I don’t know the answer to this, but I have never read any testimonials or talked to anyone who ever had such a problem. My sense is that this is not an issue for a foreign couple. For a mixed couple, the hospital might insist that the baby take the father’s surname. But in many places in Indonesia, surnames aren’t even used! So that confuses things!
REGISTERING BIRTH IN SINGAPORE
If a foreigner decides to give birth in Singapore, the following information details how to register:
ICA Immigration and Checkpoints Authority
Register Birth
http://www.ica.gov.sg/page.aspx?pageid=144&secid=143
Visitor Seeking to Deliver a Child in Singapore
http://www.ica.gov.sg/page.aspx?pageid=237&secid=338
VACCINATION SCHEDULES
Once the baby is born, the pediatrician will begin administering and tracking the new born’s immunization schedule.
As required by Indonesian Ministry of Health, the following are required in Indonesia:
Immunization Schedule
Birth HB 0
Month 1 BCG, Polio 1
Month 2 DPT/HB 1, Polio 2
Month 3 DPT/HB 2, Polio 3
Month 4 DPT/HB 3, Polio 4
Month 9 Campak
HB: Hepatitis B
DPT: Diptheria-Pertussis-Tetanus
BCG: Tuberculosis
Polio: Polio
Campak: Measles
Detailed in Buku KIA- Book of Maternal and Child Health, which can be downloaded:
http://www.depkes.go.id/downloads/jica/kia.pdf
CDC-U.S.A. Immunization Schedule
Atlanta, Georgia’s CDC, or Center for Disease Control and Prevention, provides detailed immunization schedules as required in the United States for children of all ages. It is an expanded schedule as compared to Indonesia’s. The schedule can be downloaded at the CDC site:
Recommendations and Guidelines: 2010 Child & Adolescent Immunization Schedules
http://www.cdc.gov/vaccines/recs/schedules/child-schedule.htm
Consult with your Indonesian pediatrician if you are interested in an extended vaccination schedule.
2010 CDC Immunization Schedule for download:
http://www.cdc.gov/vaccines/recs/schedules/downloads/child/2010/10_0-6yrs-schedule-pr.pdf
FURTHER INFORMATION
Maternity Hospitals and Medical Centers
List of Maternity Hospitals & Medical Centers with Recommended Maternity Departments as located in Jakarta:
JAKARTA
Brawijaya Women and Children Hospital * recommended
Jl. Taman Brawijaya, No. 1, Cipete Utara
Tel: 721 1337
http://www.brawijayahospital.com
Medistra Hospital * recommended
Rumah Sakit Medistra, Jl. Jend. Gatot Subroto Kav 59, Kuningan
Tel: 521 0200
http://www.medistra.com
Pondok Indah Hospital * recommended
Jl. Metro Duta No. UE, Pondok Indah
Tel: 769 2252
http://www.rspondokindah.co.id
Bhakti Yudha Baru Hospital
Address: Jl. Raya Sawangan
Phone: (021) 7520082
Fax: (021) 7775862
International SOS Clinics
There are many located in Jakarta. Consult their websites for details:
http://www.sosindonesia.com/Default.aspx?tabid=54
http://www.internationalsos.com/en/
BALI
Hospitals & Medical Centers
http://mydirectory.weebly.com/directory---indonesia---bali---medical---hospital--medical-centre.html
RSB. Kasih Ibu / Maternity Hospital, Bali
Jl.Teuku Umar No.120
Denpasar, Bali, Indonesia.
Tel : +62 361 223 036, 237 016
RSIA. Puri Bunda / Mother & Child Hospital, Bali
Jl.Gatot Subroto VI No.19
Denpasar, Bali, Indonesia
Tel : +62 361 437 999
Fax : +62 361 433 988
Klinik & Rumah Bersalin Griya Medika / Clinic & Maternity House, Bali
Jl.Raya Sesetan No.333 (sebelah AL Benoa)
Denpasar, Bali, Indonesia
Tel : +62 361 725 245
Klinik Umum Bersalin Mesari Usadha / Maternity Clinic, Bali
Jl.Intan LC II, Gatot Subroto
Denpasar, Bali, Indonesia.
Tel : +62 361 749 253
Prima Medika Hospital
Jl. Pulau Sarangan
Denpasar, Bali, Indonesia
Tel: 62-361-236225 Fax: 62-361-236203
rspm@indosat.net.id
http://www.primamedika.com/kebidanan.htm
BIRTHING CLASSES & POST NATAL CARE
JAKARTA
Jakarta Women and Children Clinic (child birth classes)
Jl. Prapanca Raya No. 23A,
Jakarta Selatan 12160
Tel: 7279 9911
Bikram Yoga, Jakarta
Yoga classes for expectant mothers
http://www.bikramyogajakarta.com/prenatal.htm
RS Mitra Kemayoran (RSMKK) (Hospital in Kemayoran, Jakarta)
Prenatal Classes
http://www.tabloidharapanindah.com/?tabloid=2&idart=189
ICAC Counseling Office (family counselors for expat families)
Jl. Kemang V, No. 20 AA Kemang, Jakarta Selatan
Tel: 717 0010 or 718 0010
Email: icac@cbn.net.id
www.clickingdistance.com/info/
International SOS Clinics
Many ISOS clinics are located in Jakarta. Some offer birthing & natal care classes. Contact for details:
http://www.sosindonesia.com/Default.aspx?tabid=54
http://www.internationalsos.com/en/
BALI
CHC Pregnancy Care Program
http://www.chcbali.com/mothers-babies/
Chiropactic Prenatal Care
http://www.chiropractic-asia.com/index.php?p=44604
Bumi Sehat Clinic & Foundation International *highly recommended
World acclaimed community maternal & child health center
http://www.bumisehatbali.org/