Experiencing pregnancy abroad often brings surprises. The treatments, habits, and medical approaches that catch expatriate women off guard are usually those they're discovering for the first time, such as new ways of thinking, cultural traditions, or unfamiliar healthcare practices. Some of these customs have deep cultural roots, while others prompt debate among medical professionals. Here are five countries and five very different approaches to pregnancy.
The Netherlands: Home birth as a standard option
The Dutch approach may take aback expats familiar with a highly medicalized pregnancy journey. In the Netherlands, giving birth at home isn't viewed as an alternative or unconventional choice (as it often is elsewhere). It's a mainstream option, actively encouraged by the government whenever conditions are considered suitable. Because home births are common, epidurals are rarely used in fewer than 30% of births.
For Dutch health authorities, the absence of a heavily medicalized environment doesn't equate to poor care. Quite the opposite: midwives and healthcare professionals are known for delivering high-quality support, whether at home or in clinical settings. If complications arise, the pregnant woman is transferred immediately to the nearest hospital. The hospital isn't considered the default place to give birth; it's the place you go if a problem arises.
Home births are losing ground to hospital births, however. Midwives point to increasing skepticism among certain medical professionals. Still, around 13–20% of Dutch women give birth at home, according to the Royal Dutch Organization of Midwives. This is far higher than in South Africa (4%), Turkey (2%), the United States (1.3%), or Germany (1.3%). In many European countries, home births account for fewer than 1% of deliveries (Spain, Italy, Poland, Greece…) or around 1% (Moldova, Austria, France, Sweden, Latvia, Portugal).
Expats in India, Morocco, Peru or Indonesia are more likely to hear about home births too: in these countries, the practice represents between 14% and 39% of all births.
Hong Kong: The debate over exercising during pregnancy
In Hong Kong, some pregnant women are still advised to avoid all physical activity during pregnancy. Exercise is sometimes perceived as potentially dangerous for both mother and baby. Until a few years ago, even some doctors delivered this message.
In many other countries, medical opinion differs widely: exercise isn't discouraged—in fact, it's often recommended as a valuable non-pharmaceutical “treatment” for both mother and child, provided it follows medical consultation and professional guidance.
Many Hong Kong practitioners now agree with this approach. Expats in Hong Kong will see that combining pregnancy and exercise is entirely possible. The key is choosing activities wisely. First, the mother must have no medical contraindications. Then, she should follow her doctor's recommendations regarding frequency, duration, and the stage of pregnancy.
As in other countries, high-risk activities are discouraged: contact sports (basketball, football, rugby, martial arts), any sport with a significant risk of abdominal trauma, and sports with a high risk of falling (horseback riding, skiing). Cycling in heavy traffic and mountain biking are also discouraged due to uneven terrain and the risk of falls. Caution is advised with racket sports and running—again, because falls are unpredictable.
Gentle, low-impact activities are recommended: swimming, water aerobics, walking, pregnancy-adapted gentle gymnastics, and muscle-strengthening exercises.
United States: Prenatal vitamins as routine care
For expats unaccustomed to taking supplements, this practice may come as a surprise. The United States is often portrayed as “the land of dietary supplements,” but Italy, Germany, the UK, Japan, France, and Canada are not far behind. In these countries, supplement-based treatments are widespread. Some are prescribed by doctors, while others fall under self-medication—a practice that requires caution.
This may be why prenatal vitamins receive such particular attention. These supplements are specifically formulated for pregnant women and shouldn't be mistaken for standard adult multivitamins. Women who frequently consume supplements for themselves don't always take the same approach when it comes to pregnancy.
In the US, prenatal vitamins are extremely popular. Typically containing folic acid (B9), B3, iron, omega-3 fatty acids, vitamin C, calcium, and more, they're available over the counter almost everywhere. Of course, medical advice is essential before taking them. Prenatal vitamins are meant for women with actual deficiencies. Health professionals regularly warn about potential risks, as some supplements may contain toxic metals or compounds harmful to the fetus. Incorrect dosing can also lead to vitamin overdose.
Hence, the need for medical supervision. In most cases, a balanced diet and appropriate physical activity are sufficient for both mother and baby.
Japan: The pressure of weight monitoring
Mindsets are slowly changing, but some practices remain deeply rooted. In Japan, pregnancy still often goes hand in hand with strict weight monitoring, which is much more stringent than in many other countries. Some Japanese doctors limit weight gain to no more than 1 kg per month, with a maximum of 10 kg for the entire pregnancy. This focus on the “slim pregnant woman” mirrors the broader cultural emphasis on thinness. Excessive weight gain is frowned upon—even during pregnancy.
A doctor or midwife may even prescribe a diet if they feel the woman has gained “too much.” Many expat women describe appointments as stressful because of the constant focus on weight. Some insist on asking questions or challenging their doctor's guidance, which can unsettle Japanese practitioners who are unaccustomed to such assertiveness.
The focus on weight doesn't stop after birth. Instead of immediate skin-to-skin contact, babies are often weighed first. They are weighed again at every feeding to ensure they don't become “too big.” Doctors who follow this strict monitoring sometimes use questionable arguments. The problem is that this obsession has spread among many pregnant women and mothers, raising genuine concerns among health experts, who note a trend toward “smaller” Japanese babies.
Another practice increasingly criticized by women is the near absence of epidurals. Expensive and seldom covered by insurance, epidurals remain uncommon in Japan: only 13.8% of births in 2024 used one, compared with 77% in the US (Japan Society of Obstetricians and Gynecologists). Advocates of natural childbirth argue that pain strengthens the bond between mother and child.
To encourage epidural use, and in hopes of boosting the birth rate, Tokyo's authorities have introduced a “special epidural subsidy.”
Philippines: Kind words for baby's well-being
Kind words should ideally guide every conversation, but in the Philippines, they become an intentional practice among pregnant women. The idea is simple: avoid speaking ill of others to ensure the baby's healthy development. At first glance, it may be hard to understand how negative speech could hinder a baby's growth. But strong emotions, like anger, resentment, irritability, and bitterness, can have real effects on a pregnant woman, increasing stress and potentially impacting the baby.
