Pregnancy in Macedonia

Generally, the pre-, peri- and postnatal care in Macedonia is not on a comparable level with any Western country. A national alliance of the White Ribbon Alliance for Safe Motherhood was founded last year and even granted EU funding - this speaks for itself - but soon stopped working due to political circumstances that I am not completely aware of.

Generally, DO AVOID PUBLIC HEALTHCARE INSTITUTIONS IN MACEDONIA. Hygiene is disastrous, medical care is based on personal opinion, not scientific evidence, medical staff is hired not on the grounds of qualification but personal connections.

As in any developing or transitioning country, private hospitals offer better medical care than state-run ones. Solid private hospitals in Skopje for pregnancy care and delivery are Remedika, Sistina and, the newest, Sveti Lazar. But remember, the staff is Macedonian and has been trained in institutions that are not recognized anywhere outside the country for good reasons.

Of the privat hospitals mentioned above, Sv. Lazar has become the pregnant expats´ favorite since it opened 2 years ago. If you look at the pregnancy monitoring programme on their website, you´ll see a number of "routine" procedures that are not performed routinely in your country of origin. The women I know who chose Sv. Lazar felt they were taken excellent care of, feeling that "more" is "better". As a healthcare professional, I wouldn´t agree. Too much business, too little ethics. My advice would be to obtain the (evidence based) national guidelines for prenatal care in your home country, make your Macedonian doctor stick to it, consult with your doctor at home to doublecheck anything they worry you with to make you buy even more exams, and don´t let them milk your wallet. Not because the procedures are expensive, but because it´s wrong.

Midwivery: Macedonia has abandoned the Yugoslav academic education programme for midwives shortly after independence 20 years ago for reasons that are beyond anyone. As the older midwives leave the active workforce without replacement, we see skyrocketing

C-section rates as a result. This is noted by the Macedonian Nurses´ and Midwives´ association (ZMSTAM), even though no official numbers exist. Whereever in the world babies are delivered by gynecologists whose time is expensive, as opposed to midwives, natural birth rates drop. This is an issue because C-section means double infant mortality compared to natural birth.
A member of Skopje´s International Womens´ Association for 4 years, I haven´t heard of a single foreign woman who gave birth in Macedonia naturally, not even in Sv. Lazar.
A C-section performed on a foreign private patient seems to mean too much quick and easy cash for the doctor to respect your wishes or your infant´s wellbeing. Once you´re in labour you´re in no position to argue with your gynecologist who tells you your baby´s in danger and C-section is inevitable. Even among my Macedonian employees, I know of only two who gave birth naturally while at least 25 delivered by C-section.

So. If you plan to have your baby in Macedonia, C-section is what you´re buying into. If you want a chance to deliver naturally, fly home.

Birth prep courses: hard to find.

Postnatal care (recontraction exercising, breastfeeding counselling): no such thing.

Neonatal care: While all of the hospitals mentioned above advertise fully equipped modern neonatal ICUs, I wonder who is qualified to treat critically ill infants there. Keep in mind that no formal training for nurses in pediatric intensive care exists. Also, given the small population of the country, the case numbers for such a highly specialized field can´t be enough to meet the learning curve for physicians and nurses that´s necessary to reach acceptable outcomes.

If you´re an expat and pregnant in Macedonia, my advice would be to fly home early enough to plan for a safe delivery.