Pregnancy can be a daunting experience for parents-to-be, but the Cayman Islands is lucky to have some excellent doctors, nurses and midwives who will help ensure your experience is a wonderful one.
You have two main options when considering your prenatal care and delivery. You can either choose to have your care and delivery through a private OB/GYN and deliver at the Cayman Islands Hospital or at Doctors Hospital, or you can go through the Health Services Authority (HSA), where your delivery at the Cayman Islands Hospital will be handled by the hospital's midwives, supported by the hospital OB/GYNs.
The private obstetricians (OBs) are all qualified to deliver routine obstetric care and some have additional skills in obstetrics and/or gynaecology. The care they provide is consistent with any developed country and the clinics are generally well-equipped, e.g. with modern ultrasound equipment.
To choose an OB, it is best to research them which you can do by reviewing Cayman Parent's list of OBYNs and/or ask your GP, and then visit your shortlisted candidates to find the one best suited to you. Some OBs do not charge for ‘getting to know them’ visits, but it is worth checking when making appointments.
You should look into appointing your OB as soon as you think you may be pregnant or even when you are thinking of trying, if your medical history may affect your pregnancy. You can expect to have your first scan at around six weeks.
Your chosen OB will guide you through your entire pregnancy and deliver your baby, supported by the resident midwives at your birth centre.
An alternative to a private OB is to opt for a midwife delivery through the Woman's Health Clinic at the Health Services Authority. You will then receive your care through a large team of midwives, who manage the prenatal care and deliver the baby, supported by a team of resident hospital OBs who are on call 24 hours a day should there be any problems. The midwives are highly qualified and trained to deliver babies.
Choosing midwife care is a lower cost option for having a baby in the Cayman Islands, while still offering world-class care. It’s suited to parents who are happy with, or prefer, a team approach, as opposed to having care led by the same physician throughout.
After your first appointment, OBs and midwives will typically see you every four weeks up until 28 weeks, every two weeks until 36 weeks, and then weekly until delivery, consistent with standard care in most developed countries. If issues emerge during your pregnancy, you will likely be seen more frequently. In some special circumstances you may have to go overseas before or after delivery for treatment, although thankfully such cases are very rare.
Early on in your pregnancy, you will be required to undertake some initial blood tests to rule out any infections or concerns. These usually include: full blood count, Hepatitis B screening, Rubella IgG screening, VDRL (tests for syphilis), HIV, ABO/Rh status. From nine weeks, you can also opt to have the NIPT (Non-Invasive Prenatal Test – a simple blood test) to screen for certain chromosomal and genetic conditions such as Down Syndrome. Your doctor or midwife will discuss this with you to help you make an informed choice, as well as seeking approval from your insurance company before conducting the test. Most insurance companies cover a portion of the testing fee if you are 35 years or older or if you have a medical condition warranting the test. Otherwise, you will be responsible for its cost if you choose to have it.
Between 18-23 weeks of pregnancy you will have a detailed anatomy scan of the baby to screen for congenital structural abnormalities.
Between 24-28 weeks you will be given the Glucose Tolerance Test to screen for Gestational Diabetes. It involves fasting before the blood test in the morning, then having a glucose drink, followed by another blood test an hour later. If your results show any cause for concern, you will be required to start controlling your sugar intake and may need further medical treatment, which can be administered in Cayman. In general, pregnant women should limit sugar intake during pregnancy.
Birth Plans & Paediatricians
As your pregnancy develops, you’ll want to discuss your birth plan with your OB or midwife, including your thoughts on pain relief during labour, to ensure your wishes are known. You will also want to choose the paediatrician who you’d like to care for your newborn. Cayman has both general paediatricians and some that are also qualified specialists in preterm or newborn emergencies and complications. Again, it is worth researching them, asking other parents or GPs, and visiting your shortlist. Given that infants can survive from 23-24 weeks gestation, some parents-to-be prefer to do this quite early in pregnancy. You may choose a private paediatrician or opt for the HSA paediatric team.
Birth Classes & Doulas
It’s recommended that you prepare for childbirth by enrolling in some pre-natal classes. You may also wish to employ a doula.
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Childbirth Classes, Doulas & Post-Partum Care.
In the Cayman Islands, all babies are born in hospitals. Home and water births are not currently offered. There are two maternity wards in Grand Cayman and one in Cayman Brac.
The Cayman Islands Hospital offers three single delivery suites, eight maternity rooms (three single and five double rooms) and is home to the only Neonatal Intensive Care Unit (NICU) on the Island. The standard of care is excellent.
Doctors Hospital offers the only private delivery suites on-Island. The suites have been designed for your comfort and your birth partner is welcome to stay the night.
Most high-risk pregnancies can be managed and delivered on-Island. The NICU provides excellent care for premature babies from around 28 weeks, or even earlier if needed. Sometimes it may be necessary to transfer the mum-to-be or the newborn overseas, usually the USA, for complex care. If the baby has been born, it will require an emergency passport to travel, and your own documents will need to be in order too.
Discuss with your OB which hospitals they can practise in. It’s worth touring your chosen hospital beforehand to familiarise yourself with the space, staff and amenities.
As most baby books will tell you, you don’t need to head straight to the hospital once you feel your first contraction. It is, however, advisable to discuss in advance with your OB or midwife when to contact them and how. Once you have made contact, be sure to follow their advice carefully.
When arriving at the hospital, head straight to the Maternity Ward. Don’t forget to bring your ID, insurance card if you have one and mask. Leave your hospital bag in the car, so that your partner or caregiver has both hands free to help you if necessary. They can retrieve it once you are settled.
Post Delivery Care
Once you have given birth, you will receive continuing care from the OBs, midwives and nurses at the hospital. At the HSA you will receive help with breastfeeding and caring for your baby in the 48 hours after delivery. The nurses will teach you how to gently bath your tiny newborn and how to put your baby in the car seat ready for discharge. The midwives from Women’s Health are also happy to make a home visit once you have delivered your baby, to help with any concerns or issues that you might be having. If you give birth at Doctors Hospital, you will receive a follow-up consultation to check on you and your baby's progress.
Length of Hospital Stay
How long you stay in the hospital is a decision both you and your doctor will make. Some women feel more comfortable with a longer stay, while others prefer to go home earlier. Most insurance companies cover two nights after a natural delivery, and three nights after a caesarean section (the period in labour is not calculated in this). Hospital stays are quite expensive, so check your insurance and plan accordingly. Mum will be discharged by her OB/GYN, while the baby is discharged by their paediatrician.