Across the street from Toronto’s Scotiabank Theatre is an aptly named bar, Blessing in Disguise. Its neon sign was what I first noticed stepping out of a Toronto International Film Festival screening, realizing I could no longer ignore the fact that I was late. I needed a pregnancy test. The nearby Shoppers Drug Mart was open, and I bought and hid the two-pack in my sweater, as if my contraband was the most coveted item on the midnight streetcar ride home.
***
I stared at the French word “enceinte” and the two undeniable lines that accompanied it. Emergency contraception had failed. Less than two weeks after entering Canada for a six-month study tour, a visitor with no travel health insurance, I had an unexpected pregnancy to navigate.
For a day or two, I sat alone with the news, taking no action and feeling strongly that I would fulfil this lifelong wish of motherhood, albeit a bit sooner than intended. I was juggling new journalism studies at UofT when all I wanted to do was eat and sleep all day and succumb to the basic physiological needs of the first trimester.
The first places I called after telling a friend were clinics in the city, including Planned Parenthood. It was a place I knew welcomed all in the United States, where I’m from, at least until recently, as they continue to shutter across the country. To my surprise, this centre only served patients aged 13-29, so being 32, I was out of luck. They pointed me in the direction of a few Indigenous midwifery clinics, but I was not a part of their target patient population. Being a non-resident without an OHIP card also barred me from accessing many services.
Finally, I stumbled upon a private clinic called Medcan that offered a comprehensive Early Pregnancy Program that included all of the tests I needed to start my pregnancy journey – and all for C$1,675, about US$1,200.
Medcan is like the Apple store of health clinics, full of corporate types in the waiting room and Greek yogurt and mineral water in the refrigerator for patients. They were welcoming, professional and thorough. Through the program, I had routine lab testing, 24/7 nursing communication support, non-invasive genetic screenings, a consultation with a nutritionist and referrals for two ultrasounds. The quality of care I received would have cost thousands more in the U.S., especially if uninsured. My nurse-cousin Katherine agreed, lamenting that three months of prenatal care in Toronto cost less than one month of homeowner association fees for her Chicago apartment.
In the U.S., being an uninsured pregnant woman would terrify me. In Canada, it opened doors to high-quality care, as long as you have the funds for it, which I fortunately did. American friends who have visited me have relished the 30 per cent discount we get on our Canadian restaurant bills. So, I similarly never fretted about medical bills since it felt like a discount was already built in with the exchange rate.
The extra, out-of-pocket costs I paid for three months of high-dose folic acid prenatal supplements and two ultrasounds (a dating scan and the nuchal translucency scan) were about C$600. According to GoodRx, just one ultrasound could cost anywhere between $200-$1,000 in the U.S. without health insurance. So, in total, I spent C$2,275 on first-trimester prenatal care, not much more than one month’s rent of my apartment near downtown Toronto.
Besides the steep discount I have experienced as a birth tourist, I have appreciated the kinder medical culture in Canada.
Besides the steep discount I have experienced as a birth tourist, I have appreciated the kinder medical culture in Canada. I never felt rushed during my medical appointments, and my questions and concerns were validated, addressed and followed up on without judgment. When a non-fasting blood glucose result came back a little higher than normal, an oral glucose challenge test was immediately recommended because of my family history of Type 2 diabetes. I ended up passing it, and I appreciated the more cautious, preventive approach. In the U.S., that approach would have been considered aggressive, and the more likely outcome would have been a repeat blood test or a “wait-and-see” attitude since gestational diabetes is more routinely screened for in the second trimester. As long as the body continues to tolerate pregnancy, the American health-care system does not see anything wrong.
Similarly, a nutrition consult would be rare to include in routine American prenatal care. I felt empowered learning what to eat to support my increased energy needs. How could the average pregnant woman survive the first trimester without knowing this invaluable information? To combat fatigue and support a period of intense growth, I needed to eat 20-30 grams of protein with every meal, nearly double what I needed before pregnancy. I had no idea that I needed so much, even as a trained nurse with more nutrition knowledge than the average person.
I always knew food was medicine, but it is not emphasized as much in the American context. Food felt more like a warning: pregnant women are advised on foods to avoid and the range of calories to consume and pounds to gain, no more and no less. For the first time in pregnancy – and perhaps in life in general – I thought of food as a way to thrive, not just an essential for survival.
I have since transitioned my prenatal care to the U.S., where I plan to deliver in New Jersey with the support of family. The team at Medcan was seamless in transitioning my medical records; I doubt it would have been as smooth the other way around. I was welcomed into my new obstetrics practice with the most expensive copay I have ever paid at a medical visit (US$75) and a competent but cold doctor from New York City with the pace to match.
The hospital where I will be delivering is one of the best in the state, a research hospital complete with a Level III NICU. I know baby and I will be in good hands, yet I have chosen to work with a doula to support my labour and my wishes for as non-medical a hospital birth can be. So many American women are afraid of childbirth, a valid fear because the U.S. leads high-income countries in maternal mortality rate, even higher for Indigenous and Black women. The doula costs US$2,700, a price I am willing to pay for peace of mind. According to the Toronto wellness centre, The Mom Loft, a comparable doula package would cost between C$1,350 and C$1,750.
As I traverse both countries to conclude my studies and move back to New Jersey to prepare for the third trimester, I am grateful my experience has been as smooth as can be. I know being medically oriented and having the privilege to seek and afford care on both sides of the border is not an option for many women in North America.
I also know health care is far from ideal for many in Toronto, despite my impressions of it being a world-class medical city. When baby is old enough to know the full story, I cannot wait to share how life was up north, in a place known for its warmth as much as for its cold, that welcomed an American like me without a plan.
