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Women living abroad in Morocco might wonder what to expect if they’ll be having a baby. They might be concerned about Moroccan standards for medical care and debate whether or not they should return home for the delivery. I worried about this myself after moving to Morocco!
If you ask other expats about this, you’ll probably hear a variety of good and bad experiences. Not only will everyone have their own unique stories to share about pregnancy and childbirth, but they’re also likely to compare the quality of care they received in Morocco to what they would expect in their own countries. This can lead to very mixed advice.
There are many factors to consider including prenatal care, quality of care, delivery standards, private versus public doctor and hospital care, financial costs, postpartum care, and more. This article will discuss some of the most important topics to help you have an idea of what to expect.
Prenatal Care in Morocco
In Morocco there are two types of health care, public and private. Private prenatal care in which you select your own obstetrician-gynecologist is the most popular. Public prenatal care is available at government run clinics and public hospitals.
Some private practice family doctors are also qualified to handle general prenatal care but not the delivery itself.
Private Prenatal Care
If you don’t speak French or Arabic, you’ll probably want to find an obstetrician-gynecologist (OB-GYN) who is fluent in English. This can be a challenge if you’re living in a small town or rural area. Apps such as Dabadoc might be helpful in locating a doctor, or you can ask for referrals from English speaking friends and networking groups.
Assuming your pregnancy is not high-risk, you’ll probably see your OB-GYN once every four to eight weeks, with an increase in frequency as the pregnancy progresses.
Cost of Private Prenatal Care
The cost of prenatal visits to a private OB-GYN visit can vary from one doctor to another. There is often no pattern or reason for the difference in price. There is also no correlation between the cost of a visit and the quality of care given.
Some OB-GYNs charge a set fee for prenatal appointments. This can range from 150 to 400 dirhams with an additional ultrasound fee of 150 to 300 dirhams. Other OB-GYNs might include prenatal ultrasounds in their regular appointment fee.
These figures might lead you think that the cost of prenatal care quickly adds up, and it can if you’re having a complicated pregnancy and need more than the average number of appointments.
Fortunately, most OB-GYNs offer a second appointment known as a “control” for free. So your prenatal visits will probably consist of one paid, one free, one paid, one free, etc.
Some doctors, however, require that a control visit occur within a certain number of days from the paid visit. It’s therefore best to ask your OB-GYN about their prenatal fee structure so you know what to budget.
What About Health Insurance?
If you have health insurance, expect to pay the full amount at your visit. The doctor will sign and stamp your insurance form which you’ll then submit yourself to make a claim for reimbursement.
If you’re prescribed any medicines, be sure to keep the boxes to submit with your insurance form. Moroccan insurance companies like CNSS and CNOPS won’t reimburse for them otherwise. You’ll also need to make sure to have your pharmacist sign and stamp the insurance form and prescription.
Public Prenatal Care
Public prenatal care is mostly free for Moroccan nationals and foreign residents and is followed at your local public hospital. While low cost care may sound good on the surface, public prenatal care is generally not as thorough as private and you should expect appointments to be on a first-come, first-serve basis.
To see an OB-GYN or midwife, you have to go to your local public hospital early in the morning, take a number then sit and wait for your turn, which can often take hours or even the whole day.
But don’t assume that you won’t wait a long time if you go to a private OB-GYN. Most do work by appointment, but they might run late if they have had a delivery to attend or if their rounds at the clinic took longer than expected. And there are some private doctors who see patients on a first-come, first-served basis.
Prenatal Ultrasounds and Other Screening
Public hospitals often don’t offer ultrasounds if they think the pregnancy is going well, and many won’t reveal the gender of a baby unless you persuade them to give you the information.
In contrast, private OB-GYNs often offer an early transvaginal ultrasound to check for baby’s heartbeat and to determine a due date. They’ll then schedule the next ultrasound for 12 weeks and every four to six weeks thereafter.
Private OB-GYNs also tend to be more helpful in terms of other routine and optional prenatal screening tests. Some tests that may be standard in other countries might be less common and therefore a little pricey in Morocco. Insurance coverage for these tests will vary from one plan to another.
Many Moroccans prefer to follow their prenatal care with a private OB-GYN and then give birth in a public hospital if they can’t afford a private clinic. This reflects a general perception that private prenatal care will be of a much higher standard than that of public prenatal care.
City vs. Rural Medical Care
The quality and availability of medical care in Moroccan cities versus rural areas are on two different sides of a scale. Many rural areas in Morocco simply do not have convenient access to doctors or hospitals. That combined with poverty often results in women receiving inadequate care throughout pregnancy, birth, and beyond.
Rural residents may not have the means to travel to the nearest public hospital for routine prenatal care. Some may not see a doctor for their entire pregnancy. Many women who live in rural areas give birth at home with the help of a family member or local midwife, then are sent to the nearest municipal hospital for follow-up care if needed.
Due to these challenges, some rural women decide to move to a city or town for their last month of pregnancy. They feel reassured that they’ll be able to find a doctor if there are any complications, and they feel a sense of security from being able to prepare for a hospital delivery rather than home birth.
Delivery of the Baby
Private Moroccan clinics and hospitals are generally better equipped for delivery than public hospitals. While out of reach financially for some, the cost of having a baby at a private Moroccan clinic may be only a fraction of comparable private care in your home country.
What to Pack in Your Maternity Bag
Some doctors will give you a list of what to pack in your maternity bag. If you aren’t clear on this, be sure to ask so that you don’t have any surprises and find yourself without essentials immediately following delivery.
No matter where you plan to deliver, you should expect to pack more than you might for a delivery in your home country. For the new mother that means maternity pads, toiletries, a towel, a pair or two of pajamas, a robe, and change or two of clothes. For baby you’ll need several changes of newborn clothes, newborn diapers, wipes, lotion and baby shampoo, and a blanket or two.
If planning to give birth in a public hospital, it’s important to know that nothing is provided for you. You will have to take your own bedding including sheet, pillowcase, and blanket and essentials like toilet paper on top of everything else in your maternity bag.
Having a Baby at a Public Hospital
Public hospitals do not always have an OB-GYN on site, so midwives and nurses are often the ones in charge of helping women give birth. This can actually be advantageous. There will be little to no pressure to get through labor quickly, so there is high rate of natural births in public hospitals as compared to cesareans.
The obvious disadvantage to not having an attending OB-GYN on site is if there are complications during labor or delivery. In that case, a woman will either have to wait for a doctor to arrive or she might be advised to go to the nearest private hospital that’s equipped to deal with whatever issue has arisen.
Public Hospital Costs for Delivery
After giving birth in a public hospital, women typically stay for 24 hours for a natural birth and three to four nights for a cesarean. Unless you are exempt from medical costs (like those with a RAMED card), a natural birth at a public hospital will cost between 1000 and 1500 dirhams while a cesarean will cost between 2500 and 3500 dirhams.
During a stay at a public hospital, women will be in a shared room of four to eight patients. As already mentioned, you are expected to bring your own bedding such as sheets, pillowcase and blankets, as well as your own toilet paper. And, if it’s a particularly busy day in the delivery ward and the hospital is full, women are made to share a bed or their families will be told to bring extra blankets to make a bed on the floor.
Having a Baby at a Private Clinic
Private hospitals and clinics can vary significantly in their infrastructure and level of care and cost, even within the same city. Some have neonatal intensive care units and some don’t. Some are newer and very well equipped while others have old equipment.
In addition, delivery rooms and patient care rooms may seem sterile and unwelcoming compared to maternity wards back home. S. Tota, an American woman who gave birth in 2020 at a clinic in Rabat, said that the facility where she gave birth “looked a bit like a 1960s mental health institution in the U.S.”
This was also my view of the clinic in Salé where I gave birth to my first child. The clinic itself was very dated, as was all of the equipment (including the 1960s ECG machine – suction cups and all). Despite that, I received excellent care.
When giving birth in a private setting, a woman can usually expect the OB-GYN who handled her prenatal care to be the doctor who delivers the baby. Some OB-GYNs deliver at any clinic within a city, while others will let you know in advance which clinic or clinics they prefer.
Private Clinic Costs for Delivery
The cost of delivery at a private clinic depends on many factors such as your own doctor’s delivery fees, the clinic’s fees, the duration of your stay, whehether someone stays with you overnight, whether or not you had an epidural or other medication provided by the clinic, whether you had a natural or cesarean delivery, and the type of room you select.
Most women who have a natural birth stay in a private clinic for one to two nights while women who have a cesarean will stay for two to four nights.
Many clinics offer three types of rooms for your stay: a shared room with two beds, a private room with small seating area, and a suite with a bed area and separate living room or salon area. All three generally have en suite bathrooms with shower facilities.
Given the variables, a private hospital or clinic delivery can cost anywhere from 2,000 to 10,000 dirhams for a natural birth and from 3,000 to 20,000 dirhams for a C-section.
Rate of C-sections in Morocco
As mentioned previously, a woman is more likely to give birth naturally in a Moroccan public hospital than in a private one. Although there are no set statistics that cover both public and private hospital deliveries, a source at Morocco’s ministry of health estimated that 90 percent of public hospital deliveries are by natural birth compared to only 20 to 40 percent in private hospitals.
That’s consistent with a study by CNOPS that found that as many as 60 to 80 percent of private hospital births end in a cesarean section.
The main reason that the C-section rate is lower in public hospitals is because in those settings, nurses and midwives are normally in charge of deliveries. They are more inclined to allow a woman’s labor to progress naturally and will only call a doctor if there is a complication.
Compare that to private clinics, where OB-GYNs are taking time out of their office hours or private life to tend to a delivery and therefore are more likely to be in a rush. If someone is taking too long to deliver, they may encourage the birth either by performing an unwanted episiotomy or by performing an unnecessary cesarean.
It’s also common for some OB-GYNs to try to force or scare women into having a cesarean, as these can be planned and the doctor will know exactly when and for how long they will be needed.
This happened to Alia Santos, an American who chose to deliver her baby at home in Mirlieft, Morocco. “I purposely planned for a home birth so that I wouldn’t have to have a C-section,” Alia said. When I went in (to the doctor) at 42 weeks, they tried to scare me into (having) one.”
Epidurals and Other Pain Relief
Medicated childbirth is not the norm in public hospitals, but some allow you to pay beforehand for an epidural, which costs around 500 dirhams.
In private hospitals, however, you may be able to request an epidural at any time as long as it’s still medically possible or as long as your doctor has approved. Some clinics even have gas and air available for pain relief.
Who Can Attend a Birth in Morocco?
Public hospitals typically don’t allow a birthing partner in the delivery room. Once you reach the late stages of labor and enter the birthing room, you will be alone until you’ve delivered your baby.
After your delivery, one person will be issued a pass so that they can visit you at any time. Everyone else will need to abide by standard hospital visiting hours.
Private clinics generally allow a birthing partner if you’re having a natural birth; some even allow up to three. They will be able to stay with you throughout labor and birth. If you’re having a cesarean, it will depend on the clinic rules and your doctor as to whether or not one person will be allowed in the room with you.
Following delivery, most clinics have an open door policy from 7 a.m. to 11 p.m. with no limit on the number of visitors you can have at one time. If you’re like me and prefer limited visitors (or none at all), be sure to bring it up with your OB/GYN so they can instruct the clinic to limit or refuse visitors.
Immediately Following Delivery
Private clinics have on-site pediatricians who will see your baby shortly after delivery. Most babies are then taken to a nursery in the maternity ward until you ask for them to bring you the baby. At that point, you usually can choose to have the baby in the room with you for most of your stay.
A Note to Breastfeeding Mothers
A common complaint from ladies who deliver in private Moroccan clinics is that the nurses routinely give babies formula as soon as they are born or while the baby is in the clinic nursery. This can be upsetting to new mothers who worry that bottle feeding will interfere with the baby learning to nurse or limit his intake of the antibodies found in colostrum.
Maria E., a Romanian woman living in Casablanca, observed, “The baby was bottle fed only a minute after he was born, although I had told the doctor I wanted to breastfeed. I even told the nurses I wanted to breastfeed him exclusively, but they still gave him formula in a bottle.”
Giving formula to newborns seems to be an issue only in private clinics and hospitals. In public hospitals, new mothers are encouraged to breastfeed as soon as possible.
Nursery vs. Having Baby with You
If you’re in a private clinic, having the baby in the room with you will help ensure that you can breastfeed exclusively if that’s your wish. But there are times when new mothers might prefer that their baby stay in the nursery.
It may seem daunting to allow your baby to go to the nursery. It did for me, especially with my first born – I didn’t want him out of my sight. But after an exhausting and painful emergency c-section, and an amazing midwife who swore on her life that they wouldn’t give him a bottle and would bring him to me if he needed a feed, or was crying and they couldn’t calm him, I gave in.
The extra rest I was able to get honestly gave me an advantage with my recovery, and those first few nights in the clinic were possibly when I got the most sleep during my son’s early weeks of life.
Professional postpartum care is an area that is hugely lacking in Morocco. Coming from the UK, I really felt the difference.
In the UK, once you’ve been discharged from hospital you are visited by a midwife until your baby is 10 days old. After that you receive regular visits from a health visitor. You receive information and advice about feeding, recommended tests and checks for baby, safe sleeping, bathing baby, postpartum bleeding, postpartum depression, postpartum contraception, sex, exercise, and more.
This is not the case in Morocco, regardless if someone has given birth in a public or private hospital. Most new mothers receive very little information at all, even about breastfeeding, unless they pay privately for a lactation consultant.
This may not be much of an issue for Moroccan women, who traditionally rely on family and friends for breastfeeding advice and general postpartum care. Foreign women, however, may feel very much alone in navigating the postpartum period.
Women who gave birth naturally in a private clinic usually receive basic postpartum vaginal care instructions, while those who delivered by cesarean (public or private) will receive basic wound care instructions.
All new mothers are advised to go to a six- to eight- week postpartum checkup, but otherwise are left to figure out the rest for themselves. It is not until this checkup, if attended, that postpartum contraception is discussed.
Vaccinations for Baby
Within two weeks of giving birth, be sure to take your baby for the BCG (tuberculosis) vaccine. You’ll need proof of this in order to obtain a birth certificate.
Morocco’s Ministry of Health recommends a vaccination schedule similar to what you might expect in your home country. Vaccines are free of charge at local government clinics for babies and children under age 5. However, you can also obtain them for a fee at a private pediatrician.
Sourcing Baby Products in Morocco
You can expect to find most items needed for a baby in Morocco, but not necessarily of the same quality or variety as back home. They also won’t be at the same price point; quality baby products are generally more expensive in Morocco than in the US, UK or EU.
Rachel Garcia, an American living in Casablanca, observed, “Things here are so outrageously priced and can’t compare to the quality you’d get in the States. Bottled, pacifiers and medications are so hard to come across here and don’t come in much of a variety.”
Because of that, many women choose to import or bring baby items with them from abroad. This may allow you to source exactly you want, but if you factor in the cost of international delivery (including possible import taxes) or the cost of extra baggage on a flight, you may find that the total cost is nearly the same as purchasing the same item in Morocco.
Registering Your Baby’s Birth
After your baby is born and you are leaving the clinic or hospital, you will be given a birth notice, signed or stamped by the doctor who delivered the baby. To register your baby’s birth in Morocco, you will need to take this along with the following documents to your local government administration office (Moqataa):
- Marriage Certificate
- Copy of Passport (for non-Moroccan parents)
- Copy of Carté Séjour (for foreign Moroccan residents)
- Copy of CIN (for Moroccan parents)
- Doctor’s BCG Vaccine Certificate (The BCG vaccine should be administered within two weeks of the baby’s birth. Some expats have been able to register their baby without this but most administration offices require it.)
Once you’ve submitted these documents, you’ll receive the baby’s birth certificate which can then be used to register your baby’s birth at your consulate or embassy. Note that the Moroccan birth certificate is valid only for three months from date of issue.
Be sure to contact your consulate or embassy in Morocco to learn the exact procedure. There is likely to be a list of required documents that must be gathered when registering a baby’s birth abroad and when applying for a baby’s passport. Both can often be done at the same time.
Should You Give Birth in Morocco?
There are positive and negative aspects to giving birth in any country, and of course that holds true for Morocco. Some expats may decide that it makes more sense to plan for a delivery back in their home country. Others may not want to disrupt family life to return home for a month or longer. Still others may find that the cost of a delivery back home is prohibitively expensive compared to Morocco.
Whatever your unique situation, hopefully this article has given insight of what to expect and factors to consider when planning for a birth in Morocco.
Facebook groups such as Positive Birth Morocco can be an excellent way to connect with expectant mothers in Morocco and learn more about your options.
Networking sites such as the Moroccan forum at Expat.com might be helpful as well.
Read about MarocMama’s experience of having a baby in Morocco.
Casablanca-based mothers-to-be might want to check out Birth and Beyond by Zahra Bouchibti, which offers prenatal, postpartum, breastfeeding, and parenting workshops as well as doula services.
Learn about Morocco’s Vaccination Calendar. Click the blue link at the bottom of the page to download the calendar.
Friday 3rd of July 2020
An informative, very detailed and well written article that is sure to answer all the concerns of any expectant mother living in Morocco. I feel this article even answers the concerns of pregnant women planning on travelling to Morocco for a holiday as it always pays to be prepared 'just incase' right!
Well done Amal, I look forward to reading more from you. 😊