HEATHER Turner, a 30-year-old Utah native, gave birth to her third child Adella just before the Chinese New Year in her Shanghai home without a midwife. A friend, who is a former registered nurse, and her husband were the only ones there to help with labor and delivery.

Home delivery is becoming somewhat more common in the West, but it is a gray area in China and undertaking it without a midwife in a different culture is a big decision and can be risky.

Turner's husband was just starting his own business and she was not covered by insurance so the young couple with two other children couldn't afford foreign hospitals, which cost more than 40,000 yuan (US$6,398) for natural birth alone and up to 70,000 for a C-section. It can cost well above 100,000 yuan when prenatal costs and various kinds of tests are added.

Many expats are not affluent, contrary to widespread belief in China.

Turner, who has been in China for two and a half years, could have afforded a Chinese hospital but the long waiting list and requirement of booking months in advance were unexpected.

Many Chinese mothers were pregnant around the same time because they wanted to give birth to a "dragon baby" in 2012, the auspicious Year of the Dragon in the Chinese lunar calendar.

Turner was also rejected by Chinese hospitals because she was already six months pregnant when she sought help.

"Only one hospital agreed to take me, but I didn't feel comfortable with the environment, the shouting and crowding. I felt I would be much more emotionally stable and comfortable at home," she tells Shanghai Daily.

Turner was not the only expatriate mother who has confronted and conquered challenges that come with relocation to another country, which is one reason why French medical insurance consultant Margaret Ferte recently launched the free e-book "Expat Guide to Giving Birth in China." She herself had limited insurance and carried out extensive research in Shanghai while she was pregnant.

The 60-page book contains detailed information on hospitals, prices, tests, insurance and many other issues.

The copy is downloadable at www.expatmedicare.com.

Challenges for foreign moms don't end with childbirth.

That's just the beginning. They need to find baby supplies and deal with childcare and schooling. They need to find convenient, affordable grocery stores with fresh produce. They need to offer emotional and sometimes financial support to husbands and children. Some former career women also start their own business while managing their households.

Now Turner, the American who gave birth at home, has been interviewing for part-time jobs to keep the family going.

There have been times when the family was down to their last 300 yuan, which was frightening for a mother with three children. With trust in and support from her husband, Turner had managed numerous challenges to become a stronger mother.

Many mothers or mothers-to-be followed their husbands to the exciting but very different city. Although Shanghai is often considered the most convenient Chinese city for expatriates, it is still challenging to adapt to the Oriental culture and its ways, especially for younger foreign families who are not affluent.

Adjusting is also difficult without language skills or local friends to help, which is the case for many people when they arrive. Many mothers face challenges alone since their husbands are getting adjusted to their new jobs and office, often traveling. That's not to say that fathers don't pitch in.

"It was not easy when we first arrived," says Melanie Ham, a North Carolina native who arrived with her Chinese husband back in 2003 and got pregnant shortly afterward. "It is getting better now. There has been more information available in English and we also grow into a larger expatriate community so that there is more help from others who have had similar experiences."

Having recognized the challenges for mothers, Ham, Lynda Quintana and Rose Zhang founded Shanghai Mamas (www.shanghaimamas.org), a Shanghai-based nonprofit multi-cultural group of parents from all over the world.

The community was started in 2006 by Texas native Quintana who felt the need to connect with other international families and to discuss issues of parenting, education, support and child products, and many others. At first she ran around Carrefour, signing up expat moms. It quickly attracted more than 300 members who felt the same need to connect and share.

Quintana moved back to the United States in 2009, but the group has expanded into a community with more than 3,000 registered members. Volunteers, who are also busy mothers, work for hours every week to manage the site and organize various classes, information sessions and events, including a gathering of more than 300 families on October 13.

"Gatherings, events and communities like this are very helpful for us. That's why we also have a smaller Italian community to help new comers and those more established to get connected," says Italian mother Manuela Guatelli, She notes that Italian mothers and children often have to make an extra effort to learn English, as well as Chinese, compared with English-speaking expat families.

The Shanghai Mamas' annual party for 2012 was held at the InterContinental Shanghai Expo hotel in Pudong early this month. It was loaded with exciting performances from parents and children, as well as a big vendors' session for entrepreneur mothers like Melbourne native Dominica Darrington.

Since arriving in Shanghai almost six years ago, the ex-career woman (previously in Corporate Communications and International Development) has transitioned into full-time motherhood relatively easily (she has three children under four years old), and has managed her time well so that she could start her own business.

She has devoted her passion and time to designing unisex toddler's and kid's clothes with size-adjustable snaps so that they have greater wearability and she is a strong advocate of ethically focused Made-in-China practices.

"I've found this niche market and I was always interested in sustainable design, so it's a good combination of my own interest and the market," she tells Shanghai Daily. "My husband is happy that I've found my own purpose here and supports me greatly."

The gathering and the Shanghai Mamas community, which includes many subgroups, have been especially helpful for those who are new to the city or to parenthood. It provides empowering emotional support.

"I'm amazed by the scale of this event and it's great to see so many expat families and mothers here," says one pregnant European woman, asking that her name not be used. "They have all experienced what I'm going to have, so it feels safe and supportive since I know I'm not the only one and I know where I can get help and suggestions."

She is in early stages of pregnancy and was undecided about where to give birth when she attended the event. She spoke to many mothers who advised her about how to choose hospitals and discussed various options. She decided to have her baby in China.

Choosing schools is a big decision for mothers with older children. As China plays a larger role on the international stage, many expat parents want their children to take advantage of their Shanghai experience to pick up Chinese.

The young American mother Turner sent her oldest son Miles to a bilingual school, but it was still mainly an English-speaking environment. She did research and talked to Chinese kindergartens and finally got him into a local school with the help of a Shanghainese friend. The strategy has worked well and Miles has been picking up Chinese fast, since he's the only foreign child in his school.