Twenty years ago, as my sister-in-law Vendula awaited the birth of her first child, her husband dropped her off at the nearest hospital during the deep days of December. And she waited. And waited. And waited.

A ward full of other young Czech women also languished in the sparsely furnished hospital during the required two-week, pre-delivery-date check-in, so at least she had plenty of company. Family members stopped by during tightly limited visiting hours, breaking the boredom and bringing the obligatory care package of fruit and other vitamin-packed food — a welcome supplement to the daily diet of salami, brown bread and lukewarm sweet tea.

New Year's Eve came and went. No news. New Year's Day came and went. Still no news.

Then, finally, the family received a call Jan. 3. A week later, Vendula returned home with a son, after nearly three weeks of imposed confinement.

Much has changed since then. In fact, in the past decade, conditions and standards have improved so dramatically that the Czech Republic now has one of the lowest infant mortality rates in the world. Expats who once would have headed home two months before their due dates now often opt to stay in Prague, where low hospital costs and high-quality care combine for an attractive equation.

That's not to say that the experience would be identical to one in Topeka, Toronto or Tottenham. In fact, in some ways it might be better.

Take, for example, the case of Sarah Urquhart, a Brit who moved to Prague three months ago and who expects her second child in mid-July. Worried about her inability to speak the language, Urquhart began seeking guidance from other mothers at her daughter Rachel's school.

"I heard only good things," she says now. "I feel a lot more reassured since I heard such high praise."

Prague physician Jana Stejskalová, who estimates that expats make up one-third of her clients, has seen the inside of a delivery room at both ends of Europe. After practicing medicine in Glasgow, she returned here with a sensitivity for Western attitudes and a formidable command of English.

Comparing the standards of Europe, east and west, Stejskalová says, "There's absolutely no difference. The equipment and the environment are the same. In the top hospitals in London, for instance, it might be different; but for most hospitals, it's absolutely the same." Furthermore, she says, "Mortality rates are among the lowest in the world because we have very good care and because of the high standard of neo-natal units."

American Ann Ross-Clarke stayed in Prague for the birth of her daughter Isabella, now 3 years old, to have her husband with her. Like Urquhart, she received a tour of the hospital and delivery area well ahead of her due date.

"I will say the hospital was not as nice as a U.S. one, but the care was very good," Ross-Clarke says. Among the differences: a lack of linen service, a manually adjusted bed (difficult to maneuver soon after childbirth) and the removal of the baby's umbilical cord before leaving the hospital (as opposed to letting it fall off naturally). Czech hospitals also give babies TB vaccinations — optional for expats.

On the plus side, Ross-Clarke lists a five- to seven-day hospital stay — as opposed to the 24 to 36 hours typical for childbirth at an American hospital — and a house call by a pediatrician for the baby's first check-up.

As for pre-natal care, Urquhart notes, "There are more frequent check-ups, with ultrasound at every check-up."

Both Ross-Clarke and Urquhart, however, found themselves surprised at the Czech requirement to choose a baby's name before giving birth. Both male and female names must be listed, with Czechs expected to adhere to a standard list. "Everyone at the hospital thought we were really weird for having Praha as our daughter's middle name," Ross-Clarke recalls.

Breast-feeding remains another area of concern. "Czechs are promoting breast-feeding because of the benefits to the immune system," Stejskalová says. But the relatively rigid attitude worried Urquhart. "The nurses are very helpful about breast feeding," she says; but if she opts for bottle-feeding, "I'm wondering if the nurses will be disapproving."

For expats making the decision where to give birth, Stejskalová offers the following criteria. "First, it depends on how a woman can cope with giving birth in a foreign country without family there," she says. "Second, there may be an extenuating health condition that requires having family nearby. And the third issue is health insurance. Some foreign insurance companies don't cover the Czech Republic."

Expectant mothers should check with insurers before making a decision; they should also be aware that some Czech doctors remain limited by the types of insurance they accept. Private insurance also gives the mother access to a private room, with an additional cot where the new father can bed down for the night.

Stejskalová recommends that women opt to stay in the Czech Republic if they can accept the environment and culture, if they have assimilated here and if they are not afraid to trust the system.

As for the improvement in obstetrics care in the Czech Republic, Stejskalová credits a major shift in attitude.