My husband and I met in West Africa where he was on a church planting team and I was working in public health with a faith based NGO. We got married and started our life together in his home country of Kenya. We were settled in Nairobi at the time we got pregnant and therefore planned to have the baby in Nairobi.
I felt like I had somewhat of an advantage for two reasons, 1) much of my public health work over the previous five years was in maternal child health so I had some knowledge of maternity care practices here and what I needed and 2) this was my husband’s home and we had a lot of friends and family to get advice and help from. When we were choosing where to get care and give birth we had various choices, each had their pros and cons, but we picked one of the private hospitals and decided to use their ob/gyn services over a private doctor. They had 6 doctors and at our prenatal clinics we would see whoever was in the clinic that day. We saw 4-5 of that group over the pregnancy and I was happy with the care I received. My husband enjoyed the fact that the doctor who confirmed the pregnancy was the same one who delivered the baby.
One of my main concerns about giving birth outside my passport country was the management of my pre-existing MODY(mature onset diabetes of youth/young). Before getting pregnant I had done some research on MODY in pregnancy as it is managed differently during pregnancy than other types of diabetes. I was concerned that being uncommon, the doctors would not be familiar with it and would try to manage it the same as other diabetes. I found an endocrinologist in Nairobi who was familiar with it and the ob/gyn’s mostly deferred that part of my care to her. It ended up being very laid back which is what I was looking for.
I appreciated the ability to have conversations and some decision making power regarding my care. The last decision to be made was regarding induction. The doctors were really pushing for an earlier induction due to the diabetes but based on my research and the pregnancy progressing normally without treatment, I wanted to avoid induction too early. We negotiated a 39 week induction and I tried many different (safe!) ways to get labor started!
We had a good friend from our church and small group who had just been certified as a childbirth educator and was also a doula. We did our childbirth classes with her and her husband. She also attended the birth. This was one of the best decisions we made. She shared similar beliefs about childbirth, and being Kenyan I knew she would be a good go-between with the medical team during the labor and delivery so I could focus on the labor. I had heard some stories about rushing labor and pushing certain interventions which I did not want unless necessary. She was able to advocate for me in a culturally sensitive way. This also allowed my husband to focus on supporting me.
At my last prenatal visit before the 39 week point chosen for induction, I was 2 centimeters and had a membrane sweep; I then went and had a relaxing foot massage! That evening I lost my mucus plug and started leaking fluids. I wasn’t having contractions at this time. We called our friend and she came over to see us and help decide what to do. After walking the stairs several times, I tried to get some sleep. The leaking fluid made that difficult but I got some rest!
We went in early the next morning, before Nairboi traffic got too bad! At the hospital I was 4 cm, still only having irregular, mild contractions. I did a lot of walking up and down the maternity unit but still nothing. At 10am they recommended starting pitocin to get things moving. After this, the contractions picked up, they went from 0-10 very fast! Sometime early afternoon they checked and I was about 6cm. Shortly after I was feeling a lot of pressure and they checked again, I was only 7cm but they had me move into the delivery room. I don’t know what happened so quickly after that, but soon the doctors had me start pushing and then my beautiful daughter, Niara, was born!
One of the biggest differences during the labor and postpartum period was being on a ward. Private rooms were very expensive so we didn’t do that. Having private or semi-private rooms was what I would have expected back home, and I was unsure how I would feel about laboring in such an open setting. It really didn’t bother me though. There were about 6 other beds in both labor and then post partum and it is actually encouraging in some ways knowing that you are all going through it together! I still remember the lady across from me in labor who was adamant the doctors were not going to check her again!
During both the pregnancy, delivery, and post partum experience we had a lot of support from our church community and my husband’s family, but they also knew I was not Kenyan and might not do everything the same way! It was a good balance of feeling supported but also having the freedom to make my own decisions (no I am not going bury the baby under layers of knit blankets when it is 80 degrees outside, she is not cold!)
My biggest piece of advice would be to find someone who can be that go between for you – whether it is someone from your host community or an expat who has been there for a while. It should be someone with knowledge of both childbirth, who shares or can understand your desires for your birth, and who knows the host culture. 2) Hold your plans loosely – this applies no matter where you are, but even more so outside your host culture where things may happen differently than you are used to 3) Accept support from your community near and far!