Honduras Pandemic Birth – Kristin’s story

Kristin lives in Honduras and can be found on Instagram (@add_to_the_beauty_kristen) and she has really kindly allowed me to share her birth story which she features on her blog. Click here to read more of her posts.

It has been a bit overwhelming trying to find a way to start writing out this story. Childbirth, especially for the first time mom, is literally an unprecedented experience no matter where it happens or in what kind of global crisis or time of peace it takes place. My story just happens to take place in Honduras, Central America (a country considered third world), far from family, and in the middle of a global pandemic.

I will try to use respectful language in describing my childbirth experience in this foreign country as to not cast a negative light on customs or medical practices performed here. Much is similar to the care I would receive in the states but there is also a great deal that is very different. I do want to stay true to my story and personal experience, though, including the expectations and worries I had in comparing U.S. medical care to Honduran medical care. So, with caution and respect for medical professionals in Honduras I describe here some of those differences that affected me.


The morning we arrived at the birthing center: Friday, August 28.

Prenatal

In a way, as someone once said to me, having your first baby in Honduras is probably better than having your second. There is room for fewer expectations and no previous experience with which to compare. I have to begin by saying that the idea of birthing a child in general used to scare me to death. There were moments in my adult life when I wondered if it was even something I wanted to (or could) do. Then upon seeing the positive pregnancy test on January 1st of this year, all at once I was elated and convinced that I was meant to be a mommy. An instant change occurred in me and it propelled me on a journey of education and empowerment as I learned about how my body would house and nourish a little life for nine months and then bring him into the world.

I studied everything pregnancy and childbirth as if I were getting a degree in obstetrics/gynecology. The two most beneficial books I read during this process were Ina May’s Guide to Childbirth (although I’ve never been interested in natural birth) and Pregnancy, Childbirth, and The Newborn: The Complete Guide. I have had countless fellow moms reach out to me offering support and answering all my questions. The camaraderie and connection I have felt during this time of quarantine and isolation was an ironic and unexpected surprise. Thank you, mommy friends!

When we found out I was expecting, we had not fully decided if I would give birth in the states or in Honduras, where I reside and work as a full time missionary. I preferred 100% to have my regular obgyn back home deliver my baby, with his English speaking staff, in my home country, near my family, and take advantage of the comfortable (luxurious even) hospital amenities and resources. COVID was a factor in deciding to give birth in Honduras but it mainly caused a chain reaction of other factors like: international borders closed, my Honduran husband not being able to reapply for a US visa in order to be with me, the possibility that my child, not having Honduran residency, wouldn’t be allowed entry into Honduras for an indefinite amount of time, etc. So we ended up making the best decision to keep our little family together which was having baby Kairo in Honduras.

Coming to accept this decision was not easy. It was not part of my original plan (the theme of this entire year, am I right?). I still hung on to the hope that 1. I would be able to visit home at some point during my pregnancy and that 2. my mom would be able to travel to Honduras in time for the birth. Neither ended up happening and I mourned it over and over in various stages.

We found an obgyn and private clinic in our town by word of mouth and I started my prenatal checkups. I will forever be grateful that my husband and I could share those special moments together seeing our son grow in my belly via ultrasounds. (Which otherwise wouldn’t have been possible had I continued my prenatal care in the states) We planned to shop around for a doctor because I had been forewarned by other missionary moms here of certain things that weren’t customary or even allowed, the biggest of which being whether the father is allowed to be present in the labor and delivery room. That was my first question to Dra. K on my first appointment with her and she assured me that Natán would be able to stay by my side through the entire process. (She later approved that our doula friend, Kellie, be present as well. We were sold and decided to stick with her.)

Birth

In preparation for the birth I wrote up a type of birth plan – I called it “birth preferences.” This is rarely done here. I realized it was a very uptight gringa thing to do but it gave me peace of mind in the middle of so many unknowns. I created this “plan” based on my research, friends’ previous birth experiences, and questions/conversations with my doctor here. I presented it to her and her staff (with much apologizing and excusing away this possible cultural taboo) and explained that it was not to tell them how to do their jobs but was a way to keep everyone on the same page and to help me feel organized and prepared. After all, I am a low context culture individual living in a high context culture – I like things explained explicitly and I’ve learned that too often too much is left to assumption here.

In the end, not a lot went according to my birth preferences but I had prepared myself emotionally for that anyway. If any part of my personality has been challenged since moving to Honduras it is my control-freak nature so I’ve already been on this lifelong journey of learning to “let go and let God” for a little while now. Why would a Honduran birth be any different?

Some things that did not go as planned:

  • I requested to tour the birthing center months in advance to get a visual idea of what labor and delivery would be like. What I missed in conversations with our doctor was that they were planning to completely move from one location to another. The weekend that I completed 38 weeks gestation they moved their practice to a building in the downtown area of our little city. I found this out days before we ended up scheduling my induction and it threw me for a loop.
  • I wanted to go into labor naturally but at my 39 week checkup my amniotic fluid was low so we scheduled an induction for two days before my due date (Sat. 8/29.)
  • I was determined to receive an epidural even though it is not commonly offered for vaginal births here. I was assured from the beginning that since I requested it an anesthesiologist would be available to administer the epidural. (The anesthesiologist would be traveling a bit of a distance to get to the birthing center so before scheduling the induction I understood that the possibility existed that he just wouldn’t be able to arrive in time. We tried to convince a mutual friend of ours & the clinic’s, a nurse anesthetist, to be on standby as backup but she wasn’t completely comfortable with it. At about 30 weeks gestation I was notified that there was an epidural catheter shortage in the country and that it might not be a possibility after all. I started searching for epidural kits (in country and to be sent from the states) and started to prepare myself for the possibility of a natural birth. We eventually got our hands on a kit here and had a backup sent from the states.
  • While researching U.S. prenatal standards I realized that a Group B Strep test is required around 36 weeks. I expected it to be the same here in Honduras but it is not. In fact, there are many countries (not just in Latin America) that do not require this test. Due to risk of infection of the newborn it is considered protocol in many places like the U.S. to administer penicillin during labor for any mother who didn’t get tested or whose test came back positive. It was uncomfortable to insist on getting tested and request antibiotics as a backup but I had to make the decision that I felt most at peace with. This whole decision process emphasized the tension of living between two countries and cultures and I was very emotional over it. I consulted medical professionals in both countries and each had strong opinions on what was acceptable. I ended up getting tested (swab had to be sent to a lab a couple cities away) in my 39th week and it came back negative within days of going into labor.
  • We were told on a Monday that I would be induced the following Saturday. Thursday night we received a phone call that my induction would need to be rescheduled for Friday, the following morning, because of the anesthesiologist’s availability. I was nervous but excited to have the date moved up a day and rushed to finish up all last minute preparations for baby. (Although my hospital bag had been packed for a month – bag including EVERYTHING needed for newborn and postpartum care. It is rare that clinics/hospitals here provide much more than acetaminophen.) Oh, and that anesthesiologist never did actually show up…
  • I halfway prepared to play some selected music during labor and delivery until it became obvious once inside the clinic that I would not even be able to hear my own music over the construction noises and reggeaton music from the neighboring gym. I listened to these things for the majority of my labor.

Induction Day – Friday, August 28

  • We arrived at the clinic by 9:00 am. The induction process got officially started around 10:30 or after.* They were concerned that for several hours my contractions were increasing but I was not dilating enough. I walked and used the birthing ball for most of this process. Our doula friend Kellie helped me move and relax as contractions increased.
  • My water broke at 5 cm after having increasingly stronger and frequent contractions for several hours. I wanted to shower and since we couldn’t get the hot water to work I took a cold shower.
  • When it came time for an epidural it took a while to finally get our nurse anesthetist friend (our plan B) to come to the birthing center because, for a reason we never heard, the anesthesiologist was in fact not available. By the time the IV and epidural process was started I was experiencing very strong contractions and was already at least 7 cm dilated. In the middle of administering the epidural the ENTIRE BUILDING’S POWER WENT OUT. Apparently an electrical fire had broken out in a business a couple blocks away. I finished receiving my epidural in the dark illuminated only by cell phone flashlights. In one moment of peak pain and frustration I screamed at the top of my lungs OH MY GOD and thought this is so like 2020.* Once the meds kicked in I did tell our nurse anesthetist friend that she was my favorite person! And I MEANT IT.
  • After the epidural I labored in my room a few more minutes and started pushing. I got to 9 cm and baby’s head was visible. I was then transferred from the bed to a wheelchair, wheeled into labor and delivery, and was helped to step up into the stirrup delivery chair.* Within half an hour of pushing, Kairo was born! The epidural had greatly alleviated the pain but I felt everything that was going on. It was extremely difficult but I found it AMAZING to be able to feel his little body slide out. From that moment I was giddy and on such a high. He latched on to start feeding on his first try, within 20 minutes of being born.

I am still so in awe of the miracle of birth and also at how natural and normal it felt. There were several moments during labor and delivery that I truly felt like I wouldn’t be able to go on; I just didn’t think I could do it. It was one of the hardest and most glorious things I’ve ever done. There is a photo (thanks to Kellie and Valentina for capturing such special moments) right before the very last push when I’m leaning back on Natan and feeling completely depleted. That is my last photo before becoming a mother and when I look at it now I wonder who that person even was. I’m sure I will spend the rest of my life discovering all the ways motherhood has and is changing me.

*I provide a few more details and photos in a private password-protected version of this story, shared upon request.*

Navigating hospitals in Japan – Caityln’s experience

Caityln, author of the Little snail…inching along blog (https://inchbyinchlittlesnail.com), has generously allowed me to share her experience of maternity care in Japan. To read her birth story, click here.

When you find out you’re pregnant in Japan, one of the first things you’ll want to do is “shop around” for hospitals. Despite living in Tokyo, where you might assume there is loads of information on this process available in English, I actually had a difficult time finding out much about hospitals at all. (I will say, however, that had I learned about the Tokyo Pregnancy Group earlier on, I could’ve gotten loads of advice from other pregnant ladies in the city.)

After trying my best to inform myself on a good hospital, I ended up choosing one which is known for being an excellent hospital with great English accessibility. It’s also known for being expensive, but at my first appointment a nurse told me the due amount at birth would be around 90000 yen (somewhere near $900 USD) and I thought that sounded super reasonable. As I mentioned before, this hospital doesn’t offer epidurals unless there is a case of severe pain or other extraneous circumstances, but the quality of the hospital seemed to outweigh my lack of a choice in the matter. No English documents about the price were ever provided to me, so I went along merrily until I was about 37 weeks pregnant.

Then came the day in which we got a big shock: when we went to book our room we were told the price before government assistance after birth would be 1200000 yen (over $10,000 USD). It seemed the nurse who I talked to when I first chose this hospital made a serious error in her English. We were speechless, and after leaving the appointment decided immediately that we needed to transfer to a different hospital. Over the next day and a half we were on an incredibly stressful and difficult mission to change hospitals.

At one of the choices the staff said we would need an interpreter to be with us during the entire labor and delivery. This started the process of calling several translation services, but there are no interpreters available on-call. Additionally, we couldn’t find interpreter services that were medical-related (they were all for business). The staff also said that my husband would have to be fluent in Japanese in order to be in the room during labor and delivery (which he’s not). The positive side of this choice would be that after government assistance, the entire fee would be covered. Our boss kindly offered to attend as an interpreter, but we didn’t know when I would go into labor, how long it would be, etc., so that–in addition to the unfriendliness toward non-Japanese speakers–led us not to opt with this choice.

Another choice we were given was to go to a birth clinic, which is connected to our original hospital, but significantly cheaper. However, we were warned that 1 out of 3 women are transferred to the hospital from the clinic and then have to pay the hospital fee anyway. Reasons for transfer could be as small as needing an episiotomy (which I did, in the end). The possibility of being transferred to the main hospital seemed risky to us, so we decided to keep looking.

Ultimately, after getting loads of helpful advice from some friends and from the ladies in the Tokyo Pregnancy Group, we decided to transfer to another hospital. We were very lucky the hospital accepted us as it is generally very difficult to transfer (hospitals in Japan require “booking” early in pregnancy and are super reluctant to accept patients later on in pregnancy).  I cannot express how rough the hospital search and transition was, but on the bright side, our overall experience at here was positive.

Above you can see photos of the shared rooms. The private rooms were a little bigger, but much more expensive and (in my opinion) not really worth the extra cost.

Once we switched hospital, I wanted a maternity ward tour as soon as possible. Unfortunately at our new hospital there are group tours scheduled twice a month, and if you can’t attend them, well, you’re out of luck. I’ve since learned that there is an English tour available, but no one told me that at the time, so I was left to do my best with my limited Japanese. This was a little stressful, but not nearly as stressful as trying to make phone calls to the hospital in English.

I had three really rough experiences with calling the hospital. First, a few days before I went into labor, Lillian was putting pressure on some nerves that gave me such horrible leg cramps I couldn’t walk. I was in a lot of pain, and I read online that some women experience contractions through their legs. After several hours, I decided it would be best to call the hospital, but when I called and asked for someone who spoke English, the person speaking just said she would “try her best.”

After about ten minutes of trying to explain my concern without any comprehension on the other end of the line, I started to get really upset and negative (I asked myself why I had to be giving birth in Japan, was getting really frustrated with my Japanese skills, and had started to get scared because I had no idea what I was experiencing as a soon-to-be mommy). With a shaky voice I finally said, “I know you’re trying your best to understand me, but are you sure there is no one else who might be able to speak more English that I could talk to?” And seconds after a “chotto matte” (just a moment), a fluent English speaker hopped on the line. Why she wasn’t put on immediately is beyond me, but it would have really saved me a lot of stress!

The next day I had to call again to make sure of my appointment time for the day after that. Once again I was greeted with mediocre English, and was told that I didn’t seem to have an appointment anymore. I asked if they could please make one as I was already 40 weeks pregnant. The woman said yes, and that I could see the same doctor I saw last time but that he couldn’t speak English. I responded, “Um, I saw a female doctor last time, and she could speak English.” I was then put on hold before she came back on the line and said, “Okay, you can see the doctor you saw last time who can speak English. Is 11:30 okay?” I said yes and then asked if I should come at 10:30 for the NST that the hospital requires for all pregnancies after 37 weeks.

She said, “Why do you need an NST? You are 14 weeks pregnant, right?”

“No! I’m FORTY WEEKS. Do you know which patient I am?” I was starting to get pretty frustrated, not to mention surprised and concerned. I had already given my ID number, name, birthday etc., so how were all of these issues arising? She said she knew who I was and that she was sorry because it was her first day (not particularly encouraging…). Then I was told to come early for the NST.

The last difficult phone call was when I was in labor. Long story short, there wasn’t anyone around who spoke basic English when I called to report my contractions, and I ended up having Chad take over because it was too hard to talk anyway. One thing that would have been tremendously helpful to know about is the Himawari Translation Service free for medical interpretation. I think using Himawari could have saved me a lot of headaches (though I still would have been concerned about the mix-ups when I called to confirm that appointment!).

After your baby is born, you stroll them around in little mobile cots when going from your room to the nursery, etc.. Mine was labeled “Dykehouse Caitlyn baby.”

Having difficulty communicating was probably one of the hardest parts of pregnancy in Japan, but in the end we got our beautiful girl so it’s been easy to let go a bit with time. After Lillian was born we were able to spend time recovering in the LDR, and I was brought lunch. I heard some hospitals bring a meal for the husband, too, but Chad was left to run up to the hospital restaurant, which was closed for some reason. Sadly, all he could really scrape together was a granola bar and some canned coffee.

Our sweet girl at the hospital in one of the super cute robes they provide during your stay. She has already changed so much!

My meals were overall really tasty, and were always healthy and balanced. Unless you choose the most expensive private room option (I believe it’s about the equivalent of $700 per day), even your spouse has to adhere to the 1:00-8:00 visiting hours, so I usually was only able to eat with Chad at dinner time. The visiting hours were one of the toughest parts of being at the hospital after Lillian was born.

Spaghetti dinner with tea, soup, yogurt, kiwi, salad and a sweet/savory cheese bread.

The other tough parts of my hospital stay were mostly related to being a new mommy than to anything to do with the hospital, though I did have a couple encounters that were unique to foreigners, I think. For example, when breastfeeding, Lillian liked one side better than the other, so I asked if I could pump on one side and dump the milk out (I didn’t want her to be bottle fed before the first month). The midwife looked at me like I was foolish and said, “In Japan we don’t care how the babies get the milk as long as they get their food, but foreigners just want to breastfeed.” Of course ultimately that’s what foreigners want, too, but many mommies value exclusive breastfeeding and don’t want to interfere with that in the first month. I just did what I thought was right, and ignored her comment.

Chicken, tomato, okra and mushroom dinner plate with tea, rolls, crackers, salad and apple slices.

Overall the nurses/midwives were helpful, but they weren’t always friendly. Sometimes I wondered if their lack of warmth was from the language barrier, or perhaps because they were just tired like me. (Or…perhaps I was just tired and I was imagining their coolness.) I did think it was strange that staff frequently insisted on having tests I didn’t feel were necessary, like doing NST’s before I was overdue even though everything in my pregnancy was fine, doing all my blood tests again (even though they had gotten the results for the exact same tests a week prior from my previous hospital), and telling me I should get checked for diabetes a month after birth because Lillian was bigger than Japanese babies tend to be (even though my entire pregnancy I was completely normal–at a healthy weight with healthy blood pressure, urine samples, etc.).

Breakfast of yogurt, tea, warm bread slices, salad, milk and orange slices.

One nice thing is that the hospital is very up-front about pricing, unlike my previous hospital where no pricing information was given to me in English. At Aiiku, you are given thorough information in English that breaks down the cost of giving birth and the fees for hospital stay. The strange thing is that since pregnancy isn’t covered by insurance in Japan, the fee for giving birth actually decreases if you have any emergency procedures like an episiotomy or a C-section (because those are covered by insurance). So a completely natural birth is cheaper than one that requires more medical attention!


This was one of my favorites: a lunch of potato soup, tea, pizza toasts, mixed nuts, a savory/sweet cheese waffle, yogurt, milk, salad and pineapple. Since we never ended up getting an oven this time around in Japan, we’ve taken to making these pizza toasts in our broiler 🙂

In the end I am glad we were able to transfer. Language barriers happen all over the place in Japan, even in Tokyo, so we’re still dealing with that, but on the bright side now that I’ve gone through pregnancy in Japan I know I can really handle a lot. Often in life you’re tougher than you think, and in my case I ended up with the best gift I could ever ask for: our darling daughter.

I hope this has been helpful to anyone searching for information on giving birth in Japan, or at least of interest to anyone in general!

xxCaitlyn

Lillian’s birth in Japan – Caitlyn’s story

Caitlyn has really kindly allowed me to share her birth story which can be originally found on her blog: https://inchbyinchlittlesnail.com/2016/02/08/lillians-birth-story/. Click the link to read more of Caitlyn’s posts.

By my weekly checkup on Thursday, January 28th, it was 3 days past Lillian’s expected due date, and doctors guessed we would have to begin the process of inducing labor on Monday. This would start with me coming to the hospital that day to receive something called lamaria, a seaweed native to Japan used to dilate the cervix. I really wasn’t comfortable with the idea of using lamaria, but the doctors insisted that unless I had dilated naturally at that point, that was my only option. I was a little frustrated about the lack of negotiation on this point, so I just hoped Lily would come on her own or that I would be dilated enough not to have to get the lamaria. Either way, on Tuesday I would be given meds to further progress induced labor if necessary to officially get things started.

On Friday the 29th, I was still feeling a little anxious about the possibility of induced labor, but I was happy to know that either way we’d have our sweet baby soon. My pregnancy experience overall was really good–I was thankful that Lillian was always healthy and that I was, too. However, by the last couple of weeks she was resting on nerves that gave me continual leg cramps in my thighs every time I walked, I was very achy and sore, and I was quite tired overall. I was so ready to have Lillian!

Chad and I decided to go out for dinner to get some okonomiyaki, and had a really nice time despite the gloomy weather. It was very rainy and cold, and I told Chad I hoped the rain wouldn’t turn to ice over night in case I did go into labor and we needed to get to the hospital. After dinner I also said–just in case–that we should get out some money for a taxi. I don’t know if something in me knew what was coming, but around 9 or 10 o’clock I started to feel contractions. Now, to be honest, I thought maybe the contractions were really bad gas pains at first. After all, the previous day we had eaten something called Calico Beans and I thought it had just been killing my stomach. (Side note: because of this association with Calico Beans and contractions, I really don’t want that for dinner any time soon!) When the contractions started coming about every ten minutes from about 2 in the morning, I knew for sure Calico Beans weren’t the cause of the pain and we called the hospital.

As I will explain in a future post, we had to switch hospitals about three weeks earlier, and one of the downsides was that our new hospital, didn’t seem to have as many fluent English speakers as our previous hospital. So when I called at about 3 or 4 am to tell the hospital about my contractions, I was shocked to be told there was no one who spoke English there at the moment, but that the nurse I was speaking to would try her best if I spoke slowly. Despite an experience earlier in the week with terrible communication issues over the phone, I was still incredulous that there was no one I could talk to. After several minutes of painful attempts to communicate (both painful in the mental sense from the language barrier struggle and the physical sense from having contractions at the same time), the nurse told me to call back once the contractions were occurring 5-6 minutes apart.

Around 6 am, the contractions suddenly went from coming 10 minutes apart to between 2 and 3. We didn’t waste any time and called a cab before dealing with another phone call to explain to the hospital we were coming. At this point, I was able to practice a few techniques I had learned in a prenatal yoga for birth preparation video I had been doing for a month or so. I would stand leaning against a wall or the top of something shoulder-height, put one foot back a ways and the other forward, and sway while breathing: in 5 seconds, out 5 seconds. Once we were in the taxi, I continued breathing in the same manner.

The taxi ride to the hospital was about 30 minutes. We used a taxi service that you sign up for in advance online. The service is wonderful because they knew my due date, our address, and the address of the hospital. They also have English speakers available on the phone 24 hours a day. When we got to the hospital, I was ready to have our baby already, though tougher contractions were on their way and I still had hours to go. First, I changed into a hospital gown, and after only a half an hour or so went to take a bath. I was brought breakfast but could only drink the milk box (poor Chad, who was starving, ate a couple bites at my insistence and was probably so sad to see them take the tray away mostly uneaten soon after).

Whenever I walked anywhere, I would still stop and sway with each contraction. I slid into the tub and let out a deep sigh of relief, only to have the strength of the contractions suddenly go up a notch. At this point I began to hum through pursed lips on my exhales, really focusing on the sound of my voice. It wasn’t long before the contractions got so strong that I started feeling the urge to push, and I was out of the tub, back in the LDR (labor, delivery & recovery room). A nurse checked my cervix and said, “Wow! You’re already dilated to 6 cm!” To this I replied, “That’s it!?” I remember thinking to myself, I can’t do this. I can’t do this anymore. No, I can. I have to. And I will. Don’t say can’t.

At this point, the nurses told me that if I felt the urge to push, I should resist, but my body took over and I felt as if I had no control over the pushing. I briefly wondered if I should (or could) change my mind about getting an epidural or other pain medicine, but before I could even really consider it another contraction came and my focus was solely on giving birth. Another nurse came to check my dilation only a while later and said, “Good! I think you will be able to meet your baby sometime this afternoon!” Tired, hopeful, and overwhelmed, I looked to Chad beseechingly and asked, “Is that soon?” He said yes, and though he really didn’t seem confident I just had to hope he was telling the truth. (I found out later that it was about 10:00 am at that point, but I’m glad no one told me that!).

Things continued to progress, and I was able to see the image of her head emerging reflected in the nurse’s protective glasses. Every time I pushed I tried to look and see if she was any closer to coming, but it never looked that way. Soon a team of 3 nurses came with a doctor, and they helped to “open things up” with each push because her head was a bit big for my body. I remember feeling like the whole experience was so painful and bizarre and new, and like I was almost outside of myself watching the whole thing. I had a hard time relaxing in between contractions, so much so that the nurses kept trying to remind me to relax and breathe, and that I told them, “I can’t!” They said, “You can!” but then I had another contraction and couldn’t listen to them anyway..

Lillian's Birth Story 2

Finally, I had a contraction where everyone started shouting, “Yes! Go, go, go! One more!” And I just pushed like it was nobody’s business! I thought this had to be the one to get her out because I was finished! And then, at 11:29 am, only about 4 hours after arriving at the hospital, I saw my beautiful baby girl being held up and I felt so much relief and joy. I watched nurses and midwives take her to be cleaned up while the doctor worked on cleaning me up and giving me stitches (in the end I had an episiotomy in addition to the help of the “pulling” doctors, but received no pain meds whatsoever other than anesthesia for the episiotomy stitches afterwards) and felt like it would be an eternity until I could hold her. Chad went over by her and I watched her daddy look at his sweet girl. It was only a few minutes later before I got to hold our Lillian, and my heart felt so full. I laughed and cried and just felt so tired and sore ohmygoodness. Lillian was about 3.7 kg (around 8.1 pounds) and 52.5 cm long (around 20.5 inches). The nurses and midwives kept saying what a good pusher I was, and how my labor was relatively short for a first child. (I was like, was it? Because that felt like it took an eternity.)

Technically after delivery you can stay in the LDR for a couple of hours, but I think we ended up staying a little longer. I didn’t question our extra time because I was very glad for it. I had a little lunch and Chad snacked on a granola bar and canned coffee (the hospital restaurant was strangely closed), and after a while we made the transition to what would be my room for the next five days. Then, our journey as parents began!

Photo 2-4-16, 4 10 25 PM

I’ve always had a respect for other mothers, but after experiencing childbirth myself I am even more blown away by the awesomeness of the human body. I have had some medical hurdles to overcome before, but nothing compares to the challenge of childbirth (and of course, nothing has come with such a sweet reward!).

Lillian’s first day at home from the hospital.I hope you’ve enjoyed the story of Lily’s birth, and that if you’re pregnant (especially in Japan!) it has helped you or encouraged you in some way. More to come soon about my hospital experiences before and after birth!xx Caitlyn.

P.S. Lillian was born on National Croissant Day! Who would’ve thought after my last post  that I’d be given yet another reason to love croissants?

Midwife’s Musings – Birth Preferences

What are birth preferences and why do I need them?

Well this, if I might say, is a brilliant question! Have you ever heard of a birth plan? A birth preferences list is exactly the same thing, just a slightly different name, and I’ll explain why.

A birth plan and a birth preferences list is a document or a note women and their families have written, with their preferences and detailing what their wishes are surrounding different aspects of labour and birth. This will look different for everyone and there is no right or wrong answer. It could provide information about your thoughts regarding how you would like to feed your baby, your feelings surrounding pain relief during labour, and the list goes on. There’s no hard and fast rule and so it can include anything that is particularly important for each individual woman and her family.

The key difference between a birth plan and a birth preference list is slight, but in my experience, hugely significant. The information on them can be exactly the same, but the significance is in how they are viewed and interpreted by the woman and her family. When we talk about birth plans they can seem fixed and set in place. Unfortunately with labour and birth, as much as I’d love to say this is the case, this isn’t always true. Labour and birth can be completely unexpected. Things can happen that we don’t plan. Baby’s heart rates can suddenly drop, medical complications can occur, labour can progress faster or slower than we were expecting. We can also think through all the options, but then in the heat in the moment, find that what we thought would be helpful, is actually not helpful at all.

The key difference is then that when women and families put together a birth preferences list, they have taken time to think through all the options, and decide, in an ideal world, what they would prefer, but also recognise that this may change in the moment. It is less fixed and more fluid. This mind shift might sound slight, but I promise it’s massive! Disappointment and feelings of failure (check out this post!) in relation to birth can affect families and whilst there are many complex reasons for this, I’ve found that when women go into labour informed, but also recognising and prepared that there may be changes in their choices and experience, that these families are less likely to experience these feelings, or they experience them to a lesser extent.

Why is this important?

As a midwife, I absolutely love when my patients have been able to take some time to research into different options of the care that is available to them and then take time to think through, in an ideal situation, what they would their preferences would be. This way, I know that my patients have been empowered to make a decision which is right for them and their families and I can easily know what their wishes are and how I can best support them. Birth can be somewhat fast paced, and can require decisions to be made quickly and sometimes unexpectedly. If this is the case, if a woman and her family has taken time to think through what their feelings are about certain scenarios, then that is hugely helpful and means that they aren’t having to make decisions about their care in the heat and rush of the moment without any previous thought.

When you’re giving birth in a country that is not your passport country, there are also likely to be different options available for labour and birth. Taking the time to research what your options are and deciding what your preferences will be, will mean that you are able informed and helps to prepare you and your family for what to expect. It also gives you the opportunity to see whether what you would expect from yours or your friends or family member’s experiences in you passport country, is also possible and available in your host country. My experience is that whilst some things I would expect as routine in my passport country, won’t necessarily be so here in Uganda, but I was to ask in advance, there are usually ways (they might be slightly different to what you expect) to be able to facilitate most things. This could involve practises around delayed cord clamping, vitamin K injections for the baby, Group B Strep testing, and the list goes on. It isn’t unusual, and is totally understandable, when certain tests or interventions are particularly important to a family, so it is definitely worth while to look into these, and find out if and how this can be facilitated ahead of time.

What resources can I use to inform my preferences?

Your maternity care provider should be without a doubt your biggest resource in this area. Please do feel free to ask questions. Not only will they be able to provide you answers, but they will also

How do I write a birth preference list?

I’m glad you asked! Whilst there are so many different ways to do this, I’ve actually created one especially for you, which you can download for free from the Resources page. Take a look and use it to highlight the options that you think would be best for you and your family.

Writing a birth preference list is often much simpler than it sounds. Have a sit down with your birth partner, chat together about the different options, what is important to you and why. That way, they can feel more a part of the process and also know how best to support you when your time comes.

It is also really important to talk to your maternity care provider about your birth preferences list as they can help discuss how they may be able to facilitate your wishes, particularly if it involves things that wouldn’t necessarily be routine in your host country. In different countries and cultures these lists will likely be viewed differently. In the UK for example, it is normal for midwives to ask women if they have written one during their 36 week appointment. It is usually one of the first things that we will ask about or look for in a woman’s notes when they arrive in labour. I am aware though this may not be seen in the same way in different cultures, for many different reasons. If this is the case, I still think it is important to write one, for all the reasons above, but you can keep this for your self, or your birth partner can keep it as a reminder of your wishes to help them advocate for you.

So why not check out the free pdf Birth preferences list I’ve put together especially for you – I promise you won’t regret it!

Induction in Thailand – Kristin’s story

Kristin has really kindly allowed me to share her blog post about her pregnancy and birth experience in Thailand. If you’d like to check our Kristen’s blog to see more of her content, give this link a cheeky click: https://www.familyseesworld.com/ and she can be found on Instagram at @familyseesworld.

WOW! Just wow! My baby boy is 1 year old. I think with the addition of every child to a family, time speeds up. I can’t believe a year has gone by. So, in celebration of his first birthday, I wanted to share some highlights of being pregnant abroad, and what it was like delivering in a foreign country (please read to the end if you want all the details). The decision to fly home to deliver vs staying and delivering abroad is not always an easy decision to make. I hope this post can make you laugh, and also shed some light on the questions to ask in the decision-making process. For our family, with having 3 young children, it would not have been good for any of us if I traveled back to America 2 months before the due date and remain there for 2+ months after. So we knew I would be delivering in Thailand.

My first appointment with an OBGYN was quite humorous. When I sat down with my her and discussed how I had 3 children already her questions to me were: “Does your husband know you’re pregnant?!” and “Do all of your children live with you??” both were honest questions full of surprise and shock! It was funny, and it was not the last time she would say things that I just have to laugh about. Such as the multiple times at my later ultrasound appointments she would laugh about how big my baby’s nose was! She would then tell the nurse in the room to come look, and they would both laugh!! They were in no way trying to be rude, and I laughed along with them.

Overall, the doctors’ appointments are very similar to those back in America. They would do ultrasounds every appointment if you asked (which is not true in the States), but in general the monitoring, lab tests, vitals are all on par with the timing of things with my previous pregnancies. The biggest concern I heard from foreigners about delivering babies in Thailand is the push towards a planned C-section. Since only a FEW hospitals in all of Thailand offer epidurals, and for other reasons culturally it is very normal to plan C-sections even if there is not a medical reason to do so. Because of this, any slightly atypical presentation of the baby at delivery practically requires a C-section because vaginal deliveries are just not as common. Since I developed gestational hypertension with my 3rd baby which required her to be delivered 4 weeks early (perfectly healthy!) I was acutely aware of the risks and wanted to make sure I fully trusted my OB to tell me if I required a C-section only if there was a risk to me or the baby and not just because. Therefore, I continued researching other hospitals to ensure I had that trust in my OB.

Eventually, I found a wonderful doctor in Bangkok who had delivered over 10,000 babies by the time I met her. The hospital was beautifully decorated and the labour ward had a room for a water birth and it was one of the few hospitals that offered epidurals. If there was any complication during delivery, the operating room for C-sections was literally across the hall from the delivery rooms.

Even though we live 2.5 hours away from the hospital, I was willing to make the drive for my appointments and for delivery. Thankfully, since many women travel to Bangkok at the end of their pregnancies from surrounding cities and countries, it is not uncommon to show up for the last month of pregnancy for monitoring and delivery. My delivering OBGYN offered the possibility to follow my OB in Pattaya until 36 weeks and then switch to her. I LOVED that idea, and it saved me a lot of time in the car. When my parents found out we were pregnant (on their first trip to visit us!) they decided to come stay with us for 7 weeks, spending about 3.5 weeks before and after the due date since they were retired! It was AMAZING on so many levels.

Because of the 2.5 hour drive to the hospital, and since it was my 4th baby, I put together a “delivery in the car” bag of supplies just in case! Did you know, cutting the umbilical cord is a sterile procedure? YOU do NOT cut it… you wait until you’ve arrived to the hospital so it’s done by a midwife or OB. Do not do that yourself. Have lots of towels & trash bags to put down (or a shower curtain), gloves, water, nose suction, infant hat & blanket to wrap the baby. I did lots of reading and ensured my husband and mother were well informed on how to deliver a baby in a vehicle! My mom is a nurse practitioner, so her medical expertise is very helpful, but she worked with the elderly population, so just a tad different! I figured if we were prepared then it wouldn’t be necessary, and my husband looked at me crazy anytime I was trying to “teach” him something about delivering a baby, lol.

I had an appointment 3 days before my due date on a Saturday. My mom and husband came along and I was planning to ask to be induced because of the length of time it would take to get to the hospital. Oh, I forgot to mention we have one vehicle and a driver since the company my husband works for does not allow us to drive for liability reasons. So, we share one vehicle and he works over 45 minutes away from home, and not on the way to Bangkok. Theoretically, if I went into labor in the middle of the night, or when my husband was at work it would take well over 3.5+ hours to get to the hospital. The typical expectation when delivering in Bangkok is to move there the last few weeks of your pregnancy for this reason. But having 3 other children to care for while my husband was still working full time it wasn’t possible for me.

Because of those reasons we thought it best to just be induced and not risk a delivery on the road! My OBGYN 100% agreed with this plan and at about 11:15am on Saturday May 11, 2019 she gave me cytotec to soften my cervix. We soon moved into the room for a water birth because that is what I wanted. My previous 3 deliveries I had an epidural – WHICH I LOVED!!! – but I figured for my last baby I wanted to try it natural. A while later they started a low dose of Pitocin. I generally felt pretty good. We watched movies and only a few hours later was I feeling a little uncomfortable with the contractions.

About that time the doctor came back to check how dilated I was and it was 5 cm. She advised breaking my water so at 3:00pm she did. I IMMEDIATELY started having very severe contractions and pain. She left go to back to her office and would be back to check on me after a while. The next bit seemed like forever, but in reality it was not very long. I really thought I was going to die. I asked if I could get into the birthing tub to help with pain relief. However, the hospital policy is you can only be in for a maximum of 2 hours, and if you want a water birth you have to wait until your fully dilated to get in. I understand some people it takes a long time to go from fully dilated until the baby is born, but even with my first she was out about 15 minutes and a few pushes later. Since the nurses here don’t check for dilation, and I had just been dilated to a 5cm only, it all seemed hopeless and I told my husband I needed an epidural because in my mind this was going to last a while.

My husband looked at me like… “is this the crazy talking?” not exactly sure what to do about my epidural request. I told him that I NEEDED it. So he chatted with the nurses, who said I could have one but it would take about 30 minutes. At that point I was desperate and didn’t care! I needed the idea that I would soon have relief. Well, because I was in the delivery room for the water birth, it did not have a typical hospital bed to deliver in, so we needed to move rooms. The nurse asked me to walk to the next room over. I had a contraction while walking, and then when we arrived she asked me to use the toilet before the epidural. So, I go to sit on the toilet and suddenly the baby is coming!!!

It all happened so fast. I start yelling “the baby is coming!!!” You can hear the nurses scrambling and yelling. One of the nurses is telling me to scream to let the pressure out from wanting to push, my husband comes running in (because he was moving our stuff between rooms). My mom is seeming like she’s about to pass out, and in no time Silas was born. Over the toilet. The nurse caught him, and then in the most un-glamorous way I had to walk to the bed.

He was born at 3:13pm. A whole 13 minutes after the doctor broke my water (no wonder I felt like I was dying). About 10 minutes after the delivery the doctor arrives, apologizing profusely as she had just gotten back to her office when she was called that I was in labor!

One of the many things I loved about this hospital though, was that they strongly encouraged skin to skin and breastfeeding immediately after delivery. We were able to do skin to skin for an hour before moving rooms and doing a physical for baby.

They fulfilled all my wishes – delayed cord clamping, 24-hour delay for bath, no formula, no hepatitis B vaccine at birth because he is not high risk and it can be given at a later date. I trusted the doctors and nurses to not do anything against my wishes. I know that sounds strange, but I had heard stories about other hospitals doing things against the parents’ wishes such as giving babies formula when you want to be exclusively breastfeeding and more. So, I was very pleased with the care both of us received after delivery.

My parents brought our other 3 children up to visit the following day. What sweet moments those were, watching them see their baby brother for the first time. We stayed in the hospital 3 nights and were welcomed home by some very happy kids and grandparents.

So, there you have it. I am so happy we went to Bangkok, and I highly recommend the Hospital. It was so easy being pregnant in Thailand as well – other than the heat! – but people are so kind and helpful and love, love, love babies!!

Here are some photos from our Big 1 Year Old’s birthday weekend! Carrot cake is our traditional first birthday cake! So, this was a labor of love made-from-scratch carrot cake and cream cheese frosting. Buddy boy is our “Wild One” who has the most hair of any of our kids at their first birthday’s… and the most teeth (8)! He also started walking earlier than any other kids on the day he turned 11 months. He seems to be wanting to grow up even faster than his older siblings, and this momma’s heart can’t handle it.

So if you’re a man, you probably want to stop reading now. The following are discussions of the complicated questions that all pregnant ladies ask, and want to know answers to. So you’ve been warned. Here’s a cute kid photo to end your reading.

1) The hospitals give you the price for delivery ahead of time. If you are cash-paying you need to agree to this prior to delivery. Afterwards, while still hospitalized, if you ask for something that is not included in the price, they will inform you prior to giving it, one example – an ice pack. The total must be paid prior to discharge. The prices are insanely cheaper than they are in the America (even with insurance), but it can still cost a few thousand dollars. Once again this is not hidden information, so ask the hospitals up front.

2) Most hospitals offer an enema prior to delivery – some require it. Ask your OB what the pre-delivery treatment entails.

3) Have a birth plan typed up and translated to Thai (or whatever the local language is) and print lots of copies. Review your birth plan with the physician and make sure they understand what your wishes are, and that they will follow it to the best of their ability.

4) Ask if you will be allowed skin-to-skin after delivery. Many friends here have had their babies taken to the nursery for anywhere from 2 hours to 6 hours immediately following delivery for monitoring. Even with C-sections, it is beneficial for the baby to do skin to skin with the daddy while you are being stitched up, so ask if that would be possible. At some hospitals you have to be adamant about skin to skin following delivery. Do not be shy in voicing the wishes that are best for baby and you, and do your research ahead of time.

5) If you want to exclusively breastfeed, do it! And do not feel like you have to allow the nurses to give the baby formula before to your milk has come in (typically it takes up to 2 days) as you are producing colostrum. Another friend here who wanted to exclusively breastfeed was just too nice about it. The nurses would come in with a bottle of formula every so many hours and say it was time to give the baby a bottle (even waking the baby up for the bottle). I know it is sometimes hard to speak up for yourself or your baby, especially with there is a language barrier and as a first time mom. But know that you can do it respectfully, and it will be okay. I will share that with my first baby, it took 5 days (maybe 6, I can’t remember exactly) for my milk to finally come in. I didn’t know that it hadn’t “come in” yet, and after voicing the concerns to our paediatrician about how she was waking frequently and crying a lot at night around day 4, he recommended to breastfeed (as she was still getting colostrum) and then offer a bottle of formula until the mature milk was produced. It only took a day or 2 more, but she was so much happier with a full tummy, and it wasn’t a detriment to exclusively breastfeeding after that either.

6) If you’ve had a baby before, perhaps you have experienced the mesh, stretchy underwear you are given after delivering a baby. Although completely unattractive, they work… they’re nice and big and hold things in. It is an elastic band that goes around your waist with a hook in the front and a hook in the back that connects to a pad. Yup. That’s what you’re given. You definitely feel a LOT exposed.

7) I do have to sing praises about the hospital gowns! First, in your normal exams, you are given pants to wear, that have a drape over an opening. You feel very respected and covered. After delivery you are given a gown of a thick material that essentially looks like a dress, with a nursing wrap-bra built in for easy breastfeeding while still remaining covered. The gowns were amazingly better than the thin hospital “gowns” that open in the back and provide very little coverage which you receive in America.

8) Part of the post-partum care that is included is the use of an infrared lamp. Twice a day the nurse comes in and sets up the sheets over your legs/lap to be like a tent, and at the base of your bed place the lamp to shine towards you for about 15 minutes. It is to help promote healing.

9) I got better sleep at the hospital here than ever following the birth of my previous children. If you are asleep, the nurse lets you sleep. They check your vitals about 2-3 times a day, and the latest is at 9pm at night. You are mostly given privacy unless you ask for help with something. I can’t speak for other hospitals, but Samitivej was amazing about this.

10) I was happy with the food selection on room service as they have many international patients and a good international food menu. There were a few cafes to pick up food or coffee within the hospital. My husband could also order from the room service as well.

11) Common practice in Thailand is removing your shoes prior to entering a home. So, at my delivering hospital, before entering the delivery ward, you remove your shoes and are given slippers. This is true for nurses, patients and visitors. And every time the staff enters your room they will take off their shoes/slippers as well.

12) If you’re considering giving birth abroad, you’ll need to do the research about what paperwork is required to file for citizenship in your home country. Samitivej Sukhumvit had a paid service to get the birth certificate translated to English or French, and also to take and print the passport photos of your infant. Those were such helpful services so we did not have to find a translator for official documents on our own. In regards to reporting a birth abroad in Thailand, here is the Thailand US Embassy & Consulate website which gives the instructions and details on how to “Report the Overseas Birth of a U.S. Citizen Child”. It sounds complicated but it’s not too bad if you just follow the instructions. From the time we had the appointment at the Embassy until we received his citizenship paper and passport was about 3 weeks. Depending on your country of citizenship, this may be different, so you must read up on your own country’s laws on birth abroad.

If you are considering giving birth in Thailand and have specific questions you’d like to ask, I’d love to connect with you, just message me on Facebook at Family Sees World or on IG @familyseesworld .

Midwife’s Musings – ‘Should I listen to my baby’s heart rate at home?’

Is there anything more magical than the moments that you get to hear the reassuring sound of your baby’s heart, rhythmically tapping away? 

As a midwife, that is one of my favourite sounds, and it is always such a beautiful moment when you see a Mum’s eyes light up in excitement or her anxieties eased as soon as she hears that gorgeous noise.

Now recently I’ve been seeing a lot of adverts for home dopplers or apps that can be downloaded to turn your phone into a monitor to listen into your baby’s heart rate. I totally get it. I know how reassuring it is to hear that beautiful noise.

However, as a midwife I can tell you that as great as it sounds, using home dopplers can be quite dangerous, and is something that Tommy’s, a charity that specialises in pregnancy loss and the Royal College of Midwives in the UK, advises against. This is for a number of reasons, but first of all, listening to the baby’s heart rate, is just one of many checks that reassures us of yours and your baby’s wellbeing. It forms part of the picture, but we can’t know for certain that everything is going well, just knowing this one piece of information.

Secondly, it can actually take some time for midwives and doctors to learn how to use these monitors properly. There are many different sounds that these monitors pick up; the mother’s heart rate, the baby’s movements, the placenta as well as the baby’s heart rate. I’ve had patients who think that they’ve been hearing their baby’s heart rate at home, but actually they are being falsely reassured. This can be dangerous and stop people reaching out for help when it is really needed.

Another thing to be aware of is that sadly its not uncommon for women to struggle to find their baby’s heart rate, which can happen if the baby has moved into a particularly acrobatic position. This can understandably be really worrying and upsetting if you’re home without anyone trained who can help.

So if it’s not a good idea to listen to a baby’s heart rate without a midwife or doctor, how can I know my baby is well?

The most important factor is monitoring your baby’s movements. Every baby will have their own unique pattern of movement and as long as this is normal for them, it’s a great sign that things are going well. If their movements are reduced, increased or just feel different, then it’s important to get checked out as soon as possible. 

Otherwise, keep an eye out. If you have any bleeding, think that your waters might have gone (it’s often not the ‘Hollywood’ gush many expect), you have any stomach pain, severe headaches or anything that just doesn’t feel right or if you’re not sure, then please check in with your doctor or midwife as soon as possible and we would love to do a full assessment. 

If you’d like any more information have a little look at these websites and please spread the word: 

www.tommys.org/pregnancy-information/blogs-and-stories/im-pregnant/tommys-midwives/word-us-home-dopplers

www.rcm.org.uk/media-releases/2020/january/rcm-advises-pregnant-women-againt-use-of-personal-dopplers/

www.countthekicks.org

Rainbow pregnancy in Uganda and birth in America- Lauren’s Story

I wrote about the beginning of my pregnancy journey for the blog and now I wanted to continue where I left off…

My husband, Eric, and I had been living in Mbale (the eastern region of Uganda) for the first 7 months of our marriage. When we got married we knew we would move out of Mbale for Eric’s work. We ended up in Gulu, in the northern region of Uganda.  It was a week into settling into our new home in Gulu, on April 20th, that we found out that I was pregnant! We were not so shocked, yet we were so grateful. We found out by taking a blood test at the local clinic. We went in together, they took my blood and a hour later we came back for the results and the technician said, “I don’t know if this is a good thing for you or not, but you have a positive test!” It was a GREAT thing to hear! There was some trepidation, given the previous two losses, yet I decided to cling to Proverbs 3:5-6 and enjoy the news from today without worrying about tomorrow.

Eric and I got home and would you know that a storm came then a RAINBOW. This pregnancy was to bring about our rainbow baby (a baby born after a loss). The next day was Easter and we had planned to call our families anyways, so we shared the news with them! I also had a prayer/update email that I kept. I would write regular updates to this group of about 8 friends/mentors who are so dear to me and I KNEW they were praying alongside Eric, our baby, and me.

I also had a dream of giving birth to a baby boy at 20:20 on December 20. There were a lot of ‘20s’ connected to this birth and I googled what the number 20 represents; it means many things yet one representation is that 20 is the cycle of completeness after a period of waiting and the reward is generous and full of God’s love.

About 5.5 weeks into this pregnancy nausea hit me and boy did it hit. I rarely left the house for 7 weeks out of fear that I would randomly throw up wherever I was. Also I felt so weak and the less movement I made, the better off I was.

I did have to see my doctor every two weeks for monitoring, because of the infertility challenges prior to this pregnancy. The journey to Kampala was about 5.5 hours yet we did it, every two weeks for the first trimester. I got a lot of scans and blood work and every time it was so amazing to know that I was there because a little miracle was being formed in me by God’s hands.

With my previous two pregnancies, I started writing a journal for each of the babies when I found out that I was pregnant. With this pregnancy, I held off until week 12. At that point, we had seen the baby move, heard the heartbeat, and all my stats were good! I started sharing my heart with this little one in her personal journal.  I also kept two apps on my phone to track my pregnancy and growth each week. I read What to Expect When You are Expecting each week as well. Lastly I followed along with a pregnancy prayer journal on my kindle. I read a handful of pregnancy/delivery books, throughout. I did not take so many photos, but every couple of weeks, I did snap a few to document my external growth.

Eric and I had decided early on that without a doubt, we would go back to the US for my delivery. Therefore one of the major tasks was to find a provider in the US while I was still in Uganda. I knew I did not want a hospital birth, I didn’t think a home birth was ideal because we didn’t really have a home (we were just going to be renting for a few months). I found a birthing center that was about 1.5 hours away from where we would be staying and they agreed to take me on. Also, Eric had some relatives that lived close to the center in case we needed to go there before delivery. From July onwards, I was in communication with them and they directed me on tests, etc. that they needed and after every appointment, I sent the updated records to them. All was going quite well.

The baby was due on Christmas day and the center needed to see me before 32 weeks so we decided to pack up and leave Uganda at the end of October.

By the second trimester, my doctor who I had been seeing since my miscarriages moved back to her home country.  I was feeling so much better and the pregnancy was progressing smoothly and she directed me to other doctors at the practice.

Eric and I even traveled to Ethiopia to meet up with one of his brothers and before going back to the US, I made a solo trip to Italy to meet up with a close group of friends. They had a birth way blessing for me and it was so special! I read my baby books, journaled, prayed, dreamed, and planned life with a new addition. I loved feeling her movements each day; I was truly enjoying this season of life.

At my 25-week check up, the doctor who saw me that day said that there was a gap in my cervix and that I needed a cerclage. I had no idea what do to, so I checked in with a few medical friends in the area and the US. A cervical cerclage is not recommended after 14 weeks, yet I was set to have the surgery the next morning. Eric was still in Gulu, so he got on a bus and made it by evening and we prayed together about what to do. All we were getting from the western medical professionals I was in contact with was: do NOT get the cerclage, it’s a high chance that it could bring early labor. I was advised to come back to the states and await labor if in fact this was a serious issue. We went to bed that night after Eric prayed for God to show us what do to because we were still unsure what was going to happen, yet God knew. I was scheduled for the surgery at 8am and I had a last minute appointment with a highly skilled sonographer at 7am. We woke up and went to the scan and her conclusion was there is no gap in the cervix, what we are seeing is thinning mucus. The two ends of my cervix were closed and the cervix was a good length for that stage in the pregnancy and all was normal and healthy. She did not recommend the cerclage. We aligned with what she said and what she showed us on the monitor and we got in the car, called the hospital to cancel the surgery and drove the 5 hours home! Talk about 11th hour provision. Thank you Jesus!

A few weeks into the third trimester, we were back in the states, settled into our rental and had had the first appointment at the birthing center. After several appointments there, we realized the disorganization of the care but I felt that I had no other option. It was through them that I took my glucose test and found that I had gestational diabetes so I monitored it and managed it with my diet. There was a major challenge that came up and the center ended up dropping me as a patient at 37 weeks along. They tried to help me find my next provider; it was a hospital that I had heard great things about. Although I was resistant to delivering in a hospital (primarily because of how quickly they jump to intervention, the lack of being able to move around and be flexible in labor and delivery), at this far along I could not be picky. My first appointment with them was great- I loved the staff and the OB who I met with. I was going to visit the hospital, but at that same time my sister in law had recommended a local midwife in our area and she had just agreed to take me on as a patient. Now I was set up with her for a home birth! A little concerned, but grateful for a non-hospital option.

40 weeks came and went without much progression. On New Year’s Eve night, Eric and I went out for pizza, came home, went to bed just like any normal night. The next morning I woke up at 2am with some fluid leakage. I laid back down and checked again 30 mins later then some small cramping started at around 4:30am. I was SO excited! LABOR WAS FINALLY STARTING! Eric was working on his family farm so he went to work by 4:30am and I told him that I would keep him updated on any progress or changes. I spent the morning doing things around the house and some cooking for the days ahead.  By the afternoon, my contractions were picking up and I called my doula, Faith, and midwife, Rose. Eric was setting up the birthing pool and getting the bed ready. I was on the birthing ball watching football in between contractions. There came a point where the contractions were getting too intense and I could not focus. What I did realize is that I was having back labor! My sister in law had this with two of her pregnancies so she warned me that it was not fun. When a contraction came I had to lean over the sofa or counter and Eric or Faith had to apply intense counter pressure.

I was unable to sleep, needed help to take a drink and had no desire to eat. I tried the pool and that did not feel good, laying down was challenging and I was quite miserable, yet I had a great team! I was dilating but it was slow and by early morning of January 2nd, my contractions had really slowed down.  Rose recommended so many natural things but nothing was getting my contractions back to a consistent pace. Eric drove me on bumpy roads, we went for a few walks, I tried castor oil, the peanut ball, but after 33 hours, Rose really recommended that I get to a hospital. She called the hospital that I had visited once after the birthing center dropped me as a patient and they willingly took me in. The baby had been monitored this whole time and remained so strong. Once I arrived, they wheeled me in and started me on a baby Doppler, I got an epidural (not what I wanted for my natural birth, but the relief was so needed), they started me on Pitocin and then I rested for the first time in a few days.

When things started on Jan 1st, Eric and I were excited about a New Years baby. Now it was the 2nd in the afternoon and we were excited about a Jan 2nd baby! Well 2pm turned into 4pm, turned into 10pm and by midnight I was FINALLY fully dilated and started pushing. I pushed (in a few different positions) for 2.5 hours then the nurses had me take a break for 1.5 hours. We came back together and I tried again for 2.5 hours and at that point the midwife suggested the doctor come to advise on what to do. The doctor talked to Eric and I about vacuuming the baby out and we agreed. The staff geared up and I gave three intense pushes in a matter of 6 minutes and I could feel the baby come out so quickly- it was the wildest feeling!

We hadn’t found out the gender, and I romanticized about Eric saying, ‘ It’s a…” but the room was FULL of staff and he could not tell the gender. I heard someone say a comment about a girl and I asked Eric, “ Is it a girl? Is it?” Sure enough it was! They put her directly on my chest and that was also the most incredible feeling!

I hemorrhaged and needed two units of blood and had almost a level 4 tear (her little hand was resting on her cheek) so the doctor and nurses were at work around me. I was weak and a bit out of it, Eric held our little girl for the next hour as I gained strength. 

Aubrey Anne Charlotte Ranck was born January 3, 2020 at 6:39 am weighing 7lb 4oz. She is named after both of our moms.

The labor and birth went nothing as we had planned but it was perfect because it brought us safely together with Aubrey Anne! The hospital staff was phenomenal and this experience completely changed my perspective of a hospital birth.

Being that we were living in a small town where Eric grew up, Aubrey Anne ended up being recorded as the county’s first baby to be born so we made our newspaper debut and received some fun prizes!

6 weeks later we were on our way back to Uganda. Aubrey Anne was healthy and continued to develop over the weeks and months.

By June she was 5 months old and we found out that I was pregnant, due at the end of February 2021! We were due to be back in the US for 3 weeks at the end of July for Eric’s brothers wedding. Due to Covid, the airport in Uganda was shut down, so we organized to get on a charter flight at the end of June because if we waited until July to get on a charter flight, there was a high chance that I would be sick and I did not want to travel in such conditions.

It is now the end of September and we thought the Uganda airport would be open by now so we could go back but since it is not, we have decided to remain in the US for the remainder of this pregnancy. I am getting prenatal care with the hospital provider where I delivered Aubrey Anne and I will deliver there as well. We will plan to return to Uganda by mid April after the baby is at least 8 weeks old.

Thyroid function & miscarriage in Uganda- Lauren’s Story

Eric and I got married at the end of August 2018 and three weeks later we were on our way back to Uganda!  Both of us had been living in Eastern Uganda in a town called Mbale, but most recently Eric had been finishing his masters degree in the US and was finally returning back after 2 years. I had been living and working in Mbale and returned to the US in June to prepare for our wedding and marriage. We were so excited to come back and start our African journey together!  Since I was a bit older, we decided we did not want to wait long to start having children, yet we decided to give ourselves a few months to enjoy newlywed life and settle into Mbale then we would get serious about adding to our family in January.

Well, we had just celebrated two months of marriage and found out that I was pregnant! Shocked and excited, we started the journey by telling our parents and close friends and I met with a dear friend in the community who had recently gone through pregnancy in Mbale to figure out what do I do next!

It was about 2 weeks later that I was at work on a Friday and started feeling feverish and decided to leave work early to go home to rest. I also noticed some bleeding and as the afternoon and evening progressed I was bleeding a lot and had the worst pains that I ever experienced. I called a friend in the area who is a doctor to get her opinion on what was happening- she graciously informed me to rest and get a scan on Monday. I knew that miscarriage was a real possibility; my mom had two challenging miscarriages before having a healthy pregnancy and birth and a handful of my friends had had pregnancy losses. I knew that it was all too common. As Eric and I went to get a scan on Monday, the sonographer confirmed that in fact there was a sack but no viable pregnancy. This pregnancy was so unexpected that as soon as I was getting my mind around that fact of actually being pregnant, the baby was gone. This loss hurt more physically then it did emotionally.

I healed really well and was able to go about life, work, etc. My cycle came back in 6 weeks and we resumed with the plan of getting serious about pregnancy in January. Would you know that January came and weeks later we found out that I was pregnant! So excited and more prepared; still with a small hint of concern about a loss, yet hopeful that this would be a viable pregnancy we told our parents and close friends. Then a few weeks later I woke up one morning with excessive bleeding. I woke Eric up and I was completely devastated. I knew that I had lost this baby too.  This loss hurt me so much more emotionally than physically.

It would be days before the tears dissipated. I called my friend again who is a doctor and asked her what she thought- she confirmed what I knew to be true. I did not even go for a scan because I knew all I needed to. My husband and friends cared for me and let me cry and those who has experienced loss before empathized with me by listening and sharing their own stories.

I still had hope that I would have a healthy and viable pregnancy one day. Without delay, Eric encouraged me to reach out to a good friend who lives in the capital of Kampala (about 5 hours away). In Kampala, they have better medical care than I would find in Mbale. My friend, who had prenatal care for her two pregnancies in Kampala, led us to a doctor who she had just worked with. I scheduled an appointment and we made the trip to Kampala a week later. This doctor did a thorough blood work panel and one of those being a quick TSH level test to assess my thyroid level.  This is the only blood work that came back a bit out of the normal range. Through much reading, I learned that ‘within range’ TSH levels are vital for a viable pregnancy and out of range TSH level are a major cause of early miscarriage. The developing baby is reliant on the mother’s thyroid and if I am not producing enough TSH for me, then I am not able to produce enough for my growing little one.

The doctor put me on a low dose of a simple medication and wanted to check my levels again in 6 weeks. She instructed that I was not to try to conceive until after the 6 weeks results.

I took the next few weeks to read books on miscarriage, listen to podcasts of pregnancy loss, to join an online community called The Joyful Mourning. I also learned a lot about egg health and the many reasons miscarriages can occur. I read that most doctors will not test TSH right away and it is good to ask you doctor for it. Another fascinating thing that I learned was most infertility doctors will not take on a patient unless she has had 3 or more miscarriages. I am so glad that I did not have to endure another loss in order to see a doctor. We were so fortunate in be in Uganda during this time where getting an appointment with a quality doctor only took a week, the cost was low (compared to the US), my doctor tested for TSH right away, and I could see her (the doctor) after only two losses instead of three.

I also took these weeks to share my story with my community of ladies who I prayed with each week; they were all so loving and caring and walked with me in prayer. Eric and I shared with other friends and our families too. I am also big into writing in my journal and I so I did that a lot! I wrote out some poetry and spend beautiful time in prayer and reflection that way. Another beautiful gift that came along was a new friend who I met in the Mbale community. In January, Eric and I decided to start going to a new church. Our first Sunday there, the lady next to me (who did not know me or ANYTHING about me) grabbed my hand during worship and started praying over me. I may not remember everything she said, although I do have it written in a journal somewhere, but she spoke Proverbs 3:5-6 over me.

Trust in the Lord with all your heart
    and lean not on your own understanding;
in all your ways submit to him,
    and he will make your paths straight

So I got home and wrote that on my chalkboard wall and believed afresh this passage that I had known for years!  My friendship with this dear lady really formed when I learned she was an exercise teacher, so I went 3 days a week to exercise with her and she would pray over me and she cared for me so well. Her faith and life was a turning point in my own faith and hope.

After 6 weeks, my TSH levels were within a good range and a month later I found out that I was pregnant. My doctor monitored me every two weeks and what we found was a strong growing baby!

I will share the rest of my pregnancy in another post!

The power of language- Emily’s experience of infertility & pregnancy loss in East Asia

I first became aware of the prevalence of difficult pregnancies and pregnancy loss in our early years of marriage. We were at a predominantly young church, many of them married and starting to have babies. We then began to walk with different friends through miscarriages, infertility, and scary birth situations. I remember feeling so unaware of how prevalent those things were. I quickly realized how fragile life really was.

When it came time for Matt and I to start our family, I had no idea how helpful that time would be for us in our own struggle to conceive and then our grief at our first miscarriage. We moved overseas from all of those friends right at the beginning stages of our struggle with infertility. We finally did get pregnant but shortly after went through a miscarriage. That was an especially difficult time as we were in a foreign country away from our family. However, God was so kind to care for us so well through our local international church body. And the faithfulness I saw in our brothers and sisters at our old church helped sustain me as well.

We then got pregnant again with our son Samuel who God graciously brought into this world and into our arms through an intense birth experience followed by a very scary night of postpartum hemorrhaging a week later where I had to rush to the hospital and undergo a procedure to stop the bleeding. Once again local church members were there to care for us through those traumatic events and my mind was reminded of friends from our old church who also experienced a similar situation and who God faithfully sustained through that difficult time.

We experienced another miscarriage only 5 months post-partum with our first and then just the next month were pregnant with our second son, Calvin. It has been a whirlwind to say the least.  And as I look back, I do shudder a bit at all the difficulty surrounding those various events but I also trace the kind hand of a good God who carried us through.

I often read on blogs or memes or articles about how a woman’s body is “made for this” and we should just “trust our bodies to do what they were made to do”. I struggle with those mantras because my body didn’t actually do what it was “made to do”. In fact, my body did the opposite!

Watching our friends go through all of those challenges normalized them for me and helped me be aware of the reality of loss and grief. It still was so painful to go through myself but I saw a hope in our friends that was much greater than hope in my body and its natural functions. I saw hope in Christ who suffered with us and for us and promises to renew our bodies! We don’t have to live in fear of terrible things happening to us, but we can live with hope in a God that holds everything together, even our broken bodies, and who I believe works everything, even the hard things, out for our good.

Niara’s arrival in Nairobi- Elizabeth’s story

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.

Prenatal Care

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. 

The Birth

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!

Cardiac complications and Hydrops in Indonesia- Amy’s story

Our third son Phineas’ story began about a month after our family moved overseas to Indonesia.  We had just lost a baby due to ectopic pregnancy 2 months prior and weren’t expecting to get pregnant again so soon. God had other wonderful plans.  In the midst of culture shock and the stress of transition, we found out we were expecting. We were nervous and excited, eager to have another baby in our arms. To make it even more exciting, our language teacher found out she was expecting as well, one week behind us!

Thankfully, other expat women recommended a doctor and accompanied me on my first few visits before I understood much of anything. It was a definitely a different experience as the main way that I was checked was by ultrasound every time. Everything was looking fine, and I wasn’t worried once I saw the baby was in the right place, so I didn’t pursue some of the routine testing done in America and was even hoping to try a home birth, if possible. 

However, all our plans changed when I was around 25 weeks along. The doctor found fluids around my baby’s stomach, called hydrops. They weren’t able to help us in our city, so we had to fly 2 days later to Singapore.  I spent a full day going from doctor’s office to doctor’s office by myself since my husband was taking care of our other 2 boys. It turned out that our baby’s heart rate was around 260 beats per minute, over double a normal baby’s heart rate, and the fluids were around his stomach, heart, and brain.  It was determined that I needed to take medicine to slow down his heart rate, about four times the amount a normal adult would take to slow their own HR. Because of that major risk, I had to stay in the ICU to monitor my heart rate continually and see how Phineas responded to the medicine.

I was finally checked into an ICU at a public hospital at 9 pm that night. The worst part was that I hadn’t eaten very much that day. After all the stress of the past 4 days, I finally broke down when the nurses told me the cafeteria was closed and all they could give me were some crackers and Milo. I didn’t sleep much that night (I had a roommate that was throwing up a lot, and they never dimmed the lights since most ICU patients are unconscious.), but I was comforted to know that hundreds of people were covering us in prayer.

God worked many miracles for us during those weeks. I had no side effects from the medicine and it worked to lower his heart rate! Through a chain of 7 people, we were able to find free housing! My parents were able to fly over while I was still in the hospital because the doctors were saying that he may need to be delivered if the medicine didn’t work. After 3 days in the ICU, I had to stay in the hospital for the rest of the week. Once discharged, I had 2 appointments per week to monitor his heart and fluids. After all the fluids drained from his body 6 weeks later, we were able to return to Indonesia for 4 weeks and continue language learning before going back to Singapore to wait for his birth. The pediatric cardiologist told us that he had trained doctors in our city in Indonesia and had had to re-diagnose some of their patients, so once we heard that, we decided to return for the birth so there would be clear answers as to what was wrong with his heart.

Once we returned, I had to continue getting checked often, and there was a German doctor who was very concerned about my baby’s size. He was measuring large and at 37 weeks, the doctor began pressuring me to get induced. Both my first babies were born naturally with no interventions, and I wanted to continue that trend, so getting induced sounded like a bad idea to me. I was able to hold out until the day before his due date, when I let her give me a membrane sweep. That was enough to get labor started. I was very uncomfortable that whole day and at 2:30 am when I got up to use the restroom, I had a bloody show. About an hour later, my water broke. 

I was doing well laboring at home with my husband and mother-in-law already awake and alert to what was happening. (Praise God my MIL came as we had no one else to watch our big boys.) When I overheard my mother-in-law tell my husband to trust me whenever I said to go to the hospital, I felt like it was time, around 4 am. Though my first son took 36 hours to come, my second took only 6 hours, so we knew it could be quicker.

Once we were in our room, I was mostly confined to the bed, though I didn’t have much desire to move around by that point. The first nurse we had was so loud and distracting, and I was eager for her to leave. She took forever to check me and when she did, she said that I was only at 5 cm, but not to worry because by the time the doctor comes, I’ll be ready to push. I was so discouraged as I’m pretty sure I was in transition already and she just said that so I wouldn’t try to push before the doctor came.

At one point my husband had gone to the bathroom and I had the desire to get on all fours, so I did. That nurse came in freaking out. She yelled that I wasn’t allowed to do that then grabbed me and started yelling for help. I got mad at her and told her to leave me alone, and then I just stayed there until I was ready to move. Another time, she offered me gas and I agreed, until my husband reminded me that I didn’t want that, that I wanted to be alert and with it when the baby was born, so I had to push the gas away. 

Thankfully I was only at the hospital for about an hour before the baby came. The doctor was called and she had to drive faster than ever before to make it on time. I was most comfortable laying on my side, so I stayed in that position and pushed.  I’m not sure how long I pushed, probably about 10 minutes. I was able to lift my head up and pant some in order to not tear, and the doctor did a great job of coaching me. A couple times she encouraged me to push without a contraction so it wouldn’t be such a hard push, but slowly ease him out.  That was a little strange and I didn’t have a lot of strength to push without a contraction, but maybe that was better.  As it turned out, I pushed out a 9 lb. 15 oz. (4.5 kg) baby with only a small tear! It was the least amount of damage I’ve had yet. Part way through the pushing, I reached down to feel his head, not sure if I did or not, but they said it was there.  Also I knew the doctor was very concerned about his shoulders getting stuck (shoulder dystocia), so I pushed pretty hard to get his shoulders out so she’d stopping worrying. This was the doctor who wanted to induce me and had told me all the risks and all the ways they may intervene, but thankfully the only intervention she asked about was an episiotomy and she respected our “No.”

            At 5:35 am when Phineas was born, he cried! And he was laying on the bed all purple and all I could say was, “He’s alive! He’s alive!”  We were so thankful! After the pediatricians checked him out, I was able to start nursing Phineas, but only for about 20 minutes before he was taken to the special care nursery where he stayed for the next 4 days. I got to stay at the hospital every night that Phiny was there except the last night, and my husband was wonderful to push me in my wheelchair down to the nursery to nurse him every 3 hours or so. It was not the ideal situation, but they had to continually monitor his heart. 

Phineas was diagnosed with Wolff Parkinson White syndrome, a rare condition in which one’s heart has an extra electrical path and can start racing at any moment. He was given beta blocker medicine which he continued to take until he turned 2. Praise God, we have never had another incident of his heart racing and he has been a big, strong, healthy boy. I take him back to the cardiologist every year for a checkup, and this past March while we were there, we found out I’m expecting Phineas’ baby brother at the beginning of November. Thankfully, this pregnancy has been uneventful (except for the worldwide pandemic of course;)! 

*Babies are diagnosed with Hydrops when abnormal fluid levels are found in at least two different parts of their bodies. As Amy reports, Phineas was found to have extra fluid around his stomach, heart and brain. This can sometimes be caused by heart problems and so thankfully this resolved when Amy took medication for Phineas’ heart rate. *

Midwife’s Musings- Birth bag- What do I need?

What do I need to pack?

This is a question I’m often asked by pregnant women. It’s something that can vary if you are in a host country, so I’ve included some top tips, as well as tips from Instagram followers who have kindly shared their experiences. If you’d like to add yours, feel free to make a note in the comments at the bottom and do check out the Insta page (@bumps_births_and_babies_abroad). Thanks to all who contributed!

So here we go:

  1. Packing is something that can be super fun, helping you to bond with your soon-to-be arrival and helping you to mentally prepare for this exciting moment and transition in your life. So my first piece of advice is, enjoy it!
  2. Babies can come at any time, usually between 38-42 weeks. My advice would be, having a bag ready with all you need for your birth from 35-36 weeks is great. This is when midwives and doctors will often start to ask you about your preparations and means you’re ready well in advance and not having to do a last minute rush.
  3. Whilst this list is mostly tailored to hospital or birth centre births, it’s still really helpful having everything in one place if you’re having a home birth, and it’s also really handy if you have to transfer to the hospital with short notice.
  4. Necessary items often differ in different countries depending on what facilities they have. Ask your health care provider what they would recommend, as well as friends who have already given birth in your host country. They may well have lots of suggestions of things you wouldn’t have thought of.
  5. Try and find out how many days it is expected that you will be in the hospital. Of course this can vary depending on the type of birth you have and how well you and your baby are, but finding out a rough estimate will help you prepare the right amount of clothing and supplies.

Usual items

In the UK we would usually advise mother’s to pack:

° Maternity notes

°Hygiene items such as maternity pads, soap, towels (we used to just have baby sized ones), toothbrush, tooth paste, hairbrush, breastpads etc.

°Camera (or a phone with a good camera)

°Nightwear

°Comfortable clothing for time in the hospital (often nightgowns) and for going home

°Extra snacks and drinks

°Recreational items like music, book and games (induction can be a long process)

°Cotton wool

°Nappies/diapers- You may need different sizes if you’re unsure of the size of your baby

°Baby clothes- At least two hats (one usually gets a bit messy as its put on the baby straight after they are born to keep them warm), vests, baby grows, blankets etc. We would usually advise that babies wear one more layer than we do to make sure they are warm enough.

Extra items

Here are some of the other items others who have given birth abroad have found they needed. As these are individual’s experiences, they may well vary in different health facilities in the same country but are definitely helpful pointers:

Uganda– Bedding- Sheets, pillows etc. as well as any food you’d like

Ghana– A basin to be washed in

Australia– Eye mask and multiple pjs incase of night sweats

Japan– Water and other drinks as well as a pillow

Guatemala– Many outfits for newborns (more than 3 sets were expected)

Scottland– Ear plugs

Finland– Nipple cream

China– Painkillers

Happy packing!

A Swedish experience of a challenging pregnancy and birth in the States – Sophia’s story

I was born and raised in Europe but I lived in the US when I found out I was pregnant. I had come to the US in 2005 to be an au pair (live-in nanny), and then ended up staying, getting my Bachelor’s and Master’s and working throughout. I started out in Washington DC, but moved west to Los Angeles about 6 months into my first year here.

            My maternity care and labor happened in Southern California. I found out I was pregnant in March 2019, and I was as happy as could be because I had dreamt of having children for what felt like decades! At the time, I was with the man I loved, and had a fantastic job with good benefits, so I found my OB/GYN through them.

Unfortunately I was incredibly sick in the beginning of my pregnancy, and I had a hard time standing, and sitting, plus I was dizzy and throwing up. I had taken about 7 pregnancy tests (JUST to make sure 😉 ), and I was probably in week 5 or 6 when I went to the hospital. First, I waited for 1.5 hrs in the waiting room, dying from morning sickness, then I got called into a room, waited for 45 minutes before hitting the ‘I need help’ button. I did not know it would set off an alarm and have 4 nurses running in to make sure I was ok, but I was really too sick to sit there any longer. The doctor came in, essentially stabbed me with the ultrasound-stick, shoves it around, and tells me “there is a little black spot there, maybe it is a baby, maybe it is not, I don’t know”. She proceeded to yank the ultrasound out of me as if trying to rip my uterus out and left the room. I didn’t have a chance to ask any questions, and I was so upset about the visit, I cried the whole way home in the car. Needless to say, after this encounter, I switched, and set up an appointment at a different hospital, and that went a lot better. I absolutely loved my OB/GYN there. She was kind, empathetic, caring, genuine and knowledgeable.

            In May, my boyfriend of 7 years was banned from being with me by his non-accepting family because I was pregnant and not who they wanted him to be with. His uncle called me and told me I had to get an abortion, tried to bribe me into moving back to my home-country, or come to the Middle East with them. None of the above options appealed to me, so I asked them to let me be. I have not heard from my boyfriend since – I don’t even know if he is ok.

            Unfortunately, in June 2019, most of my colleagues and I were laid off because the company was bought, so I lost my insurance. Getting on Medi-Cal was a bad dream, but getting a doctor to see me was a NIGHTMARE. No-one would accept ‘straight up Medi-Cal’, and it would take a month for one of the plans to kick in, so I was without doctor’s visits from the end of June, all of July and to the beginning of August – and I was about 6 months pregnant at that point. On August 24th, 2019, I was in a terrible car accident. My car was completely totaled, and again, I was about 6 months pregnant. By the grace of the Universe, I somehow walked out of the car. I truly had several guardian angels around me. I know it sounds weird, but I felt them surround me and protect me and my baby belly from the impact, sort of like I was in a cocoon of light. Luckily, the car behind me was an ambulance so they got to me almost right away, and helped me get to the hospital. Thankfully, both baby and I were ok, and I was FINALLY seen by a doctor.

By the beginning of August though, I had gotten a new job, so I was back on an insurance, which my old doctor accepted, so I could go back to be seen by her which felt like an amazing blessing since she knew everything about my pregnancy background. However, unfortunately, the job was not very accommodating to my pregnancy, and I didn’t get the breaks during 10-12 hr work days, or desk-props that I needed, such as a foot-stool. I was incredibly swollen (think elephant legs), borderline gestational diabetes, and I developed hypertension as a result.

Because of all this, I was induced on November 14th 2019. It was the worst. I had a bad reaction to the epidural and started throwing up and passing out, so I was in and out the whole time. I pushed for 4 hours during the night on Friday, and eventually they took me to the OR for a c-section. Before they did the c-section, my doctor tried the forceps. This was something I did not want to do, but I was so out of it from the drugs, I couldn’t say anything, and I barely noticed. Luckily, I had a girlfriend with me in the room who told my doctor not to use them anymore after 2 tries. Then they pumped me with more epidural and morphine, but unfortunately I had a bad reaction to the morphine as well and started hallucinating and telling lies, haha. I remember thinking, “why am I lying”, but I was. I was making up a story about a neighbors dog (so a gentle lie), but that is all I remember. I have also never been so thirsty in my life, as I was throughout active labor. They wouldn’t let me have any water or even ice chips since I would just throw up, but my lips, mouth and throat were literally like the Sahara. I didn’t even get a wet cloth to suck on for some moisture.

            Eventually, after 37 weeks of pregnancy, 3 days of labor, 4 hours of pushing, and a c-section, my beautiful daughter was born on Saturday, November 16th at 4.12am. Because of all the drugs and my reaction to them, I wasn’t able to hold my daughter until more than an hour later in the recovery room at the hospital. Thankfully, she latched right away and we got some much needed skin to skin. I stayed at the hospital another 4 days since I was alone, and had to heal a bit from the major surgery. The stay was great, everyone was very kind and sweet. It was an incredibly hard journey, but my daughter is the absolute best thing that ever happened to me, so it was all worth it.

            It was hard to do it on my own, without close family around, but I knew I could do it – I had been prepping all my life. I always knew I wanted children and I have worked with 100’s of kids in my day! I don’t go a day without talking with my mom, so a hot tip would be to make sure you have a fantastic and supportive team around you, even if they are not physically there. It is all about that mental health! Further more, having a couple of amazing, close friends locally to help you when you arrive home with your baby is important. Definitely have people bring you food – set up a food train even before you give birth between the close people you have locally. And lastly – don’t be shy, please ask for help when you need it! I absolutely suck at this, and many friends keep reminding me to ask for help when I need it. That is what friends are for, and you would do it for them, right? Right!

Thank you so much for reading my story <3.

Midwife’s Musings- When to ask for help

Whilst most pregnancies are ‘straight forward’ and many women won’t experience any of these problems, it is always good to be prepared, just incase. If you are pregnant or a new parent abroad, particularly if you are in a remote location, knowing when you need medical help can feel like a mine field. Our bodies are amazing, and often we have a gut instinct when something is not quite right. My first piece of advice is, trust this! Secondly, if in doubt, check it out. It is always better to reach out, to ask the question, even if it is for your maternity team to reassure you. We would much rather that you ask, than suffer in silence and sometimes smaller symptoms can add up to a big picture.

The other main point to highlight here, is making sure that you have a medical team you trust. As with the per Maternity care abroad, research different providers, and find one you trust. They may be local or they may be further away, but having someone you can ask, even via phone is vital! I don’t want to cause unnecessary worry but to quote the boys scouts, always be prepared. Hopefully you won’t need this at all but if you are living further away, it is good to think in advance about what you would do if you do need immediate help; which local clinics may be able to help with which services and whether you have medical insurance (e.g. could you be medivact/airlifted if you need assistance that is not available in your area).

Having said all of that, here are a few scenarios when you should ask for help. It is not an extensive list, but should give you a general idea. Promptly should be within but preferably before 24 hours. A helpful thing to be aware of is that for pregnant women and new babies, their immune systems are not as strong. Therefore, it is better to ask for help sooner rather than later as illnesses like malaria can become more serious, more quickly.

General

Promptly:

  • If you feel unwell in yourself. We sometimes have an innate sense that something is not right, even if we cant put our fingers on it. If you feel this, definitely trust your gut.
  • Fever. 
  • Itchy or fowl smelling discharge. 
  • Any symptoms that could be linked to tropical diseases e.g. malaria.
  • Any other concerns.

Immediately:

  • Pain or passing blood in your urine.
  • Seizures.
  • One of your legs swells more than the other, it may be red and painful. 

During pregnancy

Promptly:

  • Itchy all over and particularly on your palms or the soles of your feet. 
  • Pain or burning when passing urine or feeling like you need to pass small amounts of urine frequently.
  • Itchy or fowl smelling discharge.  
  • Any other concerns. 

Immediately:

  • Any bleeding or leaking of fluids (apart from normal discharge) from your vagina. If you think your waters might have broken you might hear a popping sensation, it could be a big ‘Hollywood’ gush or a little trickle which can make you wonder if you might be wetting yourself (pregnancy is glamorous hey!). 
  • Sudden or severe headache, your eyes may also feel funny or you see flashing lights, pain in your right side just under your rib cage or swelling in your face.
  • Severe or constant stomach pain.
  • Reduced movements- The baby’s movements are the best way to know that the baby is healthy. If the baby’s movements are less than usual, then it is important to have a check.
  • If you feel something hanging in your vagina (this could be the baby’s cord hanging down and you need help asap!).

During labour

If you are not birthing in a medical facility it is really important that you have a medically trained professional with you. They should know all the signs so I won’t go into these ones.

After the baby is born

All of these symptoms should be reported sooner rather than later. 24 hours may be too long, so it’s good to ask for help quickly if any of these occur.

Mum

  • Fowl smelling bleeding.
  • Very heavy bleeding with clots larger than the size of a 50p or large coin. 
  • If your wound or stitches smell funny, they look inflamed, you see pus or they seem to not be healing well. 
  • If your breasts become lumpy, swollen, red or painful. 
  • One of your legs swells more than the other, it may be red and painful. 
  • Seizures.
  • Fever.
  • Sudden or severe headache, your eyes may also feel funny or you see flashing lights, pain in your right side just under your rib cage or swelling in your face.
  • Any other concerns. 

Baby

  • If they are drowsy and do not wake.
  • If they are not feeding well. 
  • If they have a yellow tinge in their skin, eyes or gums.
  • Seizures. 
  • If they seem to not be increasing in weight. 
  • If they are not opening their bowels or passing urine properly. 
  • Any signs of infection around their belly button.
  • Any other concerns. 

As I say, this post is not at all meant to cause concern or worry, and hopefully these things won’t happen. For most families, pregnancies are ‘normal’, without these occurring, but it is always good to know what to do if any of these scenarios were to occur. As I’ve said above, having a maternity team you trust is key, and if in any doubt then please do reach out and ask. They would much rather that you got in touch so they can help you in anyway you need 🙂

Zed’s arrival in Ghana- Gretal’s story

Gretal kindly shared her first birth story here, and has generously written about the birth of her son Zed, below. Happy reading!

This pregnancy was very different, and more difficult, than my previous one. This may be because this pregnancy was mostly spent in an African village. The first 3 months involved low appetite and weight loss that I wasn’t able to regain till I was 6 months pregnant. I had deep cravings for what felt like everything that wasn’t available. Another thing that made this pregnancy seem extra hard was a bout of malaria at 33 weeks. Thankfully it was a rather mild case, but it came right over the time that our electricity went off for several days. The malaria was quickly followed by a mega head cold that made breathing nearly impossible when lying down. Not that I was sleeping that well anyway since it was 90 some degrees, humid and we had no fans.

My husband and I are both nurses and volunteered at a local clinic. For prenatal care my husband and I would check my weight and blood pressure every month and listen to babies heartbeat with a small Doppler we had. We had an Ultrasound done at 14 week thanks to a class we were taking at the time to further our education. At 21 weeks we had another one done. I am Rhesus negative blood type so we had to also search for a pharmacy that sold Rhogam (special medication given when the mother’s blood type is rhesus negative to protect future babies). Before the birth we again needed to buy Rhogam and keep it in a series of fridges and ice chests until after the birth. Early in my pregnancy I had packed an emergency hospital bag including cord clamps, gloves, etc. Thankfully we never needed it.

We had decided early on to do an elective c-section for this baby. There were many reasons we chose this route. One being that a vaginal delivery overseen by a Dr was not possible unless we traveled 12 hours or more.  Also because we lived in a village the unpredictability of when labor would start would mean traveling to the area of the hospital a week or two before the due date and possibly spend up to a month there should the baby go over due.  Childcare was a factor. Also see Noah’s birth story for my previous experience.  I made a poster during nursing school comparing elective c-section to vaginal births. So I knew our decision was not exactly popular. But given our circumstances and everything considered we opted for a planned c-section.

I had my hospital bag packed.  I compared my “hospital bag checklist” with the one babycenter.com sent me. Mine included things like bed linens, pillow, baby bed and mosquito repellent.

After we were admitted to the hospital on the morning of our due date, a nurse ushered me into the delivery room where I had spent about 7 hours pushing 3 years before! Oh the memories…  They prepped me for surgery and then had me wait in the maternity ward until surgery.

The nurses finally let us know they were ready for me and wheeled me down to the OR. I had to leave my flip flops behind and walk barefooted and sheet clad into the OR and onto the table. My husband got scrubbed in and joined me soon after. The anesthesiologist dug his nails into my back, marking where he intended to poke me. After sanitizing the site the needle went it and soon my toes started getting numb.

Meanwhile my abdomen was being scrubbed and things were getting exciting.  The doctor soon came in and said a quick prayer for all to go well and began. In just a few minutes. they had made an entry way for our baby low on my abdomen. The doctor got a hold of the baby’s head while his assistant pushed down hard on the top of my abdomen with both hands. There was an immense amount of pushing and pulling and I remember thinking, “I’m going to be really sore after this!”.

At 10:10am I heard the suction machine doing its job and then a little wail. My husband told me it’s a boy! Our ultra sound tech had been right! Zed Justice it was, and not the little girl everyone had predicted. My sweet nurse stepped up to receive the baby with a clean flour sack covering her arms. My husband had purchased this from the hospital when they asked him for a receiving blanket. We had only brought blankets for the baby to be wrapped in after he was cleaned up. She spread the baby’s legs to show me that he was indeed a boy and then whisked him away to weigh and measure him. She soon came back with question marks over her face…where was the grandmother? Who would dress the baby? My husband quickly offered to do this himself and dressed him while they finished stitching me up.

I was starting to have a lot of pain and finally said so. They gave me fentanyl. Immediately I felt like I was about to drift off to sleep and I started crying. This is precisely what happened last time I had a C-section. “Mama, the pain is too much?” the anesthesiologist kindly asked. “No, this medicine makes me cry, nothing is wrong” I blubbered. About 20 min later the whole scene repeated itself. “Mama, are you ok?” “Yes, this medicine makes me crazy!” I said, tears streaming down my face while trying to politely smile. I was wheeled back to the ward where my husband and baby Zed were waiting for me…Then I could not entirely blame the tears on the pain medicine.

The next 6 hours were spent flat on my back, enjoying my baby, and napping. I was just getting ready to call my mom when they gave me another dose of pain meds. The combination of hearing your own mom’s voice from a world away just after giving birth and the meds, made for a tearful, and croaky phone call! My mom was understanding and said she always cried after her babies too =)

I had not been allowed to drink or eat anything since midnight and by now I was so thirsty! We were in the middle of harmattan weather, when it is extremely dry, and I kept using chap stick and nearly hallucinated over water. We suddenly realized that we had not thought to bring antiseptic soap or a bucket for them to use to clean me up. So my husband rushed out to town and bought them.  After my 6 hours were up two nurses graciously cleaned me up and helped me walk to a private room.  My husband brought me water and I drank bag after bag (Yes, we drink bagged water, not bottled) ;).

I did deal with quite a bit of pain after my surgery unlike my previous birth.  But overall this birth experience was very peaceful and uncomplicated for which I am very thankful. I look back on it as a very positive experience. And our son is as healthy as could be!

Midwife’s Musings- Maternity care abroad

So you’re pregnant overseas? Congratulations!

At times it can be easy to feel like you’re on this journey alone, but really you’re part of a club of women who have decided to expand their families outside of their passport country, and ultimately, you’re also part of a global community of women navigating pregnancy, birth and new parenting. I don’t know about you, but I often find situations and experiences less daunting when I know I’m not on my own and that actually, I’m part of a bustling community.

I’m also aware that every maternity journey is different and this can be hugely impacted by access to maternity care. You may be living in a bustling town or city filled with medical facilities or you could be in a more rural location with limited access to medical help. Whatever situation you’re in, it’s important that you are confident about your maternity care.

Here are some handy pointers that might help:

Find a maternity team you trust

Having a great medical team (midwife, delivery nurse, doctor etc.) that you trust is crucial. It is important that you feel that whatever might happen, you have a team who have your back and will keep you and your baby safe. An important thing to be aware of is that not all doctors are qualified or have experience in obstetrics, so it’s good to make sure the person caring for you has the necessary experience and qualifications.

Research is so important here. Ask around and seek out recommendations. It is very unlikely that you will be the only expat who has given birth in your location. Ask friends, look online for any forums where people may have shared their experiences and make appointments to see a medical team. When you are confident in your team, a huge weight will be lifted, I promise!

Explore your options

You may be able to access all maternity care from conception right through to postnatal care near your home, or you may need to travel further. If you live in a remote location, you may need to travel for all your appointments or you may be able to mix and match.

Many smaller clinics (if not all) would be able to provide full antenatal and postnatal checks including blood pressure, urine checks, blood tests, measuring your stomach and listening into the baby.

If you decide to have a mixture of different health providers, it is really important to make sure you have good communication so each team knows what care you are receiving where, and to take any notes you are given to each appointment. Choose a provider you would like to be overseeing your care (doctor or midwife) and ask them how many appointments they would like with you in person and what they would recommend. They may also be able to offer some appointments on the phone and they may want to check in with you after each appointment that another health worker saw you.

If you plan to give birth further afield, it is important to consider where you can stay close to the hospital before the baby is born. It may be a more expensive option but as babies are usually born between 38-42 weeks of pregnancy, with little warning, finding accommodation is crucial. From someone who has been there before, there are few things as stressful as a race against the clock to get to a hospital! If you ask around you may find there are ministries, organisations or co-workers who can help. You won’t be the first person in this position.

As a midwife, I do feel I need to stress the importance of antenatal care, but if you genuinely cannot find anyone who can offer maternity services locally, and are unable to travel for all appointments, it is worth seeing if you could have phone appointments with a doctor/midwife and to ask if they know anywhere that could provide these checks or failing that ask if they could teach you how to check your own urine and blood pressure. Of course the gold standard is for someone medically trained to do this, but if there is no other way, then this is better than not having any monitoring at all.

Schedule of care

I’m going to begin with a bit of a caveat here. Every country and even different hospitals within the same country will have different schedules of care. I’ve mostly worked clinically in the UK, and so I can only really speak into this. It might be helpful for you to research care that is usually available in your passport country to make sure you are getting the care that you are happy with. If you are in doubt as to whether something is possible, please do ask, as investigations are often available privately (at a cost) if they aren’t routine.

If you’re in a more rural location, it may be tempting to think, ‘what can I cut’. I totally understand this. It is hard and expensive to travel for appointments, but from a midwifery perspective, I can tell you that everything we offer is evidenced based and is important in it’s own way to support you and to ensure yours and your baby’s safety.

Ultrasounds/Sonograms

We usually recommend two of these in the UK. Whilst it is a really special moment for parent’s to meet their babies, they also have medical importance:

  • Dating/Nuchal scan – 10-14 weeks – This scan measures the baby’s size and helps us to have an accurate idea of when the baby is due. Everybody’s cycle is different so dates can be up to two weeks out. At this scan, screening for Down’s Syndrome, Edward’s Syndrome and Patau’s Syndrome are also offered.
  • Anomaly scan – 18-10 weeks- Most babies are perfectly happy and healthy but the purpose of this scan is to check for any abnormalities. The baby, amniotic fluid levels and the placenta are checked and any abnormalities spotted can be further investigated throughout the pregnancy. For example, if it is known that a baby has a problem with their heart, the cardiac team can offer further specialist scans and make arrangements and plan for any care the baby may need after they are born. If something like this were the case, it may alter your decision about place of delivery, to ensure you have the necessary support available.

Appointments

Regular appointments are scheduled to ensure the health of mum and baby and whilst routine checks such as blood pressure and urine, may seem to be of little significance, they are actually hugely important. Whilst the majority of mothers will have healthy pregnancies, that is not always the case and since the introduction of routine antenatal appointments, rates of maternal mortality and morbidity drastically reduced. It is usually midwives who lead these appointments, but they can also be performed by doctors.

During each appointment your blood pressure and urine will be checked to make sure that you aren’t developing a condition called pre-eclampsia and from 25 weeks they will measure your stomach to check the growth of the baby, check for the baby’s position and listen into the baby’s heart rate. They will also check in with how the pregnancy is going, making sure there are no problems and helping to prepare you for the birth.

Schedule of appointments

As said above, these can vary but I hope this gives you an idea.

  • Booking appointment- 10-12 weeks – This is the first appointment and is longer. We talk through your medical and family history in case there is anything that could affect your pregnancy. We also offer to take bloods for HIV, Hepatitis B, Syphilis, Sickle cell, Thalassaemia, your blood group (you usually require two samples throughout pregnancy in case you need a blood transfusion) and a full blood count (iron and clotting levels in particular). If you have had one, we will review your dating/nuchal scan report.
  • 16 weeks- Blood results and scan reports are reviewed (although you would have been contacted earlier if there is a problem) and follow up is arranged if needed.
  • 25 weeks- (usually with the doctor) – This is often the first time you will see the doctor during your pregnancy. They ask how the pregnancy is going, look at your scan reports and conduct the routine tests.
  • 28 weeks – A blood test is offered to check iron levels (they tend to reduce at this stage in pregnancy so we can offer iron supplements if needed) and the second blood group. The anomaly scan report is reviewed and follow up arranged if needed with a consultant obstetrician. Anti-D injection is offered to women whose blood type is rhesus negative to protect any future pregnancies.
  • 31 weeks (Usually just for first time mothers) – Results of blood tests are discussed and we chat generally about how the pregnancy is going.
  • 34 weeks (Usually with the doctor) – Results of all scans and blood tests are reviewed as well as the routine tests.
  • 36 weeks – We pay more attention to the position of the baby. If the baby is breech (bottom first) we would talk about ways to help the baby to turn ready for birth. We also talk about your preparations and plans for birth.
  • 38 weeks (Usually with the doctor) – The doctor will speak to you about what they will recommend if the baby is not born by 41 weeks as we aim for all babies to be born by 42 weeks to make sure that the baby is still receiving a good blood supply from the placenta.
  • 40 weeks (Usually just for first time mothers) – If you would like an internal examination, a ‘cervical sweep’ can be performed which encourages the start of labour. We will also discuss again what we will advise if pregnancy continues.
  • 41 weeks (For those who have not given birth) – A ‘cervical sweep’ will be offered again and induction of labour will also be offered.

Postnatal care

It is important to talk to your maternity team to ask what they would advise for your care once your baby is born. If you give birth in another location, they will probably want to check on you a few times before you leave. Local clinics will also often be able to provide this care, so if you do decide to give birth in a larger facility in another location, it may be possible to return home after a few days (depending on yours and your baby’s health) and to continue care from there.

In the UK if everything is going smoothly, there are usually 3-5 appointments and most mums and babies are discharged at 10 days old with numbers of someone to contact if needed. Throughout these appointments we will ask how you are feeling and your general wellbeing, check your blood pressure, temperature, pulse and breathing rate, have a feel of your tummy and check that your uterus is reducing in size, check your wound if you had a cesarean or stitches if you tore, ask about your bleeding and ask about your legs. We will also ask to see your baby, check their soft spots on their heads, check they aren’t developing jaundice, their heart rate, temperature and breathing rate and we will ask about feeding as well as how often they are passing urine and opening their bowels. We can offer feeding support with either breast or formula feeding and we will weigh the baby to make sure that the baby is gaining weight well.

In the UK we offer a screening called the ‘Newborn Blood Spot’ or ‘Heal Prick’ test that is usually done when the baby is 5 days old. It screens for 9 conditions such as sickle cell disease and metabolic diseases like maple syrup urine disease. Most results come back completely normal but the conditions it screens for can be serious and so, testing enables us to give your baby the best support possible. For example, some of the metabolic conditions can have long-term consequences on babies brain development if diet is not changed appropriately. This test would be a great one to look into doing, although it may well be a private test.

Know when to contact medical help

Outside the usual schedule of care, you may need further assistance. I’ll include this in another post as this is getting long (!) but if in doubt please do ask for help. Your maternity team is there to support you and will only be pleased to help. If in doubt, we would always rather hear from you, even if it is so we can reassure you!

Noah’s birth in Ghana- Gretal’s story

My husband and I arrived in Ghana when I was 7 months pregnant with our first child. We contemplated and prayed about where to have our baby and we both came to peace about delivering at a hospital in Ghana that some of our colleagues had used for other illnesses. There was an American doctor there who met with us and we felt comfortable trying to have our baby there, allowing the midwives to deliver us unless there were complications. This is normally how things run in Ghana.  We had received antenatal care in the U.S. including an ultrasound and then kept regular track of my blood pressure, ourselves, after we arrived. My husband and I are both nurses, which gave us a measure of confidence that may or may not have been helpful to us =)

The moral of our story would be that you need to be at peace about where to have your baby. We were serious about seeking God over where and who should deliver our child. There was no writing in the sky, but we both felt secure about our decision.

A week before the baby was due, we traveled to the hospital which was about 3 hours away, and settled into a little guest house nearby. I had brought my own sheets and pads and everything I could think of that we might need for a Ghanaian hospital birth. I was new to the field, and new to parenthood… there was really no way to prepare myself. I tried to think of worst-case scenarios and decided that pushing for 5 hours would definitely be one of them! (Read on…)

Our baby took its good old time and we filled the next two weeks with memorizing all the countries of Africa, going on 3 walks a day (we got to know the locals personally!) puzzles, books, naps, you name it. My maternity clothes were getting tight… and I was very tired of being pregnant. Looking back we still treasure the couple time we had before we got launched into parenthood and all the other responsibilities and adjustments of life on the field.

Our excitement was sky high when I discovered bloody show early Saturday morning (Day 8 post due date). We got up and went for a long walk which produced regular but light contractions and we became hopeful.  My contractions were light all day but by 8pm we decided this was the real thing. My husband and I realized that our dream of going into labor in the morning and avoiding that extra night of no sleep was not going to be realized.  I wanted to stay at our guest house for as long as I could to keep from having to be penned in a small room or be away from my nice warm shower.  But at 1:30 Sunday morning hubby said he would feel better If we would just go and figure out our room and get checked awhile before things get more serious. It was about ½ km to the hospital and we kept stopping along the way to breathe through contractions. 

I went to the maternity ward and found a midwife behind the desk.  Since Ghanaian men are not in sight when a baby is born we had asked ahead of time if they could give us a private room to labor and deliver in. The maternity ward consisted of a large room with approximately 10 beds, and a small nurses station in the corner. Once delivery was imminent they would move the patient to a small delivery room that had two delivery tables with a partition in the middle.  They graciously had said we could have one of the theater rooms to labor in, so our midwife led us down to a small hot room with a cookie sheet of an exam table that was just big enough for me to lie on. She promised to return shortly to check me.  And she did.

She was a was rather rough and you can imagine my alarm when she wiped my perineum firmly and proceeded to check my progress with her entire hand inside of me. “You relax! ” she hollered.  I had not been vocal with any of my discomforts up until that point. Apparently she got the info she needed and reported that I was dilated 6 cm and that she was going to go get an amnihook and break my water. She left the room and I started to bawl. She returned an hour later and we pleaded with her to please be more gentle….She smiled pleasantly, “small small eh?”. The treatment was exactly the same only this time she included an amnihook.  “You relax!” I was coming off the bed in pain, forget relaxing! She decided to leave me alone and try again after a while.

It was nice and cool outside so we decided to go walking around the hospital grounds and parked ourselves by a small picnic table right outside the gatekeepers shack where I could rest my head on the table and stay clear of any midwife that might threaten to break my water.  At one point we were walking down a hospital corridor, when a big rat came careering around the corner. It came to an abrupt halt at the sight of us and made a hasty retreat down the hall it came from. We rolled our sleepy eyes to the ceiling and laughed cynically.

The maternity ward was busy that night and I later learned they had 8 deliveries that evening. Finally we convinced ourselves that by now if they would break my waters the baby would be born before long. So at 5:30 we let the midwife come and have another go. She was obviously trying to be considerate, but this time she decided to be quick in hopes of getting it over with in an efficient manner but she miscalculated her poking and there was some blood, more agony and no gush of water.  She got the “patient look” and said that I was dealing very well with labor but was just too uptight when she tried to check me.  We contemplated calling the Dr. now but, shift change was just around the corner, so we decided to wait and see how our next midwife would be. 

In she came at 7’Oclock. Slim fingers, I noticed and had a very kind demeanor. She introduced herself, and I decided to believe the best about her and allowed her to check me, which she did ever so gently and reported that I was at 8 cm and she was not anxious about breaking my water. I was advised to go walk or whatever I wanted to do. Big sigh of relief! It was still cooler outside than in our little room but people were milling around and seeing a pregnant white lady with disheveled hair and squatting every so often in the hallway or on a bench drew more attention than we wanted, so we stayed in our room. The contractions were strong and coming every 2-4 minutes.

My sweet midwife finally reappeared mid forenoon and checked me. I was 9cm. Soon another Dr. came to check me. She suggested we break my water.  She did it very gently and I was relieved to feel that long awaited for warm gush of water! Now things could hopefully move along and we could have this baby! They instructed me to push. I had never had a baby before but I didn’t think I felt very pushy. I had determined ahead of time not to push until I felt ready.  We were both exhausted but instead I paced around the room hanging onto my husband and squatting with each contraction and pushing with the ones I felt pushy with.

2pm the nurses advised us to come into the delivery room. This time yet another midwife checked me and told us she feels a lip that’s in the way! After not pushing for a while they checked me while I pushed to see if that lip would disappear. It did….Then they checked again no, it didn’t.

I got on my hands and knees, I rocked back and forth, I panted, I blew.

4pm. They had been periodically checking the baby’s heart rate with a Doppler. The baby seemed to be tolerating the drawn out process quite well but they couldn’t be sure because the Doppler wasn’t working the greatest. The staff kept assuring me that the baby is coming and I was doing good, but I didn’t feel any different, and I was mistrusting of their encouragement.

Hello and goodbye, worst case scenario. We were now at 7+ hrs. of pushing. They started monitoring the baby more closely and soon noticed that the heart rate was dipping more often and it was decided to do an emergency C-section. The Dr. arrived shortly and checked me. The baby was too high to attempt a vacuum birth…much to my relief, and after pushing a couple more times with no progress he left to round up the surgery team. I signed the consent form gladly and suffered through a 2 minute long contraction without pushing. My husband changed into scrubs and soon they had me on the OR table surrounded by a German nurse, Ghanaian anesthetist, American surgeon, my Ghanaian nurse and a few other assistants. For a brief moment on the OR table I wondered what would happen if I would bleed profusely for some reason. There was no blood bank. And my blood type is very rare here.

Mr. Anesthesiologist had me sit up and inserted my spinal block.  I am eternally grateful to him. You have no idea how comfortable an OR table can be! The Dr prayed over us. It was so beautiful! 8 people from very different walks of life all united in the operating room, coming together before our loving Father asking for his presence to fill the room.  The surgery began and 10 min later Dr. announced, “Wow it’s a big baby boy!”  At 6:55pm our little Noah had arrived! He started crying heartily (as well as his parents!). The nurse showed the baby to me for only a second and then whisked him off to clean him up. Everyone started to guess the weight in kilos. I was still having trouble converting kilos accurately to lbs and oz so I was little lost.  9lbs and 4oz! No wonder I was having trouble pushing him out. His head circumference was 14 in.

As they were putting the final stitches in, the electricity went off. There is generator backup but it would take several min. for it to come on. Someone quickly whipped out their phone by means of a light and thus the job was completed. The rest of the evening I was in a happy daze.  Our little Noah was the sweetest baby we’d ever seen!

Many people since sympathize with me that I had to have a c –section. To me it was such a gift after laboring for nearly 24 hrs. I am so happy that I had that option and that there was a successful outcome. I look back on this “traumatizing” experience as something sacred and bonding for us as a family and not something I look back on with regret.

Being first time parents and new to the field definitely was an identity crisis for me. I went from being an independent person who held a job as a nurse and loved it. Now I was a language learner and a mom and did not have a shared history with anyone…and I did not love it. I felt like I was completely stripped from all I was comfortable in or good at. Mix in a baby who didn’t sleep great at night and some hormones…It was a low time in my life. But it got better. I have learned over the years that you are always in a season.  That was the new baby, language learner, culture shock season. Now I know some language. The “baby” puts himself to bed practically (after his first night which was spent in a suitcase as the hospital weren’t able to provide cots- see below) and I have adjusted to life here, to the point where I am not constantly thinking about how different it is from what I was used to.  And then I got pregnant with Zed! See Zed’s birth story next week!

Midwife’s Musings- I see you Mama, you did not fail!

Hey Mama,

I see you. I see your hurt, your disappointment and your guilt. I see your shame and frustration with your body. You’ve heard the narrative that your body is built to give birth ‘naturally’ without the need for doctor’s intervention, that this is the best way to give birth and anything else is not good enough. Anything else is a failure and will hamper your ability to bond with your baby.

What I’m going to say next may be controversial, but it’s true. You did not fail! You are strong! You are a mother! You brought your gorgeous baby into the world!

Often women can be told a message that vaginal birth is the best at all costs, that your body is made for this purpose and that anything different is not good enough. Maybe those women who had caesareans, ventouse or forceps did not try hard enough. As a midwife I can tell you that unassisted vaginal birth is a wonderful and beautiful. It is usually the fastest mode of birth to recover from, it aids the baby’s immune system, triggers hormones that help early breastfeeding and bonding as well as having countless other benefits. But other delivery methods are just as beautiful. Yes we are seeing a global increase in the use of intervention during birth, and we as health professionals continue to need to work on not over intervening, but this does not mean that your experience was any less beautiful, any less significant.

Birth shame is nothing new. It’s been around for a long time! My parents were subjected to it when they attended parenting classes run by a well-known charity in the UK. As soon as they said that they were having a medically recommended planned caesarean section, they were given surprised looks and discussions re- focussed on the importance of ‘natural’ birth in a way that made them feel different and as though their birth experience would not be as ‘rich’. Occasional comments were also made by others which, probably inadvertently, gave the impression that they would not have the ‘full birth experience’ and that my mum was somehow inferior as she had not ‘done it all herself’. But let me tell you, my parent’s experience was no less significant and no less beautiful or special because of the way I was born. Instead my mum tells the tale joyfully as to how she got to walk down to my birth, remembers feeling her toes on the operating table and when she reported this to the surgeon was told, “Don’t worry, we’ve already started with the scalpal!”.

Let me tell you that I’m very grateful for intervention. I’m grateful that I was born in a time and a country that was able to facilitate my birth in a way that protected mine and my mother’s lives. I am grateful for intervention every time a baby’s heart rate drops during labour and becomes ‘pathological’ (medical speak for the baby struggling and getting to a point where the lack of Oxygen could have long term consequences) and when it means that a baby can be born safely when it would otherwise not make it due to emergencies or the position of the placenta. I am even more grateful for intervention when I live in a country where interventions are available but not necessarily affordable, leading to heartbreaking stories where otherwise healthy mother’s and babies have died or experience long term complications. Don’t get me wrong, I’m not downplaying unassisted vaginal birth, it is incredible, but I am saying that it is not necessarily the answer for every woman.

So mama, I see you. You did not fail! You gave birth to a gorgeous baby! You are strong and capable. Your birth was just as beautiful, just as significant, just as special. You are a warrior and your body nurtured and birthed your lovely child. Be proud of yourself, and what you achieved.

You are amazing!   

Midwife’s Musings – You can do it!

Before I start this post I want to begin with a caveat. Before I moved to Uganda I worked in a high-risk ward where I cared for women with complications during their pregnancies and I’ve also sadly met many families whose pregnancies did not have a happy ending or that sadly led to birth trauma. Working as a midwife you have the privilege to care for many in some of the most exciting moments of their life, but also to support families in some of the most difficult moments they will have to face.

This post is in no way meant to sugar coat pregnancy, birth or parenting and it is not meant to patronise or cause offense to those who have had difficult experiences (I’ll try and cover these topics another time).

That being said, we can often be surrounded by messages of fear. Pregnancy and birth is no different. The number of movies, TV programmes, even birthing ones, that choose to fixate on drama or to depict inaccurate information is depressing. Almost as soon as I started working on the wards as a student midwife, I decided that I wouldn’t watch all but one of these shows for these reasons (maybe one day I could work as a midwifery movie adviser?!).

It’s also human nature for us to want to share our experiences, particularly the more difficult ones and to want to know all the possibilities of what could happen. I’ve heard many birthing horror stories filled with gory details and it’s not uncommon for me to be asked, “What’s the worst thing you’ve ever seen as a midwife?”. There’s nothing wrong with sharing difficult or traumatic experiences or to ask these questions. It’s important that we have people to debrief with and it’s natural to be curious, but this shouldn’t be the only side of birth that we hear or see. Birth is beautiful in all it’s gory glory and for every difficult experience, there are many positive ones. We should have a balanced perspective!

When women give birth abroad, the fear level can also be heightened. It can be unnerving and confusing to engage in a health system that you’re not familiar with, particularly if it is in a language you’re unfamiliar with. Being separated from loved ones can also be tricky and their concerns can also cause us to worry more. It is important to remember though that many women have given birth in different countries, all around the world. I’ve worked with lots of families who were receiving maternity care outside their passport country. Different care doesn’t mean worse, it’s just different and that’s ok. Getting to know your doctors and your midwives is really helpful. Having a team around you that you trust really helps and makes all the difference. (Have a look at the Midwife’s Musings – Top Tips for Birth Abroad post for some other tips!)

Bear with me for a moment, but let’s talk about hormones, and one specifically; Oxytocin. Oxytocin is commonly called the love hormone and is used by health professionals (in synthetic form) to help increase the number and strength of contractions if labour has been progressing slowly. When women feel calm and relaxed during labour, Oxytocin is naturally released, helping them to have frequent and strong contractions, enabling labour to progress well. If we go into labour fearful, we can disrupt these hormones, working against our body’s natural rhythms.

As the name suggests, labour is difficult. It involves digging deep, using resources you never thought you had and pushing through in ways you might not have thought possible. I don’t say this to scare or frighten you, but to empower you to know that although it will be difficult, that you can and will do it and that you are strong enough! In my opinion, there’s nothing as beautiful and rewarding, whether that’s a ‘natural’ birth or an assisted birth via the use of ventouse, forceps or a caesarean section. There’s something amazing about seeing a woman’s triumphant face, when she sees that she has done it, that she has birthed her beautiful baby, in whichever way this happened!

Pregnancy, labour and birth are beautiful and deserve to be celebrated. Our bodies are made to nurture and birth a baby, and there is something incredible about this experience. If we can go into birth knowing that we are strong enough to face the challenges that pregnancy and labour pose, we are far more likely to have a positive and empowering experience, whatever type of birth that might be.

So how can the balance be readdressed and how can we enter into pregnancy and birth with realistic but optimistic expectations?

1. Read positive stories

Reading or hearing positive birthing stories is so important. It tells us that whilst it will be difficult and challenging, that it will also be hugely rewarding, special, empowering and a transformative moment.  The primary focus of this blog is to share positive stories where people have given birth abroad, to encourage and support others who are in the same situation. Positive stories have power. They tell us that it is possible and that we too can do it.

Have a read through some of the stories posted here as well as on other websites and speak to people you know have had positive experiences too.

2. Affirmations

The name, ‘affirmations’ may sound a bit strange, but I promise its not. All it involves is having positive phrases that you can think about when you’re pregnant and whilst you’re giving birth. Phrases like, “I can do this”, “My body is made to do this” and, “I am stronger than I think” can help you to realise that yes, it is going to be challenging, but that you can do it. Reading or repeat these phrases either in your head or out loud regularly can really help to get into a positive mindset.

On this website, in the resources section, there is a document called “Affirmations” (some are pictured below). It is free to download. Go check them out, download them, make them your phone screensavers, print them off and put them around your house in places you’ll regularly see them. Or even better, make your own. If at any time you start to worry, go and read these messages and remind yourself, “I can do this”!

You are strong enough! You can do it! I believe in you!

Midwife’s Musings- Top Tips for Birth Abroad

Getting ready to become a parent, or to add a new child to your growing family can often seem daunting, particularly if you’re doing so in a country that is not your passport country. Here are some handy hint of things that might help you as you prepare:

1. Which country?

I know this sounds like a basic question but it is one of the most important. Have you decided which country you would like to give birth in?

If it’s your host country, that’s great, you can get started planning and researching (feel free to jump to number 2!) but if it’s your passport country there are a few things to consider. Have you made contact with maternity services in your home country? They will want to see your maternity records, so make sure you either take copies or originals with you. Do you know your airline’s policy about when you can fly? You may need a doctor’s note to confirm they are happy that you will be safe.

Even if you are planning to give birth in your passport country, it is still worth researching your options in your host country in case you end up giving birth early or being unable to fly. Pregnancies can have a habit of leading you to the unexpected, so it’s always best to be prepared.

2. Research, research and yet more research

As a midwife, which means ‘with woman’, my role is to advocate for my client, ensuring her and her baby’s safety, but hopefully assisting her in having a positive and empowering pregnancy and birth. I am a huge advocate of my clients taking time to do their own research. By looking into different options, it means that women are able to make fully informed decisions about their care, and to decide which options may be their preference.

When you’re living abroad, this is particularly important. Finding a midwife and a doctor who you feel safe and trust is massively significant and options of pain relief, place of delivery, schedules for antenatal and postnatal care amongst others are likely to vary. This can even be the case in different hospitals in the same country. Knowing what your options are can really help you feel as prepared as possible and to feel more calm and in control throughout your pregnancy and labour.

Speaking to friends who have accessed local maternity services, going directly to speak to doctors, midwives and nurses, as well as accessing information from local health authorities (e.g. NHS Choices and Royal College of Midwives in UK) will be a great start. There will also likely be a tonne of information online and in books too. Just make sure that you’re reading from a reputable source. The brilliance and danger of the internet is that anyone can post anything at any time and it is so important to make sure that what you are reading is both accurate and up to date.

It is also worth researching maternity care in your passport country and being aware if there is something you’d like to request in your host country. It may be that you decide you’d like your baby to have the vitamin K injection after birth, or the heal prick test or that you would like the same pattern of ultrasounds. Asking whether these services would be available in your host country, even if its not routine, but via request, will also help you to know whether its possible to have the maternity care that you would like.

3. Consider your choices and make a plan

You may have heard of a ‘Birth plan’ or ‘Birth options list’ before. It may sound confusing but it is actually pretty simple. Once you’ve had a chance to do some research and found out what your options will be, it is really helpful to take some time to decide, in an ideal world, what your preferences would be.

Then all you have to do is to write this down. It can include things like where you would like to give birth, who you would like to be with you, what forms of pain relief you would like, if you would like to use things like a birthing pool, what types of positions you’d like to try and the list goes on.

These lists have two main purposes. Firstly, it helps you and your family think through what your preferences would be. Knowing this, can make you feel more prepared and in control. Secondly, it can help health professionals caring for you to know what you are hoping for or expecting.

4. Expect the unexpected

As much as it’s important to be prepared, it is also really important to realise that birth is a natural process but that it is not one that we can always control. There are many factors at play here and the most important thing for health professionals is to ensure yours and your baby’s safety. Things unfortunately don’t always go to plan. Baby’s can become ‘distressed’ with their heartbeats being effected, labour can be prolonged, or even short, and it’s not uncommon for women to change their mind about their choices once they are in established labour.

Whilst it is good to know what your preferences are, it is also good to be realistic that this may not be possible or that things may change when you’re in labour. Health professionals can try as far as possible to follow your plans, but you may have to have conversations where they recommend changing the programme, particularly if emergencies develop. Knowing that this could happen, can again help to feel more in control and prepared and having done research about all options often helps women to better cope with last minute changes.

5. Birthing and parenting classes

Attending birth and parenting classes can be really helpful from a number of different perspectives. Firstly, they can provide great education and help you with your research, but secondly, many people find they help them form a social support network with other parents-to-be. Having people you can share moments like, “I’ve just jumped into the shower with a happy sleeping baby and its 3pm” can make you feel like you can share your victories, as well as your struggles with people who understand.  

Ironically with the COVID 19 outbreak having limited many of our options surrounding physical meetings, many more options are opening up online. Again, make sure you’re getting information from a reputable source, but it is definitely worth checking out. Just be aware that if you access information from your passport country, or a country that is different to where you plan to give birth, that some of the information may be different.

6. Immigration status and finances

This is something that is hugely important. If you know that you are planning to have a baby, or you’ve just found out that you’re pregnant, this is something to look into as soon as possible. Every country has different rules and regulations over citizenship and immigration status and the earlier that you find this out, the better. You will likely need to provide information from your health professionals for applications for birth certificates, passports, visas, citizenship etc. Make sure you know what the situation is and that you get it sorted out as early as possible and that you give yourself plenty of time to make sure paperwork is sorted before booking flights.

Another thing to be aware of is the financial situation surrounding maternity care in your host country. Does your health insurance cover you or will you need separate cover? You may need to provide proof of insurance or your ability to pay for care privately prior to receiving any treatment so it is good to be aware of this.

A great place to start if you’re unsure what to do with any of these things, is to contact your country’s consulate. They will be able to direct you with where to start, what the processes are and what information and evidence you will need to provide and when.

7. Communication with loved ones

It’s normal for family or friends to feel a mixture of emotions when women are planning or expecting a baby and this is only heightened when they are separated. It is likely that they are hugely excited and fearful at the same time. We often fear the unknown, so if women are accessing care that is different to what their families are used to, it is likely that they will be worried or concerned for you. Open communication and reassurance for them can be really helpful, particularly if they are unable to visit or see you for a while.

It is worth thinking about how you can keep people involved in your pregnancy and birth, sending photos, whatsapp calls once the baby is born, making arrangements for visits etc. There is no right answer but whatever feels right to you and helps you to feel supported and connected to your loved ones!

Hope these tips help and best of luck as you start planning!

Home birth in Mozambique- Tawnya’s story

My husband and I had originally planned to have two children, close together. My son was 5 months old when my husband told me he was ready to have another. At first I cried. Not because I wasn’t ready but because I knew I’d never be pregnant again and I loved being pregnant.

We were Youth pastors in Oregon USA when our daughter was born. Our plan worked perfectly, two kids, 16 months apart, and the bonus of having a boy and a girl left no need to “try” for one or the other, it was perfect. After one year we would make it final that we’d never have another, but although the consultations were scheduled it just never fit into our calendar and it never happened.

In 2013 we travelled with our 2 and 3-year-old toddlers to Pemba, Mozambique. It was an unexpected thought when I had it, but I told my husband that maybe we should have another baby. He was quiet, which meant he didn’t feel quite ready to answer. Our time in Pemba ended and we knew we’d be returning to Africa in a few months to start our new life in a foreign place with our 2 little ones. During the transition time, I asked again what he thought and he said it would be best to wait and see what the situation was like in our soon to be new environment.

We arrived in Dondo, Mozambique in April 2014 with a 3 and 4-year-old to begin our lives as missionaries. Like I said before, our plan was perfectly laid out and we were doing what we wanted. However, when we asked God how many children we should have, I got pregnant immediately. While I was pregnant with my son I went into premature labour and they had to stop it and place me on bed rest. Due to this I was at a slightly higher risk during my second pregnancy but carried full term with both. Since I had little to no issues with my previous pregnancies we decided we would have the baby in Mozambique. We decided to have a home birth, as we felt apprehensive of delivering in the hospitals.

Of course our families were terrified, but we trusted in the Lord for His hands to guide the process. I was able to have my mom send me a care package before the pregnancy and asked her to include very specific things that were so helpful while I was recovering from my other labours in the States. It of course was challenging to navigate everything in a new country with a different language. We ordered an emergency birth kit from Amazon and had my mom send it. It had all you need to deliver a baby; gloves, umbilical clamp and a bag for the placenta amongst other things. We decided to have my husband deliver the baby since we didn’t know anyone and had a backup plan that if something went wrong we could drive the 45 minutes to a private clinic in the city.

I went to some appointments at that clinic to make sure that I could gain access to documents that proved I was pregnant in Mozambique to help file for citizenship when the time came. I would go in, the woman would look at my feet and ankles to see if they were swollen and then weigh me and that would be my appointment. One time I went in and she listened to the heartbeat with one of those ear trumpet stethoscopes.

A friend of ours volunteered to come and deliver the baby since she had worked as a labour and delivery nurse. We had planned for her to come and walk my husband through the delivery. We bought plastic tarps from the side of the road here; they use them for roofs and cover it with grass. We bought it to put under a sheet we bought in the open market so we could keep our bed clean.

On the day that the baby came, my water broke and I was 2 weeks early. My friend who was supposed to come and deliver the baby was scheduled to arrive that afternoon, her plane was delayed and she missed a connecting flight and missed the birth by 12 hours. We had Argentinean doctors staying nearby at the time and we asked if he could help if anything went wrong. I am RH- blood type so I had to find a special medication that has to be given 2 times during pregnancy and he could help administer this and give me stitches if needed. I was able to find sutures and some lidocaine in a pharmacy, praise god!

The baby was delivered in the evening and everything went great. We had to weight her with a vegetable scale since we didn’t have anything else. Her name is Ahava Adonai which means “Love my Lord” in Hebrew. She is the best gift we’ve ever been given and truly lives to her name. She has brought so much Love into our family and to all those she comes in contact with. Her spirit is soft and kind.

Deuteronomy 10:12-22

Birth in Tennessee- Nicole’s Story

I am from the USA, but my husband’s passport country is Brazil. I gave birth in Tennessee at a birth center far away from my family. My daughter, Bianca Rose, is my first biological child and she was born vaginally in a water birth. I didn’t think I would ever have a water birth, but once the midwives helped me into the tub to soothe me, I knew I was certainly not going to get out! 😂


My husband Abel sat behind me in the tub the whole time and helped me throughout along with a midwife and a nurse. My maternity care was fantastic, attentive and encouraging. When Bianca was born, she was so quiet that the midwives took action to make sure she was responsive. In that moment, Abel and I dedicated her to Jesus and put her life completely in His hands. We had done everything we could do to bring her safe and healthy into the world, and it was up to God from that time. She was wonderfully attentive, peaceful and alert, looking around at everyone, raising up and she even pulled her tiny face into a frown as she stared everyone down!

My family lives 16 hours away. They did not come to visit and help once she was born. This did not bother me much, I only realize now, the help they could have been during the long haul of parenting a newborn. I was sleep deprived for a long time.

One thing about my birth story that could be helpful to others who haven’t access to their own country’s hospitals is the fact that I used “HypnoBabies” to help birth naturally. Ok I feel like a total hippy and only tell my close girl friends about this, but HypnoBabies program really empowered me to forge positive thought patterns and keep me calm and grounded. Abel and I did lots of research to make sure hypnobirthing was not something that would go against our faith. It turns out there is actually “medical grade” self hypnosis. Basically a bunch of really cheesy sounding tracks you listen to and repeat to yourself things such as “my body was made for this, I’m calm and will have a wonderful birthing time” etc. Feel free to laugh, I know I laughed at myself a bit while doing it. But I ended up majorly benefiting from the program. I was even able to have my second child, Marie Adele, naturally in a hospital with no tearing and so quickly! I can definitely recommend the program to other moms and husbands, no matter what type of birth you plan on.

Adoption in Finland- Paola’s Story

Paola is an Italian mother living in Finland. Her multicultural family includes her husband, two children via birth and adoption, and a support child. She blogs about her family life at The Elephant Mum. She has kindly allowed me to interview her about her family’s experience of adoption in Finland.

How did you come to be in Finland?

I was born and raised in Italy and I temporarily moved to Finland in 2010 to finish my studies through an Erasmus scholarship. After a couple of months I knew I didn’t want it to end. I called my boyfriend – now husband – and told him to start packing, we were moving here! A couple of months later I got a job offer and in 2011 he joined me. I found out later that he had dreamt of moving to Finland even before meeting me, what are the odds? A few months later I found out I was pregnant and we welcomed our daughter in 2013. In 2014 we started the adoption process that would bring us to our son.


How did you find navigating the adoption process in a country which is not your passport country?

Adoption in Finland requires a long counselling period, during which a social worker writes a home study on the family. We had a rocky start as it was hard to find a social worker who would provide it in English! Luckily we succeeded and nowadays I hear it’s easier. There was no information to be found in English whatsoever. The hardest part was not the process but after the child came home. We found ourselves alone with huge challenges. It wasn’t easy. After the storm passed and we found a family balance, I went out to see if there were any families like ours: multicultural adoptive families or adopters living in Finland. I worked with a local association as a volunteer to kickstart an English speaking peer support group. To my surprise, I discovered there were many families like ours, all needing support and services.

In the past 2 years we have built a thriving community. Now most information is available in English and several events are organised to also include international members. The best thing was observing how this small group shaped the local adoption landscape: we write content for the association’s magazine, organise events for everyone, and recently we organised some webinars in English with international experts to which many Finnish people took part. That was the most powerful takeaway from this experience: how accepting diversity and adopting an inclusive approach contributed to evolve and bring benefit to the whole community. Diversity does bring value.


Are there any memories which you have, either throughout the adoption process or when your adoption had been finalised, that stand out as particularly special?

There are many special moments I hold in my heart. The first part of the process is very ‘abstract’, things get real when you are matched to a child. I remember where I was when I received the phone call announcing we had been matched. I remember sitting in the office with my husband and examining our son’s dossier. Then the trip to India to meet him of course. Since he came home I have special memories of all the milestones he reached and the things he learned, including speaking two languages, Italian and Finnish.

Is there any advice you would like to give to families who are currently considering starting the adoption process either in their home country or abroad?

I want to focus on expats who adopt because I believe there’s plenty of advice and resources for people who adopt in their home country. Concerning the process, I recommend applicants should be aware that the process and the resources might not be designed for them.

When talking about adoption, people tend to focus on the process, which honestly doesn’t matter that much. The process requires money, time, and patience, that’s it. I know it seems like the most important thing in the world when you’re in it, but as someone whose experienced the phase after, I assure you that’s not the case. Adoption is a life-long journey for everyone involved. The real work comes after the child comes home. Adoptive families require a strong support network and expats might not have that. Furthermore, expats might find language barriers when trying to find or access support services and local peer support networks. For example, will you find therapists who can communicate with you and the child?

My advice is to be aware of these aspects, to the point of truly considering if you are a good fit for an adopted child, without your own desire of becoming a parent clouding your judgement. 

On the other hand, expats have strengths when it comes to international adoption. They understand the importance of preserving cultural roots and have natural connections to local international communities they can leverage to help an adopted child to keep in touch with the culture of origin. Because we were expats, it was easy and natural for us to connect with the local Indian community, thus allowing our son to grow with a variety of role models and an authentic link to his birth culture. If possible, an expat might adopt from their country of origin, which would be a great win for the adoptee, allowing them to share ethnic and racial background with their parent(s). Similarly, I would urge expats to carefully consider if domestic adoption is a good option for the child.  Can they ensure a lifelong connection with the country, the local language (to allow reunification), and possibly the biological family? Or do they plan to move away, in time? Adoption applicants tend to make choices based on convenience, we did the same. Now I regret that, out of ignorance, we didn’t take a adoptee-centred approach in our process. 

Pregnancies and Births Abroad- Leigh’s story

One of my friends Leigh has kindly allowed me to interview her and ask her about her experience of her pregnancies and labours abroad. Please find her stories below.

Thanks so much for sharing with us today! Would you be happy to give us a brief overview of how you came to be in a foreign country when you birthed your two babies?

I’m happy to share with you Joanna! When I gave birth to my son in 2015, I had been living overseas for two years. My husband and I had been through a long process of trying to decide where and how to deliver the baby.  At first, I assumed the best option was to fly back to my home country and do a hospital delivery.  When it became clear that would not be possible, I began doing some research on pregnancy and delivery options and decided that I would check out some of the hospitals in the capital city.  After exploring those options we realized that the travel distance and cost of this kind of delivery would also not be ideal for us.  

As I began to do more reading, I came to the conclusion that a natural birth would be the best option for our family and would make most sense in a local setting.  We talked to some trusted local midwives and one of them agreed to help us with a home delivery.  In the months leading up to my due date I continued to read books on natural childbirth and also took a detailed online class (NaturalBirthandBabyCare.com) which gave me more confidence that I had the God given capability as a woman to safely and fearlessly give birth to my child in a home setting.  As I gained more information, the unknown became less of a scary thing.  Thankfully I remained healthy during the pregnancy as I continued to work, get light exercise and proper nutrition.

On the day I went into labor I used the skills and knowledge I had gained through my research to stay active and energized throughout the process.  An unexpected change in plans happened when we realized the midwife was quite far away in a nighttime church service when it was time to deliver.  Thankfully, my husband is a doctor and quickly made the decision that he would happily assume the duty of delivering our son himself.  To my surprise, he became the most amazing coach that day!  He guided me through the steps, encouraged me, and gave me the extra support I needed to complete the task.  It ended up being the most special and memorable moment of my life! 

When it came time to plan the birth of our second child in 2018, the decision was much easier this time.  We made the plan early on to do another home delivery since our previous experience was so positive.  I went into labor on my due date, and was certain this labor would be much shorter than the first time.  My instincts proved to be spot on!  As my husband was leaving his workplace that morning, our daughter decided she wasn’t going to wait for him to arrive.  Upon the realization that I would have to deliver the baby myself, I made the decision to remain positive and do what needed to be done.  I had previously planned to try a different delivery position this time, and amazingly it was just the perfect position for catching the baby myself.  It was a quick process and I felt like it was truly the hand of God who delivered our baby girl! 

Thankfully, my good friend, a nurse, was nearby and called me immediately after the birth.  She rushed over and helped with the rest of the process and by the time my husband arrived, all he had to do was listen to the story and share his excitement that I didn’t even need him that morning. The second delivery ended up being more memorable than the first!  I would not change one thing about either of my delivery experiences. 

Thanks so much! I’m sure our readers would love to hear, how did you find your maternity care?

Most of my maternity care was administered by my medically licensed family member, which of course would not be the case for most of your readers.  I did have several ultrasound scans, two of which were done in the capital city and two locally.  The quality of some of the scans were as good if not better than one I would have received in my home country, and for a much lower price as well! In many countries, antenatal care and delivery services are administered by midwives, which might be different from your passport country.  If you decide on a Natural Birth plan, receiving care from a qualified, well trained midwife will be a great benefit for both you and your baby. 

Are there one or two experiences that come to mind as particularly positive during your pregnancy, birth and parenting journeys?

Aside from the birth stories of both of my children, there are many other positive experiences I’ve had through pregnancy, birth and parenting.  Some that stand out most:

  • Gaining strength from other women knowing that most of the women around me have given birth naturally very many times, and that women are strong, made to give birth, and capable of managing all of the expected duties that come with being hard working wives and mothers. Even when I had a lot of challenges breastfeeding my firstborn, I refused to give up because breastfeeding is an expectation in the local culture.  What began as a negative experience ended up being positive because I was able to continue after many months, with support from my husband until the breastfeeding became an easier and less painful experience.
  • Focusing on appropriate, regular exercise during my second pregnancy really helped with the labor and delivery process.  Even during both of my labors, I walked up and down the stairs when I could, which helped move the process along and kept me moving instead of stationary in bed. 

How have you found becoming a mother to a newborn far away from your family?

It was most difficult with my firstborn because I didn’t have any family members nearby to help me and give me sound advice.  I didn’t ask for help from anyone, which looking back was probably not the best decision.   We managed all of the struggles of newborn care as a couple, which had both positive and negative repercussions.   With my second baby, we had developed more of a support system and the management of a newborn was much simpler.  Also, having the knowledge and experience from the previous baby made it easier, however each child is different and comes with their own challenges and surprises!

Do you have any advice for anyone who is planning to start or grow their families in a country which is different to their passport country?

My advice would be first, to do as much reading and research as possible.  Make sure you seek out trusted sources that have a proven track record, not just anything you find online.  Educate yourself on the options for childbirth in your area, making a Birth Plan (and a Plan B), and sticking confidently to your decisions as a couple.  The more preparation ahead of time, the better experience you will have!  Even if things don’t go exactly as planned, (they probably won’t) you’ll be prepared to face whatever comes up. 

Second, make sure your spouse is on board for this adventure!  They may not be ready, but they are committed to standing beside you on the journey.  The more support and understanding from your spouse, the less stressful the process will be.  It’s overwhelming at first, but as you educate yourself on childbirth, share as much as possible with your spouse.  Odds are they’re also scared, but as I mentioned before, the more knowledge and preparation, the less fear you’ll both experience.  I have the great blessing of having a doctor as a husband, but that’s not a requirement of course, just a spouse willing to learn with you and try to be understanding amidst all of the crying, emotions, and ups and downs of pregnancy, delivery, and newborn care!  If you are alone, or have a partner that’s timid about being involved in the process, it’s ok!  Find a trusted friend or other family member that will be happy to be part of your journey. 

Finally, I’d like to say that raising children in a foreign country can be a very positive experience.  Workplaces in many countries are more flexible with work schedules or even may allow you to work with your child alongside you.  Depending on your situation, you might get more maternity leave or not need to take formal maternity leave at all.  Some forms of maternity care in other countries are much more affordable, even affordable enough to be paid for in cash instead of dealing with the hassle of insurance claims. 

In my experience, raising children in a foreign country also allows many parents to have more quality time with their children and be more involved in raising them in a more simple, flexible environment.  Being part of a small supportive community of other parents in the same situation can also be a very key part of your parenting experience, and not something that would be available in many passport countries.  Another benefit to raising children in a foreign country is that in many cultures, the locals are willing to be part of caring for your children in your home, and become a key source of support and help in early childhood.  Building strong relationships with locals is quite natural when you have children and share that common experience with them. 

There’s no need to fear starting a family outside of your passport country.  Embrace it with a positive attitude, learn from others, and be open to facing the new challenges you’ll surely encounter.  You’ll look back on those years as some of the most memorable of your life!

A Rainbow baby in the Middle East- Hannah’s Story during the Corona pandemic

In my mind, Edward’s birth story begins on a sorrowful day four years ago in May. My husband and I had recently arrived in the Middle East to begin language learning when I went into preterm labor with our first baby, giving birth at 22.5 weeks. In the course of one brief day we experienced both the joy of meeting our first son and the sorrowful shock of simultaneously having to say goodbye. It was as though a piece of us had died prematurely with our infant boy, buried in a desert cemetery. We were ushered into parenthood with empty arms, in a strange country and far from home.

With that sorrow as a backdrop to the scene, imagine my awe on the day last year when I saw a magical, second line appear on the pregnancy test strip and realized that the Lord willing I would be giving birth just days away from my first son’s birth-day! I sensed that this too would be a boy and that the word “courage” was significant for this pregnancy. As much as I wanted a sibling for my two-year-old daughter, giving birth again in the same Middle Eastern country was not on my list of brave desires. From the beginning, I was begging God for strength and comfort from His presence.

The entire pregnancy held a string of challenges for me, including language learning, culture stress, morning sickness, exhaustion, anxiety, traumatic memories of losing our first baby, COVID19 and strict quarantine/curfews, insomnia, dieting for blood sugar issues with limited food options and dealing with a UTI when we weren’t allowed to leave our home. I started to realize why the Lord knew that “courage” was so essential for me. In the face of these things, my first response was not very brave!

We prayed a lot about care providers for my pregnancy and birth. Hospital births are almost exclusively the norm here; however, they also tend to be highly medicated with high C-section rates. Also, my experience at the hospital with my first birth did not make me desire to do that again! The Lord led us to a very sweet midwife who was willing to assist me with a home birth. Unfortunately, not everyone around us could understand the “crazy” decision we were making. Many times I second-guessed myself and cried to the Lord, “Am I making the wrong choice? Am I really a foolish and risk-happy mom?!” He always reminded me that we were following His peace and our desires. I could choose to rest in that with confidence. 

Due to COVID19 restrictions, travel was not permitted between cities. My midwife’s assistant (whom she would not feel comfortable delivering without) lived in the capital city, and we went through quite an ordeal trying to get her here. About 50% of the time it seemed like she wouldn’t be able to find a way to come to the birth! Just when we would come up with a solution for one difficulty that came up, another challenge would appear.

I tried to imagine how the birth would go and came up with multiple worst-case scenarios: I go into labor at some crazy hour of the night. It’s after 6pm, so everyone is under curfew. No one is allowed to drive. Midwife tries to sneak out of her house to come to mine and gets arrested. Assistant is stuck in the capital. Or maybe I’m giving birth and have an emergency and have to go to the hospital. We have no choice but to call an ambulance and they don’t let anyone else come with me… Or maybe I go into labor and no one can get to our house to come and be with my daughter, so she is wandering around, traumatized and scared without anyone to watch and care for her. Or maybe the people who were to babysit her get arrested on the way because they try to come during curfew hours. Or maybe……….

Spending your time imagining how things might end up happening in a situation that you can’t control is a really good way to end up stressed out. I began looking at the difficulties (both imagined and actual) as a test to see whether or not I would be courageous. I began to worry that God might throw me something really hard just to see how brave I would be! In the middle of my anxious wrestlings, I got a message from a friend in another country whom I rarely hear from. “You’re not as alone as you think,” she told me. “Courage comes from a heart that is convinced it is loved.” I sat in stunned tears at her unexpected and well-timed words, and realized:

I can be courageous because I am loved by my God, and this will be an interesting story because there are risks involved, and no matter what happens, it will be beautiful and my unique story to own and cherish. This is not a test of my courage, but a moment in the big picture of my life to let God prove His goodness and love for me!

By 37 weeks, I was 2.5cm dilated and having notable contractions semi-constantly. By the time I reached 39 weeks and had experienced several bouts of steady contractions which didn’t progress into labor, I finally decided I wasn’t going to keep being deceived. This baby just wasn’t coming. Not for a long, long time. 

On Mother’s Day evening, I began having consistent contractions yet again. After playing games and dancing to lively music together as a family for a few hours, we put our daughter to bed and started wondering if this was the real thing. 

The midwives decided to come over around 11pm to check me and hang out with us. I had been doing my contractions sitting on my birthing ball, coaxing them to be as strong as possible, but when the midwives came breezing in I got hit with a wave of fears and emotional/mental blocks. My blood pressure was high when the midwife checked it, and my contractions also started fizzling out. I was only 4cm dilated when checked, which surprised me. I had been hoping that all those hours of contractions would’ve given me more progress than that!

The sweet midwives gave us time to be alone as a couple and we spent the next hours praying, singing, and working through my feelings and fears. Frustratingly, labor did not pick up momentum. We all finally decided that we would go to bed and get some sleep. 

I turned the song “Never Once” by the Rasmussen family on repeat and laid awake for a long time, listening to the comforting refrain: “You are faithful, God, You are faithful! Evermore, we are breathing in your grace. Evermore, we’ll be breathing out your praise. You are faithful, God, You are faithful!” It was so exceedingly comforting. Eventually, morning dawned and I had to break the news to all that I wasn’t any farther into the labor process than I had been the night before. The good, strong contractions I’d been waiting for just weren’t coming.

We had breakfast (They asked me what I wanted and I was just honest with them: bacon and eggs with a buttered bagel and blueberries! Of course, I knew that the eggs were the only thing available here on my menu.)  Once the morning curfew was lifted at 8, our friend came to pick up Joy for the day. After they left, we decided to try doing some things to see if we could encourage the labor on. After several hours and trying many different things we all decided to stop trying to make my labor progress. I was 5cm dilated when my midwife left. She discerned that the baby’s head was turned a bit in the wrong direction, which would explain the stop-and-go labor.

After the midwives were gone, Jonathan and I looked at each other and embraced. I just “knew” by faith that somehow this disappointing delay was a gift from the Lord. It was just us: nobody else in the house, no toddler to care for. It hadn’t been like this for…well, had it ever? We surrendered whether the baby would come in hours or days, and decided to enjoy our time together. I recalled my heart’s desire and prayer that Jonathan and I would experience a greater level of intimacy and soul fellowship during this labor than we did even in our previous two births. My request was granted in such a precious way through this delay. We will always cherish remembering that afternoon we spent together loving each other and enjoying laboring together. My husband helped me do some exercises to help the baby to get in the right position, and amidst my dear midwife’s prayers from her home, he did just that. And—guess what! My contractions started to pick up in intensity. 

For various reasons, Jonathan ended up not being able to be with me much in the next interval of labor time. I found myself laboring alone…on the exercise ball, in the bathtub, etc. I was so delighted to be overtaken with these all-consuming contractions at last! I resorted to texting with my mama (who was unable to come visit me due to COVID19), and it was like she was there, encouraging me and being by my side. My contractions were pretty intense, but my husband and I weren’t quite ready to tell the midwives to come We were in awe of the “magical” force that was gearing up to release our son from my body and didn’t want to do anything to disturb it now that it finally was here!

A few minutes before 6pm found me throwing up and my husband welcoming our daughter in at the front door! It was time for the evening curfew and our friends didn’t want to risk getting arrested like one of their friends had for driving after curfew. Thus, our daughter was back with us. My husband thought quickly and contacted a very motherly single girl who was able to come over right before the 6pm curfew and care for Joy. About half an hour later when Jonathan had Joy and her new babysitter all settled and came to be with me again I said, “Well, when are we going to call the midwife?” 

He replied, “Oh, I don’t know…what do you feel? Do you want to?” 

I replied between breaths, “Well / I don’t think this / is going to stop!” So he called them to come over. A few contractions after they came, I thought I should let them know, “Um, my body is wanting to push.” 

“Well, let your body do what it wants,” the midwife replied. 

In the midst of the intensity of those contractions and the wandering thoughts of, “How many more hours will this take?” a song called “Song of Deliverance” began to play. I certainly vibed with it as I came into another super strong contraction! I wondered how much longer I would need to be doing these. And then, suddenly, with the cry, “Deliver Me!” ringing in my mind from the song, I felt a mighty surge pushing from within and the Lord delivering my child and me at the same time! The feeling of that little body moving out was actually more incredible than I had even imagined. Such a powerful release surged through my body and soul as I went from kneeling to sitting and from laboring to holding my own warm, wet, living little boy! So surprising, that after all the waiting and feeling like it would take fifteen million years for him to get here, he came so fast. Jonathan and I leaned towards each other and wept. He’s alive. He’s breathing. He’s moving. He’s opening his eyes. He’s a miracle. We did it. In our desert town. Under quarantine. Thank You, Jesus.

It was a little disappointing to find out that I had torn and needed stitches. Stitches are not funny in the least! But as I’ve thought about it, the stitches are proof that I pushed a human out, and proof that when he came, he came fast and gloriously. I did what I was made to do.

The midwives (in the words of one of them) said that this was one of “the most peaceful births” they had “ever witnessed.” That shocked me. Truly, it could only be the power of the Holy Spirit over me to give high-strung, easily-anxious-me such a peaceful and beautiful birth! 

After all the dreaming of possible crazy birth scenarios and wondering if my desire to birth at home was absurd, it was amazing to see how my caring Father worked everything out! There weren’t any complications. Someone was able to babysit my daughter the whole time I was in labor. The midwives were only stopped by the police once for driving after curfew, and the police gave them mercy. I felt amazing and strong right after the birth. My daughter was able to come in and meet her brother soon after he was born, which was something I had wished for. The Lord was so, so kind to me. He gave me a son, in May, exactly four years after we buried our first son in this very city. He gave me courage for the journey. He gave me everything I needed.

We named our son Edward Davian, meaning: “I am courageous and brave because I am loved.” I didn’t feel very courageous through the challenges I faced during pregnancy and birth, but I did learn that I am loved more deeply than I had thought. Through that love I received strength to keep pressing deeper into God and His heart. He gave me courage to make it through the challenges.

If you are reading this as a pregnant mama, I want to pass on a little word a friend of mine gave me a few months ago: 

No matter what happens, this birth will be beautiful and it will be your own unique story.

Take courage, friend. You too can be brave in your difficult moments, in the strength of the Holy Spirit and because our Good God has His loving eye on you. He is in control. We can trust, and we can be brave even when we are scared.

For those who haven’t heard the term, ‘Rainbow baby’ before, this refers to a baby who is born to parents whose previous baby or babies were sadly lost due to miscarriage, still birth or as a young baby.

The grace of a good doctor- Becky’s birth in Southeast Asia

God gave me some of the greatest gifts in life with my four sons and my sweet daughter. Pregnancy and birth stories are unique to every mom and every baby. These life-altering experiences frame much of life after they occur.  My first two children were born in the United States. I had a wonderful, caring doctor who did all my prenatal care and attended the births for my two oldest boys.  Our family was raising support with a mission agency when our second son was born.  When were a few months away from moving, we found out God had gifted us with another baby.  We already had enough things in place for our move that we decided to stick with our timeline and move halfway through my pregnancy.

I researched doctors and hospitals online ahead of our move knowing I would need to see a doctor within a couple weeks of arriving to keep continuity of care.  I still remember pulling up in the front of the hospital for my first visit. I began crying and asked my husband if we could just go home. It seems silly now to have been concerned because I walked into the office of another caring, wonderful doctor. With two toddlers in tow (our oldest boys were 3 years old and 16 months old at the time), I visited my doctor here in Southeast Asia for the first time. He was kind and gentle and listened to my history. He spent time with me and our family talking about what to expect and what he recommended.  God once again gave us a great gift.

I finished that pregnancy at 41 weeks exactly. The plan was for a water birth, something my doctor originated in our country. I went to the hospital midday on a Sunday after 14 hours of labor with very painful, but inconsistent, contractions. After an hour of monitoring, my doctor came in to see how I was.  Based on the monitor, I wasn’t far along, but when he checked me, I was quite a bit of the way through. I was moved to a room where the birthing pool had been set up for me. I got in the pool, became too warm, and got in a good laboring position on the bed. My doctor never left the room and after only being at the hospital for two hours, with just my husband and my doctor in the room, our third son was born.

A little over a year later I appeared in his office again with news that I was pregnant. He was thrilled for me and once again took great care of me.  Our children went with us to every appointment. My doctor did ultrasounds himself right in his office and would explain everything not just to me, but to each of my children. They got to the point they could pick out the heartbeat and various tiny baby parts. Their tiny sibling was loved and known because of these beautiful moments of in utero bonding. 

This time around we had built community, something I vowed to do after our third son was born just a few months after we moved. I had friends throw me a sweet little baby shower with promises to bring meals and help with older siblings after the baby was born.  Our fourth son came into the world during the wee hours of a Sunday morning in a birthing pool at the hospital.  And again, my doctor was close by for the hours we were at the hospital and spent the whole last hour in the room with me.

We went on our first home assignment a few months after our fourth son was born and loved spending time with our four boys. We sensed a shift in our family during those months and felt like maybe God was done adding to our family, but we put it in His hands and asked that He would guide us to what was next. Well, a few months after we got back we found out what was next. I was pregnant again. A few weeks after I discovered I was pregnant, I began having some pain and was worried about the pregnancy. I went into my trusted doctor, told him my pregnancy news, and also explained my symptoms. He showed some concern and immediately did an ultrasound to check for a heartbeat. He marveled right along with me when he was able to find a beautiful heartbeat from that incredibly small heart.  My fears were squashed, and I went home with pictures of my baby.

Throughout that pregnancy our boys accompanied us to appointments, watching the baby grow.  We chose not to find out the sex of our kids with any of the pregnancies and by the fifth one, those older brothers were quite opinionated about if they had a younger brother or sister.  Just like I knew with all the boys, I was quite suspicious that this pregnancy that seemed the same, but also different, would end with a girl.  My due date was February 28, but it was a leap year, so lots of people, including my doctor, were rooting for a leap day baby. February 29 came and went without a baby. I went into labor on March 1, got incredibly sick, spent March 2 in the hospital on fluids, and went home late in the afternoon to rest.  I had barely made it home when contractions kicked in again and I labored with a little sleep thrown in throughout the night.

We decided to head back to the hospital a little before it opens so the traffic would be lighter and getting admitted would hopefully go quicker. I got set back up in the same room I had been in the day before, with the new birthing tub and baby bassinet all ready.  I labored for a few hours, but then stalled out again. Due to how weak I was becoming and with my labor not progressing, my doctor gave me a little something to move things along.  In theory it was supposed to gradually move things along, but it made my labor go from 0 to 100 in about 10 minutes.  Less than an hour after getting the medication, I was ready to push.

As that was happening, my doctor said to stop. The cord was wrapped around the baby’s neck. He had the nurses call our pediatrician down (the doctor’s clinics are right inside the hospital, something that was very convenient in this situation). I finished delivering the baby and my doctor handed me a blue, limp baby girl. He had my husband quickly cut the cord and took her over to try to get her breathing while I just kept asking if she was okay. The pediatrician showed up quickly and was able to get her breathing. The first picture I have with her is full on ugly crying, but she was plump and pink and the most beautiful baby girl ever. She has been such a delight and joy to raise.

Having a baby abroad is not the easiest route to go, but I have been incredibly blessed through all three experiences.  I had a wonderful doctor and my parents were able to come stay with us when each of our babies were born here.  We also built community the longer we lived here and had people walk alongside us, as we have done for others, in this dramatic life change.  God has been so good to us and I look back on all five of my birth experiences with gratitude.

New arrival in Uganda- Abbie’s Story

My husband and I have worked in the D. R. Congo (DRC) since 2013, and were due to return from a home assignment in Canada June 2018, three months before our baby was due. We had talked with the missionary doctors in and around our location, and they recommended we go to Kampala (Uganda) for the birth, just in case, because facilities in our region are so limited (no NICUs), and because they didn’t know if they would have a blood donor for me if I needed one. We had friends who had delivered in Kampala, so we got the name of the hospital and made an appointment with an obstetrician.

We were really pleased with the level of care and the facilities at the hospital. The major differences from home were A) it’s private, so we had to pay (our insurance covered it but, as a Canadian, bringing a credit card to a doctor’s appointment just feels strange), and you don’t really need appointments, but you just find out the doctor’s schedule and show up when they are there, first-come-first-served.

Our baby was born by an emergency C-section (which is a story in itself), and I was so happy to deliver in Kampala with our amazing obstetrician. He is a great doctor. He was so patient and encouraging, and so thorough. I really wonder if another doctor would have noticed what was wrong and if they would have reacted quickly enough. He always made sure that my questions were answered, and went out of his way to care for me and make sure I was ready to get back to DRC. We also had a great experience with our daughter’s pediatrician, who was there when she was born and then did her follow up appointments.

This is maybe less crucial, but the food at the hospital was so good, the nurses and midwives were so nice, and we had a private room with a bed for my husband, which was all so wonderful (although that might have been the drugs talking…).

I think it was harder on our family than it was on us to have our baby overseas. We were happy to have it be “just us”, but I think that was because we already had friends and coworkers in Kampala who helped us and visited us. Having that community was such a blessing, but we were definitely calling our family often, and sending as many photos and videos as we could.

My advice to families in a similar situation would be to do some research. Ask around. We found a great hospital and doctors through our friends, and we had more available to us than we would have had in a small-city hospital back home. But don’t assume everything will be the same. Every country (and sometimes every hospital/midwife) does things differently. Know what you need and want, and then ask for it. Our hospital doesn’t routinely do StrepB testing, but I asked. They use a different vaccination schedule and get different vaccines than back home, and we chose to go to another hospital to follow the Canadian schedule. Knowing what to expect and how to navigate the system made everything much easier (especially when the unexpected happened).

Eden’s birth in Nepal- Kylie’s story

Giving birth to our first child in Kathmandu, Nepal was something we had prayed long about. Coming from the U.K. I knew it would be such a different experience than going back home, and we weighed the pros and cons and ultimately felt God give us peace and the green light to have Eden in Kathmandu, the place we called home. There were definite sacrifices and challenges but overall our experience was overwhelmingly positive and peaceful.

Preparing for Birth

We read a book called The Positive Birth book by Milli Hill, as well as Supernatural Childbirth by Jackie Mize, and really tried to actively surround ourselves with positive stories of births as well as lots of prayer and declaring God’s truth over us. We made the decision that my birth was going to be a good experience and researched a lot about the process of getting my body ready for the actual birth. I felt really well informed about childbirth which I felt was important as I wanted to know what was happening and to make the choices I wanted rather than rely on the doctors to tell me what to do.

God’s timing was perfect and a brand-new hospital had just been built at the end of our road, and a few people we knew had also given birth there recently so we felt in good hands. The doctor (midwives are not common place) was really good and wasn’t too surprised when we whipped out a birth plan and talked it through with her, even though it is not something the locals do. We also made sure to take a few copies in on the day so that all the medical staff knew what kind of choices we wanted to make.

We heard about a friend of a friend (an American lady) who was training to be a doula so we decided to use her for our birth and it was so helpful having her there. She had attended another birth at that hospital so she knew the staff, as well as having some great techniques for natural pain relief (I didn’t want any medical pain relief). She was also just another friendly and comforting face in a whole room of Nepali medial staff who seemed to wander in and out … including several cleaners who seemed to just want a good look! We also knew a missionary midwife whom we saw for some pre-natal checks aside from our hospital checkups. This was so helpful to get a different perspective. I didn’t put on as much weight as I expected in my pregnancy so it was helpful to talk to somebody a bit more personal and get some advice. I would definitely recommend getting to know the expat crowd as there are so many useful links you can make with other foreigners who may have had similar experiences.

The Birth

I woke up at 1am with pretty regular contractions. As the hospital was so close we just waited at home so I could rest. I actually felt super calm and peaceful and just listened to my body whilst timing my contractions. I actually wasn’t sure if it was real labour or not because all the contractions were in my back, and for all my researching I hadn’t actually come across that before. We called our doula at 7am and she said it was definitely labour! So by 9am we headed to the hospital (on our motorbike!). The doctor said I was so calm that she wasn’t convinced I was in labour (thank you Jesus!), but she checked and found that I was already 4cm dilated. They took me up to the labour ward and then it was just a blur of medical staff rushing in and out, hooking up IVs (even though I insisted I wouldn’t need drugs), and taking loads of information. My husband Matt was amazing and so calm as well. Husbands are not normally allowed in the delivery room but as we had requested it, they were very accommodating. I actually felt very listened to and respected throughout the whole experience. Our doula arrived and things began to ramp up, the pain was bearable but every contraction got more and more intense so I just put my earphones in to try and focus. I’d recorded Matt and myself reading out prayers and declarations over us and our baby so I just listened to that on repeat. They had to break my waters which was uncomfortable but not painful, and discovered that I had meconium in my water, so they wanted to hook me straight up to continuous monitoring. I didn’t want this as I wanted the freedom to move around, so I just asked if they could regularly check the baby’s heartbeat with a doppler instead which they agreed to. Soon after I felt the urge to push.

I was pushing for a couple of hours and there wasn’t much movement, so they told me they would have to use a suction cup to get the baby out, or to do a C-section. I knew in my spirit that this wasn’t the right thing and felt like they were just saying it out of fear, so we told them that we wanted to keep pushing. After a while longer (I pushed for 2.5 hours total), they said they would need to do an episiotomy which I was fine with at that stage as I was pretty exhausted and realized that she wasn’t coming easily. I don’t remember it being very painful, it was more just relief when after just a couple more pushes, our daughter Eden Rose came out.

I had heard horror stories of the placenta coming out, but mine came out without any trouble at all. They did give me an injection beforehand which is quite normal, and even though they didn’t even ask me, I wasn’t fussed at all at that stage. They then stitched me back up (again, I don’t remember this being particularly painful), and told me I had to pee before I could go to our recovery room. After several tries I couldn’t manage to go, so they had to catheterize me. Without any pain relief the whole time, this was definitely the most painful part! But fortunately it didn’t last very long!

After the Birth

I was in hospital overnight and then left the following evening. We did have a bit of a battle in paying our bill at the end as the hospital were very vague on costs and our bill ended up being 4 times more than we expected in comparison to the other foreigners who had given birth there before us. Unfortunately, we didn’t have insurance but God provided everything we needed in that moment.

We didn’t get much in the way of post-natal care. I had a one-week check up where they removed the stitches that hadn’t dissolved, and checked on Eden, and then I was completely discharged. Our Iris team and local friends were absolutely amazing at getting around us, bringing us food and just loving on us and that made it so much easier to be away from our family and friends back in the UK and South Africa (where Matt is from).

Eden’s head was purple when she came out because I had been pushing for so long. One great testimony was 3 days after we got her home we had the worst day/night where she wouldn’t stop screaming for 12 hours straight. After trying everything, Matt felt God say ‘she has a headache, massage her temples’. After just 15 minutes she was sound asleep! We did have a real issue getting her British passport through, it took many many trips to the passport office, around 35 pages of original evidence as well as an interview, before her passport finally came through 5 months later. I’d recommend to plan in advance for that and ask around if any other expats have experience with that as it can be pretty laborious. 

Midwife’s Musings- Power of Connection

Joy, fear, excitement and anticipation are just a few of the emotions which pregnant women have shared with me. There’s nothing like the journey to becoming a parent (for the first or multiple times) to provoke a whole spectrum of emotions, experienced over the course of months, weeks, days, hours and even minutes. The experience of being pregnant or giving birth in a country which is not your passport country, can often seem to intensify this due to numerous factors such as not knowing the medical system, being far away from family amongst others. There are families whose pregnancies are ‘easy’ and full of positive experiences, those whose journeys present them with challenges seemingly from the beginning right through to the end, and those whose experiences fall somewhere in between. 

No matter where a parenting journey has landed within that spectrum, something all new parents seem to have in common, is the impact their journeys have have upon their lives. Pregnancy, birth and new parenting are hugely significant and transformative experiences. Ones that irrespective of how much time has passed, often stay fixed in our minds forever. 

Preparing and adjusting to becoming a parent, changes everything. As soon as our beautiful babies are born, our thinking, love and attention shifts to caring for this new little bundle. It doesn’t matter whether this was a much longed for and carefully planned baby or an unexpected surprise. Each parenting journey looks different and is full of a huge spectrum of experience of emotions, from overwhelming love for your new addition to the fear of, ‘Am I doing this right’, compounded by the exhaustion of seemingly unending sleepless nights with a hungry baby (they will end, I promise!). Some mothers can experience antenatal or postnatal anxiety, depression, stress or face other mental health challenges. 

So what is the best way to cope with these emotions and experiences? 

Connection

Connection is hugely important to all of us. As some of the parents who have so kindly contributed to this blog have highlighted; connection, feeling heard, supported and loved is of huge significance. Without it, isolation is a serious risk. We all need someone we can confide in and share our lives with. Someone who can share in our joys and our frustrations and someone who can help us access support whether emotional, physical or for our mental health, if we need it. There’s something about sharing, that makes us feel known, that deepens friendships and that makes us feel supported. 

It doesn’t have to be a large number of friends, although it could be, but make sure you have at least one friend who you can trust to share this journey with you. It could be someone the same age who is in a similar situation to you, or maybe it could be someone who is a few years ahead, who has been there and done it and can provide some wisdom and some of their experience with you. Someone who can guide you, help you with learning how to bath a baby, helping you get the hang of breastfeeding or bottle feeding, who plies you with food when you just don’t feel up to cooking yourself and who looks after your baby so you can have a nap. You need someone who understands the excitement of managing to have a shower at 11:30am because your baby is contentedly sleeping. Someone who appreciates and isn’t grossed out by you sharing about your babies poo explosion or poonami as they are referred to in the U.K.! 

Connection with health professionals is also hugely significant. As Aggie mentioned in her story, her positive relationship with her midwives made her feel cared for, listened to, safe and supported. Having a positive relationship with midwives and doctors, is massively important at the best of times, but is of particular significance now, under the challenges of lockdown that a lot of us are facing. We need to know that we are being cared for by professionals who are acting in our best interest, who are fighting in our corner, walking this journey with us and who we can trust enough to ask for help if we need it. For me as a midwife, I loved building this kind of relationships with my clients. So wherever you are in the world, seek to find a midwife or a doctor you can form this relationship with.

When you’re abroad, connection often looks different. You may not have the same people around you as if you were in your home country. Particularly at the moment, with various borders being shut and lockdown measures being in place, it may not be possible for friends and relatives to come to visit and to provide physical support at such a crucial time. Support systems might have to look a bit different right now. It might be about whatsapp groups, video calls, online support groups and the dropping off of food supplies on our doorsteps. 

The bonus of the lockdown measures all around the world, is the whole range of groups and courses which have started online, meaning they can be accessed all over the world. Check them out, and see if any of them would be helpful and encouraging for you. 

Pregnancy is the perfect time to be preparing, to be putting things in place. If you can, try and take time to think about how connection looks for you right now, wherever you are and whatever lockdown restrictions you are currently facing. How can you ensure you will be connected? Sometimes we are required to be a bit creative, but connection is still there, it just looks a bit different. 

Dad’s experience in Papua New Guinea- Rebecca & Brandon’s Story

Rebecca and Brandon live in Papua New Guinea and they have kindly shared Brandon’s experience of their son, Tobiah’s birth.

Tobiah Carl Zimmerman was born at 11:45 pm on 11/11.  Baby weighed 3.7 kg = 8 lbs, 2 ounces. Tobiah is the main character of the book of Tobit, found in the Catholic Bible, but not in the Protestant Bible. Rebecca and I enjoyed reading Tobit together while we were dating and we had Tobit 8:4-8 read at our wedding. Carl is the name of Rebecca’s deceased grandfather on her father’s side, who was a man of great faith and the original owner of the farm we lived on in New York before we came to PNG. Here are the details of the birth.

Rebecca and I drove for an hour on beautiful mountain roads to reach the hospital. One of our biggest worries was having to drive the bumpy road to the hospital in the middle of the night in the rain (we never drive after dark otherwise). On the night of the 10th, Rebecca started having contractions, but they were sporadic and not heavy, so she went to bed. Light contractions continued the next morning so we decided it was time. I furiously finished some grading, turned in my marks for the semester, and we hit the road!  We arrived at the hospital around 11:30 am. A midwife named Joy came out to meet us, lead us to the private room that we had reserved, and served us fried egg sandwiches. Joy was very friendly and dedicated to making sure that our stay was comfortable. 

In Papua New Guinea much of the health care is provided by church run hospitals and health centers that are financially supported by the government. Unfortunately due challenges with funding, the hospital was open only for births. On the good side for us, this meant that we were free to walk around outside to help the labor progress.

Rebecca was not really settling into active labor, so we went for a walk through the main station, and we went part of the way down the hillside that Mingende is perched upon.  Many of the locals were very confused why two white skins were wandering aimlessly around and walking down the road to the cow paddock. 

As night fell, Rebecca was having stronger contractions, but not settling into a good rhythm. We decided to take it easy. We took showers and laid down to sleep. I was sure that the baby would not come until the next morning.  Around 11:00 pm, Rebecca was sleeping, when she was awoken by a contraction and her water breaking!  We alerted the nurses and told them to contact Joy (who lived nearby) and went to the labor and delivery room.  There a well-meaning, but somewhat overwhelmed nurse checked Rebecca and said that she was only 4 cm dilated. However, the nurse also said that the baby could come at any moment, which greatly confused us!  Rebecca felt like pushing, disregarded the nurse who wanted her to get in the traditional lying on your back position, and got in a good hands + knees position (which was how our daughter was delivered). We found it interesting that the PNG women, in the ward, did not moan during contractions. They made high, singing noises while they were laboring while we were there. Luckily Joy the midwife suddenly arrived and guided everyone through a surprisingly quick birth. Tobiah was almost a kilogram heavier than Tabitha, but the delivery was without complications – no tearing!

Soon Rebecca was wheeled back to our room. Tobiah picked up nursing rather quickly. I swaddled him and he and I slept together on a mattress on the floor. The three of us rested in our room the next morning. Wanting something else for dinner, we decided to return to the seminary, where Rebecca’s parents were taking care of our older children.  Rebecca was also doing quite well, less tired and in less pain than the other two deliveries.  On the way out, the bishop of Chimbu blessed Tobiah!

We are very grateful that the delivery went so well, and that we have a big, beautiful, and healthy baby boy!

Advice for new mums

Rebecca’s top recommendation for pregnant women is to eat dates daily during the last month of their pregnancy. I can’t give this the full midwifery seal of approval, as I’ve not had a chance to evaluate the research, but she reports that the two births where she had done this, lead to her being tear free!

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