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When I became pregnant with my second child, I immediately began researching hospitals.  I never considered returning to the U.S. because our medical insurance wouldn’t cover the delivery, and it would be difficult for my husband to join me.  I would have the baby here in Dubai.  Early on I narrowed it down to two choices: the American Hospital and the local government-run (Muslim) maternity hospital.  I toured both and talked to women who had delivered at each.  My gut said, “choose the American Hospital,” but my pocketbook chose the local one.  Since our medical plan doesn’t cover maternity costs, we’d have to pay.  And although it’s cheaper to deliver here than in the U.S., I couldn’t justify the cost.  This was my second child (my first daughter was born in a U.S. naval hospital on Okinawa) so I knew what to expect, what questions to ask.  The local hospital is free and it has the best neo-natal intensive care unit.  Should anything go wrong, the private hospitals send their patients to the local hospital. It was an interesting experience throughout.  My research turned up a variety of comments about the local hospital.  Some were amusing, others alarming.  An Irish woman having her second child at the local hospital said that the nurses told her “your baby will be brain damaged if you don’t breastfeed.”  Another woman, a first-time mother from Canada, was told, “If you keep screaming, the baby won’t come” and to “Stop joking, it can’t hurt that much.”  This same woman was denied pain relief, and they botched her son’s circumcision.  Afraid that her milk might not come in, she asked the pediatrician to recommend a brand of formula “just in case.”  He refused, telling her not to worry, breastfeeding is best.  Not a great experience. A good friend of mine had done the same research the year before and, much to her husband’s dismay, decided upon the American Hospital.  She started out at the local hospital, but soon decided it wasn’t for her.  During her first visit, the doctor had her take her top off and began examining her nipples to see if they were inverted, all before introducing herself.  She didn’t return after the doctor told her to “stop asking so many questions” and was told that circumcisions required general anesthesia.

The mosque outside Maura's apartment

Was my experience a representative one?  It’s hard to tell.  Even within the same hospital, women have very different experiences.  The instruction sheet for ultrasounds clearly states that “telling of the sex is prohibited” but my ultrasound technician told me I was having a girl.  Other Westerners were also told their babies’ sexes when asked.  The Canadian woman, however, who is of Lebanese descent and has an Arabic name, wasn’t able to find out the sex.  Even after she told the technician (the same woman who did mine) that she already knew from an earlier ultrasound in Canada, she was refused.  A Sri Lankan neighbor of mine was also refused.  I’ve heard that this is because boys are still highly regarded in many cultures and the hospital wants to prevent women from having selective abortions.

The only resounding positive comments I heard were that the local hospital was free and very clean, and the food was good.  Not big confidence boosters, but I wasn’t scared off.  I was prepared to do whatever necessary to make this a positive experience.  I went to each doctor’s visit with a list of questions, double-checked that my chart was accurate, and made sure I knew everything I could about my pregnancy and delivery.  I prepared for every possible scenario:  normal delivery with epidural, normal delivery without pain relief (if the epidural was unavailable), and emergency cesarean delivery.  I knew that if the last scenario occurred I’d be given general anesthesia and my husband couldn’t be present.  This is one area where the local hospital differs from the American Hospital.  It’s another reason why some women don’t use the local hospital.  Since the labor ward is shared and some women may object, your husband can’t be with you until you are moved to a private delivery room.  For some women, especially first-time mothers, this can happen several hours after admittance.   Since my pregnancy was fairly normal and my first labor was relatively short (5 hours), this didn’t concern me.  I was ready for any eventuality, or so I thought.
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The one sure thing about childbirth is uncertainty.  Unless you have a scheduled C-section, you have very little control over what happens and when.  This can be stressful or downright frightening. In most American hospitals, women are encouraged to take an active part in their deliveries, to write up birth plans (indicating desired methods of pain relief, if any; birthing position; etc.), to take birthing classes and to generally be prepared.  This can help a woman feel somewhat in control of, and more comfortable with, the big event.  It’s supposed to reduce stress and make childbirth an easier, more manageable experience. Not so with the local hospital.  One thing I realized is that there’s a wide variety of cultural ideas about childbirth, pain and comfort.  All the American (and British) magazines and books that talk about childbirth discuss how a woman can be supported, encouraged, comforted by her husband, the doctor, the nurses, perhaps even a doula (woman whose sole purpose is to comfort the mother during labor and delivery).  This is a huge event.  In other cultures, however, childbirth is just another part of life, a normal everyday occurrence.  The mother’s pain is not their primary concern.  Women have babies, with or without pain relief, and then they go home. I was prepared for the cultural differences.  During a tour of the labor and delivery ward I noticed that the women were unusually calm.  I asked the health educator if they were drugged, and she said no.  “What do you expect, that it will be painful?”  I said I knew it would be painful since this was my second child.  None of the women, even those in the later stage of active labor, were making noise or even grimacing.  It must be a cultural thing, I thought, since all of the women seemed to be from the Sub-continent.  At each doctor’s visit I noticed few other Westerners.  The waiting room was always filled with locals in black abayas (robes), and Indians and Pakistanis in saris and salwar kameez.  Most were accompanied by mothers or sisters (no men allowed in the waiting room).  I was the only one alone.  I was also one of the only women who came prepared with a list of questions.

This uncertainty about communication can be downright frightening, especially for first-time mothers.  This is another reason many women either choose the American Hospital or return to their home country.  An American friend, whose husband works for the U.S. State Department, has gone home to have both her children since their medical insurance covered the cost.  She was able to deliver in her hometown and had her family around to care for her.  This brings up another issue: having (or lacking) the support of family and close friends, which can be especially helpful after delivery.  Most of my friends who have delivered in Dubai have someone—mother, mother-in-law, sister—fly out for the birth.  This, of course, means having houseguests for an extended period at a time when you’re most tired.  Not ideal for everyone.  We chose to go it alone, leaving my older daughter with a friend while I delivered.  When you live abroad, friends often become like family.

I never lacked visitors or help when I needed it.  I conveniently delivered just before the Eid holiday (marking the end of Ramadan), so my husband had eleven days vacation.  I was able to recuperate at home and didn’t have to worry about flying back with a newborn.  Also, my older daughter’s life was disrupted less.  Having a new baby in the house is difficult enough for children to deal with. Doing so in someone else’s house, I can imagine, would make it even harder.  These were a few benefits of delivering here, rather than returning to the U.S.

There were negative aspects to my decision as well.  The less troubling was the paperwork.  Getting the baby’s birth certificate (Consular Report of Birth Abroad) and passport required more steps and red tape than they would have in the U.S.  These were just minor inconveniences, however.   The major discomforts revolved around the actual labor and delivery. 

Anyone who’s lived in a developing country knows that U.S. standards of efficiency aren’t always followed.  I went to the hospital early in labor and was sent home.  The doctor who checked me out said that I’d definitely deliver that night and should return when the pain was unbearable.  That happened three hours later.  They knew I’d be back, so I was surprised and annoyed when it took an hour for my file to arrive.  Nothing could be done until the doctor had my file.
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For me this meant another hour without an epidural or IV antibiotics.  I’m an unusual case in that I have precipitous births (fast labor) and I had a bacterial infection that required IV antibiotics during delivery.  The infection (Group B Strep) is common in pregnant women, but it can be dangerous if it’s transmitted to the baby during delivery.  Heavy doses of antibiotics given four hours prior to delivery usually thwart transmission.  My concern was that my labor wouldn’t last four hours and my baby would be at risk.  I told everyone—midwives, nurses, doctor—I saw that I needed to start the antibiotics immediately and why, but they seemed unconcerned.  “Yes, we know,” I was told, but no one seemed to be doing anything about it. This was very stressful.  I felt like they kept trying to placate me by telling me what I wanted to hear, but not acting on it.  I felt this most regarding the epidural.  The local hospital doesn’t give many epidurals.  They are available, but they’re not discussed as an option of pain relief and they’re generally discouraged.  This is because only an anesthesiologist can administer them and the hospital keeps a limited staff on call for such purposes.  Their main job is to attend cesarean sections.  Midwives, called “sisters,” tend to do everything.  Doctors only intercede when complications arise.  I knew I wanted an epidural and took all the necessary steps to get one.  I went to the anesthesia clinic beforehand and received “counseling” and a form was put in my file.  “No guarantee,” the doctor told me.  “You will have epidural, Inshallah (God willing).”  I translated this as “fat chance.”   If the anesthesiologist is available, I could have one.  If he or she is attending a C-section, I’d be out of luck.  There’s only one anesthesiologist on call at night and unfortunately that’s when I was in labor.  I’m in luck, I thought, when the doctor told me the anesthesiologist was free.  “But,” she told me, “I’m sorry.  I spoke with the anesthesiologist and we don’t do epidurals at night anymore.”  “What do you mean?”  I asked between contractions.  “I was told I could have one as long as she wasn’t attending a C-section.”  “I’m sorry.  We can give you gas and air or an injection,” she said.

A minute later the doctor returned and said, “I spoke with the doctor and she says she will give you the epidural, if you want, but she’s not very skilled at it.  She might make a mistake.  She might have to stick you five or six time, just so you know.  Do you want it?”

“Yes,” I said between contractions.

“So, should I call her?  You want it?  But you know, she’s not very skilled,” the doctor repeated.

“Yes, I want it.”

Ten minutes later the anesthesiologist arrived and said, “You woke me up.”  She prepared her tools and fumbled with my IV.  “You know I’m not very skilled,” she said and I nodded.  “You know the complications.”

“Headache or paralysis,” I said.

She called a technician in to help with the IV.  The saline had to finish before she could administer the epidural.  The tech looked like he’d just walked in off the street.  He got the IV to run faster and then helped the anesthesiologist with the epidural.  He sat next to me and pushed down on my back to open up my spine.  It seemed strange.  Here’s this man in street clothes in full view of my bare butt.  I doubt they’d do this with a local woman. 

The doctor got the catheter in first try and within minutes I was pain-free.  Everything seemed wonderful, for a while.  Within a short time I began feeling nauseous and light-headed, so they gave me an oxygen mask.  I thought it was because I’d eaten a big turkey dinner that evening—it was Thanksgiving Day—complete with three kinds of pie.  No one explained why I needed the oxygen, although it did make me feel better.  The anesthesiologist had the midwife prop me into a sitting position.  “I want the epidural to go down, not up,” she repeated.  This was a bit scary.  I imagined my stomach and lungs being anesthetized.

Maybe this nausea and light-headedness was why they wouldn’t increase the epidural’s dosage.  About two hours after they gave me the epidural I started feeling pain in my tailbone with each contraction.  This wasn’t the case with my first child.  That time I had felt no pain,  nothing, not even during the pushing stage.  I’d been pleasantly numb, but still in control.  This time, the epidural seemed to be wearing off too quickly.  I asked both midwives (there had been a shift change) to increase the dosage and they said they would, but never did.  Finally, the second midwife said she’d increase it after she broke my water.  But after she did that it was time to push. 

“Too late,” she said, indicating that I wouldn’t be able to push if the dosage were increased. The epidural was no longer working, so I experienced the hardest, most painful part of childbirth basically drug-free.  Luckily it was relatively quick—fifteen minutes—if not easy.  And in the end we had a healthy, perfect baby girl. 

If I had to do it over again, I’d still choose the local hospital.  The care may have been inconsistent—some nurses were kind and caring, others abrupt—but I never felt like my baby or I were at risk.  I think this was because I took an active role, knowing what questions to ask and asking them.  The staff concentrated on doing the job, not on emotional support.  Politeness and kindness, although they might make the mother feel better, don’t make someone competent.  My labor and delivery didn’t go exactly as I would have liked, but this is true for many women.  On the whole, I’m satisfied with the government hospital.  And, of course, it was free and clean and the food was great.
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