Saturday, January 28, 2012

You’re having this baby WHERE now?

I gave birth to Caleb in Boston.  You can’t throw a rock without hitting a world-class hospital in Boston. Mass General, Birgham and Women’s, Beth Israel...  Take your pick.  We went with a midwife practice situated in Mt. Auburn Hospital and had the patient and attentive care of trained midwives with a lifeline of doctors should they be needed (and they were).  My midwife sat next to me and held my hand through the c-section that devastated my expectations of a natural birth but that we all knew was lifesaving.  It was ideal.  

During my pregnancy, like any first time prospective mom, I was afraid of unknown amounts of pain but I was never afraid for the health of myself or my baby.

Flash forward to 2011.  I’m pregnant and in Western Kenya – a place where it’s not unheard of for women or child to perish in childbirth.  But it’s not common.  I’d seen many of the women I work with become pregnant and deliver healthy babies (in area hospitals) since I’d come to Kenya.  

Then I became pregnant, and we immediately started talking about the “safest” option, which was definitely not in Busia.   It all made me very self-conscious and directly conflicted with my “do as locals” sensibilities.  My running internal narrative was, “What makes me so much more special that I have to go somewhere else to have the baby?”  

And I certainly didn’t relish the thought of telling Kenyan friends that we would be heading to some capital city to have the baby – when there was a decent hospital in Kisumu, one that many couldn’t even afford to go to.  It all made me very self conscious. 

So, we settled on Aga Khan hospital in Kisumu – definitely the best in Western Kenya, and a few of my Kenyan colleagues had even delivered there, which help lessen my feeling of “little American princess” exceptionalism.


My first few neo-natal visits were OK.  They seemed to do the same tests that I was used to at home, and the nurse joked easily and remembered me visit to visit.  The doctor was a bit kooky – telling me that the nausea likely indicated that I was carrying a girl - but was reassuringly gray-haired and confident and seemed to have a good reputation.   

But when I asked basic questions of staff about how the birth might go and if I could see the maternity ward, the response was either uncomfortable laughter or that combination smirk/eye-roll people do when they think you’re insulting them.  I guess questioning the doc or hospital procedures is simply not done here.  And the subtext, as mzungu expat, is that I don’t trust them or their hospital.  

This was all very upsetting.  The very last thing I want to do is insult someone.  I spend a lot of conscious energy trying to tiptoe around the minefield of possible cultural insensitivities.  But, people, I come from a place that has pregnant women interviewing half a dozen docs to find the “right one,” and I myself sat through a “meet the midwives” night complete with a birthing room tour to calm the nerves of anxious new moms.  So, I thought some basic questions about how they might determine if I needed a c-section would be above board, but it was cause for offense and, worse, never quite answered.

Despite all of this, we thought we’d stay in Kisumu.  Moving to Nairobi with a toddler just for the delivery seemed incredibly uprooting and inconvenient, given we don’t have any support network there, much less a place to stay.

But then… it started to happen.  When we'd tell our expat friends they would respond with a mix of shock and concern.  One, someone who has lived here for nearly 2 decades, had a 45 minute… --I’ll just call it an intervention--with me about the decision.  

“Sure, it’s the best hospital in Western.  There’s probably a ‘best hospital in all of Namibia,’ but that doesn’t mean it’s safe.”  

“Sure, your baby might make it, but what if they took just a little too long to deliver it and it suffered brain damage.  You’d never know!”

“Sure, you met some missionaries who delivered safely there.  But, you don’t know what they think.  If the baby is harmed, they might just explain it away as god’s will.  You need to think about the health of the baby!”  

All of this made us wonder if we were being sensible yet “down with the people” or simply foolhardy.  If anything did happen to this child and I could have prevented it I would never forgive myself.  


So, I decided I needed to make a more informed decision.  But because I can’t get any information from the hospital there’s really no way to assess the risk.  

Luckily, there is a CDC office in Kisumu filled with medical-types and families.  So, I sent out an email asking for people’s experience with the local hospital and advice about my decision.
I got a torrent of responses back and each one of them advised me to have the baby in Nairobi.  There’s no neonatal emergency care in Kisumu, so (heaven forbid) if something went wrong I could be in serious trouble.  A few people retold horror stories they experienced or heard of.  Yes, doctors are by nature risk-averse and cautious, but I guess that’s how I should be when it comes to the health of this little one.

So, that’s why we’ve decided to have this baby in Nairobi.  

I still feel self-conscious when I tell Kenyan friends and colleagues. But I’m now reframing the whole thing. 

I’m not “special” nor do I think I deserve better than the “best hospital in Western.”  I guess I think EVERYONE deserves a hospital with minimal risks and that is well prepared for an emergency.  My discomfort is that we live in a world in which that is not an option for most people.  It’s an unpleasant reality and it’s made more stark by where I live, but putting myself at more risk than I need to doesn’t change that.  It does, however, make me want to try and help the situation for mothers who don’t have access to safe medical care.  

If you feel the same way, please look in to giving to the following NGOs or suggesting others:



  1. The fact that you had a c-section the first time around is reason enough to want/need a fully-equipped hospital where any unforeseen circumstance can be managed. I had Lissa at home with a midwife, but only after having our first (Nicholas) in a hospital (because I didn't know how I would react to the birth experience) and I wouldn't have dreamed of having #3 (Elizabeth) at home because it wasn't the right choice for the time/my age, etc.
    As mothers, we always make our decisions based upon the information we have at the time. Your information points you to Nairobi. No apologies or explanations necessary.
    And your point is well-taken that just because every expectant mother can't have "the best" doesn't mean you shouldn't avail yourself of what is best in your area. And further yes, we should work for a world wherein everyone has high-quality healthcare.
    You are wondrous.

    1. Thanks for sharing your experiences Heidi! You're right - everyone should feel comfortable making the right choice for themselves, but somehow the decisions is very public and you end up feeling judged by it. But I'm learning to let that go. And I know in the think of labor it will be the furthest from my mind!

  2. I'm really loving reading your blog Kim. So thoughtful, so honest, and so reassuring to those of us who have analogous internal conflicts.

    For what it's worth, it sounds to me like you sought out all the right information and made the right decision. You're not a little American princess or someone who gives into unreasonable fears (Colin: kachumbari at Msafiri? really? just poking a little fun... :), you're a compassionate and risk averse person making the choice that most families in Kenya probably wish they could make. Remember, you not going to Nairobi wouldn't make anyone else better off.

    Best of luck with the delivery! Can't wait to see pictures of the Bean!

    1. Thanks Jessica! You're totally right that not going to Nairobi is not going to help anyone - just took me a lot longer than you go get there. ; )

    2. What Jessica said!
      I've wondered what I'll do if I get pregnant again here. There's a REALLY expensive "expat" hospital that the other expats all recommend, but I know we wouldn't be able to afford it, and also...I hate the expat community a bit...know what I mean? I'd be trying the middle-of-the-road local. The hospitals here are all well-equipped but it's the cultural stuff that I'd be worried about. Like, apparently your husband can't come in during the labour until the baby is crowning. My first kid took 29 hours to get born and only three minutes of that was after he crowned...I needed my husband a lot more in the preceding 28 hours and 57 minutes obviously!!
      You made the right decision! Best of luck! And you look gorgeous.

  3. Great blog Kim.
    For sure be comfortable in your decision, as foreigners here we are constantly being judged (good & bad) so try not think about that. By the way what hospital did you choose in the end?
    I know so many people who go home to deliver for the hospital care but also the support network so it would be a difficult decision for me also especially as its my 1st.
    Take care.