I’m 36 + weeks pregnant, so last week I packed my hospital bags, checked them in at the airport, and hopped on an international flight. Destination: Cape Town, South Africa, where sunshine, ocean waves, beaches, mouthwatering fresh seafood, mountains, and stretches of vineyards await. My new life rule is that I only have babies near sunshine and oceans.
When you’re an expat about to give birth, and you reside in Lusaka, Zambia, you hightail it out of Zambia to welcome baby into the world. Some of us head to the U.S., and others to places like the U.K., and a few of us to South Africa. South Africa has some of the most top-notch medical care on the African continent. Did I mention the oceans and beaches? Plus penguins. Babies love penguins.
A few of us expats decide to go ahead and give birth in Zambia. Of course, I have friends, both local and expat, who have given birth to healthy babies in Zambia without incident. Lots of babies are born there, with a fertility rate of nearly six children per woman.
Since this is my fourth birth, I seriously contemplated staying in Zambia to give birth. With three natural and uncomplicated births under my belt (except that pesky postpartum hemorrhage thing that plagues me each time), it’s been pretty straightforward so far.
A birth in Zambia would be less complicated logistically. My husband can’t be gone from work for the whole one month before and one month after the birth. My four-year old can probably afford to miss pre-school without risking failing to get into college, but my six-year old is learning how to read and write – in a second language (French) – this year, so it’s not really fair to her to pull her out for two whole months, either. I suppose, with the support of Google Translate, I could make some attempts at homeschooling….no. Just no. Plus, there’s the familiarity, the friends, the easiness in Lusaka. Planning a birth in a different country requires more paperwork, emails, phone calls, and really savvy packing skills.
I put out some feelers and asked people’s opinions about giving birth in Lusaka. I got many stories of uneventful births that resulted in a happy baby and mother, and some recommendations for good OBs. I see a lovely OB who has the most caring bedside manner, and is available to instantly answer questions by text message (that does NOT happen in the U.S.), but unfortunately she doesn’t deliver babies anymore.
Others graced my ears with stories about the mother who needed an emergency C-section, but the medical team couldn’t get a hold of the anesthesiologist, so she had a C-section without medication. Then there was the woman who had her arms and legs strapped down during a normal vaginal childbirth, and the one who lost her baby during child birth due to poor management and care—at a private hospital in Lusaka. My doctor friends in Zambia asked me if I was crazy—one directly, and one indirectly. My lovely OB providing prenatal care for me in Lusaka laughed.
The reason for these responses is because babies die in Zambia, and mothers do too. According to UNICEF, the maternal mortality rate in Zambia is 591 deaths per 100,000 live births, the neonatal mortality rate is 34 per 1,000 live births, and the infant mortality rate is 70 per 1,000 live births. Even for those who can afford private care in the capital, Lusaka, being pregnant and giving birth is risky business. Simple complications—including postpartum hemorrhage—can go from bad to worse because of poor infrastructure, care, and a slew of other issues. (For more information about maternal health care in Zambia, check out the trailer for this fascinating documentary.)
The message was loud and clear—most likely, if I gave birth in Lusaka, everything would be fine. But, if I have the choice and the means, why would I take the risk of that small chance of something going wrong and me or my baby suffering serious health complications or worse?
So, around 20 weeks pregnant I began to plan an international babycation. I did this once before, less than two years ago. My last baby was born in Cape Town, so that helped quite a bit, especially because I used the same midwives, know the area, etc. Another bonus is that water birth is an option here in Cape Town, similar to an alternative birthing center option within a hospital that I used to deliver my first two in Chicago. There were less unknowns this time around with planning babycation round #2.
Everything is relative. Buying plane tickets for a family of five, plus a nanny, renting a house for two months, as well as a car, and paying for private health care in South Africa adds up. This is clearly cost prohibitive to most people, and I understand this inherent privilege of choice for my ocean-side babycation.
But, if I compare this Cape Town babycation cost to the cost of giving birth in the U.S., it’s at worst equal, and at best a cost-savings. For what I will pay for all my private health care, including an at-home post-natal visit and a couple nights in the hospital, combined with the cost of my two month “babycation” in South Africa…I’ll end up paying about the same or less than what I’d pay for the cost of childbirth alone in the U.S. I can pay $12,000 minimum, out-of-pocket in the US to push a baby out of me (without any medical intervention), or I can pay about $2,000 for the exact same quality of care and facility standards in Cape Town…along with all the perks of glorious sunshine and ocean views. I’ll take the penguins, thank you very much.
Our family of five, plus our nanny from Zambia, packed up with three suitcases and a boatload of car seats, and my husband helped me settle into the lovely house we rented on AirBnB in Kalk Bay, overlooking the ocean. But, my husband returned this past weekend to Lusaka with my six- and four-year old children to resume school and work.
So, here I sit with an 18-month old, nanny, and loads of sunshine and water at nearly 37 weeks pregnant. The baby is measuring at a beautiful 3kg already, and I’m having some super maddening Braxton Hicks contractions. My husband is two flights away (Lusaka- Johannesburg- Cape Town), and can get on a flight from Lusaka at 9am and rock-up into Cape Town by 3:30pm.
If baby decides to make a quick, slippery exit, Papa might miss the birth of his baby – which would be sad. He was pretty helpful the last three times – except when he told me during difficult push during crowning, “It’s just like doing back squats.” No, it’s really not like that at all. But, I’d kind of like him to be with me for the birth. So, I have the calming effect of going to sleep to the sound of ocean waves obliterated by the anxiety of my husband missing the birth. This is not a, “Will my husband make it from the office on time?” worry. It’s a, “Will my husband, with two tiny humans in tow, be able to get on the first flight out of Lusaka and make it through immigration, out of the airport, and to the hospital?”
My husband and two oldest kids plan on returning to Cape Town on April 1, 10 days before this bad boy’s due date. In the meantime, I have some amazing mama friends coming in (one from Kenya, one from Zambia) to keep me company before the crew returns, mostly to have fun and to stand-in for my husband— just in case. The next two weeks will be filled with botanical gardens, delicious food, and sea breezes. Not too shabby a way to waddle through these last few pregnancy weeks.
The next question is—will I be able to make this my last babycation? Those penguins!
This is an original guest post for World Moms Network from Jessica Menon of Gypsy Momma. Jess is a mom with three children under the age of six, with her fourth baby on the way. Jess and her family are currently based in Lusaka, Zambia.
Photos courtesy of Alda Smith. Photo of penguins and Jess and her youngest daughter at the beach courtesy of the author.
When I began CleanBirth.org in 2012, it was very important to me that the organization succeed. I wanted so much to help other mothers give birth safely. I also craved a project of my own that was unrelated to being a mother or wife.
I can remember worrying in the first year that the Clean Birth Kits wouldn’t be well received or that my partner organization in Laos, ACD-Laos, wouldn’t do their part to ensure success.
In the first 2 years, I worked endlessly with ACD-Laos and traveled to Laos twice per year. Back at home, I went to conferences, Tweeted and posted on Facebook non-stop, and sought connections and fundraising opportunities everywhere.
There was so much of me in the organization in that early period. I needed the moms in Laos to give me a purpose, as much as they needed me.
Yet, the more I traveled to Laos, the more I understood that the only agents for real change in birth practices are local nurses. With common language and traditions, these nurses are uniquely effective at conveying knowledge about safe birth.
With the goal of empowering local nurses, my partners at ACD-Laos and I spent time in 2014 establishing mutually-agreed up Monitoring and Evaluation procedures. With these clear objectives and methods of tracking funds, the way was cleared for my partners at ACD-Laos to take ownership of day-to-day activities.
In 2016, when they began conducting training without me and then requested to expand to more clinics and a hospital, it was clear that ACD-Laos and the nurses were invested and in charge.It was also clear that my role had changed.
Just as the organization had evolved, so had I. With an international move and growing kids, I no longer needed CleanBirth.org to be my purpose.
While the need is gone, my commitment is stronger than ever. I am so proud to be part of the team we’ve created: the nurses, ACD-Laos, CleanBirth.org and our supporters. Year after year we make birth safe for an increasingly large number of women in Laos.
World Moms Network has supported CleanBirth.org since the beginning. We need your help in the next 2 weeks,as we raise our largest amount ever $20,000.
Please give now if you can: http://cleanbirthorg.causevox.com/
Before my (now 24 year old) son was born, I was a SuperSitter. Not only did I work for a Babysitting Agency called SuperSitters, but I’d also studied Child Psychology, Child and Infant First Aid and aced a course which would have allowed me to open up a daycare facility of my own, if I’d wanted to. I was the person they’d call for challenging babies and children. I could soothe a colicky baby and have a normally hyperactive child fast asleep before the parents came home. They all expressed their astonishment at how well their young ones behaved when in my care. I felt supremely confident in my ability to be a great mother – after all, if other people’s children behaved so wonderfully when I looked after them, surely my own flesh and blood would be even easier, right?!
When I found out I was pregnant, I was thrilled. I read every single book on pregnancy, childbirth and parenting that I could lay my hands on, attended prenatal classes, and congratulated myself on how well-prepared I was for motherhood. A week before my due date I had my bag packed for the hospital and my birth plan written out. My husband had been prepped as to what I would need from him at each stage of labour. We were ready – or so we thought!
My due date came and went with no sign whatsoever of my son wanting to be born. I was extremely bloated and hot (January in South Africa is peak Summer heat), not to mention anxious to hold my son. To make matters even worse, my husband and I were living with my grandparents at the time, and with every braxton hicks contraction they would ask, “Is it time?” Eventually I couldn’t take it any more, so 10 days post due date I had my husband take me to the hospital. When I got there my contractions stopped again. On examination I was 3 cm dilated. The doctor asked me if I wanted to go home or if I was willing to have my labour induced. I wish that I’d been smart enough to go home, but at that moment I couldn’t face going home again without having given birth. This was to be the first of many mistakes I made as a mother.
I will spare you all the gory details, except to tell you that nothing went according to my meticulous birth plan, and I ended up needing an emergency c-section due to foetal distress. That was just the start of our problems. The surgical team struggled to get my uterus to stop bleeding after they’d delivered my son. My blood pressure nearly bottomed out and (much later) my OB-Gyn admitted that, if I hadn’t stopped bleeding when I did, she would have had to perform a hysterectomy to save my life! I thank God every day that it didn’t happen, because I wouldn’t have my beautiful daughter if it had! I’d lost so much blood that they had to keep transfusing me throughout the night. I wasn’t taken back to the maternity ward until the next day.
Because of what had happened to me, I wasn’t given the chance to breastfeed my son until much later the next day. By then they’d already given him a bottle and I never managed to get breastfeeding properly established. Instead of the minimum 6 months that I had planned to breastfeed, I ended up switching to bottle feeding almost from the day I got home. I really wish that I’d known then what I know now, like breastfeeding on demand!
As if that wasn’t bad enough, my son had severe colic for the first 3 months or so. Much to my surprise and dismay, this “SuperSitter” was completely and utterly unable to soothe her own baby! I also suffered through Postpartum Depression. I thank God every day for the unbelievable support I had from my husband, grandparents and aunt, who all stepped in and did for my son what I wasn’t able to.
Things went from bad to worse for my poor son. He projectile vomited every feed for almost 2 years, despite all our best efforts. He also often had gastroenteritis. Between puke and diarrhea we did a full load of washing every.single.day. I cried a lot during those first two years, because I felt like the world’s worst mother, and I was sure that my son wasn’t going to survive given all the vomiting.
Fast forward to today and the child I was so worried about has grown into a handsome, healthy and intelligent young man. In those early days I couldn’t even begin to dream of him becoming the man he is today. He has surpassed all my expectations, and I am incredibly proud of him.
He is now married, and is the step-dad of a lovely little girl. My son has learnt how to speak, read and write German fluently, and is currently studying Computer Science (Informatik) at Goethe University in Frankfurt.
The main reason for writing this post (apart from the fact that today is my son’s birthday!) is to give hope to all the moms who, like me, feel that they’re not “good enough” mothers. What I have learnt is that all children need to know three things – that you love them unconditionally, that you’re proud of them and that they can trust you. As long as you have those 3 things in place, nothing else really matters that much. Most of the things that we beat ourselves up for they don’t even remember when they grow up!
Was your labour and delivery what you hoped it would be? What do you wish you’d known when you were younger?
This is an original post for World Moms Blog by Mama Simona from Cape Town, South Africa.
Photo credit to the author.
Jennifer Burden, Founder & CEO of World Moms Network
As part of World Moms Blog’s collaboration with BabyCenter’s Mission Motherhood®, our World Moms are writing posts on maternal health around the world. In today’s post, Jennifer Burden writes about Jacaranda Health’s impact on maternal health in Kenya.
“Whether you are thinking about getting pregnant, currently pregnant, or a seasoned birther, there is one thing that we can all agree about avoiding. Lines in the maternity ward!! Big ones. HUGE. Because, hey, when a mother’s gotta birth, a mother’s gotta birth, right? Get out of our way, we’re coming through!!!
Long lines are the reality for moms who seek to give birth in public clinics in Kenya. Add lack of good procedures to prevent infection, being disrespected by health workers, rushed care, and overlooked emergencies to the mix; and Kenyan women report having bad experiences at public clinics. Giving birth can be frightening and dangerous for moms here. The Kenyan government is committed to help; however, there is little oversight or training to make the improvements needed…”
Read the full post, Maternal health worth traveling miles for in Kenya, over at BabyCenter’s Mission Motherhood®!
A new mom in Laos Photo Credit: Kristyn Zalota
It’s over 100 degrees Farenheit and I am dripping sweat as we enter the home of a mother who has recently given birth at a Lao hospital using a Clean Birth Kit, supplied by my organization CleanBirth.org. She is wearing a long skirt and hooded sweatshirt. Under the platform bed where she sleeps a clay pot is filled with glowing coals. Her newborn baby sleeps under blankets with mittens on her tiny hands and a knit cap. The mother, sweating profusely, is drinking piping hot herbal tea. She eats chicken four times a day and showers in the hottest water she can tolerate four times a day. Her four older children and husband are nearby, taking care of her and the household while she recovers.
This is a good birth story in Laos where my organization CleanBirth.org works. This mother birthed naturally with a Clean Birth Kit under the watchful eye of a trained midwife. Her traditions were respected and she and baby left the hospital healthy.
A baby needlessly dies.
However, many birth stories in Laos don’t tell the tale of mothers and babies surviving birth. A nurse at a rural clinic told of a 45-year old mother, pregnant with baby #14, who came into the clinic for help during labor. Her membranes had been ruptured for 29 hours and she arrived at the clinic exhausted. After a normal vaginal delivery, the newborn could breastfeed but was weak. He died 9 hours after birth, likely of an infection. The clinic does not have IV antibiotics, so the nurses were powerless to fight the infection.
World Moms help CleanBirth.org empower nurses.
CleanBirth.org Founder Kristyn Zalota training nurses in Laos
My visit to Laos last month was my fifth training trip with CleanBirth.org, the organization I started in 2012 to empower women in Laos to have safer births. Since 2012, we have provided 5,000 Clean Birth Kits and training for over 250 nurses.
This March, with my Lao partner organization ACD, we trained 71 nurses in the use and distribution of Clean Birth Kits and the WHO’s Essentials of Newborn Care.
Five of those nurses were fully funded by World Moms Blog donors, who gave $1,100 during our February fundraising campaign.
Our twice-annual trainings give nurses new skills and confidence. We also supply them with as many birth kits as they need throughout the year.
The trainings and subsequent improvement in care in the 31 clinics we serve, has led my Lao partner organization to ask that we fund an additional 13 clinics and a local hospital. When we visited the local hospital, midwives there told us that of the 50 births they see per month, 35-40 mothers bring with them our ayzh Clean Birth Kits — which they received at their local clinic. The midwives praised the convenience/effectiveness of the kits. They asked CleanBirth.org to provide around 10-15 kits per month directly to their hospital for mothers who don’t have a kit. This we will do.
It is a huge endorsement of our program to have our local partner and a hospital asking to expand our work to new areas. This means that they are seeing the benefits and that locals are deciding the future direction of the project. They are in charge.
My role as founder of CleanBirth.org will be to continue finding funding for kits and training. For just $5 we can prevent an infection like the one mentioned above. If you’d like you join our small but mighty effort please donate www.cleanbirth.org/donate.
Thank you World Moms for all of your support!
Photo Credit: March of Dimes
The tiny translucent fingers of a premature baby are stark reminders of the fragility of newborn life no matter where in the world a baby is born. When I asked a friend who works for the March of Dimes exactly what it was that the organization did I was struck that I knew so little about it. While I had traveled in the past few years on maternal and newborn health reporting trips to Ethiopia and South Africa, and written for a number of global non-profits on related issues, I was unaware that the March of Dimes was fighting for Newborn lives right here in the US.
As a mother of four and the daughter of a Polio survivor I am an active advocate for global vaccines with the United Nations Foundation’s Shot@Life campaign where one of our major goals is global Polio eradication. The March of Dimes was Founded by President Franklin D. Roosevelt in 1938 to eradicate Polio in the US, I was fascinated to find out that the March of Dimes had led the fight against Polio eradication, and although it still exists in two countries, Afghanistan and Pakistan, it was successfully eradicated in the US in 1979. Thanks in large part to the March of Dimes campaign.
The robust infrastructure of the March of Dimes was then shifted to tackle birth defects, and in the mid 1980s shifted to Community, Advocacy, Research, Education and Support services around premature birth. (the birth of an infant before 37 weeks of pregnancy). Premature babies can have serious health problems at birth and that last later into life, and about 1 in 10 babies in the US are born prematurely.
According to the March of Dimes Global Action Report on Preterm Birth; Born Too Soon :
15 million babies in the world are born prematurely each year, and that number is rising.
Preterm birth is the greatest cause of neonatal death, in the first 28 days of life.
It is the second leading cause of death in children under the age of 5 years old.
60% of preterm births occur in sub-Saharan Africa and South Asia.
75% of the deaths of premature babies could be prevented with proper medical care
Here in the US the preterm birth rate is at 9.6% , while across 184 countries of the world the statistics range from 5 to 18% for preterm birth rates per 100 live births. That means that here in the US, I was shocked to learn, we only get a report card grade of a C. You can find out where your country ranks on the Born Too Soon Global Map as well.
There is a lot of research going on to find out what factors cause preterm birth, because even healthy mothers who have done everything right during pregnancy can experience it. The risk factors that are associated with it include mothers of multiples, or who have previously had a preterm birth. Getting little or no prenatal care, being overweight or underweight during pregnancy, smoking, drinking alcohol, and drug use are all known to contribute. But there are demographics as well, if you are under 17 or over 35 these are risk factors, and here in the US researchers are working hard to find out why race also seems to play a part in the statistics.
Healthy Babies are Worth the Wait® is a comprehensive initiative by the March of Dimes to prevent preventable preterm birth, with a focus on reducing elective deliveries before 39 weeks gestation. Healthy Babies are Worth the Wait involves an education and awareness campaign, hospital quality improvement and community intervention programs. These strategies are focused on interventions and activities that have the potential to make an immediate, substantial and measurable impact on preterm birth. – www.marchofdimes.org
My friend Michelle invited me for a tour of the NICU at Women & Infants Hospital to see the work being done there by the March of Dimes. There was a stark differences between the Neonatal Intensive Care Unit that I had visited in Ethiopia at the Black Lion Hospital on my International Reporting Project Fellowship and the one we toured here in Rhode Island. I could see it had a lot to do with the presence of the March of Dimes. On the sterile 6 year old 50,000 sq. foot wing here in Rhode Island 82 babies can receive care. In the corner of the floor an entire center for family support provides programs, food, and a fun filled space for siblings to play. The support given in the hospital space seems an extension of the March of Dimes website where it encourages community support through the Share your story feature .
Photo Credit: March of Dimes
On my tour I could not help but think of the mothers I had seen across the world in Ethiopia in the largest NICU in the country with only three incubators and one nurse for every 10 babies. The mothers folded over their teeny babies with the same concerned and protective stance as the ones I saw here in Rhode Island, but with the difference of a world of support from the March of Dimes programs at hand. I was happy to learn that over the past 15 years the March of Dimes Global Programs have formed alliances with partners on the ground to help improve birth outcomes in developing countries around the world as well. All mothers love their babies with the same fierce intensity no matter where they live, and all babies deserve the chance to survive no matter where in the world they are born. I was impressed to learn about all that the March of Dimes programs do to see that happen.
This is an original post written by Elizabeth Atalay of Documama for World Moms Blog.