Giving Birth Abroad: My African Birth Story

Have you ever wondered what it's like to give birth in another country? To experience the challenges of labor and delivery far from your family & the traditional Western medical practices? Every birth story across the world is unique and beautiful in its own way. While every story may be different, this is mine.

Pregnancy in North Africa

Our family moved to Africa halfway through my pregnancy with our second son. Although pregnancy was nothing new to me, I faced a lot of anxiety over plenty of unknowns when we moved to a country I had never been to before. Now, before you call me crazy...we were blessed to have many contacts (some of our closest friends now) who had experienced pregnancies and successful births in the area we were moving to. I would NOT have been able to prepare for this birth and receive the medical care I needed if it had not been for these people helping me each step of the way.

Pretty quickly after our move, I got connected with a reputable OB who works with a lot of expat women and was trained in Western medical practices. I have so much respect and admiration for the work he puts in for his patients to this day because of the ways he was so intentional with meeting me and my son's needs medically.

The ways that countries practice medicine can vary depending on where you go. Where we live, doctors and their patients have a very personal and intentional relationship that is built on respect and trust. Patients in our country view the advice of their doctors in very high regard because becoming a doctor is extremely hard for locals! They trust everything they are prescribing is exactly what they need, no questions asked! The doctors in return offer their undivided attention to the patients blocking out entire hours for one-on-one time with them uninterrupted. When I would show up for my routine OB appointments at my doctor's private office, I was usually the only one in the waiting room and I was often there before he arrived. To this day, I have the personal numbers of every single doctor I've seen during my time overseas so far. I always felt advocated for and respected as a patient; therefore, I never felt ashamed for speaking freely about my medical needs (as it should be!).

My pregnancy with my second born was fairly uncomplicated and he appeared healthy the entire time. Every appointment I went to I would receive an ultrasound and a cervix check. Because of this, my doctor noticed I started to dilate early in the beginning of my 3rd trimester. He had me rest as much as possible in order to prevent my body from going into natural labor too early. Once I approached 36 weeks, he told me I no longer needed to be super cautious but could continue with normal life while still trying to take it somewhat easy. This was relieving to me that I had made it this far without going into labor early. Because of this, I thought I was in the clear for a successful labor & delivery.

What Private Hospitals Are Like

There are private and public hospitals in the area we live in and not every hospital is built the same way in a manner of quality. I chose a private hospital to give birth at because this specific hospital was one of the most reputable in the entire country. It contained one of the only NICUs in the area. Plus, majority of expats I knew who had hospital experiences had great things to say about this place. A benefit was most of the hospital nurses and doctors spoke English! I had already experienced one OB appointment here, so I was somewhat familiar with the layout of the hospital. There wasn't a lot that was different about visiting a small hospital in the US compared to here. The only downside about delivering in a private hospital here, is the expense. It tends to be more expensive than delivering in a public hospital (for a 2 day stay it ended up being around $1,500 with an epidural for me, meals included). As an American, I was SHOCKED when I found out this was considered expensive especially when I remember my $20k hospital bill after delivering in the US the first time around. I guess it wasn't really a downside after all!

Spontaneous Labor

Mid December 2023, I was putting my toddler down for bed when I felt like something was "off", but I couldn't put my finger on it. I knew labor was imminent because of signs my body had been displaying, but nothing had progressed so far asides from dilation. At the time, I was almost 37 weeks pregnant expecting to make one more week of pregnancy. I hopped in the shower that night to get myself ready for bed after a busy day when I noticed I was losing my mucus plug! I immediately felt alarmed but reminded myself this can be quite normal around the end stages of pregnancy and doesn't necessarily mean labor is happening. In my case however that was not true lol!

We called our babysitter, and just a little before 1am me and my husband arrived at the hospital while I was experiencing contractions 5 minutes apart. The Labor and Delivery floor was dead quiet except a couple of nurses on call. They quickly got me hooked up to a monitor where I sat there for an hour contracting before they determined I was in labor and dilated to 3cm. They called my doctor, and he answered his phone from his home and drove to the hospital quickly to deliver my baby! Labor was a speedy 2.5 hours from the time we arrived, to the time I delivered my son at 3am. My contractions were super manageable, but I decided to get the epidural just to be safe, only to have my water break while they were inserting the needle in my spine. If you've been in labor before you know that was the most uncomfortable thing that could have happened at that moment, and I immediately regretted getting it. 10 minutes after it was inserted my son came quite literally flying out to our surprise (no pushing required). I didn't know whether to laugh or cry because I had no clue what just happened until they laid him on my belly. It was the easiest most amazing thing ever!

First NICU Experiences

Not long after my son was born, they noticed his breathing was not stable because he was gasping quite visibly for air. They took him away to an oxygen chamber where they waited for the pediatrician on call to come check him out (another difference than the US...they are not in the delivery room when the baby is delivered). In order to determine what was wrong, he needed to be taken to the NICU for 24 hours, so they cleaned me up and delivered me to my room. One of the perks of being in a private hospital is the size of room you get to stay in! During my first labor & delivery, I got to stay in a room dedicated for parents with twins. This time around, the room was pretty much the same size! The nurses checked my vitals and left me alone for the entire night until 6am (yet another difference than the US). I was well rested by morning and because I had no tearing, I felt like myself again. The hospital staff brought me breakfast and my husband came with my son that morning. To back track, my husband was with me during my labor, but afterwards he returned to our home to relieve our babysitter. It was really good to be with both of them again because I really missed not being with my baby. Usually when labor and delivery go well, you are inseparable from your newly born baby in order to bond and connect. It's not only beneficial for the baby, but more importantly for the healing of the mother as well! I felt so empty without my new son whom I knew was still in the same hospital as us, but he felt miles away.

That morning the pediatrician came to give us an update on his care and condition and told me they still needed to monitor him for 24 hours. She said she expected him to only be in the hospital a short bit, but it really was up in the air at the moment. I went to the NICU to go and visit him for the first time after giving birth and he had a CPAP machine covering his tiny face and his eyes were open looking at me while I talked to him through his incubator. Even though this was the most reputable NICU (and really one of the only NICUs in our area), I noticed it was quite small and there were only two rooms where all the babies stayed. They had his incubator in the first room as you walk in and there were probably 10 other incubators side by side all next to each other, majority of them were empty. The second room was dark and had three incubators in them with a couple babies in them being monitored. The nurses' desk was in the same room with the incubators where my son was. There was no seating for parents to come and visit their children. Upon entry I had to wash my hands, put on a hair net, put on a lightweight medical robe, and cover my shoes with nets as well. The nurses watched very closely as I visited my son and would give me 10 maybe 15 minutes tops to visit him each day. The Pediatrician was usually there to give me an update, but if I asked the nurses about his condition or any specific medical questions, they always referred me to the doctor and told me they could not answer (an unfortunate difference than the US). After that initial visit I assume they didn't expect me to return again unless with my pediatrician, because when I would return periodically that entire day, they would turn me away saying they were "busy". I was really confused by this, and so were some of the nurses taking care of me on the maternity wing because they encouraged me to go visit him regularly. We'll get into those cons about the NICU staff later.

I ended up staying one more day than I needed to at the hospital just hear the final word about my son's condition. They determined he would need to stay a few more days in the hospital to regulate his breathing capabilities and they sent me home without him. That was one of the hardest moments as a mom in my life.

Unexpected Complications

We returned to the hospital the next morning to get an update from the pediatrician expecting to hear news about his progress; however, that is not what we received. To our shock, overnight he had become unstable only for the doctors and nurses to discover he had an infection in his lungs. Later we learned it could have been because he was born so quickly. In order to help him recover from this infection, they had to make a small incision on his chest and insert a tube which flushed the infection from his lungs. Additionally, they noticed on his x-ray that his lungs were partially collapsed due to the infection. He needed air forcibly pumped down his throat through his lungs to help him breath without exhausting himself. Because he had spent so much energy simply trying to inhale and exhale, they sedated him to keep him asleep and let the treatments help his body improve. The last time I saw him before this moment, he had his eyes open looking at me but now he looked lifeless as a machine pumped his chest up and down. It was absolutely heartbreaking. I kept a strong face as the doctor finished talking with me but once I got into the elevator, I couldn't help the tears from coming. We continued to visit my son twice a day delivering milk I pumped regularly and trying to get a chance to see him for as long as we were able. In total, he spent 19 days in the hospital.

When I left the hospital that day, I wasn't sure if that was the last time I would see him alive. The worst part was, I could not be with him as long as I wanted to (to an extent) like I knew I would have been able to in the US. We started asking our friends and family and everyone we knew to pray for his recovery and in a few days, he was already showing great improvement. He continued on an uphill path of recovery with a few dips along the way until we could bring him home. A couple days after Christmas I got to hold him for the first time since giving birth. I was only allowed to hold him until he no longer needed CPAP. For him that took almost 2 weeks. Once CPAP was off, they were more willing for me to come spend longer amounts of time with him in order to nurse him which he did extremely well at! The final days he was in the hospital he did not have oxygen at all, and they had me stay with him in a separate hospital room overnight with him to make sure he was fit to come home with us. When it was time to leave, we had to pay his bill in full which came out to be just under $10k.

Cons of Giving Birth Overseas (site specific)

As I think about my birth story and my son's NICU experiences I have a list of pros and cons that come to mind. Let's not end this post on a negative note so let's talk about the cons first! Most of my cons come from the NICU experience because I don't have very many complaints about my labor & delivery and personal hospital stay. If I had to be picky about my labor experience though I would say:

1. The hospitals where we live do not provide anything for you as a patient or for your baby. You are expected to bring everything you could possibly need. They didn't even provide diapers for my son when he was born, I had to pack those from home! Luckily, I was prepared for this and used a friend's hospital bag checklist from when she stayed in the same hospital.

Now for the NICU experience...

Before I list my cons, I want to make something clear first. The way a culture functions tends to bleed into their medical systems. There can be really great aspects about a culture and maybe some not so good ones and these too can show up in the way doctors and nurses practice modern medicine. There were certain cultural barriers I had to overcome and that's ok!

1. Visiting time was very limited! As I stated before, the NICU space provided was super small because their resources were limited. They did not have the capacity to let parents visit their babies as long as they wanted and still perform the duties they needed to get done.

2. There is little sense of urgency in meetings the requests of parents/patients. Unless it's a life-or-death scenario and you're not in need of urgent medical intervention, nurses can be quite slow to answer you. For example, there were times I would show up to the NICU and ask to see my son. They would tell me they were busy at the moment but wait a bit and they would call me. 9 times out of 10 they would totally forget I was there or make me wait for hours before they retrieved me...even after I would call on them multiple times! Where we live, it is considered polite among the locals to be late. Life is very slow compared to our fast-paced consumerist ideology in America. Again, this was another cultural barrier I needed to understand and accept in order to overcome.

3. I was often turned away from visiting my son because the nurses did not want me to worry about his condition. Another cultural barrier I had to overcome was the fact that they wanted to take care of everything and not have me worry about carrying any burden whatsoever (including emotionally). The nurses, in an effort to spare possible anxiety, would refuse me from visiting my son. I didn't learn this until I spoke up about how frustrated I was with their actions in doing so. I ended up sending a rather rude email to the head midwife on the Labor and Delivery floor which found it way into the inbox of the NICU nurses who read it and confronted me about it. They apologized and explained where they were coming from. However, I told them I was NOT a local and it made me even more anxious to feel like I wasn't informed on my son's condition. I'm glad I spoke up because after this conversation they were more willing to let me see him especially as he improved.

4. They did not let me hold my son until he was off of CPAP. To this day I didn't get a straight answer as to why they didn't allow me to. I understand in the US you are able to hold your baby when they're on CPAP, but every country and every hospital have their own procedures to follow.

5. The hospital did not retrieve majority of the medicines that my son needed during his NICU stay and departure from the hospital. Often times nurses would contact us telling us what my son needed while he was staying in the NICU, and it was up to us to go and fetch it for them to administer to him. Patients all over will receive from doctors' medical notes that they take to Pharmacies which are located all over. A doctor can pretty much prescribe anything including vaccines which you pick up to bring to them. The luxury of experiencing a well-stocked hospital or clinic is something I miss about living in the West.

These are the major cons I have about the NICU and hospital experience. Let's get into the pros!

Pros of Giving Birth Overseas

I don't have very many pros about the NICU but the labor experience was great!

1. Initially, I was worried about the hospital nurses preventing my husband from being in the delivery room with me. However, I am so so thankful for the doctor I had who advocated for me my entire labor! I cannot sing his praises enough; he quite literally predicted my labor almost to the day! The fact that he answered his phone in the middle of the night and showed up for me meant the world for us!

2. The nurses performed minimal checks on me during my time in the hospital. Often times you may see satire about Western hospitals with nurses bothering patients in the middle of the night multiple times. This was not the case here! I am so thankful they only checked my vitals a couple times a day and gave me time alone to rest and heal.

3. The cost of medical expenses is so much cheaper than being in the States! My hospital stay was about $1,500 and for my son's 19 day stay in the NICU which included countless lab orders, a minor surgery, days until a bilirubin light, CPAP and oxygen, and so many other things ended up being just under 10k! We could easily pay for these expenses out of pocket as a low-income family.

4. In my specific situation and with the hospital I chose, I didn't have to worry about a steep language barrier. Although there were cultural differences, I (for the most part) understood everything they were communicating to me.

Concluding Thoughts

As I reflect upon mine and my son's stay in the hospital, I am so proud of my accomplishment in simply giving birth (that's a huge achievement in and of itself) and an even bigger accomplishment to do so in a foreign country! This was quite possibly one of the hardest things I've had to do in my life to be so far away from our family all while my child was in the NICU for almost 3 weeks. This was not a typical birth experience and not all NICU stories are like ours either. Even though this was a tricky and unexpected situation to navigate through, I am thankful to be on the other side with a healthy baby! I'm thankful for the community we have built here who showed up for us on our darkest days. A family we know even came to sing Christmas carols to us on Christmas day! I learned about the culture and grew to appreciate many different aspects about living overseas. If you know of a NICU parent going through a rough patch right now, I hope this is enlightening and informative about some emotions they may be experiencing especially if their child is in the hospital for a prolonged period of time. They are going through hell right now so let's surround them and lift them up! If you are a NICU parent, I want you to know that you are so strong and so is your baby. What an accomplishment! I hope ALL my readers can be encouraged about my experiences. Till next time!