I always envisioned myself peeing in a porcelain toilet to confirm my first pregnancy, but there I was squatting over a hole in the ground. Not knowing where else to go, I went to the local hospital in Mekelle, Ethiopia to get a pregnancy test. I waited next to 15 other local women in a smelly hospital only to be greeted by a doctor that laughed when I asked for bloodwork for pregnancy confirmation. I was sent to the latrine with a paper cup and a cheap pregnancy test. I am sure that many moms living overseas have similar stories to tell.
That was just the beginning of new experiences while navigating pregnancy in the foreign country that I call home. Somedays I embraced the adventure of it all and on others I caved in to the fear and unknown. The biggest question after my pregnancy was confirmed was where to give birth. I started searching the internet for other women that had been faced with similar decisions, but I didn’t find much to help me navigate these processes. For us, it wasn’t simple; we a have business in northern Ethiopia, but our parents and siblings are all in the United States. Over the course of my prenatal care, I was very impressed with the local doctors and their knowledge, but the facilities and neonatal care in our town were lacking.
I ended up giving birth in the States and it was 100% the right decision for me, as I ended up having a very complicated birth. That being said, it was hard to be away from my husband for over a month, not be living in my Ethiopian home for three months, and to face the complications of taking our little baby back to Ethiopia. Complexities are also present for mothers that deliver their babies overseas —not being near family or friends and concerns that there might be inadequate medical care in a specific country.
At the beginning of my pregnancy I didn’t know what questions to ask to decide where to deliver my baby. Through this Taking Route community, I have come in contact with many women that have had babies while living abroad, but when I was first embarking on this journey I hardly knew anyone with that experience. I really felt alone. For each pregnant couple the questions and answers will be different, but here are some questions that might help you make a decision about care and delivery while living overseas.
If you are thinking about returning to your homeland for delivery, here are a list of questions that you might consider:
How late will your airline let you fly? We usually fly Ethiopian Airlines and their website said that 32 weeks is the cut off. That seemed pretty early to leave my husband, so I spoke to someone at the head office. They explained the process to obtain airline approval to fly later. The process proved to be stressful, but it all worked out in the end. Next time I plan to fly Emirates, as they allow you to fly up to 36 weeks. As long as you have doctor’s note you don’t even have to get airline approval up to 36 weeks on Emirates, but every airline is different.
How late will your doctor clear you to fly? If is this your first baby, it may be hard to nail your doctor on this question. Doctors are usually going to be more cautious and it is difficult to weigh the doctor’s advice against your own gut. My doctor in Ethiopia recommended I travel back at 34 weeks. As it turns out, I felt great at 34 weeks and wish I had stayed with my husband until 35 or 36 weeks. Bottom-line, this is a tough question for you and your doctor.
Would your husband/partner be able to get time off of work to join you for the baby’s delivery? It is very hard for my husband to be away from our business and there was no easy way to navigate the situation. We figured that he would stay in Ethiopia as long as possible so that he could have more time in the states after the baby was born. Both of our mother’s babies arrive at 42 weeks. We did not think we were cutting it close at all having him arrive at 38 weeks, however my water broke 4 days after he arrived.
Is there a OBGYN practice or a midwife that would deliver your baby even though if they didn’t provide care throughout your pregnancy?
As soon as I found out I was pregnant I started searching for a practice in America that would take me at 34 weeks. Some doctors and midwives won’t take woman that late in a pregnancy, so it is important to establish care in your homeland plan as soon as possible. I don’t think that I received the kind of detailed care and attention during my labor and delivery that my midwife team would have provided to a patient they had invested in throughout the pregnancy.
Do you have insurance to cover a birth back in your homeland?
Our insurance was geared more for international medical issues. I wish I had researched the matter more before we got pregnant. We had to pay more out of pocket for the delivery than would have been ideal.
Can you be away from your overseas home for 2-3 months?
Being away for so long almost killed me. I love my house and my routine in Ethiopia. It was definitely weird to bring my baby home to a place that wasn’t our home. I had an American based friend that actually had a baby the same day I did. I looked up from scrolling through Instagram photos of her perfect nursery to see the mess we were living in. At first I felt like a homeless pregnant lady and then a homeless new mom, but it was also amazing to be so near family and the comforts of America.
When would you feel comfortable traveling with baby? Would you get vaccinations for your baby before traveling back or get them once you arrive back overseas?
In America you can’t get any vaccinations until 6 weeks. If you are planning to get them before you leave, you will have to wait until the baby is 6-8 weeks old before traveling. Navigating vaccinations has proved to be difficult and we are still trying to figure it out. I want to do a delayed vaccination schedule, but also get nervous about returning to Ethiopia without vaccinating my newborn. I am hesitant to get the vaccinations in Ethiopia, as most of the vaccinations are older versions of the vaccine with preventives that I don’t believe are the best for little babies. I am not sure what to do. Additionally, remember that you will have to get a passport for your new nugget, so you will have to factor in time for that. I did find out that if your baby is an American citizen you don’t have to wait for a social security number to be generated to apply for a US passport. Getting an infant passport photo proved to be more challenging than I thought.
If you are thinking about delivering in your overseas home, here are a list of question that might help you make a decision:
Is this your first child? How well do you know your body? One of my favorite people in the world gave birth to her 4th child in Nicaragua this fall. She has a midwife friend from the States that came and helped her give birth in her home. I asked her how she made the decision to give birth in Nicaragua and she said “I know my body and I did’t want to be away from my other children and husband to give birth in America.”
How advanced is your local medical care? Where would you deliver? Is there good neonatal care nearby?
I happen to live in a city that has limited care, but there are plenty of developing countries that can still provide great care for you and your baby. I would have had to go to Kenya for delivery if I wished to stay closer to my overseas home. I figured that if I was going to Kenya, I might as well go to America to be near my family. I don’t really know anyone in Kenya so it just didn’t make sense.
Will it be hard to be away from family and support?
I was really happy to have help from family right after the baby was born. It was the physical support but also the emotional support. If you are giving birth overseas consider having a mother or sister or friend come to help you after the baby is born. I will admit that while I was in America I really missed the girl that helps me around the house in Ethiopia— I had almost forgotten how to do laundry and wash dishes. In America I had a different kind of support than I have in Ethiopia.
Whatever questions you ask during this process the answers are never easy when you are living overseas and expecting a baby. There are downsides to whatever you decide, but it will be so worth all the effort in the end.
For other overseas pregnancy resources check out these other resources: