"Everything will be fine!" Or, the saga of finding a place to deliver Baby Brother.

We were told "everything will be fine." So. Many. Times.

My posts are usually pretty positive, so here is the one about the situation where things were not ok. We knew me being pregnant would make our move here a little complicated, but certainly could not have anticipated what was about to unfold. Or maybe we could have but were trying desperately not to.

29 weeks pregnant (week of Nov 9): Fly to Saudi Arabia

Over the last few months I had read through various Facebook groups and semi-reputable news sites that Saad Specialist Hospital, the hospital Ellie was born at 3 years ago, was having financial troubles. There were rumors of strikes and doctors leaving, due to not being paid for several months. Travis had been diligently following up with the doctor at his plant for a couple months, and with some friends that had just had a baby there at the end of September to make sure our preferred doctor was still at the hospital and that L&D was still operating. In fact a few days before flying to Saudi we heard of our doctor delivering someone's baby at this hospital, and we were also hearing that the government was going to buy out the hospital and everything would be fine (!) by Jan 1. Since this was going to be my 3rd c-section, and we didn't know anyone who had had a c-section with any doctors besides this one, I was prepared to stay in Texas if this was not the case... but all signs pointed towards a positive outcome. So away we flew!

31 weeks pregnant: First appointment with Dr. A. 

You may remember him from my post about Ellie's birth 3 years ago. I was so impressed with (almost) everything about that birth experience that I was honestly less nervous about coming back to Saudi to have this baby than I was staying in Texas with a new doctor.

Upon arrival at the hospital we could tell things weren't quite right when we noticed the temporary check in desks set up in the reception area. The bathroom didn't seem as well kept up, and the lab towards the back was completely dark. There were still people milling around which made it seem somewhat normal. When we made our way up to the GYN/OB floor it was shocking to see the entire OB reception empty. The wing to the left was dark and the nursing/women's only room was dark. I think the lights were off on the turtle tank (hope someone removed the poor turtle!)  We made our way back to my doctor's waiting room and could sense the tension in the air. Once ushered into his office it was painfully obvious that this was not going to be the same as last time. He had removed everything from the walls and was clearly packing up. His first question was "so where do you plan to deliver the baby?" Not what you want to hear from your preferred doctor! We told him we were there to learn what our options were. He informed us he was leaving Saad hospital December 1 and would be practicing at Al Moosa Specialist Hospital in Al-Ahsa, which was another hour and 15 minutes beyond Khobar, or a total of a 2.5 hour drive from Jubail.  He said that he searched the entire Eastern Province and this hospital was the only one up to his standards (which we know are very high!) He was very kind and told us we were welcome to follow him there but he understood that the logistics might be difficult. He said of the hospitals in Jubail he would recommend the Royal Commission Hospital for me, since I would be having a planned c-section, which hopefully would be uncomplicated and simple. He recommended delivering at 38 weeks, to minimize the risk of going into labor because being in an emergency c-section situation here is less than ideal.

We left rather stunned, realizing that what we thought were well researched plans were now completely up in the air. I spent that afternoon and evening messaging everyone I knew to find out if we had connections to anyone with personal experience having a c-section in Jubail. In the meantime, we decided to work our different options in parallel:

In addition to the long drive, Al-Ahsa is in a "red zone" and we aren't allowed to travel there for security reasons. The US state department also has a travel warning for that area. Travis began drafting an email to S-Chem's Security Advisor to explain the situation and see if traveling to Al-Ahsa was an option at all.

There are two other hospitals in Jubail, one of which (Al-Mana) looks from the outside like it belongs in a 80's horror movie, and the other (Mouwasat) is where a friend nearly died after giving birth a couple years ago, so I understood why Dr. A had recommended the RC above the other two. In addition to the first-hand account of the terrible birth experience at Mouwasat, Travis' boss also had an awful experience at this hospital with a surgery where they LEFT A SPONGE INSIDE OF HIM, resulting in a serious infection. So we really were not keen on even visiting a doctor there at all! (Maybe we are overreacting, as we know many people give birth there every day, but this late in the game we did not want to take any chances if we had a better option!)

That evening I learned that a friend-of-a-friend also had an appointment with Dr. A that afternoon, and he had given her the name of a doctor at the Royal Commission hospital (Dr. M) who had just transferred there from Saad. This gave me some hope between the crying fits.

My good friend Linda had experience with getting appointments at the RC hospital, and she was so sweet to take me there the next day to set up an appointment. I was pleasantly surprised with the registration process--the receptionist was very friendly and the system sent me text messages to confirm my appointment! This was far more advanced than any other system I had seen in Jubail. I couldn't see Dr. M for an appointment for another week, but at least it felt like we were making progress.

In the meantime our security advisor was vetting whether it was safe or not to go to Al-Ahsa. I was relieved that they initially told Travis "okay" knowing that if we couldn't find a suitable solution in Jubail, we could have Al-Ahsa as a back up plan. Looking at the website for Al Moosa it was obvious that they are striving to be the best health care facility in the region. I was far less concerned about how things would go at this hospital knowing that Dr. A would not have his practice there if it was indeed not up to his standard, and the only thing holding us back from committing was that if we could find a way to avoid being on Saudi roads for 3 hours with a newborn, we would.

32 Weeks Pregnant: My first appointment with Dr. M at the RC hospital

I had high hopes for this appointment based on the positive experience at reception the week before. On first impressions I liked Dr. M and I believe she is a skilled physician. However she was so new that she knew nothing of the hospital's standard policies and procedures for c-sections and post-partum care. Our questions were simple, like "Can Travis be in the operating room with me?" and "How soon will I be able to nurse after the surgery?" She told us she would research these questions and let us know when we came back in two weeks. No problem. Our concern level went up a bit when she offered this: "They gave me no training, no on-boarding. They told me first day to go to clinic and start work." She was clearly frustrated with the process, which did not give us any warm fuzzies for this hospital.  She also reiterated the importance of delivering at 38 weeks, "If the c-section is planned I can guarantee my services for you. If it is emergency, there is no guarantee who will do the operation." That's pretty standard of course, but when there is only one particular doctor that is driving you toward a certain practice or hospital, it's a disconcerting thought!

After the appointment we made our way downstairs to Patient Relations to see if they could answer the questions that Dr. M could not. While wandering through the halls we ended up meeting the director of PR, and he informed us that all of their hospital rooms are undergoing renovations so their capacity is down 50%... which means ALL of the rooms are shared. I could get over this... but "because we are in Saudi Arabia", my husband would not be allowed to even ENTER the room I was staying in! While I have wonderful female friends here that I'm certain would help out, and we were hoping my mother would also be in town... due to the other red flags this was the deal breaker. It's okay though, because Mr. Patient Relations told us "We take excellent care of you! Everything will be fine! Anything you need we will accommodate." I mean, except that one thing. :-S

We decided to keep our next appointment for two weeks later and continue researching our other options, which included the long drive to Al-Ahsa, or the two other hospitals in Jubail. The final option - which we really didn't want to think about - was flying the girls and me back home to have the baby. This would involve being away from Travis for most of 10 weeks, and for the last six of those I would mostly be on my own with THREE kids, including a newborn. Staying in Saudi is definitely ideal for keeping things consistent and normal for the girls.

33 Weeks Pregnant: Meet Dr. E at Al-Mana Clinic

My friend Linda who had helped me to initially get the appointment at RC (and coincidentally is 20 weeks pregnant herself!) suggested I try her doctor, Dr. E, who was with the Al-Mana hospital system. We had used the pediatricians at the Al-Mana clinic before so I knew the clinic was nice, but I was still skeptical about the hospital thanks to the horror movie image in my head. The next day she took me to the clinic. While in the end I really liked this clinic, here's how you have an appointment there. If she had not been with me figuring out what to do next would have been really hard, because no one gave me any instruction. And this probably is a little out of order of how it actually happened, but I've slept since then:

1. Go through doors that say "Women Only" and get established as a patient at the reception desk.
2. Go down the hall to room where they take your vitals.
3. If you need a CTG scan, or a NST, go further down the hall. If you are unsure if you need this, wait until your doctor instructs you where to go.
4. Wait in hall for nurse to call you to see the doctor.
5. Visit with the doctor.
6. Since it was my first visit and they wanted lab work, the next step was to take paperwork from doctor out of the women only section to the lab reception. Then go to the lab to give my blood sample.
7. Go down another hall to a dirty Saudi bathroom to give a urine sample. Thank goodness I brought the purse with the extra toilet paper. Note for next time--wear the wrap around abaya, not the over-the-head style!
8. Turn urine sample back in to the lab.
9. Wait to meet with sonographer to get ultrasound.
10. Get ultrasound, go back to women only area and wait for doctor to review results.
11. Meet with doctor and get instructions for follow up appointment.

While this sounds pretty complicated, and it was, I was actually really impressed with the facility and how my arrival was anticipated for each step. Each area (the lab, ultrasound room, CTG etc) had my info already on the computer when I arrived and they knew who I was. So despite the confusion it really was very organized. Dr. E was great and assured us that our husbands could join us in the hospital because the post-delivery rooms are indeed private. At the end of the appointment, we asked Dr. E if we could get a tour of the hospital. She was very accommodating and called one of the nurses in L&D about showing us around.

Ready for an ultrasound!

When we arrived at the hospital, we needed help finding our way to L&D. While the inside of this hospital is better than the outside, it is not quite what I would call a state of the art facility. Once there, a nurse named Lovely met us and proceeded to tell us the procedures for a c-section and how they keep the baby safe once born. While I'm not too concerned about my (potentially) red-headed Caucasian kid getting mixed up with the others, we certainly want our hospital of choice to have good procedures for this! They didn't have anyone delivering or in surgery at that time so we were allowed to peek into the prep room and the OR. While I'm not generally familiar with hospital procedures, the OR looked decent and they obviously weren't going to let just anyone come in. In fact there were large signs on the locked doors to the prep rooms and OR that said "Women Only". Trying to gauge how strict they were on rules, the following conversation went like this:

Me: Can my husband wait in the prep room with me?
Lovely: Yes he can come in for a little, but then he will need to wait outside.
Me: Ok, can he be in the OR for the c-section?
Lovely: No.
Me: But Dr. E said that it would be okay...
Lovely: Well maybe if she gets special permission from the head of hospital.
Me: So husbands are not usually present for the c-sections?
Lovely: Not in my experience, no.

So despite having reassurances from Dr. E that we could have the delivery we wanted, the nurse made it pretty clear that this was not standard procedure. We asked about seeing the nursery and post-delivery rooms, and Lovely said not at that time but she would talk to Nurse Rosebell and call us in a day or two. We left feeling frustrated again. Just like our initial experiences at the other hospitals, this was one step forward and one step back. Linda messaged the doctor all of our questions to see if she could explain the discrepancy, and her only reply was "Everything will be excellent!" (This canned reply was really starting to get old.)

34 Weeks Pregnant: Follow up at RC with Dr. M

Upon returning for our follow up, Dr. M immediately asked "So where have you decided to deliver?" We told her we were leaning toward going to Al-Ahsa if we could make it work, and she broke out in a big smile and said "Good! You will be much happier there." So when the doctor is recommending you stay away, you know that hospital is no longer an option!

35 Weeks Pregnant: Follow up with Dr. E at Al-Mana

After thinking about it for a couple weeks, I had a new list of questions for Dr. E. We really wanted to try to make a Jubail delivery work. This doctor appeared to be our last resort in Jubail, so I wrote down everything I could think of that I wanted to know. In talking to friends we concluded that hopefully the hospital staff was just telling us the rules they have to abide by, but maybe the Dr. has the authority to do things differently. Linda joined me again and I was so thankful for her company. This appointment was a lot less complicated than the first, since I didn't need to give blood or urine samples, and she didn't order an official ultrasound. I was able to stay in the "Women Only" section the whole time I was there. I did have a non-stress test, which indicated I was having minor irregular contractions but nothing to be concerned about.


My question session went like this:

Me: How will you close the wound?
Dr. E: Dissolvable stitches
Me: How soon can I start breastfeeding?
Dr. E: Oh, 24 hours after operation.
Me: What? No, that is not acceptable. With my first two I could start nursing right away. At Saad they brought the baby to me while I was being closed up.
Dr. E: Well it is not good to nurse baby while you are under anesthesia.
Me: It was fine for the last two!
Dr. E: Oh, so you want spinal anesthesia?
Me: Yes!

Oh dear. At this point I realized that she thought this surgery would be with general anesthesia. As in, knocked out! Which makes me wonder if that's how most Saudi women have c-sections? Now it also makes more sense why the husbands aren't usually present... because what is the point if the wife is asleep? But the fact we had not even been talking about the same kind of anesthesia this whole time was very concerning! 

Dr. E: Well in that case, yes you can nurse as soon as you want. But you won't have any milk, so this is not important. We will feed the baby a glucose solution!

Me (and Linda at the same time, while my eyes nearly pop out of my head): Yes, nursing immediately IS very important! In fact I have read and been instructed by my other doctors that it is critical to try and nurse in the first hour if at all possible! And yes, the baby needs to nurse to stimulate milk production, to receive colostrum, to stimulate the uterine contractions...

Now I see that for all her competence elsewhere, Dr. E. may be about 20 years behind on current nursing theory. Anyway, on to more questions:

Me: How soon can I get up and walk?
Dr. E: Most patients don't want the catheter removed for 24 hours.
Me: Last time I walked at 12 hours and I would prefer that for better recovery.
Dr. E: Ok, 12 hours is fine.
Me: What do you do for pain management?
Dr. E: We use (and here she rattled off a list of medications that I vaguely recognized)
Me: Can our husbands stay with us both during the surgery and after delivery?
Dr. E: Yes
Me: Can we tour the nursery and post-delivery ward?
Dr. E: Yes

Off we go to the hospital again. Travis was able to meet us there so he could see what we'd be dealing with.

We found Lovely in the OR again, and she took us to pediatrics. Apparently we were supposed to get permission from the pediatrician to see the nursery, but since this step in the process had not been communicated we asked to be taken directly to the nursery. Once there another nurse explained our mistake, but thankfully instead of making me walk across the hospital again to meet with the pediatrician she makes some phone calls and we are eventually let in. (Again, glad to see they are concerned with security!) The nursery is small but adequate. It seems clean and it is very warm (not that I should be a judge of temperature... right now I think 64 is quite comfortable). There are two rooms connected by a hall, one for NICU babies and one for 'normal' babies, and several nurses present. We ask this nurse what all they do for babies in the nursery, and it all sounds pretty standard until she brings up feeding the baby "sugar water" again. When we ask why she says "To see how they respond. If baby responds ok, we will bring to mother to nurse. They will be with us for about 5 hours." This is most definitely not ok with me! I don't know anyone with a full term baby who's needed glucose solution. And in further reading online, it sounds like there are several potential concerns with this practice under normal conditions... Again, that's why they don't do this in hospitals back home! Maybe if we begged hard enough and I had enough friends following my baby around after birth we could stop this from happening. She also said that the baby would be brought to the nursery anytime visitors came... which I'm also just not ok with! I understand wanting to prevent infection... but I'm certain my visitors would be responsible and only come if they were healthy.

From the nursery they take us to the rooms where the mothers stay after delivery, and they are surprisingly big for being private rooms. The bathroom seems clean and the shower curtain looks new. Then we remind them that I will be having a c-section, and she says "Oh in that case you will be in this room for observation", another room directly across from the nurses station. I again ask if it's ok if my husband stays with me, and they reply yes. Then thank goodness Travis had the foresight to ask if it was ok if he stayed the night... because they were very clear that this would not be allowed. Unfortunately we didn't ask exactly what hours he was allowed in the room. Again Linda messages Dr. E for clarification, and she confirms that husbands are not allowed to stay over night. They must leave around 10 pm and can come back 4-5 hours later. Why this was not brought up before, and not understood as part of the question when we asked "Can our husbands stay with us" just shows how we can NEVER ask too many questions here. Even the questions you don't think you need to ask, like "will the c-section be performed with general anesthesia or a spinal".

At this point it is quite clear that delivering at this hospital means we would have to be extremely vocal with ALL of our relatively normal wants for this delivery. I never thought I would need such a specific birth plan, because every other hospital experience I've had has been modern and reasonable and I trusted them to make decisions that are consistent with the latest research for newborn health. I have a new sympathy for the billions of women in the world who cannot advocate for their own health care!

36 Weeks Pregnant: Drive to Al-Ahsa for appointment with Dr. A

Since we still were not satisfied with our local options, we decided to keep the appointment Travis had made with Dr. A a few weeks prior and make the drive to Al-Ahsa. Our security and transportation departments were incredibly supportive. Transportation had sent a couple drivers down the week before to make sure they knew the route, and our security advisor had visited twice to scope out the area. For our appointment, our security advisor drove down early to check out the hospital, and we had a second car following us in case of a flat tire or other unforeseen trouble. Thank you so much to CPChem and S-Chem for this support!

The road was surprisingly nice and there wasn't much traffic. It was a beautiful day for a drive!

The scenery was a lot more interesting than what we see near Jubail! There was also significantly less trash on the side of the road and the desert was so much prettier.

Lots of camels! The area the hospital is in is known for having a large camel auction.

Beautiful sand dunes!

Just a truck full of camels

It took exactly 2.5 hours to get to the hospital. On arrival, reception was very friendly and it was nice to see one of the nurses we had known at Saad. She took us in right away despite us being over an hour early for our appointment (we had anticipated eating lunch before hand). She spent some time making sure that my name was spelled correctly in the system (which is good, because I am not "Janeth Rodgers") and taking a detailed medical history. We chatted for a while over how sad the situation at Saad is. Dr. A came in was excited to show off his new ultrasound machine, which can show incredible detail! (Unfortunately, baby boy is getting so big and squished in there that we couldn't fully appreciate its capabilities!)

Baby brother! He has big cheeks!

We asked him our questions and he assured us that this hospital does indeed operate at the same standards as Saad. The rooms are private, Travis can be present for both the operation and stay with me through the night, and he also told us that the same anesthesiologist we had at Saad is working with him at Al-Moosa. This sealed the deal for me! The rest of our appointment was very pleasant and I can't put adequate words into how relieved and grateful I am to finally feel comfortable with our delivery plan. Yes the drive is long, but now we know the road is good and we won't have to fight with the hospital or get the doctor's permission for things that seem simple and should be standard. In fact this hospital states right on their webpage that the post-delivery rooms are designed to allow the mother's husband to be with her to support her, and they also state how pro-breastfeeding they are. I'm sad that my parents and the girls won't be able to meet the baby until we come home, but the peace of mind to deliver in a hospital I trust, with a staff I know, should be well worth it.

We will have one more appointment at Al-Moosa next week, then it will be time for delivery! Right now the c-section is scheduled for Jan 8. We will likely drive down the day before and stay in a hotel to be as rested as possible, since we have to report to the hospital at 5 am.

I'm so thankful that we have extremely good insurance, which allows birth at Al-Moosa to be possible. I'm also very grateful to our company security advisors and our transportation team, as they are going above and beyond to ensure that our trip to Al-Ahsa is safe, and they haven't pressured us a single time to take an easier option. I'm thankful to have had excellent birth experiences previously, so that I feel well educated on the subject and know what questions to ask and how things should go.  Lastly, I'm so very thankful for our good friends here who are willing to step in and help! I know most women in this country do not have these advantages.

Will everything be fine? We shall see. In the meantime I feel so much better knowing I have fully examined all our options and I am clear on our path forward. Part of me wishes I could be that activist that helps change policies, or at a minimum help to educate staff at the local hospital... but I cannot put my health or my baby's health at risk. If we end up having to deliver at Al-Mana I know that we will be okay... I don't want to give anyone the wrong idea. Our biggest hesitation is that with delivery coming so soon we don't have enough time to get all of the issues of concern cleared up with the doctor and nursing staff to make sure things go per plan. It is so much more comfortable for us to use a doctor, nurse and anesthesiologist that we have experience with, especially with this being my third c-section.

Please keep us in your prayers! For safe travels to Al-Ahsa, for baby not coming early forcing an emergency situation, and for a safe and healthy delivery! We are looking forward to sharing pictures soon!