I can't believe I had another baby in Saudi Arabia

As you can tell by the date, it's taken me awhile to work up the energy/courage/stamina to write this blog post. Max was 4 weeks old on Sunday February 5 (and that's when most of this blog post was written). I spent the first two weeks recovering and learning how to take care of a newborn again, the third week getting my feet back on the ground and adjusting to not having my parents here, and last week I was finally able to start collecting my thoughts on how to communicate this whole crazy experience. So here we are, and now he's almost 7 weeks 4 months 5 months old.

Dr. A had scheduled a planned c-section for January 8, when Max was 38 weeks and 1 day. Initially I was really hoping to schedule this surgery for 39 weeks, but starting sometime during week 37 I began having mild contractions every time I did anything more active than laying down. So I put myself on couch rest and let Travis and our nannies here do everything. Travis will tell you it wasn't much different from the previous 7 months :) At 37 weeks 5 days I was just couch resting doing some online shopping when the contractions started happening regularly enough that I began recording them on my phone. I didn't want to make a big deal out of it (Travis didn't even find out the extent until I started writing this!) but I also didn't want to do anything that would actually put me into labor. I was 3 days out from my scheduled surgery and a 2.5 hour drive from the hospital, so this was not the right time! My parents were supposed to arrive that afternoon, but unfortunately had a flight delay and did not get in until about midnight. I had planned on going to the airport to pick them up--in hindsight that would have been a terrible idea! But we did miss getting to spend the afternoon and evening them.

Friday was uneventful. We enjoyed one last breakfast out with friends at Fuddrucker's and tried to pack our hospital bag. Saturday we were scheduled to be picked up at 2:30 pm to be taken to a hotel in Al-Ahsa so we could rest before arriving at the hospital at 5 am the next morning. I was anxious, and probably should have done more sitting instead of nervously flitting around.

One last hug from the girls before we left- one of our all time favorite pictures!

Our convoy. Backup car just in case!

I had a few mild contractions that morning and afternoon, but as soon as we were picking up speed on the highway they started coming every 10 minutes. I had not experienced this with the girls so I really wasn't sure if these contractions were serious (they didn't hurt initially, but were noticeable and uncomfortable) or not. With about an hour to go in the drive the frequency and intensity started increasing. At one point they were six minutes apart and painful enough I was pretty certain this wasn't just Braxton Hicks! Travis called Dr. Joy and she advised that we should go to the hotel first and see if they calmed down. Sure enough as soon as we weren't speeding down the highway anymore the contractions slowed a lot, and I was fine for the rest of the night. But now I was so glad I had not gone to the airport 3 days earlier!!

We stayed at the Intercontinental Hotel in Al-Ahsa. The lobby is grand!

 The room service was good, so I was able to have a hearty dinner before the required fasting period.

Lasagna, a salad, and orange juice because they either didn't have or couldn't understand my original drink request... we'll never know

Our alarm woke us at 4:30 the next morning. I was very apprehensive about the surgery but also ready for this pregnancy to be over with. Check in went (mostly) smoothly, and we were shown to our room right away. I was the second c-section scheduled that morning, but they requested we arrive early at the hospital anyway just in case the first surgery was taken off the books. At this time it was only about 5:30 and the delivery was scheduled for 10:30... so we had a long time to wait.

Our hospital room. Still oh-dark-thirty outside!

There was a TV in our room, but no remote. I didn't really want to watch TV anyway. Before too long I was asked to change into the hospital gown and they hooked me up to an IV. This went a lot better than with Ellie- the nurse actually put it in my vein this time! Having such a long wait before the surgery turned out to be a blessing, because it gave me a chance to relax and pray and at 9:30 when they came to take me to the OR I was a lot less anxious than when we arrived.

As the nurses were wheeling me out of the room they asked "Would you like to cover?" Apparently there was a risk of being seen by a male non-relative on the short stroll from my room to the OR. I declined. And hopefully didn't offend them when I laughed. You can tell from the picture above I was really exposed...

We were first taken to the recovery room. There was only room for two or three beds, and I got the slot by the window:

What a view...

Soon they were ready to take me back for surgery. Travis was able to walk with us to a waiting area just outside the OR, but just as we had been informed the day prior, he wasn't able to come in. This was disappointing to us, as during our previous Saudi c-section experience he was able to be with me during the procedure.

Yep.

 
The timeline from this point forward is a little fuzzy because there was no clock in the room, and they confiscated my glasses, "No accessories!!" so I probably wouldn't have been able to see it anyway. (Can someone please explain why covering your face/hair isn't an accessory but my glasses are?)

Travis' shoe covers... no germs in the male waiting area

There seemed to be a lot of people in the OR and they all moved pretty quickly. It was cold and I couldn't stop shivering. Pretty sure it was mostly nerves. I was transferred to a nice heated OR bed and given a lot of blankets. Within minutes the anesthesiologist was there and I was being prepped for the spinal injections. Thankfully I was able to stop shivering long enough for that. This one seemed more painful then the previous ones, but again maybe it was just my anxiety getting the best of me. I was poked three times, so think these drugs/this anesthetizing procedure may have been a little different then before. I could feel the numbing agent immediately go down to my toes, obviously it was working! Soon after everyone took their places and the surgery began. Dr. Joy, who was Dr. A's head nurse, took Travis' place by my head and held my hand. I was thankful for her presence. I wish I had remembered to ask Dr. A if I was dilated since the night before it seemed like labor was eminent.

At 10:38, Max was born! He waited a few seconds before crying but then let everyone know he did NOT like this change of scenery. He had a very high pitched, monotone cry, and it was very different from what most babies sounded like. I hated that Travis wasn't there to hear it and record it!

At this time they did all the normal newborn assessments and took his vitals. The only number I was given was his weight, which was 3.39 kg. The anesthesiologist started to tell me 3.4, but Dr. A said (jokingly) no, that is not accurate! The newborn incubator thing was almost directly behind my head and I kept straining my neck to see what they were doing with Max. I couldn't so eventually gave up in frustration. This all would have been better with my husband in the room.

Max's first portrait!

My sweet newborn!

While I'm smiling in this picture, it does not capture the anxiety that clouded the whole experience for me. I am so thankful to have a healthy baby, but it bothers me that Travis is not in this picture and couldn't be there with me for the rest of the surgery. Dr. A told us that he was working to get approvals for husbands to be in the OR, but since he was brand new at the hospital it would be several weeks before it could happen. Being a trailblazer was definitely not a goal of mine and I would have been perfectly happy to let someone else do that, but hopefully we helped to make changes going forward.

They took Max to the nursery pretty quick after this and Travis saw him get wheeled by. It took most of the next hour from the time he was born until they finished sewing me up. Dr. Joy had to leave so I felt pretty alone for most of this hour and was seriously regretting my choice to have the baby here. At one point the anesthesiologist gave me a shot in the shoulder to stimulate uterine contractions and "reduce bleeding". I guess it worked but this was new to me and it was pretty painful.

Finally, surgery was over, and I was wheeled to recovery. Travis had been waiting for me, but unfortunately took a bathroom break right before I was wheeled out, so there was about a 10 minute disconnect when I didn't know where he was and he didn't realize I was in the recovery room. After another 10 - 15 minutes they brought Max to us and I was able to start nursing him. To my huge relief he latched on right away.

My first time getting to hold him! And I could wear my glasses again!

Happy Daddy

At some point the anesthesiologist brought in the pump that was to administer my pain meds. They seemed to get it hooked up and told me I could push the button every 10 minutes. I was doing that, but as the anesthesia wore off it the pain kept getting worse. We called the nurse in, who called the anesthesiologist back, and soon there was a team of people looking at this machine. We soon realized that I was the FIRST PATIENT to use this particular pain pump, and they had no idea what they were doing. By the time the pain meds started flowing, it was TWO HOURS post surgery, and I was in a LOT of pain. It would seem like 20 minutes and I'd ask if I could push the button again, and Travis would tell me it had been 4.

Again, the smile does not accurately represent my feelings at this time. Notice the team of people working on the pain pump behind me. I was happy to have my baby in my arms, but otherwise not happy.

In the middle of all this chaos, we overhear the conversation going on behind the curtain enclosing the slot next to us. There was a woman waiting to be taken to surgery for a D&C. I CANNOT BELIEVE they were so insensitive to have a woman awaiting a D&C in the same room with a mom and her brand new baby. I felt so sad for her. And I'm so thankful that when I was in that situation, my Texas doctor was compassionate enough to give me a private room.

Max was allowed to stay with us for about an hour, and then he was taken back to the nursery while they kept waiting for me to... stabilize? Who knows. Eventually I was taken back to our room, albeit in a lot of pain.

After a few hours, I finally felt like the pain was starting to be controlled. Unfortunately it was about this time I maxed out my dosage. Turns out that every 10 minutes was too frequent and it really needed to be more like 15 minutes to not max out the total dosage. It took awhile to figure out what was going on, and I'm thankful Travis is competant in understanding control systems because no one else seemed to know what had happened. The nurses kept telling me "You were only supposed to push the button when you had pain". I tried telling them nicely that "I WAS IN A LOT OF PAIN SO I KEPT PUSHING THE BUTTON", and obviously I was too nice. I had to wait 50 minutes before the pump would administer a dose again, and by that time I was back to being in A LOT OF PAIN. And I knew exactly what this meant too... remember when I congratulated the nurse above on finding the vein for my IV? Well in 2013, with Ellie's birth, the IV was not going in my vein, so my arm swelled up with pain meds and my incision kept getting more painful. They must have got that situation under control a little quicker though because I don't remember it being as bad as this.

In the meantime Max was being a fantastic baby. He slept, nursed occasionally, and at some point we realized he needed a diaper change. We started looking around for diapers and couldn't find any, so called the nurse. She informed us that "We take baby to nursery to change diaper". When we asked for them to just leave us some so we could do it, she said that was not an option. Our poor baby needed a new diaper, so we let them take him to the nursery. He didn't come back for an hour. We decided Travis would leave that evening to go buy diapers and wipes. I had almost packed some and definitely regretted not bringing them. But who would have thought a hospital room for a new baby wouldn't have diapers in it???

Also during this time I had not been allowed to eat or drink anything. I was SO thirsty so Travis was sneaking me capfuls of water. I understand the rules are in place for a reason... but this was starting to seem excessive. They finally brought me a tray with a bottle of water and a tiny bottle of juice. 

I was starting to lose all hope of being able to walk that evening, which meant I was also losing hope we could go home after two nights. I was getting rather depressed, not to mention tired and irritated. Travis was doing a great job of updating all our friends and family on social media, but at one point I told him "STOP TELLING EVERYONE I AM DOING WELL. I AM NOT DOING WELL." I realize that in the grand scheme of things I was fine (as in, alive) but reality confirmed why I had had a lot of anxiety leading up to this day. Somehow I had known it would be a rough couple of days.

Max had to be taken to the nursery again so we thought this was a good opportunity for Travis to go get diapers and dinner for himself. He had found a McDonalds and a grocery store on a map, but as most well-researched plans in Saudi go, the roads to get there were one way, closed, or left turns were blocked so our driver ended up taking him to a large mall. Here he found what he was looking for, and he tried to get a fruit cup for me. Despite being on the menu at McDonalds they didn't have it, so he found a smoothie place. It took a lot of broken english but he finally communicated that we just wanted fruit in a cup.

A few more hours into the evening the pain pump turned off again. This time they took it away and gave me some injections for the pain instead. At this time we also realized that at some point my catheter bag had disconnected... and had leaked all over my bed. I had been covered with blankets all day and hadn't noticed. Travis went to go find our nurse, who had been very friendly in the morning, and she giggled and ran off. That didn't sit well with him and he found another nurse who thankfully was willing to help. The nurse asked if I wanted to try and walk to the bathroom instead of reconnecting the catheter. I knew walking across the room wouldn't be pleasant but I was happy for the opportunity. With a lot of help I made it there and back. This gave me the hope and confidence I needed that I was actually recovering and wouldn't be in a hospital bed forever. This may sound dramatic but it had been a rough day!

 It was also at this time I learned they did not have the standard issue mesh underwear. Something about "the delivery truck did not make it this week." No, I had not packed my own! While not critical to my health or well being it certainly added to my frustration.

I was also brought a tray of soft foods, which included a really good noodle broth soup, and also shrimp stir fry... and a fried egg roll. Not my first choice for a post surgery meal. I couldn't yet sit up so Travis had to spoon feed me.

In the middle of the night a nurse came to give me an antibiotic in my IV. The IV had been disconnected for a few hours at this point, and when she connected the bag with the antibiotic to the cannula it wouldn't flow. She started saying "We need to push the clot." Travis appeared to be sleeping soundly, but when I repeated "You are going to push a clot?" he jumped up immediately. I'm no medical professional, so I don't know if this is standard procedure, but some blood had backed up inside the canula and clotted and I think she was trying to use saline in a syringe to loosen it. Which seems to me like would have then pushed the clot back inside my vein, which sounded like a really bad idea. She insisted that the saline was going to liquify the clot so I didn't need to worry. To my relief it didn't work, she quit trying to force the clot, and just inserted a new canula into the other hand. Maybe this is normal but again I was really wishing I was in the USA.

We attempted to get a few more hours of sleep, but I was too frustrated, scared, tired, etc. Max slept great so that was a relief. In the morning I was served an omelette and bean breakfast and some freshly blended mango juice that was actually really good. At least the food was decent even though everything else was crazy.

Breakfast also included cereal with buttermilk (gross) and a whole apple.

Lunch was roast chicken, a baked potato, and "tuna salad". I had never had this version before--literally tuna on lettuce with ranch. It actually was pretty good. Oh and don't forget the fried thing. I don't know why every meal had to have a fried thing.

The next day and a half are now a blur. We watched a few terrible movies on the only english channel, and I tried to get up and walk as much as I could. We were so excited that my doctor and the pediatrician cleared us to leave on day 3 so we did everything we could to make sure that was going to happen.

Our second afternoon in the hospital Travis received a phone call from our security advisor asking him to meet in the lobby. We were concerned that maybe his rogue trip to the mall the night before for food and diapers had somehow been against the rules. Instead he came back with this!

Our security advisor and transportation team had brought us flowers and chocolates!

I can't tell you how much I appreciated this gesture. It made me cry, and I don't think it was just the hormones! Getting to this point had already been such an ordeal, and being 2.5 hours away from 'home', and in a state department no-go zone, meant that no friends were coming to visit. This gesture helped us to not feel so alone in this crazy situation.

The last morning I had proudly walked myself to the bathroom when what looked like a Saudi nurse came in. She asked if I had "exercise", and I thought it was pretty obvious by the fact I was standing mostly unassisted in the bathroom that I was doing pretty well with my 'exercise'. Then she made me lay in the bed and proceeded to make me do a lot of leg lifts, and told me to repeat them three times a day. I realized she must be some kind of physical therapist. I don't remember receiving this service with the other births! Think I would have preferred some good ol' American painkillers though.

A typical gift for a new baby! The options for hospital décor is elaborate!

Once I received the all-clear from administration that we could leave, we were still waiting on Max to be discharged from the nursery. He'd been there several hours and I was really wanting to feed him, so we packed up and asked for our wheelchair. I had intended on getting a few more pictures in the room but leaving was more important. We made our way to the nursery, and they showed me to a feeding room nearby. A few minutes later they brought in my baby. Since it was a private room, with a sign that said "breastfeeding room" on the door, I deemed it safe to take off my abaya. I started nursing Max. A few minutes later there was a knock, the door flung open, and a Saudi man started to enter before noticing me. He noticed me, then profusely apologized and stood back so his wife could enter the room. She was fully covered with a veiled abaya that didn't even have eye slits. A nurse followed her with a baby in an incubator. There was some arguing in arabic, the nurse says since they won't be discharged until the evening, and it would be best if she fed the baby now, then the husband said "This is her third baby, she does not need your help, she will feed the baby in our room" and then they all left. Clearly she (or maybe just her husband?) wasn't comfortable with her nursing with me in the room. You may be wondering why she didn't have the baby in her room to nurse in the first place? Why get all gussied up in abaya, hijab, and niqab when you can just have your baby in your room? Well here is what I have observed/concluded based on my observations from this hospital stay and input from others:

1) When Saudi women have a baby, the baby stays in the nursery while the mom rests for 3 days. Sometimes the husband is there, but I think he doesn't tend to be there the entire time like we are accustomed to.
2) Since babies spend all their time in the nursery, there is no need for diapers and wipes or burp cloths in the mom's rooms.
3) When everyone goes home mom starts nursing. They don't seem to value colostrum nursing immediately like we do back home.
4) Max appeared to be the biggest baby there by birth weight--and he's a very average size baby. Not sure what conclusions to draw from this but I thought it was odd.

Maybe this is inaccurate, but that's my impression of how this generally works here. Since my experience at Saad was so much more 'normal' I really had no idea how different things were in the rest of the country.

After nursing Max they took him back to the nursery to change him into our clothes (no keeping the hospital issue sleepers here). Travis left to get the final things from the hospital room and bring the car seat. He started fussing as we were putting him in and the nurse said "It's hurting him!" We told her he was fine and every baby in the USA had to be in a car seat before leaving the hospital. She said "You are in Saudi, you don't need this!" Again we told her it was much safer and we were going to leave him in the car seat. She didn't like it but obviously wasn't going to change our minds. This is what Saudi's usually carry their babies in:

Yes this is what Saudi's put their newborns in. Not a stroller, not a car seat, but a glorified pillow. They hold this on their laps in the car. The top buttons to into that triangle keep them from falling out. Because that makes it safe enough for a vehicle on some of the most dangerous roads in the world... SMH.

What is very ironic about this conversation is about two hours earlier a lady came into the room and gave me a brochure on newborn care. Guess what was recommended in this brochure? Putting babies in car seats!! I wish I'd had this on hand to show the nurse when we were leaving.

The drive home was mostly uneventful, but I was disappointed we had to take the busy roads through Khobar instead of the slower, quieter roads home. That was a little nervewracking and kind of painful (for me, the roads were bumpy and that is not pleasant on a fresh C-section!) But otherwise our excellent drivers got us home safely.

SO HAPPY TO BE LEAVING THAT PLACE

Our friends had left a beautiful wreath on the front door welcoming us home as well as some decorations inside. And of course the girls and my parents were so excited to see us!

Hello Grandpa!

Lucy can't stand to be more than arms length away from her baby brother!

This sums up the sibling relationship nicely!

Max's audiometric test at 1 week old

The first few weeks home were harder than I remembered post-partum being with the girls. The pain meds they gave me on checkout were contraindicated for breastfeeding (lots more eye rolling here) so I was only taking Tylenol. I was also not given proper meds to get my digestion system back on track so I had a painful couple of weeks working through those issues. But we survived, Max is thriving, and I'm both relieved and thankful that we don't have any lasting complications.

Would I have a baby in Saudi again?

Absolutely not.