[Tlc] Slate Article: A Mother and Daughter Find Life in Bangkok

Thu May 7 06:30:17 PDT 2009

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A Mother and Daughter Find Life in Bangkok
The question a pregnant woman should never ask in Thailand.
By Rachel Louise Snyder
Updated Thursday, May 7, 2009, at 6:48 AM ET

  _____  

From: Rachel Louise Snyder
Subject: Where Should We Have Our Baby?
Posted Wednesday, May 6, 2009, at 6:59 AM ET

An enormous nipple bobbled slightly on the TV screen in front of me.
Beside it was a set of tiny heart-shaped lips belonging to a newborn,
pecking birdlike around the nipple's circumference. The lips failed to
find their prey. This poor child's first grand failure in the world is,
I was told, the unfortunate result of a mother on drugs. "Damn
crackheads," I thought. 

But the drugs in this case, said our placid wide-mouthed instructor,
were your regular old garden-variety epidural. "Damn epidural-heads," I
thought, then I realized I was in all likelihood referring to myself. 

The next scene showed a similar bull's-eye teat, a similar heart-shaped
mouth, only this time the lips hit upon the nipple almost immediately. A
few of us students offered up a quiet Hooray! to the tiny nonverbal
hero. It was as if we'd been given a glimpse into this child's blessed
future … an alternative Montessori-style education where he would excel
at dodge ball and four square, followed by a stint in high school as
class president and homecoming king, valedictorian at Harvard (perhaps
Cambridge), after which he would land a six-figure-a-year job right out
of B-school. Eventually, his golden journey would culminate at his
deathbed, where he would be surrounded by children and grandchildren,
cooing back all the powerful lessons of morality and ethics he taught
them. And all because his brave mother grimaced through labor sans
epidural. 

A small crowd of couples, including my husband and me, watched the
video. We were sitting in an arctic room just off the women's health
center of Samitivej Hospital—that's "Sa-mitt-i-vay"—in Bangkok,
Thailand. Only tropical cultures can make air conditioning this cold.
(Citizens of Hong Kong routinely come down with colds from the frigid
subways and office buildings.) I am American, and my husband is British.
There was also a Belgian couple, two Australian couples, one
Japanese-American couple, two couples from India, and the rest a
combination of gorgeous Thai women with unremarkable Western men.
Generally speaking, we were not the medical tourists one hears about so
often these days; we were, more accurately, medical expatriates (except
the Thai women, of course). Most of the women were a month or so from
their due dates and were taking this class as one in a series of
prenatal preparation courses offered by the hospital. Other classes
covered topics like breast-feeding, exercise, hormones, newborn care,
and discipline. Only one woman was 24 hours away from her due date. 

Me. 

"I feel like we're pretty ready for the birth," one American man with a
beautiful Thai wife piped up. (Later, she confessed she had been born in
a taxi. So, not only was she smoking hot, but she had probably had such
an easy birth experience that she didn't even entertain the idea of
becoming an epidural-head.) "We've had a pretty good pregnancy so far,"
he said. "No strange food cravings. No nausea." 

We? In a moment of willpower as great as any I've ever shown, I
refrained from clobbering him, in part because maneuvering from my floor
pillow to the spot across the room where he lounged with knees hugged to
chest would have required a flexibility and a feat of anti-gravity that
had been lost to me for months by that point. My husband, knowing my
thoughts, looked at me from the corner of his eye and grinned. He, at
least, was under no illusion that childbirth is a tag-team effort, at
least not physically. Instead, I said, "You only feel ready because you
have another month. Wait until you're a day away." Then he would see how
unready a person can feel.

As my due date drew ever nearer, my anxiety level increased
exponentially. About 10 days before my due date, and despite the fact
that we live in the tropics, I realized that I had no socks for the
baby. No socks. So I hoofed it from one baby store to another pointing
to my feet and then to my belly, trying to make several dozen Thai
salesgirls aware of the seriousness of this mission. Finally, I found a
pair printed with lime-green train cars in the baby store at Samitivej.
At some point during my socks recon mission, I realized I had no pajamas
to wear at the hospital. My God, I told my husband, I'll be naked. Naked
among strangers! He suggested I bring T-shirts. 

"But what if I have to get up and go to the bathroom in the middle of
the night? The nurses will see me in my underwear!" 

So I did what any emerging mother would do in my place: I came up with
the most convoluted plan I could possibly concoct. It involved my cousin
Alyssa driving to a store in Santa Monica, Calif., and picking up
pregnancy PJs, then sending them to an expat mail service I use in
Oregon, where they sat for several days before being sent via DHL to my
serviced apartment in Bangkok. 

They are the most expensive pajamas I will ever own. 

I also imported special laundry powder to wash the cloth diapers that I
insisted we use. I ironed some baby clothes, even though I had not
touched an iron in five years. In a last-minute panic caused by a New
York Times headline, I tossed the plastic bottles we'd bought in the
States and opted instead for old-fashioned glass bottles free of
potentially harmful chemicals—all regardless of the fact that I was
planning to breast-feed. 

Despite my hysteria, Samitivej Hospital was doing everything it could to
ready me. In addition to the prenatal classes, I was given free passes
to pre- and postnatal exercise classes at a family gym nearby. I got
discounts at a local baby-care outlet and a coupon for a pregnancy
massage. The hospital had lactation consultants on call 24 hours a day
and an expat liaison who ran interception between the many foreigners
who come from around the region to give birth here and the entire
hospital staff. The hospital even has services to take care of parents'
visa extensions and passport paperwork for newborns. 

Samitivej was the result of what had been a painstaking decision for my
husband, Paul, and me. We have lived in Cambodia for the last five
years. The only sure thing about being a pregnant Westerner in Cambodia
is that you do not want to give birth there. (Early in my pregnancy, I'd
gone with some friends to get an ultrasound at a clinic that boasted a
new color machine and cost only $10. When I arrived, I had to wake up
the entire staff.) In a case of spectacular bad timing, I found myself
pregnant just before we were due to get married, after which I was
immediately scheduled to go on a book tour of North America. So, in her
first trimester, my baby rode an elephant through the jungle to a
hilltop pagoda for a Buddhist marriage blessing, and a month later she
chalked up tens of thousands of prenatal miles flying from Asia to
America, then East Coast to West Coast and back, visiting doctors in
Cambodia, Bangkok, New York, Maryland, Chicago, Los Angeles, and
Washington, D.C. Her pre-birth medical records were like a lesson in
geography. 

Finally, back in Cambodia and seven months pregnant, my husband and I
pondered where to give birth. America was out, since our global health
insurance policy—like most global health insurance policies—covered us
in every country in the world except the United States. (So profoundly
screwed up is the American health care system that its reputation is
globally infamous, and thus the entire U.S. medical establishment is
feverishly avoided in every corner of the world. If we wanted to add
U.S. coverage to our current policy, our annual premium would nearly
triple.) We considered Canada (closer to my family), England (closer to
his), Australia (developed-world care closer to the region in which we
actually reside), and Bangkok (less than an hour's flight from Phnom
Penh, with health care standards that are quickly surpassing those
offered in any developed country). 

Each place had its appeal and its drawbacks. In England and Canada,
women in labor sometimes arrive at hospitals so jam-packed with patients
there are no beds available. One friend in London was discharged 12
hours after giving birth. 

"Could you even walk?" I asked her. 

"Sort of," she said. 

My Australian friends in Phnom Penh said their national health system
was similarly strained, and both Sydney and Melbourne were prohibitively
expensive places to live for two months while waiting for the birth.
None of the hospitals we looked at offered private rooms except those in
Bangkok. And not just private rooms, but Western-trained staff, experts
on call 24 hours a day, state-of-the-art equipment, and reasonable
costs. (A regular birth with no complications runs around $2,000,
including the hospital stay. A C-section is about $7,500. The average
cost of a birth with no complications in the States is about $30,000.)
So, in the end, the choice seemed obvious. 

The hospital most often cited in press articles about medical tourism is
Bumrungrad—a place where my husband and I have both received excellent
care. But Bumrungrad also feels a bit like a medical factory. Patients
waiting in loud, pastel-colored rooms encircled by a dozen doctor's
offices, into which they are called, one at a time, like placid farm
animals. 

So we chose Samitivej Hospital, dubbed "the baby hospital" by the dozens
of foreigners who give birth there every month. Five-star service is the
aphorism most often uttered in conjunction with Samitivej. When we first
pulled up, white-gloved men helped us out of the taxi, holding umbrellas
over our heads to deflect sun, rain, dust, or other disagreeable
meteorology. The main level has a gourmet bakery, wireless Internet, and
an Au Bon Pain. Downstairs there was a Starbucks, a fancy Japanese
restaurant, a posh baby-supply store (with footies), a bookstore, a
7-Eleven, and a cafeteria selling homemade baked goods or gourmet Thai
and Italian food. 

Samitivej is the only hospital in Thailand certified by the World Health
Organization's Baby-Friendly Hospital Initiative, which aims to
encourage natural childbirth, improve maternal and newborn care, and in
particular to increase breast-feeding rates. Nearly 20,000 hospitals
around the world are certified. (Sixty-five are similarly certified
<http://www.babyfriendlyusa.org/>  in the United States.) The goal,
Samitivej tells expectant mothers, is natural childbirth, and their
C-section rate, at 40 percent, is something the teacher of our prenatal
class seemed embarrassed by. The hospital would prefer it to be
somewhere around 10 percent. The rate in England and Wales these days is
22 percent, while in the United States
<http://www.childbirthconnection.org/article.asp?ck=10456>  it is a
whopping 31 percent. The World Health Organization recommends that
C-section rates stay at 5 percent to 10 percent. 

After the nipple propaganda movie, I began to feel guilty about how I
might screw up my unborn child with an epidural. (Would I ruin her for
life if I couldn't take the pain and simply had to have an epidural?)
The teacher held up a placard with the stages of labor, illustrated
first by smiley faces that grew increasingly more like frowns with each
subsequent stage. According to this chart, we would spend five or six
hours in Stage 1, the smiley face. After Stage 1, Stage 2 offered seven
or eight hours of a sort of stoic grimace, followed by two or three
hours of intense frowning (Stage 3), and then an hour or two of pushing.
The "pushing" of Stage 4 had no memorable emoticon on the chart, but if
it were up to me, it might resemble something like unexploded ordnance
with a very long fuse. 

All together, her chart suggested this smiley, stoic, frowny, explosive
progression. All of which would last 12, maybe 16, hours. In hindsight,
this was probably the moment where I began my fantasy. Sitting in that
freezing cold room in the post-epidural-head video haze among my global
sisters, I started to think quietly to myself that maybe I could do it
without an epidural. Sure, stubbing a toe brought tears to my eyes most
of the time, but maybe this was something different. A kind of nonpain
pain. And perhaps I really did have the necessary tolerance. After all,
who wanted to have a child so dumb she was unable to locate a food
source just millimeters away from her mouth? No, indeed. I wanted that
brilliant newborn, the one who spotted the bull's-eye less than an hour
after her entry to the great wide world. That would be my child. And her
life would, could—thanks to her long-suffering mother—be assured of
success in all her endeavors. 

It turns out, every budding mother in that room had exactly the same
vision.

  _____  

From: Rachel Louise Snyder
Subject: Is Love Really Inevitable?
Posted Thursday, May 7, 2009, at 6:48 AM ET

At the next prenatal class—I was by now overdue by several days—the
teacher led us to the second-floor birthing unit of Samitivej Hospital,
the women lumbering, the men holding their hands somewhere in the
vicinity of their wives' lower backs in an attempt to hide whatever
inadequacies they felt. Throughout the prenatal class, we were
inadvertently reminded over and over that the main stage was all about
mommy and baby. Dad was just a side show. Or a roadie. 

The second-floor birthing room was a soft, dreamy mirage of
childbirth-as-miracle, the kind of place Katie Holmes might silently and
with nary a frown <http://www.slate.com/id/2128041/>  deliver her child.
A large birthing pool dominated the room, and many women, myself
included, expressed a desire to "give it a whirl" when the moment came.
(As a scuba diver, I'd cut myself on coral, and I knew that the pain
only hit once you were out of the water, so it made sense to me that a
birthing pool would reduce the pain of labor.) There was also a
4-foot-long bed (no lying down during labor), a chair with the crotch
area cut out of it, a mat, a floor-to-ceiling ladder, a rope, an
exercise ball, a kitchenette with microwave and minifridge, an oil
burner, a stereo/CD player, and dimmer switches on all the lights. I
could have curled up right there and given birth. 

I didn't tell my husband, Paul, that I wasn't planning to get an
epidural <http://www.slate.com/id/2217481/entry/2217482/> . I didn't
want to look like a wimp if, midway through, I decided I just couldn't
do without it. With the exception of needles, which make the blood drain
from his face, there is not a wimpy cell in his body. He spent 24 years
in the commando forces, and to this day is the only human I know who can
do all of the following: 1) get himself out of a minefield intact, 2)
stabilize a sucking chest wound with a plastic bag, 3) build a stretcher
with found objects, and 4) locate the femoral artery and staunch the
spurting blood flow of both human and canine casualties alike, should
such a tragedy strike. He can also navigate his way out of a desert or
get himself out of quicksand.

I wanted to surprise him with my resilience, to show him how all those
times that I'd screamed in terror while rock climbing or capsizing in
one of several water crafts (a Hobie cat in Honduras, a kayak in the
Mekong), I was merely shielding my inner ruffian. I had fantasies of him
telling the story to friends over pints of Guinness: how I was a total
hard ass who, for seven years of life with him, had been in hiding,
emerging only at that crucial moment when our daughter first began to
surface into the world. 

In the previous class <http://www.slate.com/id/2217481/entry/2217482/> ,
our teacher had shown us a chart of the labor stages that went something
like this: Stage 1, smiley. Stage 2, stoic. Stage 3, frowny. Stage 4,
unexploded ordnance. I wasn't worried about the first three stages, but
the fourth … that was the killer. If you made it to the fourth stage
without an epidural, you pretty much had no choice but to suck it up. I
wondered if I'd make it all the way from smiley through stoic and march
proudly into frowny only to find that I simply couldn't take it, but
it'd be too late. A few women suggested this as a possibility, but the
teacher just smiled and nodded, assuring us that she was familiar with
this dilemma while simultaneously failing to offer a smidgeon of
comfort. 

In truth, though, there was another question that haunted me much more.
It was a question that began with pain but ended with love. And it so
terrified me that I'd kept it to myself. I had not been particularly
present during my pregnancy. I never played classical music for my
unborn child; I didn't rub my belly or talk to her. I was terrified for
nine months straight, in part because the slobbery, sticky noisemakers
my friends who'd procreated had produced held zero appeal to me. On rare
occasions when I'd been called upon to acknowledge a friend's child, it
made me grumpy and mildly nauseous. Baby-sitting turned me downright
hostile. So the only real manifestation of my pregnancy was a near total
satisfaction of my cravings, which tended mostly toward bagels and cream
cheese—not, truthfully, all that far removed from my average,
nonpregnancy cravings. 

But the question was this: After all those months of watching your body
become less yours and more someone else's, and then after all those
hours of a pain that no one—no matter how great a writer—no one has ever
been able to capture in words; after all the worry and anxiety and
energy … after all of it, was love a guarantee? What if, I would think
to myself late at night with Paul sleeping beside me and my own enormous
body engulfed in the fires of heartburn, and mere days—or hours—away
from the most profound change I would ever experience in my life, what
if it's all just too much? What if I cannot love her? 

Having this thought when you are on home turf, just a short distance
from close friends and family, is one thing. In the warm light of home,
sitting with your best friend over cups of tea, you can hash out
questions like these. You can voice your fears to someone other than
your husband, who surely has fears of his own. You can watch your
friends who have already had kids, see the way they touch their
children, the way they look at them. That generally answers this
question. Or at least keeps it at bay. But in a place where everyone is
foreign, where you can't do something as simple as read a road sign, and
where children and babies are held in a cultural esteem akin to royalty,
this question goes unanswered. And in the space of a question without
answer, you began to hear how much a void can echo. 

I couldn't stop thinking about it. I was so sure I would freak out and
that in the absence of my closest friends or any family at all, this
unanswered question would offer a cavity for hysteria and despair to
settle into. I began to prepare Paul for this post-birth moment. I told
him the stages of postpartum depression, from mild to severe. I
explained the general symptoms and told him how I felt these symptoms
might manifest themselves in me. I looked up counseling services in
Bangkok and found one run by an American and a Frenchman. I told Paul
not to wait to get help, to just make a call at the first sign that
something was amiss. I was doing what I thought was the best thing to
do: prepare. 

And then it hit me. The wonderfully calm smiling teacher of my prenatal
class at Samitivej had surely dealt with enough foreigners to know how
to answer my question. As a Thai woman, she herself may never have
experienced the profound dread I was experiencing, but surely this
question had been posed to her. In most of Asia, children are cared for
by immediate and extended family and are revered as gifts in a way that
I've never seen in the United States. Teenage boys will coo at newborns,
and shopgirls will ignore other customers so they can giggle at babies.
Waitresses will carry your child around so that you can enjoy your meal,
and taxi drivers will turn around at stoplights to admire the child in
the backseat. Strangers stop you on the street to tell you your child is
lovely at least once an hour, and many ask to take photos. Security
guards in office buildings gaze adoringly at babies, and newborns are
often a ticket into diplomatic lines at airports, thereby avoiding long
customs queues. But even given this cultural reverence, surely she had
some insight that would at least calm me down in these final hours. 

After our tour of the well-outfitted birthing room, where we women
discussed the best oil scents for a calm birth experience (I opted for
lemongrass, a few others chose jasmine or ylang-ylang), we were offered
a perfunctory look at the monitoring rooms, where we'd be taken if—God
forbid—there was a problem and we needed to be connected to a fetal
monitor, or if we had to have an epidural. Beyond the monitoring room
was the operating theater, which we weren't shown at all. This class
didn't cover problems; it only covered fantasy. 

I waited until everyone else had left, and I made my way to the
instructor. She was a small woman with cropped hair and a persistent,
calming smile. She had assured each of us that she'd be just a phone
call away, when it was our time. (I was skeptical of this. How could one
small Thai woman help every single woman who came through her class?
When my time did finally come, true to her word, she not only came up to
visit, but when I needed help with breast-feeding, she spoke to me by
phone even though she was on vacation.) 

I told her I had a difficult question. I explained the scenario that
kept replaying over and over in my mind. Like every other woman in the
class, I had a peaceful vision of my childbirth experience, which
included things like scented oils, a loving husband massaging my lower
back, and a baby slipping gently into the world, coaxed by a soft-spoken
doctor and his midwife assistant. But statistically, I told her, we
couldn't all enjoy this scenario. I was nearly 40; the numbers weren't
with me. So what happened, I asked, if you go through all that pain, the
worst pain you can imagine, and you end up having some problems, and you
must have an epidural, or maybe even a C-section—I think I may have had
tears in my eyes; I can't remember now—but after all that this little
baby has put you through, what if you just don't have it in you to love
her? 

Does that ever happen? 

I noticed right away that her smile had vanished. She was no longer
looking at me with that placid, calm gaze. Instead, her eyes were wild
and had a hint of something between shock and annoyance sort of akin to
Stage 4, unexploded ordnance on her chart. She clutched papers to her
chest. And before I even heard her answer, I realized with deep dread
that of all the places in which this question can be posed, Asia is not
one of them. 

"No," she said. "That never happens." 

Rachel Louise Snyder's book Fugitive Denim: A Moving Story of People and
Pants in the Borderless World of Global Trade
<http://www.amazon.com/gp/product/0393335429?ie=UTF8&tag=slatmaga-20&lin
k_code=as3&camp=211189&creative=373489&creativeASIN=0393335429>  has
just been released in paperback. She and her partner are relocating from
Phnom Penh, Cambodia, to Washington, D.C., in summer 2009 with their
Bangkok baby and their Cambodian street dog.

Article URL: http://www.slate.com/id/2217481/

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