A few people have sent me emails asking what prenatal care is like here in Saudi Arabia. Here’s what it’s been like for me so far.
So, as I’m sure you’re sick of reading about, I’m set to have a baby here in Riyadh in about four months. This was not the plan in the beginning–i.e., when we first moved here. Before we moved here, I made Mr. Mostafa promise that all of our children would be birthed in the States. This was for a few reasons. One, I wanted to have all of my friends and family nearby (not, like, in the hospital room nearby, but you know, geographically) when I had a baby. Two, I figured it was only fair, since our kids are probably going to grow up going to school in Saudi Arabia and spending only summers (and hopefully, the occasional winter break) in the States. And three…well, I admit it: given the amount of vitriol that President Obama faced in his first term about whether or not he was actually eligible to become president, even though his mother was very much an American citizen and thus, he would be too, no matter where in the world he was born, I wanted to make sure that our little one could become President of the United States someday, if he or she wanted to. What can I say? I didn’t want any dream to be out of reach for my kids.
But besides setting me back in my academic work, our surprise bundle of joy decided to arrive well before we were in any way set up to afford a birth in the States. Since our insurance only covers care here in Saudi Arabia, I would have had to give birth there without insurance, which, depending on how smoothly the birth goes, can end up costing practically year of current tuition at Harvard. So I decided that, hey, she will still be an American citizen no matter where she is born, and if she is destined to become President Mostafa, she will have a legal mind brilliant enough to argue and win the inevitable Supreme Court case challenging her eligibility and the Constitutional definition of “a natural-born U.S. citizen” (no, I’m not a tiger mom at all. I swear).
So as we stood staring dumbfounded at seven positive pregnancy tests and one negative–Mr. Mostafa took the negative one; because we were in such disbelief that all of mine were positive, he wanted to make sure that the tests were all working correctly–we somehow decided that we should probably go to the doctor. Although I was shocked, I was pretty sure that seven positive tests were irrefutable evidence that I was pregnant, but Saleh refused to believe it ’til we went to the doctor.
So we called a hospital and got an appointment for later that evening. When we arrived, the staff seemed pretty interested in the fact that I was American. They were kind, and asked me questions. Then they were surprised to find out that my husband is Saudi; even though he was wearing the traditional thobe and shmagh, I guess because he is rather white (with adorable rosy cheeks, but that’s neither here nor there), he confused them. (That happens a lot here, actually; I guess when people hear us speaking English to each other, they think we’re just two Americans in Saudi clothes trying to blend in. In restaurants, the waiters always bring us both English menus and Saleh always has to request one in Arabic for himself.) Then at one point, as a nurse took some blood from my arm, Saleh was called out of the room to take care of something with the insurance. As soon as he left, the nurse started asking questions.
“So you are from America? And your husband is Saudi?” she asked.
“Yes,” I said.
“And you are happy?” she continued.
“Yes,” I said. “I mean, life here can be difficult; it’s very different than America. But yes, very happy.”
“And he is kind to you?” she said.
“Yes, he is kind,” I assured her.
This has happened to me several times, in different hospitals. When Saleh is out of the room, the seemingly protective nurses always want to know if I’m okay, if I’m happy, if my husband is nice to me. I always wonder if they ask Saudi women the same questions. And I always wonder what they would–or could–do if the answer was, “No.”
When Saleh returned and the blood draw was done, we were escorted into the doctor’s office. As we sat at her desk, we explained that I had taken three pregnancy tests (okay, that was a little white lie) and that they all came out positive.
“And you still don’t believe it?” she scoffed. Then she asked a few questions, wrote out a prescription for a blood test in the lab (I wasn’t sure why I had to have my blood drawn again, but I did), and sent us on our way. No pamphlets about what medicines were safe or what foods I needed to be eating, nothing like that.
Before I stood up, I asked, “Can you tell me my due date?”
She waved her hand and replied, “Oh, come back in a month. We’ll do a scan and tell you then.”
So we went down to the lab in another part of the hospital, where I nervously had more blood drawn as Mr. Mostafa did a little silly dance in front of me to make me laugh. Then, after the nurse told us to call back in two hours for the results, we went out to dinner (longest two hours of our lives, despite the amazing Lebanese food at Burj al Hamam). Once we were back in the car after dinner, Saleh called the lab and broke into a huge grin as he listened to the person on the other end. And just like that, it was official.
The next morning, I called the doctor we had visited to see what I should do now. It turned out she didn’t even know my test results yet! She said, “So the test was positive?” I responded that it was. She said, “Congratulations. Take a prenatal vitamin!”
“Thank you,” I said.
And then she hung up.
I have to admit, I was a bit underwhelmed by the whole thing. I don’t know what I expected, exactly, as I had never been pregnant in the States, so I didn’t have any comparative experience, but I know I expected more. I had at least expected to walk out of the office knowing an estimated due date. When I told my close friends and family later that night that I was expecting, they all wanted to know my due date, and I had to say I didn’t know.
But Saleh was pretty underwhelmed, as well. After we established that we weren’t planning to return to that doctor, we started looking around for another. We chose one that was in the same hospital system but at a different location, but when we called for an appointment with her, we found out that she didn’t have an opening for more than month, and being the jittery first-time parents we are, we preferred to get an appointment sooner than that, so that we had a doctor lined up in case we had questions or in case, God forbid, there was some sort of emergency. So we called another hospital.
By chance, the doctor we chose at this other hospital had an opening for the next day; we pounced on it. We chose her because she had a long list of credentials, including board certifications in the U.K. and France, and both of those maternity care systems are more encouraging when it comes to natural birth than the U.S. and Saudi Arabia’s maternity care systems, which are very similar in that they are both notoriously medicalized. We thought that since this doctor had training in the U.K. and France, she might be more willing to allow me to at least attempt to have as natural a birth as possible (no continuous fetal monitoring, no epidurals, no Pitocin, no C-section unless absolutely medically necessary, etc.).
Furthermore, as silly as this sounds, I really wanted a doctor who was highly fluent in English. This generally isn’t a problem when it comes to doctors in the Kingdom; they all speak English to some degree. And I certainly don’t think that speaking English is in itself an indicator of a good doctor. But we figured that since she had U.K. board certifications, she must have spent at least some time training in the U.K. and would therefore understand my questions more clearly and be able to articulate clear responses to those questions and thus help put me at ease. And of course, there was the added bonus of knowing that if I ended up in the delivery room spewing profanity at her as I demanded the best drugs the hospital had to offer, there would be no confusion.
Our doctor also happens to be the head of the Fertility Unit and the OB/GYN Unit at this particular hospital, so she was incredibly busy. But we were happy to have an appointment with her. In addition to the previous reasons, she was also in the hospital where we hope to have the baby. For one, this hospital has a British midwife working in the delivery room there whom I’ve been told is my “best hope for a natural birth in Riyadh.” Secondly, like most private hospitals in the Kingdom, this hospital allows the father of the baby to be present in the delivery room with his laboring wife, unlike most public hospitals, which don’t allow anyone to be in the room with the laboring woman. This particular hospital allows one person to be in the delivery room with the laboring woman, whether that person is the baby’s dad, the woman’s mother, a doula, or whomever. Other private hospitals allow more than one person to be in the room, but we decided that as long as Saleh could be in the room, we were fine. (And I’ve also heard that the food at this hospital is excellent, and you know, for a chubby American girl, that’s something to consider!)
Many Saudi men do not wish to be present for the actual birth of their babies; In that way, it’s a lot like the 1950s in America. They prefer to be out in the waiting room. Saleh used to be that way, honestly. Before we got married, we discussed having children, and when he said he didn’t want to be in the delivery room when I was having a baby and seemed shocked by the idea, I sort of blew up on him. (“Excuse me? So you plan to just knock me up and then let me suffer alone? Oh, no, sir. You’re going to be in that room, cheering me on, supporting me. You don’t get to skip out on that!”) I guess I must have sounded really serious/scary when I went on that rant, because we haven’t had to have that discussion twice. Since then, whether or not he’ll be in the delivery room has not been up for discussion. He’s embraced his role as my labor coach.
Plus, he can’t wait to meet his daughter.
We ended up liking this doctor. Although waiting times are long and our appointments with her are very short, I feel like she knows what she’s doing and simply doesn’t waste time going over things that could go wrong, things that would leave me unnecessarily panicky. She gives me plenty of time to ask questions, and when we told her that we hoped to deliver with the midwife in the delivery room, she responded approvingly, saying, “For normal pregnancies, I think the midwives actually do a better job than we doctors do. You know, we are trained to look for problems, so sometimes we see problems even when there are none. Of course, if there is an emergency where you need a C-section or something like that, I will be there for that. But as long as the pregnancy and delivery are going smoothly, the midwife is an excellent choice.”
So that made us feel better.
So now, once a month, we go to the doctor. I don’t know what prenatal appointments in the States are like, but if the article on BabyCenter.com is accurate, they’re much less concise than what happens in Saudi Arabia. Here, it goes something like this.
First, we check in at the reception desk.
You can see that most of the receptionists are Saudi women, most of whom choose to wear a niqab. From the neck down, they’re in uniforms with the hospital emblem on the pocket. In this hospital, Saudi women are not employed as nurses; you can see a few nurses standing in the back of the photo, to the left. I asked Saleh if Saudi women are ever employed as nurses; he replied, “Yes, but mostly just at the public hospitals.”
So after we check in and pay the copay (with insurance, I don’t think we have ever paid more than 20 riyals–about $5.33–for one of my prenatal appointments), the receptionist gives me a little slip with the hospital emblem and a big number on it. This is the number they will call when it’s my turn to see the doctor. Whenever I get the number, I always ask Saleh how to say it in Arabic, because they always call it in Arabic first. Then if no one answers, they will call it in English. But I like to know the Arabic so the nurse doesn’t have to walk up and down all the hallways calling the Arabic number before she switches to English and repeats the process. So I may not be able to fluently count to a hundred in Arabic quite yet, but if by some chance you need to know how to say, “Seventy-three” or “forty-eight,” I’m your girl.
After I get my number, we head back to the waiting area. This part of the hospital is always bustling like a beehive. Like other hospitals, waiting areas are mostly segregated by gender, and in the part of the hospital where my doctor is, there is no waiting area for men. There aren’t even any chairs in the hallway. So if I decide to go into the ladies’ waiting area, Saleh has to stand in the hallway. And there is always at least an hour of waiting, because the doctor is so busy. It frustrates me that there are no waiting areas for families in this part of the hospital. I guess the idea is that only a women’s waiting area is needed because the floor is full of doctors for women. But there are always quite a few husbands, including mine, accompanying their wives to appointments. And they are always stuck standing in the hallway. For at least an hour.
Walking into the ladies’ waiting area is another interesting experience. It’s a large rectangular room with chairs along all the walls, so all of the women are facing each other. I’m generally the only one who isn’t wearing a niqab, so I tend to feel quite naked. (If there’s one thing that Saudi Arabia will teach you, it’s that nakedness is relative. Although I find my abaya quite comfy most of the time, if I wore it in the States, I’d feel like a black-swathed mummy. Yet in Riyadh, I often feel a bit tarty because my face is always showing.)
Secondly, there’s the greetings, which always make me smile. See, when Muslims meet one another, they’re supposed to say, “As-salaam alaikom.” Roughly translated, it means, “Peace be with you,” but it’s used like “Hello” in many Muslim cultures. And when someone greets you this way, you’re supposed to reply, “Walaikom as-salaam.” Which, of course, means, “Peace be upon you also.” So whenever a woman enters the waiting room (which is always packed full), she will say oh-so-softly, in a barely audible voice, “As-salaam alaikom.” Except it sounds more like, “Aslmalkm.” (And it may actually be a variation intended to address the whole room of ladies, but if it is, I can’t tell, because it’s always so quiet.)
And then the room full of ladies will respond in kind, just as softly. However, because they all whisper, it sort of sounds like you’re in a pit of snakes. It sounds something like, “Wlkmsmmmsmsmssssmsmss.”
The first time I entered the waiting room, I didn’t know this particular bit of protocol. At my second prenatal appointment, I gave it a try. Except, like my father before me, I don’t really know how to whisper. So I strolled on into that room and said loudly and clearly, “As-salaam alaikom!” (Which I’m pretty sure is wrong, anyway…like I mentioned before, Arabic has a variation for speaking to more than one person, and another variation for speaking to multiple females. I should learn that.)
The room full of ladies in niqab looked up at me, amusement in their eyes, and watched me take a seat as they all replied, “Wlkmsmmmsmsmssssmsmss.”
Since that first visit, I’ve gotten better at saying my greeting much more quietly.
Anyway, after about an hour of waiting, a nurse comes and calls out my number. I follow her into a small room which is divided by a large curtain. Behind the curtain is an exam table and an ultrasound machine. Saleh can’t come in the room with me just yet, because there may be another patient behind the curtain. So he stands outside until he is called. Kinda like a puppy, poor guy.
Once in the room, the nurse takes my weight (my absolute favorite part of the whole visit, let me tell you). After that, if there is no other patient on the other side of the curtain, I’m escorted behind the curtain and asked to sit on the exam table. While one nurse takes my blood pressure, another nurse calls Saleh in.
After the blood pressure is done, I lay back on the exam table and a very quick ultrasound is done. At every single appointment. Last month we had our first major ultrasound, in a different part of the hospital, where we found out the baby’s sex and got to see her little head, spine, legs, arms, tummy…and her beautiful little heart beating, clear as day. On this ultrasound, it’s mostly fuzz, except we can see the shape of our little one. We also hear the heartbeat a few times: whooshwhooshwhoosh (these are the most comforting two seconds in my entire month). And that’s it. The whole thing takes less than 30 seconds.
The first time they did this to me, I was puzzled. Was this an ultrasound? It was nothing like they show on TV, where someone points out the parts of the baby and reassures the mom that everything is just fine. I expected that reassurance, at least. Instead, the nurse stared at the screen, did a few clicks, and said nothing. This was at the stage where we were supposed to be able to see the heartbeat, but not yet at a stage where we could actually hear it. I, of course, had no idea what to be looking for, and I guess Saleh could see the panic rising in my eyes, because finally he piped up and said, “Is everything okay?”
The nurse looked slightly startled, like she’d forgot we were there, and said, “Oh, yes…fine.”
So, yeah. Now we don’t have to go through that worry, because we can hear our little girl’s heart beating instead of having to study the screen for it. And we also don’t worry about the nurse being silent as she does the ultrasound, because now we know that she’s not the only one seeing it. After the little ultrasound is done, the nurse wipes the goop off my belly, I hop off the exam table, and a nurse escorts Saleh and me into the room next door.
The room next door is our doctor’s office. I’ve mentioned in a previous post how when you go to the doctor’s office here, you actually go to the doctor’s office. It’s not like in the States, where you get put in an exam room and then the doctor makes his or her rounds. So when we walk into our doctor’s office, she is sitting behind her huge desk. There are always two or three nurses standing behind her. On the wall opposite her desk is a large TV mounted on the wall, where the ultrasounds happening in the next room are broadcast so she can see them. So when we walk in, there is always a giant ultrasound photo of our daughter on the TV screen.
We sit. With the huge desk and the nurses standing behind the doctor, the whole thing makes you feel like you’re visiting a mob boss to ask for a favor on the day of his daughter’s wedding…which is why our code phrase for “going a doctor’s appointment” is now “going to see the Godfather.” (Me: “I’m hungry.” Saleh: “We’ll have lunch after we go see the Godfather.”)
Despite her somewhat sinister nickname, our doctor is very nice. She tells us that everything looks good with the baby (so far, thank God), and she asks how I am feeling. She asks if I have any questions or concerns. Then she prescribes me my monthly prenatal vitamins. As she announces exactly what medicines and/or tests she is prescribing, the nurses behind her bustle around, filling out the necessary paperwork. When they are done, they place the paperwork in front of her. She double-checks it and signs it, and that’s it!
It’s all very simple, mostly. Insurance seems a lot more simple, too, although occasionally there are glitches that require a lot of waiting. See, here, the insurance approves or rejects requested treatments almost immediately. The receptionist submits the request for approval, and a few minutes later they know if the insurance will cover it, and then you pay the small amount required. It’s not like in the States, where you pay your copay at the doctor’s office and then wait a few weeks until you get the Explanation of Benefits in the mail from your insurance provider that tells you exactly what the doctor billed your insurance and exactly how much the insurance paid–and of course, they always specify that THIS IS NOT A BILL (always in caps lock, just like that), just to let you know that although no one is asking for this massive chunk of change right now, in another couple of weeks you are going to get a bill for this amount from your doctor, so you better start putting up your eBay listings now, buddy.
Here it’s not like that, although as I mentioned before, there are glitches sometimes. After our first appointment, our doctor prescribed a pretty basic battery of prenatal tests. We tried to get that taken care of before we left the hospital, but it took so long for us to get an answer on our insurance approval request that the receptionist just told us to come back later that afternoon.
So we did. But when we showed up, we were told that the insurance had rejected our request. We asked the receptionist to re-submit the request; there was no reason for it to be rejected. This time, a quick rejection followed. So she sent us back to a different section of the hospital, the insurance approvals desk.
When we got there, Saleh explained what was going on. The man pulled up our file and reviewed the information. It turned out that some confusion had been caused by the fact that our doctor is the head of the Fertility Unit as well as the OB/GYN Unit in the hospital, because he said, “If it’s because of your fertility treatments, your insurance won’t cover that.”
Saleh looked confused, then stunned. Then he said, “Fertility treatments? No, no, no fertility treatments…we got this baby, uh…the all-natural way.” Saleh was quite stern on this humorous if slightly humiliating point, but he turned red as he said it, and while the man behind the desk got the insurance approval done quickly after that, he looked amused but embarrassed, as well. The whole thing brought to mind my parents’ pool stick rack.
Let me explain.
See, when I was about five, my dad got something he’d always dreamed of having: a pool table. It is still a really beautiful table, and it was kind of my dad’s baby when my brother and I were kids. We played pool all the time (my dad even bought us little kid-sized cue sticks for us to use, back when we were just barely big enough to see over the edge of the table), and we lived in fear of scratching the table felt or, as we got bigger, accidentally bumping a stick on the ceiling.
To hold all the pool sticks, my dad bought a used Miller Beer pool stick rack. On top of the rack was a huge mirrored Miller Beer emblem, and underneath the emblem was a smaller mirrored sign that said, “Made the American Way,” which was the beer’s advertising slogan. My dad doesn’t drink beer, so he had the Miller Beer emblem replaced with a giant picture of me and my brother when we were babies.
Because, you know, we too were “made the American way.”
When my brother and I were little, we were confused as to why my parents–and every other adult who visited the house–found our pool stick rack so hilarious. As we got older and we understood exactly what it meant, we were mortified. So now, I suppose this blog post will serve as one of those many parental actions that shall mortify my little girl when she gets old enough to read it and understand that her Baba made sure the man behind the insurance approvals desk–and everyone else within earshot–knew exactly how she got here, thank you very much.
Oh, my little girl. Mommy loves you.