Hellobee

My friend M lives in a remote village an hour north of El Nido, so for the past month she’s been living with me in the island capital, as it’s difficult to get to the hospital 7-8 hours away from her home in case she goes into labor early. She’s a 26-year-old first time mom and her parents in The Netherlands won’t be able to make it for the birth, so I had been helping her prepare for birth, postpartum, and infant care. M’s doctor gave her an initial due date of January 14th, but then later revised it to January 21st. She gave birth early the morning of the 22nd, and let me say that giving birth in the Philippines is a completely different experience than giving birth in the US!

M was planning on giving birth at a birthing center where several expats we know have given birth recently. I told her that she wouldn’t be able to get an epidural there, and she was prepared to give it a try, knowing that she could transfer to a hospital to get an epidural if she wanted one.

By the evening of the 19th, two days from her due date, she had been having regular contractions for 24 hours. But that evening the contractions completely stopped. On the 21st she visited her doctor who administered something to her cervix to speed up labor around 1pm. By the time 4pm rolled around, the contractions were painful enough that she headed to the birth center with her husband. I didn’t think she was close to 4 centimeters yet given how slowly first labors usually progress, and told her to message me after the doctor checked how far she was dilated. At 6:13pm she was 3 centimeters dilated, and already in quite a bit of pain. I arrived at the birthing center by 9pm, and someone came in to check on her shortly afterwards. M said that if she hadn’t made any progress since her last check, she couldn’t go on like this after 5 hours of painful contractions.

The nurse declared that she was 2 cm along, at which point M started crying. How could she have made negative progress in 3 hours?! At that point M said that she wanted it to be over and wanted a c-section right away. If it was this painful at 3cm, there was no way she could make it all the way to 10cm and have the energy to push. I tried to reassure her that a c-section was far away, and that she would feel a lot better once she got an epidural.

M was then examined by the doctor and given an ultrasound in his office. He said that she was 3cm dilated, 60% effaced. I asked if she could receive an epidural, as getting one at 4-5cm is typical in the US. The doctor said because she was in a lot of pain and still had a long way to go, he recommended that she get the epidural and that it wouldn’t be a problem to get one at the hospital. I was definitely on team epidural so we packed up our things and drove to the hospital less than 10 minutes away and checked into the emergency room.

1 0 : 0 0 P M  –  T H E  H O S P I T A L

We got to the hospital and I filled out all the intake forms. The on call anesthesiologist was busy for the next hour and a half, so they asked if we wanted them to page another doctor that was not on call. Yes of course! She couldn’t wait another minute! It took about an hour for the other anesthesiologist to arrive, and he scrubbed in as soon as he arrived. I told M that she would have to remain still while the epidural was being administered, which was probably a mistake because she freaked out about not being able to sit still through contractions. I just remember how difficult it was for me to sit still while my epidural was being administered with Charlie. M was a little distraught that neither of us would be allowed in the operating room while she was getting the epidural, but I told her it was the same in the US and that she would feel so much better in just a little bit.

1 1 : 0 0 P M  –  T H E  E P I D U R A L

M’s husband had to leave with a hospital staff member to the hospital on the other side of town because they had run out of meds they needed. Whether or not that meant a delay in getting the epidural we did not know. M’s husband didn’t have the authority to purchase the meds which is why the staff was accompanying him. Unfortunately this is a very common problem here. When one of my close friends wanted an epidural, they couldn’t locate some piece they needed to insert it at any hospital in town. Finally the anesthesiologist found an expired one in her medical bag and asked if my friend still wanted to use it (yes she did).

Luckily M was able to get the epidural. The meds run was for the next dose! She was wheeled out of the OR at 11:35pm and into the laboring room. She was now 5cm dilated and feeling much better and calmer. The epidural insertion wasn’t that bad because they let her remain in a fetal position. However I don’t think it was nearly as high a dosage as I had with my kids because she could still feel her contractions quite strongly. But she was relieved that the intensity was nowhere near what it was before she got the epidural.

Right before M was wheeled out of the OR, I saw a woman clearly in labor wheeled into the delivery room, which was adjacent to the laboring room. Because of a connecting door, we could hear every moan and scream. This was not what I wanted an already scared M to hear, so I blasted Spotify on my phone to drown out the sounds. Ten minutes later we heard a baby crying, and I was amazed at how short the labor was, and mused that it must have been at least her second or third child.

1 2 : 0 0  A M – 5 C M

I asked the anesthesiologist how long he thought it would take before she reached 10cm. He said maybe 1-3 hours. That sounded crazy short to me, and I posted on the Hellobee boards asking how long it took first time moms from getting the epidural to the time they started pushing. In retrospect, I’m pretty certain that they gave her something to speed up labor. They administered something to her without explaining what it was or asking her if she wanted it. But I wasn’t there to be able to say anything or advocate for her, and being a first time mom, she didn’t know any better either.

My monkeys were still at home awake, so I headed home to get them to bed. I thought that I had many hours before M would be close to pushing. M immediately took a nap to try to rest up for pushing.

1 2 : 4 3  A M  –  7  C M

M’s husband messaged me 40 minutes later to let me know that she was now at 7cm, and the doctor said that they would be bringing her into the delivery room soon. I was still at home wrestling my monkeys down who had been up playing with some friends visiting from El Nido. A very short hour later at 1:42 am, her husband messaged that they were wheeling her into the delivery room. I couldn’t believe she had progressed to 10cm so quickly, and I was worried because she didn’t get much rest and I knew she was too tired to push.

2 : 0 0 A M  –  T H E  D E L I V E R Y  R O O M

I got to the hospital by 2 am to find her husband in the waiting room alone. Neither of us had known that we would not be allowed in the delivery room! This is standard practice in the Philippines, and M’s husband was so scared that he was glad that he wasn’t in the delivery room. Apparently she had let out a blood-curdling scream right before I arrived.

We waited with bated breath and 10 minutes later we heard a baby cry. Relief washed over us as we knew that the baby was born! The anesthesiologist poked his head out to give us a thumbs up and let us know that the baby was ok. I could not believe that she pushed the baby out in 10 minutes because she was utterly exhausted and got about an hour of sleep before she had to start pushing. I thought she must have summoned some superhuman strength!

A nurse brought out baby D so we could meet him for the first time. He was 6.4 lbs, healthy, and amazingly alert and calm!

just born! 

T H E  L A B O R

So how did M push baby out in 10 minutes when she was so exhausted?

Once in the delivery room, they broke her water right away and the first ten minutes they instructed her to push, but she was so tired she couldn’t do it. Then the nurses started pressing down hard on her stomach, while the doctor pressed down hard on her vagina, which M said was the most painful part of the process. By pressing and pulling they manually expelled the baby from her body in 10 minutes. M never even pushed at all.

I was completely and utterly shocked when I heard this! I’ve talked to several moms that gave birth here, and they were shocked too when I told them the story. But this must be common practice because the doctor from the birthing center instructed the nurses from the hospital what to do, and they were already familiar with the process. Had I been in the room, I absolutely would not have allowed this to happen.

Perhaps because many patients here are uninformed, doctors are used to making decisions for them without consulting them. I’m certain that they gave M interventions without consulting her. In the delivery room she was out of it, all alone, and couldn’t advocate for herself so she let them do what they wanted to do. The doctor left so quickly afterwards, I don’t know exactly what happened in that room. Though M is thankful that both she and the baby are healthy, looking back on it she realizes that what they did was wrong. Perhaps that’s why the woman giving birth before her only took 10 minutes as well.

P O S T  L A B O R

M was wheeled out and we had been told by the doctor that the baby would be taken away for a couple of hours for observation, but they actually brought him out right away. All of us went into the shared room, which was the only one available, with 4 beds and 4 additional family members sleeping on benches or in bed with the patients. I was told that the room would be filled only with postpartum moms, but only M was a new mom. There was no bassinet, and the baby was supposed to cosleep with mom on the small bed that didn’t have any siderails. No instructions were given so I asked the nurses about breastfeeding, and they said that she could try if the baby seemed hungry then left and said they’d be back in the morning.

There were no privacy curtains, but luckily M wasn’t shy about trying to breastfeed with everyone looking on and baby took to it really well for a first timer! But there was no way M could sleep with the baby next to her as she was worried about suffocating it, and she was utterly exhausted. Dad sat in a chair and held baby so that M could sleep. I headed home at 3:50am after making sure they were ok. I was exhausted from getting over food poisoning the day before.

The total for the doctor, anesthesiologist, epidural, room, and vaccines in one of the two best hospitals on the island came to $720 USD.

arriving home for the first time 

The whole family is at my house until all doctor’s appointments are completed and they can go back to their village. Amazingly, Charlie is completely smitten while Olive could care less. And despite holding the baby all the time and appreciating his utter cuteness, it did not spark one ounce of baby fever.

my dogs are very curious, not jealous, and really seem to like the baby

Dutch crackers topped with butter and sprinkles that taste like star anise/licorice. You traditionally eat these after giving birth with blue sprinkles for boys and pink for girls. M’s friend, who is also Dutch and has a Filipino husband, brought them back from Holland for her.