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.
"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 YorkTimes 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 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 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.