23 September 2014

Our Armenian birth story (and a 4.5-star review of Erebouni Medical Center)

Last year, following the heartache of unsuccessful adoption attempts, Jarred and I decided we were ready to have a second child of our own.  Kind of backwards, right?  I think people usually decide to adopt when they are unsuccessful in their attempts to conceive -- as always, we are not like most people!

Before long, we had worked out the ideal timing of the pregnancy, birth, maternity leave, etc., and by Thanksgiving we were on our way to baby number two!  At Christmas we informed Nathan that he was finally going to become a big brother, and he was thrilled.  At six years old, he was mature enough to learn the [simplified] facts of human reproduction, and he was more than happy to be involved every step of the way.  He came to my OB appointments, watched fetal development videos with me online, reminded me to take my vitamins and eat healthy snacks every day, told me to move away when there was someone smoking nearby, and watched with fascination as my belly -- and other parts -- grew larger, counting down the weeks until the estimated date of delivery: August 19th, 2014.  Even my students were excited, and I have to commend them for putting up with my mood swings and complaints throughout the second semester, on top of all the other pressures of school, college applications, and teenage life in general!

Other expat moms we know have traveled back to their home countries to give birth, and Jarred and I considered what was best for our family.  On the one hand, we wanted to give birth in the U.S. again in case of any unexpected medical emergencies, like what happened with Nathan (if you don't know, look up "congenital d-TGA"), but because the baby was due so close to the start of the school year -- Jarred had to be back at work on August 25th, and Nate's first day of school was the 28th -- that meant that there was a good chance that I would have to stay with my parents in Florida to recover from the birth, so Jarred and Nate could go back to Armenia without missing school; then at some point I'd have to fly back to Yerevan with a newborn (my mom offered to accompany me).  But I didn't want to be separated from my boys, so we decided it was better to deliver here if everything looked normal, and keep the U.S. as a backup plan in case we discovered was an above-average risk of birth defects.

Luckily, we had an excellent OB-GYN, Dr. Abovyan, who monitored everything very closely throughout the pregnancy and confidently assured us that we would have a healthy baby.  I also consulted with Nathan's cardiologist in Orlando, as well as my aunt's OB-GYN and a recommended radiologist in Washington when I had to travel there in June for work.  Their findings aligned with Dr. Abovyan's opinion, and I was able to relax and stop worrying about a repeat of Nathan's condition and other major issues.

Enjoying my last trimester and celebrating the 4th of July with some light hiking in Virginia before returning to Yerevan for the final countdown to delivery day.

Once we were sure we would have the baby in Yerevan, I began preparing myself for an Armenian birth experience.  After hearing from women who had given birth here, I wasn't sure what to expect.  Armenia isn't exactly renowned for world-class medical care, yet obviously there are healthy babies born here every day.  I hadn't heard any complaints from local Armenians, but I got mixed feedback from diaspora women and women with dual citizenship who were able to compare their experiences to previous births in developed countries.  Particularly nerve-wracking were stories like those of Lara Aharonian, co-founder of the Women's Resource Center.  Again my concerns were allayed when our doctor took us on a tour of the new "premium" maternity ward at Erebouni Medical Center, which opened in spring 2014.  Of course, the outside of the hospital (and most of the inside) still looks like a run-down, underfunded, Cold War-era institution...but not the maternity ward!  For more details, keep reading.

After a productive but restful summer, we all felt ready to meet the baby (and I was ready not to be pregnant anymore in the height of summer).  Friends and family members made "bets" to guess her birth date.  August 19th came and went, and so did the 20th, 21st,  and 22nd...everyone lost the betting game.  At an appointment with Dr. Abovyan on the 23rd, we discussed our options.  To avoid an increased risk of complications, he didn't want the pregnancy to continue beyond 41 weeks, and told me to be prepared for a medical induction on the 26th if the baby wasn't born on her own before then.  I asked him if he could perform a membrane sweep, a procedure which had worked to kick-start labor in my first pregnancy.  He agreed it was worth a try, and asked me to return the following morning.

At 11:00 AM on Sunday, August 24th, Dr. Abovyan performed my membrane sweep and sent me home.  Anxious, I kept myself busy cleaning the kitchen and making a batch of granola bars.  I felt some cramps, but didn't think much of them.  After a while, I sat and drank a cup of red raspberry leaf tea, a drink I hadn't tried before, but which I had heard is traditionally used to promote uterine contractions and lactation.   My cramps became more intense, and I went to my bedroom to lie down and rest.  When the cramps didn't subside after about 30 minutes, I got up and tried doing some stretches and yoga poses.  Unlike my Braxton-Hicks contractions, which I had been feeling since early June, these sensations didn't go away; in fact, they were coming quite regularly, and getting stronger, too.  This was it.  We told Nathan that the baby was ready to be born; he was very worried seeing me in pain and didn't know what to say or do, so he ran to his room and returned with this adorable, hastily made drawing:

We loaded our already-packed suitcase into the car, dropped off a nervous but excited Nathan with his overnight bag at a friend's house, then called the doctor and told him we were on our way to the hospital.  Jarred timed my contractions as we drove.  Upon arrival, Dr. Abovyan evaluated my progress and said that though my cervix had begun to efface, it was not dilated yet.  The baby's heart beat was normal, and I was admitted to labor and delivery around 3:00 in the afternoon.

 Just admitted to labor and delivery, about 3:00 PM.

Although our Armenian friends had informed us that husbands were generally not allowed -- or brave enough -- to stay with their wives (unless perhaps you gave the right person a "gift"), this was, thankfully, not the case at Erebouni.  After the doctor said things were going well but would still take a few hours, Jarred called our parents in Florida to give them an update.  While making sure I was laboring as comfortably as possible, Jarred realized he had forgotten to pack his own overnight bag.  He figured he could go home, grab a few essentials, and be back in less than an hour.  No problem, right?  When he returned an hour and a half later, breathless and stressed out, he told me a crazy story:

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As Jarred drove away from the hospital, he got a phone call.  A police officer saw him using his phone while driving and pulled him over.  Of course, everyone here uses their phones while driving, even bus drivers, so this was unexpected.  Then the officer gave Jarred a really hard time about driving on a foreign driver's license...something no other traffic cop has ever cared about before.  Jarred asked him how much money he wanted, and the cop insisted he didn't want any.  They argued, the cop wanted to tow the car to some impound lot, Jarred pleaded for compassion since his wife was in labor, the cop didn't care, and finally -- assisted by the negotiation skills of our employer's procurement officer -- Jarred, ahem, "persuaded" the officer to let him go.
***

Fortunately, this was the worst thing that happened that day.  As soon as Jarred returned to the hospital, he was by my side the whole time, helping me focus on my breathing, and supporting me physically and emotionally.  He even set up iTunes on his MacBook to play some Miles Davis.  Things started moving quickly...so quickly I was no longer keeping track of time.  I requested an epidural, which was administered by a stern but kindly anesthesiologist (who spoke English fluently); immediately afterward my water broke; and shortly after that, I could feel the baby descending.  Time to push!  The nurses (who were clearly enjoying the jazz music playing in the background) transferred me to the delivery bed, and at 8:30 PM, as the bluesy strains of "One for Daddy-O" filled the room, Amira Tamar Blackmer entered the world!

 Fathers are welcome in labor and delivery at Erebouni Medical Center, and a good thing, too: there's no way I could have done it without Jarred, my #1 coach... in the gym and the delivery room!

At last we had our "Armenian" daughter!  It felt wonderful to hold my little girl, to hug her and feed her and look into her eyes as long as I wanted...since Nathan had been whisked away immediately after his birth due to his health problems, I didn't get a chance to do all these things with him until he was discharged a few weeks after his heart surgery.  We called the big brother right away and gave him the good news, which he couldn't believe and needed us to repeat a couple of times!  Then Jarred emailed the first few baby photos to our parents, and I spoke to my mom for a minute.  I couldn't help but be grateful to be living in the 21st century, to be able to take advantage of constant connectivity and instantaneous communication with relatives, even while giving birth on another continent!

Mommy-baby bonding time.

After resting for about an hour, we were transferred to our recovery suite, which was like a large hotel room.  There was a queen-size bed with a stylish zebra-striped bedspread, a comfortable fold-out sofa, coffee table, a dining table and chairs, a bathroom with a spacious shower, a mini-refrigerator, flatscreen TV, more closet and shelf space than I knew what to do with, a changing table, air conditioning, and big windows with blackout curtains.  (This was a medium-large sized room -- we had also been shown the VIP Suite, with a huge living area and two bathrooms, when we took the tour a few months ago.  Smaller rooms are also available.)  There was a call button next to the bed that rang at the nurse's station down the hall, free wi-fi (weak signal, though), and bottled water replenished daily.   A huge advantage over other local hospitals is the fact that maternity patients are served three meals a day (nothing gourmet, but generous portions of simple homestyle foods).  There was also a small cafe on the same floor in case family members or visitors wished to eat.  This was nothing like the Soviet horror stories I had heard in the past -- talk about progress!

Big brother Nathan sits on the sofa with his new baby sister.  He laughs when she loses a sock and her toes tickle his leg.

Amira and I recovered well in such luxurious accommodations, with assistance from the incredible medical team.  We were required to stay for three days, and throughout each day, we received visits from my OB/GYN, two pediatricians, the deputy-director of the maternity ward, and the very attentive team of nurses and cleaning staff.  So I had plenty of opportunities to ask questions or request pain medication or help in any aspect of our care.  And when I needed help in the middle of the night (which I did because Amira had some bad reflux) or at any other time, I simply pressed the call button and a nurse arrived within a few seconds.  Almost every detail of our stay met or exceeded the level of professionalism and service I would expect in a Western facility...

There were just a few things missing (literally), but because of the "horror stories," I came mostly prepared.  The hospital did not provide maxi pads, bar soap (only a cheap liquid soap at the sink), shampoo, nipple cream, or important baby supplies like diapers, wipes, towels, or burp cloths.  It seemed I was expected to bring these things myself (although neither my doctor nor anyone one from the hospital informed me in advance).  I hadn't thought about nipple cream -- I didn't need it with Nathan since I was pumping and storing rather than breastfeeding for his first few weeks while he was on a strict diet of IV fluids and air, poor baby.  Yet even though the nurses didn't have any to give me, they offered to send someone down to the apteka (pharmacy) on the ground floor and purchase some if I gave them the money.  So in the end, I still had everything I needed, with relatively little inconvenience.  And honestly, from admission to discharge I believe the nurses were more friendly, patient, and understanding -- despite our language barriers! -- than the nurses assigned to me after my first birth at Winnie Palmer Hospital for Women in Orlando.

Saying goodbye to the dedicated ladies who made our hospital stay so comfortable.

So that's our story!  Our little cherub came home on August 27th, just before Nate's first day of second grade.  He is a proud and loving brother, and we couldn't be happier to have two wonderful, healthy children.  Our family feels complete.

Our birth announcement, created at Shutterfly.com and sent to family and friends around the world.


Nathan usually smiles for his annual back-to-school photo, but this year, he was upset because he couldn't spend more time with his new baby sister...she had come home only the day before, after all!



Happy first month, sweetheart!

Amira is Arabic for "princess."  Tamar is Hebrew for "date palm," and is also the name of a legendary Armenian princess, a powerful medieval Georgian queen, and in ancient Georgian mythology, the goddess of the sky and summer.  Our daughter's name will always remind us of the beauty, history, and romanticism we've grown to love about this very special corner of the earth called the South Caucasus. 

***

I hope that our birth story will give other expats an idea of "what to expect when you're expecting" in Armenia.  Things definitely aren't as bad as they used to be, especially at Erebouni Medical Center, so don't be afraid to conceive here if a(nother) child is in your life plans, or feel like you have to travel to another country for prenatal care or to give birth.  As you can see, we had a very positive experience overall, with a sweet baby girl as our reward!  Feel free to contact us if you want to know how to reach Dr. Abovyan or wish to ask questions about pregnancy and birth in Armenia!