Summer in Vietnam is hot. Not just hot, but a stifling, perspiration-soaked, still-hot-after-four-daily-showers heat that pervades every moment spent outside of an air-conditioned space. Yet you wouldn’t know this by looking at Vietnamese women. Unlike places where climate dictates what people wear, in Vietnam, dress has little to do with temperature. Despite the heat, Vietnamese women often cover themselves from head-to-toe in business casual work clothes, or long silk "Vietnamese pajamas,” large sunglasses, face masks, elbow-length gloves, and stockings: every inch of them shielded from the sun. Respecting this form of dress, a combination of cultural formality and a desire for white, unblemished skin, was part of life as an expatriate in Vietnam. But at nine months pregnant, dressing to go out in the heat became one of the few discomforts of an otherwise easy pregnancy.
Aside from the heat, being pregnant in Vietnam was enjoyable. During my previous visits, I had been repeatedly asked whether I was married ("Why not?”), whether I had children ("Why not?”), and when I planned to accomplish both of these desirable goals ("Soon!”). Now that I was on my way, my growing belly made me quite popular. Neighbors, street vendors, women in the markets, all acknowledged my pregnancy with friendly comments and smiles. The most common question was, "Con gai? Con trai? (Girl? Boy?)” My response, "Con gai,” was always met with approving nods. I’m sure if I understood more Vietnamese, this question would not have been the last. Unfortunately, or perhaps fortunately, I was spared further conversation due to my inability to communicate beyond, "Girl? Boy?”
For two years, my husband and I had been living in Ho Chi Minh City where he was working as a teacher at an international school. We had moved to Asia to further explore the diverse cultures and destinations we had come to know only briefly on a previous trip. Once in Vietnam, we immersed ourselves in the southern culture with an apartment in a traditional urban neighborhood, Vietnamese language lessons, frequent visits to local restaurants and food stalls, and even learning how to navigate a motorbike in Ho Chi Minh City traffic. Being health-conscious, we especially loved the holistic Eastern approach to health, emphasizing balance, prevention, individual responsibility, and of course, regular massages.
When we learned I was pregnant in August of 2009, we were excited to experience this new phase of life in a country we’d grown to love. After our initial celebrations, we began to discuss healthcare options. I watched the documentary "The Business of Being Born” and read books promoting natural-birth options. I learned about the domino effect of unnecessary interventions that can occur in hospital settings, where artificial induction could lead to caesarian section and where medical intervention sometimes works against the body’s natural ability to birth a child. Since I was terrified of needles and all manner of operating equipment, an epidural and cesarean were things I hoped to avoid at all costs. Yet, while I wanted a natural-birth experience for our baby, I wasn’t looking forward to the painful part of natural childbirth. I had read that things typically discouraged in strict medical settings—movement, water, natural birthing positions—could help to ease some of the pain. I wanted my birth experience to be as natural, and yet still as painless, as possible.
When I began searching for an environment and practitioner who would accommodate a natural-birth plan, my husband was supportive, but ultimately, he just wanted to be there.
I began with what I knew. "I could fly home to deliver. There are lots of birthing centers in Florida.”
"That’s a long way to go to have a baby. Isn’t there anything around here?”
"Singapore has water birth and hypno-birthing classes. Women go there from all over Southeast Asia to deliver.” I envisioned delivering in a day spa, gazing out the window at the gleaming towers of downtown Singapore.
"That would be cool, but it sounds expensive. Do they accept Vietnamese insurance?”
"Hmmm, probably not. Let’s see… Thailand has an international hospital that promotes natural birth. I’ve heard the nurses will even fly here to accompany you on the plane.” My mouth began to water at the thought of three meals of Thai food a day.
"Thailand would be sweet, but what if the baby comes early? How would I get there in time for the birth? What about a hospital here?”
"A hospital here?” After a year of Vietnamese lessons, I could confidently order two beers at the corner store and tell my neighbors I was going to the market, but I was pretty sure I wouldn’t learn enough to ask for a birthing ball by May. Was there even a Vietnamese word for birthing ball?
With my husband’s encouragement, I learned of a nearby international hospital and began contacting other women who had delivered there. Over multiple glasses of ca phe sua da, sweet Vietnamese iced coffee, I interviewed other new expat mothers. Each woman I talked with had a different story, but each had a happy ending. Many of the women also wanted control over the birth of their child and were satisfied with their experience. They encouraged me to follow through with our decision to deliver in Vietnam. The hospital was staffed with French and Vietnamese professionals; everyone spoke some combination of English, French and Vietnamese; and they adhered to the highest of international medical standards. Only the story of a nurse standing on the table, physically pushing on the mother’s abdomen gave me pause, but ultimately we decided to stay for practical and financial reasons. It would not meet many of my hopes for a natural birthing environment, but it would be safe and professional, and hopefully, we would have some control over the experience.
We made our initial appointments at the international hospital and began taking childbirth preparation classes from a British midwife with other expatriate couples expecting in the spring. Aside from one woman who was flying home to deliver, the others were all delivering at the local international hospital and all had the same doctor, Dr. Thomas, a Frenchman practicing temporarily in Vietnam. Neither my husband nor I had heard of Dr. Thomas; we had met with a Vietnamese doctor at the hospital. She was professional and experienced, if not overly warm, but so far we were satisfied with her care. Yet after our first class, we began to doubt our choice.
Most of the women in the class had questions and concerns similar to my own, and the midwife’s answer to them all was, "If you are with Dr. Thomas, you will be fine.”
"What if I don’t want medication?”
"If you are with Dr. Thomas, you will be fine.”
"Will they strap me down? What if I want to walk around?”
"If you are with Dr. Thomas, you will be fine.”
"What if I don’t want to be induced unless medically necessary?”
"If you are with Dr. Thomas, you will be fine.”
And then me: "What if I am not with Dr. Thomas?”
"If you are with … oh, well. I would talk to Dr. Thomas and see if he can take you on.”
Later that day, my husband and I made an appointment to see Dr. Thomas. I knew I would not have a truly natural birth experience in the hospital, but I did hope to have some control over what happened. I wanted to be free to walk around during labor, to avoid artificial induction, to deliver without medication, and to nurse and bond with our baby immediately after birth. I also hoped to avoid lying on my back with my feet up in stirrups, but that, I was told, was the only option for a hospital birth in Vietnam, even with Dr. Thomas.
Dr. Thomas saw us the following week. He was friendly, warm, and welcoming. My shoulders, tense since the previous week’s class, finally relaxed. Maybe there was hope for our natural birth after all. Yet after listening to our concerns, Dr. Thomas immediately told us there was no need for us to switch doctors. He informed us, contrary to what the midwife had said, his practices were no different from those of the other doctors. He tried to assure us that we would be fine with the doctor we had selected and made no request for us to return. As public displays of emotion were taboo in Vietnam, I held back my tears until we arrived home.
At my next doctor’s appointment, I presented our doctor with a birth plan, in both English and Vietnamese. I asked if I could explain it to her and she listened patiently while I described the birthing experience I hoped to have. When I was finished, she nodded and said, "Yes. I have seen these. Foreign women bring them in all the time. I will see what I can do, but ultimately, we have to do what we have to do at the time the baby is coming.” I respectfully restated my case, silently hoping our baby would be born on our doctor’s day off.
Next to the actual delivery, many of my reoccurring fears revolved around the logistics of getting to the hospital when I went into labor. Our apartment in central Ho Chi Minh City was in a traditional urban Vietnamese neighborhood. Small winding alleys lined with narrow, multi-level homes opened onto a wider residential street. This central street, lined with small family-owned restaurants and businesses, led out to a busy thoroughfare. To get to the main road, we had to walk down our narrow alley, around a few corners, down other narrow alleys to the central street, then down the central street to the main road. Once there, we still had to select our mode of transportation.
Roads in Vietnamese cities are typically filled with motorbikes, small 100 cc scooters that swarm the streets at all times of day, taking over sidewalks during rush hour to keep the flow moving. Taxis and other cars are relegated to one lane in order to allow the motorbikes safer passage in the other lanes. Unlike the motorbike riders who seem to disregard all rules of the road, taxi drivers rarely breach this one-lane rule, making taxi rides much longer than the same distance on a motorbike. While I thought it would be more comfortable riding to the hospital, in labor, in a taxi, there was a risk that we might not make it in time. I wasn’t sure which would be worse: laboring on a speeding motorbike or delivering in a taxi. Ultimately, I decided to put the decision off until I went into labor.
One decision that could not be put off was when to fly home for the summer. As much as we loved Vietnam, we had decided that we should at least be closer to, if not quite in the same country as, friends and family back home once we had a baby, so my husband had accepted a teaching position in Central America for the following year. He had to report by the end of July, which gave us only a short window of time in which to visit family and friends at home in the summer. In order to be granted permission to leave the country with our baby, we had to secure multiple documents—a Vietnamese birth certificate, a Certificate of Birth Abroad, an exit visa, and a passport—in a process we had been told would take three to five weeks. We wanted to select a day to fly which would leave us enough time in Vietnam to secure all of the necessary paperwork and enough time to visit family and friends in multiple states back home before leaving again. As our daughter was due on Monday, May 10th, we figured that flying home on Tuesday, June 15th would give us the time we needed on either end, but with very little room for error.
By Monday, May 17th, I was starting to get nervous. Now, in addition to my typical first-time-mother fears of childbirth and my worries about delivering in the back of a Vietnamese cab, I began to worry that we would miss our flight home. When I showed up for our appointment at the US Consulate, the consular-staff member looked around expectantly when I presented my paperwork, only to look confused when I pointed to my still-pregnant form. While I was relieved when the consular staff graciously assured me they could expedite our paperwork whenever the baby decided to come, I was still plagued with nagging fears of artificial induction and an operating room, so my husband and I stepped up our own induction efforts.
Sitting in the small street-side dining room of our favorite Indian restaurant, we requested "Indian” spicy food for dinner, despite the heat outside. We sought out the bumpiest routes home on our motorbike. We even stepped up the pace on our evening walks around the track, trying to ignore curious stares as sweat pooled in our shoes. Despite our efforts, by my appointment with the doctor on Wednesday, May 19th, the baby had still not budged.
Our doctor suggested we schedule an induction for that Friday, May 21st. She cautioned against waiting too long after the due date to deliver, saying it could pose risks to the baby’s health. Anxious and frightened, yet not wanting to harm my child, I agreed and left for home, still secretly hoping the baby would come on her own. Later, knowing how strongly I felt about laboring naturally, my husband suggested we put off the induction until Monday the 24th since the baby was not technically two weeks late until that day. With his support, I called the doctor’s office and rescheduled the induction for Monday. At 42 weeks pregnant, I turned our brisk mile walk into a full speed run around the track. By 7:00 Saturday morning, our weeks of waiting and worrying were over. We called our families to tell them the baby was coming.
After a mad dash around the apartment to collect our things, we were ready to go. Not wanting to get trapped in rush hour traffic, we decided to risk the trip by motorbike. The twenty-minute trip led us down busy city streets packed with motorbikes, past beautiful French colonial hotels, over bridges, past river ports with enormous cargo ships, and into Ho Chi Minh City’s modern suburbs. We blended easily into the seamless flow of vehicles, no one giving even a second glance to the Western woman in labor on the back of a motorbike amid the heavy flow of traffic, except, maybe, when I pulled out our video camera to document the ride for the amusement of our child in years to come.
We arrived at the hospital around 7:30 am and went straight to the maternity ward on the fifth floor. When we entered the ward, we found five nurses standing around the nurses’ station and no other patients in sight. The nurses looked at us quizzically without saying anything, so I began to explain that I thought I was in labor and that my contractions were two minutes apart. The nurses all looked at us and then at each other. Finally a nurse looked down at a file on the counter and said, "Ms. Sharon Brown?”
When I said yes, she replied, "That patient is not here yet.”
Confused, I explained, "I am Sharon Brown.”
The nurse looked at the file again and said, "You’re not supposed to be here until Monday.”
"Yes,” I explained, "but that is for a scheduled induction. I think I’m in labor now.”
She looked at me again, consulted the file on the counter and said, "You were supposed to be here on Friday.”
"Yes,” I agreed, my voice rising a bit in panic, "that was the original appointment, but we changed it to Monday. But I am here now and I think I am in labor.” The nurses’ brows furrowed. As I looked around nervously, a customer service plaque on the wall caught my eye, "Number 1: Excellent patient communication!”
As I looked back at the nurses’ station, one nurse motioned for us to follow her. Grateful, we followed her out of the maternity ward, to the elevator and down to the second floor to Labor and Delivery. Once I realized my mistake, I understood the nurses’ confusion, as women do not usually go up to the maternity ward until after they deliver their babies.
Once on the Labor and Delivery floor, we were led into a double room. I was hooked up to a machine that monitored my contractions, along with the baby’s heartbeat and movements. The machine immediately began recording a heartbeat and movement, but, to our surprise, no contractions. After another thirty minutes, with my husband diligently timing them on his stopwatch, my contractions returned, but not at the rate that had brought us in that morning. The nurse came in and told us that we could go home. "No baby today. You have baby tomorrow,” she predicted.
As I was walking out of the room, I felt a strong contraction that made me pause in the hallway. Another one came on down in the lobby. By the time the next one came on, as we walked out to the parking lot, I told my husband that it might not be a good idea to go home. I reminded him that my mother had short labors. He nodded, but suggested it might be better for me to labor at home where I was free to move around unhindered and get something to eat and drink. I agreed, not wanting to face induction merely because we had been in the hospital too long without progress. So we headed home, making a quick stop at the international grocery store for a box of pancake mix—after all, I was still pregnant and craving banana pancakes.
Because my contractions were now much stronger, the ride home on our motorbike was less enjoyable. Once we arrived home, I was positive that the hospital, even if just the lobby, was where I should be. Thirty minutes later, after a hastily prepared batch of banana pancakes, we were back on the motorbike, recording, "Baby’s Ride to the Hospital, Take Two.”
Once we arrived, the next two hours at the hospital passed in a painful blur of shameless screaming on my part, mostly about the fact that I couldn’t do whatever they were asking me to do: a) breathe, b) don’t push, c) push, d) don’t scream, in a room full of Vietnamese woman repeating, "Don’t cry, don’t cry, don’t cry,” and "You try, you try, you try.” From their panicked reaction to my outbursts, I assumed that their typical deliveries took place with happily sedated mothers birthing in peaceful silence. In the end, with my husband’s reassuring hand on my arm and a small Vietnamese nurse standing on my bed pushing down on my abdomen, I delivered a healthy baby girl.
Although our daughter was born without medication, I did not consider my birth experience natural. Except for the absence of artificial induction and pain medication, I was subject to continuous fetal monitoring, made to remain lying in bed during active labor, given an episiotomy against my wishes and had my daughter removed by vacuum. She was taken immediately for examination and returned only briefly for a short five-minute bonding period, before being whisked off to the Neonatal Intensive Care Unit (NICU) for monitoring due to the meconium in her lungs. The experience left me frustrated, disappointed, and exhausted, but it culminated in the birth of a healthy baby girl, and for that I was grateful. The Vietnamese emphasis on deference to authority and adherence to a rigid hospital rule structure did not allow me the birth experience I had hoped for, but their competence and professionalism delivered my daughter safely into, if not my arms, at least the arms of the doctor. While I mourned a little for the "magical” natural birth experience reported by others, I was ready to forget it all and move on to the business of caring for my daughter, but even that wouldn’t come easily in Vietnam.
For the first weeks of a baby’s life, new mothers are expected to focus all of their energy on their own recovery. Infant care and all other tasks of daily life are taken over by close friends and family members, allowing the mother to rest. This expectation begins in the hospital, where mothers rest in their rooms, while a host of capable nurses take crying babies and return them, expertly swaddled, in a peaceful sleep.
Because I was determined to nurse our daughter from the beginning, I was hesitant to let her spend any time in the nursery. I had been warned that Vietnam was a very formula-friendly environment where nurses would give bottles to babies even when expressly asked not to do so, not out of any form of disrespect, but simply because that was the way things were done. During the four nights I was in the hospital, I spent hours pacing the halls with a crying baby, acting out a familiar scene from many American movies and television shows. I felt it was my duty. I paced the back halls, taking care to avoid the nurses’ station where I was inevitably met with requests to take the baby or confused smiles. Ultimately, each night around 4 am, after a few near misses with doorways and some stumbling attempts to catch the baby before dropping her on the floor, I gave in and handed her over. Each morning, my red-faced, screaming child would be transformed into an angelic bundle presented to me in a neonatal cart by a smiling nurse. I knew infant formula was a part of the spell that was cast over my child, but in my early-morning sleep-deprived state, gratitude won out over any concern I had about future nursing struggles.
As is the case for many expatriate couples, both my family and my husband’s family were twenty-four hours away on the other side of the world when our daughter was born. Once home, we would have no doting grandmothers to take the baby and allow us to sleep, no generous siblings to bring dinner. We did, however, have our friends, a second family that we had made over the years, who came to visit, bring treats, and hold the baby. For our families at home, we kept up a regular stream of newborn photographs and videos, and a promise to bring our daughter home to visit them during our upcoming summer break. Many of my daydreams included the moment I would place my daughter in my mother’s arms. But for that to happen, we needed to get home.
In addition to the seclusion of their mothers, newborn babies in Vietnam typically remain inside for their first one to three months of life. Our daughter, unfortunately, did not have the luxury of time on her side. After just four days in the hospital, my daughter and I were out on the streets, taxiing to various governmental offices for paperwork to secure her Vietnamese birth certificate and exit visa, which we would need to apply for her certificate of birth abroad and passport to leave the country. Because of this breach of custom, we received a lot of attention from the grandmothers in our alley. Each time we left our apartment, they stopped us to look at my daughter and dispense some sort of advice. I couldn’t understand much of what they said, but there were two obvious themes among them: the baby was too young to be out, and she was underdressed!
Given that Vietnamese women cover themselves from head to toe in ninety-degree heat, it should not have surprised me that this would be the case for babies as well. I had become comfortable wearing the characteristic face mask and the more formal coverage required by local custom, but as a new mother, I was hesitant to risk overheating my baby. Each time we were stopped, we would be given instructions via sign language. In addition to her regular clothes, we were told, the baby should be dressed in a hat, socks, and gloves: the hat to protect her head, the socks to keep her warm, and the gloves to keep her from scratching her face. For the first few days, I responded with an understanding nod and a gesture to my bag. Out of respect, I indicated that I had all of the necessary articles of clothing, even though my daughter wasn’t wearing them at the time. After two days of admonishments from little old Vietnamese women, I caved.
For our morning outing on the third day of bureaucratic paper-gathering, I dressed my week-old daughter in a onesie, matching socks, a hat, and little pink gloves. As we walked down the alleyway, inquisitive glances turned into approving smiles. As I neared the end of the alley feeling quite pleased with myself, I was stopped by a young Vietnamese man who addressed me in unaccented English.
"Hello. Is that your daughter?”
"Yes.”
"How old is she?”
"One month,” I replied, feeling bad about my lie, but hoping to avoid a lecture on another grievous breach of local custom.
"Why do you have her all bundled up? It is way too hot for all of those clothes!”
"Are you serious!?” I exclaimed. "You are obviously not from around here! Where are you from?”
"Canada,” he replied, smiling.
Once in the cab, I removed all of my daughter’s extra clothing and learned to live with disapproval for the next three weeks.
Finally, three weeks after the birth of our daughter, we had collected all of the necessary paperwork, packed our bags, and were headed back to the United States. Because we had to report to our next post in late July, we did not have any plans to return to Vietnam in the near future. We were sad to leave, but happy to be taking a big part of Vietnam with us: two years of memories and the unchangeable fact that our daughter was born there.
We hope one day Vietnam will not just be a place on her birth certificate, but a very real place she will come to know. A place where the present and the past live side by side, where the foreign mixes with the familiar. A country of narrow winding alleys and rainbow-colored houses, of country dirt roads and emerald green rice fields, of sleepy delta towns and bustling cities. Of hot "winters” and sweltering summers; of curious stares and friendly smiles. Of steaming hot pho and sweet iced coffee; of fresh grilled squid and savory shrimp pancakes. Of a deep love of country and a proud heritage; of a long, colorful history and a fast-moving present. A place where we made a life, friends, and memories in a culture that was once so foreign, and where one day, our daughter might return to make memories of her own.
Sharon Brown is a freelance writer and editor. She published her first essay on life abroad in Forced to Fly II and is currently working on a book about expat life in Vietnam. Sharon has lived and traveled throughout Asia and Central America. She currently resides in the DC metro area in the US with her husband and two small children. More stories can be found on her blog at Tales and Inspirations.