The Mom Whose Water Broke at 26 Weeks in a Foreign Country

Because no two paths to parenthood look the same, “How I Got This Baby” is a series that invites parents to share their stories.

Soon after they started dating, Mariam and Martino began dreaming of hopscotching the globe together. Born to parents from Pakistan, Mariam was raised in New York and Bahrain while Martino grew up in Italy, the son of an Italian father and a German mother. They met while studying abroad in the United Kingdom, and by their early 20s, they were engaged.

Martino’s work at a shipping company kept the couple on the move as newlyweds. Over the course of ten years, they relocated four times. In 2011, Mariam got pregnant in Denmark and gave birth to their first child, a daughter, in Singapore. Two and a half years later, she got pregnant in Singapore, and gave birth to her second child, a son, in Dubai. In 2018, they moved to Ghana. Her experience with prenatal care and delivery varied widely from place to place.

Then, in February 2020, Mariam and Martino received some big news. Martino’s company was closing its Ghana office and would be relocating him and his family to Portugal in the coming months. Soon after, Mariam learned she was pregnant.

The pandemic started — and the world shut down — a few weeks later.

The couple weren’t entirely sure how to handle the move from Africa to Europe. Many international flights were grounded, and they didn’t know if Ghana would let them out or if Portugal would let them in. As they tried to make travel plans, Mariam started to experience pregnancy complications. There were hints that Mariam had a subchorionic hemorrhage, when bleeding occurs between the amniotic sac and the uterine wall, but Mariam’s doctor didn’t know for sure. There were a few times she bled and thought she was miscarrying. She tried to take it easy — which was simpler than expected, given the pandemic had closed offices and schools — and made it to her second trimester.

In those quiet weeks at home, Mariam started to get organized for the family’s move. She joined online expat groups to get up to speed on schools and neighborhoods as well as doctors and hospitals. Health care is covered for everyone in Portugal, but you can purchase private supplemental insurance for access to private hospitals, which have more amenities like private rooms and one-on-one care than public hospitals do. Mariam opted for a private one. Her pregnancy was high-risk, and given she didn’t speak Portuguese, she wanted the easiest possible birth experience. She found a physician who spoke fluent English and got to know her in a telehealth appointment.

Mariam wanted to move as soon as she could. There was no NICU in Accra, where they lived, which concerned her. Her doctor in Ghana cleared her to travel around the 20-week mark, following months without bleeding — but Mariam and her family weren’t ready to move until she was 26 weeks along. The couple worked with the Italian embassy and wound up being med-evacuated to Europe. “It was a crazy experience … getting out of Ghana was like something out of a James Bond movie,” she says. They landed in Italy, and then stayed for a week in Germany, where Mariam’s in-laws lived. Mariam and Martino then left their 7- and 5-year-old kids to stay with their grandparents for a week while they continued on to Portugal to get settled. They had plans to find a rental house, open bank accounts, and enroll the kids in school. Then they’d go back to Germany to retrieve their children.

They thought the hardest part — traveling to a new country mid-pandemic — was behind them. But soon, an unforeseen pregnancy complication landed Mariam in the hospital. She shares the story of her third pregnancy:

On her water breaking at 26 weeks

It was July 2020 when we first arrived in Portugal. Martino and I checked into our hotel and started doing everything we needed to do — going to the bank, looking at houses. Lisbon was charming, and we were enjoying the weather and eating all this great food. Then, on our third night there, at about 2:30 in the morning, my water broke with a gush. I went to the bathroom, thinking I had to pee, and then thought: Wait. This is amniotic fluid. I panicked and woke up my husband. We had no car, so we jumped into an Uber and went to the private hospital I had selected.

I was gripped with fear, but I calmed myself down by the time we arrived. I kept telling myself, Okay, we’re here. I just need to trust the people I’ve chosen. My OB happened to be there, coming out of a delivery. She examined me and confirmed I’d broken my water. Then she told me I couldn’t stay — that I would have to be transferred to one of the public hospitals.

That’s when I learned that in Portugal, if you deliver before 32 weeks, you are automatically transferred to a public hospital because it has a Level IV NICU, which offers the most advanced care. Because public hospitals are state-run, they’re better funded with more resources. Ironically, the private hospital I’d chosen wasn’t as well-equipped.

On discovering she had to be hospitalized with no visitors

The next thing she said was that my husband couldn’t join me. I panicked again. I’m used to advocating for myself — I’ve lived in ten countries on four continents, and I can speak four languages and butcher a few more. But this was really stressful even for me, because I didn’t understand what was going to happen next or how the public health-care system worked. And now I was all on my own.

They put me in an ambulance and transferred me to this huge yellow building that looked like a crumbling cathedral. I was put in a room with a bunch of other patients, none of whom spoke English.

I don’t think they knew what to make of me. There I was, a woman of color, who probably looked nothing like what they expected from a person with an Italian passport. I had no medical file. People were looking at me, like, Who are you? Who moves countries while they’re pregnant? You could just see their eyes go wide, like I’d arrived from Mars or something. They couldn’t figure me out.

And in the meantime, I was thinking to myself, Am I losing this baby? What’s happening? My mind was racing. I was all on my own, and couldn’t easily ask questions. I’d gone to great lengths to choose my OB, but in the new hospital, I couldn’t see her anymore. Instead I was seeing a different doctor every day — never the same physician consistently.

On starting inpatient bedrest

When your water breaks early, your body doesn’t necessarily go right into labor. My physicians wanted me to stay pregnant for as long as I could. “Every day you keep him in is a victory,” one doctor told me. So they put me on bed rest and gave me IV fluids since the baby could replenish his own fluids by urination. People who haven’t been through this may not realize it, but breaking your water early and then being on bed rest is uncomfortable. You shift or move in the bed, and you can feel yourself lose fluid. One of the first things I asked for was sanitary pads. I was constantly changing them.

I felt reassured that my treatment was going well when a friend of a friend who happened to be a physician in Lisbon managed to visit me one day. He told me that everything my physicians were doing seemed right. My husband’s company is Danish, and they also put me in touch with a specialist in Copenhagen so I could ask questions and compare the hospital’s protocol with the Danish protocol. Speaking to him also helped me feel more confident that I was on the right track.

On adjusting to life in a hospital ward

I was sharing a room with anywhere from six to nine women at a time, a situation with pros and cons. The biggest pro: A lot of us were in the same situation. The night I arrived, one of the other patients motioned to where I could put my things. I sat on my bed and cried. Then the woman in the bed next to me stood up, came over and gave me a hug. A nurse was there, and she translated when the woman spoke. “It gets better,” the woman said. “Hang in there.” There were moments like that that made me feel less alone.

There were also obviously some downsides. If you’ve ever stayed overnight in a hospital, you know how hard it is to sleep. With nine patients in a room, there was constant activity, and I basically stopped sleeping. I was already thinking to myself all day long, Keep the baby in, keep the baby in. Stopping sleep on top of that compounded my stress.

The nurses were really kind. In Portugal, the national dessert is this delicious little custard tart called pastel de nata. Every day I was able to stay pregnant, a nurse would bring me one, almost like a little prize. It was very thoughtful — something to look forward to.

On figuring out how to communicate with her doctors

In the private health-care system, which is used by a lot of foreigners, many doctors speak English. But in the public hospital, few did.

Thankfully I had my phone. I kept pulling it up and using Google Translate. I’d write a note in English, translate it into Portuguese, then show it to the nurse or doctor. Once I started doing that, I could see a change in my caregivers — they seemed to empathize. After a while, I started using Google Translate’s audio feature, which worked even better.

There’s a cultural norm here that’s different from what I’m used to, and I didn’t understand it in the beginning. The doctor’s word is the be all, end all. You don’t dare question. But I had to push things. For example, I’m always severely anemic when I’m pregnant and need iron transfusions and I frantically tried to communicate that to my Portuguese doctors. But I had to really advocate. Once my husband was able to send my medical history and records to the hospital, the physicians finally understood.

On her mental health

While on bed rest, I did a lot of texting — with my parents, who are in Karachi — and with my friends and family. People didn’t know what to say to me, so often they’d say things like, “Stay positive.” I knew they meant well, but it made me feel like I couldn’t express my insecurities, worries, and anxieties to them. So for the first time in my life, I asked to see a psychologist. I have a pretty high threshold for physical pain, but I felt like I was losing the mental battle. It took the hospital a few days to find someone who could speak English, but they did, and I had daily sessions for a while. The hospital’s bed-rest policy was strict; I was only allowed to get up to go to the bathroom, and was only allowed one shower a week, so my therapy happened at the bedside. Most of the other patients around me in the room didn’t speak English, so I suppose I took comfort in the language barrier and didn’t worry too much about our discussions. Honestly, the sessions saved my sanity. Finally I had an outlet to express myself and ask all the questions I didn’t want to burden my husband and my family with, like, Will my baby make it? Will he be okay?

On how her family fared while she was hospitalized

When I went into labor, my in-laws told us to let the kids stay with them and that they’d fly them to Lisbon when we were ready for them. The kids ended up staying there for four more weeks. I worried about them a lot.

We talked every day on WhatsApp, but everything was hard for them to grasp, and sometimes they cried. I felt a lot of guilt. Here they were, going through all of these transitions: new country, new language, new school, new home, new sibling, all in the middle of a pandemic. All I could think was, I’ve literally moved them across continents, and now I’m not there for them.

I changed rooms a couple of times during my stay and at one point I was put in one where I could have a bed by the window. My husband would go to the little park outside it and stand outside and wave, so I could see him. When my kids finally arrived from Germany, he brought them to the park, so they could wave, too. My heart just broke when I saw them there, jumping up and down. We were so close to each other, yet so far.

On having an emergency C-section at 30 weeks

When I was 30 weeks and five days, my temperature started spiking and I experienced some bleeding — both signs of an infection. My physicians thought the baby would be safer on the outside than on the inside.

I begged them to let my husband be with me. I’d never had a C-section before, let alone an emergency one, and I’d never given birth without my husband. But they wouldn’t allow it.

Our son, Miro, was born tiny — under two pounds. His name is Italian, and comes from the word miraculo, which means miracle. I heard him cry, a relief. But when I asked for his APGAR score, and a nurse held up two fingers out of ten, my heart dropped, and I started crying.

I didn’t get to see Miro or hold him. They whisked him away. Martino was in the waiting room, and he wound up seeing the baby before I did. It was another 36 hours before I got to see him.

On going home without her baby

Immediately after the birth, a nurse wheeled me into a recovery room with four other patients. I was in a lot of pain, and really out of sorts. It was surreal — almost as if the experience was happening to somebody else.

I felt relieved that the C-section had gone well and that Miro was alive. But everything else was a question mark. I had no idea if he had been born with any challenges or issues.

I had been begging to see the NICU before I gave birth, but the staff at the hospital wouldn’t let me. But after I gave birth, they sent a NICU doctor to speak with me, and he put me at ease. He explained that the NICU is set up in three different sections, and told me that Miro would start in the part with the most fragile babies. If he did well, he’d move up to the intermediate level, and then finally the level where babies are closer to going home. It helped to know how things would go.

Martino was finally allowed up to see me a couple of hours after I gave birth. It had been more than five weeks since I’d been able to hug him. We were grateful to be in the same room and overjoyed that Miro was here, but we were also consumed with fear about what would come next. Martino kept saying, “I’m so proud of you, you did it, he’s doing great, he’s stable.” That made me feel better. We tried to comfort each other.

Four days after my C-section, I was discharged. Physically leaving the hospital — leaving my son — was excruciatingly hard. That’s when I broke down. I felt like I was giving up on him. I also don’t think I’ve ever felt so uprooted and displaced. I was crying, and I think some of the nurses were confused, like, Don’t you want to go home? But I didn’t feel like I had a home.

On reuniting with her older children

I moved right into a house that Martino had found for us while I was hospitalized. It was so emotional to see my older kids. I tried to spend a lot of time with them, to make sure they didn’t feel like they were being forgotten, even while we were busy going back and forth to the NICU. Martino and I were the only people who could visit Miro, but we couldn’t visit him at the same time due to COVID protocols. The kids didn’t understand why they couldn’t visit their new brother, too.

But they’re really resilient kids — probably a result of them growing up around the world. They were happy to have me back and I was glad I could focus on them and give them more of my attention and time, which I probably wouldn’t have been able to do if the baby was home.

On her son’s NICU stay

When I finally stepped into the NICU, it was another culture shock. Compared to the rest of the building, everything was futuristic and new. There were a lot of machines and noises, and I felt out of my depth. But it was incredible to finally see Miro. He was so little; every inch of him was covered in tubes, and I could barely tell what he looked like.

Pretty soon, Miro started to show us he had a mind of his own. The third time I saw him, he kicked off one of his socks. The nurse tried to put it back on and he squealed in protest. “This one is going to be a fighter!” the nurse said.

When I was finally able to hold him, I think that was the best day. He was 2 weeks old, and it was all I wanted to do — see him up close and smell his hair. He was doing really well at that point, so I started feeling more positive.

We were lucky. Although we had been through a lot, Miro did really well in the NICU — no brain bleeds, no surgeries. It could’ve been so much worse.

And I was able to produce milk for Miro without issue. That was a weight off my shoulders. We also didn’t have to worry about paying hospital bills; the Portuguese national health-care system covered Miro’s whole NICU stay and most of my hospital stay. My husband’s international medical insurance covered any remainder. We were so grateful.

Miro was discharged after five and a half weeks. We couldn’t wait to bring him home.

On acclimating to their new life as a family of five

We were overjoyed to have Miro with us. It felt like we’d cleared a huge hurdle. But a lot of challenges remained. We were still very protective because we didn’t want Miro to get sick. As transplants, we didn’t have friends yet, and couldn’t easily make any. We were already isolated as expats, but the pandemic, and Miro’s fragility, forced us to self-isolate even more.

There was also the language barrier. I pick up languages fairly well, but my introduction to Portuguese was so traumatic that I think it affected my ability to learn. I really needed to reframe my emotions. It was such an intense time.

For months and months, I couldn’t bring myself to go back inside the hospital where Miro was born. Once he was released, I found it hard to step inside those walls again. Miro had a few follow-up appointments there, and I’d ask my husband to take him. It took me almost a year to physically walk inside the building again.

On Miro today

These days Miro is your average three-nager: feisty, stubborn, strong-willed. He’s doing really well, and you’d never guess what a rough start he had. He has these gorgeous curls and blue-green eyes and attends a little Portuguese day-care nursery. He’s speaking better Portuguese than I am.

When I see him throwing a tantrum in the mall because he wants to go up the elevator a million times, I say to myself, “Ah, right. This little boy is going to be fine in life.”

Kristen Mascia , 2024-05-16 18:00:00

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