My Birth Plan Was Not to Die: Why I Gave Birth Outside of the USA

As I sat across from my OBGYN in a private hospital in Panama City, Panama, on a Friday morning, I was asked what my birth plan looked like. I turned my head to the right, looking out the floor-to-ceiling window of her 27th-floor office; I saw the beautiful water of my birth country and thought quickly about the happiest moments in my life, my childhood spent in Panama. I turned back and faced my doctor, who was waiting patiently and with an expression that seemed one of curiosity. I then said, with tears welling up in my eyes and a weak smile, "My birth plan is not to die." 

A birth plan is exactly as it sounds: a plan for how you would hopefully like the birth process to go. All sorts of things can happen during and after birth, but having a plan and being prepared for as much as possible can help alleviate some of the stress and guide you and the practitioners. There are also situations that might arise where your regular doctor is not present, and another doctor needs to know your preferences. Perhaps you are not able to communicate on the day due to pain, exhaustion from labour, general anaesthesia, or some other event. It's important that your thoughts, your words, and your feelings are known to as many as possible in a written form.  

In 2023, pregnant, I returned to Panama, having decided to make my home in the place where my parents, grandparents, and I had taken our first breaths of life.  

Panama is a place where I spent every summer of my childhood, swimming in the water at the beach, waving hello and chatting with locals who honoured their Indigenous ancestors through dress and customs, and listening to stories of childhoods long since passed, told by my grandparents, aunts, and uncles.  

Chema Photo

Although I was born in Panama City, at around one and a half years old, my mother relocated us both to the United States for what was considered a better place for me to grow up, with more opportunities. But Panama, over the decades, has become a place where many foreigners are seeking out opportunities, such as flocking to Panama for the chance to retire and have a better quality of life, one more affordable but with amenities in healthcare that rival modern medical centres in other parts of the developed world. 

Jafar Ahmed

My OBGYN, who shall be called Dr. C throughout this article, worked in one of the newer private hospitals in Panama City and was someone who I found to be recommended by several moms in an expat moms Facebook group. The moms who had recommended Dr. C mentioned that she was one of the few doctors who listened, was more holistic in her approach and didn't push having a caesarean section (c-section). They also said she spoke English, and although I am mostly fluent in Spanish, I find it better to communicate technical matters in English. I was also given a friendly warning that the first visit was two hours long so that the doctor could get to know me better. I had never had a two-hour initial doctor consultation in my life, but I didn't have anything else scheduled that day, so I thought, sure, that's fine.  

We talked at times in Spanish, but mostly in English, about the cost (which was much lower than in the USA), what the process might be like with lab work, vitamins, my general health, and any fears I had during pregnancy and the upcoming birth.  

I asked Dr. C if she knew who Serena Williams was, and she said yes. I recounted an Elle magazine article in which Serena Williams, an internationally-known stellar athlete, told the story of giving birth to a beautiful daughter, but after that, used the following words to describe her experience in the hospital, "…all I could think was I'm dying." "No one was really listening to what I was saying." " I was exhausted.""I persisted." I told Dr. C that I didn't want that experience. Serena Williams is rich and famous, married to someone of the same calibre, and knows other rich and famous people. Yet, there she was, during what should have continued to be a beautiful experience, attempting with all she had in her to be "heard and appropriately treated."

Domo.

"We certainly know that from national numbers […] that Black women have worse maternal outcomes at every income level, which is pretty startling," said Dr. Scott Harris, Alabama's Department of Public Health State Health Officer, in an Associated Press News article. 

Of course, it doesn't matter how much money or clout a woman has; none of that should have anything to do with bringing a life into this world and her experience afterwards, but for pregnant Black women in the USA, having the most, being the best, might not make a difference either. 

I'm an average Black woman with minimal savings, no influential connections, and single, having decided one day that I wanted to have a child and sought assistance from a fertility clinic in Peru (we'll talk about that location some other time).  

If Serena Williams, along with many other Black women, had endured awful, at times life-ending experiences in the United States, then I felt I, a Black woman, could not, would not, have my child there. So, there I was in Panama, in an OBGYN office on the 27th floor of a private hospital, telling Dr. C that I just wanted to live and I didn't want to have to beg for medical treatment or pain intervention. Dr. C looked straight at me with all seriousness but clearly saddened at the most basic medical care I was asking her for, maybe pleading for, and said ‘we won't let that happen.’  

During my second trimester, however, I lost weight due to nausea and morning sickness, and it seemed I suffered through disdain of all sights and smell of food except for maybe five items, but my baby boy grew each week, healthy and stronger, and I was happy, relieved, and amazed. During my third trimester, I had regained my taste back for most foods, and I prepared for vaginal birth with a doula who I had hired. I was also delighted to be in the presence of my mom, who came from the USA back to her birth land to help me become a mother; all the while, she made my favourite foods like Chicheme (a sweet corn and milk soup) and Sancocha (a savoury soup with vegetables, beef, and flour dumplings).  

In week 35, my blood pressure rose above 120/80 and wasn't coming down despite my mom's homemade brew of local fruit, a biweekly appointment with an acupuncturist, and increased rest and water. In week 37, an induction was scheduled, but the morning of, my baby had turned again, and his head was underneath my right breast. I had taken a course called Spinning Babies, and my baby boy was definitely living up to the name, never remaining in the same place each scan, and now was sitting up, it appeared his head was close to my heart.  

An emergency c-section was now necessary, as my doctor didn't want complications to occur with my blood pressure rising and things becoming out of our control. In the early evening hours, a few days into January 2024, Dr C., her assisting doctor, two anaesthesiologists, a paediatrician whom I had selected in advance, my doula, two nurses, I think, and my mom, cheered as my baby and I met each other. 

Jalila Clarke

I cry to this day when I reminisce on how wonderful that day and every day since has been with my baby.  

In the ensuing days in the hospital, I'll be honest and say that the food was not tasty, and there were no supplies I could use to take care of my baby in the 16th-floor private room, which provided an ocean view and enjoyment of sunrise each day. But the most important things were never neglected: I was never in pain, and I was monitored frequently for any indication of pain or infection or issue that might arise. 

Also, my OBGYN, one of the anesthesiologists, and my baby's paediatrician visited me during my three-day stay, smiled wide at me and my baby and had a conversation with me, asking me how I was doing, not just checking on our charts.  

As I checked out, a prescription for pain medication was given to me by my doctor, and appointments were made for me and my baby. My baby is going on four months now, and all is good.  

He's happy, we're happy, still living in Panama, but in a rural area instead of the city, where we listen to the wind, watch the rain, eat fresh fruit often, and sway in a hammock, among the other standard and special things in a day. 

Meritt Thomas