Westerner Navigates Birth on the Nile

CAIRO —  When my daughter is older, I’ll probably fill her head with the exotic experience of giving birth on an island on the Nile.

Manial, the island off downtown Cairo where Thandi was born, does have a battered charm -- and, attesting to its elegant past, an early 20th century palace that houses a museum for stuffed antelope and other royal hunting trophies.

Its present, though, is garish and gritty, its main street choked with honking taxis even at 2 a.m. on Nov. 25, when I was in labor and headed to the hospital, husband and mother-in-law in tow.

Thandi had chosen a festive moment for her arrival. It was Ramadan, the Muslim fasting month when Cairenes make up for days of abstinence with nights of revelry. The sidewalks were crowded with window shoppers, many sporting the new clothes traditionally purchased to celebrate the end of Ramadan.

Near the hospital, two restaurants specializing in koshari, an Egyptian fast food, were having rival grand openings -- the obligatory Arabic pop music blaring from outdoor speakers and giant, clown-shaped balloons dancing over air-jet machines.

We could have flown to the United States for Thandi’s birth, but that would have meant more time off work, camping out at my parents in San Diego or in-laws in Denver and, worst of all, forgoing the pleasure of bringing our daughter straight from the hospital to the apartment near the Egyptian national museum that has been home for more than four years.

A birth in this capital of at least 16 million -- one of the most densely populated cities in the world -- is, to put it mildly, an everyday thing. Statisticians estimate that an Egyptian baby is born every 24 seconds or so, for a total of more than 69 million, and counting, tick, tock.

Last year, while researching a story about the birth of conjoined twins in a remote southern Egyptian village, I learned of a government program to put every village in reach of clinics for newborns and mothers. I also visited a high-tech neonatal surgical intensive care unit at a state-run hospital in Cairo. More Egyptian babies are surviving, even those with severe problems such as the conjoined twins who were sent to the United States for successful separation surgery. According to the latest UNICEF report, infant mortality in Egypt plunged from 189 deaths per 1,000 births in 1960 to 35 in 2001.

I delivered at El Nada, a private maternity hospital, among many such clinics whose appearance in recent years testifies to a growing middle and upper class in Egypt. El Nada’s rooms resemble those in a four-star hotel. It even has a royal suite with whirlpool bath. We passed.

As far as El Nada’s nurses and doctors were concerned, we were the ones who were out of the ordinary. They asked about “Thandi,” a common South African name meaning “beloved” that we chose to celebrate having met when I was an AP correspondent in Johannesburg, and struggled to pronounce it.

Medically, having our baby in Cairo presented no problem. Culturally, though, I prepared for possible clashes.

Of course, some cultural differences barely register with us anymore. The Muslim nurses at El Nada wore head scarfs, and they and the doctors peppered their conversation with praises and exhortations to Allah. I’ve gotten used to that, seeing it as just one of the ways individuals conform to the demands of family, clan and society in tradition-bound Egypt.

No one was bothered that I, obviously foreign and presumed non-Muslim, didn’t don a scarf. In Saudi Arabia and Iran, the law dictates that women veil themselves, while in Egypt, it is a matter of choice -- though one often influenced by peer pressure.

We took the religious trappings in stride, as we did the smell of cigarette smoke in my room. The previous occupants smoked heavily, even around their newborn, the nurse explained as she brought us a can of air freshener. American-style anti-smoking sentiment isn’t unheard of in Cairo, just widely unheeded.

Some differences turned out to be not so different. The nursery attendant who came up to teach us to change a diaper first doused Thandi’s tiny bottom with a white lotion from an unlabeled bottle. The attendant spoke little English and so it took her a while to make clear the lotion was zinc oxide for diaper rash.

We sniffed that that seemed old-fashioned, placing our confidence instead in the diaper rash remedy recommended by friends and brought from the States -- one in a fancy tube with exhaustive labeling and an 800 number to call should we want more information. Its chief ingredient turned out to be ... zinc oxide.

As we navigated our birth on the Nile, we were fortunate a friend had recommended an obstetrician well suited to act as our guide. Hussain Abolmakarem -- soon just Dr. Hussain to us -- is an Egyptian who trained in Britain and returns there every summer to keep up with new techniques. He was patient, candid and seemed to enjoy solving the kinds of puzzles created when Western assumptions meet Middle Eastern realities.

Dr. Hussain commiserated with us over the lack of -- and lack of concern about -- seat belts. They’re very hard to find in Cairo, so we had no way to anchor Thandi’s car seat. My husband, Fred Glick, found one and, using skills learned as a former theater rigger, installed it in a taxi we use often. The driver produced a gift for Thandi: a tiny gold hand of Fatima, believed to ward off evil. We pinned the five-fingered charm to Thandi’s car-seat cushion.

It was Dr. Hussain who counseled us on how much to tip the hospital staff, and to discreetly give the total to the head floor nurse but make sure at least one junior staff member was with her. A witness, he said, would ensure the pounds were distributed as we wished.

More substantively, Dr. Hussain welcomed Fred into the delivery room, unusual in Egypt, and supported my wish to be alert during delivery, in contrast with women he knew who had demanded Caesareans under full anesthetic as soon as they learned they were pregnant. Dr. Hussain stressed he would intervene as little as possible, but that we needed to be flexible, as there was no way anyone could predict how delivery would progress.

It progressed so slowly Dr. Hussain had to perform a C-section under local anesthetic with Fred, scrubbed and robed, sitting at my shoulder. As Dr. Hussain and team got to work, I asked Fred to sing to me.

“What should I sing?”

I requested a children’s ditty, “I’m being swallowed by a boa constrictor.” Fred teased later that I must have thought it was the only song to which he knew all the lyrics. I think I just wanted him to make me laugh.

Thandi, looking beautiful, bemused and slightly blue, was presented to her parents soon after her father crooned the last verse: “Oh heck, oh heck, he’s up to my neck. Oh dread, oh dread, he swallowed my -- schlirppp!”

Shel Silverstein on the Nile. What could be more exotic?