Pregnancy and Birth in Puerto Rico as an Expat

by Anjelica Malone

As I inch closer to my goal of becoming a midwife, I imagine starting my own childbirth practice in Puerto Rico, where I gave birth to my first daughter. It’s quite interesting to think about how the care I will provide to my clients will compare with the care I received during my pregnancy and birth five years ago.

When I arrived in Puerto Rico in 2011, I knew nothing about the maternity and healthcare system on the island. As I began to make friends and meet women growing little lives inside of them, they shared with me their concerns and desires.

They were looking for providers who were well-trained, would answer their questions with honesty and forthrightness, understood their hope of having a low intervention labor, and would be allowed to birth in a location where they felt safe and supported.

Anjelica and her husband in Puerto Rico.

These are the very same things that many women here on the mainland U.S. look for when they become pregnant. The difference is, the expat women in Puerto Rico, and eventually myself, were preparing for birth in a location far from their families, and in a culture where patients aren’t encouraged to question their provider. And they were doing all of this in a Spanish-English mix, which made conversing with clarity more difficult for both them and their provider.

In June 2012, when I discovered I was pregnant with our first daughter, I was excited to visit my OBGYN. I was anxious to find out what the hospital would offer as far as prenatal classes, mother and baby friendly practices that supported breastfeeding, and rooming-in with my new baby after birth. What I quickly discovered after my first visit was that these things were not standard practices in Puerto Rico. Not only were they uncommon, they were practically unheard of on the western side of the island where I was living.

Anjelica outside her home in Puerto Rico.

While I was not heavily immersed within the mom community, and I only knew a handful of mothers who weren’t from Puerto Rico but had delivered on the island, one day I was invited to walk with a group of moms along a beach path. At this time I hadn’t shared my baby news with anyone and was simply navigating these new waters with open ears and lots of internet searching.

As we walked, one woman began to share about her birth in the metro area—the same place I was likely to give birth. She explained how she had meant to have this amazing doula at her birth, but for some reason wasn’t able to have her there. But she had a friend who used the doula’s services and raved about the monumental difference it made to have her with her and her husband during labor. She recommended that if I ever became pregnant while in Puerto Rico, I should reach out to her.

Of course I quickly looked her up and within just a short amount of time, my husband and I were scheduled to meet the renowned Rosemary—the doula that I now hold in sacred admiration.

Immediately upon meeting Rosemary I realized that having an empowered birth in Puerto Rico was possible, but we needed to prepare and equip ourselves well.

Over the next few months, Rosemary took us through birthing-abroad bootcamp. Her training center (a.k.a. studio space) was filled with aromatic oils and birth balls. The walls were lined with construction paper scribbled with birth affirmations across them. Most importantly, the whole place exuded a warm air of unconditional love.

In her tiny studio, Rosemary helped my husband and I talk through how we would handle the separation that would come when I immediately checked into the hospital. In the hospital I was to deliver in, all women are placed in a communal triage room upon check in, with other laboring women. Women stay there until labor has progressed enough to need a delivery room. No doula, no husband, and no support people are allowed there. During that holding time, my husband was to go downstairs and pay for our private recovery room. Without this, he’d have to leave soon after the birth and I’d be left in a recovery room with a group of other moms who’d also just given birth.

Rosemary also explained to us how she would give my husband the “eye” if she spotted scissors ready to perform an unnecessary episiotomy, something still widely practiced on the island. She gave us many more tips that helped prepare us for by delivery.

Anjelica with her doula, Rosemary.

On the day I went into labor, Rosemary arrived with her game-face on. She held a café con leche in hand for my husband and had nerves of steel for the nurses that would try and shove her aside as she supported her client (me) who was refusing to lie still in the bed, demanded to walk, pee, and seek refuge in the bathroom.

Even though it had its challenges, birthing in Puerto Rico was one of the very best things to ever happen to me. Really! Before that time I didn’t know the variety of ways in which all women need support that resonates with their culture and lifestyle when preparing for and experiencing childbirth.

I’m not sure I would have learned this without being in a situation that pushed me to find my own advocate while living in Puerto Rico.

That birth experience, followed by my second baby delivered on Guam, helped me to conceptualize what a supportive, personalized, women’s wellness practice could look like. And thanks to Rosemary that day, and her training in the months before, we had a positive experience that has established my belief that every woman—no matter where they’re from or where they live—deserves to be empowered to make the decisions they believe are best for their body and their baby.

About the Author

Anjelica Malone is the author of Milk Boss 101: The Modern Breastfeeding Journal and Guide. She is also a Certified Lactation Educator Counselor, birth and postpartum doula, and a Childbirth Educator serving women in the Seattle area, where she lives with her husband, two Little Women, and their mini-dachshund, Aoki. Visit www.AnjelicaMalone.com to book her services or read her blog, A Global Tribe of Women, which focus on encouraging women to embrace their passions and equipping them to navigate motherhood in the way that’s most natural to them. Instagram: @AnjelicaMalone