Tuesday, 29 May 2012

The women's rights thing

"Female infanticide is the intentional killing of baby girls due to the preference for male babies and from the low value associated with the birth of females.

So this happens frequently here in India.  A baby girl is not so useful.  It's actually illegal for a Doctor to reveal the sex of one's baby during pregnancy.  I was so culture-clueless last week when I met a young pregnant Indian girl.  My first question was so western...."do you know what you're having?"  She reminded me that she can't know.  In fact, we wanted to be surprised about the sex of our twins.  There are so few pleasant surprises in life, we relish them.   The Doctor asked us if we wanted to know the sex, but we declined.  I guess the whole flying around the world and paying a big chunk of money to have a baby indicated that we would welcome either a boy or a girl into our family.  Or in our lucky case, both!  

It's not so easy to understand.  Obviously there are vast differences in how women are valued across class.  We are meeting modern, self-assured women.  Our new friend is very confident and strong.  She is very lucky, at 35 and unmarried, she could be a financial burden on her family.  But, because her family is wealthy, she is not forced into a marriage she doesn't want.  She is allowed to stay with her parents and brothers families.  But all is not equal.  Her dad divided his riches between his two sons.  So now, she relies on the kindness of her brothers to buy her an apartment, a new car.  I don't pity this woman.  She is happy and fortunate to live a life without too much pressure put upon her.  That is her reward: low expectations.  But shouldn't she be treated as an equal child of her father?  Why should she be dependent upon the kindness of her brothers to buy her a car?  You know they buy themselves Audi's and she gets a Fiat.  They chose when to give her money, so yes, they bought the apartment, but no they didn't renovate the kitchen.  They control her life by deciding what they will and won't support financially.  Yet, she is happy and fortunate to live such a life.   

Our nanny decided to leave her husband, based upon his philandering with her "sister".  I was impressed by the strength in her conviction.  She decided within 24 hours that she would divorce him.  She is financially supporting her extended family, so has the confidence an income can provide.  But now, she relies on her brother to be the man in her life.  Yesterday she told me that she needed to go buy more traditional Indian clothes.  Now that her brother is the man in her life, she must obey.  I don't think her brother even has a job.  How can he tell her how to dress when she supports him?  

On the other end of the spectrum, there is the hospital where our babies were conceived.  This hospital and fertility clinic is run by Dr. Naina Patel.  Dr. Patel is a force.  She has had a major impact on her city and is renowned throughout India as the premier fertility specialist.  Her husband abandoned his medical practice to work with her.  He clearly plays an important, yet supporting role in her practice, preparing the legal and bureaucratic paperwork.  There are many doctors and nurses working in the Dr. Naina Patel hospital, but not one is a man.  

For me, India is sometimes a relief.  The men don't even see me.  Matteo orders the meals, pays the bills and asks for directions.  I am invisible.  Sometimes, it's a nice break.  But I think I am lucky to have been born where I was.  

The "alleged" father

One of the hoops we had to jump through in this international surrogacy road was proving that these babies are ours.  We are passing US citizenship through parenthood, so we need to prove that they are in fact our kids genetically.  When searching for the DNA testing center near us, I discovered that there are but a few we could choose from.  There is a certification process that only some testing centers have completed to qualify for this purpose.  Apparently DNA testing for international surrogacy is a small fraction of all the DNA testing done in the US.  Monday's are their busy day.  Lots of weekend drama makes Monday's busy for the DNA testing folks.  I hoped we wouldn't need to call from India on a Monday.  The process is a bit demeaning as every time I call, they refer to my husband and sperm donor as the "alleged father".  I feel like I'm on the Jerry Springer show.    


We've been here just a week now.  We have no idea when we'll be leaving, as it's all up to the US consulate and DNACenter.com of Fairfield, Ohio (more on that later).

We have a friend who helped us make arrangements for a hotel here in Mumbai.  Mumbai is a bustling metropolis with really expensive 5-Star hotel options, so a friend really comes in handy.  There were many cryptic text messages and emails from Reshma leading up to our visit.  She kept referencing "the club", saying that we would really love it as there were many things to do there like swimming in the pool, playing cards or working out in the gym.  We weren't really sure what this club was, nor was there any way to google it.  We were out of our comfort zone.  In the days of researching online, we usually make educated choices about travel and everything really.  Reshma kept saying, "don't be too American", meaning let it go, let me host you, don't try to control everything and keep me at an arms length.  So, we went with it.  The challenge is that her "club" only has about 20 rooms and it is highly in demand.  Our travel schedule kept moving, as it still does.  It was impossible to know when we might be cleared for Oliver and Camilla to fly.  So our first three nights in Mumbai were spent in the "club" of a colleague...the NSCI--National Sports Club of India before moving.   Now we're staying at Reshma's club--the Malabar Hill Club.  This one is much nicer. The location is fantastic, on top of the hill, in one of the highest end neighborhoods in Mumbai.  The club is reasonably priced, has a great room with decent restaurant, pool and gym.  It seems that real upside to the club is the bar.  Drinking isn't really widespread here in Mumbai, but apparently it happens behind closed doors at the club and members stop by every evening.

We have been adopted by our new friend Reshma, who, out of town our first night in Mumbai, arranged for her boyfriend to take us to dinner and give us an evening tour of the city.  She is all encompassing and has engaged us fully.  India is a group culture and we are in one now.  We have met Reshma's family, visited her favorite stores and restaurants and see her every day.  Her life is really different from ours and our mutual discovery is enriching our experience.  Reshma is the only daughter of a successful businessman who started in the textile trade.  She has two brothers who have extended the family business to include wood flooring and antiques.  She is a warm, effervescent, open woman who deserves more time later.

Our first morning in Mumbai, we headed straight to the US Consulate at the Banda Kurla Complex about 45 minutes north of downtown.  We were early for our appointment and struck by the high level of security.  The machine gun stations with sandbags surrounding the complex is always a little jarring, but this is Mumbai which was victim to the major terrorist attack last year at the famous Taj Hotel.  We were the first people in line, 20 minutes early for our appointment, hoping to get the process of getting home kickstarted.  I had spent hours preparing the paperwork:  legal copies of our surrogate contract, records of prenatal care for the babies, Indian birth certificates, hospital records and releases, statements that our financial records with the doctors were up to date, copies of our passports and visas, marriage liscence, stella's birth certificate, Matteo & my birth certificates, Matteo's US Naturalization document, tax records and W2s for the last 5 years.  I'm sure I must be forgetting something, but the list is long.  I hoped that my organization and preparation would smooth the way in this arduous process of bureaucracy.  It wouldn't be so.  While we were praised for being diligent, we were also told the process wouldn't all happen today and to expect a few weeks.  Ugh.  We had prepared for the reality that we would likely have to match the babies DNA to ours, so were tested already in the US.  After applying for the CRBA--Consular record of birth abroad--for Camilla and Oliver, we would have to have 2 DNA test kits shipped from the US to the consulate in Mumbai.  Upon its' arrival we would be scheduled for another appointment.  I tried in vain to have the testing center mail the kits before our appointment with the consulate, but they refused.  We needed the formal letter requesting such a test before they would ship it.  We monitored the shipment every step of the way.  Fedex from Ohio to Indianapolis to Paris to New Dehli and finally to Mumbai.  It was signed for at the consulate on Saturday at 12:38pm.  Not too bad.  We jumped on the phone Wednesday morning and now here 4 days later, it has arrived and we have tracking information.   We were feeling optimistic.  Until we called the consulate.  Closed Monday for Memorial Day, Closed Wednesday for an Indian Holiday.  DNA testing only happens on Tuesday & Thursday afternoons.  The kit, while in the complex takes one or two days to get to them.  They will call me back when they have it.  Doomsday.  She actually said it would be next Tuesday.  So we'll be sitting in Mumbai for 2 full weeks waiting for the damned DNA test kits to arrive.  I keep calling back, hoping by some small chance of luck that we can get sqeezed in on Thursday.  After the babies are tested, it will be another 2 weeks here as we wait for the results from the US and for the passports to be generated.  Then two days for the Indian Visa.  It looks like we'll be lucky to be home by June 14th.  

In the meantime, we are so happy we brought Maloa with us to Mumbai.  She gives us the freedom to sleep and see some sights during the day.  Mumbai is a really big city with a few sights.  We have visited a few of them and will see more before leaving.  We are struck by the huge gap between rich and poor as Mumbai has much wealth.  The skyline features the most expensive single home ever built anywhere...a staggering $300M USD.  The home has a maintenance staff of 300 for it's 4 residents.  Yet, while visiting temples, we see the huge population of poor and disabled begging for a penny.  We have eaten dinners in 5 star hotel restaurants where the bill was $100 and we have eaten in small, local spots for $3.  We are paying our full-time, live-in nanny $20 per day, yet having pre-arranged viewings in art-galleries where the going price for a painting is $40,000.  It's hard to absorb the contrast.  

It looks like we'll be spending another week in Mumbai.  The monsoons come in June, so I guess the upside is we'll experience a bit of that.  I look forward to seeing the rain clean the layers of dust and filth away.  We thought about heading south to Goa for a little respite on the beach, but the threat of monsoon season and some caution travelling unnecessarily with the twins held us back.  For now, the journey continues.

Saturday, 26 May 2012

The trip to Mumbai

On Monday, the twins were cleared by Dr. Anita to fly to Mumbai.  We had scheduled an appointment at the US Consulate in Mumbai on Wednesday morning, so had planned to fly on Tuesday.  We reassured the doctor that we were bringing our nanny, the fabulous Maloa, with us, and that we were spending a week, to minimize the travel impact on the babies.  Camilla gained almost 100 grams in 3 days and was above her birthweight.  Oliver gained less, but was still gaining.  He has been vomiting a bit after eating, so now is taking Domperidone every 6 hours.  Great news.  Our long journey home begins now.  

The next 24 hours brought lots of organization and planning.  We bought our tickets to Mumbai online.  We have been impressed with how smoothly some things work here in India.  When Matteo's credit card was rejected due to fraud protection, within one minute his phone rang.  The online booking agency was ringing him to help him complete the transaction.  That would never happen in the US.  Tickets bought, we moved on to hotels.  We advised the Rama of our departure and contacted our friend in Mumbai to help us book accomodations in Mumbai.  We packed our things, sent Maloa home to do the same and said our goodbyes.  We are planning on coming back through Anand on our way home, so this is just a break.  

Tuesday morning was a bit chaotic of course.  We inhaled a quick breakfast and headed over to the clinic to say our emotional goodbye to Kailash.  Then the car service picked us up and we were off to the airport.  Not without drama, the driver was late & needed gas.  For an 11:55 flight, we arrived at the airport at 11:20.  I was panicked we'd miss the flight, but as things go in India, we were just on time.  Our carry-on bags were a big drama, over the limit by 2-3X...7kg is nothing!  We had to check our most precious belongings (not Oliver & Camilla thank God) and hope for a safe arrival in Mumbai.  The hour-long flight to Mumbai was a breeze and the airport was so modern.  First impressions are Mumbai is very cosmopolitan.  We fetch our bags and gather our thoughts.  The cutest old lady can't believe we have twins, this small.  She asks her son to take our photo together.  The whole family jumps in and blesses us.  So sweet.  

We head to the Mehru car service desk.  This is the air-conditioned option.  You set up an account with your mobile number, call the car, and they come to take you to your destination.  It works so smoothly.  Again, an utter surprise.  We book the car inside the airport;  by the time we use the restroom the cellphone is ringing.  Our driver is looking for us.  We are sent a text message with his liscence plate, name and phone number.   That was easy, now to the hotel.   I'll save that part for tomorrow.     

The point & counter-point

We were having a conversation the other night with a local Mumbai-ite or Mumbian...not really sure what the proper term is.  He was unsure of surrogacy and brought up the adoption point.  There are SO many children in orphanages here in India...why bring another baby into the world when you could give something back to someone in need?  This is a valid point.  We agree and would love to take in an orphaned child from an impoverished nation.  We considered it seriously and opted for surrogacy because we aren't sure our family is ready to take on a child who has spent time in an orphanage.  These kids need lots of love, attention and time.  While there are no guarantees with children, biological or adopted, the likelihood of there being issues is almost certain with an adopted kid.  We both work full-time.  We already have a child.  We aren't sure we have the resources or the family situation in place to take on a kid who has spent his or her first year in an orphanage.  The systems put in place to protect children do sometimes cause harm.  This is the tragedy.  

This gentleman also made the point that if he was an intended parent, he wouldn't necessarily want his child in the womb of these surrogates.  Much better if it was his happy, balanced, healthy wife.  Again, agreed.  I would have loved to have been pregnant, unfortunately, that was not an option.   Matteo made the counter-point that Indian's of his class are raised very much by household help.  Everyone has nannies.  Why is it that the womb is so precious, but the minute the child is born, the nanny is an adequate substitution for the mother?   

The conversations continue.  

The money and the goodbye

The premise of surrogacy is that one exchanges money for a service.  What price should one pay to the woman who births one's children?  How can one put a price on the life of their kid?  That is an impossible question, but one we must answer.

One of the reasons we opted for surrogacy in India was the impact the money could have on the life of the surrogate.  We are told that her fee compares to 8 years of her husbands potential earnings.  When we started this whole process, it was very important to us that our surrogate walk away feeling positive about the experience.  We felt a tremendous responsibility to the community in Anand, but more importantly to our future children to make sure that we did this right, with respect and dignity.  We found a way, through an acquaintance (now friend...more on her later), to provide gifts to Kailash throughout her pregnancy.  On trust alone, we sent a chunk of money to someone Matteo briefly met, on the promise that she would intermittently help us send desirable treats to our surrogate.  The first treats arrived to much excitement.  Dried fruits, biscuits, nuts, saris, and a gold chain.  Our surrogate was the talk of the house!   She was one of the lucky ones with a generous family sponsoring her pregnancy.

When we arrived in Anand, we went to see Kailash immediately after seeing Oliver and Camilla.  She was sore from her c-section and recovering in bed.  Her sister-in-law Daksha was with her and we  shared a few moments together.  Fairly soon after our arrival, Kailash started asking for food.  She wanted some nuts and dried fruit.  Then she wanted some papaya..every day.  We obliged.  Sending the runner out for nuts, searching all over town for the papaya.  These were simple delights that were easy for us to provide.   We started to see a pattern.  The day after buying 3kg of dried fruit and nuts, they mysteriously disappeared from Kailash's room.  We bought her whatever she wanted to eat, but we never actually saw her eat any of it.  Was she sending it home to her family?   She couldn't possibly have consumed all that food.

At 9pm one night, a knock on our hotel room door revealed Kailash and Daksha, stopping by for a quick visit.  We were a bit perplexed, the twins were still in NICU.  It was awkward to find them dropping by when we were already in bed.  We couldn't really communicate, so called our friend for some translation help.  We gave Kailash the gold jewelry that we bought for her and tried to talk as best we could.  Daksha offered to babysit if we needed help once the twins came  home.

A few days later, when we hired Moloa as our nanny, Daksha was furious.  She yelled at Moloa, feeling that she had stolen her job as nanny.  Even though she had never been a nanny, nor had any experience with premie's, she felt that she deserved the job.  Now we understood, we were the money train.  Daksha continued to show her displeasure with our choice of Moloa as nanny.  She berated her at every opportunity and looked miserable whenever we interacted.  We were hoping Daksha could facilitate the running of the breast-milk to the babies every 2 hours.  Instead, she proved difficult at every turn;  one day delivering, the next disappearing.  Finally she just said that she wanted us to pay her something for the service.  At that point I was done, we would make do without Daksha.

Another night, another knock on our door.  All the other families staying at the Rama can't understand what's happening, it's like a party in our room every day.  They don't get visitors, why do we have so many?  This time, Nirmala.  We have no idea who she is and why she is here.  She comes in, sits down and tells us that she runs the surrogate house where Kailash stayed when she was carrying our beautiful babies.  She tells us that Kailash ate the food she cooked.  She is not so subtly asking for some kind of financial recognition.  Everybody wants their cut.  I can't help but wonder who will show up tomorrow.  

At some point, I get mad.  How is it that everyone is continuously asking for something?  I don't want to give anything anymore..on principle alone.  But then my husband reminds me that these people have nothing.  This woman who carried our children is going back to her village to earn 20cents a day.  The poverty line in India is 28 rupees per day.  That's roughly 50 cents per day in USD.  I can make her happy by buying a papaya every day.  And who cares if she sends the $30 of dried fruit home to her family?  Her kids have never been able to indulge in such riches.  The point is to make her happy.  

There is an impossible divide between the Indian surrogate and the intended parents.  In our time here, we have seen both ends of the spectrum.  One American mother tries to bond with her surrogate, spending the last months of pregnancy here in India, treating her like family long after the children are born.  We see the husband continue to ask for money from this woman.  To us, it appears that the woman is willing a relationship to exist that doesn't.  She is naive.  On the other hand, we have seen most families make a small (sometimes meager) gift to the surrogate or their children.  They aren't so careful to make sure that the surrogate feels appreciated and they don't consider her feelings.  Their focus is on moving forward, past the surrogate days and onto their lives as new parents.   We carefully walk the line in the middle, ultimately knowing that Kailash feels positive about her experience and us.   In a few years, when we explain our actions to our children, they will be the ultimate judge.

We said goodbye to Kailash on Monday.  We gave her a cash donation that we felt would feel significant, as well as lots of photos of her with us and the babies.  We also gave her a small gift for Daksha, who was back in her village.  It was an emotional day.  We all cried.  There is no value on the gift she has given our family, no amount of money, neither dollars nor rupees that is appropriate.  It is priceless.    

Sunday, 20 May 2012

The heat

Today was the hottest day I've ever felt.  44 degrees celcius or 112 F.  It is a humid heat.  A heat that takes the power out intermittently in the afternoon.  Living in fear of a power outage when I'm trapped on a crowded elevator, I take the stairs in the heat.  I've stopped wearing my contact lenses.  The minute I step outdoors, they dry out.  Indoors, the air conditioning dries them out.  I wonder what Indians do about it?  They can't all wear glasses?  Tonight we took a rickshaw across town to a fancy dinner.  It had to be over 100 degrees at 8pm.  The streets are full of people.  All day long they are holed up inside their homes, lounging around, minimizing every effort in the heat of the day.  Night comes and they take to the streets.  It's so hot I feel claustrophobic.  There is a heat-induced panic attack lurking just below the surface.  I remind myself to just breathe.  It feels like there is an elephant sitting on my chest.  Impossible to take in air.  The monsoons come in a few weeks.  These are the hottest days of the year.  

At breakfast, a nice man from Jaipur was sitting with us.  He was complaining about the heat.  He comes from the north, the desert in Rajasthan, where it is a dry heat.  Even he is complaining.  It sure is hot. 

The nanny

Similar to the concept of a runner, the nanny is a must-have in Anand! With our daughter Stella, we did everything ourselves. We've actually been fortunate enough to have never hired a baby-sitter let alone a nanny.  Upon arrival in Anand, we were constantly asked, do you have help? We proudly said, no. Yet, the doctors were semi-reticent to release our own children to us without this described "help". After a few days in NICU, the brutality of the two-hour feeding cycle with twins set in. We could do it, but it would be hard.  After talking to a few families and nurses, we learned more about the nannies. Yet another branch of the cottage industry of surrogacy. One can hire a nanny for either a 12 hour schedule or 24 hours. The going rate is 500 rupees per day per kid. That is $10 per day in US dollars. We thought, $20 a day to have someone who would cover the nights to let us sleep and also be available the rest of the time to work as needed? Are we idiots? Sign me up! Now I've got to find a good one!

Sandiya (favorite NICU nurse) recommends a sweet looking Bengali woman named Maloa. Hired!  No background check, no CPR training, but I call her the baby whisperer. We've spent 5 days together and I can't imagine living without her. She is really, really good with newborns. And our little guys are small. I love being a mama, but truth be told, I enjoy the 5 year old kid way more than the newborn phase. This is a lot of work x 2. The payoff will come later. A little (or a lot) of help makes a difference. She gives sponge baths, massages them with coconut oil (they smell like almond joys), changes diapers, washes clothes, covers all the night-time feedings and some of the daytime feedings. Maloa is here with the babies so we can go out to dinner. Thank god, we need some escape from this hotel room. She sleeps on a mattress on the floor about 3 feet from our bed. It's pretty close quarters and we considered getting a second room. Unanimously, people thought we were crazy. How could we monitor her attention to the wee ones? We didn't want to be the outliers.  So here we are, one happy family of 5 in an 18'X12' hotel room 24x7.  My good friend Tina asked about our room.  She had visions of the English Patient, with a soft breeze blowing in the curtains.  Tina has such a vivid imagination:)  Oh how I wish for some of that romanticism.  This is a practical business hotel..the only frill is the fridge in the room and HBO.  Check it out:

Maloa came here from Bangladesh with her husband for his job. He has had some health issues, kidney stones, which have precluded him from working the last few years. To support her family she was a surrogate twice. Then she started being a nanny for families who need help here in Anand. She tells us of a family from the Bay area that she worked for for 3 months; they are trying to sponsor her to come to the US, but her visa was rejected. They must have really loved her. She is supporting her family (2 kids, boys 8 & 11)and very proud of her work. When she first came into our room she asked where everything was; still in suitcases. She unpacked all the baby gear, organized our situation and took over. Matteo retreated to the lobby, forced out. The first day Maloa covered all the basics. I kept reminding her that we had managed not to kill our daughter, and thus were not completely baby-ignorant. It was more than a little annoying.

The first night was kind of strange. We slept fitfully since Maloa was on the phone (yes, 3 feet away from our bed) and had all the lights on. We told her she couldn't be on the phone and only one side light could be on. Seriously, is this how it goes? Not working for us. How could this woman have been so highly recommended? The second night, Maloa woke me at midnight and says she has a problem at home and needs to go. Oh no. We were on our own. Maloa returns at 8am and appears upset. But so are we. This thing does not appear to be working. Is she a flake? Around noon, Maloa starts opening up. There is a woman she calls her sister; she is not genetically related, but good friends from Nepal. Maloa brought her here to Anand to live with her and her family.  She introduced this woman as her sister to help avoid the local gossip and character assault, since she is a single mother.  Recently there had been turmoil in Maloa's house, as her mother and brother accused her husband of sleeping with her "sister". Maloa defended her husband and told her family to back off---move out if they had to. Last night, Maloa found them together. Her husband was having an affair with this woman, her supposed sister. She was devastated. Betrayed not only by her husband, but also her "sister". She had cursed her family, not believed them when they warned her of her husband's philandering ways. They wouldn't forgive her. I held her for long time, wiped her tears, cursed the bastard until her mom came.  Her family is supporting her of course and counseling her to stay with him;  her children need a father.  She points out that he isn't a very good father--never home, favoring the daughter of his lover.  She is divorcing him.  All around the world, people look different, seem different, but we're all the same. Babies need the same things and so do we.

A few days later, Maloa is a little distracted.  She runs out to meet with the lawyer.  She takes a 3 hour break to play with her kids.  We are happy to give her the time to do what she needs to do.  We are paying her but $20 USD per day.  Even if she just covers the nights for us, we're still lucky to have her.  Now that I'm used to having Maloa around, How will I live without her back in Lafayette? Maybe we should stay here in Anand until Oliver and Camilla are sleeping through the night???? I am half serious when I say this.

Matteo is helping her build a website.  Anybody need a Bengali nanny?  

Saturday, 19 May 2012

The runner

India is an interesting place. The first days we spent checking things out, organizing our little world. Figuring out out local sources for things we need like the steam sterilizer (for baby bottles), papayas (good for breast milk production), cell phone sim card and battery...the list goes on. It was exhausting running around in the 115 degree heat like crazy people, until we learned about the runners. After all, labor is readily available in India. Our runner is named Dinesh. He came highly recommended by a friend in Mumbai. It works like this: we call him, he comes to us at our hotel. We tell him what we need, he gets it and brings it back. Sure he adds a little markup, but boy is it convenient. We had a cellphone in need of a battery and a SIM card. Dinesh appeared in our hotel lobby a few minutes after we rang him. A few hours later he was back, the phone fully functioning with a 70 rupee prepaid card. He charged us 100 rupees, which also included the battery and the running. That was the best 30 rupees I've spent this week....for all of your reference 30 rupees is roughly 60 cents in us dollars.

Our surrogate wanted some fruit. Dates, walnuts, cashews and papaya, and some coconut water (i guess the craze made it here too:) Now this brings up another point. Why is the doctor not providing the foods my surrogate wants to eat? It's not like she's asking for truffles and cheetos. Thus stuff is good for you and she's breastfeeding. Of course we'll buy it for her. After spending an hour searching all over the city for a papaya, we called in some help. Voila, magically Dinesh appears with all the goodies, sparing us again from the heat.

We need a hotel in mumbai. No use booking that online, we have a few people on the ground working on our behalf.
Everything here is done the way we used to do it. We talk to people. It's kind of refreshing.

Friday, 18 May 2012

The pumping

Everyone knows...la leche has been very successful. getting the message out.  Breast is better.

Well, my breasts don't have any milk in them.  I barely had enough with Stella and this time, there's no chance.  Kailash does have milk in her breasts and I want it.  Camilla is just 4 lbs.  She needs it.  Oliver, well, he'll just have to make do with Similac.  Part of the surrogacy contract requires Kailash to provide breast milk for 15 days.  After that, we can have more, but we need to negotiate the details.

The first days in NICU, before we got here, I'm not sure what was happening on the breast milk front.  I think nothing.  Then I asked for it and Kailash started pumping.  She was transferred 2 blocks to the hospital where the NICU was located for ease.  I asked her to come down to NICU to pump every 2 hours, but somehow something was lost in the Gujarati-English translation.  She did come, but only when my bossy nurse Sandiya called her down for feeding time.  Love Sandiya!   This was the easiest time for milk collection, yet somehow we were still just hitting maybe 4-5 pumping sessions per day....when the babies are eating 12 times.

I realized I needed to be managing Kailash and telling her what I wanted.  I erroneously assumed someone else directed her to pump every 2 hours and to deliver that milk to the babies.  When we brought the babies back to the Rama, things got even worse.  Now the milk needed to be delivered down the street.  And the pump needed to be sterilized.  Kailash is back at the Dr. Patel hospital where she gave birth.  Every 2 hours, we need to fetch milk from Kailash and bring the pump back to the Rama for sterilizaton.  Then the process begins again.  Back and forth and forth and back.  It was so much easier when I could just lift up my shirt.  I feel like a drug runner, or a gerbil on a treadmill.  I'm almost ready to quit, but working on finding a runner to pay to do the back and forth.  Everything can be outsourced in India.   

The husband

Today I met the husband of our surrogate.  He was spending a few hours visiting with Kailash.  Again, suffering from the inability to speak Gujarati, I could only move my arms around like a fool trying to mime my message.  He was so referential.  There is a strong class and caste culture here in India and I'm sure I'm in a different class than he.  I couldn't help but wonder how he felt meeting me.  He gave me his chair and didn't really make eye contact.  I tried to thank him.  He let his wife give us this gift.  She bore my children.  She couldn't have done it without his acceptance and support.  At the same time, this is a traditional society.  I wonder how he feels about his wife being pregnant with another couple's child?  I wonder if he tells his friends Kailash is away visting family, rather than telling the truth?  I wonder if he feels inadequate that she has to do this to support the family?  So many questions, but a giant gulf between us.  

The surrogate

Rent a womb, that's basically what surrogacy is. At it's core, it is two women helping each other, or bartering. One wants a baby, but can't carry one, while another can surely carry a baby, but needs money. On the surface it is straightforward, but look a little deeper and complexities abound. We are all human after all.

Our surrogate was chosen for us by Dr. Patel. Her name is Kailash and like most surrogates here in Anand, she is from a poor village outside of the city. She is a mom of two kids, a ten year old girl and an eight year old boy. I just saw their photos today--they are really cute. The surrogates who become pregnant here leave their families for their entire pregnancy and are put up in one of two houses managed by Dr. Patel and her staff. From my perspective, hopeful mama, it sounded great. I had every assurance that my babies would get all the nutrients, vitamins and pre-natal care they needed. I knew my surrogate was passing her days munching on snacks (probably spicier than the root beer floats I consumed every day of my pregnancy), watching Bollywood movies, and gossiping with another 30 or 40 pregnant women in her same situation. India gave me relief from wanting to call my surrogate every day, from wondering if it was her car in the pileup on the 880. I knew a world away she was insulated. Insulated from her daily chores, hunger, and stress, but also (here's where it starts to get complicated.....) isolated from her community, family and home.

One of the requirements to be a surrogate is that the woman is already a mother.  While this validates that the woman can bear children, and it ensures that the woman will not likely feel a pull to keep our baby, it also means that her kids must spend almost a year without their mother.  I couldn't imagine that, but I also couldn't imagine much of the hardship of her life either.  Complicated, right?

All of the women who chose to be surrogates for Dr. Patel's clinic are married with children.  They need the full support of their families to do this.  In India families live together multi-generationally, so the whole family supports the effort of the surrogate.  The husband must also be in full agreement and sign legal contracts to that point.  In our case, the sister-in-law of our surrogate (her name is Daksha) was the enabler of the surrogacy.  She heard about it, brought the idea to Kailash and convinced her brother (Kailash's husband) that it was a good idea.  For all of this effort, her family benefits financially and she gets a "finders fee" from Dr. Patel.  India's economy is based on this cash "finders fee".  The wheels are greased constantly---another topic for another day.

There was an article on the cover of the paper today (The Times of India) about surrogacy.  It described how most surrogates use the money they have earned:  31% buy a home, 28% clear a debt, 20% invest in savings or financial securities, 11% pay for education of their children.  I guess, this is probably pretty similar to what American surrogates do with their earnings.  Comparing the impact of the money on an Indian surrogate's life with the life of an American surrogate, it seems that the Indian experience is more life-changing.  Many of these women are rebuilding their lives with the money they earn as surrogates.  At the same time, some are exploited and in the most tragic cases, some die.  When considering surrogacy in India, we asked ourselves if we were taking advantage of the poorest of the poor.  This is the big one.  Really complicated.  I'm sure some people in our family disagree with us, but, in the end, we didn't see a big difference between India and the US in this respect.  Money is the motivator.  As long as we were honest and respectful, we thought we could help Kailash improve the quality of life for her and her family.  Nearing the end of our journey, I think this is still true.  That said, my story has a happy ending.  Thank God I'll never know how I would have felt if it didn't turn out so well for us & Kailash.

In comparing Indian surrogacy with surrogacy in the US, I was attracted to the forced distance in our relationship.  In the US, I could imagine hanging out with my surrogate on a Friday night, watching movies and eating root beer floats.  We'd be besties...but then she'd deliver my baby (or babies) and what?  Would we stay friends?  Would we vacation together?  Would my kids know her as surri?  Would she feel a "special connection" with my kid?  Did I want that?  It could get awkward, fast.  Kailash and I don't speak the same language.  She wanted to hold the babies and we let her.  We took a bunch of photos together and will give her some prints before we leave.  We smile and try to communicate, taking advantage of a translator whenever we find one.  We really have tried to treat her well and with respect, but we aren't best-friends.  I don't have her cellphone number and if I try to send pictures of Camilla and Oliver as they get older, I've heard they won't realistically get to her.   I think she's happy she helped us.  I think she is happy to be going home soon to her family.

Medically, this surrogacy business is complicated stuff, and this clinic is high volume.  There are shots and medications, lots of ultrasounds, likely twin pregnancies, likely c-sections.  We considered how it must feel for Kailash.  Does the doctor really spend time explaining what she's doing, why she's taking certain drugs?  I don't know Kailash's education level, but am certain it's low.  I'm sure there is not a lot of time spend on educating her about fertility and pregnancy.  Is she treated like a cow headed for slaughter? Even if I treat her with respect and dignity, does my doctor?   It's so complicated.

Anybody have any thoughts to add?

Thursday, 17 May 2012

The perception

It's hard to understand how these people here in Gujarat think about Dr. Patel's clinic and the idea of surrogacy. It is for sure big business and not highly regulated in India, for now. Anand is not exactly a tourist destination, so the locals all must know implicitly that we white people are here to get a baby one way or another. When they're not trying to run us over with their motorbikes or rickshaws, locals on the street greet us with a friendly wave or smile. Matteo and I were not sitting together on the flight from Doha to Ahmedabad (lucky me, upgraded:). Separately our seat mates asked us why we were going to Anand. I answered honestly, to no response, while Matteo averted the question. It's hard to know how to navigate our situation is a conservative culture, where my dress always seems to be too revealing. We have mostly encountered those who work in businesses that benefit tremendously from this "baby-business". Here at the Rama, the drivers, runners, nannies, lawyers, doctors, they all seem to be accepting and happy to participate in our journey. The Rama is expanding, constructing another floor of rooms which could surely not happen without Dr. Patel. The workers who benefit from our "baby-tourism" are happy to be of service and don't shy away from the reality of the babies arrival, nor the complicated relationship with the surrogate. The city seems quite middle class, missing the abject poverty we witnessed in the New Delhi and Rajasthan. People seem to be making an honest living, supporting their families and generally pretty happy.

Wednesday, 16 May 2012

The logistics

Anand is the milk capital of India, reachable by flight from Mumbai in one hour and just over an hours drive from at the Ahmedabad airport. Landing in Ahmedabad in the middle of the night was an experience. Imagine. It's 3am local time and the line at customs is 200 people deep. It seems like a strange time for 3 flights to land simultaneously, but we wait. The airport is new, just built 2 years ago and I am struck by how modern it feels compared to my memories of New Dehli. There is a fountain inside and the sound of cicadas chirping fills Immigration control. It is hot, must be above 90. The crowd around us as we wait for our bag is energized, no jet lag in this group. We are magically blessed with priority tags on our bags, so head outside to find our driver. Again, it's now 3:30am. There are loads of people lined up outside the airport waiting to greet their loved ones, at least 500. There are people hanging out in the parking lot, sitting in a patch of grass. I am keenly aware that it is the middle of the night, but I don't think these people care. It's hot and I guess nobody has to get up for work in the morning????

We are staying at the hotel closest to the hospital where our kids are, the Rama residency. It's clean and close and just fine for our needs. It is an interesting place in that most of the guests are couples, like us, staying here as they fetch their newborn children. Some are cycling through rounds of IVF with Dr. Patel, hoping to have kids either with or without surrogacy. Every possible scenario can be found here at the Rama. There are couples from the US, Canada, Australia, Nigeria, Japan and many from other parts of India as well. I'll save her clinic details for another post, as it is a story by itself. It's strange to meet people from everywhere, some close to us in SF, most of whom we have absolutely nothing in common with, except this one huge thing. We have come half-way around the world to have a baby (or babies in our case:). We all live almost exclusively in our rooms. It is baking 115 degrees outside. Walking to the hospital mid-day we feel the heat radiating up our legs from the asphalt. We all hide in the sanctuary of our semi-sterile, cool hotel rooms. We bump into each other at breakfast in the hotel, in NICU, or in the office of Dr. Hitesh solving problems. We ask about each others babies development and condition constantly, sharing in the celebrations when each baby comes home to the Rama. While many babies are born here (i heard 3 per day), only some are in NICU. The days we spent there with Oliver and Camilla serve as a reminder of how lucky we are after all.

We are a little horrified by the unanimous avoidance of Indian food. We are here in India, happy to indulge in Palak Paneer, street-side samosas, Chana masala and exquisite mangos for every meal. Yes, I can understand that the spicy lentil soup for breakfast may be a little much for some of us, however I will not cave to the crazy. Most of our compatriots are eating corn flakes in their room for breakfast and Dominoes pizza for dinner. As aliens, one would think we would gather and share more of the experience together. If only for a bar, coffee bar or lounge. There is the cool hotel lobby and sometimes we hang out there for a quick chat with passers-by, but we long for a late night card game or something more.

The first days in nicu

Every day looks better than the last. When we first saw our little ones in nicu, we couldn't help but be moved by how small they looked. Oliver was 2.6kg or 5 lbs 12 oz. Camilla was so much smaller at 1.8kg or 4lbs 4 oz. At first we were told they were doing well, just off oxygen and would need to be in the hospital for 1-2 weeks. They weren't yet sucking from a bottle, that was the next big milestone. Their condition was a bit of a surprise to us since we had been told they were fine. We didn't even know how much they weighed until arriving at their bedside. It was frustrating and more than a little unnerving to fly half way around the world to get to our newborn twins while not knowing the smallest details of their arrival into the world. That night we changed all of our travel plans, assuming we'd be India for longer than originally planned. Then, Surprise! In India just when you think you have a firm understanding of what's going on, it all changes. At 10:00am the next morning they were both drinking from a bottle. We held them and fed them much of the afternoon. Camilla needed a little time under the lights to combat her jaundice. We could see the end of this long road appearing closer. The doctors and nurses in nicu were encouraged and teasing out of us our parental fortitude. Should they really trust us with these two little angels? Were we prepared for the grueling 2 hour cycles of one hour plus for the foreseeable future? Had we arranged a nanny to help us out here in anand? Were we prepared to sterilize in our little hotel room and did we know how to make formula? With each feeding sandiya (the head nurse in nicu) trusted us a little more. Toward the end of the day we are told we can take them home in 2-3 days. Sunday passed much like saturday, but now they say we can bring home our babies tomorrow! Scrambling yet again, we moved all our travel plans. Sandiya is one of the few in nicu who speaks english. While english is the national language of india, gujarati is spoken here. Sandiya is small with a vey big presence. She reminds us of my good friend wilma, commanding everyone around her and controlling everything. We love her caring for our babes. Monday morning arrives and we have a meeting with the neonatologist Dr. Anita. We really like her. Where dr. Patel is, similar to most other fertility specialists, a marketer exploiting a business opportunity, dr. Anita is a doctor in the truest sense, caring truly for her patients. We learn she is passing through the bay area in June with her husband and daughter who are also doctors. They are spending two days in the East Bay with a family whose daughter was born at 26 weeks and spent 3 months in her nicu. We are happy to invite her to dinner when she is in town, assuming we'll be there by then:). Our hotel situation seems a little insecure for the next two days, so we decide to leave the babies in nicu for one more day. While most of our focus has been on Oliver and Camilla, we still need to deal with legal and paperwork issues. Dr. Hitesh, who is dr. Patel's husband is the documentation man. While in his office organizing the Indian birth certificates, we bump into a film crew from south Korea. They are doing a piece on surrogacy for korean tv and want to follow us around, ask some questions, meet our surrogate and our babies. We are going to be famous in Korea! Tomorrow is a big day, we are bringing our babies home! To celebrate, we invite Sandiya and her family out to dinner. We are in a vegetarian zone, but Sandiya has been raving about a certain chicken at this local restaurant. We convince her to let us take her out to dinner with her husband and young son. At 8:30, she knocks on our door and we are off. Over dinner, without the constant beeping of nicu alarms and needy babies, Sandiya tells us her story. She was orphaned and raised in a catholic hostel with her five brothers and sisters. She had an American sponsor who paid for her education. He asked her what she wanted to study and she chose nursing. After an arranged marriage, she moved here to anand and applied for the job in nicu at Dr. Anita's hospital. She is a very impressive young woman and hearing her story reminded us of how much difference one can make in the life of another. Her sponsor saved her and she is fully aware of that fact. We will not soon forget Sandiya who cared for our babies before we could.

Monday, 14 May 2012

The journey

The journey is long. SFO to franfurt 11 hour flight With a 3 hour layover At 10am local time, indulge in the last beer for awhile. And a few sausages:) Frankfurt to Doha, quatar 6 hour flight. Then a quick 1 hour connection. Doha to Ahmedabad 3 hour flight. Arrive in India at 3am local time 28 hours after leaving 202 Anderson street for the last time. We arrive at the Rama hotel 1 1/2 hours later at 5am. Here we are.

The call

It's Monday 5/7 7:00am pst and from the bathroom upstairs I hear matteo answer his phone. I think it's strange that he's speaking English at this early hour and not the usual Italian. Oh no, I feel a pit in my stomach and the adrenaline starts running as I hear him say "oh, hold on, let me get jenn". The babies were born last night! It's a a boy and a girl. They are fine. Quickly the chaos ensues. Two days later we'll be on a plane. In retrospect those days were insane. Rebooking flights takes hours. We run the last trip to the new house in Lafayette. We are moving from 202 Anderson street in bernal heights to the burbs, the land of great public schools! When we leave this house to pick up our twins, born at 34 weeks to our surrogate in Anand, India, it will be for the last time. Home is now 790 Los palos manor in sunny Lafayette. Stella, our 5 year old daughter, comes down with a fever and is vomiting. We debate the cause of this unfortunately timed illness: is she so upset about the twins, or really physically sick? As her condition worsens, we realize she must be truly ill. How can we leave her with her nonno in this condition. For the first time I am feeling the parental pull....who needs me more? My sick 5 year old whose world is in turmoil, sleeping in an empty bedroom (all her beloved books and toys in lafayette) or my newborn twins....just one photo proves their existence? At the same time, having urgent meetings with painters and real estate agent to coordinate last details to get this house on the market. One quick trip to the office and pediatric urgent care clinic later and we are on a plane. We are on our way to our family of 5.