A ward of plenty

Anthony Gauci was just grinding into a U-turn on Salam Street when he heard his wife, Juliet, yell, "Stop!" from the back seat of their Camry. It was just before 5.00am on Aug 25, and Juliet was about to give birth. With the hospital still a few hundred metres off, Anthony gambled and hit the accelerator. Five men were smoking on the hospital steps when Anthony zoomed up a minute later. They watched as he dashed out of the car and gathered up Juliet, a brunette in a long nightshirt who shuffled a few steps and then stopped. As Anthony tells it now: "Before you know it, whoosh!"

Anthony just managed to catch his newborn daughter before she landed on the pavement. As the smokers watched in shock, a swirl of midwives and doctors materialised in the car park, cutting the umbilical cord and ushering mother, father and daughter inside. And with that, thanks to Anthony's press of the accelerator, Leilani Sophia Gauci became one of the 900 or so babies born that month at the Corniche Hospital.

The Abu Dhabi International Airport ranks easily as the busiest port of entry into the emirate. But with some 11,000 new arrivals every year, the Corniche Hospital may qualify as a distant second. A dedicated maternity and women's hospital, the Corniche has presided over the births of Sheikhs' and guest workers' children alike for the past 30 years. But now, as Abu Dhabi's plans for reinvention proceed apace, the hospital's future is uncertain.

The Corniche is a beige, four-level building situated off Salam Street, just behind the five-star Sheraton Corniche. It was founded in the 1970s at the behest of Sheikh Zayed's wife, Sheikha Fatima, who insisted that the historic expansion of medical facilities under way at the time should include a hospital dedicated to women. A splashy new hotel was requisitioned and converted to suit Sheikha Fatima's request. Originally designed to resemble a falcon in flight from the air, the hotel was not exactly built with medical efficiency in mind. And so, in 1988, the current, 235-bed hospital building was erected in its place.

Since then, encouraging large families among citizens has become a matter of public policy in the Emirates, where numerous incentives to bear children reflect a looming demographic anxiety. (Expatriates flood into the country every which way, but Emiratis, with few exceptions, must enter by birth.) Hence the Corniche Hospital's mission relates at least tangentially to the project of "Emiratisation".

But the hospital also serves a huge population of expatriate women - expectant mothers of over 100 nationalities who happen to be in the Emirates when it comes time to give birth. For many of these women, marooned away from family, the hospital plays a surprisingly large role. Maha Noor, an Egyptian journalist, found herself pregnant with her first child in Abu Dhabi last summer, away from the support networks of extended family and old friends. She enrolled in several classes at the Corniche - on childbirth and parenting, on keeping fit during pregnancy. "They reassured me," she says. "I didn't know anything. My family's not with me. Because I am alone, I needed to arm myself with every possible thing."

Over the course of all those classes and checkups, she says, the Corniche came to feel like a home away from home. Sometimes, after her appointments were over, Noor says she would linger in the waiting room for a while - just to be among other expectant mothers. Noor is not the only isolated expatriate who has felt this impulse. My own wife, who gave birth at the Corniche three months ago, says she sometimes did the same thing.

Birth is one of the most common human experiences, but it is also an event that is as intensely private and shrouded in custom as any other. Hence, midwives at the Corniche wind up becoming accidental anthropologists - casually familiar with the various cultures surrounding childbirth. "Say somebody had a baby in Egypt," says Kay Fraser, an Australian midwife who left the Corniche this month after working there for 13 years. "They would use a lot of drugs in Egypt. But then you look at somebody like a Sudanese woman - she is not going to use an epidural. She wouldn't think of it."

Fraser, who gave birth to two of her children at the Corniche, says she has also been able to watch as regional attitudes towards birth have changed over the years. "When I first started working here, you didn't get many UAE men that would go in the delivery room. But you're starting to see more of that," she says. Men are allowed in delivery rooms for labour and birth at the Corniche, but are relegated to a special men's waiting room during antenatal check-ups and exams.

The jostling of cultures and sensibilities is a running theme at the Corniche. Modesty may brush up against talk of empowerment and openness about the body. Midwives from South Africa, Fiji and the Philippines mix with those from Scotland, Germany and Lebanon. And in the oddly intimate moments of labour and recovery, the different groups and classes of Abu Dhabi brush up against each other. One of the more unique features of the Corniche is its Royal Suite, where Sheikhas may recover after giving birth. Fraser recalls walking into the suite once while it was occupied. An interior designer had been flown in from Europe just for the occasion. The newborn's apparel was by Christian Dior, and the congratulatory flower arrangements incorporated fish tanks and live birds.

However, while Sheikhas may recover in the Royal Suite, even royalty usually give birth on the normal delivery ward, where they could be labouring down the hall from anyone. The last birth Fraser attended as a midwife at the Corniche, for instance, was with a Pashtun taxi driver's wife, who spoke not a word of English. Plans for the hospital's future are up in the air, but changes seem likely in the next months and years.For 30 years, the Corniche operated under a British administration. In September, it was taken over by the Abu Dhabi Health Services Company, or SEHA, which will in turn hand the Corniche over to Johns Hopkins Medicine, an American institution, in the coming months.

Some say that a switch from British to American management could signal a transition that strikes at a contemporary debate about childbirth. In Britain, something called the "normal birth movement" has gained traction in public hospitals. The basic argument is that birth is a normal and not a medical event; hence midwives should oversee most deliveries, and doctors need only get involved when there are complications. Medical interventions like labour induction, epidurals, episiotomies and Caesarean sections should be kept to a minimum, "normal" birth advocates say, because one intervention tends to cascade into others. The Corniche more or less follows this model of care.

In the US, however, midwives and the normal birth movement have much less of a foothold. According to the standard American model of maternity care, doctors preside over births, and close medical monitoring - and often intervention - is seen as the best way to manage risk. The Corniche reports that 16 per cent of its births end in a Caesarean section. The American C-section rate, by contrast, was 31 per cent in 2006. "I can understand how there might be this concern that, if it moves from a British model of care to an American model of care, the intervention rate might increase," says Gillian Smith, the director of the Royal College of Midwives in Scotland.

Smith is quick to add that Johns Hopkins is one of the most respected names in medicine in the world. And Fraser, the departing Corniche midwife, says she is optimistic that much about the hospital will improve under the new management. The hospital has faced a bumpy road recently in its attempts to keep up to date; it only computerised its day-to-day operations - including medical record-keeping and appointment booking - this summer, a transition that put extra strain on the Corniche's struggle with a heavy patient load.

That heavy patient load, however, stems largely from the hospital's long-standing good reputation - and from the relative scarcity of maternity care in Abu Dhabi. (United Eastern Medical Services, an Emirati private company, just announced plans to open a new, 300-bed maternity and paediatric hospital near the Maqta Bridge by 2011, indicating more options on the horizon.) When I wrote to the Corniche's new administrators to ask how the hospital's emphases might change, they responded that it was too soon to say. "At the moment, SEHA is in a transition phase with the Corniche," wrote SEHA's manager for corporate marketing. He went on only to confirm that the Corniche "is a venerable institution, fully accredited by the Joint Commission International, and one with a strong connection and sense of responsibility to the community".

The other day, Fraser and a few other midwives were sitting around, mulling the future of the Corniche, and trying to figure out how many children had been born at the hospital in its years of operation. They guessed it must be near a quarter of a million. Of those, Fraser says, more were born in the hospital car park than you might think. Right after Anthony and Juliet checked into hospital following their dramatic birth on the pavement, Anthony suddenly realised he'd left the car wide open outside. So he rushed downstairs. On the front steps, he ran into the five cigarette-smoking men who had just watched in shock as Leilani dropped into the world.

"It was like I had five of my mates waiting for me," Anthony says. "They were high-fiving and giving me handshakes and putting their arms around me." One of the men was a Kuwaiti husband whose wife was facing complications four months into her pregnancy. Another was an Emirati whose wife was in labour. A Pakistani taxi driver came up and said he nearly videotaped the birth with his mobile phone, but then thought better of it. The suddenly gregarious crowd began volunteering names for the baby, clapping Anthony on the back all the while. "They were just so genuinely with me on it," he says.

Listening to her husband recount the story one evening five weeks after the event, Juliet paces their living room, bouncing Leilani in a sling. The newborn has just fallen asleep, and Juliet speaks softly. "The boundaries dissolve when you have a baby," she says.