Tuesday, March 10, 2009

Stay Put Baby

No riding on bumpy roads. No spicy food. No long walks. We can't have this baby quite yet.

Well, we could. I'd just rather not. There's nothing like being 35 weeks prego and re-starting the search for an obstetrician!

The very first doctor we went to see was not a good fit for us. The minute we sat down with her she started talking about when I could schedule my c-section and at the end of the appointment she instructed me to not eat - that I had plenty of extra weight on me as it was and I didn't need to gain anymore with pregnancy - so, naturally, I should stop eating. (Not uncommon advice apparently as my friend (who is quite active, in shape, and not at all overweight) down in Rio received a similar suggestion of meal skipping from her first doctor.)

So when we went to visit the second doctor, we went in with a nice long list of concerns and our preferences regarding labor and birth. From the very beginning, we've wanted a very natural,
drug-free, knife-free birth (so long as the pregnancy was healthy and all that, of course.) The first consultation we discussed our very specific wishes at length with the doctor and she assured us that she had no problem with any of it and even suggested her preferred hospital for our birth. It seemed quite perfect.

During our consultation with the doula we want to use, she encouraged us to really talk frankly with our doctor and make sure we're on the same page. We assured the doula that we had spoken with our doctor at length about our desires and she was on board. We were then warned that "she might say now that she won't do a routine episiotomy, but when it comes right down to it, the episiotomy rate for most doctors here is seriously like 99%."

So last Monday we took a copy of our birth preferences/birth plan to our doctor. I had worked really hard to get it all written out in proper Portuguese (given that our doctor doesn't speak English and probably none of the hospital staff will either.)

As she started reading, her eyes got big. Now please note that none of this should have been new. This was all stuff we had told her we wanted all along. And all along she would tell us there was no problem, she loved natural births.

And then she started in on why our wishes were impossible:

- Did you know that 99% of women require an episiotomy? That our bodies won't allow a baby to born unless we're cut? (Silly me, I thought that my body was designed for childbirth! And she just gave me a blank stare when I told her the things I've been doing to help avoid needing an episiotomy - I'm pretty sure she'd never even heard of such things.)

- The hospital she so emphatically suggested when we told her what we were looking for? Hmmm, now she says that me wanting to be free to move around during labor is impossible there - I'd have to stay in a bed. (But I can lie on my left side if I don't want to be on my back. Oh goody, now there's an exceptional set of options!)

- Not wanting an epidural? Oh, well, that's okay with her. She'll just give me a series of locals to numb me up real good. What?!? I don't want to be numb? But, that will hurt!

- I don't want my membranes to be artificially ruptured or Pitocin routinely given. Unless there is some medical reason to speed things up, I want things to progress on their own. But, but, but, you could be in labor over 10 hours! (Well, yes, this is my first child. I fully expect to be in labor much longer than that!)

- Eric with me at all times? Well, probably there won't be any room for him in the pre-birth area where I'd be laboring. But he can certainly come into the operating room to watch the birth. And oh, yeah, by the way, all births must happen in the operating room.

I swear, for a moment there I thought I was planning a birth in 1962. I knew before getting pregnant that Brasil has a really high elective c-section rate (as high as 90% in some private hospitals) and that "normal" births tend to be very medicalized and with tons of routine interventions. But, I was encouraged when I found a group in BH that is promoting and trying to educate women and doctors on more natural alternatives. And I really thought I'd found a doctor who was on the same page! (And it should be noted that I have no issues with epidurals, enemas, episiotomies, and the sort, if that's what you want or if it's medically necessary. But I also believe that my body was designed for birthing-babies and I personally don't want needles and scalpels unless a problem arises! Childbirth just really doesn't scare me. *I'll get back to you in April regarding whether or not I should have been afraid. hehehe)

Anyway, our doctor went on for at least 20 minutes explaining why she couldn't help us with the birth we wanted. Nevermind Eric and I had talked to her about each of these points specifically in the past and were always told that it was no problem at all! (I hate to generalize, but this has really been the typical experience for us in dealing with people here. No one will ever tell us that they can't do something. The answer is always "yes" until it comes right down to the wire or you really push for honesty. Just one example: after our crib hadn't been delivered within the 30 days we were promised, we called. Turns out they were expecting the shipment that day! (They said.) The next two times we called we were assured it would be delivered "tomorrow". A few weeks later, we had our crib.)

In the end, after seeing everything in writing (and I guess finally deciding that we were serious), our doctor told us if this is what we want, then we really should find a different doctor. Lovely.

So we got a referral to a couple doctors that our doula routinely works with, and we've got appointments to meet them. Over the weekend we went around visiting several different hospitals and the lone birth center in town. (The birth center is by far our first choice now, but they only have 5 rooms and they stay pretty full, so we're going to need a back-up plan.)

And so therein lies our current quandary.

Sort of related: I dreamed last night that I was giving birth squatting in the corner of a thatched-roof hut somewhere deep in the jungle with a medicine woman and surrounded by an array of monkeys, mosquitos, and malaria. It was kind of a nice dream. But then again, I've always really liked monkeys.

21 comments:

Pacifica said...

Can your doula serve as a midwife? If she can, do a home birth and use the hospital or birth center as a backup. My sister-in-law has had 4 kids at home and will have the 5th around April 9th.

Emily said...

Our doula doesn't do anything medical, so that's not an option. But at least one of the doctors we're going to see does attend homebirths as well as working in hospitals - it's certainly an option we're considering too!

Fernanda said...

Emily, I stop by in your blog sometimes...I'm so sorry you've been through all this in the last minute. Hope everything works out with the new doctor!

Jill said...

Oh, Emily! Though I haven't been through the labor/delivery part of becoming a mom, I understand last minute bumps and challenges!

I'll be praying for direction and peace while you wait.

Lori - Blondie in Brazil said...

Oh wow. I'm so sorry to hear you are having all these problems! I'll keep you all in my prayers. I'm sure everything will come together when it is time.

DRL said...

Oh no! I wish you luck with the third doctor. I was thinking of not doing a birth plan but I think I might have to do something now!

AcesHigh said...

I think it will be easier to convince a brazilian doctor about delivering a baby the natural way, than convincing a brazilian girl to do that. There is no argument in the world that can convince my girlfriend about natural childbirth over c-section. I already gave up. (also, a woman will hardly accept MEN trying to convince them about something "they will never experience the pain".)

Corinne said...

Somehow I am not surprised. The doctors stay with you throughout the entire labor process (at least mine did) and since they have other patients, this may explain why they just consider it "normal" procedure to speed it up (in my case a separating of the membranes and Pitocin, not that I minded, the whole process from water breaking to birth was about 6 1/2). In the US where the doc comes in only at the last minute and you are monitored by nurses, perhaps there is more flexibility about taking your time (since it is not the docs time you are taking :). Also, there is a lot of confusion between "parto normal" (vaginal birth) e "parto natural" (drug-free birth). Most people just think vaginal birth when you say parto natural, unless you really spell it out for you. My experience with my OB/GYN when I talked about a natural birth (I had no intention of having one, just mentioned I had bought the hyno-birthing book and was practicing some breathing techniques), is that those people are off their rockers and NO WAY would she be a part of something like that. It is possible that your doc didn´t think you were serious and would OF COURSE change your mind. This is no excuse, however.

Good luck with your new search and when you look at hospitals ask VERY specifically about the pre-labor area, etc. In my case it was a room with about 4 beds and a front area where all the C-sections were waiting and watching TV (while I was the ONLY one in actual labor, dealing with a Pitocin drip and enema). NO hubbies, only my doctor. Hubby was "sent for" only AFTER my epidural when we went into the delivery/operating room. This is common procedure in most hospitals, so if they tell you something different (like Eric can be part of the whole thing), ask AGAIN and ask to get it in writing. You would hate to have this revelation as you are in labor and have to be sans Eric until the last minute.

AcesHigh said...

Does anyone knows of any brazilian website/group that promotes normal delivery (uh, normal birth?)

I want to choose some texts to send to female friends and acquaintances.

Emily said...

Thanks for all the thoughts and prayers. We're not freaked out or anything, just a bit annoyed.

Our appt with the new doctor is Friday, so we should know more then.

People have been having babies for a long time (in Brasil) and it will all work out in the end. We're just sort of picky. ;)
----------------------
Fernanda, thanks for stopping by and for the good wishes!

Jill, I'd guess that you've probably dealt with a lot more bumps and challenges than we have! I can't imagine all the work that must have gone into your journey to mommyhood!!!

Lori, we appreciate the prayers.

DRL, yep, I'd highly recommend putting some of your preferences in writing and giving them to your doctor, just to make sure everybody's on the same page!

Aces High, I'd dare say you're right. I have Brasilian friends here who think I'm crazy for not having a c-section. There seems to be this idea that a "parto normal" is old technology and why on earth would anyone do that when you have the option of a c-section? No one seems to think about the additional recovery/risks involved with surgery!

Corinne, thanks for sharing your experience. I definitely think our doctor was sure we'd change our minds before we went into labor! And yes, given my preferences, we're asking and looking A LOT at the pre-birth area of the hospitals!

Emily said...

Aces,

A couple good sources:

This website has some research papers translated into Portuguese

http://www.lamaze.org/ChildbirthEducators/ResourcesforEducators/CarePracticePapers/tabid/90/Default.aspx

And this is the blog of BH's group promoting normal/natural births

http://bemnascer.blogspot.com/

Ray Adkins said...

Emily,

There was a lot of water birth ( in the bath tub )going on while we lived in Sao Paulo during the 90's.
It was all natural birth, no drugs, no surgeries and it was done at people's homes, at their bathtubs with the presence of nurses and doctor and a hospital nearby as a back up plan.
I don't know if that option would help you.
I am sure you and Eric will pull it off with no problems.
Good luck with everything.

Ray

Beth O. said...

I am shocked! I'm glad you are able to handle this so well. I had turned to Jason and told him that I didn't care where ag engineering was moving, I would not be having my babies in South America, because I would not be as patient and easy going. Kudos to you...

As a medical person... I would agree with others and go with a home birth. I have a friend who has assisted them for 30 or so years and I feel that for those who desire the natural way and can safely achieve it, this is one of the best routes.

Whatever you find to help make your decision, good luck.

Laural Out Loud said...

This is why I'm having all my babies here in the States before we move to Brasil. I just don't want to have to deal with the exact thing you are experiencing.

Gabi was supposed to be born in a birth center (I went to weeks overdue and had to be induced in a hospital). I'm a huge advocate for natural birth, and am hoping our next one can be born at home. Thank goodness you have your doula and her recommendations!

Can't wait to here how your little one enters the world! And you're right- babies are born in Brasil all the time, so no matter what happens, you should be fine. But hopefully you'll get the birth that you want.

AcesHigh said...

Woman pro c-section always have lots of stories about babies being tangled on the umbilical cord and getting lack of oxygen and future brain problems, as also other stories.

I suspect there are lots of such stories about c-sections also... they just happen to be UNTOLD...

AcesHigh said...

Thanks for the links Emily. That BH group pro natural births can surely indicate you good doctors that realize natural births, maybe they can even blacklist your previous doctor.

AcesHigh said...

sorry for the 3 posts in a row. This link describes the myths so common among brazilian women about the "dangers" or normal delivery

http://www.partodoprincipio.com.br/conteudo.php?src=mitos&ext=html

Fernanda said...

Hello, Emily
I came across ur blog through another blog and as a brazilian woman, I would like to say that I am sorry to hear that ur pregnancy experience in Brazil is not being as ideal as u probably expected, but I would also like to say to u that natural pain-intervention-free-births do happen in Brazil and it's not rare. Obviously, like u said, cesarean is a very "normal" and common way to give birth here in Brazil, but I wouldnt like u to have the impression that natural births don't happen in my country. In one of the comments above left by Beth O. where she says something on the lines of not wanting to have babies in South America, I think that was a bit offensive as it sounded that South America is nothing but a big jungle and not good or suitable enough to be the birth place of babies which I personally find very offensive and even a bit discriminatory.
I have many friends and acquaintances who have also had doulas and had wonderful experiences in water births as well as home births with not surgical intervention. Please, I ask you, do not give people, from outside Brazil, the impression that here that's how things are done, that we are primates and do things in an undeveloped way. Many of my brazilian friends chose to have their babies either in birth centres and also at home and some, simply chose to have cesareans. I have never heard a single comment about a bad experience in giving birth naturally in my country, but you do need to do ur research with a long time in advance. If ur doctor doesnt agree with ur birth plan, that are many natural birth groups in most states of Brazil that u can contact and have more information of how to get the right help so u can have the natural birth u wish, it's just a matter to acquire the right information. Use the internet and I'm sure you will be able to find useful information but please, don't spread the msg or give the impression that in Brazil things are done in a very archaic way because this is just not true. Some people have wonderful experiences and others dont but that has nothing to do with the country they choose to give birth in, its all a matter of personal experience and being able to get the right info and making the right contacts. So many other women have had such a wonderful experience in giving birth here, in whatever way they choose, that I wouldn't like ur experience to give people the wrong idea because that would just be unfair.
About ur doctor not speaking english, I'm sure you and ur husband were aware that not everyone speaks english in Brazil and I dont think this is something that u should expect to happen. Same way if I went to live in the States and chose to have a child there, I wouldnt expect doctors and staff to speak my language. If I chose to live there, then it's up to me to learn their language. No one in Brazil has absolutely no obligation to speak english, same way that in the States no one would have the obligation to speak portuguese just so they could communicate with me. Forgive my honesty, but I think this is a very american way to think, that whole world has to speak english and behave in a way that americans expect us to behave, this is just unrealistic.
My advice is that u contact groups specialized in natural births, try to get as much info as u can and go from there.
Try to look for "parto humanizado belo horizonte" in google and u will come across some useful links such as
http://www.amigasdoparto.com.br/referenc.html

http://www.pbh.gov.br/smsa/bhpelopartonormal/movimento/index.html

http://www.partohumanizadobh.blogspot.com/

I hope u have the best experience u can possibly have in giving birth to ur baby but if after that u still think that in Brazil things are done in a very obsolete way, then maybe in ur future pregancies u should consider staying in America like ur friend Beth O. suggested.
I don't mean to be offensive, but sometimes the american way of thinking and how they perceive the rest of the world to be, based purely on their personal experiences, really does my head in and ends up giving Brazil and brazilians, a bad fame which is completely unfair.
All the best to u and ur family!

Regards,
Fernanda
(femassafera@gmail.com)

Beth O. said...

Fernanda,
I in no way meant to insult anyone. However, working in nursing, I tend to be very particular in regards to my health care. I do not have Emily's patience, nor would I have her sunny outlook after so many bumps in her road. I loved living abroad in Europe, however I know I am more comfortable with a health care system that while far from perfect, I am familiar with.

AcesHigh said...

I wonder if its possible to sue the doctor who said "ok, ok" and then in the last instant said "no way I am doing that".

Or at least denounce her to the Minas Gerais Medicine Council.

Emily said...

Fernanda:

Honestly my biggest issue is just that my doctor essentially lied to me for 6 months.

However, I have found all along that the options for a natural birth are very limited in Brasil, or at least in BH where I am. In a city of nearly 5 million, there is one birth center - it has five beds. None of the private hospitals will accept my wishes as expressed in my birth plan. The women involved in the natural birth movement here (all Brasilians) warned me that it would be difficult. I'm a pretty positive thinker though and never assumed it was this hard to have the birth you desire. Short of getting in at the sole birth center or having a home birth, you're given very few choices here.

The usual attitude towards birth is just generally a more medically-minded approach. A couple quotes from the Brasilian book, "Mamãe, papai...estou chegando!"

"Medalha de Ouro
O Brasil é campeão em número de cesarianas. Somente no Sistema Único de Sáude, 30 por cento das gestantes dão à luz através deste método, enquanto na Ingla-terra, são apenas cinco a sete por cento dos casos" page 154

Bragging about a high number of c-sections? And that's just the public system. I have seen the percentages of c-sections in the private hositals of BH. They were between 65-90%, depending on the hospital!

Also, quoted from the same book:

"A episiotomia é um procedimento cirúrgico em que é feita uma incisão no períneo, para facilitar o parto. Esta prática comum ocorre em 99% dos partos normais...os médicos incluem essa incisão nos procedimentos de routina." page 167

And never have I expected anyone in Brasil to speak English. Which is the reason why, after gathering my thoughts in English, I wrote my birth plan in Portuguese. My husband and I had private Portuguese tutoring multiple times per week for the entire first year that we lived here. While my Portuguese still isn't perfect, it's all I use in my day-to-day intereactions with people.

My apologies if I offended you, but this has been my experience. I never claim to be an expert on all things Brasil, my blog solely exists to share stories about my experiences while living in your country - a place that I thoroughly enjoy spending my time.