Pregnancy (Part 2)

You know it has been a long time since you last blogged when you forget your password, get locked out of the system, and have to reset your password through email. But I have a really good excuse…I had a baby. And for all you new parents out there you know what I’m talking about, and for all you expecting parents out there you will know what I am talking about really soon.

Now that I have fully experienced having a baby in Sao Paulo, I guess it’s time I share my experience…

Before I get into the labor and delivery process I wanted to comment on one thing that happened during my prenatal care. The OB/GYN that we chose was very good during my entire pregnancy and one of the reasons I liked her so much was that she was very current with research. One of the newer things in pregnancy is that pregnant women and their spouses should get a pertussis vaccine while the women is pregnant even if they already had the vaccine as a child. I actually already knew this from being a nurse in America but my OB/GYN also suggested it. The only problem she said was that because it is not mandatory in Brazil, we would have to pay for it.

We decided to go to the public system just to see if we could get the vaccine for free. After 30 minutes of explaining our situation to the nurse and a doctor it was no go. Our doctor was right we had to pay. It cost about R$280.00 or $140.00 dollars at the diagnostic center, we looked around for cheaper but this seems to be the going rate. In the end, I was the only one who got the vaccine because I would be giving the antibodies through my breast milk and we couldn’t afford for my husband to get it. Until this new policy is made mandatory by the Brazilian government you will have to pay.

Now on to my labor and delivery…

Disclaimer: This is one persons experience, every delivery and hospital stay is different for everyone no matter what country you live in.

My contractions started on a Saturday night around midnight. We called the doctor and she said because the contractions were irregular and bearable, that we should stay home. Three hours later the intensity of pain with my contractions grew and we were very anxious so we went to hospital Sao Luiz around 3am.

They admitted me to the labor room which was a small room with a gurney and a bathroom attached. I spent the morning there laboring with increasing pain. By 11am the pain was unbearable but I had only dilated to about 4cm and my contractions continued to be irregular and short; so in order to progress my labor the doctor wanted to start me on oxytocin. Unfortunately oxytocin would also increase my labor pain and at this point I was in tears every time I had a contraction. So I decided to get an Epidural. Prior to the Epidural my water broke and I was transferred to the beautiful delivery room where I took a whirlpool bath as I waited for the anesthesiologist which really helped with the pain.

The anesthesiologist was wonderful and explained the whole procedure (in English). After the Epidural I was much more comfortable but still able to feel some of the contractions to know when to push. The oxytocin helped with the intensity of my contractions and over the next three hours I progressed to 9.5cm dilatation. The only problem was that the baby was not descending down the birth canal.

In order to assist the baby I did a lot of walking, squatting, and bouncing on a yoga ball but to no avail. I also started pushing which I continued for the next three hours and every time they checked me, the baby’s head had hardly moved. At this point the doctors explained to me that without any progress they were doubtful that the baby could be born naturally but they were still willing to try for a couple more hours. The good thing is that until this point the baby never showed any signs of distress. The doctors left me and my husband alone and after an emotional discussion I felt that it was best that I have a Cesarean section at this point to ensure the baby’s safety.

Exhausted and drained they wheeled me into the delivery room and prepped me for surgery. I was so exhausted and sleep deprived at this point that I could barely stay awake during surgery, but the moment they pulled the baby out a sense of relief fell over me and I was so happy to see him that I couldn’t help but cry:) The doctors said that because of the baby’s size (8.69lbs) and position I would have never been able to push him out but on the bright side because I was in Brazil I was getting the best c-section in the world.

Unfortunately because I had a c-section I had to stay in recovery while the baby was whisked away to the nursery. It wasn’t for another 4 hours that I was able to see him again which caused me a lot of anxiety and I got to the point where I was going to get out of bed to go to the nursery to get my baby. But finally they brought him.

I started breastfeeding right away but it was very difficult because he would cry and get very frustrated. My husband and I stayed up all night with the baby while he cried, until finally the nurse said that I was not producing enough colostrum and that I needed to supplement with formula. Even though I knew from being a nurse that this was not the right thing to do I agreed because I was so exhausted and emotional at this point. The next day I discovered that overnight the women in the nursery were not nurses but technical nurses who go by protocols like giving formula. When I talked to the real nurse the next morning she said that I did have enough colostrum but the problem was the baby was not latching correctly, she showed me how to teach him how to latch and said that I would need a lot of patience. That night again the baby did not sleep and left my husband and I exhausted.

A couple of days later I was discharged and the real adventure began.

I would not say that my hospital stay at Sao Luiz was bad but there were definitely some negatives as well as positives, so I wrote out a simple list of both:

Positives:

  • The doctors were amazing! This is not actually a hospital positive because I chose my own doctor. My doctor, her husband (also a gynecologist), and the anesthesiologist all stayed with me for most of my delivery. There was no nurse monitoring me, it was my doctor! This would never happen in America!
  • Medical equipment and medications. All comparable to American standards. Some of the medications have different names or we don’t use in America but are all the same class of drugs.
  • Postpartum room was lovely and had a couch for my husband to sleep.
  • Food was pretty good and there was a lot of it, they brought in so many trays that we started hording food in our mini fridge.
  • All the nurses were nice but the language barrier was an issue.
  • Unlimited visiting
  • Cable TV and a channel to view the nursery if your baby is there.

Negatives:

  • Not being able to nurse my baby right after birth even though I had a c-section was traumatic and then not seeing my baby for four hours after that.
  • I was left in the OR because my husband stayed to translate and he wasn’t allowed in the recovery room and it was freezing!
  • Not having a nurse at night to help you out if you have problems with nursing.
  • Being woken up all night long by the nurses for vitals and medications. (I think that is every hospital though)
  • The architecture of the rooms make it so the sounds of the cafeteria  downstairs are so loud it seems like it is right outside your room. So again hard to sleep.
  • The language barrier really made it hard to communicate with the nurses and they seemed uncomfortable with that.
  • The hospital pediatrician was the most useless person in the hospital.
  • I didn’t like that they performed every exam and test on my baby in the nursery, so I never got to see what they were doing to him.

That about sums it up. All in all it was an okay experience, my hope is that this information is helpful to someone else out there.

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Pregnancy (Part 1)

When my husband and I decided to get pregnant with our first child in Brazil, we made sure that we had several things in place before embarking on this new journey. My husband is Brazilian and knows the ups and downs of the healthcare system and although Brazil has a public healthcare system; one of his priorities was to have a good job with healthcare insurance because the public system is still lacking in many ways. So as you read my experiences keep this in mind; this is only one person’s perspective of Sao Paulo’s healthcare system.

After only a couple of months of trying to get pregnant I missed my period. My first instinct was to go get a home pregnancy test but my husband said they were really expensive and it was best just to go get my labs drawn because our insurance covers such costs. So we went to the lab and had my blood drawn. A couple of days later it was confirmed; I was super pregnant. Our next mission was to find a doctor. My husband’s sister had lived in Sao Paulo for several years and her OB/GYN spoke english and was well-educated; so we decided to go to her.

We are very lucky because Dr. Zuzanna is an excellent doctor. She spent an hour with us on our initial consultation and even preformed an ultrasound at only 8 weeks. She answered all of my questions about food and even told me about a Brazilian lotion she used to prevent stretch marks (Payot). She prescribed me prenatal vitamins and educated me on what to expect in the several weeks to come. We also talked about the fact that I would like to have a “natural birth”meaning that I don’t want an elective cesarean section.

C-section rates in certain cities in Brazil (including Sao Paulo) are very high. In some private hospitals they are as high as 90%. For several reasons there has become a culture within Brazilian society for woman to want to have c-sections. One reason is convenience, for both the doctor and the woman, other reasons include: doctors get paid more for less time when performing c-sections, doctors pressure patients to have c-section, and woman are afraid of pain associated with labor. Unfortunately, the culture of c-sections being safer and less painful is really a misnomer. There is a very good article on HuffPost online about this very subject http://www.huffingtonpost.com/2012/08/11/brazils-women-rebel-again_n_1767972.html.

Since my initial consultation which Dr. Zuzanna, I have had several labs drawn and two morphological ultrasounds as well as ultrasounds during every appointment. I definitely feel that our doctor is doing a thorough job in following my pregnancy. I do have to go to an outside lab to get my blood work done but this was not new to me because in the US I would go to an outside lab as well. I have read other blogs where people are annoyed they can’t get all their blood work done at the same office.

We have been to two different labs here in Sao Paulo; the first one we went to wa s Delboni Auriemo Medicina Diagnóstica which was very good but a+ Medicina Diagnóstica was just around the corner from our apartment so we decided to try them. A+ lab was less crowded but when it came to giving us my password to get my results online, we had to wait for a half our because they couldn’t figure out how to put a foreigner in their system. Needless to say we went back to Delboni.

So far being pregnant in Brazil does not seem that different from being pregnant in the US despite minor differences. As things come up I will be happy to explore even more about the child rearing experience in Brazil.