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So I’m crazy (about natural births)

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But mostly I’m crazy in the eyes of most doctors in Brazil.  Since my husband is ever so sympathetic (sarcasm), I thought a Doula would be wonderful.  She could help inform me about what positions I should move into so I can help the birth move along, massage in the right spots, and generally keep things happy and moving a long. BIG Doula fan here <<——

I AM EMILY…

So I went through the list of Doula’s in Sao Paulo, and emailed them in Portuguese in English searching for an English speaking Doula, and found two.  Raquel Olivia and Cris Toledano.  I also found GAMA and Ana Cristina a midwife (who from readings seems to be the other English speaking popular expat midwife in Sao Paulo other than Marcia from Prima Luz).  They told me that I needed my doctor’s approval… um okay that’s kind of weird… this is my birth, I can have whomever I want right?! ha, this is Brazil everything is mandated by some obscure law.  In fact in 2006 they passed a law saying hospitals had to allow a woman the right to have someone with her. Random right?  Albert Einstein in fact allows Doulas up until the birth part, and then they cannot participate.

So I had a list for my doctor on what she would let me do about natural (when I say natural she hears vaginal I’m sure).  I generally got the impression from the answers that my doctor has one idea in the back of her mind, and is totally happy telling me everything she thinks I want to hear… my husband says I’m a crazy hormonal, paranoid pregnant woman…. maybe, we will see.

Here are my questions:

  1. Can I have a Doula? I only work with Midwives (that’s the Brazilian way of making it hard on me, and the short answer is no).  Marcia Koifmann was out of town, and Ana Cristina only delivers at Sao Luiz… So meeting my doctor’s midwives at my next appt.  Good thing I have super expat insurance.
  2. How many days over can I go? 10 days over, and I have to meet with her ever 2 days
  3. If my water breaks how many hours before I have to be induced? 12 hours
  4. Do I have to stay in bed during labor? Only if i get an epidural (I think she missed the natural part)
  5. Mandatory fetal monitoring? Only after epidural, otherwise every 15
  6. Can I eat once admitted? Yes eating and drinking until you get the epidural.. again with the epidural.
  7. Enema? Nope
  8. Can I keep the baby with me after birth?  30 minutes of bonding time, and then 4 hours where neither you or the father can be with them other than looking through a glass window!
  9. What tests and procedures are done? Vitamin K, Hep B and TB, hearing, and genetic blood test
  10. What do you put in the baby’s eyes? Silver Nitrate, and regular antibiotics are not an option… for the record the US switched to antibiotics like 10 years ago…tho Sao Luiz said something about lasers???
  11. When will you show up? When you are 7cm.  Midwife when you get to the hospital.
  12. How will you bill us? We will quote you up front, then send you the bill after birth and you have 1 week to pay it all, then submit to your insurance for reimbursement
  13. What about the baby pediatrician? If you can get the neonatalagist to sign off on it and take responsibility should something happens, sure (again Brasilian no there).
  14. How long is the hospital stay? 2-3 days (google translated link here from Einstein showing a 3 day package)
  15. Does that increase with C-section? Nope- 3 days.
  16. Will you wait to clamp the cord if I want? Yes
  17. Do I have to use stirrups and lay on a surgical bed? Umm yes it’s the only way. In fact, she looked at me like I was speaking Chinese…. yes people you can deliver a baby in other positions. Like maybe I want to stand on my head or something, heck if I know what I’ll feel like, but I don’t want to be told I can’t… I’m a bit stubborn.

The reality is my husband is not into natural births.  He thinks I’m a granola eating nut job.  I’m actually doing hypnobabies home study right now, so we’ll see how effective that is… and yes maybe I’m a nut job. But my mom had 5 kids naturally and said it was no big deal…. so I’ve got to be able to do this.

I have to say after the above conversation I am even more invested in making sure I have this birth 100% natural.  There’s now a level of stubborn pride attached to this whole birthing in Brasil adventure.  Either way, I’m not meeting all of her Midwives (4 of em, 2 speak English, and one REALLY speaks English), so hopefully my paranoia will dissipate.  The first Midwife pointed out that all of the women in the public hospitals have babies naturally. . .

*UPDATE* I get a lot of questions from individuals on this, so I assume like me it is a hotly Googled topic.  Deleting cleaning up some of my old files of baby prep in Brazil I found the following links on natural childbirth that I found useful … and hope you do it.  I left in Google Translate to English for everyone’s convenience.

About scrubgrub

I'm just another soul on the internet, posting random thoughts into the ether, because well I love stumbling on other peoples random thoughts, so I figured why not add mine to the mix too. I'm also the mom to two very funny little boys, and how can you not share that with everyone?

20 responses »

  1. Yeah- I was gonna say that public=natural and breast feeding. lol.

    Reply
  2. You can do it! It’s worth the fight to have the kind of birth you want. I had a c-section with my first, then a VBAC at the hospital, then a homebirth. Of course this was all in the US, but it was SO worth it to fight for my VBAC. I wish that it wasn’t so hard for women to have babies. We’ve been doing it outside of hospitals, without c-sections, without interventions for all of history. Maybe things can change in Brasil…

    Reply
  3. What about episiotomies? I heard they just do them all the time down there. Its one of the old things they used to do the US frequently and now don’t really use it that much anymore only when baby is really big.

    Reply
    • I’ve still got to ask that, but as I am using a midwife I’m waiting to ask that part to them, to see if they can’t help out more on that end, as episiotomies are fairly normal here

      Reply
  4. you need to be really clear that you want a “parto natural” not a “parto normal”. Parto normal is vaginal birth, which are common in the public hospitals. Natural births (without pain meds) are NOT common in Brazil, even in the public system. I did not intend on going without the epidural, but mentioned to my OBGYN towards the end of my pregnancy that a good friend of mine did. She made it perfectly clear that she thought that idea was crazy and she would never be the doctor for that kind of birth. That said, she was very encouaging of vaginal births. So, when you see your doctor make sure you tell her “sem remedios”. You would hate to find out her policies when you are already in labor! I had an American friend here in BH who had to switch doctors at 7 months because, even though she was explicit about natural birth the WHOLE time, the doctor finally understood she was serious and told her he would not do it.

    Also, I have no way to know if the procedures I had were the norm, but my water broke before I was having contractions (had had a strong round of false ones the night before) and my doc sent me straight to the hospital. Once there, she ruptured my membranes, sent hubby up to the room to wait, gave me an enema and a pitosin drip. I was in a labor room (a commom room with lots of beds (in which I was the only one in labor) and a bunch of women (maybe 5) watching TV waiting for their C-sections. My doc was with me the whole time (but hubby was not allowed) and we waited for the anethesiologist. I was dilating pretty quickly and we had to wait about 45 extra minutes for the epidural. At which point I was a good 7cm. Right after the epidural, hubby came down because we were ready to go into delivery (at my hospital hubby could only be present for the moment of delivery). The doc gave me an episiotomy and the anethesiologist was laying across my belly pushing the baby down (apparently this is a common practice in Brazil to apply pressure on the top of the belly to move the baby down). Once my kid was born I was super groggy from the meds and only could hold him for what felt like a couple of minutes. It was a good 4 hours before I got to see him in my hospital room. He stayed with me during the day (I came in Thursday am and left Sat am), but they took him at night. My labor was fast (water broke at 8:30am and kid was born at 1:20pm). It was very obvious to me that doctors are very in charge of your progress and are definitely not in favor of letting nature take its course. Sorry for the long post, but there seems to be little effort by doctors to give you details of what exactly will happen during birth. You ask and you get a “don´t worry, it will all be fine” kind of an answer. No wonder most Brazilian woman I know choose a c-section out of fear. They don´t get any info about what is going to happen.

    Reply
    • I have heard a lot of similar to the above, but I am truly hoping my doctor is somewhere in between the extremes, as she seems to be pretty good about saying we shouldn’t do a C-section. I’ve got a month, so I want to continue to have the clarifying convos with her over the course of time. No one is pushing on my stomach… I don’t care what I have to do.

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  5. I like to read your blog. I’m not a doctor, but I’d like to give you an unsolicited advice. I beg your pardon, but what about letting the Brazilian doctors play the way they are used to do? São Luiz and Einstein are the finest facilities in São Paulo, probably well above the American standard. If you want a Brazilian birth, don’t try to make it the way it would be done in America. You risk they won’t know what to do! Let they do what they’re best at.

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    • Well if the doctors in Brazil would stop performing unnecessary procedures such as c sections, and episiotomies, and silver nitrate etc etc, Then we wouldn’t be having this discussion. And I am sorry not trying to offend but Albert Einstein is not better than US hospitals.

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      • yes silver nitrate is one that I just don’t get. Considering how smart Brazil is about other things. Silver nitrate is just cheap. It irritates children’s eyes, and is not as effective as the antibiotic ointments used today at killing of STDs… so not sure why they haven’t considered it at all.

    • Jenner appreciate your thoughts; however, while both hospitals are definitely wonderful in terms of many things, and probably most of all security, there are practices that are culturally part of Brazil. Many of the things I am asking for unfortunately not even all of the US (as I think Europe is probably ahead of us even) does. The practices that I’m looking to do are those recommended by numerous well respected medical studies. Even WHO has recommended that some of the Brazilian practices need to change, and I feel like there has been an effort to change this. As for not knowing what to do, the only thing I’m risking by requesting no medicine is their time… a baby still comes out the hole at the end of a tunnel🙂

      Reply
  6. Your gut feeling is right regarding your doctor´s practice. Basically expect a standard normal birth, legs in stirrups etc. If you´re fine with that, that´s fine.
    If you do actually want a natural birth, I could give you some referalls.
    Also there are pediatricians who go to the birth and don´t give the baby silver nitrate etc even if that´s standard procedure. Let me know if you would like referalls!

    Reply
    • This is all so interesting, I had no idea what silver nitrate was until I googled it. Yikes! Andrea, I would love some recommendations. I am not quite there yet regarding having a baby right now, but I would like to start with a doctor in the beginning that understands I want natural birth well before I am even pregnant to prevent what Corinne was describing. Thanks –

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    • Andrea, I would love to get your referrals too!!

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    • I’m an American just moved to Sao Paulo and would also like your referrals. I’m 29 weeks pregnant and very concerned about the interventional approaches here for birth. I’d like a natural birth with as few medications or interventions. I believe the birth is a critical time for the mother-baby connection. Please help me if you can!

      Reply
    • Dear Andrea,

      I am german and recently moved to Sao Paulo. Do you have any recommendations for doctors or hospitals in SP which favour natural births? Any tips regarding that matter would be very helpful!
      Thank you!
      Anna

      Reply
      • Anna,

        I just moved here in December from Basel (CH) but am American and have spent a lot of time searching for natural birth options in Brazil (as I’m due in April).Here is a list of “humanized” doctors that might be a good place to start. I also know the most famous humanized physician in Sao Paulo is German so he maybe able to help you (all my medical documents are in German so I had to find a doctor with Portuguese-German-English language skills). http://criandogente.wordpress.com/2010/06/25/profissionais-da-parto-humanizado/ Dr. Kuhn is the German MD I was mentioning on this list. If you search for doulas in SP you may also find good references from them. Pro Matre and Sao Luiz both looked like good options in SP if you would like a hospital – otherwise there are a number of good birthing centers with midwives (my husband would never go for this). Hope this is helpful! Best of luck to you!

      • Hi Emily,
        thank you so much for your answer! The list is super helpful and now I am more confident that everything will work out.
        Thanks again!!!

  7. Please feel free to get in touch with me directly: aa.prado@uol.com.br

    Reply

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