Pregnancy Conundrums

So.... how long does labour and delivery take?  Not so long, right?  It is amazing how much time it has spent in my thoughts the past week.  It is weird to wake up and feel like I've been thinking about it all night long.... and not very restfully!

Anyways, I had some disheartening moments yesterday, as we explored "Hospital Alley" in Recife.  Let me tell you, there are probably 20 hospitals within a couple of kilometres of each other (actually I just read that in the greater metropolitan region of Recife there are 417!).  Some private, some public, some for specific specialties.

Our doctor gave us his price for a normal birth which includes his team of nurses.  Then he gave us the names of two hospitals he likes to work out of, which you also pay for separately, mostly just for the room and board, forgoing the possibility anything out of the ordinary happens.  Then he also gave us a price for a pediatrician, which we will need for our baby, and then also a price for an anesthesiologist, just in case.  I'm not going to lie, it was slightly more pricey than anticipated.

We researched the two hospitals online and found that one of them barely did any normal births, so we scratched that one off our list.  Besides, it was the 5 star hospital, and would have been more pricey just for the "chic-ness" of it all.  The other sounded slightly better: Memorial Sao Jose.  We also saw a lot of comments about people being happy with a natural birth at another private hospital here in Recife, Real Hospital Portugues (RHP), so we thought we'd check out that one as well.  And lastly, for interest sake, we had read about a public hospital who had just put in four "rooms" just for natural births.  This hospital is interesting because, from what we gather, it is part of a group of public hospitals that had private funds come in.  This hospital group is called IMIP, and the specific hospital we went to was called Hospital Pedro II.  A lady who goes to our church here in Vera Cruz had a baby there in the past year and reports she had a good experience and a completely natural birth.

The first hospital (RHP) was friendly and we had a hotel guide show us around.  Their procedure was what we had been told about; first you come in and get observed, and they'll hook you up to an i.v., because obviously you'll want a medication to speed up your labour, then if you are far along maybe you'll go right to the operating room where you'll have your baby, or maybe you'll go to your apartment to labour first and then to the operating room.  Once your baby is born it will go to the nursery and you will head back up to your apartment.  Your husband can stay with you the whole time and overnight.  The baby can also stay with you after being checked in the nursery.  We got to see the rooms pre and post delivery, which were nice, had an individual bathroom, a shower but no bath.  We were not allowed to go check out the operating room.  I have to admit this bothers me, as I would like to see the operating room beds and what they have in there.  

The second hospital was the Hospital Pedro II, the public hospital.  The small waiting room area was full of pregnant women, and they spilled out of the door onto chairs outside.  It seemed to be more of a maternity clinic as well.  We spoke to the lady at triage, while everyone watched us and our children with interest.  What are these foreigners talking about?  The interesting thing was we got ushered immediately in behind triage (right where everybody could still watch us), and she got a doctor to come talk to us.  We thought we were just asking for some information, such as can we see the facilities, do we need to meet with a doctor there before we have the baby, how much would it cost.... somehow she thought we needed a room because I was in pain.  As I happily stood there twiddling my thumbs, the doctor came to make sure I was okay.  When she realized everything was fine, she nicely explained about the room.  It held 4 women in one room, with partitions (in the pictures online it looks  like office cubicle walls), and was meant for natural births.  You would stay in that room for the entire time.  There was one bathroom shared by all  4 women.  We couldn't go check it out because of course it was being used.  And somehow public hospitals are also free for foreigners who are there legally.  Shaun had informed me of this yesterday however I did not believe it (sorry, honey!).  The doctor spoke English and said the room was very nice, however not a 5 star.  She said everyone here has lots of experience with normal births.  She told us to just show up in labour, and as my pregnancy is low risk, I would qualify for these "special" rooms geared for normal deliveries.  I forgot to ask whether the baby stays with you, but on the internet it looks like they encourage it.  We will have to ask the girl we know who just had a baby there.  Here is a link to the Warm Space :)

The third one, Memorial Sao Jose, was much like the first one, still couldn't see the operating room they whisk you to before birth, baby goes to the nursery after birth, etc.  They wouldn't give us a set price because they want a list from our doctor saying exactly what he would like to use, but the cash office gave an approximate number for a one day stay, and it was already quite a bit more than the first private hospital we checked out.

I know I have to accept that things will be different than my other babies' deliveries.  And I also know I have high expectations, as some of the things that you read about here are typical of lots of hospitals in developed countries, and may not seem too abnormal.  In our small community hospital in Langley, there are private rooms for labour, delivery, post-partum, and your baby stays with you.  And I think in Canada even if I had a shared room until I delivered, or my baby went to a nursery, or anything like that, I would have less reservations.  There are a few reasons for this.  One example is a friend of mine who had a baby here a few months ago, and as is typical the baby went to the nursery.  Then she had a hard time feeding him.  After numerous attempts he spit up formula.  An example of why it bothers me that I won't know what is happening for my baby, and that I have no power to control that.  Once again, maybe a small thing for many people.  And I have to admit, I was very skeptical that doctors would do something that you don't like.  But I hear more and more stories, for example, of people who are hooked up to an IV to "prevent dehydration" and end up with pitocin and pain meds, even if they have requested nothing.  I am not morally opposed to pain meds, believe me, but the thought that they can justify anything and that they do makes me adament that I will not have an IV hooked up to me during labour.       

So some pros and cons:

Private hospital
pros - nice private rooms. less busy. you know your doctor
cons - pushy for medication and c-sections, you go to an operating room that you have not seen when you deliver where you and your husband have to be fully gowned up, do you really know your doctor? baby is not with you after birth

Public hospital (that we went to anyway)    
pros - staff have more experience with normal births, less pushy for c-sections, not sure about medications and other interventions, stay in the same room the whole time, free, husband can stay with you and it sounds like the baby stays with you on the internet, specifically because they encourage breast-feeding
cons - shared room the entire time, one bathroom for everyone, very busy (may be turned away if full), could not see the room, not sure if baby can stay with you, you get whichever doctor is there.

Because I know in our Canadian culture it is difficult to comprehend how pervasive unnecessary medical interventions are in Brazil, here is a chart Shaun stumbled across regarding percentages of c-sections in the hospitals here in Recife.  And also to be clear, I am not saying that c-sections are not essential in some cases, or medications, or what-have-you.  But it needs to be about the mother and baby, not about the doctor's wishes and desires.

So I contemplated midwives and homebirths, however that brings up its own lists of pros and cons for me, particularly when we spent an hour getting home and almost the whole way was behind an ambulance that couldn't move due to traffic.

So there you have it, the reason for [some] of my restless nights.  But in the end, labour is typically self-limiting.  I can't say I am an earthy type mother that embraces labour and delivery in the best of scenarios, so does it matter if I share a room with 3 other ladies while having a baby?  or whether I get raced away to a different room 11 floors away when I am ready to deliver?  I guess this is something I will have to grapple with in my sleep again tonight....