We Had a Baby in a Third World Country
Universal healthcare can provide positive experiences even in third world countries
10 at night.
“Hun, I feel something tugging my belly down. Did you hear a slight ‘pop’?”
“No, I’m gonna go check it out.”
And as soon as she got out of bed to ‘check it out’ a puddle of clear liquid burst down. Oh yeah, baby, game time!
Thus began the 18-hour effort that was to push out the most beautiful human being I’ve ever seen in my entire life.
I’m going to start by saying two things —
First — I was not the one feeling contractions, nor did I push, nor do I have the equipment to push. If the implication wasn’t heavy-handed enough, I’m the father.
Second — This story takes place in Brazil, we went to a government-funded maternity ward, and our health plan was SUS, the Brazilian universal healthcare system.
I want this story to communicate the effectiveness of the healthcare system here in Brazil, as well as some of its shortcomings.
Plans and Expectations vs Reality
My wife and I are big hippies, we’re very naturalistic and childbirth is no exception. In Salvador, the capital of the state we live in, there is a famous maternity center called ‘Mansão do Caminho’ (Mansion of the Way) where a doula accompanies every guest, and the births are extremely humanized. This means that everything in during the labor is centered around the mother and the child. The position the mom will deliver, the lighting, the location — these are all determined by the mother and what makes her feel comfortable. It is about empowering and humanizing the act of giving birth.
People come from all over the country to have their children there because it is one of the best places in this country to have a kid, and it is all done through SUS.
But you can only go there on two conditions, the first is that you can only have normal births there. No cesarian sections, no high blood pressure, no gestational diabetes, no risks. They simply do not have the equipment to handle those situations.
The second is that you can only go right when you’re about to have the baby. One of my cousins that had a baby there jokes that even if her water broke and she was feeling strong contractions, she would only get in the car to go there once she started crowning.
We did not have our baby there. My wife had oscillating blood pressure, at times it was stable, but it would jump at certain moments, especially if she was nervous or anxious. She had to take methyldopa to regulate her blood pressure — which ruled out the mansion.
Throughout our time here everyone recommended the maternity hospital Maternidade José Maria de Magalhães Netto (colloquially called Maria Magalhães.) It is a teaching hospital, and it has the best equipment to handle at-risk childbirths. Payment is also through SUS. This is where we had our baby.
Once my wife’s water broke, we got in the car with my father and my brother, and we showed up to the emergency entrance at Maria Magalhães. We went to the registration desk and I said my wife’s water broke, she has high blood pressure, we’re ready to go here. The receptionist took our documents, fifteen minutes later we were called into a room to do some tests, take blood pressure, listen to heartbeats — all the preliminary work.
After that, we were sent back to the lobby to wait for a while. We went outside and walked around in the parking lot to calm down for a while, and in about an hour we were given a bed, did some more exams and bloodwork and my wife took a shower and put on a hospital gown.
During this preliminary testing, we found out that my wife had light preeclampsia. My baby’s heartbeat was down to 80–90 bpm. She was given a small cup of what she said tasted like the drink she had while testing her blood sugar. I’m not sure what it was. After she drank it, my baby’s heart-rate stabilized.
We waited for about another hour, and by midnight, we were escorted to the room where the baby would be born.
Once we got to the labor/delivery room, we stayed mostly to ourselves. The doctors and nurses would come back to check in on everything every hour or two to make sure everything was going okay.
One of the things we discovered at Maria Magalhães was that we didn’t have ‘a doctor.’ Usually, the closest doctor would come in and check on us. This means we got to meet about three or four doctors during the labor.
Around three AM, one of the doctors came and told us that our labor was going well, but it was going a bit slowly, and since my wife had high blood pressure she recommended oxytocin to induce the birth. We were hesitant, but we agreed to the lowest dose.
They occasionally brought us juice, but she wasn’t allowed to eat anything. Just the juice.
Things continued going well until about two hours later, my baby’s heart rate was oscillating with each contraction. They monitored in three sessions of twenty minutes each and continued routinely. Not a cause for worry.
I had a piece of bread and some coffee for breakfast.
Contractions started to get heavier and heavier, and I’m thankful that I don’t have to feel them.
She had spent a part of the morning screaming in pain. She spent half an hour in a shower, and the hot water helped her calm down.
We relaxed for a while and a while later, another doctor came in and said that things are going well still, but recommended upping the dose of oxytocin. She was in pain and wanted things to finish, so we agreed.
The contractions started getting really heavy. She was screaming and everyone in the hospital knew she was in pain. My wife wanted this baby to be born already. We called a nurse and she calmly asked: “CAN YOU GET THIS BABY OUT OF ME ALREADY!!!!”
At this point she just wanted a c-section to get things done. If I were in control, I would try to do everything I can before resorting to a c-section, but I’m not the one who felt contractions — I can only guess by how tightly my wife squeezed and how loud she screamed that it wasn’t a walk in the park.
A doctor came in, an older guy he spoke to us in Spanish. He said that in this hospital if things are going well then they prefer normal births. Things were going well, she was contracting well, she had good dilation, it would be a normal birth.
Around one o’clock, a volunteer doula noticed some screaming and came to the rescue!
She helped calm us both down and talked us through the pain. She showed us exercises to help my wife dilate more, and she talked us through the pain some more. She reassured us about how well everything was going.
At around the same time, an obstetrician passed by and said she had some interns who were here for training, and asked us if we would mind if they could come in to better understand the circumstances. We agreed to allow them.
During the screaming and all the chaos going on, we found some calmness in the room, especially after the epidural! We asked for it once the pain became too much to control.
After a short nap, the contractions came back, they weren’t as painful though.
While the doctor that came to visit us with students wasn’t on call at the time, we felt comfortable with her and the students around. They reassured us and gave us a very positive experience. She ended up delivering our baby.
Around 3 o’clock, she placed a catheter to remove a whole lot of urine from my wife. This made a lot of the discomfort and swelling go away.
Once my wife had dilated sufficiently things kicked into gear quickly. They adjusted the bed so that she had good support. They gave her instructions on different positions she could push from, how to control her breathing. They twisted up a hospital gown and gave my wife the middle and me the two ends, and we both played tug of war. In the end, we both won a baby.
Once the baby was completely out, they immediately gave her to my wife, and they did all of the cleaning, bloodwork — everything they could at her lap.
They asked me to cut the umbilical cord.
They took her away to weigh her and measure her height, and brought her straight back to her mother.
It was an emotional and beautiful process.
Once the baby was born and all the commotion was done, doctors and nurses and doulas out of the room, we settled down.
My sister-in-law came to visit, and my dad and brother also came. I swapped places for a while with my sister-in-law and stayed outside for a while with my dad.
Right after the baby was born, the nurses told us that we already had a bed in the infirmary reserved. It took four hours to get upstairs into the infirmary.
We were given diapers, some cotton, 70% alcohol and some q-tips as well as some instructions regarding the baby. We shared a room with three other moms and their newborns. There was no curtain or anything that would give us privacy.
They gave us some food for dinner, but my wife still felt hungry after. It was a loaf of bread and some soup. During the night she complained a few times that she was hungry, and I had asked the nursing staff, they said there would only be food in the morning.
Here we were required to stay for the next 48 hours.
Once morning came, they informed me that the policy had changed, and only patients would get breakfast. I had to go out to get something to eat. Our biggest issue while we were in the infirmary was the food. It was too little, we felt hungry throughout the day. I had to resort to sneaking in some snacks and making friends with the doormen. Food for patients was breakfast, lunch, and dinner, as well as a light snack in the afternoon.
We thought the food was a bit sugary, not the type of food we would normally eat at home. I asked to speak to the nutritionist and she put my wife on a diabetic’s diet. For us, that resolved things.
While we were there though, I made a big effort to communicate as much as possible with the staff. Any questions I had were given direct answers. It seemed that everyone was very involved in their departments because I had to be very picky about who I asked about getting cleaning supplies or food. There wasn’t a lot of communication between departments, but everyone on staff was well informed at least regarding their department.
Forty-eight hours had elapsed, and my baby still had not pooped. We had to stay for another day. She’s a contrarian just like her father though, as soon as the pediatrician left, and we were stuck in the infirmary for another day, she popped one out.
The next afternoon we were already back home and taking care of our business.
The whole process was free of cost, except for my food in the mornings and afternoons.
I can’t say the whole process was stellar, but we felt the whole thing helped us feel more confident that we could actually handle everything.
We left the maternity with a birth certificate and a CPF (Brazilian social security number) for my daughter. It was altogether a positive experience for us.
From what I’ve heard speaking with family, it was even better a few years ago. The food wasn’t an issue, there was more staff communication, and babies left the hospital with all the required tests. I had to go out and find places to do exams on my daughter that, if she were born a few years ago, she would have done before leaving the maternity.
I’m blessed to have been able to go through such a wonderful experience, in a society where not everyone has the income available to buy health insurance, having a system that allows everyone regardless of race, gender or social status to have a positive, individualized experience in one of the most special moments in life.
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