Pregnancy in Brazil: too posh to push?

Pregnancy is celebrated big time here in Brazil. I’ve seen at least 2 photos of positive pregnancy tests on Facebook and, as soon as the sex is known, a name is chosen, everyone knows about it and asks after little Pedro as if he was he was in the room playing. The baby shower is booked and the preparations begin. Big belly “Beyoncé style” photos are normal.

I’ve always been aware that, after 9 months of waiting for the baby to be cooked, cesaerran sections are favoured here in brazil, but I wasn’t fully aware of the reasons why until experiencing pregnancy for myself in this somewhat complicated country.

It is not impossible to find a lady who has had a natural birth but she is likely to be quite mature or have had some specific reason for having a normal birth, and that includes all socio-economic groups.

Having had Antonio naturally in the UK with no hassle, I know I was very fortunate but also know it’s what I would opt for in the future, if at all possible. Our health insurance covers pregnancy (when you’ve had the plan for 6 months, which we hadn’t at the start so had to pay steeply for some tests and first 2 ultrasounds) but, nevertheless, the obvious course of action was to make the initial appointments at the private clinic. After all, I wasn’t entirely convinced by state care. And yet, I was surprised at the amount of time waiting at the appointments, especially for private healthcare. I was also not particularly impressed with the lack of/confusing information given. Tests were passed to me which were later deemed unnecessary, and I personally didn’t feel particularly pleased with the overall organisation. We weren’t told we could collect scan pictures 4 days after the scan and arrived at the next appointment to be greeted by a angry doctor. One appointment also had to be cancelled by the doctor and, they did try to ring the afternoon before, but I missed both calls and so we trapsed into town unnecessarily. That’s another thing: the private clinics are in town so not so handy. However, the tests and scans and have been very thorough, probably more so than the NHS (they do 4 routine scans here) and, once we had a grip of things, it all seemed ok.

However, when I asked the doctor about a natural birth, she told us it was complicated with health insurance because the system favours cesaerrans. I was told I would need to have the baby in a public hospital and also pay 2000 reais minimum for a private nurse. I left the appointment rather upset. However, God is good and, upon chatting to some women in our small group, I discovered one lady has 2 relatives who work in a public maternity hospital. She offered to help me out to see a good doctor on the state care and essentially do 2 sets of prenatal appointments (public and private) but have the baby on state care for free and naturally, if possible. I was delighted!

My friend, Itamatiana, sorted me out with the national health card I needed (even though the system couldn’t find my place of birth and wanted to know which state I was from) and we saw the doctor last month. The system was very efficient, indeed, much quicker than the private hospital, and the doctor seems good. I have now had an ultrasound on the state care. Again, the waiting time was much quicker. Everything looked fine on the scan but it the didn’t seem particularly thorough…I wonder if the private sector was slow for a good reason.

So why are c-sections favoured anyway?

  • The nature of the system: health insurance doesn’t cover the doctors’ time so it’s quicker and less hassle to pre-book a section. There are no midwives here so it’s much more expensive, even on state care, for doctors to attend a natural birth. Generally, it’s not even offered to women with health plans. They are taken on the road to a section with no discussion of other options. For those who seek a natural birth, I have heard that “excuses” are often given as to why it’s not possible nearer the time, or even at the time.
  • Brazilian culture: women nowadays here seem to have a fear of pain, fear of the unknown, lack of understanding of natural births and pain relief options and are worried about their bodies being ruined afterwards. You know where you stand with a section, and all that.
  • Benefits of having surgery: lots women here opt to combine a c section with liposuction, or more commonly, getting your tubes tied. I have already been asked by someone in the church if I ‘ll be doing the latter. I think 2 kids is maybe seen as plenty? Again, health plans will probably only cover these operations as a one size fits all package. If you opt for a natural birth, you will pay double.
  • Historically, the state hospitals have not always been attractive. Although it is more possible to have a natural birth there, it may not attract many due to the fact that the conditions have been poor in the past, i.e. no air conditioning, overcrowding, poor patient care etc. If a natural birth isn’t the speciality, then there may not be so many options for pain relief, and certainly no birthing pools and TENS machines in this neck of the woods! This is one of the poorest states in Brazil, after all.
  • Recovery time isn’t such a big deal: while in the West, we are desperate to get out and about and sometimes in competition to see who gets their figure back and is up and moving the quickest, the often longer or stricter recovery with a section is not really a problem here. They do relaxing and accepting help well here!

To me, it’s quite a sad state of affairs as there are many well documented benefits of a natural birth, and at the very least, surely there should be a choice for the patient without a  price premium.

Will the system change?

Possibly. The state is now encouraging natural births, to some women’s great frustration. My sister-in-law works in a health post and has heard women complaining that they were forced into a natural birth! There are now more, well equipped maternity hospitals in the city, indeed, there are 2 within 15 minutes of our house and the hospitals have received great investment. All wards are air-conditioned and, interestingly, many of the same doctors work across state and private care, as in the case of both doctors we have seen. The gap is perhaps closing between private and state care and we have seen people who have done the opposite of what we will do, i.e. doing pre-natal care on the state and have the birth privately. However, it will take time to get over the barriers of fear and inconvenience that surround natural births.

For now, we are quite happy to stick with the state care unless some complication arises. It may not be the NHS and there won’t be any cosy midwife home visits, but we trust that there will be a new baby in a few months and the rest is in God’s hands.


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