Fighting for a “normal” birth in Brazil

There are plenty of differences between life in the UK and Brazil. I’ve spoken about just a few of them in my blog so far. Many are small things of little importance, such as food and the weather. But occasionally I come across a difference that I just can’t get my head around, and today I’m going to ponder one of those: BIRTH.

I’m very excited about the impending arrival of our little one in 3 months time. As this will be our first child, everything is new to us about this process, and I only have an idea of what normally happens in the UK. I don’t wish to bash brazilian healthcare, nor to constantly compare the two countries, but I will have to make some comparisons in order to express my opinion on this subject. So here goes.

The cesarean rate in the UK is around 25%. A large portion of the population uses the public health service, and so cesareans are only conducted in emergencies, or scheduled in advance for women with underlying health issues. To request a cesarean purely out of personal choice, you would have to be under private healthcare. In Brazil, those that can afford it have private healthcare, which includes everyone except the very poorest, and somewhere along the lines it seems that the cesarean has come to be seen as the “better” way of giving birth. Whether mothers choose it or doctors advocate it because they think it is safer, easier or quicker I don’t know, and there are many other articles contemplating the reasoning behind it, but the cesarean rate here in private hospitals is currently 80-90%, sometimes even higher.

I am often asked by brazilian women if I am going to have a c-section, and when I reply with a “hopefully not”, the looks I get range from genuine shock to ‘why???’ to ‘crazy foreigner!!’. It was a similar story last week I went to visit our local, private hospital in Belo Horizonte, Mater Dei. It was a general tour for pregnant women considering giving birth at that hospital. I went along with my husband, knowing full well that most people have cesareans here, still surprised to see that I was the only of the group hoping for a birth that didn’t involve major abdominal surgery. The whole visit, for me, was an eye-opener.

The girl taking us around the facilities explained that there is the cesarean (which is in the operating theatre, exactly as you would imagine); there is the ‘normal birth’ (which also ends up in the operating theatre where the mother is usually given an epidural and episiotomy); and there is the ‘natural birth’ (which, as long as you don’t need any pain relief, can take place in one of the standard rooms with one of two doctors trained in this kind of birth, neither of which is based at this hospital). I was astounded. ‘Normal’ doesn’t sound normal to me at all. The very sight of the operating theatre had my heart racing and my husband had to pull me away.

Operating theatre at Mater Dei hospital, Belo Horizonte, Brazil

Operating theatre at Mater Dei hospital, Belo Horizonte, Brazil

In the UK in recent years there has been a bigger shift towards natural births: a natural birth in my view involves less or no pain relief, and greater freedom for the mother to do whatever feels right, without intervention unless truly necessary. Many hospitals have separate birth centres, where you can be separated from the more clinical hospital environment and take advantage of facilities such as birthing pools to help with the pain.

I knew that to find something similar in Belo Horizonte would be more difficult, but I felt truly naive when I saw the reality. I have a wonderful, highly experienced obstetrician who speaks English, but when mentioning giving birth in any position other than lying on a bed on my back, she was noticeably uncomfortable.

Back to the tour and there were a few things that did make me laugh. The other mummies-to-be only asked questions concerning how they could be sure to get one of the bigger rooms, and how many visitors they could have. “Yes, your photographer can be present in the operating theatre” the girl said, “other friends/family can watch through the glass window.” She couldn’t answer many of my questions however, as she had never seen a natural birth.

I know that discussing births can be sensitive, and I would never wish to tell someone that having a cesarean is wrong or not the best path for them. I am, afterall, not a doctor and not experienced in any of this! I also know that the state of play here in Brazil will vary depending on where you live. Sure, I could go to a public hospital, but there the standard of care is likely to be much lower than you find on the NHS in the UK. My story is based solely on my experience so far here in Belo Horizonte, and my personal preferences. I’m no hippy and I’m not afraid to accept pain relief if I need it. What I am against is a system that has forgotten how to cater for people that don’t want surgery, to the point that most women don’t feel brave or confident enough to have a normal birth.

As I said before, I am not saying that the quality of healthcare on offer in the UK is better overall. For sure, if I wanted a cesarean or cosmetic surgery, Brazil would be the place to do it. The point I am trying to make is that the woman has OPTIONS in the UK. If she wants to avoid surgery and assisted birth, there are more experienced midwives to try and help them down that path, as long as mother nature allows, and they have the facilities for this. The focus is on what the mother wants and what is best for her and the baby, rather than being ruled by hospital policies, and what the doctor finds more convenient.

I have only visited one hospital so far, but from our research we know our options are limited. We have however heard of an institute that is pro natural labour, and we are hoping to meet with them next month to see what they can offer. I’d be lying if I said I haven’t already mentally thrown all my eggs into that basket!

I would love to hear comments from anyone who has faced similar challenges in Brazil, and in the meantime I will update you on my situation.

Related articles:

Brazil’s women rebel against c-section: Huffington Post

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15 responses to “Fighting for a “normal” birth in Brazil

  1. For this I am thankful to have given birth to my boys in Canada. Though for a natural birth I had to jump on the phone as soon as I knew I was pregnant to make sure there was room for me with the midwives. Aren’t there any midwives in BH?

    • From what I can gather, no, not really. Midwives exist as nurses who assist the obstetricians in the hospital, and therefore I imagine the extent of what they can do is much smaller than perhaps in the UK or Canada. In most areas there is certainly no option to be visited at home by midwives.

  2. Oh, it is like reading my own blog post only I didn’t write it yet!! I have wanted to write about this but I am so upset with the whole thing that I have not had the energy to. I always knew that cesarean was a big thing here but I never thought it would be so hard to get a normal birth if that was your choice. People in SP think I am a nutter foreigner too for opting for such a “horribly painful option”. Because major abdominal surgery sounds so much more thrilling…..

    First of all I went to an OB who accepts my insurance, but will still take R$4000 “under the table” to be there at the delivery as he, as he himself put it, “has been working too long with this to earn only about R$800 for a delivery”, which presumably is his return from the insurance company. I went looking for other doctors and the one I have now would only charge R$2000. After realising that in Sweden you have your pre-natal with a gynaecologist and then the birth happens with whichever OB is on duty on the day, I thought that’s what I will do. I know someone who did the same and it worked fine.

    Ok so I am now 35 weeks pregnant and this week I came across a lot of information about birth in Brazil. Wish I had seen it earlier.

    I have come to realise that they go as far as lying to you at the hospital to make you change your mind. I am pretty sure that is what happened to two of my foreign friends here, both wanted natural and ended up with a cesarean. One mothers water broke and they said they had to do the cesarean to avoid infections. Worried about your baby’s health she accepted, but they didn’t even try to wait for the contractions. They could have waited for a whole day or two before this would have caused a problem. Another one I read about was treated really badly by the nurses and they kept her husband away from her with different excuses which was a torment to her (against Brazilian law!!). She eventually gave in as she felt so bad and in pain at the same time.

    It really pisses me off and scares me at the same time. Did you know they strap your arms down to do a cesarean, so when the baby is born you can’t reach out to touch him/her. You can just get a peek then they take the baby away for whatever and you get to see him/her only about 2 hours later. I can’t imagine not getting my baby straight away (which I understand you do when you have a normal birth)

    I have been in contact with a woman who has a blog called Renata Correa and she has explained that no doctor who are pro-natural birth accepts insurance plans, so you need to pay them privately. Very expensive and I hear you pay R$8000 or more for the delivery (plus all the pre-natals). There are 7 OBs in SP who do natural births as a norm. That is 7 OBs in a state of over 20 million people!! Scary.

    Oh, ironically the hospital I had chosen has the highest cesarean rate in SP (possibly Brazil). I did the tour as well a month ago and after told my husband that I felt it was very focused on cesareans… I was also the only one who seemed to want a normal birth and didn’t worry too much about the room, whether I can have someone from my salon fix me up so I look good and how many visitors can come at once… I might even chose the University Hospital instead, even though its public!! At least they have a good reputation and the government doesn’t pay for unnecessary cesareans! Going to check it out in two weeks.

    I hope we both get the birth we are looking for, I am keeping my fingers crossed for us both! Sorry about the very long answer!!!

    • Hi CJ. On the one hand I want to say I’m sorry you’re going through this too, and I really am, and at the same time, it is actually nice to hear from someone from another city in Brazil who understands! It’s not something great to be stressing about when you’re pregnant so I really do hope you find a solution/compromise soon.

      It seems outrageous to me that your original OB was so blunt about the money! My current OB would also charge about that much for the delivery I think, and the pro-natural birth institute I’m meeting in two weeks charges even more. I’m also tempted to look at the public hospitals! In the UK you also don’t normally know who will deliver your baby, and unless there is a problem, they are groups of midwives who then change shifts. It’s nice to know who will be with you at the time, but that’s what you pay so much for here. Instead in the UK you’re encouraged to write a birth plan, with your ideal chain of events and preferences for pain relief etc, so that supposedly whoever is on duty understands your wishes. The thought of being bullied into/lied to about needing a cesarean doesn’t bear thinking about. I hope my husband will be able to stand up for me and continue to think rationally when I’m not able to.

      I hadn’t heard about having your arms strapped down during a cesarean either (!!!) but that’s just added another reason to my list of why I’d prefer not to have one!

      I’ll be watching with interest if you blog about this too. Good luck and keep me posted! Jen

  3. Hi, Thank-you for your blog. I have recently moved to BH (from Canada) and am doing some preliminary research for an OB, birth options etc. The lack of midwives is disappointing (but not surprising). I am wondering how your visit went to the pro-natural birth institute and if you would mind sharing the name of it. Also, can you tell me the name of your English-speaking OB? Thanks for any help and I hope your pregnancy is going well.

    • Hi there, I’m so sorry for the delay in replying and thank you for your comment! Welcome to BH 🙂 I hope you’re enjoying it so far. It’s difficult at first to move to a new place.

      My pregnancy and birth is now being handled by Instituto Nascer , which is the clinic I mentioned that is very pro-natural birth. My doctor there speaks good English, Dra Quesia Villamil, and they also have a doula available that speaks English I believe. I’ve been impressed with their care so far. They offer classes about pregnancy, breastfeeding, labour, newborn care etc and a choice of hospitals for the birth.

      If I can help any further just let me know, and good luck!

  4. Hi Jen, if you need some more info on natural birhs in BH, please email me. My wife will be glad to tell her experience in BH. You have to struggle, but your are not alone. Some medics do understand our point of view. Greetz !

    • Hi Francois, thanks so much for your message! Unfortunately the last few weeks of pregnancy have been rather manic with doctors appointments and last minute preparations, so I am only now getting round to replying. I am now much more comfortable that I have found a doctor with the same/similar desires as me for the birth, so I’m feeling much more positive about it. I would have loved to hear your wife’s experience too. I hope it all went well for her!

      • Hello, I am glad you found the Instituto Nascer, whom helped my wife having a marvelous little daughter (third child). We worked with Dr Renato Janone, who left the team, but is continuing by its own. Our little daughter was born almost on the ground of the Hospital Mater Dei, which is quite uncommon for Brazilian standards (this is, the Doctors did allow what my wife wanted at that moment, leaving them in difficult positions to assist her giving birth). It was the most beautiful birth of the 3 we had ! Good luck !

  5. How did your plans with the birth go? I’d love to talk on it as I’m currently a pregnant expat in Brazil seeking natural birth.

    • Hi there, I’m so sorry for the delay in responding to your comment! I’ve completely neglected my blog since having a baby but I have been meaning to post something about my experience. It was great. Painful of course but all natural because I was afraid to have an epidural. I was lucky that it went smoothly and I had a great midwife and doctor to help me through it. I really recommend Quesia Villamil at Instituto Nascer. I’d be happy to answer any more questions and all the best with your pregnancy! Jen

  6. Hi, I am currently a pregnant expat in belo horizonte. I read your blog and decided to check out Instituto Nascer website. seems very impressive. I tried calling the hospital however receptionist doesn’t speak any english and neither do i speak Portuguese. Is there a way i can avoid this? Also i will love to know if they accept Unimed insurance and how much am still expected to pay for the birth. Am new here and getting quiet frustrated with the systems.

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