Saturday, July 31, 2010

Doctor hunting and being pregnant away from home...

I have found being pregnant in Latin America to be quite interesting. As we traveled through Central America people would get excited at my pregnancy and tell me that I was having a boy as a way of wishing good luck on us and our unborn child. In Latin cultures boys are wanted so they will carry on the family name, so I think it threw them off when I proudly announced that we are having a girl.

It has been hard for me to be away from the US and go through all of the body changes, life changes, environment changes, and language changes that come with moving to a new country. Even though I have lived in Ecuador before, now it is very different. We were always here temporarily and never had to build a life or handle things that come with everyday life here, such as finding an OBGYN or a pediatrician.

I have read the entire "What to Expect When You're Expecting" and many online resources related to pregnancy and birth and had a really good idea about what type of birth I wanted when we moved. The difficulty with having something in mind and expectations is that you may not be able to find these same things in another country. I wanted (and still want) a birth as natural as possible. No drugs, no episiotomy, non-continuous fetal monitoring, and either a water birth or a vertical birth. Luckily most of Arturo's friends are married and have children so I was able to start with them to get OBGYN recommendations. The only unfortunate thing was when I started talking to them about their doctors and asked them how they liked the doctors they chose they all told me their doctors were 'okay' and their experiences were 'fine'. For me, that just won't cut it. I wanted a doctor I would like. A doctor who would listen to me, explain things to me, and work with me... especially since I'm in a new country and am having my first child.

We started by visiting a couple of clinics to see what they were like. To be very honest I was a bit intimidated by the whole thing and things here are a family event. So my mother-in-law, father-in-law, Arturo, and me were all at these clinics trying to ask questions. I was the one who was supposed to know what to ask, but I didn't have the vocabulary or any idea about how to interview a doctor. Plus, here it is not common practice to interview doctors. The first doctor was a bit taken aback by our request, but obliged and didn't try to charge us for a consult. The second doctor we went to wouldn't listen to us (we also didn't push the issue) and we ended up doing a consult. He talked to Arturo and not to me and made many assumptions about me and my lifestyle just because I am from the U.S. Yeah, this made me mad. After that I gave up and waited to talk to my Lamaze teacher about doctor recommendations. She gave us GREAT recommendations and we found a doctor and a back-up that we were happy with.

The moral of the story, it may be hard, but don't give up! You'll find someone you like!

Okay, I'm rambling, so here are a few facts about birthing options and clinics in Cuenca, Ecuador:
  1. Doctors are not used to being interviewed. You have to walk in and say something along the lines of "I know this is not commonplace here, but I am looking for a doctor and want to interview you, I do not need to have an exam".
  2. Hospitals do not have labor and delivery like they do in the states. Some clinics we visited you give birth in surgery and then they take you to your room. Others have birthing rooms (rather than surgery), but then you're taken to recovery just like anyone else. There are not wings of hospitals dedicated to babies and pregnant mothers.
  3. Most hospitals and clinics will not give you a "tour" of the facilities. This is not normal. Most won't even show you a birthing room.
  4. No matter where you go (for the most part, I didn't visit EVERY clinic) you will labor in your room, give birth in the birthing room, then be moved back to your room. So you will be moved twice during the birth process.
  5. Natural births range from $600 to $1,000. C-sections range from $1,000 to $1,500. (this is without insurance)
  6. C-sections are very common here. If you are against c-sections or do not want an unnecessary c-section you will have to pick your doctor carefully.
  7. Episiotomies are still a common practice here so you need to be very straightforward if you don't want one and find a doctor who feels they are not a necessary practice.
  8. Lamaze classes with a certified Lamaze instructor ARE available (at least for now). My instructor's name is Rocio Samper and she is listed on the Lamaze International website. Her email address is She is bilingual (English/Spanish) and lived in the States for quite a while. She is fantastic and gave us many recommendations for doctors, which is how we found our doctor (Dr. Xavier Molina). Rocio charges $70 for 7 Lamaze classes.
  9. Doulas are not common here and there are only a couple in town. Although Rocio is not a certified doula we are using her because she is very experienced and is working toward becoming an OBGYN. She has assisted in over 200 births. We will also have spent quite a bit of time working with her in our Lamaze classes and she is bilingual. I highly recommend her. Rocio charges between $150 for normal length births and $200 for longer births. She doesn't charge more than $200.
  10. Midwives (in Spanish they are called parteras) are not the same in Ecuador and the US. Parteras are women who happen to have a lot of experience with births and attend the births to act as the doctor and as the support. However, they typically do not have certifications of any kind, are not 'trained' by professional institutions, and have learned through years of helping other parteras. They tend to be found in rural areas where there are very few hospital or clinic options available.
  11. If you want a water birth you will have to do it in Quito or in Otavalo. There are no options in Cuenca.
  12. Take a deep breath, it will all be okay and everything will work out!
Hasta luego!

Heading in to week 32 of pregnancy in Cuenca, Ecuador