Brynn Barineau

Tag: Doctors in Brazil

  • 7 Weeks Early

    7 Weeks Early

    Almost three weeks old!
    Almost three weeks old!

    The contractions started just before 5pm.  I didn’t know that’s what they were.  It was my first pregnancy and I’d never felt a contraction.  Everything I read about contractions emphasized back pain.  Oh the back pain!  I had no back pain. So much for preliminary research.

    What I had was pain across my lower abdomen that seemed to come in waves.  While watching my students study during the last few minutes of class for the day, I chalked the pain up to intestinal problems.  The one classic pregnancy symptom I’d had the joy of experiencing for several months was constipation.  I assumed the pain was my intestine finally in revolt, not contractions.

    Also, I was only 33 weeks along.

    I noted the increasing intensity of the pain as I caught a ride home from a fellow teacher.  I thought it odd when I finally  scurried into my bathroom at home that I didn’t really have to go.  Still, I did not think contractions.  It was 7 weeks before my due date.  I didn’t even dismiss the thought of contractions.  The thought has to enter your head in order to dismiss it and the idea of contractions never did.

    By 6:15pm however, I was in sufficient enough pain to ask my husband to call my doctor.  My doctor told me to get in a warm shower and sent my husband off to buy some pregnancy safe pain killers.  When the shower failed to lessen the pain, I began to think something was wrong.  Then there was blood.

    I called my husband.  He turned back before ever reaching the drug store.  He was on the phone with my doctor when he walked back into the apartment.  As I was yanking on clothes in the bedroom, I heard him ask “How much blood is there? If it’s just…” He stopped talking.  He’d seen the bathmat.  In less than a minute we were in the car on our way to the doctor’s office.

    Thankfully, Dr. Batistuta’s office is only five minutes from our apartment and he was working late.  It was about 7pm and the office was empty except for the doctor and his secretary, as my husband helped me climb the stairs to the exam room.  The pain was now so intense I wanted nothing more than to close my eyes and breathe.  But there were questions and Portuguese verbs to conjugate in order to answer.  I used to think speaking in Portuguese on the phone was difficult.  Speaking in Portuguese during a contraction is much harder.

    Placental Abruption.  That was my Portuguese phrase of the day.

    My doctor explained that the baby’s heart rate was elevated and that combined with the blood and contractions made him think the placenta had torn from the uterus and blood was now pumping into the uterus.  I was headed for an emergency c-section.

    After a flurry of discussion between my husband and the doctor, some quick phone calls made by his assistant, they confirmed no office with an ultrasound was open to confirm this diagnosis so we would be going straight to the emergency room.  At least, that’s what I was told happened.  I was still lying on the exam table breathing through contractions and pain that went from aching to breathtaking, never completely disappearing.

    A little before 8pm I was standing outside with my doctor trying to have small talk in Portuguese while my husband got the car.  Twenty minutes later my doctor was wheeling me into the emergency room and pushing me over to some nurses who began giving a flurry of instructions in Portuguese.  I was being prepped for emergency surgery 7 weeks before my due date and strangely enough I was not panicked.  I was too occupied with breathing through contractions and understanding the directions I was given to really dwell on worst case scenarios.  Contractions are a great distraction.  Contractions and conjugating Portuguese verbs.

    I never thought I would die.  I never thought I could die.  I never thought my baby would die.  In the moment, I never once feared for my life or my baby’s.  It was only afterwards, when researching placental abruptions, that I learned just how serious the situation was.  Not as much for me as for her.  While I lay on my side curled into a ball having a needle stuck between vertebrae, I was worried about the kinds of complications my daughter could have being born so early.  Would she have eye or ear problems?  Would she have some sort of neurological problem?  Would her lungs be working yet?

    I didn’t bring any of this up to my husband as he sat by my head in canary yellow scrubs pointedly not looking in the direction of my open abdomen.  The c-section is certainly one of the most surreal experiences of my life.  To be fully conscious while your abdomen is opened and people stick their hands in and root around your internal organs…well, surreal doesn’t quite cover it.  I felt tugging, sometimes hard tugging but absolutely no pain.  There was one hard tug and suddenly a baby was crying.  I cried for the first and only time all night.

    My daughter was born at 8:50pm on July 11.  We thought she was 33 weeks but her initial exams put her developmentally at 35 weeks.  She was just small so the ultrasounds underestimated her age.  She was 2.005kg or 4 1/2lbs.  She was on oxygen for a day and then under a UV lamp for four.  Some problems concerning her lactose tolerance resulted in her staying in Intensive care for 26 days.  But those 26 days are the subject of a future post.

    4 months old!
    4 months old!

    Yesterday, my daughter celebrated her 3 month birthday.  She smiles and coos and refuses to sleep during the day anywhere but in a someone’s arms.  That’s why there haven’t been many posts recently.  It’s hard to type with a baby in your arms.  A perfectly healthy, happy, and breathtakingly beautiful baby.

     

    flower

  • My Recommendation for an OBGYN in Vitoria

    My Recommendation for an OBGYN in Vitoria

    My expat identity has taken a back seat in my last few posts to the teacher or pregnant woman part of me, but after reading some blog entries from other expats in Brazil I’ve been inspired to finally write a post that has been in the back of my mind for some time.

    Coconut Water is officially recommending Dr. Paulo Batistuta for anyone in Vitoria looking for an OBGYN.

    While I’ve endorsed several Brazilian food options including açaí and moqueca capixaba, this is Coconut Water’s first official endorsement of a healthcare professional in Brazil and I’m recommending Dr. Batistuta with the same fervor I do a big bowl of açaí.

    A fairly common complaint from expats here is that doctors in Brazil don’t really explain things to you.  They tell you to get a test and bring them the results.  Unless the results require being ordered to get another test or bypass surgery, that’s all you’ll hear about them.  Another complaint specific to women in the process of childbearing is that doctors here in Brazil prefer doing c-sections to pretty much anything else.  (I’d believe even more than sex given the rate at which they are performed here.)  Some private hospitals in Brazil have c-section rates as high as 90%.

    Dr. Batistuta (Dr. Paulo here in Brazil where they use first names) defies both of these stereotypes.

    Personal anecdote.  After an early ultrasound, I noticed there was one item that had an abnormal reading, specifically low blood flow in the left uterine artery. When we took the results to Dr. Batistuta, I asked about it and Dr. Batistuta picked up a pen and immediately began sketching a uterus and arteries.  He explained what the test measured and what the result meant.  He even sketched out exactly where the placenta was attached in my uterus.  You know, the more information the better.  He assured us that this wasn’t a problem given the normal results for everything else and we’d check it again at the next ultrasound.  He was right.  Everything was normal at the next ultrasound.

    Dr. Batistuta never rushes us out the door.  I’ll pull out a list of questions.  He’ll happily answer everyone, giving me cards, books, even DVDs that will provide further information.  While I’m in the bathroom changing I can hear him and my husband chatting away about upgrading their computers’ operating systems.  We were in his office for almost an hour during our last visit.

    As for c-sections, Dr. Batistuta is one of the leading voices in Brazil for natural childbirth.  If you speak Portuguese you can watch him being interviewed on youtube.  While he will state point blank he believes the best birth for the mother and baby is one with no unnecessary medical intervention, he has also told me that ultimately the doctors and staff are there to support me and what I want.  If I ask for drugs, they will give me drugs.

    I should mention cost.  One of the great things about Vitoria is that you can get great medical care (private) for half the cost of what you’d pay in Rio or Sao Paulo.  For an office visit, Dr. Batistuta charges BR$200 ($118).  We pay this out of pocket at the visit and send a receipt to our insurance company for reimbursement.  For the actual birth, Dr. Batistuta is charging BR$4.000 ($2,353). Again, we’ll pay and get reimbursed later.  (Once the whole birthing process is said and done, I’ll do a summary of all medical expenses for giving birth in Vitoria.)

    Finally, the language issue.  Our visits are conducted exclusively in Portuguese but when I have to use an English phrase Dr. Batistuta understands.  (I suspect he is modest about his level of English and understands way more English than he lets on.)  Fortunately, my husband attends every visit and supplements my intermediate Portuguese with his native tongue thus preventing any serious misunderstandings.  I can’t say for sure how it would go if you don’t speak any Portuguese. I think everyone could muddle through but it is important to know that Vitoria is a much smaller city than Rio, Sao Paulo or Belo Horizonte and English speaking professionals are in much shorter supply here.

    If you are an expat in Vitoria looking for an OBGYN, I strongly recommend Dr. Batistuta.  He talks to his patients as intellectual equals.  He supports natural birth and medical intervention only when necessary.  He understands some English and is very patient when listening to bad Portuguese.  You can find his profile and contact info with the CECON medical group.

  • Diagnosis: Information Overload

    Diagnosis: Information Overload

    The Internet is amazing.  Easy communication between continents, quick access to the rules on semicolon usage, and adorable animal videos.  What’s not to love?  Well, for me, the gross amount of information available on pregnancy and mothering.  Here is a tiny sample of the useful info the Internet has provided me concerning pregnancy.
    Google query:  “What to eat while pregnant?”
    You absolutely have to get enough folic acid, vitamin C, Calcium, iron and about a dozen other things while pregnant or your baby will not have a fully developed spinal cord, skeleton, or eyebrows. You can get these things from dark green vegetables, citrus fruits, beans, milk, yogurt, steak, eggs.

    Google query: “gas and indigestion while pregnant”

    You will inevitably suffer from gas and indigestion.  In the case of severe pain avoid eating dark green vegetables, citrus fruits, beans, and dairy products.

    Google query: “Foods to avoid while pregnant”

    Avoid any undercooked meat and eggs and any unpasteurized dairy or fruit juices.  Consuming these will cause terrible bacteria to eat your baby.

    Google query: “Important nutrients while pregnant”

    You really, really need to eat a lot of iron, which the body easily absorbs from meat and eggs, spinach and beans.

     

    An hour of this will make a sane person’s head explode.  You should eat beans and broccoli but not if you want to avoid being doubled over with gas pain.  You should eat lots of meat and dairy but only if it’s been pasteurized or cooked until it can be used as a spare tire.  This is the curse of too much information.  Spend enough time researching and you will inevitably end up with contradictory information.   If it’s not flat out contradictory, it will at least make every bite of salad cause for an anxiety attack and present you with the choice of gritting through passing a beach ball through your intestines or depriving your baby of vital nutrients.  And we all know which option a good mother would choose.

    During my first few weeks, I had pretty much convinced myself there was no way the baby could make it out of my uterus alive when I had my first consultation with Dr. Paulo Batistuta.  Leaning back in his chair, he listened while I asked about eating fish and peanut butter and salad prepared by anyone’s hands other my own.  He smiled and said “Go ahead enjoy.”  Restaurants don’t do very good business if their patrons get sick, so they keep their food clean and fresh.  As long as my peanut butter is made in the USA, it’s no problem.  (Remember, Brazilian peanuts can carry a liver-eating fungus.)  And fish? Well, of course. Moqueca capixaba is delicious, isn’t it?  Yes, doctor.  Yes it is.  And thanks to you, I will now be able to enjoy it without a side of guilt.

    Internet research is basically the only skill I got in college and it has become something of a curse since being pregnant.  Dr. Paulo is exactly the zen master this patient needs.  Eat a balanced diet. Cook everything until there’s no pink.  Stop using Google.  Everyone will be fine.

  • My Dentist, My Sadist

    Today, I met the world’s friendliest dentist. Hmm, maybe I should rephrase given that dentists have not traditionally set the bar high when it comes to amicability. Today, I met a dentist who could not have been friendlier had she been inhaling her own laughing gas.

    It was my first trip to the dentist in Brazil. It was my first trip to the dentist in a decade. Maybe not quite that long. It’s hard to remember.

    Anyway, the last dentist I liked had video games and Disney movies playing in her waiting. Since the age of ten, every dentist I’ve had has been competent but distant and all business, in the way I imagine disembowlers must have been.

    My dentist today greeted me with a huge smile and flattering yet oddly enthusiastic declaration of how pretty I am. I think complimenting might be office policy to hook new patients and if so, I was sold. The smiling and over-the-top-compliments were such a welcome change for a dentist’s office; I thanked her and introduced myself to Doctor Gabriella.

    Brazilians use first names right away, even in professional contexts. It gives every encounter a personal feel. In Brazil, I don’t have bankers, dentists and doctors. I have a large network of personal acquaintances with a diverse skill set.

    Gabriella and I chatted about all the obvious first meeting facts: where are you from, how long have you lived here, which country do you like better. (There is no way to answer that last question honestly without offending someone. I just go with “Wow, that’s hard. They’re so many good things about both.”) Right before we got started I mumbled something about how long it had been since my last trip and then I waited for the shaming to begin.

    I’d always assumed that dentists are taught that shame is the only way to make people floss regularly. A patient must be told whatever she is doing, it is not done frequently or well enough and ultimately not sufficient to keep her teeth from falling out of her head. And toothless people go to hell.

    It was quite a shock then when Doctor Gabriella gently plied my lips and cheek away from my teeth and assured me they were very clean. When she spotted a cavity she called it a “little thing” that we can fix quickly. No lectures. A cavity and no lecture. I wonder if this woman knows what a disgrace she is to her profession.

    When we were done she walked me to reception area, asked me to come back for a cleaning and cavity filled, then she gave me a big hug and kiss on the cheek. A Brazilian that hugs. A dentist that is genuinely pleasant. I was completely thrown. I didn’t know how to react. I did know I liked it. So I’m going back for more next Tuesday at 9am.

  • Combatting Hypertension and Puritans

    Rio has a way of bringing out the Puritan in me.  I see a fourteen year-old girl in a thong and I’m thrown into what can only be described as a tizzy.  I turned into a flustered grandmother when handed a government sponsored condom upon arrival at the Carnaval parade.  My husband says not to be too hard on myself.  He says I’m just a product of my culture.

    I’d like to protest but he’s right.  Americans are so uptight about sex.  Brazilians seems to be more open about sex and the fact that people actually have it.  This open attitude is certainly embraced by the ministry of health as demonstrated by their carnaval themed condoms and a report they issued last week.

    A new study shows the rate of hypertension in Brazil has risen from 21.5% in 2006 to 24.4% of the population in 2009.  Hypertension is a problem the US and Brazil share but Brazil seems to be taking a slightly different approach to combatting the problem.

    As part of fighting hypertension, the health minister recommends, “besides eating five portions of fruits a day, you could try to have sex five times a day.”

    Take a minute and try to imagine an American cabinet member or any government official saying those words to the press.  If your head hasn’t exploded from trying to visualize something so inconceivable, move on to imagining the voices of the FOX news pundits.  And finally, picture the headline a week later announcing the resignation of this official.

    Here in Brazil, the newspaper article acknowledged the minister was joking and further quoted him seriously recommending, “dance, sex, a change in diet” and physical activity as ways to combat high blood pressure.  Then the article went on to discuss the report in greater detail.

    A government official recommends sex five times a day and the reporter focuses on hypertension statistics?  What is wrong with these people?

    As far as I know, the health minister still has his job and no reports have come in of children irrevocably damaged from hearing their government acknowledge that there are physical benefits from a healthy sex life.

    But before anyone starts applying for residency visas, a word of caution.  While Brazilians have fewer hang ups about sex, the country is far from being a bastion of liberal values.  If any daughters result from these hypertension treatments, good luck convincing their fathers to let them play soccer.  Soccer turns girls into lesbians.

    Now, if you’ll excuse me.  I’ve had french fries a few times this week and my husband is out of town.  I’ll just have to go to the gym.