Stacy: Delivery experience at Hospital Brasilia

Q&A with Stacy, who delivered her baby at Hosital Brasilia with Dr Salete Rios. Stacy labored for eight hours with no progress before delivering via Caesarian section.

How do you feel about your birth experience? What would you change and how?

I feel great about my birth experience. I would say it was on par or above the experience I had in the United States. Fortunately for us, Morgan and Phill had already compiled a list of paperwork items that needed to be addressed for our baby, so we didn't muddle through the experience, we knew exactly what to do because of their research and experience.
One thing I would change was my aftercare experience. I did not like that for the aftercare of a c-section, I was prescribed a headache medicine. I found the pain was much more profound and needed more pain relief. My Dra. refused to help, but our Med Unit at the Embassy took care of me when she didn't.

Why did you chose to stay (or go) for your delivery?

I chose to stay here in Brasilia because I did not want to be away from my husband and other baby for the minimum 6 weeks I would have had to, had a chose to give birth in the States.

Why did you chose your doctor/midwife? Were you happy with your choice? Did you feel like you had control over your labor experience?

I chose my doctor, Dra. Salete because of her close location to our house and once I got to know her, I felt very confident in her abilities and felt her love toward our family. I wrote a birth plan out for her and she was bewildered. No one had ever given one to her before. We went through it line by line and she did whatever she could to accomodate me, reminding me that the ultimate decisions would be up to her.

Did you find Brasilia to be a pregnant-friendly place? How so?

Yes I did. Besides all of the other women who were pregnant at the time, I felt like I had a great network of ladies to share with. Brazilian people also adore pregnant women and I was given special attention and consideration whereever I went - the grocery store, the bank, etc.

Describe your labor. Is there anything you would do differently?

I have what is known as cervical stenosis, so every part of me goes into labor, except my cervix, which refuses to open. It happened with both of my deliveries. However badly I wanted to give birth naturally, my body would not cooperate. Dra. Salete knew about my condition, but she also allowed me to labor as long as I wanted as long as the baby and I weren't in danger. When we reached a certain point, hour 8, she suggested that we move towards a c section. In my state of crying as I was wheeled into surgery, she gave me another option to continue labor if I so chose. She was accomodating on every level.

Would you have gone to the hospital sooner? Later?

I went to the hospital when my contractions were 3 minutes apart, figuring there is no way they could force a c section on me at that point. Ends up that they didn't force me, but it was still the only way my baby could be delivered. I would still have gone in at the same time. No reason to sit around the hospital and not be allowed to eat or walk or do whatever I wanted.

How was the treatment of your newborn by the hospital staff?

They treated my new baby beautifully. They also treated me very well. They came in all the time to check on her and me. They bathed her daily.

If you had assistance with breastfeeding, was is useful?

I received a run down in Portuguese on how to do it, by a male nurse, no less. I found his advice very helpful, but my baby was a natural pro.

Thanks for sharing Stacy! I know many women will benefit from hearing about your experience.

Circumcision

The procedure for circumcision in Brasilia is typically quite different than in the United States. As such,  some families who considered having it done have forgone the procedure on baby boys born here. In Brazil the procedure is more commonly done on boys once they reach the age of 4 or 5. When it is done on babies, it is typically performed when the infant is 7-10 days old, as a surgical procedure at the hospital. Surgeons require general/mask anesthesia. The procedure is performed using stitches.

One family here had the procedure done by a local doctor but have said subsequently that they wish they had not.

I know of one family who found a doctor in São Paulo willing to come to Brasilia to perform a circumcision. The doctor is Dr. Decio Blucher from Hospital San Luiz. Dr. Blucher charged R$1800 for the procedure, and the family paid for his flight to Brasilia. He performs the circumcision like it is commonly done in the United States, with no sedation, just some sugar water and a numbing shot. They were happy with the results.

DECIO BLUCHER (CRM:63233)
Especialidade: Cirurgia Pediatrica,Cirurgia aparelho digestivo; orgaos anexos e parede abdomin.
Endereço: R.PEDROSO ALVARENGA - 1245 - CJ 22
Cidade: SAO PAULO
UF: SP
CEP: 04531-012
Telefone: (11) 3071.0695

If you are unsure of the risks and/or benefits, here are a few links to help you get started with your decision.
Circumcise or Don't - Quandary For Parents - NYTimes.com
The Case Against The Case Against Circumcision - NY Magazine
Why A Growing Number of Parents Are Saying No - NY Magazine
Intact America
AIDS Prevention Inspires Ways to Make Circumcision Easier - NYTimes.com

If you know of a doctor in Brasilia that you would recommend for circumcision, or if you'd like to weigh in on the question of circumcision in general, please comment below.

Documenting Your Brazilian-born Diplomatic Child

DOCUMENTING YOUR BRAZILIAN-BORN DIPLOMATIC CHILD

1.     Brazilian Birth Certificate

a.     Comments: Children born in Brazil to diplomatic parents do NOT receive Brazilian citizenship. The Cartorio will register the child as a non-citizen diplomat in the computer, but the birth certificate will not look any different from that of a Brazilian citizen.

b.     Steps and Required Documentation:

                                               i.     Go to O Cartorio Marcelo Ribas next to Patio Brasil

                                             ii.     Need the hospital certificate of live birth or two witnesses for a home birth

                                            iii.     Bring marriage certificate

                                            iv.     Carteiras and diplomatic passports of parents

                                              v.     Birth certificate will be issued on site in less than an hour

2.     Consular Report of Birth Abroad (CRBA)

a.     Comments: The CRBA documents that the child is an American Citizen. In most cases, it will serve as the child’s birth certificate, but not always. You may still want to consider getting a certified translation of the Brazilian birth certificate, but it is not necessarily required. CRBAs are adjudicated at post, but no longer issued here. It could take more than a month to get the CRBA back from the United States.

b.     Steps and Required Documentation:

                                               i.     DS-2029

                                             ii.     Brazilian birth certificate

                                            iii.     One passport photo (2” x 2” or 5cm x 5cm)

                                            iv.     Marriage certificate

                                              v.     Passports for both parents

                                            vi.     Other documentation may be required as explained here.

                                           vii.     Fee: $100

2.     Tourist Passport

a.     Comments: You should apply for a tourist passport for the child at the same time as the CRBA.

b.     Steps and Required Documentation:

                                               i.     An unsigned but completed DS-11 (N.B.: The online application might not let you proceed without a social security number. Fill out the pdf version instead.)

                                             ii.     One passport photo(2” x 2” or 5cm x 5cm)

                                            iii.     Fee: $105

3.     State Department EFM

a.     Comments: Your HR Tech in HR/EX can help you officially add your child as a dependent and Eligible Family Member, but it is up to you to know what to ask for. Children born at post are not typically added to your current travel orders, but will be added to your next travel orders for your onward assignment. The child does not need to be on your orders to go on R&R with you because R&R is funded by post and not Washington.

b.     Steps and Required Documentation:

                                               i.     OF-126: Fill out a new OF-126 on HR Online. Your HR Tech should send you an email after the OF-126 is submitted asking for documentation. You may typically send a scanned copy of the CRBA or the Brazilian birth certificate with certified translation.

                                             ii.     DS-1640 (Request for Passport Services): After your OF-126 is approved by the HR Tech, your child should appear on your Employee Profile on HR Online. Ask your HR Tech to email you a DS-1640, which is a memo to the Special Issuance Agency requesting passport services for you and all dependents. Make sure your new child is on it.

                                            iii.     Travel Orders: Your new child will not be added to your current orders if born at post. Children born in the U.S. will be added. Your new child should automatically be on your next orders for your onward assignment once the Medical Clearance is finished. If not, work with your HR Tech.

4.     Medical Clearance

a.     Comments: The medical clearance is needed before your child can be added to your next orders. So, it might not be needed right away, but start early because Med in Washington can get heavily backlogged.

b.     Steps and Required Documentation:

                                               i.     You should schedule an appointment in the Med Unit at about 30 days after birth.

                                             ii.     After the appointment, the Med Unit will send the paperwork to Med in Washington for approval, which can take several months during busy times.

                                            iii.     You will receive an email notifying you when the medical clearance is approved.

5.     Diplomatic Passport

a.     Comments: The diplomatic passport cannot be issued until your CRBA is back and you have the DS-1640 and/or new travel orders.

b.     Steps and Required Documentation:

                                               i.     Schedule an appointment with the Consular Section and bring

                                             ii.     CRBA

                                            iii.     Diplomatic passports for both parents

                                            iv.     DS-1640

                                              v.     Your current travel orders and next orders if available

                                            vi.     An unsigned but completed DS-11

                                           vii.     Diplomatic passport application

                                         viii.     One passport photo

                                            ix.     Both parents and the child must appear

6.     Social Security Number

a.     Comments: You can apply anytime after you have the child’s passport, CRBA, and birth certificate. Might work best to apply at the same time as you do the diplomatic passport.

b.     Steps and Required Documentation:

                                               i.     Fill out form SS-5 and bring

                                             ii.     CRBA

                                            iii.     Brazilian birth certificate

                                            iv.     Passport (tourist or diplomatic) of the child

                                              v.     Apply at Consular Section

7.     Brazilian Visa and Carteira

a.     Comments: Post’s HR office will help you apply for a visa and carteira.

b.     Steps and Required Documentation:

Pregnancy/Delivery Panel - Feb 2012

Earlier this year a group of women got together to share their experiences being pregnant and delivering babies in Brasilia. The audio file below is a recording of the discussion. Minute notations to follow soon.

Click here to download the file.
(FYI: It's big, the meeting was 90 minutes long.)

Key medical phrases English-Portuguese

Portuguese - English medical phrasebook

I am pregnant 
Estou gravida

I would like to make an appointment
Eu gostaria de marcar uma consulta


I would like to have...   Eu gostaria de ter ...
a natural delivery          um parto natural
a cesearian                     uma cesariana
an ultrasound                um ultrasonografia
a blood test                    uma prova de sangue
a glucose screening     rastreio de glicose
an amniocentisis           um amniocentese
an epidural                     um epidural
a water birth                   parto na água 


What have I missed that you found useful to know during your pregnancy or labor?

Month-by-month tips

Months 1-3
o Visit the Health Unit. They will explain your local health care options and help you make an appointment with a local OB. See English-speaking OBs.
o If your doctor requests that you get blood tests at a Sabin clinic, bring your form (pedido) to the Health Unit to be transcribed onto embassy stationary as the embassy has a much lower rate negotiated for the tests. Sabin will give you a username and password and you will be able to get the results from all your tests online.


Months 4-6
o For the Glucose Screening Test, Sabin in QI 13 near Carrefour has large recliners that make the two-hour wait more tolerable.
o Find a doula, if desired. See Midwives and Doulas.
o Write up a birth plan
o Contact HR to have a layette shipment added to your travel orders


Months 6-9
o Brazil requires that you are tested for several Strep-B and several STDs within 4 weeks of your due date. If you do not have these test results with you at the hospital you will be tested on site and/or given an antibiotic during your labor.
o Choose a local pediatrician
o Attend 3-day antenatal class at Hospital Santa Lucia. You must call on the first day of the month to reserve a spot in that month’s course.


After the baby is born
o Decide if you will do a blood screening for your newborn. The local one is offered through Sabin (teste do pezinho), or you can mail a blood sample to the US through the Med Unit. Blood needs to be drawn in the first week after birth. If you choose the local test, a specially-trained Sabin phlebotomist will come to your house and collect the sample from your newborn. Results are available in about a week. Call 3329-8081 to schedule an appointment (coleta em domicillo). [I highly recommend this service. The phlebotomist was a total pro.]
o You will need to get a certificate of birth abroad (CRBA) and passport for your baby. See “Documenting Your Brazil-born Baby” for details. 

Things to take to the hospital

This list was compiled with the input of several women who gave birth at Santa Lucia Hospital. 


Check-in: Your spouse or partner will check you in, and depending on how far advanced your labor is, you will be taken to a recovery room (to labor) or the delivery room.
- Bring the guarantee of payment (garante o pagamento) from the embassy to avoid up-front deposit requests
- A paper with your name, address, phone number, CPF, etc in portuguese


Bring the following because it can be difficult (or impossible) to obtain from the nursing staff:
o Robe
o Birthing ball
o Gatorade or Agua de Coco
o Fruits and snacks (hospital meals are spartan and heavy on rice and beans)
o Clothes for the baby in the delivery room (they only provide a diaper and thin blanket)
o Tylenol/Ibuprofen
o Ice-pack pads for perineal swelling or tears
o Heavy-flow disposable absorbent pads (kotex)
o Pillow from home
o Lots of cash - bills start coming immediately
o Food for spouse or partner (meals are only provided for the mother)